That is the part that keeps me up at night. Not that the disease is hard to treat. It is that we are catching it so late.

This week on The Heart of Innovation, Dr. John Phillips and I sat down with a research team from UC San Diego that is working to change that: vascular surgeon Dr. Elsie Ross, cardiologist Dr. Mattheus Ramsis, and engineering PhD student Ava Faccetti. What they are building together started with a cup of black coffee and a question that nobody had thought to ask before.

Dr. Ross had been in AI since 2013, long before it was a buzzword in medicine. She was thinking about PAD patients showing up too late, primary care doctors not checking pulses, people going years without a diagnosis and then landing in surgery. Dr. Ramsis had been working with PPG signals since a fellowship at UCSF, where he helped co-develop the AFib detection algorithm that Samsung uses in their smartwatch today. When they both ended up at UCSD as medical directors of informatics, Dr. Ramsis pitched his work at a meeting, and Dr. Ross was in the audience. She knocked on his door the next day and said they should talk.

Over coffee, she told him about PAD and the physiology behind it. He told her about PPG signals. And then somebody mentioned that a PPG signal is captured at the same time a patient gets an ankle-brachial index test. They looked at each other and both had the same thought at the same moment: there is probably something here.

PPG stands for photoplethysmography, which is why everyone on the show quickly agreed to just call it PPG. It is the same light-reflection technology your smartwatch uses to track your heart rate. You can capture it from any vascular bed, a finger, a wrist, a toe. What Dr. Ross realized was that if you put the sensor at the toe, you are reading the signal right where PAD shows up first. Arteries narrow from the feet up. The toe is the canary.

The team pulled thousands of signals from the vascular lab, with help from medical student collaborator Mustafa who physically extracted them from the records. Ava took those signals and did something that Gemini will describe as AI and that Ava herself would push back on slightly. They did not just feed the data into a model and hope for the best. They sat in meetings with Dr. Ross and looked at signals side by side, some from patients with PAD and some without, and asked her to tell them which was which and why. They were trying to translate physiology into something a computer could reason about. That is a different thing than a black box algorithm spitting out a prediction with no explanation behind it.

They validated the model against the ABI, the ankle-brachial index, which is the clinical gold standard for PAD diagnosis. And the results were strong enough that about nine or ten months ago, sitting in a meeting, they looked at what they had found and said: yeah, this is going to work.

The vision from here is not another expensive machine bolted to the floor of a specialty clinic. It is a consumer device. Something you can use at home, or at CVS, or at your fire department, the same way you check a blood pressure or take a temperature. Not a diagnosis, but an indication, something that says you should probably go see someone about this, before tissue is dying and surgeons are out of options.

Dr. John made the point on air that this is how medicine has to move. We have spent decades building remarkable tools that live inside the walls of specialty practices and academic medical centers. The patients who need them most are the ones least likely to walk through those doors. Rural patients. Patients with no primary care. Asymptomatic patients who feel fine right up until they do not.

An ABI requires you to show up, lie down, have a cuff put on your arm and your leg, and have someone calculate the ratio. That is a real barrier for a lot of people. A four-second toe signal on a phone is not.

I have covered healthcare innovation for a long time and I have sat across from a lot of researchers. What I noticed about this team is that none of them started with the technology and worked backward to find a problem to solve. Dr. Ross started with patients who were losing limbs and worked forward to find a tool that could reach them earlier. It’s important to always start with the patient. It is the difference between a product and a mission.

They are still in the validation phase. There is more work to do. But the core algorithm is built, the foundational paper is complete, and the goal is an FDA-approved screening tool that puts some version of a vascular lab reading in the hands of the people who need it most.

If you want to hear the full conversation, including how Dr. Ramsis accidentally missed the first meeting with Ava’s lab director and it somehow still worked out, click the video above or find us on YouTube at youtube.com/@TheWayToMyHeart or catch us live on AM 1220 KDOW every Saturday morning.

And if you or someone you know has leg pain, wounds that do not heal, or feet that are cold or numb, please do not wait for a device. Call our leg saver hotline at 1-833-PAD-LEGS or visit padhelp.org. The current standard of care can still save a limb if you catch it in time. That is what we are here for.

More on the research:

DOI: https://doi.org/10.1038/s41746-026-02655-w

Vern and I go back to the Konocti Harbor Quarterback Shootout, a celebrity golf tournament at Konocti Harbor Resort up in Lake County. He was at KRON 4 at the time, deep into the segment that made him famous around here, “Mr. Involvement,” where his producers would find ways to throw him into whatever sport he was covering. Not cover it. Do it. He got tackled by NFL players, pinned on wrestling mats. So when the shootout wanted water sports coverage and somebody said, hey, there is a fellow Bay Area sports anchor who performs as a professional show skier at Six Flags Marine World in Vallejo on weekends, the decision made itself. They brought me in to show Vern how it worked on a swivel ski.

He held up fine. What he did not know was how easy I went on him. On weekends I was the cherry on top of a three-tier human pyramid on water, holding the American flag in a pink skirt, skiing around the lake. I could have put him in that pyramid. We still have the video. Watch the episode if you want to see what the early career looked like before the microphone.

That is how we met. He became a mentor. Years later we both ended up on a healthcare innovation radio show, and the fact that it is not as strange as it sounds is exactly what this episode is about.

When the Body Sends a Bill

Vern turned 64 this year. He looks like he is in his 40s and he will tell you so himself, but here is the thing he also told us on air: when you are young, you feel like a tank. Nothing touches you. The late nights, the bad habits, whatever you need to get through the grind of a 41-year career. And then somewhere in your 50s, the body sends a bill. His came as a Type 2 diabetes diagnosis. Pre-diabetes first, then Type 1, now Type 2, and every single day is about working the A1C number down through exercise, diet, and weight management. He wants to be around for grandkids someday. He wants 20 more years. Those are his words, not mine.

That lands on a healthcare innovation show because Type 2 diabetes is not separate from what we cover. It is a vascular disease. It damages arteries. It is one of the primary drivers of peripheral artery disease, of critical limb threatening ischemia, of the exact conditions our leg saver hotline exists for. The people who call us often did not know how interconnected it all was until something went wrong. Vern knowing it, managing it, talking about it publicly at 64, that is the message.

Which brings us to June 8th. Every year, Vern hosts the Vern Glenn Invitational, a celebrity charity golf tournament in Marin County that benefits local Marin charities. The lineup reads like a flashback reel of Bay Area sports history. Lorenzo Neal, 16-year NFL veteran and Vern’s own guest analyst during football season, whose block on the Music City Miracle kickoff is one of the most important plays in playoff history. Bill Cartwright, longtime Chicago Bull. Toy Cook, 49er Super Bowl champion. JT, who won the very first VGI. Brandy Chastain won last year’s celebrity putting contest, only woman in the field, took home a gift certificate to Omaha Steaks, and is missing this one because June 8th is her wedding anniversary and her son’s birthday. Nobody is fighting her on that.

None of these people are paid to be there. Vern told us that plainly. They get treated well, championship course, plated dinner, but they volunteer their time. And some of them keep coming back because, as Vern put it, time has passed them by and people have forgotten. Being asked still means something. He wants to hear every story, even the ones he has heard 20 times over. You could see it when he talked about interviewing Hank Aaron at Candlestick Park on a live shot, calm and composed on camera, absolutely screaming on the inside because he was talking to the home run king. He has been in this business for 41 years and he still screams on the inside. That is why there are six Emmys.

What Six Emmys Actually Takes

Dr. John wanted to know how you actually get an Emmy, and the answer is worth knowing. In the Northern California region, you compile your best work, up to 10 or 15 minutes depending on category, and submit it to be judged by peers in markets that have no idea who you are. Blind scoring on a seven to ten point scale. Not every category produces a winner. If nobody scores high enough, the award simply does not go out that year. Vern was nominated five times before he won. His mother refused to attend any of the ceremonies until he actually took one home. When he finally did, he was the only person nominated in his category. His category is a solo craft award, one person, no ensemble, judged on nothing but what you did in front of a camera. He has won it six times.

He just re-signed at KPIX. He said he has a number in mind, a point where he will know it is time, but he is not there yet. Dr. John made the point on air that staying engaged, working, learning, doing things that require your brain to stay sharp, is itself a form of disease prevention. The research on cognitive decline backs that up. Retiring with nothing to do is not rest. It is a risk. Vern loves what he does. That still matters.

Golf is part of it too. He had stepped away from playing for a while, and the tournament pulled him back. Walking 18 holes is three to five miles. Gary Player, who Vern quoted on air, said happiness is a long walk with a putter, and Player is in his late 80s still competing. For someone managing Type 2 diabetes, that is not a hobby. That is medicine. And watching former 49ers and NBA veterans stay out on the course in their 60s and 70s is the kind of modeling that no PSA ever quite achieves, because it is just people you respect doing the work in front of you.

Back to the key lime pie, because it is the best way to close this. May 2020, everybody locked down, my dad’s birthday coming up and he had one request, a key lime pie from a place that was closed. I mentioned it to Vern. He said bring your dad over. We will sit outside six feet apart and I will make him one. He did not know my dad. He just offered. My dad has not stopped talking about it since, and this year, for his birthday, he had one request: Vern Glenn and another key lime pie. He got both.

That is the whole person. Six Emmys, 41 years, Hall of Fame. And he still makes the pie.

The Vern Glenn Invitational is Monday, June 8th. Registration and details at vernglenninvitational.net. Arrive around 9am, meet the athletes, have breakfast. All proceeds go to local Marin County charities. And if you happen to see someone near the first tee with a blood pressure cuff, that is us. Purely voluntary. The shoes can stay on.

The Heart of Innovation airs every Saturday morning on AM 1220 KDOW. Watch the full episode on YouTube at youtube.com/@thewaytomyheart or click on the video above.

Most of the technology world never knew that Phil McKinney has been managing a genetic heart condition since he was 17 years old. It runs in his family. His father nearly died from it at a time when the medical community barely understood it, and it can kill a young, healthy person mid-game with no warning whatsoever.

A close friend of mine, Justin, who ran Patient Pro Marketing in the vascular world, died from it not long ago. He had no idea he had it, and neither did anyone in his family. That story is far more common than Phil McKinney’s, which is exactly why McKinney’s is worth telling.

The condition is hypertrophic cardiomyopathy, or HCM, a genetic mutation that causes the heart’s left ventricle, the main pumping chamber, to thicken abnormally. About one in 500 people carry it, most without any idea. As that wall thickens, it can block blood from leaving the heart through the aorta, generate lethal electrical rhythms, and cause sudden cardiac arrest.

McKinney and his father carry the apical variant, where the thickening concentrates at the very tip of the heart rather than the upper wall. In the U.S. it accounts for roughly three to ten percent of HCM cases depending on the population studied. Both forms can carry a risk of dangerous arrhythmias and sudden cardiac death. The difference is where the thickening occurs and how it’s found. Standard HCM can sometimes show up on a regular echocardiogram. Apical HCM frequently doesn’t, and cardiac MRI is often the only way to see it, which is part of why it goes undiagnosed for so long.

Dr. John Phillips, my co-host on The Heart of Innovation and an interventional cardiologist, described how this plays out: when a soccer player drops on the pitch or a football player collapses mid-game, HCM is frequently the culprit. “It can affect a young, healthy person and cause sudden death,” he said. Most of the time, the person had no idea anything was wrong.

McKinney’s father found out in 1975 or 1976 through a routine physical required for an adult Boy Scout volunteer position. Their family physician in Chicago caught a faint murmur and sent him to the University of Chicago, where one of the few cardiologists working in this area at the time confirmed the diagnosis. Two years later, the elder McKinney went in for open-heart surgery to thin the thickened wall. He was only the seventh person in the world to have the procedure. Dozens of physicians crowded the OR, and the family signed releases so the surgery could be filmed and shared with cardiologists across the country.

Phil McKinney was 17 and in the waiting room that November. He had just started dating Michelle that September, the same month the University of Chicago brought in his father’s male relatives for early genetic testing and Phil received his own diagnosis. They had met three years earlier through the Boy Scouts Explorer program. When they started dating, she asked how close he was to his Eagle Scout. Five merit badges, he told her, three weeks, probably not enough time. She told him she didn’t date non-Eagles. He finished five merit badges in three weeks and earned his Eagle with 11 hours to spare before his 18th birthday.

His soccer career ended that same fall.

McKinney has lived with this condition for nearly 50 years, and what he describes most is that he feels nothing. Today his heart throws ventricular tachycardia and premature ventricular contractions in patterns that alarm hospital monitoring teams on sight, 20, 25, 30 consecutive beats of VTAC. Staff always ask him the same question: don’t you feel it?

“I don’t feel the arrhythmias,” he said. “I don’t think my heart rhythm has ever been normal. I don’t know what normal feels like for everybody else.”

That answer explains why this condition kills people who had no warning. When you have never had a normal baseline, nothing feels out of the ordinary. The disease progresses and the person has no idea, which is how a seemingly healthy athlete ends up face down on a court.

Stanford became central to McKinney’s care when he joined HP and moved to the Bay Area, where his uncle already lived in Vallejo and his brother eventually settled. Dr. Euan Ashley, who founded Stanford’s Center for Inherited Cardiovascular Disease and now chairs the Department of Medicine there, brought the living male members of the family together for testing.

That monitoring showed medications alone weren’t enough. McKinney became a test case for early non-invasive cardiac monitoring before eventually receiving an implantable cardioverter-defibrillator, an ICD that watches his heart rhythm continuously and delivers a shock if a lethal rhythm takes hold. He’s now on his third device, with battery swaps every seven to eight years. It has never fired.

His father’s device did, more than once, and McKinney witnessed some of those episodes. His father grew up in Kentucky and described the sensation as being kicked in the chest by a horse, a comparison he knew firsthand. When McKinney’s own device was implanted, the technician asked whether he wanted an audio tone to count down the seconds before a potential shock. His answer was no. “I don’t want the stress of the beep beep beep counting down. No thank you.”

Douglas Salisbury, who leads our PAD Warrior Task Force and also has apical HCM, knows what a firing device feels like. Three days after his myectomy, his device went off three times in ten minutes. “I have never experienced anything like that in my life,” he said.

McKinney also carried coronary artery blockages from his mother’s side. In February 2023, his wife Michelle, a neonatal intensive care nurse who spent 25 years in that specialty and earned her master’s in nursing from the University of Evansville, dragged him to Mayo Clinic for his annual workup, as she always does. His standard echos came back flagged, and the clinical team told him to stay.

He ended up in open-heart surgery. The plan was a quadruple bypass, but surgeons could only complete three once they were inside because scar tissue and buildup around the heart blocked access to some of the blockages entirely. While they had him open, they also performed a MAZE procedure, surgically rewiring the heart’s electrical pathways to address the atrial fibrillation he had been fighting for years. McKinney had been cardioverted roughly 35 times in his life, on a cycle of needing the outpatient procedure every six weeks because his heart would never convert back on its own. Since February 2023, he has had zero episodes of AFib.

All three of McKinney’s children have been tested. His oldest daughter carries the mutation but has not developed the disease. When she gave birth to McKinney’s first grandchild 13 years ago, Stanford sent two cardiologists to observe the delivery at the other hospital to monitor for any cardiac effects from labor.

The family had secured life insurance for all three kids before any genetic testing happened, knowing what a diagnosis could mean for coverage. McKinney himself has been uninsurable for individual life coverage since he was 17, relying entirely on employer group policies through his career at HP and CableLabs. A diagnosis follows you through every insurance application you’ll ever fill out.

McKinney’s message to anyone with family history of cardiac events, and especially to parents of young athletes, is to push for an echocardiogram and fight with the insurance company if necessary. A routine youth sports physical won’t catch a structural abnormality. A five-minute echo very often will. If there’s cardiac history in the family, ask about genetic testing, because identifying the mutation gives the next generation a chance at the same outcome McKinney and his brother have had.

“Be an advocate for yourself,” he said. “Find good care. With early diagnosis and good medical care, you can have a great, normal life.”

McKinney is 65. His brother is approaching 70. Their father made it to 68 before the condition took him. A family physician heard a murmur at a Boy Scout physical and sent a man to the right doctor. That one referral changed everything for three generations of McKinneys.

Justin never got that far. He never knew there was anything to find. Get checked.

If you have questions about this story, you can call the Global PAD Association’s Leg Saver Hotline at 1-833-PAD-LEGS.

Don’t focus on facility name or Google reviews.

What you want to know is whether that vascular doctor has the practical skill set to take a wire and balloon all the way into the smallest vessels in the foot, when it’s medically appropriate, to restore blood flow and heal a wound.

Ask whether they have surgical options available at their clinic or through a direct referral if intervention isn’t enough.

The older doctor may have more experience. The younger doctor may be quicker to adopt newer techniques. What actually matters is whether they’ve worked below the knee and ankle, whether they’ve gone retrograde (coming up from the foot, calf, or behind the knee) when the anatomy called for it. And what surgical options are also available if wires and balloons aren’t enough.

Ask those questions directly.

The answer tells you more than any credential on the wall.

But skill set is only part of what you’re looking for. The other part is what happened later that same Friday night, after I got off the phone with that daughter.

I reached out to three vascular specialists I work closely with, Dr. Eric Secemski, Dr. Anahita Dua, and Dr. Matthew Menard. All three were in London at another prestigious conference called Charing Cross. It was 10:30 at night there. Dr. Menard had gone on to enjoy a couple of days in Copenhagen. I’m fairly certain I woke him up twice. All three responded. But Dr. Menard was first to respond and facilitated emergency room care for this woman, talked to his team, put his name down as supervising physician, requested all the appropriate tests, and committed to taking care of her personally on Monday. Dr. Dua and Dr. Secemski were ready to do the same.

On the show, Dr. Phillips quoted Adam Smith’s The Theory of Moral Sentiments: “The wise and virtuous man is at all times willing that his own private interests should be yielded to the public interest.” Three doctors, in the middle of the night, overseas, on their own time. That’s what it looks like.

And that kind of selflessness isn’t limited to legs.

The same spirit shows up when a heart stops, and sometimes the line between life and death is a forgotten laptop.

We aired a local TV news story on the show about a reunion between a man named Mark Lamont and the team at Riverside Methodist Hospital who brought him back to life last December. The reunion was coordinated by Abiomed, the company behind the Impella heart pump. Mark came inside from shoveling snow, felt chest pain, and his wife and son called 911. By the time EMS arrived, he was gone. The defibrillator was used on him forty times before his heart held.

Dr. Phillips was on call that day. The ER called to give him a heads-up that they had a heart attack patient coming in, which is standard. What’s also standard is that the interventional cardiologist waits for a follow-up call once the patient is stable and ready. Dr. Phillips was already on his way back to the hospital anyway to pick up a forgotten laptop. When he arrived, instead of going to his office to wait for that second call, he went straight down to the ER on his own. Nobody asked him to. He just went. What he found was a man being kept alive by a machine, a team that had run out of options, and an ER physician who told him there was nothing left to do. Dr. Phillips had to decide whether to call it.

“I could have just said, we’re done,” he told us. “That is on me. I would have put the nail, truly the nail, in his coffin.”

He didn’t call it. Mark Lamont survived, turned 69 in January, and is going to come on our show. A forgotten laptop put Dr. Phillips in the building. A gut feeling sent him down that hallway instead of to his office. “I call it serendipity,” he said. But serendipity only works if you show up.

Dr. Phillips also pointed out that Mark’s own habits played a role in making his body amenable to reboot. His body was fit enough to survive what forty shocks and an emergency intervention demand. “If he would have been sedentary, I mean, the guy was shoveling snow for crying out loud, he probably would not have survived,” he said. Exercise doesn’t guarantee anything. But it can be the difference between a body that has something left to fight with and one that doesn’t. And even when you do everything right, there are no guarantees. You can exercise, see your doctor regularly, get checked out, and still have no idea what’s quietly building.

I know that personally. On the flight home from Italy, I landed to a text from a friend telling me that Patrick Muldoon had died.

Most people know Patrick from Melrose Place, Days of Our Lives, Starship Troopers, and the Hallmark movies he had been making right up until the end.

I met him years ago when I hosted the red carpet for Star Wars: Revenge of the Sith.

A lot of the celebrities didn’t want to spend time with the public crowd, so a handful of them drifted upstairs where I was setting up for my TV broadcast. Patrick was one of them, and we just ended up talking for a while. Later, I did a story on him for Forbes about actors moving into music. He had a band called Sleeping Masses.

((Check out one of their songs I used for a KRON4 news segment on a new pastime in Silicon Valley, Snowkiting below))

I went down to his studio in LA, no air conditioning, baking hot, had to run the camera myself because my photographer couldn’t make it, and he was a complete sport about the whole thing. Afterward he took me to In-N-Out Burger for my first double-double. That was Patrick.

He was 57.

His girlfriend found him on the floor outside the shower. He was already gone. The most likely cause is a heart attack, possibly a blood clot, though no autopsy results have been made public so we don’t know with certainty. Dr. Phillips noted on the show that there are other possibilities too, a ruptured aneurysm, an aortic dissection. My own mother died of an aortic dissection that was written down as a heart attack. Without an autopsy, sometimes you never get a clear answer. What is certain is that whatever took Patrick moved faster than anyone could have intervened. These events can happen that way, silently, without warning, in someone who by all appearances had no reason to be at risk.

To Patrick’s family, his girlfriend, his best friend Karen McCullough, and his close friend Denise Richards, I am so sorry. He was a genuinely good person, and the tabloid headlines going after his past are not the story. The story is that he was kind, he was talented, and he was 57.

In honor of Patrick: Get your heart checked. Exercise. Pay attention. And if you’re dealing with a vascular condition and a doctor tells you nothing can be done, call us at the Global PAD Association on our Leg Saver Hotline at 1-833-PAD-LEGS before you accept that answer. Because as this episode showed, sometimes everything is possible. And sometimes the only thing standing between a patient and a lost limb or a lost life is a doctor willing to walk down a hallway.

But what if it didn’t have to be?

This week on The Heart of Innovation, we featured Dr. Chris Bruce, part of a research collaboration between the NIH and Emory University that just performed something that has never been done in human history:

A fully catheter-based coronary bypass, completed without opening the chest, on a beating heart, through a tiny puncture in the groin.

They are calling it VECTOR.

Joining us as co-host was Dr. James Joye, an interventional cardiologist who invented a minimally invasive catheter-based bypass technique for the leg arteries, now distributed by Endologix, and who has spent decades thinking about how to bring that same philosophy to the heart.

When I asked Dr. Bruce whether VECTOR signals the beginning of the end for the Zipper Club, he didn’t oversell it.

“I would love to think so, but we’re very early on. If you think back to people putting transcatheter heart valves in patients 15 or 20 years ago, people probably thought they were a little bit crazy and on the edge, and now it’s mainstream in most hospitals worldwide. I don’t know where it’s going to go in 15 or 20 years, but it’s nice to think that it might inspire other people to get creative and think about how we can make this a procedure for more than just the very, very sick with no other options.”

That framing matters, because the patient who received the world’s first VECTOR procedure was exactly that: someone with no other options.

A procedure invented for one patient

The NIH and Emory collaboration has a track record of tackling complex medical situations where no good options exist commercially. Dr. Bruce walked us through what made this case so unusual. The patient had a surgically replaced heart valve that had become severely narrowed over time. A second open-heart surgery was the obvious answer, but the patient was too sick to survive it.

“They’ll die on the table, essentially, if we try.”

So the team turned to placing a new valve inside the old one via catheter from the leg, a less invasive approach they use regularly. But in this patient, doing that would cause the old valve’s leaflets to swing open like trapdoors and block the left coronary artery, which supplies blood directly to the heart muscle. Block that, and as Dr. Bruce explained, you get a massive heart attack on the table with essentially 100% mortality without heroic intervention. Techniques exist to cut the leaflet down the midline so it opens like a window rather than a trapdoor, but this patient’s leaflets were so calcified that those weren’t viable either.

That’s when the idea came.

“He really was a patient with no options. So in talking about the patient, the idea came: if we’re going to block the artery, why don’t we just move it out of the way?”

The Saturday morning phone call that started it all

Dr. Bruce described the moment the plan took shape. It was a Saturday morning when Dr. Robert Lederman at the NIH called him.

“He said, I’ve just come off the phone with Vasilis, and we’re going to move the coronary artery. And I was like, okay, sure.”

Dr. Joye, who has been through the process of translating a novel catheter technique into clinical use, laughed at that. Moving a coronary artery through open-heart surgery is something cardiac surgeons do. Moving one through a catheter, without opening the chest, on a beating heart, had never been done.

What followed was a period of iteration in the animal lab at the NIH, working through the technique step by step until it was refined enough to attempt in a human. Dr. Bruce described spending four and five hours at a stretch in those animal sessions, working through failed attempts and learning from each one. Then the team analyzed the patient’s CT scans in detail, mapped out every projection angle and contingency, and went to Emory to attempt it for the first time in a human being.

“We were all pretty relaxed, to be honest, going in by the time we did it.”

What actually happened in that lab

Dr. Joye explained the mechanics for our audience in terms that cut through the clinical language. The coronary arteries originate at the base of the aorta, just above the heart. What the team did was create a new connection point higher up on the aorta, above where the new valve would sit, so blood could still reach the heart after the valve was deployed. They did this entirely through catheters.

One wire was advanced backward through the coronary artery and pushed out through the vessel wall. A second wire was burned through the wall of the aorta using an electrosurgical generator. Both wires then had to meet in the pericardial space, the natural cavity between the lining of the heart and the heart muscle itself, where a snare on one catheter captured the other wire and pulled it through. A covered stent was then deployed to bridge the two exit points, acting as the new conduit for blood.

The procedure itself took about five hours. The patient was in the lab for seven to eight hours in total.

There was one complication: bleeding into the pericardium. Dr. Bruce was matter-of-fact about it.

“That did happen at one point in the procedure, bleeding into the lining of the heart, into the pericardium, and we had to pop a needle in and drain that off. But again, expected. We reacted very quickly to that. There’s always unexpected things. Thankfully, none of those happened.”

He drew a clear distinction between expected complications, the ones you have a contingency for going in, and unexpected ones. The bleeding was the former.

Then came the moment of truth. After everything was in place, the team deployed the new heart valve. The old leaflets swung shut as predicted, blocking the original route to the coronary artery. Everyone waited to see whether blood would flow through the new catheter-built graft instead.

“It was quite reassuring to see good blood flow down into the coronaries through the graft, despite us having blocked it as predicted.”

How the patient did

The procedure was performed about a year before we spoke. Dr. Bruce delivered the update plainly.

“The patient, unfortunately, is no longer with us, but not related to a complication of this. There were a lot of other things going on that were life-limiting in the longer term for him as well. But when he passed away from other issues, there was no sign of any heart attack or ischemia or anything from the things that we did, which was of some reassurance after 9 or 10 months.”

A second patient has since undergone a version of the procedure involving both coronary arteries. The technique is being refined.

Where this could go

Dr. Bruce was thoughtful about the road ahead. He sees potential applications beyond the specific valve scenario that prompted this first case, including calcified lesions where coronary arteries meet the aorta, stents that fracture or fail to expand, and eventually more traditional coronary bypass grafting. He even sketched out a future worth imagining:

“You could imagine a world where you can have a robotic off-pump Lima to LAD, and then vector grafts to the circumflex and right. Those kind of things, we’re thinking.”

Dr. Joye, who knows from experience what it takes to get from a novel idea to something that works reliably in a broad range of hands, named the real challenge ahead.

“Doing it is one thing in a 7- or 8-hour procedure, but breaking it down to something that can be done in 90 minutes in kind of anybody’s hands is really the challenge.”

VECTOR is not the end of open-heart surgery. But it is a documented, peer-reviewed proof that a coronary bypass can be performed through a catheter on a beating heart without cracking a chest. That has never existed before. And if the history of procedures like TAVR tells us anything, the distance between a first-in-human case and a mainstream standard of care can close faster than anyone expects.

Watch the full conversation at the top of this article.

For more information you can also call the Global PAD Association’s Leg Saver Hotline at 1-833-PAD-LEGS

For millions of people, that is exactly their reality, and most of them have been told there is nothing more that can be done.

On a recent episode of The Heart of Innovation on KDOW, my co-host Dr. John Phillips and I went deep on a procedure that most patients, and honestly many physicians, don’t even know exists yet. It’s called renal denervation. It’s FDA-approved. And as of October 2025, it’s covered by Medicare.

We were joined by two people who have spent over a decade inside this technology: Julie Trudel, Medtronic’s Senior Director of R&D, and Jason Fontana, VP of Global Marketing and Renal Denervation General Manager. To understand why this procedure matters, you first have to understand something about your kidneys that most people are never told.

The Nerve Pathway Pills Can’t Reach

Most people know kidneys filter waste and manage fluid. What most people don’t know is that a web of sympathetic nerves runs from your brain, down your spine, and wraps directly around your renal artery, and those nerves have a powerful hand in controlling your blood pressure.

“Those sympathetic nerves,” Julie explained, “like a little mesh of spaghetti that runs around the renal artery, they control the tone of your artery and dictate how much resistance to flow that artery will present to the body.”

Standard blood pressure medications target the kidneys’ hormonal systems, things like renin and fluid retention. But none of them directly target this nerve network. Which means for some patients, no matter how many pills they take, there’s a signaling problem running in the background that medication was never designed to reach.

In a healthy system, those nerves respond to stress and then stand down. In many patients with resistant hypertension, they never stand down. Jason described it plainly: “In a lot of patients with high blood pressure, that sense that everything is amped up, these nerves are constantly firing.” The body stays locked in a permanent fight-or-flight state, and the pills aren’t built to address it.

Doctors understood this nerve connection as far back as the 1930s. Their solution was to open patients up near the spine and physically cut the nerves. “Quite often when you do it surgically, these are hard to see,” Julie said, “and you may cut more than what you really should be cutting.” It worked, but at a real cost, and it faded from practice once blood pressure medications arrived.

Then catheter technology changed the equation. By the mid-2000s, the question was no longer whether those nerves could be calmed. It was whether you could do it without a single incision.

A catheter goes into the renal artery. Energy is applied against the vessel wall. Julie asked us to try something during the show: rub your hands together quickly. Feel the warmth? That’s the principle.

“What we’re doing with that little catheter, we’re bringing energy right against the vessel wall,” she said. “That energy makes the tissue around the renal artery vibrate like you did with your hand. By generating all this vibration, the nerves end up warming up just enough to a point where their activity level gets interrupted.”

No cutting, no implant, nothing left behind in the body.

“What we’ve been able to figure out,” Jason added, “is that you make this one spot, this one change, interrupt the signaling in the kidney, and that calms down all these nerves throughout the body.”

Getting to that moment of clarity, though, required surviving a crisis that nearly killed the technology entirely.

January 13, 2014

Jason remembered the date without pausing.

“Very cold day in Minneapolis. We were in a room with our CEO, Omar Ishak.”

The Symplicity HTN-3 trial had just produced results that seemed to say the procedure didn’t work. The kind of results that end programs. The kind that send teams home.

Ishak asked three questions. Is it safe? “It’s completely safe. No safety signal at all.” Do you think it works? “Yes, we do. And this is why.” Then came the last one, which Jason described as “not funny at the time, but funny now.” The CEO looked at them and said: “This is why we do research.”

The program survived, though barely.

“It was close to being dead,” Julie said. “I can only be so grateful for the general manager, Jason, Nina, Sean Salman, and Jason Wyman, who went in front of our CEO and advocated for it. It took champions.”

They went back into the data. Over 600 separate analyses of that one trial. “We knew every angle,” Jason said, “and everything that kind of went wrong.” Two problems kept surfacing. The original device required manual, point-by-point ablation: move the catheter, fire, move again. No two physicians performed it quite the same way, and no two patients got quite the same treatment. And critically, the team had no reliable way to confirm whether patients were actually taking their medications during the trial. Without that, they couldn’t cleanly separate the procedure’s effect from the noise.

Julie redesigned the catheter from the ground up. The new version, called the Spiral, applied ablations in a corkscrew pattern, ensuring consistent contact with the vessel wall regardless of who was performing the procedure. They restructured the trials to include medication monitoring. Then they started over.

What kept them going was a letter.

A man in his seventies from Florida had wanted to enroll in HTN-3 but couldn’t find a participating hospital near his hometown. So he paid out of pocket and flew to Germany to have the procedure done. His blood pressure dropped. He came off medications that had been causing him terrible side effects. And when HTN-3 failed and it looked like the technology might disappear, he sat down at a typewriter and wrote to Medtronic.

“Dear Medtronic, I want to tell you, keep continuing this procedure.”

The letter worked its way through the company until it reached Julie’s desk. Jason still remembered the patient’s words: “I got my life back.”

That letter, from a man who flew to another country and typed his case on a typewriter because he wanted others to have what he had, carried a team through 600 analyses and a near-death moment in a Minneapolis conference room, all the way to FDA approval in November 2023.

As Dr. Phillips said at the top of the show, quoting Babe Ruth: “It’s hard to beat a person who never gives up.”

Now the question is whether patients know this option exists…because the healthcare system, as Dr. Phillips described it, is not doing a great job of making sure they find out.

If You’ve Been Told Your Blood Pressure Is Uncontrollable

He called it a chronic “pass the buck” problem with hypertension. A cardiologist spots elevated pressure, adds it to the notes, tells the patient to stay on their meds and talk to their primary care doctor. The primary care doctor assumes the cardiologist would have acted if it were serious. A nephrologist maybe gets looped in eventually. The patient moves through the system and nobody owns the problem.

“Very few patients are controlled appropriately,” Dr. Phillips said. “And it’s often a pass-the-buck kind of treatment.”

Renal denervation is designed for the patient stuck in that loop, someone already doing everything right who still can’t get their numbers down. Jason described the ideal candidate clearly: “You’ve done lifestyle management, you’ve done the right thing. You’re taking your medications, you may be on one, two, three, four medications, and your blood pressure is still high. You’re doing the right thing, but you need a little help.”

Not everyone with high blood pressure qualifies; the indication is specific to uncontrolled hypertension in patients who have already exhausted the conventional options. And it doesn’t replace medication. Dr. Phillips put it simply: “Think of it as an airbag in your car. But always put your seatbelt on too.”

As for the procedure itself, it runs about 15 to 20 minutes under sedation, a catheter goes in through the groin artery with the wrist approach in development, and patients go home the same day. “Your blood pressure might change a little,” Dr. Phillips said, “so just be cognizant of that. We’re always following these patients closely.”

You Deserve to Know This Exists

The Symplicity Spyral received FDA approval in November 2023. Medicare finalized national coverage in October 2025. The clinical data now stretches to three years and continues to strengthen, with blood pressure reductions remaining durable well beyond the procedure date. The only thing missing is patients who know to ask for it.

If you’re on multiple blood pressure medications and your numbers are still high, bring your home readings to your next appointment and ask your doctor directly about renal denervation and the Symplicity Spyral system. Don’t wait for it to come up. In a system that tends to pass the buck, the patient who advocates for themselves is the patient who gets answers. This procedure exists. It’s covered. And now you know to ask for it.

The Heart of Innovation airs on KDOW AM 1220, brought to you by the Global PAD Association at padhelp.org. Hosted by Emmy Award-winning journalist and Global PAD Association founder Kym McNicholas and interventional cardiologist Dr. John Phillips, founder of Save My Piggies Health and Wellness.

I’ve known Meredith Perry long enough to know she doesn’t mess around. The first time I really understood how her brain works, we were in the back seat of a car driving from the airport to Sedona. Everyone was complaining about swollen ankles from the flight. Most people just groan and move on. Meredith immediately started designing a product…cute sandals that could disguise flight-puffed ankles. She called them “cankle flops.” I was fascinated. That instinct, to see a problem and immediately engineer a solution, is just how she’s wired.

So when she told me she’d built a headband that reads your brainwaves and uses precisely timed sound pulses to guide your brain from wakefulness into sleep…I wasn’t shocked. I was curious. And after sitting down with her on The Heart of Innovation, the show I co-host with interventional cardiologist Dr. John Phillips, I walked away convinced this is one of the most important health technologies I’ve covered in years. Not just because of what it does for sleep, but because of what sleep does to your heart.

When Sleep Became a Cardiovascular Variable

Here’s what I didn’t fully appreciate before this episode: sleep is no longer just a lifestyle concern. It’s a cardiovascular variable, and the medical community is treating it that way.

A 2022 study in the Journal of the American College of Cardiology followed more than 7,000 adults and found that people sleeping fewer than six hours a night faced a significantly higher risk of atherosclerotic cardiovascular disease compared to those sleeping seven to eight hours. The American Heart Association now lists sleep duration as one of eight pillars of cardiovascular health in its Life’s Essential 8 framework. Research in the European Heart Journal has tied short and fragmented sleep to elevated risks of coronary heart disease and stroke.

Dr. John Phillips, who treats cardiovascular and vascular patients every day, confirmed what the research shows. “Statistically speaking, 10 to 15 percent of all adults have insomnia,” he told me on air. “And consistently poor sleep puts real stress on the cardiovascular system… elevated blood pressure, disrupted heart rate, increased sympathetic tone. We see it in our patients all the time.”

Six and a Half Years to Get Here

Meredith launched Elemind in 2019. She thought it would take two years to reach the market. It took more than six. Seven hardware iterations. Four years of getting the comfort right because, as she put it with characteristic bluntness, if people won’t wear it to sleep, none of the technology matters.

“It would be massive. But it’s life or death,” she said. “Like, if you’re selling a product that people are going to wear to sleep and it’s not comfortable… it doesn’t matter how good your technology is. They’ll just toss it out and then your company goes bankrupt.”

So she waited. And iterated. And waited some more. The version on the market today is lighter than a kiwi fruit, pillow-soft on the sides, and designed to work whether you sleep on your back, your side, or your stomach. I asked about stomach sleepers specifically — I’m one — and she pointed out that even stomach sleepers turn their heads to breathe. The device is thin enough to handle it.

How a NASA Researcher Started Thinking About Your Brain

Here’s the part of the origin story I found most fascinating. Meredith didn’t come to sleep through insomnia. She came to it through a much bigger question: what if medicine could intervene earlier, before disease sets in, without pharmaceuticals that alter the whole body systemically? What if the brain itself could be influenced from the outside, in a targeted way?

That question led her to MIT neuroscientist Dr. Ed Boyden, one of the leading figures in neuroscience, and conversations about what she calls read-write neurotechnology. Not just measuring the brain’s electrical activity, the way an EEG does passively. But actually writing back to it. Interacting with it. Changing it.

Dr. Boyden and Meredith’s other co-founders had already been developing neuromodulation techniques to do exactly that, and their first application wasn’t sleep at all. It was tremor control. They showed that the same type of precisely timed acoustic stimulation could help someone with essential tremor or Parkinson’s disease physically stop shaking. The brain’s patterns, it turns out, can be interrupted and redirected from the outside using sound.

“If you can change the brain, you can change behavior,” Meredith explained. “And by behavior, I mean you can move someone from an awake state to a sleep state. Sleep was our first application — but it won’t be our last.”

Sleep made sense as the entry point for a few reasons. It’s universal…everyone sleeps, or tries to. The transition from wakefulness to sleep is one of the most well-mapped brainwave sequences in neuroscience. And it’s a problem that affects tens of millions of people who are desperate for something that isn’t a pill. Meredith saw a clear lane and took it.

How It Actually Works — Because I Made Her Explain It Simply

I’ll be honest: I asked Meredith to break this down for the lay person, because neuromodulation is not exactly dinner table vocabulary. Here’s what she told me.

The brain is an electrochemical organ, constantly producing electrical activity that we can measure from the outside using EEG sensors, the same way an EKG measures the heart. Different frequencies tell us what state the brain is in. When you close your eyes and you’re still awake, your brain is producing high-frequency alpha waves. As you drift toward sleep, those frequencies slow down predictably.

Elemind has five EEG sensors embedded in the headband that read those brainwave patterns in real time. When the device detects patterns associated with wakefulness, it sends a brief pulse of pink noise…not through your ears, but through a bone conductor pressed against your forehead. The skull vibrates. Your brain interprets that as sound. And if the pulse hits at precisely the right moment in the brainwave cycle, it disrupts the wakefulness pattern.

“There’s a specific moment along the wave that, if you hit it with a stimulus, the pattern is maximally disrupted. It’s the timing that matters…not the sound itself.”

She compared it to an ocean wave. Hit it at the right angle at the right moment, and you can cancel it out. She called it noise cancellation for the brain. Once the device detects that you’ve actually fallen asleep, the stimulation fades. And if you wake up in the middle of the night, there’s a button on the underside of the band…what the Elemind team calls the go-back-to-sleep button…that restarts the whole process.

Later this year, they’re releasing a deep sleep stimulation feature via firmware update. That means people who buy the device today don’t need to buy a new one — it just gets better through software.

What I Really Wanted to Know: How Is This Different From My Oura Ring Collecting Dust?

I’ll be transparent about this: I got an Oura Ring years ago when I interviewed someone from the company. It sat in a box almost immediately. And I stopped wearing my Apple Watch because it kept pinging me in the middle of the night while supposedly tracking my sleep. I raised this with Meredith, and her answer was clarifying.

Most sleep wearables are read-only. They measure what happens and report it back to you in the morning. Elemind is read-write. It’s not tracking your sleep to show you data…it’s actively intervening while the transition is happening. Every sound pulse is a real-time response to your specific brain activity at that exact moment.

“That’s why you can’t just play pink noise from your phone and call it a day,” she said. “We have to read the brain in real time to know how to stimulate. Without that, it’s just ambient sound, which is very different from neuromodulation.”

That distinction matters more than it sounds. The difference between a babbling brook app and a device that reads and responds to your brain is the difference between hoping you relax and actually changing the electrical state of your brain.

The Clinical Trial She Didn’t Have to Do

Here’s something I respect enormously about Meredith: she ran a clinical trial even though she didn’t have to. Wellness devices don’t require FDA approval or peer-reviewed evidence. Most companies skip the science entirely. Elemind chose not to.

“There’s a lot of snake oil out there,” she said. “We will not make a single claim that isn’t backed by a clinical trial and peer reviewed in a scientific journal. All of our papers are in the Nature portfolio.”

The trial showed that 76% of people with sleep onset insomnia could fall asleep in roughly half the time when using Elemind versus their baseline. And this wasn’t self-reported, the brainwave data was scored by independent polysomnographers who didn’t know which condition the participants were in. No bias. Just brainwaves.

Real-world data backs it up too. From approximately 10,000 users in 2025, people were consistently falling asleep in an average of 11 minutes — regardless of the day of the week or the season. That consistency, she noted, is genuinely unusual. Sleep patterns typically vary. Elemind’s apparently don’t.

One Thing Elemind Is Not, And One Surprising Partnership

I want to be clear about something, because viewers asked during our live taping and it’s worth addressing directly: Elemind does not treat obstructive sleep apnea. Sleep apnea is a structural problem…the airway collapses, oxygen drops, the brain wakes you up. That requires a physical intervention, and the CPAP machine remains the standard of care. Elemind cannot and does not replace it.

But here’s what’s interesting: Elemind is partnering with ResMed, the leading CPAP manufacturer, on a clinical study…not to treat sleep apnea, but to study whether Elemind can improve CPAP adherence. The CPAP has a notorious compliance problem. A lot of people get prescribed it and stop using it because falling asleep with a mask strapped to your face is genuinely uncomfortable. The hypothesis is that if Elemind can help someone fall asleep faster, the discomfort of the mask becomes easier to tolerate and more people actually stick with the therapy. If that holds up, a wellness device becomes a clinical tool — just not in the way viewers assumed.

There’s also a pain angle that surfaced near the end of our show. A viewer with peripheral artery disease called in — he described lying awake all night dangling his legs over the bed because of ischemic pain, waiting on insurance authorization for a procedure to fix blocked arteries. Meredith mentioned that Elemind has conducted a trial using its deep sleep stimulation technology alongside sedation anesthesia and found participants could tolerate more pain before waking from the procedure. Whether that translates to helping people sleep through chronic pain at home isn’t yet known. But the question is now being asked.

The Campaign That Made Me Love This Company

I have to talk about Sleeping with the CEO… because it’s one of the most creative, confident marketing campaigns I’ve seen in health tech.

Meredith takes a lawn chair into the streets of New York City. Washington Square Park. The High Line. Giants tailgates. Airplane cabins. She approaches strangers, asks them to lie down and put on the headband, and films them falling asleep. She naps alongside them. She calls the campaign Sleeping with the CEO.

“We got thrown out of Times Square by a police officer,” she told me. I loved that. “But the point was: if you can fall asleep in the middle of Times Square with Elemind on, you can fall asleep anywhere.”

What I find compelling about this isn’t just the boldness. It’s what it says about the product’s confidence. Sleep wearables have a notorious drawer problem…people buy them, wear them for a week, and abandon them. The fact that Meredith is out here demonstrating this on skeptical strangers in the loudest city in America, and it’s working, tells me something about how much she trusts what she’s built.

Best of Sleeping With the CEO

What’s Next — and Why It Matters

Sleep is just the beginning. As Meredith put it: “Sleep is our Trojan horse into the rest of the brain.” The longer vision is a device that tracks and optimizes brain health overnight — starting with sleep, moving toward tremor control, cognitive health, and beyond. The technology she’s built can, in principle, be integrated into headphones, eyeglasses, VR headsets, or anything that touches the head.

For now it’s a wellness device — not a prescription product — and it’s available directly to consumers. An optional subscription unlocks sleep data and advanced features. You can use FSA and HSA dollars toward the purchase.

I left this interview thinking about the patient who called in with his legs dangling over the bed at 3am. I thought about the CPAP machine sitting on somebody’s nightstand, unworn. I thought about Dr. John’s comment that sleep is now sitting beside cholesterol and blood pressure as a driver of cardiovascular disease. And I thought about how, for all of the data and the science and the seven iterations and the clinical trials, what Meredith Perry really built is something that actually works — on strangers, on planes, in Times Square, in the dark.

That’s not nothing. That might be everything. Learn more at elemindtech.com.

Citations

1. Dominguez F, et al. “Association of Sleep Duration With Atherosclerotic Cardiovascular Disease Risk.” Journal of the American College of Cardiology. 2022;79(15):1475–1485.

2. Daghlas I, et al. “Sleep Duration and Risk of Coronary Heart Disease and Stroke.” European Heart Journal. 2021;42(35):3549–3557.

3. Lloyd-Jones DM, et al. “Life’s Essential 8.” Circulation. 2022;146:e18–e43.

4. Makarem N, et al. “Sleep Duration and 24-Hour Blood Pressure Patterns.” Hypertension. 2020;75(2):497–505.

5. Christensen MA, et al. “Sleep Fragmentation and Incident Atrial Fibrillation.” Journal of the American Heart Association. 2023;12:e028942.

Larry “Shorty” Coleman delivered those words to lawmakers during the bipartisan relaunch of the Congressional Peripheral Artery Disease (PAD) Caucus.

A Harlem Globetrotter who has played basketball since he was eleven, Shorty built his life around movement. Conditioning. Endurance. The instinct to push through pain. When his leg began to hurt, he treated it like an athlete treats a cramp. Something temporary. Something manageable.

He was one of the patients who spoke on Capitol Hill at the caucus relaunch, alongside physicians, industry leaders, and another PAD patient, Dawn-Marie.

Both Shorty and Dawn-Marie rolled in.

Neither walked in.

They were not there for sympathy. They were there to explain how a disease more prevalent and deadlier than most cancers combined was allowed to progress unchecked until amputation became the outcome.

And how that progression did not have to happen.

Peripheral Artery Disease is not rare. It is poor circulation in the legs that increases cardiovascular morbidity and mortality. In high-risk patients such as those with diabetes, hypertension, hyperlipidemia, clotting disorders, or autoimmune disease, early testing can identify disease before it advances to tissue loss. In many cases, progression can be slowed with medication, risk-factor control, and coordinated vascular care.

That is what the physicians and patients who stood before Congress made clear. And that is what they discussed in depth on this week’s episode of The Heart of Innovation.

Dr. John Phillips and I invited Shorty, Dawn-Marie, vascular surgeon Dr. Bob Tahara, and interventional cardiologist Dr. Andrew Klein to share what was said during the relaunch of the PAD Caucus and why it matters now. The focus was direct: expand coverage for early PAD testing, require documented vascular evaluation before non-traumatic amputation, and address insurance delays and denials that stall limb-saving care while amputations move forward with far less resistance.

The relaunch centers on reviving the Amputation Reduction and Compassion Act, legislation that lost traction after Congressman Donald Payne Jr., who had PAD and championed the bill, passed away. The ARC Act would expand coverage for early PAD testing among high-risk patients and require documented vascular evaluation before any non-traumatic amputation proceeds.

For clinicians, those provisions address two persistent gaps. Too many high-risk patients are not screened early. Too many amputations proceed without comprehensive vascular assessment.

Shorty’s story underscores the first gap.

“Don’t take for granted it’s just a cramp,” he told lawmakers.

He described escalating leg pain and the assumption that it was muscular. He spoke about diabetes in his family. About going to the emergency room when the pain intensified. Looking back, he believes earlier specialist evaluation might have changed his trajectory.

Dawn-Marie followed him at the caucus relaunch.

She began with questions.

When you leave this building and walk to your car in the snow, she asked lawmakers, what does that require? When your child runs ahead of you at the park and you step onto wood chips to push them on a swing, what does that require? When you go to the beach and your children run toward the ocean, can you reach them?

She cannot.

But her message to lawmakers did not stop at life after amputation.

Before the amputation, the leg pain was severe enough that she would sit on the floor in public because she could not keep walking. She sought medical care and described worsening symptoms.

Doctors dismissed it.

She then had a heart attack.

She underwent two heart catheterizations.

The leg pain continued to intensify.

Still, she said, no vascular evaluation was performed. No PAD diagnosis was made. No coordinated assessment connected her cardiac disease with her limb ischemia.

That sequence is not isolated. It is why the ARC Act is back on the table.

Early testing for high-risk patients. Documented vascular evaluation before non-traumatic amputation. Connecting cardiac disease and limb ischemia instead of treating them as separate silos.

During the broadcast, I shared what we see through the Global PAD Association hotline. Patients are told it is neuropathy. Or diabetes. Or aging. They are reassured. When they finally get proper testing, the diagnosis is PAD.

When we actually get them tested, it is PAD.

And once they reach a physician willing to pursue true limb salvage, major amputation is often mitigated or prevented altogether.

Dr. Bob Tahara addressed what that work requires. Disease below the knee. Malleolar reconstructions. Time-intensive procedures that not everyone is trained or willing to perform.

“You have to be willing to go below the knee,” he said. “Not everybody’s capable of doing that.”

He also made a point that resonated in the room. Amputation has existed for as long as surgery has existed. Revascularization is comparatively recent.

“Amputation’s been around for a long time,” he said. “Revascularization is really a recent technology.”

Yet reimbursement systems often treat them as though the older solution is the default.

The conversation turned to insurance pre-authorization. I asked how it is possible that amputations receive approval so readily, while revascularization procedures are delayed, scrutinized, or denied.

Patients call the Global PAD Association’s Leg saver Hotline in the middle of the night.

“I need hope. I need help,” they say. “Walk me through dangling my legs. Pacing. Trying to get blood back into my feet.”

They wait. Tissue deteriorates. Two weeks later, a denial.

Meanwhile, a major amputation moves forward.

Dawn-Marie added another layer.

“There are a lot of doctors that think you’re going to get a prosthetic, like no big deal,” she said. “You’re going to get a prosthetic the moment you have the amputation. Within a year, you’ll be walking like no problem.”

Then she addressed physicians directly.

“Stop promising,” she said. “If you’re a physician or a surgeon, stop giving the false hopes of walking within the first year. I’m almost five years out, and I still don’t walk.”

The human cost does not end in the operating room.

Dr. Tahara noted that once patients reach a major level amputation, rehabilitation is difficult and outcomes are often limited. And PAD rarely affects only one limb.

“Disease burden is always bilateral,” he said.

Dawn-Marie knows that reality. Her remaining leg is still diseased. Physicians are cautious after what happened with the first.

“I still have young children,” she said. “I still have to go to the supermarket. I have to keep going. I can’t afford to stop and lose my other leg.”

The relaunch of the Congressional PAD Caucus brings these stories back into the room where policy is shaped.

Shorty assumed a cramp would pass.

Dawn-Marie sat on the floor in public because the pain was overwhelming, survived a heart attack and two cardiac catheterizations, and still was not evaluated for PAD until amputation was unavoidable.

The physicians who stood beside them are not asking for sympathy. They are asking for standardization. Early testing in high-risk patients. Documented vascular evaluation before amputation. Reimbursement structures that do not delay limb salvage while accelerating limb loss.

We already know how to detect PAD.

The question is whether we will do it consistently.

Recognition is not optional. It is the difference between intervention and regret.

About the PAD Pulse Alliance and Get a Pulse on PAD Campaign

The relaunch of the Congressional Peripheral Artery Disease Caucus was supported by the PAD Pulse Alliance, a coalition of leading cardiovascular and vascular organizations working to improve PAD awareness, screening, and treatment standards.

Founding members include the Association of Black Cardiologists (ABC), the Society for Cardiovascular Angiography and Interventions (SCAI), the Society of Interventional Radiology (SIR), and the Society for Vascular Surgery (SVS). Supporting partners include the American Podiatric Medical Association, the CardioVascular Coalition, the CLI Global Society, Corazon, the Global PAD Association, the Outpatient Endovascular and Interventional Society, the Preventive Cardiovascular Nurses Association, and the Society for Vascular Medicine.

The initiative is driven in part through SCAI’s Get a Pulse on PAD campaign, which aims to educate clinicians and the public about PAD risk factors, symptom recognition, and the importance of early testing. The campaign is supported by industry partners including BD, Biomedix, and others committed to improving early detection and limb preservation.

Together, the coalition is focused on advancing policy solutions that expand high-risk PAD screening, require vascular evaluation before non-traumatic amputation, and reduce preventable limb loss nationwide.

That warning, delivered during a recent episode of The Heart of Innovation, underscores a growing concern among vascular specialists nationwide: a Medicare billing issue that could sharply curtail access to limb-saving care for patients with one of the deadliest and most under-recognized vascular diseases in the country.

The discussion took place on The Heart of Innovation, which I host, with guest co-host Dr. Todd Berland, a vascular surgeon and host of The Vascular Surgery Show on SiriusXM Doctor Radio. Joining us were Dr. Elliot Adams and Dr. Bob Tahara, past president of the Outpatient Endovascular and Interventional Society (OEIS), who has spent years working with Medicare on coverage and reimbursement issues affecting vascular care.

At the center of the issue are newly implemented CPT codes that went into effect January 1, designed to better reflect the complexity of modern peripheral artery disease interventions. Older codes were retired and replaced with a structure that differentiates less severe disease from chronic total occlusions, procedures that often require advanced tools, longer procedure times, and substantially higher costs. Medicare has already valued these services within the physician fee schedule.

Despite that, physicians report that claims submitted correctly under the new codes are being denied when procedures are performed in office-based labs across states administered by Medicare contractors Noridian and Novitas.

Peripheral artery disease, or PAD, is often misunderstood as a condition of discomfort rather than danger. In reality, it is a progressive vascular disease that affects millions of Americans and is closely linked to heart attack, stroke, and premature death. An estimated three in five people who suffer a heart attack also have PAD, frequently without knowing it. In advanced stages, PAD carries a mortality risk that rivals or exceeds that of many common cancers. When circulation becomes critically compromised, patients develop severe ischemic pain, non-healing wounds, and tissue loss. Delay care, and the likelihood of amputation rises sharply.

Office-based labs have transformed how these patients are treated.

By allowing vascular specialists to perform complex revascularization procedures outside the hospital setting, physicians have expanded access to care, particularly in rural and underserved areas, shortened wait times, and reduced amputation rates. In many communities, these labs are not a convenience; they are the only timely access point for advanced limb-salvage care.

That model, however, depends on reimbursement that covers the cost of treatment. Unlike hospital-based care, physicians operating office-based labs are financially responsible for every component of the procedure. As Dr. Tahara explained during the broadcast,

“When you treat patients in an office-based facility, the physician is responsible for every wire, every stent, every atherectomy device, every lithotripsy catheter, every supply. Reimbursement isn’t profit. It’s what allows the care to happen at all.”

For Dr. Adams, the consequences of nonpayment are already tangible. Since January 1, his practice has received no reimbursement for procedures billed under the new CPT codes.

“For doctors to not get paid for these procedures is a big, big problem,” he said. “We front the cost of everything.”

In rural regions, the implications extend well beyond individual practices. Dr. Adams described the impact his office-based lab has had on patient outcomes in his area.

“Before we opened our lab, we were seeing close to 100 amputations a year,” he said. “Afterward, that number dropped to around 20. If these labs close or have to cut back, those numbers are going to go back up.”

During the discussion, concerns were raised that denials may be extending beyond office-based labs into ambulatory surgery centers, with contractors citing site-of-service issues. Dr. Tahara addressed that explanation by pointing out that Medicare has already established valuation for these services across care settings, making prolonged nonpayment difficult to reconcile with existing policy.

Compounding the uncertainty is a lack of clear communication. When contacted for comment, Noridian referred inquiries to Medicare. Medicare indicated a response would be provided within 24 to 48 hours. As of airtime, no response had been received.

Dr. Tahara cautioned against assuming intent, emphasizing instead the complexity of Medicare’s administrative structure. Still, he warned that delay itself carries serious consequences.

“This is only sustainable for a couple of months at best,” he said. “Practices cannot continue to front the cost of care indefinitely.”

He drew a direct parallel to what is already occurring under Medicare Advantage plans, which he has pointedly referred to as “Medicare disadvantage.” Prior authorizations and peer-to-peer reviews routinely delay time-sensitive vascular care.

“Just like what we’re seeing with Medicare (dis)Advantage plans that delay and deny procedures, doctors will be forced to cut back on their procedure schedules,” he said. “And when that happens, more patients end up with amputations.”

During the discussion, I shared an example that illustrates the stakes.

A patient with limb-threatening disease was denied revascularization following a peer-to-peer review conducted by a physician outside the vascular specialty, an OBGYN. The patient ultimately presented to the emergency department and underwent amputation rather than limb salvage.

Reimbursement Uncertainty Will Lead To Office Shutdowns & Amputations

If reimbursement uncertainty forces office-based labs to scale back services or shut down altogether, the burden will shift to hospitals that are already operating at capacity.

Wait times will increase.

Disease will progress.

Amputation rates will rise.

Ironically, amputations themselves are rarely questioned or delayed by payers, despite their lifelong cost to patients and the healthcare system.

Insurance companies cover amputations cart blanche without question.

Whether the current situation represents a temporary implementation failure or a broader shift in how limb-salvage care is delivered remains unresolved. What is clear is that peripheral artery disease does not pause while reimbursement questions are sorted out.

Physicians are acting in good faith to support these patients.

They continue to treat patients, absorbing financial risk in the hope that clarity will come quickly.

Advocacy organizations and professional societies are escalating the issue within Medicare, and Dr. Tahara is scheduled to address reimbursement concerns at an upcoming congressional PAD caucus. But if a government shuts down again, and Dr. Tahara doesn’t have a chance to address Congress, we could see a dramatic increase in amputations over the next three months.

Dr. Tahara asked during the discussion for patients to reach out to their state representatives to help address the situation urgently. He also suggested that if patients receive a notice from Medicare indicating it will not cover a limb-saving procedure, they share it immediately with the treating physician’s office. Many denials, he explained, can be challenged, but only if clinicians are made aware of them.

At the same time, Dr. Tahara emphasized that physicians and professional societies are working urgently to resolve the issue before it reaches patients, before denial letters go out, and before further limb-saving care is disrupted.

In vascular disease, time is tissue.

All of the physicians on the panel agreed that these Medicare denials cannot be ignored and must be addressed immediately.

By the time the consequences surface, they are no longer measured in policy or process, but in amputations that could have been prevented.

🚨 If you are a physician, clinician, or billing professional seeing these denials, we want to hear from you.
🚨 If you are a patient who has received a Medicare denial or delay for PAD care, your story matters.

📞 Leg Saver Hotline: 1-833-PAD-LEGS
🌐 Patient education & support: www.PADhelp.org
🎧 More episodes: www.TheHeartofInnovation.org

Some people practice medicine because it’s their profession. Others practice it because it’s who they are—at their core.

That distinction matters when life intervenes.

When Dr. Jean Chen joined Dr. John Phillips and me on The Heart of Innovation, the conversation unfolded less like a career recap and more like a reflection on service, resilience, and what happens when a calling refuses to disappear—even when the body changes.

Jean grew up in Taiwan, in a household where medicine wasn’t a profession so much as a responsibility. Her mother was a registered nurse. Her father, a pediatrician. Both came from poverty. Both believed deeply that healthcare was a human right.

By the time she was five years old, Jean knew she wanted to be a doctor.

“I wanted to help other people,” she told us. “I felt medicine is a human right. Everyone deserves to be treated. It shouldn’t be based on economic status or power.”

She watched her father quietly use his own money to treat patients who couldn’t afford care. She watched both parents volunteer in disaster-stricken communities. Service wasn’t something discussed in her home—it was demonstrated.

That ethic followed her family when they immigrated to the United States, leaving behind established careers so their children could have opportunities they never did. Her father repeated residency in Ohio. Her mother worked as a nurse’s aide while studying for U.S. boards. They lived in a small rental, rebuilt from scratch, and never complained.

“I am so grateful to the United States,” Jean said. “You have no idea how grateful I am.”

Years later, while taking a year off from Cornell and working on a surgical oncology floor, Jean experienced a moment that permanently altered her path. A patient returned from surgery, crying in Jean’s arms.

“She said, ‘I will never, ever square dance again,’” Jean recalled. The woman had lost her leg after developing a foot ulcer.

“That broke my heart,” she said. “I felt there should be something we could do.”

Diabetes already ran through Jean’s family—on both sides. That moment crystallized something she couldn’t shake. Amputation wasn’t just a medical outcome. It was an economic, emotional, and psychological loss that rippled through families.

Podiatry and limb preservation became her way forward.

Saving limbs meant saving independence. Saving livelihoods. Saving dignity.

Then, years into her career, everything changed.

A car accident during residency caused a severe cervical spine injury. At first, Jean did what so many physicians do—she pushed through. Over time, the symptoms worsened. She began falling. She developed foot drop. Imaging revealed spinal cord compression serious enough that paralysis was no longer theoretical.

Multiple surgeries followed. One was delayed for months during the early days of COVID, while her condition deteriorated. By the time she reached the operating room, the left side of her body was barely functional.

Afterward, her primary care physician delivered the words no physician expects to hear.

She could no longer safely practice podiatry.

Jean couldn’t reliably feel her hands. She couldn’t turn her neck adequately. This wasn’t a professional choice. It was a medical reality.

“It was devastating,” she said. “The depression was really bad. And of course, the diabetes got really bad.”

Stress didn’t just affect her emotionally. It showed up metabolically. Her A1C climbed as her sense of identity collapsed.

With encouragement from her physician, Jean sought mental health support—something she now urges others not to delay.

“It’s okay to have disappointments in life,” she said. “But if you’re feeling depressed, please get help.”

She leaned on her husband, who helped her bathe, dress, attend physical therapy, and relearn how to move through the world again. She leaned on a close friend—a diabetes educator—who didn’t offer pamphlets or platitudes, but practical strategies that actually worked.

Tools you could use on a hard day.

Then came another moment that drove home just how personal all of this was.

After more than 20 years living with diabetes, Jean began experiencing nausea, vomiting, and atypical chest pain. She didn’t present like the textbook heart attack patient. She was told it might be acid reflux.

She wasn’t convinced. Neither was her mother, a coronary intensive care nurse.

“She said, ‘You can’t have her in and out of the hospital all the time,’” Jean recalled. “‘Why don’t you do the cardiac cath and really see what’s going on?’”

That insistence saved her life.

Jean had an 80% blockage in her left anterior descending artery—the widowmaker. A stent was placed.

“If I had a major heart attack,” she said quietly, “I don’t know if I’d still be here.”

The Calling Didn’t End. It Adapted.

What became clear as the conversation continued was that Jean’s story didn’t end in a heart attack and it didn’t end when she was told she could no longer practice podiatry.

It widened.

The same instinct that had drawn her to medicine at five years old, that had pulled her toward limb preservation, that had carried her through illness and recovery, was still there—quiet, persistent, and looking for another way to serve.

By the time Dr. Jean Chen reached what she now calls her aha moment, she had already lived more medicine than many clinicians encounter in a lifetime—on both sides of the stethoscope.

Her career as a podiatrist had ended not by choice, but by necessity. Her body no longer allowed her to safely do the work she loved. The loss wasn’t just professional. It was personal. Identity-deep.

And layered on top of that loss was something she knew all too well: uncontrolled diabetes.

The depression that followed her surgeries didn’t stay confined to her thoughts. It showed up in her labs. Her A1C climbed. Stress, grief, and uncertainty all fed the same physiological fire.

“I knew what I was supposed to do,” she said. “But knowing and doing are not always the same thing—especially when you’re hurting.”

Her endocrinologist saw what was happening and asked a question that quietly shifted everything.

What do you want to do?

Not what she had lost.
Not what she could no longer perform.
But how she wanted to continue showing up in medicine.

For Jean, the answer didn’t come from reinvention. It came from recognition.

She had spent decades counseling patients on wound care, limb preservation, and diabetes-related complications. She had spent years watching people struggle not because they didn’t care—but because they were overwhelmed, unsupported, and often handed information without context.

She had also lived the reality of being handed educational materials that felt disconnected from real life.

“I’ve gone to diabetic educators before,” she said. “You get a handout and think, ‘What am I supposed to do with this?’”

What made the difference for her wasn’t theory. It was application.

During her recovery, one of her closest friends—herself a diabetes educator, chef, and PhD in nutrition—worked with her day by day. Not with rules. With strategies. Not with judgment. With realism.

“They were the same tricks she used with her patients,” Jean said. “And they worked.”

That was the moment it clicked.

Diabetes education isn’t a downgrade from medicine.
It is medicine.

It is behavior change, stress management, metabolic insight, and accountability—delivered in a way that respects the human being living with the disease.

Jean realized something else, too. Teaching others created accountability for herself. When you are helping patients problem-solve their nutrition, movement, stress, and daily routines, you are forced to stay honest about your own.

Education became reciprocal.

And deeply clinical.

As Dr. John Phillips pointed out during the conversation, Jean occupies a rare and powerful space: a physician who is also a long-term patient. Someone who understands risk factors not just academically, but viscerally.

That dual perspective matters—especially when we talk about diabetes, vascular disease, and limb loss.

Uncontrolled diabetes accelerates atherosclerosis.
It fuels peripheral artery disease.
It drives heart attacks, strokes, and amputations.

And yet, too many patients are told to “eat better” or “manage stress” without being given the tools to do either.

Jean’s work lives in that gap.

She doesn’t just tell patients what should happen. She helps them figure out what can happen—within the constraints of their lives, their bodies, and their mental health.

Her story also reinforces a truth we don’t say out loud often enough: mental health is not separate from physical outcomes. Depression doesn’t just sap motivation. It alters physiology. Stress doesn’t just feel bad. It raises blood sugar, blood pressure, and vascular risk.

Jean lived that reality. And she now teaches from it.

Listening to her, it became clear that nothing about her journey was wasted—not the detours, not the losses, not even the moments that nearly cost her life.

They sharpened her purpose.

They expanded her reach.

And they made her better at what she does now.

This is what medicine looks like when it adapts without losing its soul.

And it’s why conversations like this matter—because patients don’t live in silos. Diabetes, heart disease, leg pain, mental health, and mobility are all part of the same story.

Support For Diabetes and Peripheral Artery Disease

If you or someone you love is living with diabetes, unexplained leg pain, wounds that won’t heal, or changes in walking ability, don’t wait until a crisis forces the conversation.

Call the PAD Leg Saver Hotline: 1-833-PAD-LEGS
Visit PADhelp.org
Join the Global PAD Association community

Because early education, real support, and the right care team don’t just change outcomes.

They change lives.

Some interviews start with credentials.

This one started with a love lyric.

And honestly? That feels exactly right for The Heart of Innovation — because innovation isn’t always a new device or a new technique. Sometimes it’s a new way to stay human in the middle of a high-stakes career… and a new way to keep your heart in the work when the work is heavy.

This week on the show, Dr. John Phillips and I sat down with Dr. Robert McLafferty, a vascular surgeon from Oregon who has spent decades saving life and limb — while quietly building a second life as a songwriter. Not a “one-day I’ll do it” dream. Not a midlife hobby he posts about twice a year.

A real body of work. Albums. A master’s program. Studio time with 25+ musicians. And a plan to keep medicine in his life while leaning more fully into music.

And here’s the twist that made this episode feel even more 2025:

Rob is doing this right as the music industry is staring down AI — not as a novelty, but as a force that’s already writing and generating songs in seconds.

So we talked about the intersection of all of it:

• what it means to be a physician with rhythm

• why creative work can reinvigorate clinical work

• and how “human-made” art survives when machines can generate sound on demand

A vascular surgeon with real rhythm (and real range)

We opened the show the way we often do — with a little behind-the-scenes life.

John was on call (because of course he was), and we had one of those moments that snaps you back to purpose: when a patient needs help now, and you remember why the work matters.

We also took a moment to recognize Douglas Salisbury, one of our PAD navigators and a PAD Warrior himself, who had been fielding early-morning calls on our PAD Leg Saver Hotline (1-833-PAD-LEGS) — doing what he always does: listening, steadying, offering hope, and helping people find the care they need.

And before we brought Rob in fully, John delivered one of his “vascular moments of inspiration,” pulling quotes from Arthur Conan Doyle — because apparently even Sherlock Holmes can make it into a PAD conversation if you give John enough coffee and a microphone.

Then we got to Rob.

He was in Key West at a conference (yes, we were jealous). But what really stood out wasn’t the location — it was the energy.

When I asked him how he’s balancing full-time vascular surgery with Berklee College of Music coursework, he didn’t hesitate:

It’s “the hardest fun I’ve ever had.”

That line alone tells you a lot about him.

The long road back to music

Rob grew up in Maine, taught himself guitar in high school, and wrote songs early — love songs, first-love songs, the kind you only write when your whole world feels like a single person.

At the same time, he wanted medicine. Specifically: he thought he’d become a pediatric surgeon.

And like so many people who carry two callings, one of them got buried under the weight of training.

He told us his guitar playing faded in med school… and basically stopped in residency. He even said he has regrets about that — because music could have been the balance.

But life isn’t neat. It rarely lets you keep everything at once.

The return to music came years later, catalyzed by a relationship — a partner who encouraged him to pick the guitar up again. He found his old notebooks from high school — handwritten lyrics, old drafts — and something woke up in him.

From there, it turned into momentum: writing again, approaching musicians in Portland, stepping into a studio for the first time, and watching the songs he wrote alone “blossom” with other artists shaping the sound.

He laughed about playing “executive producer,” clarifying that it basically meant: he paid for everything. (Relatable. Also: respect.)

The surprising part: music made him love medicine more

Here’s the part I didn’t expect — and maybe you won’t either.

When we asked how music has influenced his practice, Rob said it has reinvigorated his love for medicine.

Not less medicine. Not escape-from-medicine.

More enjoyment inside medicine.

He described being more relaxed, more engaged, and more connected — and how it opened a door to conversations with patients that aren’t purely clinical. That matters, especially in vascular care, where fear and uncertainty can live in the room even when nobody says the words out loud.

He also articulated something that, as a journalist-turned-patient-advocate, I’ve seen over and over:

Patients often don’t remember every detail of the visit.
They remember how they felt when they left.

And he named something physicians don’t always talk about publicly, but patients feel instantly when it’s done well:

Self-disclosure, used thoughtfully, can be powerful.

When a patient sees you as human — not just a technician, not just a title — trust deepens. And trust changes outcomes. Not because trust is “soft.” Because trust is compliance, follow-up, showing up, walking, stopping smoking, believing it’s worth trying again.

That’s not fluff. That’s vascular reality.

The AI question: when a machine can write a song in 30 seconds

Then we went where The Heart of Innovation always goes: into the future.

John brought up the elephant in every songwriter’s room right now — AI-generated music — and asked how Rob feels about it.

Rob didn’t sugarcoat it. He said most songwriters aren’t happy about it, because it can feel like replacement — and he pointed to tools like Suno (spelling it out on air) that can generate a song from a prompt almost instantly.

But he also made an important observation: AI-generated songs often have a sameness — a recognizable pattern — and he believes human songwriters remain viable because of technique, craft, and the subtle choices that keep listeners engaged.

And then he gave us something I absolutely loved: a glimpse into what Berklee is teaching him — not vague inspiration, but tools.

He talked about songwriting techniques like:

• Anaphora (repetition at the beginning of lines — “Every breath you take…”)

• Epistrophe (repetition at the end of lines)

• Epinelepsis (beginning and ending with the same word/phrase — he used “Yesterday” as the classic example)

If you’re a medicine person, the moment where he says “Epinelepsis sounds like a disease” is going to make you smile. Because yes. Yes it does.

And if you’re a creative person, you know exactly why this matters:

In a world where AI can generate “a song,” what will separate the artists isn’t just emotion — it’s craft.

What he wants next

Rob’s vision isn’t just releasing another album. He wants to co-write. He wants to attend writing camps. He wants to build a library of songs that can be pitched, and he’s already formed an LLC: Clear Sky Songs.

He also made it clear he’s not abruptly abandoning medicine. He’ll likely step out of the operating room in the next few years, but he can continue in roles like wound care, clinic work, and medical directorship — the kind of “medicine with longevity.”

And that, in its own way, is a message worth hearing if you’re in any demanding career:

You don’t have to burn your first identity to build the second.
You can evolve.

Where to find his music (and how to hear “With You”)

Rob is on streaming platforms under Rob McLafferty. He has three albums out, with a fourth album (“My Astoria”) expected in the spring, and he played us a portion of his bluegrass song “With You.”

And if you’re anything like me, that opening lyric will stick — not because it’s flashy, but because it’s simple and honest.

Which feels like the whole point.

A note from us (Global PAD Association)

If you or someone you love is navigating PAD symptoms — leg pain with walking, wounds that won’t heal, cold feet, numbness, burning, tingling — and you feel stuck or unheard, our team is here to listen and help point you toward next steps.

PAD Leg Saver Hotline: 1-833-PAD-LEGS
More resources: PADhelp.org | TheWayToMyHeart.org

Join our Facebook Support Group at PADSupportGroup.org

And if this episode hit you on a personal level — if you’re holding a “second calling” inside you that you’ve been pushing down because life is busy — consider this your nudge.

Sometimes the most innovative thing you can do is bring your whole self back online.

We are “With you.”

“If your life is not on the line, fight for your limb.” — Jimontanae “Jae” McBride

When doctors told Jimontanae “Jae” McBride that her mother’s leg would need to be amputated, she refused to believe it. The words hung in the air like a sentence — “There’s nothing more we can do.” Her mom, affectionately known as Mama Joyce, was exhausted, medicated, and losing hope. But Jae wasn’t ready to let go.

She opened her laptop, went to Google, and typed the same words any desperate daughter might: “Best doctor for peripheral artery disease in the United States.” What came up changed everything. The name at the top of her search results was Dr. John Phillips — an interventional cardiologist from Ohio and my cohost on The Heart of Innovation.

That single search set off a chain reaction that would save not just one leg, but perhaps countless others in the future. Through Dr. Phillips’ name, Jae found us — our Global PAD Association, the PAD Support Group at PADSupportGroup.org, and the Leg Saver Hotline at 1-833-PAD-LEGS. Within hours, she reached out for help. Within days, we were working together to connect her with specialists who could offer a second opinion — and real hope.

But what happened next is where this story turns from a search for a doctor into a master class in love, faith, and pure determination.

Jae’s mom had already endured two failed bypass surgeries. The hospital told her there was nothing more to be done — that it was time to amputate. But Jae had seen enough to know that when life isn’t on the line, an amputation should never be the first option. She prayed, she researched, and she pushed back. When the hospital refused to transfer her mother for that second opinion, she drew a line in the sand.

“I told them,” she recalled, “‘Either every doctor involved in my mom’s case is in her room in five minutes, or I’m taking her home myself.’” And they showed up.

That kind of courage doesn’t come from textbooks or training — it comes from love that refuses to give up. Jae stood alone in a room full of authority, outnumbered and out-credentialed, but she never backed down. Even when hospital staff allegedly warned her she’d be “stuck with the bill” if she signed her mother out, she said she didn’t care. “If saving my mom’s life and limb meant paying that bill, I’d pay it.”

It was faith over fear. And it worked.

Through our network, she connected with a team willing to re-evaluate her mother’s case. Blood flow was restored. The leg that was once marked for removal began to recover. And the woman who’d been told she’d never walk again? She’s now walking with a cane — not a walker — and laughing as she tells me, “I have both my legs and all ten little piggies.”

Jae laughs, too, recalling how her mother begged for her walker back after that first long walk around the house. “I told her no,” she said, “because that walker’s gone, Mama. You’re walking now.”

But this story isn’t just about one leg saved. It’s about a daughter who transformed desperation into purpose. Somewhere along the way, Jae began inventing. When she couldn’t find a wound-care product that fit her mother’s needs, she decided to make one. She taught herself patent law, studied medical device language, learned AutoCAD to draw her own schematics, and, with her husband, built a prototype for a topical oxygen delivery system to help cleanse wounds and improve local oxygenation at home.

When I asked her what drove her to do all that, she didn’t hesitate. “There was just no other choice,” she said. “When someone you love is in pain, you do whatever it takes.”

That determination didn’t stop with her mom’s recovery. Jae has since joined the Global PAD Association’s Board of Directors, lending her voice to help expand our Leg Saver Hotline and build stronger support for families facing the same devastating choices she once did. Her advocacy is reshaping what family involvement looks like in limb-threatening disease.

Dr. Phillips said it best during our show: “We need advocates. We need family members and patients like Jae who speak up and spread the word. Mama Joyce is walking today because her daughter never gave up.”

For that, the Global PAD Association is honoring Jimontanae “Jae” McBride with the PAD Family Advocate of the Year Award through the Global PAD Impact Awards — not only for saving her mother’s leg, but for inspiring families everywhere to fight for their loved ones when others say it’s over.

“If your life is not on the line,” Jae said through tears, “don’t give up. Get that second opinion. There are options. There is hope.”

Her story is living proof that advocacy saves limbs — and love saves lives.

Watch the full interview on The Heart of Innovation and share it with someone who might need to hear it. Because sometimes, the most powerful medicine is a daughter who refuses to stop fighting.

For anyone who’s followed his journey, it was a chilling déjà vu. The man known for speed and swagger has spent years battling circulation issues—multiple blockages, repeated procedures, and even the loss of two toes. He’s long described himself as “hypercoagulable,” meaning his blood clots more easily than most.

So when news broke that he underwent yet another procedure to remove a clot, fans and physicians alike wondered: Why does this keep happening?

To unpack what might be going on, my co-host, interventional cardiologist Dr. John Phillips and I talked to Vascular Surgeon Dr. Esteban Henao from Albuquerque, New Mexico, during our The Heart of Innovation radio show and podcast.

Dr. Henao said while his first inclination was to think the clots may have been triggered by the Bladder Cancer, he went on to say that what Sanders may be experiencing is “the perfect storm”—a collision of multiple risk factors that feed off each other. “He’s a type 2 diabetic,” he said, “which already damages small vessels and slows circulation. He also has a hereditary tendency for clotting—what we call a hypercoagulable state. And on top of that, he may have aneurysmal disease in his leg.”

He explained that as arteries expand—especially behind the knee where the popliteal artery runs—they can collect a thick, mud-like buildup of old clot. Over time, that material can break loose and travel downstream, blocking blood flow to the foot and toes. “It’s exactly the kind of scenario,” Henao said, “that can lead to tissue loss, even when a patient has access to world-class care.”

For Sanders, that “perfect storm” has already cost him two toes. For others, it can cost a leg—or their life.

Dr. Phillips added that the phrase “blood clot” often confuses people. “Most assume it’s something that happens in the veins, but clots can also form in the arteries,” he said. “The difference is that a venous clot blocks blood from returning to the heart, while an arterial clot blocks blood from reaching your tissues. Either one can be devastating.”

According to the CDC, about 900,000 Americans develop a venous clot each year, and roughly 100,000 die from pulmonary embolisms—when a clot travels to the lungs. “A quarter of those people die without warning,” Phillips said. “That’s why awareness and prevention are everything.”

But awareness alone isn’t enough — for both venous AND arterial clots.

Access and equity remain the biggest gaps in vascular care.

“If Deion weren’t Deion,” Henao said, “if he were just an average guy walking into a hospital with leg pain, there’s a good chance he would’ve lost that entire leg.” He explained that even in 2025, far too many emergency departments lack rapid vascular evaluation. “Once those first six hours are gone,” he said, “the tissue is dead. No matter how advanced your treatment, you can’t bring back a leg that’s been starved of blood that long.”

That same lack of access affects millions of Americans with peripheral artery disease, or PAD. Studies show one in five people over sixty has it, yet more than seventy percent have never heard the term. In a survey of patients from our Global PAD Association network, more than two-thirds said their first symptoms—leg cramps, fatigue, or foot pain—were brushed off as “just aging,” “neuropathy,” or “arthritis.”

By the time many are diagnosed, the damage is done.

And that’s why stories like Deion’s matter. When a public figure confronts a condition, most people don’t talk about, it opens a door for conversation—and potentially, for change. We saw it just weeks ago when former President Trump’s chronic venous insufficiency made headlines. He didn’t become defined by the disease, but by acknowledging it, he helped millions recognize a condition they’d never heard of.

The same could happen here.

Sanders’ willingness to speak publicly about his struggle—no matter how painful or personal—might be what helps another man or woman recognize the warning signs in time. Because sometimes, one story, one question, one trip to the doctor, can make the difference between losing a leg and saving it.

If you are experiencing leg pain, leg cramps or neuropathy, call the Global PAD Association’s Leg Saver Hotline at 1-833-PAD-LEGS or go to PADhelp.org

You can also join the Global PAD Association’s Facebook Group for Peripheral Artery Disease at PADsupportGroup.org

“I spent this past week in my yard, power washing, doing some painting, trimming with the electric trimmer. I mean, I can do anything I want to really,” says 78-year-old Judy, whose life transformed after a procedure most Americans have never heard of.

Just months earlier, she couldn’t even open her microwave or lift a fork to eat.

Judy was one of a couple of patients we interviewed on the latest episode of “The Heart of Innovation” as we broadcast live from the Multidisciplinary Musculoskeletal Care Conference hosted by Vascular Solutions of North Carolina. With Dr. John Phillips off saving “piggies” (his affectionate term for patients’ feet) at the hospital, I welcomed guest co-host Justin Lesh, CEO of Patient Pro Marketing, who was on site interviewing physicians and patients.

The focus of the conference was bringing together all stakeholders dealing with osteoarthritis pain—orthopedic surgeons, interventional cardiologists, pain management physicians, and physical therapists—to discuss ways everyone can work together to best help patients. Among the treatment options highlighted was a promising minimally invasive procedure called artery embolization.

The Multidisciplinary Approach

“If your body is a house, I’m the wall guy, I’m the bone guy. The electricity guy is the nerve guy. And the water flow guy is the vascular guy,” explained Dr. Hardy Singh, an orthopedic surgeon speaking at the conference. “We all have to come together to make the house function.”

This metaphor captured the essence of the conference: bringing together specialists from various disciplines to improve patient outcomes through collaboration.

“The number one thing that’s hurting our patients today is communication,” Dr. Singh continued. “We don’t communicate as providers, we don’t document. Every doctor gets to play the telephone game of what did you say last time? It’s hurting patients.”

This siloed approach to medicine has long left patients falling through the cracks. As I’ve seen in my work with the Global PAD Association, more than 70% of patients with peripheral artery disease (PAD) are initially misdiagnosed as they’re shuttled between specialists, each viewing only one piece of the puzzle.

It’s also an issue with PAD patients as well as others who suffer from osteoarthritis. The orthopedic surgeon may not have a surgical option available to a patient. So, they send the patient to physical therapy. If that doesn’t provide relief for the patient, they may be sent to vascular to assess the arteries again. If that’s not the problem, the patient is sent to pain management.

It’s just a never-ending cycle for these patients leaving so many without hope.

That’s why Dr. Sid Rao, founder of the Conference and Vascular Solutions of North Carolina wanted to bring all stakeholders together to talk about pain and how they can better communicate to ensure everyone is aware of all treatment options available for osteoarthrities, especially the newer, minimally invasive, artery embolization.

How Artery Embolization Works

During our broadcast, Justin explained how artery embolization targets specific blood vessels that contribute to inflammation and pain in affected joints.

“The doctor goes in through a catheter and puts a tiny little embolization particle to stop some of these blood vessels that have grown and are contributing to the inflammation,” he reported after speaking with physicians at the conference.

What he’s describing is quite fascinating. In osteoarthritis, the body develops new abnormal blood vessels around affected joints as part of the inflammatory response. These blood vessels actually contribute to the pain and swelling that make movement difficult. Embolization works by strategically blocking these specific vessels.

During the procedure, doctors insert a thin catheter through a small incision, usually in the groin area, and guide it precisely to the problematic blood vessels using advanced imaging technology. They then release tiny particles that block these vessels, reducing blood flow to the inflamed areas without affecting healthy tissue or normal blood supply to the joint. It’s like turning down the volume on the inflammation without disrupting the joint’s normal function.

The procedure is performed under local anesthesia, and most patients go home the same day. Many report improvement in their symptoms within days or even hours.

Research shows that embolization can provide relief lasting up to two years, with some studies suggesting even longer benefits. As Justin noted during our broadcast, “If that gets you two years to get walking, to get healthy, to get in shape, and the worst-case scenario is it just doesn’t work, there’s no real downside.”

Patient Success Stories

Khalid Iqbal shared his experience with hand embolization on our broadcast. He had suffered from severe arthritis in his left thumb that progressively limited his mobility.

“I could not open any jar. I could not push anything. I could not hold anything in my hand,” Khalid explained. “My severity at that time was in the high 90s.”

What made his story particularly interesting was that Khalid was introduced to the procedure by his son, Amr Iqbal, who serves as COO of Vascular Solutions of North Carolina. Khalid decided to have his hands treated only after seeing how well his wife responded to knee embolization. She was walking thousands of steps the day after her procedure.

After undergoing embolization with Dr. Sid Rao, Khalid experienced significant improvement. “I was moving my thumb. The next day, I drove to Virginia using my hand.” As a retired mechanical engineer who still enjoys tinkering with tools, regaining hand function transformed his daily life.

For Judy, who we heard from earlier, the procedure quite literally gave her life back. After being told she needed shoulder replacement surgery with a six-month recovery—impossible for someone living alone as a widow—she found hope in embolization.

“They give you a shot… That was the only thing that had to heal up,” Judy explained on our show. “When you go out, you are good to go.”

Her relief was immediate. She later had the same procedure done on her knee and foot, enabling her to return to activities she thought were permanently beyond her reach.

These success stories aren’t limited to knees and hands. During the conference, physicians discussed applications for shoulder pain, plantar fasciitis, and even potential applications for cervical, lower back, and hip pain.

Implications for PAD Patients

The implications for PAD patients particularly resonated with me. In my work with the Global PAD Association, I’ve seen how walking is essential therapy for these patients to grow collateral blood vessels around blockages. But osteoarthritis pain in the knees can make walking impossible.

By treating knee osteoarthritis through embolization, PAD patients can potentially walk more comfortably, improving both their joint pain and circulation. As one doctor emphasized during the conference, “The number one thing any medical provider can do to help a patient have a longer life is get them to walk more.”

Taking Action

If you have peripheral artery disease and need to walk as medicine but your osteoarthritis is holding you back, call our Global PAD Association Leg Saver Hotline at 1-833-PAD-LEGS. We can help connect you with specialists who understand both conditions and can explore minimally invasive options like embolization that might help you get back on your feet.

As Judy advised during our broadcast: “Tell everybody, especially for us elderly people… I wish everybody knew about it.”

I certainly told my Dad. I mentioned on air that he is scheduled to undergo the procedure for osteoarthritis in his hands in the coming weeks. As with any procedure, there are risks involved. It’s important to talk to your own doctor to determine the best treatment plan for your presentation of symptoms.

This article is based on the October 4, 2025 episode of “The Heart of Innovation” on KDOW, featuring guest co-host Justin Lesh, CEO of Patient Pro Marketing, reporting from the Multidisciplinary Musculoskeletal Care Conference at Vascular Solutions of North Carolina.

“It’s more important to know what sort of person has a disease than to know what sort of disease a person has.”

This Hippocrates quote, shared by Dr. John Phillips during our Heart of Innovation interview, perfectly captures the philosophy that has earned Dr. Sara Rose-Sauld recognition as America’s PAD Podiatrist of the Year for 2025.

Dr. Rose, a podiatrist at Massachusetts General Hospital in Boston, embodies this patient-first approach in every aspect of her practice. She sees beyond the condition to understand the whole person—a perspective that has made her exceptionally effective at healing complex wounds and preventing amputations that others might have deemed impossible.

This prestigious honor comes directly from patients who’ve experienced her life-changing care. They consistently highlight how Dr. Rose addresses both the physical and emotional aspects of peripheral artery disease (PAD)—poor circulation mainly in the legs which impacts one in five people over the age of 60.

During our interview, Dr. Rose shared that treating complex PAD cases wasn’t her original career plan. “I did not go into podiatry thinking this is what I was going to do. I went into podiatry thinking I was going to treat kids and sports and everything was going to be cute.”

Her perspective changed when she discovered the profound impact she could make through limb salvage. “When you treat these patients, it’s actually extremely rewarding as a clinician to make a significant difference in a life. The patient that I’m actually saving their foot and saving their limb, potentially saving their life, I found that a lot more rewarding than making someone’s foot look a little cuter or bunion a little straighter.”

Dr. Rose completed extensive training in limb salvage during her surgical residency in Florida before joining Mass General, where there was a significant need for her expertise. But as our guest co-host Dr. Alper pointed out, Mass General wasn’t traditionally podiatry-forward.

How did she overcome this challenge? “What I did was just make a whole bunch of friends,” she explained. Her breakthrough came when Dr. Anahita Dua, a vascular surgeon who started around the same time, paged her about a patient. “She paged me and said, ‘Hey, can you see this patient? Do you think they need a below knee amputation?’ And I said, ‘No, they just need a ray amputation.’” Dr. Dua invited her to scrub in, and their collaboration began. “I just helped prevent an amputation. And she’s like, ‘This is awesome. I’ll send you all my patients.’”

This partnership highlights the importance of multidisciplinary teamwork in treating PAD effectively. Dr. Phillips noted during our conversation, “There’s such a symbiotic relationship… it truly does take a village to take care of these people. No one person can do it themselves.”

What truly sets Dr. Rose apart is her deep compassion for patients. She shared a story about a large, intimidating patient who already had one leg amputated and a partial amputation on his other foot. When he came in for a skin graft, he refused to let the nursing staff place an IV and threatened the resident.

Where others saw an uncooperative patient, Dr. Rose recognized fear. “He was scared that he was going to lose his other leg,” she explained. Her solution was remarkably simple: “I literally held this man’s hand while he got the IV put in.” That compassionate act made all the difference. “If I had not sat there holding this man’s hand, I think he may not have another leg because he would have not gone into the operating room that day.”

Dr. Rose also challenges the typical “non-compliance” label often applied to patients. “A lot of times these patients, they’re labeled noncompliant, and a lot of times they are. But sometimes there’s a reason behind that,” she points out. “They’re not elevating their leg—maybe they don’t have a place to elevate their leg at home.” This perspective shift from judgment to understanding is crucial for effective patient care.

Patient education is another cornerstone of Dr. Rose’s approach. She finds that patients at all educational levels are interested in the research behind their treatments. “Even when they’re involved in a clinical trial, they think it’s the coolest thing. They want to learn more about it. We see a lot of different people… homeless people, very well-educated Harvard staff, celebrities… It doesn’t matter. They all have some interest when you’re like, ‘Hey, look at this. This is the latest data we’ve come up with.’”

Despite her remarkable success, Dr. Rose candidly shared the emotional toll of cases where amputation couldn’t be avoided. She recounted the devastating story of a Somali patient with five children whom she had treated for years. After successfully healing a wound on one foot, the patient developed a heel wound on the other foot that wouldn’t heal. When the patient became septic, Dr. Rose recommended amputation, but the patient and her husband initially refused consent despite extensive efforts to involve interpreters and spiritual care.

“By the time they did consent, it was too late,” Dr. Rose shared, clearly still affected by the loss. This willingness to share both triumphs and heartbreaks reveals her deep commitment to her patients.

On a lighter note, Dr. Rose’s sense of humor came through when she shared a story about a patient who wanted to preserve her auto-amputated toe to make into a Halloween necklace. The patient had her mummified toe “sitting right there on her dresser” and was looking for someone who could help her turn it into jewelry!

Creating a Legacy in PAD Care

Dr. Rose doesn’t just treat PAD patients—she’s transforming how the entire medical community approaches limb salvage. During our conversation, Dr. Alper reflected on the evolution of podiatric involvement in PAD treatment. “When I was training and when I first started—the first 20 years of my practice—this was not even an option on the radar for a podiatrist. We just didn’t do these things.”

Back then, podiatrists primarily served as “gatekeepers,” identifying the disease and referring patients to other specialists. Frustrated by these limitations, Dr. Alper eventually “set down my surgical practice to focus completely on wounds… because to me, there had to have been a better option for these patients.”

Dr. Rose represents that better option. As Dr. Alper put it, “Sarah was right out in front with working with other physicians, other specialties to really make sure that the patient got everything they needed, right down to the physical therapist to help teaching them walk again.”

Her collaborative approach creates a comprehensive care model that addresses all aspects of PAD. But her influence extends beyond her own patients. Through lectures across the country, she’s shaping how the next generation approaches limb salvage. “She not only talks to people that are peers, but she’s inspiring the students as well to say, ‘This is something that I could do,’” Dr. Alper explained.

This educational impact multiplies her effectiveness. While Dr. Rose personally saves hundreds of limbs, by training others, she’s indirectly saving thousands more. As Dr. Alper noted, “This really is not only the future, this is the presence of podiatry in general.”

Taking Action: What PAD Patients Need to Know

The work of physicians like Dr. Rose demonstrates that PAD doesn’t have to lead to amputation. Early intervention is key, and recognizing symptoms is the first step.

If you experience leg pain when walking, slow-healing wounds, or numbness in your feet, don’t dismiss these as normal signs of aging. They could indicate PAD, and timely treatment can prevent serious complications.

Call our Global PAD Association’s Leg Saver Hotline at 1-833-PAD-LEGS to learn more about PAD, discuss your symptoms, and connect with skilled specialists like Dr. Rose who understand the importance of limb preservation.

You can also find support through our communities: join our Facebook PAD group at padsupportgroup.org or our PAD walking group at walkingsupportgroup.com to connect with others who understand your journey.

Dr. Rose’s story reminds us that with the right care approach—one that combines clinical expertise, collaboration across specialties, and genuine compassion—we can save both limbs and lives. Sometimes, saving a limb starts with something as simple as holding a patient’s hand and truly seeing the person behind the disease.

Disclaimer: These awards are not to be considered an endorsement for any specific doctor. They are nominated and voted on by patients and an independent panel. Always do your homework to find the best doctor for your situation. You can call the Global PAD Association’s hotline for help finding appropriate care for your specific needs.

Fast forward to today, where I’m applying what I learned through my dad’s experience to help people with Peripheral Artery Disease (PAD) through the Global PAD Association. I’m frustrated by the revolving door of procedures where doctors just “roto-root” leg arteries without addressing the underlying causes of plaque buildup. That’s why I was thrilled to bring Dr. Lily Johnston, a vascular surgeon from Scripps in San Diego, onto our recent episode of The Heart of Innovation. She’s not just treating blocked arteries but working to prevent them from becoming blocked in the first place.

Early Detection: Finding Arterial Disease Before Symptoms Appear

“What drives my passion is recognizing that this is a long disease process,” Dr. Johnston explained during our conversation. “It takes decades for plaque to form and accumulate, and then rupture and become a huge problem. If we could only get patients earlier in this disease process, we would have an opportunity to really dig deep into these metabolic risk factors that drive the progression of plaque buildup or atherosclerosis.”

The contrast between how we approach cardiovascular disease versus other conditions is striking. We have normalized cancer screenings through mammography, colonoscopy, and lung cancer tests, yet cardiovascular disease—the leading cause of death worldwide—lacks standardized early detection protocols.

Dr. Johnston uses several imaging techniques for early detection that could identify arterial disease years or even decades before symptoms appear. She explained, “We can talk about coronary calcium score, CCTA or coronary CT angiography. We can talk about CIMT (Carotid Intima-Media Thickness), which is not super popular in the cardiology space, but is something I’ve used very successfully in my practice.”

CIMT is particularly valuable as it measures the thickness of the inner layers of the carotid artery to detect early arterial thickening and plaque. It’s non-invasive and doesn’t involve radiation, making it an excellent screening tool that more doctors should utilize. But detecting disease is only half the battle—understanding who’s at risk is equally crucial.

The Metabolic Syndrome Reality: Nearly 9 in 10 Americans at Risk

Early detection becomes even more critical when we consider how widespread metabolic risk factors actually are. Dr. Johnston referenced research from the National Health and Nutrition Examination Survey (NHANES) showing that only about 12% of American adults are metabolically healthy—meaning they have optimal levels of all five key factors: blood glucose, triglycerides, HDL cholesterol, blood pressure, and waist circumference without medications. This research, published by the University of North Carolina at Chapel Hill’s Gillings School of Global Public Health in 2018, analyzed data from 8,721 people between 2009 and 2016.

“If you look at the United States and take the NHANES data and ask how many people meet zero out of five criteria for metabolic syndrome… it’s about 12%, or maybe even less now,” Dr. Johnston noted. This widespread metabolic dysfunction is driving the epidemic of arterial disease we’re seeing today.

The good news? Targeting insulin resistance—which Dr. Johnston identifies as the root cause—can improve all these markers simultaneously. “If we target the root of insulin resistance, we can actually improve all those markers of metabolic syndrome because that’s how they’re related,” she explained. Identifying these risk factors early requires going beyond standard medical testing.

Advanced Testing: Beyond Basic Cholesterol Panels

With metabolic syndrome affecting so many Americans, standard cholesterol testing simply misses too much critical information about what’s actually happening in your arteries. Dr. Johnston’s approach includes comprehensive assessments that reveal a much more complete picture:

“Our initial lab panel covers a broad swath of things. We do advanced lipid testing. We do metabolic testing, including fasting insulin, fasting glucose. We’ll check homocysteine and uric acid, Lp(a), little a. And I offer patients an opportunity to check their ApoE genotype because that may impact recommendations in terms of risk for Alzheimer’s disease and cardiovascular disease.”

The advanced lipid testing she mentions goes far beyond the standard cholesterol panel. It includes particle numbers and sizes, which are often much better predictors of cardiovascular risk than standard LDL measurements. Homocysteine testing can reveal issues with methylation pathways (like my father’s MTHFR mutation), while Lp(a) is a genetic risk factor for accelerated atherosclerosis that many doctors never check.

Dr. Johnston confirmed this comprehensive approach works: “For patients like Kim’s dad with elevated homocysteine and an MTHFR mutation, I would employ a methylated B vitamin to try to bring that homocysteine down and reduce the risk of particularly stroke, but also major adverse cardiac events.” But beyond these specific markers, inflammation emerged as perhaps the most significant modifiable risk factor in our discussion.

Inflammation: The Arterial Damage You Can’t Ignore

While advanced lipid and metabolic testing provide valuable insights, understanding inflammatory processes may be even more critical for preventing arterial disease. “Inflammation is an enormous opportunity for us to get involved and try to reduce risk,” Dr. Johnston emphasized. “We should absolutely be testing for it and trying to intervene when we find it.”

However, she cautions against treating inflammation without understanding its source: “We know that just treating the immune system comes with a cost. We have reduced cardiac events, which is great. But we’ve actually increased infections when all we do is suppress the immune system.”

Dr. Johnston advocates finding the underlying causes: “Why do we have inflammation? Is it visceral adiposity or visceral fat accumulation? Is it periodontal disease? Is it untreated sleep apnea? Understanding why, rather than just suppressing the immune system—that’s where we get the magic.”

Many of my PAD patients don’t realize that inflammation is often the driving force behind their arterial disease. Simply measuring high-sensitivity C-reactive protein (hsCRP) and addressing sources of inflammation can make a dramatic difference in disease progression. And among those inflammatory drivers, one condition stood out in our conversation as particularly important yet frequently overlooked.

Sleep Apnea: The Hidden Cardiovascular Risk Multiplier

When discussing sources of inflammation, Dr. Johnston highlighted sleep apnea as a remarkably powerful risk factor that most physicians miss. She shared research showing that treating sleep apnea can cut the risk of heart attack and stroke in half.

“If you have sleep apnea and you treat it, it will cut your risk of heart attack and stroke in half,” she stated. “This is amazing—reduced cardiac events. Number needed to treat is like 3.” A “number needed to treat” of 3 means that for every three people with sleep apnea who get proper treatment, one major cardiovascular event is prevented—an extraordinarily powerful intervention.

When I asked about the rising prevalence of sleep apnea, Dr. Johnston provided fascinating context: “Correlation with a diagnosis of obesity is high, but there are people with deviated septums and weird jaw anatomy. If you read the book ‘Breath’ by James Nestor, he talks about how we don’t chew crunchy food anymore, and it’s changed our facial anatomy.”

Many of my PAD patients have undiagnosed sleep apnea. Getting proper sleep testing and treatment can be life-changing for their arterial health, often more so than medications or procedures. This exemplifies why patient education and involvement in their own care is so critical for long-term success.

Patient Empowerment: Taking Control of Your Vascular Health

With so many factors affecting arterial health—from metabolic markers to inflammation to sleep quality—patients need to become active participants in their care. Dr. Johnston’s practice embodies this philosophy. Her initial consultation lasts two hours and covers lifestyle pillars including nutrition, movement, sleep, stress, social connection, and toxic disruptors. She even performs point-of-care ultrasound to check carotid arteries for evidence of inflammation or plaque.

This comprehensive approach is exactly what’s needed to break the cycle of “sick care” that dominates our healthcare system, especially for PAD patients caught in the revolving door of procedures.

“If you want to make the most out of that visit with your doctor, you are empowered and have the responsibility to make it as easy for your physician as possible to really dive into the issue at hand,” she explained. This means coming prepared with your medical history, medication list, and specific questions based on your research. But empowerment isn’t just about gathering information—it’s about creating sustainable changes that improve health over time.

Realistic Health Improvement: Starting Where You Are

Perhaps the most refreshing aspect of Dr. Johnston’s approach is her commitment to meeting patients where they are. Rather than overwhelming them with complete lifestyle overhauls that feel impossible to maintain, she advocates starting with achievable changes:

“Pick the low hanging fruit. What feels achievable and get a win—get a checkbox in your book that says ‘I did this for me, and I did it, and I feel better.’ And now I can do another thing. We prove to ourselves that we are worth it, that these interventions are worth it, and we build our own confidence.”

She acknowledges that not every intervention works for every patient and that personalization is key: “I can offer you a solution that’s nutritionally based. We can focus on your nutrition or your exercise. Let’s talk about structured exercise. Or let’s work on your sleep hygiene and getting you tested for sleep apnea. Or let’s talk about your connections and your social and your stress.”

For PAD patients who’ve been told to just “stop smoking and exercise more,” this personalized approach offers real hope for breaking the cycle of recurring blockages. By focusing on specific, actionable steps, patients can begin making meaningful progress immediately.

Taking Action: Steps Toward Healthier Arteries

Based on our conversation with Dr. Johnston, here are key actions anyone concerned about arterial health should consider:

1. Request advanced testing beyond standard cholesterol panels, including inflammatory markers, homocysteine, Lp(a), and insulin resistance, fasting glucose

2. Consider screening for sleep apnea, especially if you have cardiovascular risk factors or don’t feel rested after sleeping

3. Focus on addressing insulin resistance and diabetes through diet and lifestyle modifications sooner rather than waiting until it leads to vascular complications.

4. Prepare thoroughly for medical appointments, bringing complete medication lists and medical history

5. Start with one achievable health change rather than trying to transform everything at once

As Dr. Johnston put it: “Let’s start with one thing that feels like you want to tackle it, that’s easy and achievable, and do it and check that box and then be brave and pick another one and go from there.”

The Future of Arterial Health: Prevention Over Procedures

Dr. Johnston represents the vanguard of a new approach to arterial health—one focused on prevention, early detection, and treating root causes rather than symptoms. “My mission is to put myself out of business as a surgeon,” she told us, highlighting her commitment to preventing the need for invasive procedures whenever possible.

Her integrative approach combines the best of conventional medicine with evidence-informed nutritional and lifestyle interventions. By addressing metabolic dysfunction, inflammation, and other root causes of arterial disease, we can prevent countless heart attacks, strokes, and limb-threatening conditions.

At the Global PAD Association, we’ve long advocated for this comprehensive approach to vascular health. Dr. Johnston’s work validates what we’ve seen in countless patients—that addressing the underlying causes of arterial disease can dramatically improve outcomes and quality of life.

To learn more about Dr. Johnston’s approach to vascular health, visit Vascular Health Institute at www.vascularhealthinstitute.org or connect with her on LinkedIn at Lily Johnston MD.

For more resources on managing peripheral artery disease and heart health, visit padhelp.org or call the Global PAD Association’s Leg Saver Hotline at 833-PAD-LEGS. Also, tune in to The Heart of Innovation podcast for ongoing conversations with leading experts in vascular health at Youtube.TheWayToMyHeart

The Call That Changed Everything

It was an ordinary day at the Global PAD Association when Patrick called our Leg Saver hotline (1-833-PAD-LEGS). Driving from Chicago to Florida and experiencing excruciating leg pain, he reached out in desperation. Little did I know this call would lead to one of the most inspiring patient journeys we’ve featured on our “Save My Piggies” episodes.

“I was experiencing leg pain,” Patrick told me during our recent Heart of Innovation broadcast. “And so I knew I had to get back to Florida to see my surgeon there. So I called your hotline number.”

That call connected Patrick with Douglas, our PAD Warrior Task Force Chairman, who spent over 30 minutes talking with Patrick about walking as medicine – how consistent walking can help develop collateral blood vessels to bypass blockages. It was the beginning of Patrick’s education about his condition, but far from the end of his journey.

When “Quick Care” Isn’t Quality Care

After returning to Florida and symptoms worsened despite a regimented walking program, Patrick sought treatment from local surgeons. What he encountered should serve as a warning sign to anyone dealing with peripheral artery disease.

“My surgeon down in Naples, Florida, he tried to be in and out in less than a half hour,” Patrick explained, frustration evident in his voice. “He couldn’t through my blockages quickly, so it’s like, in and out and go on to the next client.”

This “assembly line” approach to vascular care is something I warn patients about constantly. Complex PAD cases – especially those involving multiple blockages or previous procedures – require time, patience, and expertise. When Patrick told me about his experience with doctors rushing through procedures, I wasn’t surprised that he wasn’t getting results.

Even more concerning, Patrick discovered that many of the specialists he consulted didn’t have the tools or knowledge to address his specific situation with multiple blockages in stents above the knee as well as blockages that had formed later in his arteries below his knee, which is typical for diabetics. He told us that they couldn’t or wouldn’t attempt to clear it using advanced techniques like pedal access (going through the foot).

“The surgeons down in Florida, no one was willing to or knew how to go through the foot if they couldn’t get through my blockage coming down from the groin.” They didn’t have the tools that Dr. Phillips had,” he shared.

One surgeon claimed to have a specialized device (the Diamondback 360) but didn’t even have it available in the operating room. Patrick was understandably disappointed – and increasingly worried about his options.

“I knew through your show that, like Dr. Phillips said, he won’t give up,” Patrick explained. “Dr. Phillips has the tools, he can solve the problem.”

From Viewer to Patient: The Power of Education

What makes Patrick’s story particularly meaningful to me is how he took his health journey into his own hands through education. It’s not often you see a patient that can talk about the different tools and techniques that may be available to open arteries and not settle for amputation.

How did he learn this information?

For months, while dealing with debilitating claudication pain that limited his ability to walk and enjoy life, Patrick immersed himself in our content.

“I would go to a coffee shop every day, and I’d watch your videos. I’d watch them at home,” he recalled. “How am I going to solve this problem?”

Patrick wasn’t just passively consuming information – he was becoming an informed advocate for his own care. He learned about different treatment approaches, specialized tools, and the importance of finding a doctor with the right expertise and commitment. He could identify devices by name and understand approaches like pedal access that many general vascular specialists don’t offer.

“I was depressed and sad about this. I can’t find the right surgeon. They don’t want to use the tools.” Patrick shared. “And the major bypass scared me because if the artery is already clogged and then they want to do the other bypass, if the bypass gets clogged, well, then what’s the third choice? After that, they want to cut your leg off.”

That’s the devastating reality many PAD patients face – the feeling that amputation is inevitable when procedures fail. But as Patrick learned through our broadcasts, that doesn’t have to be the case.

“You and Dr. Phillips taught me that there are options for us. If we find the right surgeons like Dr. Phillips that can unblock an artery and will take the time, we have options.”

The Journey to Dr. Phillips

While there are a large number of vascular specialists across Florida with advanced skills, Patrick struggled on his own to find the one he felt was right for him. By late February, not wanting to suffer any longer trying to vet doctors in his area, Patrick had made his decision to travel for his care. After nearly four months of watching our shows and researching his options, he felt Dr. Phillips in Columbus, Ohio was the perfect fit – over 1,000 miles from his home in Florida.

“It took me a while to get to him, but I should have just gone to him first through watching you,” Patrick admitted.

When Patrick finally arrived for his consultation with Dr. Phillips in April, it was a moment of recognition for both of them. Dr. Phillips, who regularly co-hosts our Heart of Innovation shows with me, immediately realized this wasn’t just any patient – this was someone who had sought him out specifically because of our work raising awareness about PAD treatment options.

“It got me thinking like, wow, there’s more of a reach and an impact that this show has than I anticipated,” Dr. Phillips reflected during our broadcast. “But it also made me feel like there’s a fiduciary responsibility… This gentleman took time out of his life to come see us. And I feel like there’s a responsibility not more so than others, but I mean, it’s a little bit like, man, I really need to figure out a way to help this guy.”

That moment speaks volumes about the kind of doctor Dr. Phillips is – and why Patrick’s instincts to seek him out were spot on. While some doctors see patients as cases to be processed as quickly as possible, Dr. Phillips saw the trust Patrick had placed in him by traveling so far and felt a deep responsibility to honor that trust.

A Complex Case Requires Masterful Care

In realizing that walking and medicine hadn’t been enough to help relieve Patrick’s symptoms and a previous revascularization attempt had failed, Dr. Phillips moved forward with scheduling an angiogram, where he could get a better look inside his arteries and treat if necessary.

The treatment Patrick needed was far from routine.

Having had multiple stents placed in his left leg years earlier, with overlapping layers and complete blockages, his case presented significant challenges.

“It was probably one of the harder cases that I had to do to try to get through some of these blockages,” Dr. Phillips explained. Unlike the doctors who gave up after 30 minutes, Dr. Phillips was committed to spending the time to see if he could find a solution to ease Patrick’s pain.

Using a laser device to break up the plaque and restore flow through the blocked stents, Dr. Phillips encountered a critical moment when debris from the procedure threatened to block the one remaining artery supplying blood to Patrick’s foot.

“There was so much debris that we use a little device to catch it and that kind of overflowed,” Dr. Phillips shared. “It blocked off the only artery that he had left in the leg below the knee. And we had to go suck that out.”

This moment illustrates exactly why patients with complex PAD need specialists with advanced training and a full arsenal of tools. Had this complication occurred with a less experienced physician, the outcome could have been catastrophic. It’s also why advanced specialists like Dr. Phillips don’t rush into doing procedures unless absolutely necessary, because there are serious risks, especially with only one vessel out of three channeling blood flow into the foot as in Patrick’s case.

“I thought, man, this is not what I want to have happen right now for this poor guy,” Dr. Phillips admitted. “But no, you just have to have a little perseverance.”

That perseverance paid off.

Dr. Phillips successfully cleared the blockage in the stents without having to place additional stents as well as clearing the debris that had collected during the procedure distally, preserving Patrick’s options for future treatment if needed. “I made sure we preserved landing zones in case a bypass is ever needed for Patrick, which is incredibly important — to always keep contingency plans in mind with every procedure,” explained Dr. Phillips. “It felt pretty good at the end,” he added – an understatement that doesn’t capture the life-changing impact this success had for Patrick.

In fact, the case was so instructive that Dr. Phillips now uses it as a teaching example: “I’m teaching a course for Phillips at the end of August and his case I’m using as a teaching point for a number of things.”

Addressing the Root Causes: Beyond the Procedure

At the Global PAD Association, we know that saving legs isn’t just about clearing blockages – it’s about addressing the underlying conditions that cause those blockages in the first place. For Patrick, as for many PAD patients, diabetes was a significant contributing factor.

That’s why we connected Patrick with Dr. Michael Dansinger, our Chief Medical Officer and world-renowned diabetes reversal expert at DiabetesReversalPartners.com. Patrick has been working with Dr. Dansinger to bring his blood sugar under control, a critical step in preventing future vascular problems.

“My A1C is down to an eight,” Patrick shared during our conversation. “By the next time I do a blood draw, it should be like 6.8, so I’ll be in the safety zone.” Dr. Dansinger will still work to get him down below 6 over time.

Patrick admitted he had struggled with dietary changes while dealing with the stress of his leg issues. “I had too much sugar sometimes, like strawberry banana smoothies and stuff like that and pizza. I was a bad boy,” he confessed with a smile.

But with his leg pain resolved, Patrick now has renewed motivation to focus on his overall health. “I definitely see the benefit. I have to be under seven. So I have no excuse now. I’m healthy now because of Dr. Phillips. So there’s no more excuses.”

Dr. Phillips emphasized the connection between diabetes and PAD during our broadcast: “I truly believe that it is an inflammatory process. There’s clearly something about the inflammation and the diabetes that certainly affects our kind of global inflammatory state.”

So, while a doctor may do their part in clearing the blockages, they’re not going to stay open long unless diabetes is controlled.

This comprehensive approach – addressing both the immediate blockages and the underlying conditions – is essential for long-term success in PAD treatment.

From Limitation to Liberation: Patrick’s New Life

The transformation in Patrick’s life since his procedure has been nothing short of remarkable. From being unable to enjoy a state fair because of excruciating pain, he’s now planning trips across the country and around the world.

“Life is great,” Patrick told us with genuine enthusiasm. “I’ll be in Chicago Friday, I’ll be back in Columbus on the 5th to see Dr. Phillips again. I’m gonna go to La Jolla next month, going to Egypt in January, maybe San Francisco in March for an AI convention. I can travel.”

When I suggested we should walk across the Golden Gate Bridge together when he visits San Francisco, Patrick was all in. This is a man who, just months earlier, couldn’t walk through a fair without debilitating pain. Now he’s contemplating walking across one of the longest bridges in the world – and filming it for our channel as inspiration for others.

Patrick is also getting back to his regular exercise routine: “I’m going to be back going to my gym on Friday. I go to like an LA Fitness. And I’m going back to the gym five days a week.”

This is the ultimate victory for PAD patients – regaining the freedom to move, to travel, to exercise, to live life on their own terms instead of being limited by pain and fear.

Lessons from Patrick’s Journey: What Every PAD Patient Should Know

When I asked Patrick what advice he would give to others watching our show, his answer was clear and powerful:

“The best advice is listen to your show, get a second or third opinion, but you need a critical limb salvage specialist. And people are talking to people that are not critical limb salvage specialists, and they’re not gonna get the result they want because certain surgeons only know certain things.”

Patrick’s journey highlights several crucial lessons for anyone dealing with PAD:

1. Don’t rush into a procedure. Patrick wishes he didn’t have the stents placed five years prior. Instead, he wished his doctor got him on a regimented walking program such as the “My Steps” program (Patient Sign-up Here) offered by the Global PAD Association to start building ‘natural bypass’. “The stents just ended up blocked up and more,” says Patrick.

2. Don’t settle for rushed care. If your doctor is trying to get through your procedure in 30 minutes or less, that’s a red flag. Complex PAD cases require time and patience.

3. Seek out true expertise. Not all vascular specialists have the same training, tools, or techniques. Look specifically for critical limb salvage specialists who have experience with advanced approaches. You can learn more on the Global PAD Association’s Find A Doctor page.

4. Educate yourself. Patrick spent months watching our videos and learning about his condition. That knowledge empowered him to seek out the right care instead of accepting limited options. Go to youtube.com/@thewaytomyheart for more than 1,000 videos on a variety of topics related to PAD.

5. Address the root causes. Treating the blockages is essential, but managing conditions like diabetes is equally important for long-term success.

6. Be willing to travel if necessary. The right doctor might not be in your hometown, but as Patrick’s story shows, traveling for the right care can be life-changing. You can always call the Leg Saver Hotline for assistance in finding an advanced skilled specialist near you at 1-833-PAD-LEGS.

Your Legs Are Worth Fighting For

Patrick’s journey from Florida to Ohio in search of the right doctor is a powerful reminder that when it comes to PAD, persistence pays off. He refused to accept that amputation was inevitable. He refused to believe there were no other options. He refused to give up on his legs – and because of that determination, he’s now living a full, active life again.

“Thank God I found your show and I found the two of you,” Patrick told us during the broadcast – words that remind me why we do this work every day at the Global PAD Association.

If you’re dealing with PAD or know someone who is, remember Patrick’s story. Remember that there are options beyond what your local doctor might offer. Remember that the right specialist with the right tools can make all the difference.

Call our Leg Saver hotline at 1-833-PAD-LEGS for personalized guidance from our team of PAD warriors and medical experts. Join our support community at PADSupportGroup.org to connect with others who understand what you’re going through. Visit our YouTube channel at youtube.com/thewaytotheheart to learn about treatment options, hear from specialists like Dr. Phillips, and be inspired by stories like Patrick’s.

Your legs are worth fighting for. Don’t stop until you find a doctor who won’t stop fighting for them too.

Disclaimer:

Save My Piggies is a series of real patients and professionals sharing their individual experiences.

Individual results may vary, patient testimonials are not claimed to represent typical results or guarantee that anyone will achieve the same or similar results.

This series is for educational purposes only and any advice offered is not a substitute for medical advice from your own supervising physician. Do not act on any information provided in this series without the explicit consent from your healthcare team.

For information on vascular diseases go to www.PADhelp.org.

A crisis is unfolding in American healthcare that has remained largely hidden from public view despite its staggering human and economic costs. Every year, approximately 150,000 Americans undergo lower limb amputations due to advanced stage peripheral artery disease (PAD)—a condition likened to “cancer of the legs” by medical professionals. With lifetime healthcare costs exceeding $100 billion, these amputations represent both a human tragedy and economic burden. What’s particularly alarming is that PAD affects nearly 20 million Americans, making it more prevalent than breast cancer, prostate cancer, and colon cancer combined, yet it receives a fraction of the attention and research funding.

What most don’t realize is that many of these life-altering surgeries are potentially preventable—if patients could access the advanced care they need. At the center of this crisis is a troubling trend: insurance giants like Humana (NYSE: HUM), Aetna, a CVS Health Company(NYSE: CVS, UnitedHealthcare (NYSE: UNH), and various Blue Cross Blue Shield Association (Especially Blue Cross Blue Shield of Michigan led by CEO Tricia Keith where a patient, Scott, tells me they dropped the CLI Operator who saved his leg) have Medicare Advantage plans that are systematically restricting access to advanced limb-saving procedures while readily funding amputations.

Humana's latest policy limitations I recently obtained, created by a team now led by CEO Jim Rechtin are a great example of what's happening where they target sophisticated techniques that can restore blood flow to dying tissue in the lower legs and feet—the very procedures that represent the last hope for patients facing limb loss.

For investors and industry watchers, this isn’t just a medical issue—it’s a case study in how misaligned incentives create enormous market inefficiencies and human suffering, while simultaneously opening opportunities for disruptive innovation.

The Growing Epidemic Nobody’s Talking About

What makes this situation particularly alarming is the perfect storm brewing in American health. We’re witnessing an unprecedented rise in late-stage peripheral artery disease (PAD), known clinically as critical limb-ischemia (CLI). While PAD traditionally affected larger vessels above the knee, the current epidemic is manifesting as a “bottoms up” disease pattern—primarily targeting the smaller vessels in the foot and calf first.

This shift to predominantly below-knee, smaller vessel disease is critically important because the evidence base and treatment guidelines for these anatomical regions haven’t kept pace with the disease’s evolution. Current treatment protocols were largely developed for larger vessel disease, while this new wave of smaller vessel disease presents unique challenges that require specialized approaches.

Driving this surge are two major risk factors reaching epidemic proportions: diabetes and chronic kidney disease. These conditions specifically damage smaller vessels and often present without the classic progression of leg cramps or intermittent claudication that responds to walking therapy and medication. Instead, patients suddenly appear with non-healing wounds or debilitating nighttime pain when the only remaining options are advanced intervention or amputation.

The tragedy? When insurance restricts coverage for specialized below-knee and foot procedures, they’re effectively removing every option except amputation from the physician’s toolkit.

The Technology Insurance Doesn’t Want You to Access

When PAD advances to critical stages, especially in the smaller vessels below the knee and in the foot, specialized techniques become necessary to restore circulation.

These advanced limb salvage procedures include atherectomy (precision devices that remove arterial plaque), specialized balloon angioplasty, and targeted drug delivery systems. For patients with severe disease, these techniques often represent the difference between keeping a limb and losing it.

The technical challenge of treating these vessels cannot be overstated. The vessels below the knee and in the foot are often no wider than a coffee stirrer, making standard approaches frequently inadequate for restoring blood flow effectively.

But Humana’s policy—citing “insufficient evidence” on the use of these limb salvage tools and techniques—now restricts coverage for these procedures in precisely the anatomical areas where they’re most needed.

Really?

This creates an absurd scenario where insurance will not cover the cost of advanced procedures that might save a limb based on ‘insufficient evidence.’

Yet there’s plenty of evidence that shows that not saving it will increase a patient’s mortality rate.

The Evidence Double Standard

The most troubling aspect of this crisis may be the selective scrutiny of evidence by insurance companies. When it comes to limb-saving procedures, insurers demand gold-standard proof, but when it comes to amputations—which carry significantly higher mortality rates—they require virtually no evidence at all.

Humana’s recent policy limiting coverage for atherectomy in infrapopliteal arteries claims there is an “absence of current, widely-used treatment guidelines or acceptable clinical literature examining benefit and long-term clinical outcomes.” This statement is demonstrably false. A comprehensive systematic literature review presented at VIVA 2024 identified over 300 original research articles on atherectomy outcomes, including high-quality meta-analyses, randomized trials, and multicenter observational studies. One meta-analysis specifically demonstrated that atherectomy followed by drug-coated balloon angioplasty reduced amputation risk by 44% compared to drug-coated balloon angioplasty alone.

Yet Humana and other insurers conveniently ignore this substantial body of evidence while selectively citing research such as by Dr. Caitlin Hicks of Johns Hopkins. Her retrospective analysis of Medicare data suggested a correlation between certain interventional procedures and subsequent amputations. It's important research taken out of context by insurance companies. Insurers have seized on this association to claim that procedures like atherectomy might actually increase amputation risk—despite the fact that the correlation made doesn’t prove causation, especially in retrospective analyses. Plus, the patients in question who are being denied these procedures are already a toe stub away from amputation, not in the early 'intermittent claudication stage.'

What these insurers fail to mention is that Dr. Hicks herself acknowledges that “atherectomy has its time and place” and can be appropriate in certain cases. Her concern was about potential overuse in patients with mild symptoms (which is also a very serious issue), not about denying these procedures to patients facing imminent limb loss. Yet insurance companies have leveraged research like hers to create barriers for all patients, including those for whom these procedures represent the last hope to save a limb.

The insurance double standard becomes even more striking when you look at what they’re willing to approve without question. Research by Dr. Eric A. Secemsky, MD, MSc, RPVI, FACC, FAHA, FSCAI, FSVM of Beth Israel Deaconess Medical Center revealed that more than 60% of amputations are performed without any attempt to restore blood flow in the year prior to amputation, with 90% occurring without a vascular evaluation at all. So, the majority of amputations are performed not due to too many attempts to save the limb, but none at all. Yet these amputation procedures receive automatic insurance approval with no questions asked -- even though this physician behavior does not align with American Heart Association and Society for Vascular Surgery guidelines which state that a full vascular evaluation should be performed AND an attempt to restore inline blood flow should be made prior to any amputation.

It’s important to emphasize that there is absolutely no credible medical evidence suggesting that proceeding directly to amputation without attempting revascularization leads to better outcomes. In fact, all available data points in the opposite direction—patients who receive interventional procedures have better survival rates, better quality of life, and better functional outcomes than those who undergo primary amputation. Yet insurance companies continue to create barriers to these procedures while fast-tracking amputations, a policy stance completely unsupported by medical evidence.

The contrast is impossible to ignore: insurance companies express grave concern about interventional procedures potentially leading to amputation in some cases, yet show zero concern about the vastly more common practice of proceeding directly to amputation without trying any limb-saving measures first.

Humana’s policy even explicitly rejects innovative “last chance” interventions like deep vein arterialization—procedures that may represent the final hope for patients who have exhausted all conventional options. This policy flies in the face of clinical evidence from multiple studies, including the PROMISE I early feasibility study and the ALPS Multicenter Study, which demonstrate that deep vein arterialization significantly improves amputation-free survival by up to 29% in “no-option” patients who would otherwise face certain amputation. When Humana claims there’s “insufficient evidence” for these procedures, they’re deliberately ignoring robust clinical data that could save patients’ limbs and lives.

This approach of applying extraordinarily high evidence standards to limb-saving procedures while requiring virtually no evidence for amputation authorization speaks volumes about the company’s true priorities.

The mortality implications of this double standard cannot be overstated. Research from the Journal of Vascular Surgery shows that patients undergoing primary amputation face mortality rates approaching five times that of the general diabetic population, with a startling 48% mortality rate within just one year of major amputation. Even more concerning, the five-year survival rate after major lower extremity amputation can be as low as 30-35%, worse than many forms of cancer.

These alarming mortality statistics further strengthen the case for limb salvage. Studies consistently demonstrate that patients who receive successful limb-saving procedures have significantly better outcomes, with research showing that 74% of patients maintain or improve their ambulatory status following limb preservation. This improved mobility is critical—especially considering that 3 in 5 people who suffer heart attacks have PAD, and maintaining ambulation significantly reduces cardiovascular mortality.

The situation has become so egregious that it demands a new level of oversight. When insurance companies selectively interpret evidence to deny life-altering procedures—particularly when their policies directly contradict the recommendations of multiple medical societies—patients deserve transparency. At minimum, insurers like Humana should be required to have their evidence standards and policy-making data reviewed by an independent government board, ensuring that coverage decisions aren’t being driven purely by financial considerations.

This isn’t about whether a specific procedure deserves universal approval—it’s about applying consistent evidence standards across all treatment options. When insurance companies readily approve amputations without requiring evidence of attempted limb salvage, while simultaneously denying coverage for procedures that might prevent those same amputations, the message couldn’t be clearer: insurance policies favor immediate amputation over evidence-based limb preservation, regardless of what medical science or professional guidelines recommend.

The Financially Perverse Healthcare Market

When you examine this behavior from a financial perspective, perhaps this “Let’s not bother” mentality versus “Let’s try” to save a leg mentality makes sense for insurance companies.

At first glance, however, it may defy logic.

An amputation costs approximately $30,000 to $40,000 in immediate surgical expenses. However, the lifetime cost of an amputation—including prosthetics, rehabilitation, home modifications, and lost productivity—often exceeds $500,000 per patient.

Advanced limb salvage procedures typically cost between $10,000 and $20,000. Even accounting for potential reinterventions, the cost-benefit analysis overwhelmingly favors attempting limb preservation first.

So why would insurers prefer the more expensive long-term option? The answer reveals troubling incentives within our healthcare system. The financial calculus becomes clearer when examining medical outcomes data. Research shows that patients who undergo amputations face dramatically higher mortality rates—studies document one-year mortality rates between 38.3% to 40%. By three years post-amputation, mortality rates exceed 60%.

This high mortality rate is linked to the significant burden of comorbidities in these patients. Those undergoing major amputations for CLI typically have multiple chronic conditions that are already costly to treat—diabetes, cardiac disease, and renal failure chief among them. The decline in mobility following amputation further accelerates cardiovascular decline.

When a patient dies within a year or two of amputation, the insurer avoids hundreds of thousands in long-term care costs. The math is brutal but straightforward: pay $40,000 for an amputation now, or risk ongoing treatments for a patient with multiple chronic conditions who might live for years with an intact limb.

What’s even more troubling is that now, instead of following through on recent agreements with HHS Secretary RFK Jr. to minimize pre-authorization barriers, insurance companies are simply dropping physicians who specialize in these limb-saving procedures from their networks entirely. This effective elimination of specialists represents a disturbing new tactic—one that circumvents any promise of streamlining approvals by removing patient access to qualified providers in the first place.

The insurance company calculus ignores what any patient would tell you: “I’d rather you give it the grand old try to save my leg versus taking the lazy way out and just cutting it off, even if it means multiple procedures.”

Shouldn’t healthcare be about improving the quality of life for patients?

The Human and Economic Cost: Real Lives at Stake

Behind the statistics and market dynamics are real patients whose lives are permanently altered by these policies. These aren’t just abstract economic calculations—they represent thousands of Americans caught in a system where insurance decisions override physician expertise, often with devastating consequences.

Consider Thomas from Louisiana, whose doctor has successfully kept him ambulatory for three years through periodic minimally invasive procedures—despite his first physician recommending immediate amputation. Thomas maintains an active lifestyle, continuing to work and exercise regularly. Yet each time he needs a procedure—typically when pain already wakes him from sleep—his insurance company forces him to endure weeks or months of waiting for approval.

In his most recent experience, after enduring two months of nightly suffering, his insurer denied the minimally invasive procedure his specialist recommended, instead suggesting a major bypass surgery. This decision came from a doctor who had never examined Thomas, spoken with him, or reviewed his complete medical history—despite clear documentation that Thomas is not a surgical candidate. The only approach that works for him is periodic interventional procedures, combined with walking and medication.

Another patient’s story reveals how delays can be catastrophic. After presenting with a gangrenous toe, her doctor recommended using balloon angioplasty and atherectomy to restore blood flow through the small vessels below her knee. The insurance company initially denied the procedure. Though they eventually approved it after a peer-to-peer review, the delay proved devastating. By the time approval came through, the patient had already undergone a below-knee amputation. The hospital doctor, unfamiliar with below-knee revascularization techniques, had convinced her that saving her leg wasn’t possible.

If only insurance had approved the procedure by a doctor who would at least follow Society for Vascular Surgery and American Heart Association guidelines to at least try to restore inline flow prior to amputation, she might have a better quality of life.

Instead, she is suffering both physically and emotionally enduring a long recovery in a rehabilitation facility away from her family. The emotional and psychological impacts of an amputation are real. Amputations inflict profound psychological wounds that often parallel the physical trauma itself. Approximately 21-35% of amputation patients experience clinical depression, significantly higher than the 10-15% rate in the general population, with many also developing anxiety and post-traumatic stress disorder due to altered body image and perceived loss of independence. The emotional journey mirrors the intense grief experienced after losing a loved one, as patients struggle with a distorted sense of self, social isolation, and the devastating fear of being seen as "incomplete" - psychological effects that can persist long after the physical wounds have healed.

Even worse, for the 85% of patients with diabetes, the amputation often accelerates the decline of other systems. That increases the economic toll far beyond the initial amputation cost -- increasing hospitalization rates and medication requirements. Many amputees also require extensive modifications to their homes and vehicles. Plus, they face significantly reduced earning capacity—over 60% never return to full employment.

So, when we talk about a $100 billion amputation crisis, we’re discussing not just healthcare spending, but the collective human and economic toll on individuals, families, and communities across America.

Policy Solutions and Market Innovation

Addressing this crisis requires a multi-pronged approach, with both policy reforms and market innovations working in concert. The ARC Act represents one important component—by mandating PAD testing for all patients with high-risk factors, it would enable early detection and intervention before patients advance to critical stages. Early detection means early treatment that can stall disease progression, even for those with diabetes and chronic kidney disease.

However, we can’t wait for a single comprehensive solution. We must act now on multiple fronts to address the insurance bottleneck that’s costing patients their limbs and lives. We need to ensure insurance companies support doctors’ efforts to save limbs, even if that means multiple procedures for some patients.

If insurers truly care about evidence-based medicine, they should apply the same rigorous standards to all procedures—including amputations. They should demand vascular evaluation before approving any amputation, in accordance with clinical guidelines. They should eliminate the practice of retroactive denials after providing authorization. Most importantly, they should acknowledge that their primary expertise is in finance, not medicine—and defer to qualified clinicians on complex treatment decisions.

From a policy perspective, Medicare and regulatory agencies should consider:

• Requiring adherence to clinical guidelines before amputation approval

• Implementing true value-based payment models that reward limb preservation

• Creating transparency requirements around network adequacy for limb preservation specialists

• Reforming insurance incentives so that the financial burden of poor long-term outcomes from amputation remains with the insurer who denied limb-saving care

For investors and industry leaders, the opportunities lie in:

• Value-based care models specifically targeting amputation prevention

• Technology innovations that can navigate the challenging below-knee and foot vessels

• Telehealth platforms connecting patients with limb preservation specialists regardless of geography

• Data analytics solutions that identify high-risk patients before emergent situations develop

These policy and market solutions represent more than just business opportunities—they offer a path to realigning our healthcare system around what should be its primary goal: preserving life and function.

The fundamental question isn’t whether atherectomy or any specific procedure deserves blanket approval. It’s whether we want a healthcare system where insurance companies increasingly control treatment decisions while applying wildly inconsistent evidence standards depending on financial implications.

As I recently wrote to our patient community: “The BIGGEST reason people are losing limbs to amputation is NOT because they’re getting too many endovascular procedures. It’s because they’re getting too few or NONE AT ALL.” This isn’t just my opinion—it’s what the hard data shows.

Would we accept an insurance company telling cancer patients they’ve had too many chances at survival? Of course not. So why is “cancer of the legs” treated differently?

We need accountability on BOTH sides—for those doing too many procedures AND for those too quick to amputate. But dropping dedicated specialists from networks only hurts the patients who need them most.

For those facing limb loss, the stakes couldn’t be higher. Every day that insurance companies delay appropriate care, patients move closer to preventable amputations. Every policy that restricts physician options without meaningful clinical input potentially condemns patients to unnecessary disability.

As patients, investors, and industry leaders, we must demand greater transparency around coverage decisions, question policies that substitute administrative judgment for clinical expertise, and recognize when evidence is being selectively interpreted to justify predetermined financial outcomes.

For PAD patients specifically, we must ensure access to the full range of treatment options appropriate for their individual situations—before it’s too late. Because in the battle between insurance profits and patient limbs, there’s no question which should take priority.

References:

Secemsky EA, et al. Association of Lower Extremity Endovascular Revascularization With Major Adverse Limb Events and Mortality. JAMA Netw Open. 2022;5(8):e2226561.

American Medical Association. 2023 AMA Prior Authorization (PA) Physician Survey. AMA Advocacy Resource Center.

Barshes NR, et al. The contingent value of a lower extremity amputation: a preliminary economic model of clinical and economic factors. Journal of Vascular Surgery. 2019;70(5):1648-1657.

Society for Vascular Surgery. Global Vascular Guidelines on the Management of Chronic Limb-Threatening Ischemia. Eur J Vasc Endovasc Surg. 2019;58(1S):S1-S109.e33.

Creager MA, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease. Circulation. 2019;140:e596–e646.

Carr J, Secemsky E, et al. A Systematic Review of Peripheral Atherectomy: Evidence and the Opportunity for Future Guidance. Presented at VIVA 2024.

Fanelli F, et al. Atherectomy for Lower Limb Revascularization: A Systematic Review and Meta-Analysis. Journal of Endovascular Therapy. 2023;30(2):211-224.

Clair DG, et al. PROMISE I: Early feasibility study of the LimFlow System for percutaneous deep vein arterialization in no-option chronic limb-threatening ischemia: 12-month results. J Vasc Surg. 2021;74(5):1626-1635.

Schmidt A, et al. Midterm outcomes of percutaneous deep venous arterialization with a dedicated system for patients with no-option chronic limb-threatening ischemia: the ALPS Multicenter Study. J Endovasc Ther. 2020;27(4):658-665.

McKechnie, P. S., & John, A. (2014). Anxiety and depression following traumatic limb amputation: A systematic review. Injury, 45(12), 1859-1866. https://doi.org/10.1016/j.injury.2014.09.015.

When news broke about former President Donald Trump’s diagnosis of chronic venous insufficiency (CVI), many Americans had the same reaction: “What is that?” This widespread confusion is precisely why this high-profile case matters to healthcare entrepreneurs and investors. Trump’s diagnosis has inadvertently spotlighted a massively underserved market that affects billions worldwide yet remains virtually invisible in medical education and healthcare investment landscapes.

In a recent interview for our “What’s Up Doc” series, I spoke with Dr. Deepak Sudheendra of 360 Vascular in Ohio, a leading expert on venous and arterial disease. What he revealed about the gaps in CVI diagnosis, treatment, and reimbursement exposes not just a healthcare failure but a substantial market opportunity for innovative companies.

The $3B+ Market Hiding in Plain Sight

“One in four adults will develop CVI in their lifetime,” Dr. Sudheendra explained during our conversation. “But when you add in risk factors like being overweight, having multiple pregnancies, or working in occupations where you’re sitting or standing all day—which is most of us—and include genetics, then it could be up to 90% of the population depending on the demographic you’re studying.”

This translates to potentially billions of people worldwide with a condition that significantly impacts quality of life but receives minimal attention in healthcare systems. The global compression therapy market alone is projected to reach $3.9 billion by 2026, growing at a CAGR of 5.2% from 2021, according to Markets and Markets research.

The Education Gap Creating Market Inefficiency

Unlike peripheral artery disease (PAD), which we discuss frequently at the Global PAD Association, CVI isn’t commonly taught in medical schools or residency programs. Dr. Sudheendra’s experience highlights this systemic failure: “When I have medical students rotate with me, I ask them questions about chronic venous insufficiency. Nine times out of ten, nobody can answer any questions other than, ‘Oh, I have seen varicose veins.’”

This education gap creates a market inefficiency where patients often go undiagnosed or misdiagnosed for years. For entrepreneurs and investors, this represents a classic opportunity: a large, underserved population combined with a systemic failure to address their needs.

The Diagnostic Obstacle Course: A Technology Opportunity

Proper diagnosis of CVI requires a standing venous reflux ultrasound—a test many facilities don’t perform correctly. “If you’re doing a proper venous ultrasound, it will be about a 45-minute to one-hour exam,” Dr. Sudheendra noted. “The vast majority of places will do it lying down, and then you don’t get the information you need.”

Why don’t more facilities perform this test correctly? Dr. Sudheendra identified a key market failure: “When you order a standing reflux ultrasound, there is no separate code for it. It is the same code as a DVT study. Now, the DVT study takes 15 minutes. A reflux ultrasound takes about 70 minutes to do properly. And you get the same payment.”

This reimbursement disparity creates a disincentive for proper diagnosis—a problem ripe for disruption through technology that could make standing ultrasounds more efficient or through advocacy for updated reimbursement codes.

The $50B Chronic Disease Management Opportunity

What makes CVI particularly interesting from a business perspective is its chronic nature and progression. Dr. Sudheendra outlined six stages of vein disease, from purple spider veins to ulcers, noting: “It can take maybe 40 years to go from stage one to stage six. But what amazes me is in 40 years, not one physician addressed venous disease.”

This lengthy progression represents a massive opportunity in the chronic disease management space, which Grand View Research values at over $50 billion globally. Companies developing long-term monitoring solutions, patient engagement platforms, or even specialized wearable devices could capture significant value in this untapped market.

Prevention Economics: The Business Case for Early Intervention

The economics of CVI prevention are compelling. Compression stockings—which Dr. Sudheendra recommends for “everybody on Earth”—represent a simple, non-invasive intervention that could prevent or delay the need for more expensive procedures.

“In general, we don’t want to do unnecessary procedures on people,” he explained. “So if there are things that we can do to minimize our chances of having to get a procedure later on in our life, why not take it?”

This prevention-focused approach aligns perfectly with value-based care models gaining traction throughout healthcare. For businesses developing consumer health products or preventive care solutions, the CVI market offers substantial opportunity with relatively low regulatory barriers compared to more invasive interventions.

The Innovation Gap in Treatment Options

While current treatments for CVI include compression therapy, lifestyle modifications, and various minimally invasive procedures like vein ablation and venous seal, the field lacks the innovation we’ve seen in other specialties.

“Vein stripping surgery, which I have done—the last one I did, I think, was 2001 or 2002—is rarely done now,” Dr. Sudheendra noted. “What’s considered the gold standard is vein ablation or thermal ablation.”

However, these procedures still have limitations and side effects. The relative stagnation in treatment innovation points to opportunities for medical device companies and pharmaceutical developers to create next-generation solutions for this massive patient population.

The Business Imperative: Addressing CVI as a Workforce Health Issue

For business leaders, CVI’s impact on workforce productivity deserves attention. Dr. Sudheendra shared a telling anecdote about a cardiac surgeon colleague who considered early retirement due to leg pain from undiagnosed CVI: “He said, ‘I may have to retire from surgery in the next couple years. I thought I would make it to 65. I’m 57. I just cannot stand. My legs ache so bad.’”

This productivity impact multiplied across billions of potential sufferers represents a substantial economic burden—and an opportunity for workplace health programs and benefits innovations that specifically address vascular health.

The Path Forward for Entrepreneurs and Investors

President Trump’s diagnosis brings momentary attention to CVI, but creating lasting change—and capturing the associated market opportunity—requires sustained innovation and advocacy.

For entrepreneurs entering this space, several avenues appear particularly promising:

1. Diagnostic technology innovations that make standing venous reflux tests more efficient or create new diagnostic approaches

2. Reimbursement and healthcare policy advocacy to address the payment disparities that discourage proper diagnosis

3. Consumer-friendly compression therapy products that overcome the adoption barriers Dr. Sudheendra noted

4. Digital health platforms for long-term CVI monitoring and management

5. Workplace health programs specifically addressing vascular health

6. Next-generation minimally invasive treatments that improve upon current procedures

The Bottom Line: A Blue Ocean Opportunity

President Trump’s CVI diagnosis, while seemingly minor in the context of his overall health, illuminates a blue ocean opportunity in healthcare. The combination of high prevalence, low awareness, diagnostic challenges, and treatment gaps creates ideal conditions for disruptive innovation.

“For a condition that affects literally billions and billions of people around the world,” Dr. Sudheendra remarked, “it’s still amazing to me that it’s just not taught.”

This education gap extends beyond medical schools to healthcare investors and entrepreneurs. Those who recognize the scale of the CVI opportunity now have a chance to create significant value—both financially and in terms of improved quality of life for the countless people affected by this overlooked condition.

References:

1. Markets and Markets. (2021). “Compression Therapy Market by Technique, Product, Application - Global Forecast to 2026.”

2. Grand View Research. (2022). “Chronic Disease Management Market Size Report, 2022-2030.”

3. Eberhardt, R. T., & Raffetto, J. D. (2014). “Chronic venous insufficiency.” Circulation, 130(4), 333-346.

4. Rabe, E., et al. (2018). “Epidemiology of chronic venous disorders in geographically diverse populations: results from the Vein Consult Program.” International Angiology, 37(1), 32-42.

5. American Venous Forum. (2020). “Guidelines for Management of Venous Disorders.”

In our recent “Save My Piggies” segment on “The Heart of Innovation,” Mike and his mother Debra shared their parallel journeys with peripheral artery disease. Their story isn’t just about blockages in arteries—it’s about blockages in care access, information flow, and emotional support that must be addressed alongside technological innovation.

The Diagnosis: When Google Becomes Your Doctor

“I went on Dr. Google around November last year because the pain wasn’t easing at all,” Mike explained during our conversation. “The first things that were coming up with the leg cramp was PAD.”

For Mike, this Google search was especially terrifying because PAD wasn’t just some abstract medical condition—it was the same disease that had cost his mother her leg in 2014. This personal connection turned what might have been concerning information into a deeply frightening possibility.

This first touchpoint highlights a critical reality: most patients are introduced to PAD not by healthcare professionals but through their own research. This is partly because, as I noted during our show, “More than 70% of people in the US alone don’t even know about PAD.” Even more troubling, “many doctors are even brushing it off as back issues, old age, or just part of diabetes.”

The awareness gap creates a dangerous scenario where patients either don’t recognize symptoms until the disease is advanced or, like Mike, face the terrifying experience of self-diagnosis without proper context or support.

The Healthcare Maze: Navigating Critical Gaps in Care

Mike’s journey through the UK healthcare system reveals problems that extend beyond national boundaries. When he returned to the UK in January, his general practitioner promptly ordered an Ankle-Brachial Index (ABI) test, which confirmed suspicions of PAD.

The doctor immediately started Mike on statins, blood pressure medication, and low-dose aspirin—all standard protocol. But then came the waiting game for a specialist consultation, which in the UK can stretch to 18 months. This gap between diagnosis and specialist care creates what I call the “PAD limbo”—a period where patients know something is seriously wrong but lack expert guidance on what to do about it.

“In the UK, you have to wait sometimes 12 to 18 months to actually see a vascular surgeon,” I explained during our conversation. “And that wait time, you’re noticing every nuance. You’re noticing that little extra burning in one foot and tingling in the other.”

For Mike, the fear of ending up like his mother drove him to take drastic action. Rather than waiting for his scheduled appointment, he went to the Accident & Emergency department (A&E) when he noticed his feet turning “multicolored underneath” after shopping. This emergency visit connected him with a different pathway to care.

“An A&E doctor saw me,” Mike explained. “And she referred me straight away to a vascular hot clinic, which was three or four days after that, where I went in for an ultrasound scan.”

It was during this ultrasound at the hot clinic that they discovered a 75% narrowing in his superficial femoral artery, confirming the PAD diagnosis with specific detail about the blockage’s location and severity.

The vascular doctor Mike saw did provide some basic lifestyle guidance—telling him to quit smoking, start walking, and change his diet. However, this advice lacked the detailed, practical guidance he needed. There was no structured exercise plan, no specific nutritional recommendations, and no clear explanation of how these changes would affect his condition. He was essentially given broad directives without a roadmap for implementation.

This limited guidance highlights a persistent problem in PAD care: even when patients overcome access barriers, they often receive fragmented or generalized advice that doesn’t provide the comprehensive, practical direction needed to effectively manage their condition.

The Online Spiral: From Fear to Empowerment

With only basic guidance and mounting anxiety, Mike turned back to the internet—where things initially got worse before they got better.

“All you have to go on is Dr. Google that tells you that you’re going to be dead in five years with a PAD diagnosis,” I noted during our conversation.

And that’s exactly what Mike found. Websites with alarming statistics like “PAD patients have a 5-year mortality rate of up to 30%” or articles stating “One in three PAD patients won’t survive beyond 5 years after diagnosis” dominated his search results. Without context explaining that these figures primarily apply to the most severe cases with multiple risk factors, Mike—like countless other newly diagnosed patients—assumed the worst about his own prognosis.

This grim outlook deepened his emotional crisis. “I was just lying on the couch every single day, not moving. I was just doing my treadmill and just getting on the couch. And just crying. And just crying and wondering what was going to happen.”

But the internet that first terrified him ultimately became his lifeline when he discovered patient communities. Through the Global PAD Association’s Facebook groups and several other organizations’ online communities, Mike found what his formal healthcare couldn’t provide: comprehensive guidance on improving his prognosis naturally and real-time support from others walking the same path.

“I’ve had loads of decent advice, especially off these guys that are on the chat,” Mike shared, referring to fellow patients in these support groups. “Alan, Douglas and Marie and Josh… they’ve all been massive, massive help to me over the last few months and they brought me away from my depression sometimes with personal calls.”

Through communities at padsupportgroup.org, walkingsupportgroup.com, and other patient-led groups on Facebook such as PAD/PVD and Exercise Regiment for Peripheral Artery Disease, Mike gained diverse perspectives that all reinforced a consistent message: lifestyle modifications aren’t just supplementary—they’re the foundation of effective PAD management. By synthesizing information from these various sources, he crafted a personalized strategy that worked for his specific circumstances.

This peer support filled critical gaps in his care journey—providing emotional support when he was at his lowest, practical advice on lifestyle modifications, and reassurance from those who had walked the same path.

The Emotional Fallout: PAD’s Invisible Symptom

But even with peer support and expert guidance from online communities, the psychological toll of Mike’s journey continues to affect him daily. This is not unusual—research shows that the psychological burden of PAD is both significant and widespread.

A 2025 study published in BJPsych Open found that 26.8% of PAD patients meet clinical thresholds for anxiety or depression, more than double the rate in the general population over age 65. Another study in the Journal of Vascular Nursing reported that PAD patients score particularly low in quality-of-life measures related to self-concept and feelings. This clinical evidence confirms what Mike’s experience illustrates so vividly—PAD is not just a physical condition but an emotional journey marked by fear, uncertainty, and psychological distress.

“When I get up in the morning, I check my pulses. I check my pulses every single morning in my groin, in my ankle, in my feet, just to make sure that it’s still there and I’m not losing any kind of circulation. It’s an OCD thing,” Mike explained.

His mother confirmed the severity of his emotional struggle: “Just worried about him, worried about his mental health for a long time because he did sort of hit rock bottom.”

This psychological dimension of PAD remains largely unaddressed in conventional care pathways. Yet it significantly impacts treatment adherence, lifestyle modifications, and ultimately, outcomes. As the Global PAD Association’s PAD Warrior Task Force Chairman said in our last PAD Leg Saver Hotline episode: “How can you get motivated to walk, walk, walk through the pain, when you fear the pain you are walking into? Even more, how do you quit smoking when smoking is what you do to ease stress and anxiety and a diagnosis like PAD increases stress and anxiety. We need support.”

Psychological support and counseling is something that Consultant Vascular Surgeon and PAD Researcher Dr. Ankur Thapar recently addressed in an interview on our “What’s Up Doc” series for UK patients. He said, “We understand how important it is to support the emotional and mental part of being diagnosed with a chronic illness like PAD and we try to integrate support into our limb salvage program.”

More programs do need to consider doing the same. But hearing Dr. Thapar’s acknowledgement of this aspect of PAD is a big step in care as it’s likely others will see his success and follow suit.

Learning from Experience: The Procedure Paradox

Psychological support is particularly crucial for patients like Mike, whose family history creates an added layer of fear. With proper emotional guidance, patients can find the courage to “take the bull by the horns”—as Dr. Phillips put it—and embrace the lifestyle changes that often render invasive procedures unnecessary. This mental shift from fear to empowerment can be transformative, allowing patients to realize that much can be accomplished through their own actions, without ever needing a needle or knife.

Mike’s apprehension about following his mother’s path is entirely understandable. Yet ironically, her experience offers one of the most powerful lessons about PAD treatment that vascular specialists increasingly emphasize: sometimes the most aggressive interventions can lead to the worst outcomes.

Debra’s experience with PAD, beginning with her diagnosis in 2011, reflects an approach that many patients still assume is best—addressing blockages through immediate interventional procedures.

“I had the stents put in,” Debra recounted. “I had the blockage removed in my artery, had stent put in. Then a year later, had a larger stent. And the year after having a larger stent, then I had the femoral artery bypassed.” Despite these multiple interventions, she ultimately lost her leg below the knee in January 2014.

Dr. Phillips explained why this cascade of procedures often leads to worse outcomes: “As soon as you have one procedure, you’re pretty much guaranteed another one… each time you intervene, you can flick a little debris and it can close one… Now you’ve damaged the arteries past it into the foot. And that’s when people get into trouble.”

This insight has led Dr. Phillips and many leading vascular specialists to advocate for a more conservative approach that prioritizes lifestyle modifications over early intervention. When advising Mike, Dr. Phillips’ guidance was clear and direct: “You need to put off any procedure as long as you can.”

This advice represents a crucial perspective shift that both patients and industry professionals must understand: the first response to claudication shouldn’t be to “fix” the blockage but to help the body adapt to it and potentially develop its own natural bypasses through consistent exercise.

While advanced minimally invasive technologies certainly have their place for patients with critical limb ischemia or those who don’t respond to conservative measures, Debra’s experience demonstrates why they shouldn’t be the automatic first-line response. The best approach to PAD often isn’t the most technologically sophisticated but the most physiologically harmonious.

Lifestyle as Medicine: The Patient’s Power

So far, Mike's comprehensive lifestyle changes are proving successful.

“I’ve changed my diet in a massive way,” Mike explained. “I stay away from any fried food, any pre-made meals… I’ve started eating a lot more vegetables… a lot more salad… a lot of salmon, a lot of white fish… a lot of chicken. I’ve cut back on red meat.”

Combined with his exercise regimen—“an hour and 40 minutes on the treadmill every single morning”—and quitting smoking “cold turkey,” these changes have transformed his health profile. “I’ve had a recent blood test last month, and they’ve come back into range. They’ve practically halved because of everything that I’ve been doing.”

Mike’s mother Debra expressed pride in her son’s response to his efforts: “I’m super proud of him because he gave up smoking cold turkey… And he needed to do, and he’s done the best thing. He’s stopped smoking, he’s walking, he’s exercising, and he’s eating healthy.”

Dr. Phillips also praised Mike for his lifestyle changes.

“I could sense in your voice that you’re a little bit scared, taking it day by day,” Dr. Phillips observed before offering affirmation for his path, “Based on my experience and what you are doing right now and the fact that it sounds like you can feel your pulses still in your foot, that’s a huge indicator that your blood flow is okay… you’re going to be okay.”

The relief in Mike’s response was palpable: “I appreciate that, doctor. Thank you.”

If only he had this type of affirmation from his own healthcare team -- This moment highlights how powerful even brief specialist guidance can be for PAD patients—and how technologies that expand access to such guidance could transform the patient experience during those critical waiting periods to improve adherence to these life and limb-saving lifestyle modifications.

The Path Forward: Comprehensive PAD Care

Mike’s journey reveals a critical truth for all stakeholders in PAD care: our current fragmented approach places an enormous burden on patients. Despite receiving a diagnosis and basic medical intervention, Mike had to piece together his own comprehensive care plan—finding detailed lifestyle guidance through online communities, battling psychological distress largely on his own, and waiting months for expert reassurance about his prognosis.

This gap between what patients need and what our healthcare systems currently provide represents both a challenge and an opportunity for innovation. The most impactful advances won’t come from developing incrementally better stents or atherectomy devices, but from creating integrated care pathways that address the full spectrum of patient needs from diagnosis through long-term management.

For patients with intermittent claudication like Mike, this means prioritizing robust lifestyle support programs that provide structured exercise guidance, detailed nutritional counseling, and psychological resources to manage the anxiety that often accompanies diagnosis. Such programs could significantly improve adherence to the very interventions that might help patients avoid invasive procedures altogether.

For those who eventually require intervention, Debra’s experience demonstrates why we must develop technologies and approaches that minimize the cascade effect of procedures leading to complications. This means not just creating “better” devices, but fundamentally rethinking when and how we intervene—always with the goal of preserving long-term vascular health rather than simply addressing immediate blockages.

Most importantly, these innovations must be grounded in the lived experiences of patients themselves. As Dr. Phillips explained, this is why the Save My Piggies initiative focuses on letting patients “tell their story. We say, you know, your life, your limb, your story.” These narratives reveal gaps in care that clinical trials and imaging studies cannot—illustrating the practical, emotional, and informational challenges that determine whether patients like Mike and Debra ultimately keep their limbs and maintain their quality of life.

So, in my opinion PAD care pathways are at a crossroads. We can continue developing incremental improvements to existing devices and procedures, or we can embrace a more holistic vision that addresses the entire patient journey. Mike and Debra’s story makes a compelling case for the latter—showing us that truly effective PAD care must integrate medical intervention, lifestyle support, psychological counseling, and expert guidance within systems that don’t leave patients to navigate these waters alone.

This is the future of PAD care: not just clearing blockages, but clearing pathways to comprehensive care that empowers patients while providing the support they need to truly thrive.

Kym McNicholas is an Emmy Award-winning journalist and CEO of the Global PAD Association. To learn more about the “Save My Piggies” initiative or to join our support communities, visit padsupportgroup.org and walkingsupportgroup.com.

References

1. Govekar SG, D’Souza JP, Kotian RR. Impact of peripheral artery disease on daily living: A study on knowledge, contributing factors and quality of life among patients. Journal of Vascular Nursing. 2025;43(2):73-79.

2. Bergman M, Bergman H, Busuttil A, Abdelkhalek H, White E. Prevalence of Cognitive Impairment and Mental Health Disorders in Peripheral Arterial Disease Patients: Implications for Surgical Outcomes. BJPsych Open. 2025;11(Suppl 1):S23.