Interventional Cardiologist Barry Tedder has been advocating for months for one of his patients to undergo a potentially life-saving procedure that uses minimally invasive methods instead of surgery. Unfortunately, their insurance has denied coverage for it, causing frustration for Dr. Tedder and unimaginable suffering for his patient. This situation is not unique - insurance companies are consistently denying reimbursement requests from physicians for minimally invasive procedures that aim to open up the arteries of patients suffering from Peripheral Artery Disease (P.A.D.). P.A.D., a disease that is more prevalent and deadlier than all cancers combined (excluding lung cancer), causes severe leg pain during physical activity and can even disrupt sleep due to restricted blood flow caused by plaque buildup in the arteries. Vascular specialists are urging insurance companies to cover the necessary procedures to alleviate the suffering and prevent limb loss, but these requests are being consistently denied. To talk about these denials, Kym McNicholas and Dr. John Phillips are joined by Dr. Barry Tedder.

Get ready for the unscripted, candid stories of patients and their experiences along their journey with a disease more prevalent and deadlier than all cancers combined except for lung cancer. It's called Peripheral Artery Disease (PAD), which is poor circulation in mainly the leg arteries. Juanita talks about her experience that led her to amputation without a PAD Diagnosis. Without a PAD diagnosis, she didn't know that her arteries need to and could potentially be opened up by an advanced skilled doctor. She explains, that if it weren't for her daughter finding Dr. Jihad Mustapha at Advanced Cardiac and Vascular Centers in Michigan on Twitter, she would've lost more than her toes. When doctors wanted to remove her leg below-the-knee, she got in her car and drove to Michigan where Dr. Mustapha was able to maintain her legs in tact for the last seven years. She urges everyone, especially the African American Community which is up to four times likely to have their leg amputated than others, to always get a second opinion from a doctor who will fight alongside you to keep you walking on two feet. You don't want to miss her powerful message also to the the medical community to take a stand against amputation and treat patients as if they were family. Karen and her husband Axel join hosts Kym McNicholas and Dr. John Phillips, along with guest physician Dr. James Antezana, to drive home the importance of getting a second opinion as a title and white coat don't guarantee the best, most advanced limb salvage options. Karen was locked into an HMO in the San Francisco Bay Area with a Vascular Surgeon only a year out of fellowship who would only offer a surgical procedure known as an axillobifemoral bypass, which entails placing a tube from the shoulder to groin and splits off into both legs to bypass blockages in her aorta and iliac arteries. This procedure is rarely performed as frontline therapy and is considered palliative care in the UK because it has low durability and high mortality rate. A second opinion from her doctor's superior only affirmed the axillo bypass as the best strategy. A third opinion at a different facility within the HMO shed light on an even more dire issue, blocked renal arteries. But he declined to take over her care due to corporate politics. They found TheWayToMyHeart.org, which directed them to a known limb saver outside of the HMO, but the HMO decline coverage as 

Karen's care team was confident in their care plan. They decided to pursue the consult on their own dime and discovered Karen was months away from dialysis with a narrowing in her renal arteries upwards of 90-percent. Her HMO vascular surgeons denied the need to address her renal arteries, brushing the one 'shriveled' up kidney as likely a birth defect. They took money out of their life savings to not only have Dr. James Joye open up her renal arteries but also her aorta and renal arteries in a minimally invasive way using wires, balloons, and stents. A year later and she is continuing to thrive. Axel says, "I have my wife back."

This show started out with a conversation about Peripheral Artery Disease (P.A.D.) Awareness Month where I shared my experience meeting and presenting alongside Congressman Henry Cuellar and Mission Heart & Vascular Interventional Cardiologist Dr. Pedro Mego MD FSCAI about this circulation issue that is more prevalent and deadlier than all cancers combined except for lung cancer. It was part of the South Texas CLI (Critical Limb Ischemia, advanced stage of P.A.D.) and Limb Salvage Club’s (501c3) meeting of community leaders and media. During their discussion, they educated Cuellar’s constituents about a piece of legislation he’s pushing, which is the Amputation Reduction and Compassion Act. The ARC Act, if passed, would require Medicare and group insurance to cover initial testing for P.A.D. and that hospitals and surgeons perform a vascular assessment in order to get reimbursed for any amputation. Interventional Cardiologist, Dr. Robert Coronado, who was filling in during this episode for Dr. John Phillips, affirmed the need for this legislation for the sake of the patients, with more than 51% of overall P.A.D.-related amputations being preventable if only patients were diagnosed sooner and physicians performed a vascular assessment prior to offering amputation. One of the biggest risk factors for P.A.D. is diabetes and Kym adds that time is of the essence for action, with P.A.D. soon to become an epidemic as the American Diabetes Association now reports 1 in 2 U.S. Adults are either pre-diabetic or diabetic and 85% of all diabetic-related amputations as being preventable if only, as Dr. Coronado suggests, early diagnosis and proper vascular assessments in a timely manner.

The discussion about Peripheral Artery Disease transitioned into a conversation about another vascular disorder that is prevalent and often overlooked and undertreated, which is venous vascular disease as a caller expressed concern about not getting a definitive diagnosis and treatment to bring her relief for what she explains as venous-related leg pain. But the overriding message between this caller and another raises concern over patients feeling unheard and left to suffer without answers to what ails them. In an article from 2017 published in the Harvard Business Review titled "Creating Time for Genuine Patient Listening," the writers assert that the true healing potential of modern medicine relies on a resource that is currently being depleted: the time and capacity to genuinely listen to patients, understand their narratives, and grasp not only what ails them but also what truly matters to them. However, this approach seems to be more of an exception than a rule within today's healthcare system. Factors such as staffing deficits, mounting workloads accompanied by additional documentation requirements, and constant pressure from healthcare administrators demanding doctors do more with less are all hindering their ability to engage in meaningful conversations with patients.

This episode features Ashley and Douglas sharing their recent experiences during medical appointments. Due to these limitations within the healthcare system, both patients leave these encounters uncertain about whether they will live another day or if walking will remain possible for them. Dr. Coronado offers additional support and inspiration for Ashley and Douglas as they navigate through their health challenges. 

Ashley is a scientist with a PhD who was a former competitive athlete that now is in a wheelchair due to debilitating pain in her thighs when she stands up or begins to walk. Doctors acknowledge the potential for iliac vein compression in both legs but keep sending her away from consults without definitive answers and any hope for relief.  Dr. Coronado validates Ashley's experience by explaining that venous vascular disease is not only the most prevalent vascular disorder worldwide but also frequently overlooked and misdiagnosed. He urges her to continue to get additional opinions until she finds the answers she deserves so she can get her life back.

In another case, Douglas recounts his encounter with a heart surgeon whom he traveled over three hours to see regarding test results indicating that his heart was functioning at only 50% capacity and the presence of an arterial blood clot in his heart. However, during their scheduled 20-minute consultation, the surgeon abruptly left to take a phone call and returned, merely allowing five minutes with Douglas where he hastily prescribed additional heart medications and schedule another test for one month later. As for Douglas, he shares his experience with a heart surgeon whom he drove more than three hours to see to discuss test results that indicated his heart was only pumping at 50% of what it should and the presence of a blood clot somewhere in his arteries. Within moments of beginning the scheduled 20-minute consult, the surgeon left to answer a call and when he came back in the room, only devoted five minutes to ordering some additional heart medications and scheduling another test for a month later. He wouldn't spend additional time with Douglas listening to, addressing, and easing concerns about dizziness that resulted in a fall earlier that day, 48 episodes reported in another heart monitor test, as well as continued tachycardia and frequent activation of his defibrillator each day - all leaving Douglas with an impending sense of mortality. Dr. Coronado assured Douglas that shouldn't be the normalcy of a physician, especially one that is addressing life-threatening coronary issues. He also suggested a trip to the emergency room for critical bloodwork and additional timely imaging if symptoms continue.

The moral of this episode is the critical importance of relationship-centered communication as critical to saving life and limb. 

The most vulnerable populations suffering from poor circulation, known as Peripheral Artery Disease Who are at-risk of amputation, are those living in Medical Deserts. A "medical desert" describes a community lacking access to medical necessities, resulting in increased morbidity and mortality. For the PAD patient, that medical necessity is a vascular specialist. One-third of hospitals across the U.S have postings for vascular surgeons, and because of that patients are progressing to a limb-threatening stage of the, known as critical limb ischemia, where the threat of amputation is real without timely, effective, limb-saving care. If only there was a way for vascular specialists in other areas to help physicians in medical deserts better care for these patients? That's the Idea behind Zivian Health. Co-Founder Dr.Rafid Fadul, an Intensive Care Pulmonologist, shares how Zivian Health is striving to improve collaboration amongst physicians across the globe. By connecting physicians across geographical boundaries and leveraging technology-driven solutions like telemedicine, Zivian Health aims to Bridge the gap between medical deserts and areas with greater access to specialized care.