In the summer, your feet are exposed to the elements more often which is especially concerning for those with diabetes, neuropathy, and Peripheral Artery Disease (P.A.D.), which is poor circulation due to plaque build-up in the arteries. Podiatrist Dr. David Alper joins hosts Kym McNicholas and Dr. John Phillips to talk about how to prevent common foot problems and complications.
An important part of today’s discussion was about how lack of circulation can put patients at-risk of more severe complications during the summer especially. Wounds don’t heal as quickly and easily without proper blood flow. So, if you have diabetes or P.A.D., it’s important to have a vascular specialist and podiatrist team up to help both on the inside of your arteries and outside of your foot. Dr. Anthony Pozun, an Interventional Cardiologist with Modern Vascular in the Phoenix area of Arizona, was listening to the show and called in to drive home that point. He added that tools and techniques for restoring blood flow have advanced to the point where some physicians know how to carefully navigate clear into the small vessels in the foot to help clear a path if necessary for even more flow to heal wounds faster, especially in diabetics who tend to have more vascular issues in their lower extremities.
Patients wrote in many questions during today’s broadcast as well about choosing appropriate shoes and proper toe nail care. Dr. Alper emphasized that flip flops are not the most supportive choice for the feet especially because they force you to grip the shoe with your big toe and second toe, which can lead to bunions and hammer toe problems. That can also pose a problem for those with neuropathy who might not feel a friction wound brewing between the two toes. Dr. Alper suggested that summer footwear should have at least a band around the heel so the foot remains secure and supported without effort. And if you do a lot of walking or running, that sneakers should be replaced every six months to ensure the best support for exercise programs. As for toe nail care, he discussed the importance of learning from a podiatrist how to cut your toe nails properly and to shy away from nail salons if you have diabetes, neuropathy, and/or P.A.D. One of the most important points Dr. Alper raises about avoiding summer foot problems is the use of sunscreen. He said that some of the most frequent visits to his clinic during the summer were by those with second degree burns or worse, not just on the top of their feet, but also the bottom. The latter of course is due to forgoing shoes on hot pavement.
Also in this episode, you don't want to miss our Save My Piggies segment where a patient, Sheryl and her Vascular Surgeon in Oklahoma City, Dr. Bernardino Rocha, share an inspiring story of how a second opinion made the difference between life and limb. She found Dr. Rocha through nonprofit advocacy organization The Way To My Heart after she spent months in a wheelchair with no hope of ever walking again. Her primary care physician had misdiagnosed her symptoms of leg pain and cramps as gout and when medicine didn’t help it, he offered her muscle relaxers and told her to drink plenty of fluid to relieve the cramps in her foot and calf. It wasn’t until she went to a podiatrist for an unrelated issue that he discovered signs of a circulatory problem. Further testing uncovered she had Peripheral Artery Disease, restricted blood flow in the leg arteries due to plaque build-up. That is what was causing all the leg cramps. She thought the proper diagnosis would lead her to an easy solution, but her vascular surgeon told her that the only thing he could do was an extensive bypass that he didn’t think would last very long and amputation was in her future. The Way To My Heart sent her to Dr. Rocha for a second opinion and he was able to easily clear the artery blockages using minimally invasive tools and techniques. After the angiogram procedure she felt immediate pain relief and was able to get out of the wheelchair, with a regular walking regimen each day whether on pavement or in the pool.
Make sure to listen to today’s broadcast!
Are your arteries on fire? Are there hidden (or obvious) correctable risk factors that are fueling the fire? In most cases specialized blood testing, along with a careful evaluation by a knowledgeable healthcare provider, can uncover multiple addressable areas that can reduce your risk of ongoing artery damage.
On this week's The Heart of Innovation, hosts Kym McNicholas and Dr. John Phillips are joined by Dr. Michael Dansinger, Medical Director at heart-health company Boston Heart Diagnostics, that does specialized blood testing to help doctors and patients manage and prevent vascular diseases including peripheral artery disease. Boston Heart also provides ultra-personalized nutrition and lifestyle prescriptions for patients based on their blood test results and other factors specific to each patient. Blood tests must be ordered by healthcare providers and are partially covered by medical insurance in most cases.
They discuss a variety of different advanced blood tests for cardiovascular health and what they mean. Why is it important to perform advanced bloodwork? It's for:
There are seven different categories of specialized cardiovascular blood tests offered through Boston Heart Diagnostics:
During this show, we focused mainly on particles that cause artery damage, cholesterol source, cholesterol elimination, inflammation, and diabetes risk. More specifically:
LDL cholesterol: The concentration of cholesterol in LDL particles. Levels around 60-70 mg/dL are optimal for artery health, especially in people with known cardiovascular disease or peripheral vascular disease. It usually requires statin medications to get that low. Levels of 70-100 mg/dL are reasonably good for people without known vascular disease.
ApoB: This measures the concentration of LDL particles rather than the concentration of cholesterol contained in LDL particles. ApoB levels predict cardiovascular risk slightly better than LDL cholesterol.
LDL-P: This is an alternative way to measure the concentration of LDL particles.
Small-dense LDL cholesterol: Most of the damage caused by the smallest and densest LDL particles. Boston Heart measures the amount and percentage of cholesterol specifically in small-dense LDL particles. Publishes studies show this test is a superior predictor of cardiovascular disease, and you want the levels to be as low as possible. Along with appropriate medications and/or supplements, lifestyle changes such as weight loss, eating less refined sugars and starch, and daily exercise can reduce small-dense LDL cholesterol.
Lipoprotein (a): This is an artery-damaging particle that is too high in about 20% of men and women. High levels can run in families since it is genetically determined.
Cholesterol production: The liver makes cholesterol. In some people the liver makes too much cholesterol leading to high levels of LDL particles, including small-dense LDL particles. This may happen for genetic reasons, or because there is a lot of fat accumulated in the liver, or for other reasons. There are blood tests that identify whether high cholesterol levels are due to overproduction. Weight loss can reduce fatty liver and cholesterol overproduction. Statin drugs (for example Crestor or Lipitor) reduce cholesterol production from by the liver. Repeat testing of cholesterol production levels can demonstrate the effectiveness of treatments.
Cholesterol absorption: The intestines absorb cholesterol. In some people (about 25-30%) the main source of high LDL cholesterol levels is from over-absorption rather than over-production of cholesterol. These people are more sensitive than others to dietary cholesterol, and they do not respond as well to statin drugs. They respond well to medications (like ezetimibe) and supplements (like fiber and plant sterols/stanols) that block cholesterol absorption by the intestines. In this way, knowing the source of high LDL cholesterol can guide treatment decisions by doctors and patients.
HDL cholesterol: Most people call this “good cholesterol” but it is actually a way to measure the level of HDL particles. HDL particles help remove excess cholesterol from the body. Higher levels of HDL cholesterol indicate lower risk of heart and vascular diseases. Exercise raises HDL cholesterol; smoking lowers HDL cholesterol.
Large HDL particles: You want your HDL particles to be large. The large HDL particles are the ones that remove cholesterol most effectively. Unfortunately unhealthy refined sugars and starches, abdominal obesity, and insulin resistance prevent the HDL particles from becoming large and mature. Think of apples on a tree that never become large and ripe because the tree is not getting what it needs. People with cardiovascular disease often lack the large HDL particles, which can be measured most effectively with the “HDL Map” test by Boston Heart. Studies show the HDL map test is very effective at measuring improvements caused by favorable lifestyle changes.
Studies show that among people age 65 and older in the U.S., about 25% have diabetes, plus another 50% have prediabetes! We are all at risk for diabetes in our lifetime, and there are blood tests for measuring that risk. Healthy lifestyle choices and certain medications can delay the progression from prediabetes to full type 2 diabetes, or potentially improve type 2 diabetes to the point of remission.
Hemoglobin A1c: this simple blood test is in common use, and can be used to measure the risk or extent of prediabetes or diabetes. It provides a 2 to 3 month average blood sugar reading by showing how “sugar coated” your blood is.
Insulin testing: This simple blood test is done after an overnight fast. Insulin is a hormone made by the pancreas to move sugar (glucose) from the blood into tissues to be used for energy. Some people have abnormally high or low insulin levels in the blood, which an be used to provide measures of diabetes risk. Improvements in insulin levels can be used to measure improvements in diabetes risk. At Boston Heart we offer a test called the “Beta Cell Function and Risk Index” which uses fasting insulin and glucose levels to monitor diabetes risk and recommend treatments based on the specific results.
Prediabetes assessment testing: This test offered by Boston Heart gives doctors and patients a measure of how rapidly a patient is moving from prediabetes toward prediabetes toward type 2 diabetes. The test uses a combination of multiple blood tests and clinical factors that have been shown to predict (with an accuracy of 92%) the 10-year risk of diabetes in patients with prediabetes.
When we talk about “fire” in the arteries that is another way saying “inflammation” in the arteries. We can use special blood tests to measure different aspects of inflammation.
C-reactive protein (CRP): This is the most common test for inflammation. Increased blood levels means there is inflammation somewhere in the body, from any cause. If there is no sign of infection, injury, or illness that could cause inflammation, then an increased blood level is often a measure of the intensity of ongoing artery damage from any cause.
MPO: This is also known as “myeloperoxidase”. It is a general measure of active white blood cells and inflammation. In someone with known coronary artery disease, high levels of MPO can signal “hot plaque” that is at risk to cause a heart attack.
LpPLA2: This is also known as the “PLAC test”. It is a measure of inflammation caused by cholesterol plaque inside the artery walls. It is more specific to artery health than C-reactive protein or MPO.
Quote of the Day: “You have the power over your mind – not outside events. Realize this, and you will find strength.” ~ Marcus Aurelius
Why do my veins seem bigger in the summer? That question leads Emmy Award-winning Journalist Kym McNicholas into an in-depth discussion with co-host Interventional Cardiologist Dr. John Phillips, Hill Vascular's Vascular Surgeon Dr. Bradley hill, and world-renowned vein expert from London, Dr. Mark Whitely, about varicose veins, chronic venous insufficiency, and Deep Venous Thrombosis (blood clots). They talk about the reasons why only 10% of the 30 million Americans, who are estimated to have venous issues, actually get treated and what the advanced treatments are for not only superficial veins but also deep veins.
A key issue in this show's discussion is types of vein issues that are merely cosmetic versus ones that indicate a more significant health risk that must be addressed. A debate also arose about the use of compression socks as frontline treatment for many venous issues and the difference in philosophy between the United Kingdom and United States. Dr. Misha Ginsberg, Interventional Radiologist at Froedtert South in Wisconsin called in after hearing the discussion to join in and share his perspective. The one critical non-negotiable when it comes to compression stockings, as expressed by Dr. Bradley Hill and agreed upon by all doctors present on the show, is for use on long flights and car rides. That's because when sedentary the leg muscles aren't contracting as effectively as they do when walking to help usher the blood back to the heart, and blood clots can develop.
Listen to the show for a dynamic discussion about venous health, critical questions that should be asked of every patient who presents with vein-related symptoms, and when treatment should be sought.
While most vascular events seem to happen in winter versus summer, fun in the sun can impact your vascular health, increasing your morbidity and mortality. So, during episode five of The Heart of Innovation, co-hosts Emmy Award-winning Journalist Kym McNicholas and Interventional Cardiologist Dr. John Phillips are joined by Interventional Cardiologist Dr. George Adams, Director of Cardiovascular & Peripheral Research at Rex Hospital in North Carolina, to talk about who is most at-risk of weathering from the summer heat and how to mitigate that risk.
We hear the broken record to hydrate, hydrate, hydrate on hot days. But on this show we talk about why it’s important. Dr. Phillips explains that when our body heats up, normally we sweat as the primary means of helping our body control its temperature. But dehydration impairs this process and can lead to heat stroke, heat exhaustion, even heart attack. Dr. Adams adds that those with Peripheral Artery Disease, restricted blood flow in mainly the legs due to plaque build-up, dehydration can also lead to increased claudication, or leg cramps, stopping you in your tracks. They both contend that adding fluid with electrolytes is important, making sure your choice beverage is not high in sugar or sodium, will help reduce risk of dehydration. The Way To My Heart’s Nurse Practitioner Kay suggests tonic water as well, especially to reduce leg cramps. She advises not to ‘chug’ it all at once, but to instead, sip it gradually throughout your exercise regiment and throughout the day.
Did you know general medications you take for vascular issues and other ailments can also cause dehydration, reduce your body’s ability to sweat, and increase your risk of sunburn? During the show Kym also mentions some of those as advised by The Way To My Heart’s Pharmacy Advisor Dr. Avni Kardani. They include diuretics (water pills), allergy medications such as Benadryl and pseudophedrine, anti-depressants, blood thinners, drugs for arrythmia, NSAIDs, and even chemotherapy drugs. She suggests asking your physician or pharmacist these questions:
Several patients called in during the broadcast including Monique, Marcia, and Heidi who had specific questions about exercising more effectively during the summer months to reduce risk of injury, whether the heat can increase someone’s risk of a heart attack if they have heavy plaque build-up in their coronary arteries, and if the heat plays a role in increased fatigue following a procedure to unblock arteries in the legs or heart during the summer months. Interventional Cardiologists’ Dr. Phillips and Dr. Adams were able to help those patients during the LIVE broadcast. Patients are welcome to call-in LIVE during the show each Saturday starting at 11am PT, 1pm CT, 2pm ET to talk to a vascular specialist. The call-in number is: 1-888-367-5329.
Tune into the show to learn more about the summer heat and vascular health. Also, you don’t want to miss this week’s Save My Piggies segment as Bill from Ohio shares his story of perseverance using walking as medicine when doctors told him there was no other surgical option that wasn’t high-risk for him. You will be inspired by his ability to improve his vascular health with every step he takes! Dr. Phillips and Dr. Adams explain why this is possible by discussing the mechanism of action by which walking can increase circulation.