Description: Type 2 diabetes and obesity are epidemics that can lead to amputation due to a common complication known as peripheral artery disease (P.A.D.), which is plaque build-up in mainly the leg arteries that restricts blood flow. But the right diet can help mitigate risk for limb loss. Hosts Kym McNicholas and Interventional Cardiologist Dr. John Phillips are joined by Nurse Practitioner Kay Smith to chat with special guest Dr. Michael Dansinger, Wellness Director for Boston Heart Diagnostics, about diabetes reversal, eating strategies to for P.A.D. prevention, and the secret to weight loss based on USA Network's The Biggest Loser reality show.

Dr. Michael Dansinger is Founding Director of the Diabetes Reversal Program at Tufts Medical Center in Boston . He also serves on the CDC’s Expert Panel for Worksite Wellness Programs and on the Council of Directors for the True Health Initiative, a leading international voice for health and wellness. Dr. Dansinger previously served as the Nutrition and Obesity Editor for Medscape Journal of Medicine and was the principal investigator of the Tufts Popular Diet Trial comparing the Atkins, Zone, Weight Watchers and Ornish eating plans for weight loss and heart disease risk-factor reduction (published in JAMA). Dansinger was the nutrition doctor for NBC's The Biggest Loser for 10 years and designer of the Biggest Loser Diet, which won top awards from U.S. News & World Report (including No. 1 Best Diet for Diabetes).

Before Dr. Dansinger got into the heart of this episode's feature topic on how diet can reduce a diabetic's risk for vascular complications, the show kicked off with a discussion about obstacles patients face in healthcare. Nurse Practitioner Kay Smith shared her experience in Scotland, spending four hours in pre-operative protocols for a surgery planned for next week, only to have her physician cancel her surgery appointment due to a condition called, atrial fibrillation, that she was never informed of but was written in her medical chart. Kym and Dr. Dansinger weighed in on lessons others can learn from this experience which includes two critical questions all patients should ask following any medical appointment:

1. What are you writing in my chart that I should be aware of so I don't miss any assessment or diagnosis?
2. Can I get a copy of my cases notes for this appointment? This may be available through your facility's medical app or platform. You can also request it through a facility's medical records department.

Kym also shared her nightmare experience with her dad falling a second time in two weeks. The first fall was out of their area and resulted in emergency surgery to replace a previous hip replacement and stabalize an elbow fracture with pins and wires. This second fall resulted in an additional hairline fracture in his femur, re-opening of the hip replacement incision, and a displacement of the pins in his elbow. An ambulance trip to the emergency room left Kym and her dad with more questions than answers. The emergency physician and clinicians refused to call the on-call orthopedic surgeon to review his xrays. If they did, they would've learned of his additional hairline fracture in the femur and would've sent him home in a wheelchair. Instead, he was told to get up and walk despite debilitating pain and a continued run of the fracture. Even more, they didn't remove that half pulled off wound dressing, didn't apply temporary steri strips to reseal the wound that opened, and sent him home with only half the wound covered. So, when he arrived home, within 10 minutes the paramedics had to be called as the wound dehiesced further and he had to be taken to a larger hospital facility in Marin County, California with a more experienced trauma team. There, he was scheduled for time in the operating room to properly clean, re-sutre, and dress the incision site. He was also admitted until an orthopedic surgeon could get a physical therapist and occupational therapist to work with him on his new orders for limited weight-bearing.

Dr. Dansinger and Dr. Phillips both were horrified by Kym's experience with her dad. They agree that under no circumstances should Kym's dad have been released from the first emergency room without an orthopedic surgeon reviewing the images and without proper wound care. They each expressed the importance of physicians and clinicians taking the time necessary to listen to the patients and fully assess the entire situation and for patients and their advocates to have patience with medical staff. But they were also not surprised due to an overwhelmed healthcare system, especially since the COVID epidemic. Dr. Dansinger says as our population continues to age this will become an even bigger problem of overcrowded hospital facilities and not enough staff to manage them. It's why he shifted from an urgent care doctor to focusing on prevention of chronic illness. That includes diabetes. That's where the hosts transitioned the conversation into focusing more intently on what patients can do to reverse it and mitigate their risk for serious vascular complications such as amputation.

Description: What patients say and what doctors hear is often very different. That's often the case with what doctors say and patients hear as well. But sometimes those conversations are well understood by both the patient and the physician, and may leave either one or both, speechless. During this episode, patients share stories about conversations with their doctor that have left them speechless. Hosts Kym McNicholas and Interventional Cardiologist Dr. John Phillips are joined by Dr. Kirk Minkus and Nurse Practitioner Kay Smith who will also share their funniest and even endearing moments with patients.

Dr. Minkus and Dr. Phillips shared similar stories about patients with Peripheral Artery Disease, plaque build-up in mainly the leg arteries that restrict blood flow, that they helped by opening up the arteries and restoring blood flow to their legs, who had an unexpected result following the procedure. Dr. Minkus had a young couple tell him he saved their marriage and Dr. Phillips had a couple upwards of 90 years old who felt like teenagers again with increased intimacy. Nurse Practitioner Kay Smith shared the story of a patient who refused her help to get a second opinion from an advanced skilled vascular specialist known for limb salvage techniques and went ahead with an amputation which might've been prevented. The shocking thing was the 'Goodbye Leg party' which was complete with yard signs and cake celebrating this milestone.

Host Kym McNicholas kicked off a series of stories from patient perspective, about physician encounters, that surprised them. She attends appointments with patients who have Peripheral Artery Disease as an advocate through The Way To My Heart. During one appointment the physician told a patient that it wasn't effective to treat below-the-knee and that a bypass wouldn't be effective because flow through her one vessel (out of three) running through the calf, was sluggish. So, her only option was to walk, walk, walk until she couldn't walk anymore and when the pain was too much, he would amputate. When she asked for a second opinion, he replied, "I don't need a second opinion as I'm confident in my assessment." Ultimately Kym was able to get the patient a second opinion from an advanced skilled physician who opened up her vessels below-the knee and she's still walking more than a year later.

Two patient callers, Michelle and Tabitha, shared their physician experiences before Nurse Practitioner Kay talked about a patient she was helping in the United Kingdom who was getting the plaque in her iliac artery cleared using endovascular approaches. No sedation was used during the procedure. In response to the patient's cries of pain and her nurse with tears shedding in empathy, the doctor responded by saying, "It's not a good day unless I make a nurse and patient cry." And if that wasn't shocking enough, Dave from Indianapolis left everyone speechless for a moment when he shared his experience at a medical conference where a physician held a seminar on how to prevent patients from getting a second opinion.

One highlight of the show was the Save My Piggies segment where a patient, Douglas, candidly talks about his fight for life and limb. His vascular surgeon escalated procedures every 3-6 months as his arteries continued to re-block, leaving the patient with few options to keep his limbs and fighting for his life like never before within two years of his first two stents. He was never diagnosed with Peripheral Artery Disease, offered critical medications for management, or had a discussion about lifestyle changes. It wasn't until Douglas found The Way To My Heart, did he finally get referred to another vascular specialist who was able to get him on the right path to living a better quality of life.

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Description: If you have been diagnosed with a form of vascular disease such as Heart Disease, plaque build-up that has the potential to restrict blood flow in the coronary arteries or Peripheral Artery Disease, which impacts the leg arteries then it is likely you have plaque build-up in other vessels in the body, especially small vessels including those that feed the prostate. In this episode, hosts Kym McNicholas and Dr. John Phillips are joined by Board Certified Vascular and Interventional Radiologist Dr. Charles Nutting , who specializes in small vessel revascularization and prostate artery embolization (PAE), an outpatient procedure that involves the release of microscopic, plastic beads into the arteries that feed the prostate gland. We discuss who might be a candidate, the risks involved, and how to talk to your doctor about sexual dysfunction, what might be causing it, and available treatment options.

A patient, Douglas, joined the conversation, sharing his personal story experiencing sexual dysfunction as a first sign of systemic vascular problems. Also, The Way To My Heart Nurse Practitioner Kay Smith shares her story of assisting in a PAE procedure for a 19-year-old who was able to have an erection for the first time in his life while still on the table after physicians completed the case.

During today's show, Dr. John Phillips is broadcasting LIVE from an educational seminar for clinicians that was put together by device maker Cook Medical. Kym is LIVE from the Vascular Institute in Sacramento, California where she observed Dr. Inder Singh saving the leg of a The Way To My Heart Inc patient who was on deck for a below-the-knee amputation. Dr. Singh shares how he was able to restore additional blood flow to help heal wounds on the patient's foot.

To find an Interventional Radiologist in your area who may offer Prostate Artery Embolization (PAE), go to the Society of Radiology’s website: https://www.sirweb.org/

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Description: It might be odd to think that on a show about vascular health, hosts Kym McNicholas and Dr. John Phillips are talking about fibroids, which are noncancerous growths in a woman's uterus. There is a vascular connection. First, studies show that cardiovascular risk factors were slightly more common for women with fibroids than for women without fibroids. Fibroids have been associated with hypertension and atherosclerosis, and some recommend using fibroids as a marker for future cardiovascular disease (CVD). Second, there’s a minimally invasive technique to treat fibroids without surgery that’s becoming more prevalent, known as Uterine artery embolization (UAE), where the blood supply of the fibroids is cut off, causing the fibroids to shrink.

During this episode Kym and Dr. Phillips talk to Advanced Vascular Centers Interventional Radiologist Dr. Mary Costantino about Uterine Artery Embolization (UAE), what it is, how it’s performed, its effectiveness, and when it’s warranted versus the traditional and mainstream treatment using a hysterectomy, which is the physical removal of the uterus. We also discuss why UAE isn’t offered to most women as an alternative to hysterectomy and how reimbursement may be a contributing factor as payers offer facilities more for the invasive versus minimally-invasive options. UAE isn’t right for everyone, however. Some researchers express concern about using UAE in younger women with reproductive plans due to possible pregnancy complications down the road. But if hysterectomy is the only other alternative, which prevents even the possibility of a pregnancy, Dr. Costatino believes it’s important for gynecologists to have an open, candid discussion about all available options along with the benefits and risks of each one. She contends that it is not fair to withhold the availability of UAE from patients and afford them the benefit of being able to gather all pertinent information and weigh her options. Dr. Costantino talks about how it’s the women, themselves, who are actually the driving force behind the growing popularity of using UAE as an option to treat fibroids, because they’re doing their homework, not wanting to be out of work with an up to six-week recovery from hysterectomy versus a small puncture in the wrist or groin as the only external entry point for treatment using UAE, that allows a woman back on her feet in days. An important takeaway that Dr. Costantino shares about fibroid treatment, is it’s not something to rush into for any woman. Some women never have lifestyle-limiting symptoms or complications. But those who have lifestyle limiting symptoms including the below, should have the discussion about all treatment options with their gynecologist:

• Heavy menstrual bleeding.
• Menstrual periods lasting more than a week.
• Pelvic pressure or pain.
• Frequent urination.
• Difficulty emptying the bladder.
•  
• Backache or leg pains.

If treatment is right for you, ask your gynecologist for a referral to a surgeon who would perform a hysterectomy AND to an Interventional Radiologist who can perform a UAE so that you can best weight all available options and decide what is best for you.

For more information go to Dr. Costantino’s website: https://advancedvascularcenters.com/uterine-fibroids/

And to find an Interventional Radiologist in your area who may treat fibroids, go to the Society of Radiology’s website: https://www.sirweb.org/

Make sure to listen to today’s broadcast!