Why is it that some doctors are on the cutting-edge with new treatments while others still use the tools and techniques they learned from medical school despite advancements in medicine? That’s the topic Emmy Award-winning Co-host Kym McNicholas and Interventional Cardiologist Dr. John Phillips are tackling in this week’s The Heart of Innovation show. Kym is LIVE from Italy on the heels of CLI-C, one of the most prestigious conferences in the world for treating blocked arteries in the legs, an issue which impacts one in five people over age 60, known as Peripheral Artery Disease (P.A.D.). Without proper treatment, P.A.D. can lead to amputation, stroke, and even heart attack. Only 10% of vascular specialists, whether it’s a vascular surgeon, interventional radiologist, or interventional cardiologist, are trained in advanced treatment tools and techniques to save limbs for the most complex cases of P.A.D., which we see in patients who have Critical Limb Ischemia (CLI), limb threatening artery blockages. That’s because innovation around the treatment of these patients is moving at the speed of light and physicians may not be aware of the opportunities to learn what’s new and next.
You might wonder, “How is that possible that physicians aren’t aware of what’s new and next?”
The answer is that it depends on where the physician decides to pursue their continuing medical education activities (CME).
Physicians are required to participate in continuing medical education (CME) activities to meet requirements of state medical boards, medical specialty societies, etc. for licensing and accreditation. The purpose of requiring CME credits, is to encourage physicians to main, develop, or increase the knowledge, and skills. They can earn these credits by attending live meetings, working online, or watching course recordings on a variety of topics related to patient care, community health or public health, preventive medicine, quality assurance or improvement, risk management, and more. Physicians are not required to attend specific sessions covering cutting-edge treatments
A lot of factors play into the CME activities of any physician such as facility, society guidelines for a specific practice which may either encourage or limit interest in certain treatment approaches, interest in new ideas, resistance to new ideas that may interfere with their standardized approach, family obligations, networking opportunities, and more. So, while they all may have the title of doctor, a specific specialty, fancy pedigree, work in a prestigious facility, it doesn’t necessarily reflect their current knowledge and ability as compared to their peers.
In this episode, Kym and Dr. Phillips use the CLI-C conference as an example of a CME activity that offers vascular specialists the ability to not only hear about new tools and techniques to treat complex artery blockages in the legs, but to see them put into practice with multiple live cases that allow attendees to interact with physicians in hospitals who are treating a patient in real-time. Dr. Mariano Palena and Dr. Marco Manzi were the leading physicians for this particular course in Padua, Italy this past week. They share the importance of coming to these events to discuss and even debate new treatment options for patients. The greatest value, they say, is in the open discussions that transpire between physicians with a variety of different perspectives and then seeing a physician during the LIVE case implement the best ideas as well as the patient outcomes. They encourage patients to use online resources such as The Way To My Heart to learn the most advanced treatment options for P.A.D., then search online to see what conferences physicians can attend to learn them, and see if their physician attends those conferences or ones like them to ensure they’re on the cutting-edge. Some key questions discussed during the show, which patients can ask their physician about when it comes to continuing include:
Tune into the show to learn more about why it’s important for physicians to broaden their scope and attend a variety of different CME activities, as well as how a patient can determine if their physician is on the cutting edge. Also, you don’t want to miss this week’s Save My Piggies segment as author and triathlete Kevin Morgan shares his story which drives home the importance of advanced medical education as he was forced to self-diagnose when his physicians failed to diagnose an abdominal aneurysm that was about to rupture. His advanced research skills as a veterinarian and pathologist led him to attribute his symptoms to an aneurysm. He independently got an abdominal ultrasound and sought a second opinion using his scans to prove his own initial diagnosis. Successful treatment for the aneurysm has kept him on his feet competing as a triathlete and inspiring others through his blog at www.athletewithstent.com.
C.H.A.T. is an acronym for Carotids, Heart, Abdomen, and Toes. In this show, Hosts Kym McNicholas and Dr. John Phillips, along with guest co-host Nurse Practitioner Kay Smith drive home the importance of urging your doctor to perform a full head-to-toe vascular assessment during each annual exam, especially if you have high-risk factors such as family history, diabetes, autoimmune disease, celiac disease, obesity, former/current smoker, and more.
What do we mean by C.H.A.T.:
C, Carotids. The carotid arteries, located in your neck, are the major blood vessels that carry blood and oxygen to your brain. Plaque build-up can narrow those vessels. If the plaque breaks off and flows up to your brain, it can cause a stroke. Your physician will use a stethoscope to listen for a bruit (Brew-ee), which is turbulent blood flow. Follow-up testing may include a duplex ultrasound.
H, Heart. The heart plays an important role in pumping blood and nutrients, including oxygen, throughout the body. Plaque can develop in the coronary arteries and restrict blood flow, starving the heart of oxygen. This can cause chest, pain, shortness of breath, angina, or heart attack. The heart can also develop trouble with electrical signals that coordinate the heartbeat, and structural problems such as with heart valves, which keep blood flowing in the right direction. "Leaky valves," which don't close properly, can put a strain on the heart. Your physician will listen to your heart for abnormal sounds, and check your heart rate, pulse, blood pressure, and oxygen saturation using various tools. Follow-up testing may include an ECG, stress test, CT scan, echocardiogram, and heart catheterization.
A, Abdomen. Large arteries critical in supplying blood flow to major organs such as your kidneys, stomach, liver, spleen, bowels, and then into the legs are found in your abdomen (e.g., aorta, iliac, renal arteries). Plaque build-up in these arteries may be silent until damage to those organs occurs. Your doctor may listen with a stethoscope for abnormal sounds in the abdomen, such as turbulent flow. Your doctor may also feel for a pulsating aorta as it could signal an aneurysm, which is a balloon-like bulge in the blood vessel caused by weakening in all three layers of the vessel wall. Screening is critical because an aneurysm can grow undetected with the first symptom being a life-threatening rupture. Risk factors include heredity, age, smoking, high blood pressure, and hyperlipidemia. Follow-up testing may include an ultrasound, a CT scan, and MRA.
T, Toes. The health of arteries in your legs and feet can indicate a risk for heart attack, stroke, and amputation. If you have plaque build-up in your leg arteries, called Peripheral Artery Disease (P.A.D.), it's likely to be happening elsewhere in your body, especially in your heart. Many patients with P.A.D. have no symptoms yet remain at high risk for bad outcomes. That is why screening is recommended in high-risk patients, especially ones with diabetes and/or a history of smoking. Your doctor may ask about leg cramps or weakness when you walk, also if you have neuropathy, numbness, or tingling. They may also examine your skin for discoloration or wounds and feel for pulses. Follow-up tests may include an Ankle-Brachial Index (ABI) Test and ultrasound.
Kym shares the story of what inspired the C.H.A.T. campaign: her mom who unexpectedly passed from an undetected aneurysm. She explains that if only her physician would’ve taken a few seconds to listen for a bruit, turbulent flow, in her abdomen upon complaints of textbook symptoms such as shortness of breath, sudden back pain, and erratic blood pressure, she might still be here today. Kym’s dad also joined the conversation to share his story about how his primary care physician missed indications he was on the verge of a heart attack and how they had to fight for his life. With proper diagnosis and appropriate treatment, he is now, at 80 years old, walking 4.5 miles daily, including hills, and putting down 30 push-ups in one breath using the Wim Hoff method.
Kym uses her dad’s story to point out that life and limb depend on the training of a primary care physician. She explains why antiquated approaches to diagnosis at that level such as a basic lipid panel are not enough to determine if a patient needs to see a cardiologist or other vascular specialist because 50% of heart attack sufferers have normal basic lipid panels. She points out the primitive nature of the stethoscope and the need for more physicians to adopt an advanced technology that doesn’t require a trained ear to detect subtle life-threatening abnormalities, such as with Eko Devices. Eko Devices makes a newer, more advanced stethoscope, which uses AI to help with the advanced detection of heart problems. She gets CEO Connor Landgraf to jump on the line for a moment to explain how this technology is a game-changer for primary care physicians who have a lot to do in a short amount of time with each patient. The Eko Stethoscope allows them to perform a deeper life-saving assessment in seconds.
Several callers also shared their experiences:
Kevin, an ironman finisher, former veterinarian, and pathologist, shared his story of how he saved his own life by self-diagnosing an aneurysm when his doctors overlooked it. He says he’s gone on to write books and a blog to inspire others to live strong.
Diana, a patient with Peripheral Artery Disease (P.A.D.), expressed concern that despite having P.A.D. and atherosclerosis in her carotid arteries, her physicians refuse to check her heart because she doesn’t have obvious symptoms of plaque build-up in the heart. Dr. Phillips chimes to say that she and others need to step-up their self-advocacy and push for even just a stress test on the treadmill if they have any risk factors. Nurse Practitioner Kay added to the conversation, sharing her experience with having an unexpected heart attack with her doctors having never checked her heart either despite having P.A.D.
Everyone knows of the condition Cardiovascular Disease, also known as Heart Disease, which is plaque build-up in the arteries around the heart. In the legs, plaque build-up in the arteries is known as Peripheral Artery Disease (P.A.D.). It can also impact the arms and sometimes the small arteries in the brain. But it's mainly the legs.
Three-in-five heart attack sufferers, one-five over age 60, and one-three diabetics over age 50 have it. Globally, it is estimated that over 200 million people have P.A.D. Most don't know it until it reaches advanced stages and heart attack, stroke, and amputation are imminent.
Doctors may misdiagnose textbook symptoms of leg pain and leg cramps as diabetic neuropathy, diabetic foot, fibromyalgia, old age, arthritis, or even spinal/sciatic problems. But it’s easy to diagnose or rule out with even two fingers and two seconds with a doctor feeling a patient’s leg pulses.
Douglas, a P.A.D. patient from Texas, calls in to ask about walking as medicine for P.A.D. A brisk 30-minute walk a few times a week can help your body create a ‘natural bypass' around blockages by triggering the body’s collateral network of vessels.
Pushing through some of the pain and cramping caused by that restricted blood flow tells your body, “Hey, we have a demand for additional blood flow that we aren’t meeting, so let’s call in for some back-up!”
The back is our collateral network of vessels that lay dormant until they’re needed to re-route flow around blockages to feed oxygen and other nutrients to the lower extremities. Dr. John Phillips, co-host of The Heart of Innovation, explains to Douglas how to walk effectively to kick that collateral network into gear to improve circulation naturally.
What is The Heart of Innovation? This first episode, Co-Hosts Emmy Award-winning Journalist/Patient Navigator Kym McNicholas and Interventional Cardiologist Dr.
John Phillips talks about the catalysts for creating change in healthcare through this radio show/podcast.
We specifically address vascular diseases with Heart Disease remaining the #1 killer and the many associated ailments contributing to vascular complications, whether diabetes, autoimmune disorders, COVID-19, Peripheral Artery Disease, stroke, aneurysm, or others.
Dr. Phillips and Kym explain their passion for specifically addressing Peripheral Artery Disease (P.A.D.), which is restricted blood flow mainly in the leg arteries because of plaque build-up, which affects three-in-five heart attack sufferers and one in five over age 60.
Dr. Phillips started out his career focusing on unblocking arteries in the heart but has since expanded his practice to include using the same type of tools and techniques to unblock arteries in the legs and prevent amputations. He found patients would come to him for second opinions after a physician would say they have no option but amputation, and his advanced skill set could save their legs.
To encourage all patients to get that very important second opinion from a physician with an advanced skill set, he started the Save My Piggies podcast, featuring patients telling their stories to inspire other patients to fight for their legs and not settle for amputation.
Kym shifted her career from journalist to P.A.D. Navigator started The Way To My Heart (501(c)(3) non-profit) after covering a story on a new device designed to unblock arteries.
For the story, she traveled to nearly a dozen countries and more than thirty states, watching hundreds of doctors perform thousands of hours of procedures to unblock arteries using advanced minimally invasive tools and techniques as well as traditional approaches such as bypass and amputation. It was during her global journey that she learned that different doctors have different tools and techniques that dictate different patient outcomes.
For example, one patient may get their leg saved by one doctor, while another patient with the same presentation of the disease is getting their leg amputated by another.
Listen to the show at this link to hear the details of their journeys and more about what you can expect each week on this show, which encourages doctors, patients, researchers, innovators, decision-makers, and all healthcare professionals to have a candid
discussion about how to shape the future of care and improve outcomes for patients with vascular diseases.
One patient called in during this episode and an advanced skilled Interventional Cardiologist, Dr. Fadi Saab, both shared the same message that it’s important for patients and physicians alike to understand what’s new and next in the treatment of vascular disease in order to improve outcomes.