“They told her it wasn’t possible to treat below the knee. They’re going to amputate her leg.”
That was a daughter calling our Global PAD Association leg-saver hotline on a Friday evening. She and her mother and her mother’s husband were sitting in their car, trying to decide which emergency room to drive to, because they couldn’t go back to the hospital that was planning to cut off her mom’s leg. The doctor had said the blockage was too far downstream, that small vessels below the knee simply couldn’t be treated. Case closed.
Except it isn’t true. And that call is exactly why Dr. John Phillips and I had just spent the week in Venice at the CLI-C conference, the annual event that Dr. Mariano Palena and Dr. Marco Manzi put together to educate physicians on the most advanced limb salvage techniques in the world. Physicians flew in from Ukraine, Romania, Egypt, Singapore, everywhere. Dr. Phillips has been going since 2014. It’s where he first learned to do the complex work below the knee that too many vascular doctors in the U.S. still insist isn’t possible. And until more of them learn otherwise, that daughter’s phone call won’t be the last.
We talked about all of it on this past Saturday’s episode of The Heart of Innovation on AM1220 KDOW, and it turned into one of the most powerful conversations we’ve had on the show.
For anyone new to this: we’re talking about Peripheral Artery Disease, or PAD, specifically its most dangerous form, Critical Limb Threatening Ischemia, or CLTI. Poor circulation in the leg arteries, caused by plaque buildup that blocks blood flow to the point where wounds can’t heal, tissue starts to die, and amputation becomes the only option on the table, at least for doctors who don’t know what they’re doing. Roughly 150,000 to 160,000 major amputations happen in the United States every year, and about half of them are from vascular disease. PAD is more prevalent and deadlier than most cancers combined, and most people have never heard of it. As Dr. Phillips said on the show, “We have a lot of work to do.”
That work is exactly what CLI-C is about. It isn’t a room full of doctors in suits watching PowerPoints. It’s live cases, real patients, physicians from all over the world watching and learning techniques in real time, including techniques that many U.S. doctors still insist aren’t possible. At this year’s conference I watched a physician access a tiny artery in the foot by going through the space between the big toe and the second toe, threading a wire up from below to try to restore blood flow. I had never seen that in my life. When I mentioned it on the show, Dr. Phillips told me he had done exactly that procedure two days prior.
He explained how it works. A 21-gauge needle, roughly the diameter of those calcified arteries themselves, gets inserted into the vessel. “The arteries have to be pretty calcified, at least have a kind of a core of calcium around them, so they’re stable, and you can kind of poke into it,” he said. “That stabilizes the needle, and you can get a little wire in there to hopefully get where you need to go.” European doctors, who often don’t have access to the advanced devices U.S. physicians rely on, have become extraordinarily skilled with the basics: a wire, a balloon, and a deep understanding of anatomy. “If you have a wire and you can get through the blockage, and you have a balloon, you can open it up,” Dr. Phillips explained. “Does it last forever? No. But typically it’s enough to help with wound healing and help prevent a minor or major amputation.”
Which brings us back to that mother sitting in the car on a Friday night, facing the loss of her leg because her doctor never learned any of this.
Treating vessels below the knee is possible. Not in every patient, not in every clinical situation, but in many. Going in through the foot, coming up from below, accessing arteries between the toes: these are real techniques that skilled operators perform regularly. Not trying, not even considering a retrograde approach, that isn’t a clinical decision. It’s a skills gap. And it’s why our listener Douglas called in during the show to ask the question that every PAD patient eventually needs to answer: how do you find a doctor who actually has these skills?
Don’t focus on title.
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.
