At first, Rich was just a friend from the dog park.

“He had a couple of dogs and I had a dog and we were in a group one day,” says Dale Tunnell, a research psychologist in Sun City West, AZ. “We sat down and talked and found we had shared experiences in the military: I was in the Army and Rich is a former Marine. We became close. We’re closer than most brothers are.”

When they met, Rich was overweight and had back problems. He’d had a heart bypass years earlier that inspired him to quit smoking.

Later, when Rich was diagnosed with peripheral artery disease (PAD), he was hopeful that it could be treated.

“He was cheerful and pragmatic about the things he couldn’t control,” Tunnell says. “He knew PAD was the result of how he lived, but probably wouldn’t go back and change anything.”

Only a small number of people with PAD need to have an amputation. But multiple doctors and treatments couldn’t prevent Rich from eventually losing a leg below the knee. Tunnel says his buddy became “morose.”

Rich’s wife is his primary caregiver. Tunnell also worked hard to bolster Rich’s spirits. “Rich is very blustery. He’s not pompous but very gregarious and vocal,” he says. “I’ll bring him chai tea and we’ll talk about our experiences and politics and anything he wants to talk about. The only guy he’ll listen to is me.”

Then one day, Rich’s wife asked Tunnell to drive her husband to an appointment. That’s when Tunnell turned into his friend’s advocate. Throughout the process, Tunnell has seen firsthand how hard PAD can be on both the person and their caregiver.

“To the patient, PAD can feel like a never-ending deal and probably the last thing that’s going to happen to them before they die — and it may be,” he says. “The caregiver is going to hurt as much as the patient. They’re going to curse themselves for not being able to do more. It’s the nature of the beast. If you care, there’s always the feeling of despair: I wish there was more I could do.”

Patience, with yourself and your loved one, is the most important part of caring for someone with PAD.

“You’re dealing with someone who has a whole range of habits they need to modify,” says Danielle Mondesir, a nurse practitioner with Modern Vascular, an outpatient medical clinic in Houston. “A lot of patients are depressed because they can’t do things they enjoy anymore. They’re anxious because they know PAD can end in amputation, though that’s not the case with everyone.”

Those with PAD aren’t the only ones who feel frustrated. Many spouses, partners, and loved ones feel angry because they saw this coming.

“They’ve pushed their loved ones to stop smoking or watch their sugar. They say, ‘I told them to stop. I told them this would be an issue,’” Mondesir says. “They want the best for their loved one but couldn’t get through to them. Sometimes it takes more than PAD to make them stop.”

It’s normal to feel helpless watching your loved one deal with the physical and emotional aspects of PAD, but there are ways you can make progress.

“This is a chronic disease, and it takes effort not just by the patient but the caregiver to get the best outcomes,” Mondesir says. “Patients don’t do as well if the caregiver just brings them to appointments and isn’t as involved. The more you learn about PAD, the more you’ll understand what it takes to be there for your loved one.”