If you have symptoms A, B, and C, it is likely your physician will follow a decision-tree that leads them to choose X as treatment. Treatment algorithms exist across healthcare. They're detailed, step-by-step flow charts that outline the recommended treatment for patients with a specific disorder. These algorithms are a critical foundation for any physician. They're also critical for standardizing treatment around the world so as to provide equitable care. In this week's show hosts, Kym McNicholas and Dr. John Phillips are joined by The Way To My Heart's Nurse Practitioner Kay Smith and Rush Hospital's Dr. Kumar Madassery about the value of treatment algorithms as well as where they fall short for patients, costing life and limb. They also discuss critical questions patients can ask their doctor to determine their treatment algorithm so they can weigh it against another physician who may use a different flow chart for treatment. During the Save My Piggies segment in the second half of the show, a patient, John, and his wife, Amy, who discovered almost too late that different doctors have different treatment algorithms, share their plight to save his life and limb and the importance of getting a second opinion.
Dignity is an important component of providing care for dying patients and their families. Death with dignity is an
end-of-life option, governed by state legislation in the United States, and other lawmakers around the world. It
allows certain people with terminal illness to voluntarily and legally request and receive a prescription medication
from their physician to hasten their death in a peaceful, humane, and dignified manner. In today's show we talk
about what you need to know about your freedom of choice when it comes to dignity in dying. It's an important
conversation that could impact the discussions you have about life and death with your family and healthcare
team.
COVID-19 in its early days was classified as only a respiratory illness with varying degrees of severity. But as healthcare professionals learned more over time, they started also considering it a vascular disease because of blood clots that led to serious complications, including death, in patients suffering from COVID-19. In today's show hosts, Dr. John Phillips and Kym McNicholas are joined by guest co-host Nurse Practitioner Kay Smith and Cardiothoracic Surgeon Dr. David Allie, and a patient who almost lost his legs following vascular complications due to COVID-19, to talk about those vascular complications and strategies to minimize arterial/venous thromboembolism (blood clots), myocardial infarction (damage to the heart muscle caused by lack of blood supply, which could be the result of a blood clot) complications. Some of those strategies discussed include earlier bloodwork to check cardiovascular biomarkers such as D-dimer and troponin as well as ultrasound imaging of the lungs, heart, and legs upon the early presentation of symptoms, which could signal an earlier need for aggressive intervention and treatment.
How much easier would it be if we had instant access to our medical records, especially imaging, so we could make real-time decisions on our care and even get a second opinion in a timely manner? The reality is that although HIPAA mandates our right for access to our medical records, get copies of them, and request chances be made to them, policies differ depending on facility which hinder a patient's ability to get access real-time. Some charge to release the records, asking patients to cover the 'administrative costs.' Some wait until the very last moment to send under HIPAA's 30-day requirement between the time the request was made and honored. Some even take advantage of a one-time 30-day extension, further delaying the release of records. The delay in getting those records could cost life and limb. But there is some light on the horizon with the new Cures Act as well as innovation by entrepreneurs around medical records access. Leading the discussion is Bill Anderson, Advisor to Digicare, which is creating a platform that at its foundation democratizes access to all medical records for the patient across facilities, and even more, using a special algorithm brings the information to life by highlighting key medical terms and offering patients the ability to instantly get them defined and explained. He's also VP of Partnerships for Briya, which allows patients, physicians, and researchers, and data analytics tools to be able to access and make sense of data from any location, in any format, in near real-time. In the last half of the show, a patient shares her story of perseverance with Peripheral Artery Disease (P.A.D.), a chronic circulation issue impacting mainly the legs, that impacts one in five over age 60. Diagnosed and treated at early onset of symptoms such as leg cramps and pain in the buttocks, hips, thighs, or calves, reduces a patient's risk of heart attack, stroke, and amputation.
Hosts Interventional Cardiologist Dr. John Phillips and Emmy Award-winning journalist Kym McNicholas are talking about innovation around ALS. Most are familiar with ALS now more than ever because o the famous internet ice bucket challenge involving the pouring of a bucket of ice water over a person's head, either by another person or self-administered, to promote awareness of Amyotrophic lateral sclerosis , or ALS. ALS is a progressive nervous system disease that affects nerve cells in the brain and spinal cord, causing loss of muscle. Most people with this disease begin with muscle stiffness or weakness. But they eventually lose the ability to walk, dress, write, speak, swallow, and ultimately breathe on their own when the muscle paralysis spreads to vital organs such as the lungs. We are talking about it here on the Heart of Innovation for three reasons: First, although it's not considered a vascular disease, some researchers believe that an ALS-linked gene mutation could cause disruptions in the blood-spinal cord barrier, causing the neurovascular inflammatory response, which is ALS; Second, due to the lack of mobility as ALS progresses, many people with ALS end up with circulation issues in the legs (Circulation issues in the legs is known as peripheral vascular disease. We've talked about that at length on this show where arteries start hardening and the flaps that help usher blood flow back to the heart start malfunctioning.); Third, innovation around treatment and disease management has led to a longer, better quality of life for people with ALS due to organizations such as the Gleason Foundation, founded by former New Orleans Saints NFL great Steve Gleason. Kearney Gray, Director of development for the Gleason Foundation talks about how patient-driven innovation with communication and mobility are helping patients to live a longer, better quality of life. The Gleason foundation has played an integral role in raising the patient voice to create change in care, empowering companies to create new, novel approaches to improving communication for people with ALS, and not only educating lawmakers on ALS, but inspiring them to take action to help elevate care. Dietitian Melissa Hooper also joins the discussion to talk about the importance of nutrition in slowing the progression of disease and improving the quality of life of people with ALS. Since people with ALS maintain their cognitive ability throughout disease progression, knowing what's to come and what's happening can impact mental well-being. So, Kathryn Walker, CEO, MSN-Anesthesia, MSN-Psychiatry, at mental wellness treatment centers, Rivatalist, adds to the conversation with available options to improve mental health.
Description:
Having a chronic illness and/or a surgical procedure can be scary. In this episode of the Heart of Innovation, we are talking about pre and post surgery stress and anxiety, especially tomophobia, 'the fear of surgery'. In the hospital, people are given medicine to help them sleep or sedatives to put them at ease. At home, it's not always as easy. Either way, many times the hurry up and wait game for any procedure is sure to put you on edge. The Way To My Heart Nurse Practitioner Kay Smith along with CRNA Kathryn Walker, CEO of Rivitalist , a group of mental wellness centers and her colleague Beth Ward, a Licensed Clinical Social Worker (LCSW) talk to hosts Kym McNicholas and Interventional Cardiologist Dr. John Phillips about how to discuss doubt, fears, and anxiety with your healthcare team. They also offer tangible, actionable ways in which you can put yourself at ease pre and post surgery.
Grady, a family member of a patient who is now recovering from open heart surgery kicked off the discussion with a candid description of his experience leading up to his brother's procedure. He discussed the fear driven by the procedure itself but also the revolving door of physicians, the numerous pre-operative tests, the gaps in communication at times, and worries about what happens if treatment doesn't work. He also drove home the importance of a patient's healthcare team to recognize the stress and anxiety of a patient's family and to keep them in the loop to ensure all are on the same page so they can more effectively support the patient and help accelerate versus hinder the healing process.
Marcia, a patient with peripheral artery disease (P.A.D.), asked the therapists and Dr. Phillips about how to deal with post-surgery symptoms and the emotional stress that comes with so many questions that may arise between appointments with her healthcare team. Most patients don't have a physician or clinician on speed dial every single time a question pops up. So, what might be a small, normal post-surgery side effect, can be magnified the longer a patient waits for an answer.
A big takeaway from CRNA Kathryn and LCSW Beth is to recognize that stress, anxiety, and fear step from worrying about the future and things you can't control. They say the key is to focus on what you can control. Draw a circle on a piece of paper and place inside the circle all of the things you are worried about that YOU can actually do something about. That includes planning for options to accelerate recovery, such as starting to contemplate rehab possibilities, setting up a meeting with a dietitian, obtaining items for improved comfort and mobility at home, etc. Focus on those. For the others, sit down and come up with questions that may arise around them which can be discussed with your healthcare team or that of your family member.
In summary, it's most important to not burden yourself with regrets of the past and the 'what if's' of the future. Catch them coming into your mind, and remind yourself to look for things that are within your power tand control to change and do right now.
For more, listen to this powerful conversation:
Description:
Douglas is on deck for open heart surgery and decided to join the show just minutes before air time to inspire others through sharing his courageous journey. He heard that Dr. Mehrzad Zarghouni, Interventional Radiologist with Houston Vein & Vascular, was going to be on the show as guest co-host since Dr. Phillips was on call and taking care of an urgent heart patient at Ohio Health. So, he popped on just before our producer Aikman did the final countdown. Why? Douglas wanted to thank Dr. Z, who was named U.S. Vascular Doctor of the Year 2022 by advocacy nonprofit The Way To My Heart, for saving his life. Douglas had shown up to see Dr. Z a few months ago for a procedure to unblock arteries in his legs because of a disease known as Peripheral Artery Disease, which is defined by plaque build-up in mainly the leg arteries which restricts blood flow, causing debilitating pain.
The way Dr. Z described the situation, Douglas seemed off that morning and was complaining of fatigue and chest pain. Dr. Z canceled the procedure and sent Douglas immediately to the emergency department and called a friend , an Interventional Cardiologist, who was on call that day to urgently assess him and who was able to get diagnosed and stabilized.
Douglas has a rare ailment known as apical hypertrophic cardiomyopathy, which is when the walls of the heart become thicker than they should be and this excessive thickening can cause the heart to become more stiff and leaves less room for blood to fill the heart.
Douglas is now on deck for open heart surgery next week to improve his prognosis.
During the show Douglas was able to ask our guest panel questions to ease his fears about the procedure and what to expect post-procedure. The Way To My Heart Nurse Practitioner Kay Smith was able to provide an in-depth explanation of Douglas' situation. Nurse Practitioner/CRNA Kathryn Walker, a former cardiac anesthesiologist, who's also CEO of Revitalist, a group of mental wellness treatment centers, walked Douglas step-by-step through what to expect from the moment he's wheeled down to the operating room clear through recovery. Dietitian Melissa Hooper (www.dietitianmelissa.com) answered Douglas' questions about how to improve his nutritional health following open heart surgery including cutting cholesterol, animal fats, and processed foods out of his diet.
Also, in the show's Save My Piggies segment, Dr. John Corl, Interventional Cardiologist with Christ Hospital in Cincinnati, Ohio is joined by his patient Marcia to talk about how the right doctor and "modern medicine" changed her life and made her "new" again. Marcia discusses how she was able to push through the pain associated with blocked arteries in her legs, known as peripheral artery disease, to help re-route blood flow through the body’s network of collateral vessels that lay dormant until you need them to improve circulation. This collateral network kept her legs alive until she was able to find Dr. Corl through The Way To My Heart, and he was able to clear multiple severe blockages in her upper thighs and lower abdominal region. She now walks more than 10,000 steps daily.
Description:
You don’t want to miss this compelling episode of The Heart of Innovation, not only because it has the potential to save life and limb through a deep dive into how walking can help create a ‘natural bypass,’ but because a patient shares his story of how a second opinion changed his life.
In segment three, Duke and his vascular specialist Dr. Yazan Khatib at First Coast Cardiovascular Institute in Jacksonville, Florida talk about how a leg amputation was thwarted. Duke has Peripheral Artery Disease (P.A.D.), which is a chronic circulation issue in mainly the legs. Duke had multiple interventions and bypasses to restore blood flow to his legs before finding Dr. Khatib. The catalyst for Duke seeking help from Dr. Khatib was the point where his previous doctor told him that it wasn’t worth his time and energy financially to delay what he believed was the inevitable, which was amputation. It was Duke’s Primary Care Physician who told him to get a second opinion before amputation. Four years later, Duke is still walking on two feet thanks to regular maintenance by Dr.Khatib and lifestyle modifications, especially walking.
Walking is the best medicine for P.A.D. That’s why during this episode, hosts Kym McNicholas and Dr. John Phillips spend the majority of time leading up to the Save My Piggies segment and afterwards talking to Interventional Radiologist Dr. Lorenzo Patrone, 2022 European Patient Champion and 2020 Global Vascular Doctor of the Year, about why walking is the best medicine for P.A.D. and other circulation issues. Mass General Hospital Vascular Surgeon Dr. Anahita Dua also shares how to walk effectively to wake up and grow your collateral network to help improve circulation without intervention.
P.A.D. is defined by a narrowing of the arteries, mainly in the legs, due to plaque build-up. When flow is restricted, muscles, organs, and tissue are starved of critical nutrients, including oxygen. This may cause symptoms, such as leg pain and cramping when walking (claudication). Even worse, it could prevent healing of sores on your feet, leading to ischemia, meaning tissue loss. Wounds need oxygen to heal. Your body does have a back-up system. It's the collateral network, known as your body's "natural bypass."
The collateral network consists of smaller vessels available to handle extra demand. What makes them so special is they have the ability to expand and even grow if necessary to keep up with demand.
Walking helps to accelerate this process.
When you walk or exercise, your heart starts to pump harder and faster to circulate blood to deliver oxygen to your muscles, organs, and tissues. If arteries can't handle the additional rush of blood flow, the collateral vessels re-structure to meet the increased demand.
Think about it like our freeway system. If there's an obstacle such as an accident on the freeway blocking the flow of traffic, more cars veer off on to side roads to continue moving forward towards their destination. Collateral vessels, like side roads, can vary in capacity, but unlike side roads collateral vessels can expand and grow with increased demand. The extent to which your collateral network can keep up with demand, depends on the individual and stage of disease.
The collateral network's effectiveness may be limited in individuals with advanced age PAD and those with smaller vessel disease below-the-knee. That's why it's important to get a full vascular assessment. During this assessment, discuss with your physician:
For those without Critical Limb Threatening Ischemia (CLTI), standard protocols for treating P.A.D. suggest a three-month program that consists of medical and exercise therapy. During that time, physicians assess whether an antiplatelet drug and/or a vasodilator, coupled with brisk walking will help your body to increase flow not only through narrowed arteries, but also through the collateral network.
If you are post-procedure, following an intervention or bypass, your physician will prescribe a walking regimen to help maintain the recently treated vessels open, as well as to continue to maintain and build your collateral network. If a covered stent is used or bypass is performed collateral vessels will be impacted in those areas, but walking will remain critical to increase demand for blood flow to maintain those vessels open.
Some facilities offer a formal Supervised Exercise Therapy (SET) program to support walking as medicine for P.A.D. patients. If your physician doesn’t have a formal walking program, go to TheWayToMyHeart.org to sign up for My Steps, which is a text-based program designed to meet each individual patient’s needs and goals to increase long-term accountability.
Description: Chronic physical illness can lead to depression and anxiety, resulting in a mental health crisis which can further jeopardize a patient's health. The Heart of Innovation hosts Kym McNicholas and Dr. John Phillips are joined by The Way To My Heart's Nurse Practitioner Kay Smith, legendary business and financial reporter Bambi Francisco (Founder and CEO of Vator.TV), and Revitalist (Mental wellness treatment center chain in six states including Tennessee and Kentucky) CEO Kathryn Walker to talk about the problem and innovative solutions to improve mental health in patients with chronic physical ailments.
Today’s show kicked off with a couple inspirational quotes by Queen Elizabeth II to celebrate the impact she’s had on the world during her reign:
“Everyone is our neighbour, no matter what race, creed, or colour.”
“When peace comes, remember it will be for us, the children of today, to make the world of tomorrow a better and happier place.”
Queen passed away this past week of what may have been a massive stroke, although upon publish of this article, cause of death had not been released to the public. Dr. Phillips commented on the prevalence of strokes in the elderly, and the importance of getting checked annually for one common cause, which is atrial fibrillation, an irregular and often rapid heart rate that can lead to blood clots. Now that the COVID-19 lockdown has lifted and hospital facilities are starting to operate again at a normal rate, it’s important for everyone to C.H.A.T. with their doctor about vascular health, which means to ask their physician to check their Carotids, Heart, Abdomen (Aneurysm), and Toes (arteries and veins).
The discussion on vascular health backed into the topic of the day, which is mental health and chronic physical illness. Bambi Francisco runs a content distribution network, Vator.TV, which includes regular salons on mental health. Her next event, “Future of Behavioral and Mental Health is October 26th where topics will include “Reinventing the doctor’s role”, “Future of Clinics”, “Lifestyle” and more. The premise for the event as well as how she began her discussion on mental health, is that for at least a decade, about one out of five Americans suffered from some sort of mental disorder. In the case of depression, it’s become almost an epidemic rom being a rare condition 50 years ago. Critics have argued the rise has a lot to do with pathologizing normal psychic and somatic behavior, meaning society’s idea of normal often means never feeling sad or hopeless. Covid and policies around the lockdown that kept kids out of schools has contributed to the elevated levels of mental stress. But it’s also weighed heavily on those with chronic illnesses.
Kathryn Walker, CEO of Revitalist, who’s also an ICU Nurse explains why chronic physical illnesses can impact mental well-being and how psychedelics such as ketamine are becoming more accepted as mainstream treatment. Nurse Practitioner Kay also discusses the importance o Virtual Reality in the treatment of mental health issues and Bambi Francisco highlights the rise in faith-based technologies to improve mental well-being.
Diane, a patient with Peripheral Artery Disease (P.A.D.), which is a chronic circulation issue, talks about the impact of P.A.D. on her mental state and how finding the right vascular specialist who uses advanced minimally invasive tools and techniques can make all the difference in the world in not only providing pain relief, but also restoring hope, her mental state, as well as her love life.
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:
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: Patients are on the frontlines when it comes to uncovering gaps in our healthcare system. That's why this episode features patients who have Peripheral Artery Disease, restricted blood flow in mainly the leg arteries due to plaque build-up, and live in low-socioeconomic areas, talking about how they are treated and what might help improve care. Physicians who care for these patients also weigh-in. All guests on today’s program are attending The Way To My Heart Inc’s first in-person “Making the Impossible, Possible, P.A.D. Warrior conference in Chicago, Illinois, which is focusing on sharing cutting-edge information with P.A.D. patients. Host Kym McNicholas is broadcasting LIVE from the event. Host Dr. John Phillips is broadcasting LIVE from Newark airport in New Jersey following a medical seminar, put together by device maker Cook Medical, where he was educating other physicians and clinicians on new tools and techniques for unblocking leg arteries in minimally invasive ways.
Kym kicked off the show talking about gaps in emergency healthcare after her dad spent the week in the hospital following a fall. He fractured his right femur and right elbow. He was left in the emergency room without an orthopedic consult for 9.5 hours awaiting potential surgery. Kym expressed concern that he is a heart disease patient at-risk of blood clots, being left in one position laying down for such a long period of time without taking his blood thinners, not being given fluids, and not urinating despite a full bladder. He was only taken care once Kym arrived and was able to start advocating for him. She pushed to get a phone consult with the orthopedic surgeon who had already left the hospital without seeing her dad, confirmed the surgery for the next day, got a Levonox shot ordered, finally got him a can to empty his bladder, and had the nurse place circulating socks on his feet. This experience led to Kym and Dr. Phillips discussing the importance of emergency room staff taking steps to prevent vascular complications whether they’re related to the reason for admittance or not.
Following that conversation, other physicians joined in to discuss their ideas for improving care. Key points made by Vascular Surgeon Dr. James Antezana, M.D., FSVS, RPVI (Charlotte, North Carolina), Dr. Paramjit "Romi" Chopra (Chicago, Illinois), Kumar Madassery (Chicago, Illinois), and Dr. Mohammad Elsayed, MD (Schaumberg, Illinois) include the importance of:
· Working with Primary Care Physicians to recognize the symptoms of P.A.D. to get patients diagnosed and treated in early stages.
· Improving the communication between different physicians to ensure a timely, effective multidisciplinary approach to treating patients with P.A.D.
· More consistency in treatment for P.A.D., favoring more advanced limb salvage tools and techniques to reduce the number of preventable amputations.
Patients who spoke out on the show agreed with what the physicians had to say and had a few of their own ideas as well on shaping the future of P.A.D. care. They include:
· Encouraging patients to get a second opinion versus telling them there’s no other option but what is being offered in that moment at that facility.
· Making sure to offer a proper diagnosis for P.A.D. versus simply telling a patient they have circulation issues related to diabetes.
· Performing an exhaustive angiogram using advanced tools and techniques to try and revascularize vessels prior to amputation.
A big highlight during the show happened when one patient expressed concern about her vascular specialist refusing to treat blocked vessels below the knee despite rest pain at night. Kym was able to call over a vascular specialist attending the event to hear her story and give her hope that relief is on the way as he would review her case and exhaust all efforts to get her back on her feet pain-free.
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.
Click on the link below to listen to today's show!
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/
Make sure to listen to today’s broadcast!
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:
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/
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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.
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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.
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.
Covid 19 has shed light on the incredible inequities when it comes to access to nutritious foods.
Food insecurity is a big factor when it comes to nutritional deficiencies that leave our bodies vulnerable to viruses and chronic illness – whether it’s covid, diabetes, heart disease, or peripheral artery disease.
You can’t stay healthy without nutrition and you can’t heal without nutrition. Therefore, it’s a vicious cycle that needs to be broken.
But Dole Asia Holdings and its subsidiaries are calling on all innovators to work together to break the cycle with its increased focus on tackling food insecurities.
They’ve launched the Sunshine For All Fund, which is a 2 million dollar annual fund that will support global strategic partnerships and innovation in the crucial areas of sustainability, food access, and waste.
Dr. Lara Ramdin, Chief Innovation Officer of Dole Packaged Foods. discusses the business' transformation, which is deeply rooted in its purpose, and how to partner with their effort with Emmy Award-winning host Kym McNicholas
A 45-year-old woman recently shared her story with me after finding our patient advocacy nonprofit The Way To My Heart and wishing she had found it sooner because we may have helped her save not just one leg but both. Two months after being diagnosed with Peripheral Artery Disease, a narrowing of mainly the leg arteries due to plaque build-up, her hospital vascular specialist told her that the vessels below her knee were severely compromised and too small to treat. He told her to walk until she couldn’t walk anymore and then he would amputate.
One night about six months later, she woke up at 2am because the pain was unbearable and she decided it was her leg or life. So, she and her husband drove to the emergency room where physicians pumped her full of powerful pain medications until her surgeon arrived and took her to the operating room to amputate her leg at the knee. She had never thought to get a second opinion as her vascular specialist was the head of the department at a large University Hospital. She thought he was the best and didn’t think to question his skillset until he gave her the same option for her left leg one year later. That’s when she found The Way To My Heart and we directed her to a “Pedal Loop Specialist” trained in navigating the small blood vessels below-the-knee to restore flow.
This woman’s story is not unique. Nearly 200,000 needless amputations are performed annually due to advanced stages of PAD, known as Critical Limb Threatening Ischemia. Navigating smaller, compromised vessels below-the-knee is risky and requires highly skilled interventionalists, special tools, and additional time, which are few and far between. New technology has the potential to change that. LimFlow has formalized a technique used by advanced interventionalists to re-route blood flow around a blockage in an artery below-the-knee using a vein. Arteries naturally deliver blood flow to the foot and veins are responsible for outflow. LimFlow’s system includes a specially designed crossing device to easily make the artery to vein connection. Forward flow is enabled in the vein through a disabling of the venous valves using a valvulotome. An extension stent is placed to block smaller veins from taking blood flow in the newly converted vein back to the heart, and a tapered crossing stent is used to bridge the artery to vein connection.
LimFlow’s CEO Dan Rose shares the backstory behind the system, which has already received CE Mark for use in Europe, and is well on it’s path to U.S. FDA clearance in the Q&A below.