What We Get Wrong About Poor Circulation (with Vascular Surgeon Dr. Jackie Majors)

When people hear “poor circulation,” they often assume the answer is a procedure. Not so fast. In this episode of Knife Down, Dr. Jacqueline Majors and I talk about when opening a blocked artery helps, when it backfires, and why the real work of saving legs often starts long before the operating room.

We get into what patients with poor circulation, blocked leg arteries, leg pain with walking, smoking-related vascular disease, and diabetes actually need to know. We talk about when a procedure helps, when it can make things worse, why not every blockage should be opened, and how lifestyle change, medical therapy, and careful decision-making can sometimes save a limb better than another stent.

We also talk about what vascular surgery training gets right and what it misses, how Dr. Majors built a limb salvage-focused private practice, why strength training matters for vascular patients, and how to help people make meaningful changes without shame, perfectionism, or all-or-nothing thinking.

Dr. Jacqueline Majors, MD is a board-certified vascular surgeon, Co-Owner, and Director of Limb Salvage at Zenith Vascular & Fibroid Center in Memphis, Tennessee. She is CEO of Vascular Excellence, PLLC, a consulting firm spanning expert witness work and locum tenens. She is also Founder and CEO of AnatomyPad, a patient education and operative planning product. She has performed multiple first-in-state procedures in Tennessee, including absorbable stents, retrievable BTK stents, advanced thrombectomy, and intravascular lithotripsy.

Dr. Majors is a two-time Castle Connolly Top Doctor and multiple Top Doctor in Tennessee award recipient. She serves as an industry KOL, speaking nationally on drug-coated balloon therapy, intravascular lithotripsy, carotid disease, and limb salvage. She hosts Center of Excellence courses in Memphis, is the Vice Chair of the Young Physicians Association for the Tennessee Medical Association, and serves on the Board of the Memphis Medical Society.

A former Division I athlete and nationally licensed soccer coach, she brings that same discipline to medicine, business, and patient care. Her philosophy: excellence is not an outcome. It is a discipline.

Find Dr. Majors here:
https://www.instagram.com/zenithmemphis/
https://www.linkedin.com/company/zenith-memphis/
https://www.facebook.com/zenithmemphis

This episode is for education only and is not personal medical advice. If you have symptoms of poor circulation, a nonhealing wound, rest pain, or concern for blocked arteries, please talk with your own physician.

Chapters
00:00 Introduction
00:18 Why prevention matters in vascular surgery
04:07 Nutrition, sleep, stress, and the athlete mindset
08:07 Why she chose vascular surgery
10:57 Talking to patients about new procedures
14:13 What vascular training misses about lifestyle
16:43 Nutrition philosophy: from “eat healthy” to low-carb Mediterranean
22:38 Patient stories: saving limbs without rushing to procedure
27:12 Why not every blocked leg artery should be fixed
31:24 Why poor circulation is underrecognized
34:35 Building a limb salvage-focused private practice
43:24 Social media, physician education, and the modern doctor
49:59 How Dr. Majors approaches food, exercise, and habit change
57:05 Walking, strength training, and insulin resistance
01:01:00 Helping patients who aren’t ready to change
01:05:44 Smoking, diabetes, and whether all plaque is the same
01:08:05 What medical management vascular surgeons should own
01:11:34 How to get screened for poor circulation
01:13:53 The top 3 ways to prevent blocked leg arteries
01:15:15 Favorite procedures, resources, and AnatomyPad
01:19:30 Where to find Dr. Jacqueline Majors

Sign up for more information on my own practice here: https://corsighthealth.com/

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Transcript

SPEAKER_01 0:00

Hey everybody, welcome to another episode of Knife Down. My name is Dr. Lily Johnston. I am a board certified vascular surgeon. And today I have with me another board certified vascular surgeon, Dr. Jaclyn Majors. Jackie, thank you so much for being here. Welcome to the show. Thanks for having me, Lily. Happy to be you're here. So you and I were first connected through Kim McNicholas, who is a PAD warrior and somebody who is really doing the big work to try to raise awareness about peripheral arterial disease. But you and I kind of connected on a deeper level about some of the work we are doing to help patients understand what else they can do besides surgery to address this disease. How did you get interested in recommending the prevention side of things to patients?

SPEAKER_00 0:48

Well, I think that's a great point that we have another obligation to patients to not just fix the problems, but also my mentality and yours has been how can we help prevent or possibly change the course of this disease? And as you know, peripheral arterial disease, any type of atherosclerotic disease that affects the blood vessels is not something that we cure with surgery or medication. It's something that we have just told patients we will manage with them over the rest of their lifetime. And diet and exercise are really these empowering tools that the patient can take control of and start making real changes in their life.

SPEAKER_01 1:34

So tell us kind of how you came to be a vascular surgeon. What was your pathway like? And when did it become clear to you that this was part of your path?

SPEAKER_00 1:45

So my background definitely influences how I practice as a vascular surgeon. I played Division I college soccer, and that type of exercise and healthy lifestyle and discipline has impacted the way that I parent my children from, and also as how I am a health coach and how I'm also a leader in the operating room when I'm leading teams. So that healthy exercise lifestyle, I have seen how that really enhanced my life and helped me think about things differently and also have prevented many other diseases. I'm almost 50 years old and I really have no health problems. And I attribute that to a lifetime of dedication to exercise and eating well. So going through my college career, I then became a competitive soccer coach for many years before I decided to return and become a physician. And so again, my background in coaching people to come from one skill set and to improve their skill set to become better than they were, whether it's a physical skill or even a mental skill, learning how to push through things, learning how to calm down nerves, all of this influences how I take care of patients today. So then after deciding to go to med school, I went through and did a surgery rotation. And after that one surgery, that's all it took for me to scrub in and see this is where I want to be. This is how I am still able to get into the zone or the flow state where the whole world disappears and you're tunnel focused, and everything is in that moment right there at our hands. So I enjoy that intensity and focus. And then the other side is I still get to coach my patients and help them live a better and healthier lifestyle. So definitely my sports background has influenced the way that I think about things and how I practice medicine with my patients. I have so many questions.

SPEAKER_01 4:09

Was nutrition a big part of your training when you were playing Division I soccer? And was that something that you helped your players when you were a coach? And what about like sleep and stress management? Stuff off the field. How a big part was that of the sports world for you?

SPEAKER_00 4:25

Absolutely. So we call it being the whole package, the entire athlete. And the fact that when you applied those nutrition paramounts as well as sleep and stress reduction, your performance on the field improves. And I remember, I'm going to tell you a little story when we were in high school, and my high school team was extremely good. We all went and played Division I soccer. We would practice twice a day. We were very dedicated. And we went through this fad. You know, we were still girls in high school, and we went through this fad where we decided to eat only this vegetable soup diet that was going around. And so here we are, these high performance athletes that are running and doing fitness and multiple practices a day. And we came and one week it kind of all came to a head that most of us girls that were doing this new vegetable diet, we could not perform. We were dropping like flies on the field. And our coach came to us and said, You are high performance athletes. You girls should not be worrying about your weight. And as you guys can see from today, your performance was horrible and actually dangerous for you guys. So even in high school, I had a little awakening right there that what I'm putting in my body predicts how I feel and my outcomes. So that really came into college as well, where we had nutrition coaches and things like that as well.

SPEAKER_01 6:05

How have you managed the demands of a busy surgical lifestyle on your health? Because I think people don't intuitively it makes sense, but we don't get as much sleep as we might want. And trying to eat a healthful meal in the hospital can be almost impossible. And the stress gets to us. How I just, it's a lifestyle that is not conducive to our own personal well-being. How have you managed that?

SPEAKER_00 6:32

You're absolutely right about that. Well, one of the things that I did do is in the past two years, I did open my own practice. So that has allowed me to have the a little more control over that. But during training and even when during my really busy earlier years as well, meal preparation where I prep meals beforehand. So I know that when I'm in the hospital, even if I don't get a, you know, the lunch there, I have something in my bag that I can quickly heat up that will sustain me through the cases. Because as you know, some of our cases can last four, five, six hours. And any type of um hypoglycemic state or anything like that can impair our judgment as well as our performance. So again, I'm going back to my athletic years about how do I, I see ourselves as surgeon athletes. How do I maintain that peak performance? Same thing as bedtimes. Um, I make sure that I go to bed early, especially when I've got four or five cases the next day. I told my son this week, I'm not staying up to see you after you get home from your basketball game. I've got five cases in the morning. I'm going to bed and prioritizing my sleep. So I'm trying to demonstrate for them as well. You know, you've got to get home and get to bed as well, too. So it's not easy, but giving yourself grace, especially in these high performance fields, that do the best you can and realize that that usually is good enough.

SPEAKER_01 8:07

Yeah. Tell me how you picked vascular surgery, because I think a lot of the high performance athletes I know end up going into orthopedics because it's kind of the same mentality and they're so used to having this high performing patient population that the coaching's easier, right? The patients already come wanting to be active and resume their activities and do all their sports. And I find that that's the natural next step for a lot of the people who came in as high performance athletes into medicine. How did you pick vascular?

SPEAKER_00 8:40

Well, I did think I was going to be an orthopedic surgeon. I thought sports medicine, coaching background. You know, I'm very much of a, you know, usually the only female in the room was the only female in the coaching staff, things like that. I was very much used to being that. I thought that orthopedics was going to be a natural fit for me. But when I saw the different types of surgery, I realized with my specific personality as a vascular surgeon, we're very detail-oriented. We're very precise. And a lot of orthopedic surgeries are drilling and hammering and things like that, which that didn't uh sit well with me, knowing that what I want to do is very fine, detailed work. You know, some of the movements that we do are millimeters of difference and change. And um, I really enjoy that part. So vascular surgery drew me to it because the detailed work, two, all of the new and novel technologies that are coming out constantly. Vascular surgery is a relatively young specialty, and so we've got lots of cool and interesting tools, and we're doing things different every year. That appeals to me as well as being a very innovative and entrepreneur type person. And then the third thing is that with our vascular surgery patients, we get to take care of them for the rest of their lives. And I really enjoy that longitudinal care for patients. Some patients I've been taking care of for seven years now, and I've seen, you know, different ups and downs in their lives and how they've made it through different challenging surgeries. And then the last thing is the limb salvage. Um, as we talked about with my sports background, I know that movement is life. And we see it over and over that we are meant to move as human beings. It enhances our lives, it enriches our brains. And when I can help prevent amputations, I know that I'm not only saving a limb, I am saving this patient's life and enabling them to be fully participatory in their life. So those things are just wonderful for me about vascular surgery.

SPEAKER_01 10:57

That's so great. I was at a holiday dinner with some family friends, and we were talking about a new procedure. So I had just done uh a detour endovascular bypass, and I was like, yeah, it was the first one in our hospital. I was all excited. And they're like, oh my God, how did you learn to do that? Like, that wasn't in your training. That's so dangerous and scary. And I thought, wow, it's true. Our specialty is so lucky. We have so much new innovation and new technology. But how do you explain to patients that this new procedure is actually solving a problem we didn't have a good problem for before? And it's not an experiment, it's not scary, but we also don't have as much information, as much data, as much outcomes, you know, to inform these things as we might want for the older procedures. How do you balance that and talk to your patients about new new procedures?

SPEAKER_00 11:50

You're exactly right. And the same thing in in my OBL this year, we performed the first of multiple different types of procedures, whether in the city or the state. And it's always trying to be on the forefront of what data do we have? And then having that conversation with the patients. Uh, we put in the first absorbable stint for a patient. And I had a long discussion with them about it and said, you know, this is the data that we have so far. It looks very promising. I don't think this is any more dangerous than the type of products that we have now. I do think the upside is a lot higher for you. And had that conversation with them. They said, let's do it, let's go for it. And really, we're at kind of this scenario where the patient had only a couple more chances to save their leg. And when you've developed a relationship with a patient and demonstrated, hey, I may not have all the answers, but I'm gonna do the best that I can for you with the best information I have. And this is my recommendation. Once you develop this trust with patients, they really want to be a part of that. And sometimes patients ask me, they're like, Well, I know it was the first. Did are you gonna post about it? And I'll say, Are you okay if I post your case or on LinkedIn or something like that? And they want to be a part of it. They feel special about it. And there, but there are some patients that are they're like, I don't know. I I don't want to try something new. I want to, you know, stick with this. And I respect that. You know, that's okay for the patients to say that, but the majority of them are excited as I am about trying something new and trying to see if they can be a part of the change.

SPEAKER_01 13:37

Yeah, that's great. And you know, we share that philosophy. I think in informed consent is really shared decision making and to be as open and honest with our patients as possible. The technology is new and exists because it is dealing with a problem that didn't have a great solution previously. And if we think this patient is a good candidate, and to the best of our knowledge, you know, this is gonna help them, we think, then, you know, I offer it and I offer the other solution and see what they want to do and how we how we can proceed to serve them and get get them well. How much of your practice now was modeled for you in training? When I was training in vascular surgery, I didn't have a lot of my attendings who spent time talking to patients about what they ate or how they moved or how they slept. And that was something I had to figure out how to do. Now you had the coaching background, so maybe that came naturally from there. But what do you think your training got right? And where did we miss?

SPEAKER_00 14:42

Well, our training did not focus on diet and exercise. Uh, and when you're in training, your objective is to how do I become the best surgeon I can and learn the most types of surgeries in a very short period of time. Two years sounds like a long time to some people, but as you and I know, the breadth of vascular surgery and becoming very skilled in all the different types of procedures we do in two years, that was my primary focus. And so, of course, I would talk to patients about, hey, your hemoglobin A1C, which is that measure of insulin resistance, is very high. We've got to get that down in order to improve wound healing. Or I would speak to them about smoking, but not to the depth that I would talk to them about this now. And that really comes from that understanding that you are what you consume. And understanding that has really been a journey for me through my postgraduate years that started at very young age, knowing I'm a high performance athlete. I have to fuel my body in a specific way to get the best performance, whether it's hydration, proteins, fats. But now I'm talking about it and looking at it in a much different way. Like, interesting enough, like what types of music you listen to, what type of news channels you watch, all of those things that we consume impact our health to a much higher degree than we have acknowledged in society. And so if I can make these little changes with my understanding about the neuroscience, the physiology, and the pathophysiology behind all of these diet, exercise, sleep, stress, if I can help my patients make a difference and even you know a broader sense, I think that it's up to us to continue to seek out that knowledge beyond. But it definitely wasn't really much in training. For sure.

SPEAKER_01 16:43

Let's talk about the nutrition piece, because I know that's something that you and I are both really passionate about. Where did you start counseling patients about nutrition and how has your philosophy evolved over time?

SPEAKER_00 16:56

So at first, when it was nutrition, I was just just eat healthy. And that is so ambiguous. It's so obtuse, it's like this black box. What does that even mean? And so then it became okay, well, what kind of studies can I look into? And there are lots and lots of nutrition studies out there, and that became overwhelming. And I started really one of the main books I read was you know, The Big Fat Surprise. Um, and that was uh really interesting about how we as a culture changed our mentality and our thought process as well as our diets based on really some human emotion and not really based on data. And so that really got me looking into well, what is the mechanism of action of the different medications that we're using, as well as what is the cause of this plaque and calcium buildup? And so when I really honed in on just specifically that aspect, what is causing this plaque and calcium? That's when I really had my eyes being open. Previously I had recommended a Mediterranean diet, and I think I sent this to you, but this is like a little handout that the patients get and trying to give them something, some kind of guide, because that was the best studied or the most studied diet we had, the Mediterranean diet. And now I'm shifting away towards a Mediterranean diet low carb.

SPEAKER_01 18:37

Yeah.

SPEAKER_00 18:37

Because we're seeing now that really our culture as well as our recommendations in the past about these low-fat, high-carb diets are really what has spiked that diabetesity epidemic, the diabetes and the obesity. So understanding that and now trying to slowly change, because as human beings, we do terrible with quick change. So slowly integrating and changing this into my practice and recommendations and understanding with even my staff on counseling patients, we're really moving away from just the blanket Mediterranean diet to we want proteins and fats, low carb to no carb diet. So great.

SPEAKER_01 19:28

So, how do you approach this in your particular patient population? Because you're in Tennessee, you're in the South, and you know, it's one thing for me in California to say, sure, go eat a Mediterranean low glycemic diet, right? Fish is plentiful. Um, our socioeconomic situation is different here in many parts of my patient population, anyway. I imagine that's actually kind of a tough sell for many of your patients, but tell me if if I'm right or off base on that.

SPEAKER_00 19:58

We love our fried chicken and barbecue down here, that's for sure. And so one of the things that I've talked to the patients about is again, don't go home and get rid of everything in your pantry. Let's start making small changes at a time. So the first thing that I talk to them about is their fats. What are you cooking with? What are you using at home? Let's focus on you're using olive oil, avocado oil, regular butter. And I'll let them know get rid of all that fake butter, get rid of the country crock, get rid of the I can't believe it's not butter, all of those things. And let's this first month just change what oils you're using. And we kind of move through it as a month by month. We'll say, let's make a big change each month. And what I tell them is that if we do this, where we make a change once a month, where the next month it's gonna say, okay, I'm no longer eating cereal for breakfast. I'm going to make sure that I'm eating eggs for breakfast or full fat yogurt with some berries and nuts, talking to them about the different options that they can sub in. I said, that's all I want you to do for month two. So coming up with a month-by-month single change plan, when you look back from a year from now, you'll be a different person. And it's again encouraging them, let's make lifestyle changes, not focus on a fad diet. So that's how I talk to them about how to embrace the change so it's not too scary. And then a lot of times I'll tell them and be honest with them and humanize myself and say, hey, I've got teenagers at home. During the week, I eat really clean, I do really well. But on the weekend, when I'm getting to hang out with my teenagers and we're gonna order a pizza, I'm gonna eat the pizza. If I'm, you know, at a sports thing where I'm watching my kids play sports and the only thing they have is a burger that for me to eat for lunch that day, I'm gonna Eat that burger that day. So I just talked to them about balance your life and don't be so restrictive that it's unattainable, but really try to do 80% of your life, you're eating right, you're eating clean, you're focusing. And then on the weekend or when you're with your family, you know, or spending time with your church, which is very popular down here, very much ingrained in the culture. Go to that fried chicken fry after church. Have that fellowship, continue to participate in those things. And then during the week, you're eating clean. That's, I think that's the best way that I've found to approach with my patients.

SPEAKER_01 22:37

Can you think of an example of a patient who really sort of saw the light and went all in on this and had a great outcome?

SPEAKER_00 22:46

I do. There is a patient that came in with critical limb ischemia. They're at risk of an amputation of their foot. Their hemoglobin A1C was almost eight. And we sat down and had a really big discussion about the lifestyle that that that patient had that was going to affect them for the rest of their life. And I said, It right now we have a moment. You know, this is the moment where your path can go one way or another way. And we talked about making changes and their diet, and they really listened. And when I we went through their limb salvage process and they were telling me their updates, and then we saved the foot. Three months later, the patient comes back. The hemoglobin A1C was almost completely normal. And he had developed a really conscious effort about his diet. He was a truck driver, and he was making sure he ate his beets every day because beets have nitric oxide in them, which our blood vessels love. He was now preparing his meals at home. And this is two years ago, and I haven't had to do another procedure on him since, which is, you know, can be uncommon, especially with some patients with diabetes and peripheral disease. So that's one shining example of this patient that we are the whole staff is so proud of him and so impressed by him. And he feels a difference in his life.

SPEAKER_01 24:23

I think that's a wonderful example, especially because he's a truck driver. And some people might come and say, well, I can't do this because I don't have a refrigerator. I don't have a stove most of the time. I can't prepare my meals. And there are, there's always a way. And we have to help our patients come up with that way. It's not their job to necessarily solve all those problems, but I do think it's a testament to how empowering it can be to just decide you're going to do it. And whatever obstacle comes up, we'll work through it together and figure out how to do that. But I am I'm excited and proud of your patient too. That sounds like a truly remarkable uh transformation for him.

SPEAKER_00 25:07

There was another patient that came in this week as well, which was fascinating. That the patient had had multiple previous operations, occluded stents in both of his thigh arteries that had been placed by another facility. And he was having significant claudication, that repetitive pain with walking a specific distance. But he was also smoking. And his pressures in his legs, both of his legs, were 0.5. So he only had maybe 50% blood flow to both of his legs. And I saw him in November. And one of the other things I coach patients on is not only their food, but also their smoking lifestyle. And we talk about different tips and techniques about things that he can do to change his habit. And we had a good conversation about it. And he came in just this week, and his pressures are now 0.7 in both of his legs. And talking with the patient, he became very tearful and was like, You changed my life, and I'm not having the problems that I used to have. And I quit smoking. And it was just so, you know, it was better than doing an operation, honestly. I don't maybe not that much, but it was better than such a great reward and felt so good for him to see how making that change in his life has completely changed his life. Like he may, I was like, you may never need an operation from me at this point. You may be able to live the rest of your life because you did that hard work, and now you get to hang out with your buddies at the pool hall or do whatever you want to do. Like those are the things he's retired, but you know, those are the things that patients want to be able to do is participate in their life without having to continually stop and sit down and things like that. And he was able to do that because he made that lifestyle change.

SPEAKER_01 27:12

Yeah. This brings up a great point, which is just because there's disease doesn't mean we have to go treat it and clean it out. And sometimes that's a tough conversation with patients because, well, somebody put a stent in there, now it's clogged. Obviously, we should go fix it, right? Dr. Majors, why aren't why aren't you going to go fix it? How do you talk to patients about this idea of limb-threatening ischemia, about symptoms versus ABIs and how we make decisions and and what the downsides are to procedures?

SPEAKER_00 27:44

Agree. And that goes back to what we talked about earlier about that informed consent. And when I talk to patients about procedures, I let them know that no matter what type of blood vessel surgery I do, whether it's I'm operating from the inside or I'm making fine tiny stitches on the outside of the artery, I am causing trauma. And at those trauma sites, scar tissue can form and I can't stop it. So we really want to make decisions about when it's worth it to operate and when we feel like it's better to be patient and work on other things that don't put the patient at risk. So we definitely, I definitely have those conversations all the time. And I'm surprised with how patients sometimes say, I never heard this or I never understood this about my disease. You're the first doctor that's ever explained that to me. And I find that sad and happy at the same time, but I'm glad that I've been able to make that connection with them that they do have some power over whether or not they get an operation.

SPEAKER_01 28:50

Absolutely. And I think I never like to disparage my colleagues, but there are definitely a few bad actors out there who are telling patients that they need a procedure every three months just to go check, right? It's like a tune-up for your car and will put stents in patients who really should be walking more and smoking not at all. And um, it's it's a tough environment when patients are being told different things by different people. But those of us who are truly in the business of saving legs and saving lives, I think know that it takes only one bad outcome in somebody who was just having pain with walking to really make you uh cautious about intervening until it's really necessary and the patient's really going to get a lot of benefit from it.

SPEAKER_00 29:42

You're exactly right. And what I tell those patients that maybe having a little numbness, a little tingling, or just that I can start having some pain at about half a block or a block. I really have a good discussion with them at that point and let them know you have blockage in your blood vessels. You're not going to feel like you were 20. But we can do different types of programs with physical therapy or walking or lifestyle modifications or even some medications to enable you to have even have a better performance from your walking. But going in and doing these quick fixes, there's only three times that I go in and do an operation on your blood vessels. That's if you're at risk of amputation, you have intractable pain called rest pain that does not go away. Or if you can't do things in your daily activities of life, meaning you can't make it through the grocery store without having to stop two or three times. At that point, from my opinion, you need an intervention. If you work at a warehouse and you have to put chairs along the length of the warehouse because you can't walk from one end to the other at your job, you need an operation. But if it's something where I get a little bit of cramping or it's a little bit of pain after I walk two to three blocks, at that point, it's hey, we've got movement here to be able to do something without an operation. Because as soon as I go in and intervene, that scar tissue cascade starts and we can't stop it. Yeah, for sure.

SPEAKER_01 31:24

Which brings me to another point, which is PAD, peripheral arterial disease, the buildup of plaque in these arteries in our legs predominantly. This is a systemic disease. You and I see patients with blockages in the legs, in the neck, sometimes even in the arm. And I feel like many of these patients are shocked and surprised when they have plaque buildup here. They then never knew that was a thing. Everybody knows plaque in the heart is a thing. Everybody knows about heart attack and stroke. But why is PAD so like such the ugly stepchild of atherosclerosis?

SPEAKER_00 32:04

I think it's because the majority of it is asymptomatic. That a lot of these patients will develop this plaque and calcium that builds up and they don't have any symptoms until all of a sudden their limb is threatened with an amputation. That the body is pretty miraculous and can build alternative highways that can keep them functioning at their baseline, that they don't even know that they've got 100% blockage in a blood vessel in their leg. So I think that because it's asymptomatic, we as a medical community aren't screening for it enough to have those conversations with the patients. And then a lot of times the patients develop it and then they don't know they have it until now we're talking about, hey, if you don't have a procedure, you may end up with an amputation. So I think that the under-identified uh identification of it by, you know, the medical community at large as well, and then the nature of the disease as so I think that those are the two reasons why it isn't front and center, because everybody knows what a heart attack is, but people don't know what an ischemic foot is. Right.

SPEAKER_01 33:18

What are you doing as part of your practice to help bring awareness to this disease?

SPEAKER_00 33:25

Well, one of the things that I like to do is I I talk a lot on social media. So I am on different social media platforms, whether it's LinkedIn, presenting complex cases to my colleagues to keep them up to date about what we're able to do or how we're able to save legs. What or I am on TikTok as Dr. Memphis, and I'm talking about eating healthy and what you're doing and how risk of PAD can happen. So I think that we have to do a better job of outreaching into the community and meeting people where they are to discuss these disease processes that are going on. My practice also, my partner and I go out and we talk to different family physician practices. We go and answer questions. So we do lots of different types of lunch and learns to also educate and answer questions about if you're concerned, you know, send them over. We can easily do these screening processes and identify patients and try to change their ultimate trajectory to keep them out of the operating room or amputation risk.

SPEAKER_01 34:35

Tell me a little bit more about your practice and how you made the decision to open your own, how that process what that was like for you.

SPEAKER_00 34:45

Well, my practice is called Zenith Vascular and Fibroid Center. And this is an outpatient facility where we have two angiosuites where we can perform procedures here in the office. We have clinic as well as ultrasound capability. My partner is an interventional radiologist, and he started another practice about five years ago. And then in 2023, I was decided that I wanted to go out on my own. And he and I met by some chance of fate with looking at the same building at the same time. And we decided to buy the building and partner together and build a practice that was a healthy place for people to come and work, as well as a place where we were focused really on quality patient care. Neither he or I are interested in having seeing hundreds of patients a day. We really want to protect our lifestyle as well as be able to spend time with patients. So we created this type of practice in order to be able to do that. Here at the practice, I am focused primarily on limb salvage. As you know, vascular surgery we operate on every blood vessel in the body. So I still do lots of different surgeries, but the majority of surgeries that I do are patients that are sent to me from foot and ankle surgeons as well as wound care, that these patients are risking amputation. And they may have had previous interventions or had I might be their second or third opinion where somebody tells them they need an amputation and they end up at my doorstep. And we are in the business of trying to save limbs.

SPEAKER_01 36:45

What made you decide you needed to go out on your own and start your own practice?

SPEAKER_00 36:50

Well, I have been in private practice in one way or another since I graduated uh fellowship. And I really like that autonomy away from a uh big hospital system. I feel like big hospital systems, they are can be very slow just because of how big they are with the administration to adopt new technologies or to make changes in systems or even practice referral patterns and things like that. And I have an entrepreneurial spirit. I am a very creative person, and I really wanted to create something in my own vision. I knew what I had in mind, I knew how I wanted to take care of patients, and I had seen how it was done in different hospital systems or big giant groups, and I felt that I could do it better and have better outcomes for patients. So the business side, the creativity with the marketing, as well as having that autonomy and control over the practice and how patients are taken care of. That's what I was seeking in as vascular surgeons. This is how we're able to do it is having our own practice with an OBL.

SPEAKER_01 38:07

Let's dig a little deeper in that because I think I know what the difference is between I'm you know employed in a big hospital system, and I think I have some sense about what the difference would be as a patient experiencing my practice in a hospital setting versus what they might get if they came to Zenith. Tell me exactly what one what you wanted to be different and what you are able to provide patients in your practice that just isn't possible in a hospital-based setting most of the time.

SPEAKER_00 38:36

I'll give you a couple examples. Uh, one, when the patient calls our office, a person answers every single time. Um, two, we have specific coordinators for each of the doctors. So if the patient has a question, they are not called back for three or four days. They have a direct line of a person that they can ask their questions about. What time do I need to be at the hospital? I forgot when my pre-anesthesia testing was. I went to my cardiologist today and they said that they needed to talk to you. Um, you know, they have this direct line of communication to be able to navigate the healthcare system, which can be very challenging. We have one facility. So when the patient comes to our one-story facility, they do not have to navigate a parking garage or four or five buildings or anything like that. And as you know, our vascular patients tend to be older patients. And so for a patient to be able to pull up into the parking lot, walk right into the door, they can get their ultrasound, their clinic visit, and even their procedure all done at the same facility. That really, like sometimes the relief you see on the patients, like, where are we going to do this procedure? I'm like, right here in our office. They're like, really? I mean, they do you just feel it that, like, oh, I know where this is, I can make it back here. And then the other thing is, is that we have cultivated a staff here that is unbelievable. We have people come in and visit and watch us do techniques and we do different procedures here, and we are complimented all the time on your staff is so on mission. They, every single one of them cares about the patients. They're not overworked. Every single staff member feels appreciated here, and they are exceptional at their job. And we cultivated that uh to create an amazing work environment. And the patients feel that every single day in clinic that I'm there, I get at least two or three compliments, whether it's on our front desk staff, our ultrasound techs, our nurses, they are saying you have got the best people working here. I feel really taken care of. And they're allowed to do that. They feel like they can do that because we have such a good work environment here as well. It's amazing.

SPEAKER_01 41:09

I know though, that a practice like that is not a straight path to success. I am sure that either on the medicine side or on the business side or both, there were some stumbling blocks. What have been some of like the big mistakes or big things that you really tripped over on your path to being so successful?

SPEAKER_00 41:31

Well, like you said, just the sheer expense of this is uh is a big deal. And when you are the owner as well as the surgeon, you know, you have to make sure that you are operating. I may not take as many vacations as I did at when I was employed somewhere else. Um, I may not, so those are things where I have to make sure, hey, I've got to make payroll. I've got to make sure that I'm producing enough so that my staff is taken care of and we don't have a dip six weeks later. So those are things that I think about differently. That maybe some people would say, well, I want to make sure I have my however many weeks of vacation a year. I may not take that many many because I've got a greater responsibility. Um, the other thing is anytime that there is a hiccup, like for example, when change healthcare, when that was hacked last year, two years ago, that was a really difficult time for our practice. Um, when we're producing, patients are still coming, but a whole entire system where we don't have a huge endowment like a hospital system or anything like that, but those little things can impact the individual practice a lot more. So constantly thinking about how we can mitigate any type of holdups or things that are out of our control, those are things that I did not realize until you become an owner. So there's a constant continuing education where I'm getting AI to teach me accounting and marketing techniques and all of these other things that I'm learning to become an even better business owner.

SPEAKER_01 43:24

Let's think about the marketing piece. You said you were very active on social media, which is partly education, but also partly marketing. What has been your experience, sort of being a personality on social media now?

SPEAKER_00 43:38

Well, one of the things that I've noticed is that it has allowed me more opportunities to talk about vascular surgery. And I could talk about vascular surgery all day. I love what we do. I think we make a huge difference in patients' lives. And so being noticeable on different Social media platforms has allowed more opportunities where people now are reaching out to me to ask me to be on a podcast or to contribute an article or go to a speaking engagement. And I think that being willing to market yourself and do that personal branding where you're known for different specific things that you're passionate about, that opens the doors for you to either get your brand more visible or even your practice more visible. And in that sense, now people become more educated and understand about periphery disease, karate disease, or anything like that. So I'm a teacher and definitely an educator at heart. And I see that when you take the time to create content that you're interested in and you want people to know, you will start having people reach out to you for more opportunities to spread your information.

SPEAKER_01 44:58

Do you think there's a dark side to social media, especially as a physician? Or is it risky to be a physician very visible on social media?

SPEAKER_00 45:07

I think it depends on what you're doing. So certainly I don't post my kids on social media. I'm very protective of my family life. I try to keep it where I'm posting about what I'm interested in, whether it's encouraging women to be more confident, encouraging women to be entrepreneurs, whether it's to talk about what type of diet you're eating. Some of the things that could identify more personal aspects of my life are not on there. I think that's just a part of a safety thing. And then certainly I have other female surgeons that I'm friends with who are in different employment situations, and they have to be very careful about what they say. They have to be very careful about what they say as well as what they are posting about. For example, if they're employed by a hospital system, uh you have to make sure that you disclose this is not a reflection of my employer or their beliefs. These are my own personal beliefs. I am not employed by a hospital system, so I don't have to worry about those types of barriers that can be up there. So certainly you need to make sure you're not posting anything without patient permission or patient information. And you want to make sure that your employment doesn't have any policies against you filming in specific places or things like that. But other than that, I think it's our duty as healthcare professionals and physicians to speak up and speak out about things that affect our community and our patients.

SPEAKER_01 46:54

Yeah. Good points. I think it's it's so tough. It's not really part of our professional education, right? It's this is not something that was talked about when I was in medical school or in training. Uh, yes, we are teachers, but we have this experience teaching one-on-one in the exam room or in the hospital with patients. This idea that we would go teach to a camera, to a wide audience is very different for us. But I do think it's actually part of our responsibility in many ways now because our patients are getting information from the internet. They are getting information uh from Google and YouTube and Reddit. And we can choose to participate and try to be a voice of well-reasoned, well-evidence-based information for them, or we can let them hear it from the other people who graduated from Dr. Google School of Medicine and teach themselves and try to deal with that on the back end. So I agree with you. This is this is a huge part of what the modern physician and surgeon should be doing, but it's it's a tough sell for many of our of our colleagues. Let's talk about you. Sorry, one and did you want to finish that up?

SPEAKER_00 48:09

Well, like you said, this wasn't part of our training. Certainly, you and I did not get training on how to do a podcast or how to be interviewed or even how to talk to the camera. But it's something where if you're a physician, you're smart. You can figure things out, you're adaptable, you have to adapt to different changing paradigms in medicine. And this is just the next technology step because AI is coming next. And so learning about how do we reach the patient, how do we give them good information from experts and credible resources and not nutrition moms 747? You know, we need to be the ones delivering this very credible advice as well as information to the population.

SPEAKER_01 48:58

How often in your practice do you have a patient come to you now with a printout from their language model, like Chat GPT or GROC or Gemini, with like, here's what I was told to ask you, or here's what I think is happening next?

SPEAKER_00 49:11

There's at least one patient in the clinic that asked me something that, you know, well, I saw this on social media, or I saw this, somebody said that I need to be eating beets. And I'll and I'll be able to say, yes, and this is why. Let's talk about that. And then some people say, Well, I don't need to take my aspirin anymore because I'm taking turmeric. And I'll say, well, let's have a discussion about that and the different things that those two chemicals in your blood and what they do. So every week there's there's somebody that's coming in. I saw this on social media, or they're coming with a printout or something like that. So we have to be able to not dismiss the patients, but be able to give the best information we have to guide them.

SPEAKER_01 49:57

Yeah, for sure. So you are a mom, you are a practice owner, you are a busy vascular surgeon, and yet I firmly believe that you are walking the walk of this healthful lifestyle because I can see that it's something you're just deeply passionate about and have been for many years. How do you do that? How does your own nutrition play out in your daily, daily life?

SPEAKER_00 50:22

Well, I know that because I've eaten healthy for so long that when I don't, or I do have those tournament weekends or those, you know, where you're traveling and out of town and you're kind of just getting what you can, I can tell right away my body doesn't feel as well. I'm lethargic. I feel, you know, kind of bloated, I feel puffy even. And those are types of things where I value feeling great and never getting sick and always feeling healthy and having that type of energy. And so it becomes almost this self-fulfilling prophecy. And those are the things that I talk about with the patients. So whenever I'm encouraging them about exercise, I start off again with very small goals and I say, just five minutes a day. If you can start with five minutes a day, I want you to do five minutes a day, no matter what it is, and do that for a week. And then the next week, I want you to go to six minutes a day. And they're like, that's it. And I was like, that's it. I don't want you to do anything more. And they're like, why don't you want me to do more than that? And I was like, because what I want you to create is a as a habit. I want you to create a habit more than anything else. And once you start creating that habit, you're gonna feel good. You're gonna feel different. When you start eating healthy and you start moving your body, your body, you're gonna, I want more of that. And it becomes this almost addictive lifestyle that once you feel so good because of your diet, because of your exercise, because you're sleeping, because you're minimizing the stress by turning off the news. When you start doing that and you start feeling the change, there's no way you're gonna go back.

SPEAKER_01 52:12

So, how do you like prepare meals? Who cooks in the house? What do you do to make this easy for yourself and for your family? What are your go-to lunches, dinners, things like that? Super practical.

SPEAKER_00 52:24

So I do a lot of meal prep on the weekends. There was um an actual social media influencer that I saw, and she got five of these Pyrex bowls, and they're four cup bowls, and she would divvy out her macronutrients. So she would have vegetables, she would have protein, and she would have some type of carbohydrate possibly in the bowl. And you divvy them out between the five servings, and then you cook them all on one cookie sheet in the oven. And it takes about 35 minutes, probably 45 minutes total, to put everything all together. And now I have five meals for the week, for whether I'm at the hospital, I'm at my clinic, I don't have time in between, or if I come home late at night, I know that I've got a healthy meal in the dinner I've prepared myself that's not processed. So that's just one small example that I will do. The other thing is that I'll batch make my breakfast for the week. Um, I'll use um like faro, which is a whole grain that I really like. It's pretty nutty. It's kind of like a brown rice with some ground beef and vegetables and lentils, and I'll throw that all into a rice cooker or pressure cooker. And then I just heat that up and I eat that all breakfast for the week, or I eat an entire avocado. One avocado has fiber, fats, and protein all in that just for you know, breakfast for the week. So I try to have that where I'm not guessing because when you're hungry and you don't have a plan, that's when you are weak and you're gonna grab for the cookies or whatever, you know, is your weakness right there. So I try to have a plan. And it takes me maybe an hour or so to prep all of this on a Sunday, but then I'm ready for the week. So those are easy things that I do to have my family eat healthy as well as myself. One of the other things that I do is I I don't have those things in the house. So my kids know that there is there's no soda in the house. We don't have it. One of the things that I think that's the worst thing that we can do is drink our sugars. And so we have water in the house. Um, my kids play sports, so there is some type of electrolyte replacement in the house for them. But majority of the time, we don't keep the things in the house that I don't want them to eat.

SPEAKER_01 54:56

How have they taken that?

SPEAKER_00 54:59

Um well, they they are not fond of it, but they they see the the change. Like when um, I think it was about three or four years ago, I got rid of all cereal. I was like, cereal is not allowed in the house. It is nothing but sugar. This is not your breakfast. You guys need to come up, and we will come up together with a good breakfast for you. And so now there it's it's acy bowls. I'm letting them go where they'll eat an egg, egg, and bacon sandwich in the morning for breakfast. I'd much rather them eat that than a bowl of cereal. So there's some compromise there, but definitely it's something like where I get, is that organic? And so they know and they're good sports about it. Awesome. And someday they'll thank you.

SPEAKER_01 55:51

Agreed. I am sure that you are still very active since you grew up in the athletic world. What does your exercise and movement strategy for the week look like?

SPEAKER_00 56:03

Well, right now, where it's like cold in the winter, it is 5 a.m. Pilates. So trying to find time to work out in the afternoon when you have kids that are full of sports, and then I have lots of different business dinners and meetings. I'm on different boards that I need to participate in. So banking on that after work, because as a surgeon, you know, you never know when it's gonna end. So it's 5 a.m. exercise class for me. On the weekends, I try to play golf. I love to walk and play golf. I think I play better when I walk. So I'm definitely a walker when I play golf. I love doing that. And then we, my family has two great Danes. And so those dogs get walked and they are big dogs, so we go a big distance for them.

SPEAKER_01 56:53

That's great. Uh, there are a couple of great Danes that come to uh the farmer's market that's down the road from me, and I look forward to seeing them on the weekend. It's um, they have no idea who I am, but I I know who they are because they're hard to miss and uh it's always always a highlight. Do you think that, you know, walking has always been this standard for our collodican patients, those patients that have pain when they walk. We know that walk, walk, walk is a great, great medicine, probably the best medicine for them. I have always wondered if strength training would also be helpful. And I've never seen a study about it, but do you have thoughts about this?

SPEAKER_00 57:28

I do talk to them about that. So, as you know, some of our patients, they're in the limb salvage moment where they can't walk.

unknown 57:37

Right.

SPEAKER_00 57:37

They're in wheelchairs, they're, you know, they're only can walk on crutches, they can only do touchdown on their heel, different reasons why they cannot walk at that moment. So then I talk to them about chair exercises, and that can be as simple as five to 10 pound weights, and they're working their biceps or they're working their quads. And so that strength training or that resistance training also helps to increase the nitric oxide vessel relaxation, which is what we want. We want our blood vessels to be nice and plump. We don't want them to be all tight and constricted. So I talk to them about those activities. And like you said, our women, female population, talking to them, I have been pushing that quite a bit for the last six months, that our older females need to be doing some type of resistance training. If our older females develop a hip fracture, 30% of them will be dead within a year. And so, as females, we lose 8% of our muscle mass each decade. And so we have got to make sure that we are prioritizing those types of activities. And over here in the corner, I have a kettlebell. It's pink and it's beautiful. And so sometimes my staff comes in here and they do around the world and we do squats together and different things, and I let them know that every time you are doing that, it's like your 401k. It compounds, it all adds up and it counts. So even if you only got five minutes of arm-resistant training today, it's going to add up long term for your overall health bank. So I absolutely agree with you that resistance training, whether we have data showing it specifically helps for far tira disease or not, we know how beneficial it is for insulin control, nitric oxide production, as well as preventing injuries and keeping that balance going.

SPEAKER_01 59:38

Yeah, it's great that you mentioned the insulin control piece. Cause I was going to say for my diabetic patients and my pre-diabetic patients, anybody with insulin resistance that I have diagnosed, I remind them that muscle is one of the biggest utilizers or users of glucose in the body. And so, yes, of course, that 10-minute walk after a meal will attenuate some of the glucose spike, but the more muscle you have, the more effective that walk can be, the more muscle there is to soak up any of that sugar. And so the more you build that muscle, the more that's available to you as a way to process some of that glucose that comes after our meals. That's great. I agree.

SPEAKER_00 1:00:17

And I think that the a lot of our patients, when we try to make it as small a barrier as possible for them to make that first step. Because when people think resistance training, they're like, I got to get a gym membership, I've got to go for 30 minutes to an hour, three to four times a week. And that where you're removing that, that's another great power of social media as well, that you can meet people in these five minutes or you know, less 30 seconds. You know, just even doing those resistance training five minutes a day, it adds up over time. So creating that very small barrier where they feel comfortable that they can do resistance training or weightlifting. Yeah.

SPEAKER_01 1:00:59

And I think, you know, those are patients who are ready to make change, but just don't know how. And those patients are easy to help because we can help them work through these obstacles one at a time, right? What is the barrier? What is the fear, the concern, and you know, that's valid, and we work through that. I also have patients who are not ready to make change and who still persist in the behaviors that brought them to our office, the smoking, the inability to change a nutritional pattern that has resulted in elevated blood sugar and that A1C of 10. How do you approach those patients?

SPEAKER_00 1:01:38

So, as talking to patients that are, I'm not interested in quitting smoking. Uh, I've been doing this for 40 years, every day of my life, I'm not interested. And one of the things that I'll talk to them about and say, okay, let's talk about what happens if you did quit smoking. Um, let's talk about the benefits. And so giving them more, I'm not trying to convince them, but I'm trying to provide them with information education. So even on our Zenith website, we have what happens to your body five minutes after you don't smoke, 20 minutes, an hour, a day, two weeks, you know, so on and so on, about the different changes that you will see in your body. And sometimes people hearing it over and over, one of the things I learned in sales and marketing research is that people need something presented to them seven times, a lot of times before they're gonna purchase or buy it. So I don't give up on these patients. I just keep presenting information to them every time. And I'll say, I'm here for you. I'm here for you when you're ready. And it's gonna be the biggest decision of your life. You can do it. I have patients that do it all the time, and I'm here for you when you're ready. So try to trying to break things up into very small achievable habits, assessing where the patient is right then. Are they still in the pre-contemplative stage? Are they still thinking about it, or are they ready to make a decision and acting on where that patient is at the moment? So I think those are really the factors that I focus on.

SPEAKER_01 1:03:12

Yeah, and it sounds like you do a great job of being kind and being compassionate and not shaming people. I think a lot of patients, and I learned this, you know, through through my certification in obesity medicine as well, patients are just so tired of being told that they're bad, right? And whether that's smoking, whether that's their body mass index, they're just tired of feeling ashamed. And I think there is a way to be compassionate about this and say, I understand that this is something that serves you. And this is something that you cannot give up yet. I understand. Do you, you know, can can I, but I would be a bad doctor if we didn't just mention it. And it's okay, we don't have to spend a lot of time on it. But um, you know, I'm still gonna take care of you. I'm not going anywhere. This is this is not a make or break thing for our relationship. And you're still a good person, right? Even if you're doing these things that you know are not helpful for your leg or the other medical problems that you may have.

SPEAKER_00 1:04:19

That's right. We we have to remove that shame because otherwise they're not gonna have real honest conversations with us about where they are and what's actually going on in their lives. And a lot of times, sometimes it isn't their fault. Um smoking, as well as some of our carbohydrate diets, they're very addictive. And I don't think that people understand how this addiction, how do we change that? That's different than you know, some choices that you're you're making about turning on the news or not. But sometimes people can't turn that on and off. And reaching people and letting them know there is a program in your brain, and we have to reprogram that. And that's gonna take some time and effort, and it's something that can be done. And when you're ready to make that decision, like you said, I'm gonna be here for you for it. And so once sometimes just removing that, knowing that, hey, this isn't necessarily your fault. You know, you may not have had the opportunity. Like I had a patient that said his grandfather used to light his cigarettes and hand them to him when he was eight years old. Do you think that kid had a chance? So recognizing, hey, wow, this is something that you may not have chosen in your life, but now you want to make that change. And this is how we're gonna do it together. Yeah.

SPEAKER_01 1:05:44

Let me ask you while we're on the subject of different pathways, do you think that atherosclerosis is the same in somebody who smokes as their primary risk factor versus the atherosclerosis that comes from diabetes? Are they different diseases?

SPEAKER_00 1:06:01

Well, that's tough. So we know that they have different disease patterns, whereas the insulin resistance affects really the small arterial vessels first. And that starts down in the toes and works its way up. We know that the smoking with the high inflammatory carcinogens that really starts affecting the larger arteries, the aorta, the iliacs, the thigh arteries, those really start developing this coral reef calcification. So while the result is the same, you get blockage in the blood vessels. There is a different physiology that happens to both of these types of patients.

SPEAKER_01 1:06:48

Yeah. I think there's probably more too, right? We know patients with autoimmune disease have this inflammatory cascade that they also seem to develop, whether it's related to vasculitis or truly just plaque formation. And we see familial hypercholesterolemia, LP little A, we see all these different mechanisms that ultimately end up with patients in our office with stenosis. But I'm not sure that it's all the same disease. And I wonder how, you know, in 10 or 20 years, what our understanding will be of plaque and how we how we can help people prevent it, depending on what starts this process in the first place.

SPEAKER_00 1:07:27

I agree because, like you said, even uh renal disease patients, patients that are on dialysis, they develop plaque and calcium in different parts of the arterial wall compared to our smokers or our diabetic patients. And we're just now starting to see that with when we're doing cross-sectional analysis of these diseased arteries and seeing that there's medial wall calcification and how do we treat that? And I agree with you. And this is what's so exciting about vascular surgery is that we're constantly evolving and learning and changing as we grow.

SPEAKER_01 1:08:05

Let me ask you a little bit about the medical management side of things. I know you're super into the coaching piece and the nutrition and the exercise and movement, sleep and stress. And I know that you're a true expert in the intervention piece. And in between, I think that there's the medical management. And as much as we have guidelines that say we should manage diabetes and we should be on aspirin and lipid lowering therapy, and we should sort of do this. How in the weeds do you get with your patients about dual antiplatelet versus Voyager trial and low dose Zorelto and SGLT2 inhibitors and GLP1 receptor agonists and a lot of sort of the newer tools from a medication standpoint that are coming out to help us manage these patients with truly terrible end stage PAD?

SPEAKER_00 1:08:54

Well, as a vascular surgeon, I can't be everything for the patient. And that's that's hard, that is hard because sometimes I want to be. I want to take over everything and want to be in charge of it, but that's not what's right for the patient. And you only have so much time to spend with a patient in your clinic environment. And so trying to manage every single aspect of diet, exercise, medications, I try to focus on what we call best medical therapy. So the things that I want to focus on is what is their past medical medical history? Do they have vascular disease and other vascular beds that have been identified? Coronary R disease, carotid disease, mesenteric disease, et cetera. And are they on a baby aspirin? Just basic baby aspirin, 81 milligrams. Are they on a cholesterol management drug, some type of statin? We know that statins can decrease their risk of cardiovascular events in patients with PAD. We also know it has some type of plaque modification that it can stabilize some unstable plaques. We also know that it can cause some vasodilation that can help some of the small arteries within the foot itself. So aspirin, making sure they're on a statin of cholesterol drug. And then the other thing is that they may or may not be need to be on dual antiplatelet therapy as well. So I try to focus on those three aspects on every single patient. And then any patient that has diabetes, I want to know their last hemoglobin A1C. And that tells us a predictor of how well they have been controlling their insulin resistance, their diabetes over the last three months. And that really allows us to talk to them about hey, this is affecting your wound healing. You know, when your hemoglobin A1C is really high and your sugars are uncontrolled, your immune system doesn't work as well. And so if they're having trouble with that, and certainly if they have a level of obesity, we ask them to talk to their primary care doctor about some of these peptides and things like that. And we'll write it down on a sheet for them. But as far as me taking over and managing those and ordering some of these lab values to get into the weeds about it, I don't think that I have that scope right now. And I think it'd be hard for a lot of vascular surgeons to embrace that large of a scope. Uh, but certainly we need to be prescribing and making sure that our patients are on that best medical therapy that is recommended by the Society of Vascular Surgery.

SPEAKER_01 1:11:34

Yeah. Let's say there's somebody watching this podcast who's concerned that maybe they have some risk factors for the development of PAD. What would you tell that person in terms of how to go about getting screened for peripheral arterial disease?

SPEAKER_00 1:11:50

One of the easiest things that you can do, it's called an ankle brachial index. It is not invasive. Uh, it takes a blood pressure in your arm, just like you go to a regular doctor's office and get all the time. And it also takes a blood pressure around your calf at your ankle. And we compare those ratios to see if they're in normal range. One is normal. Anything above or below that, we start looking that is there a possibility of blood vessel disease? Because your blood pressure in your arm should be the same that it's in the leg. So it's a very easy test to do. It's not invasive, it's not painful, it's not very expensive, but that's a very easy screening tool that you can take a look at and see: hey, is there perforarterial disease there? And what about the symptoms that patients should look out for? So when you start having trouble walking a certain amount of distance, if you start having repeatable heaviness, fatigue, sometimes cramping in your calves or thighs, and which goes away once you stop and rest and the blood flow catches up, that can be a sign that you've got blockages or your pipe system, your highway, blood blood vessel highway system is not completely open. You can start having loss of hair on the lower part of the leg. The skin can get very shiny, signifying it's not getting enough blood flow. You can start to have discoloration in your feet. Um, they can start looking red or even extremely pale. Sometimes they can look either way, but if they're starting to become discoloration in your feet, especially at your toes or the base of the toes. And then the highest risk is would be a non-healing wound. If you're not healing a wound that has been there for a few weeks, that would be something that you would want to expedite and quickly get to a physician's office for evaluation.

SPEAKER_01 1:13:53

And after our conversation, I'm sure people are really excited not to ever get peripheral arterial disease. What do you think are like the three most important things people can do to prevent the development or progression of PAD?

SPEAKER_00 1:14:08

First, don't smoke. I think that quit smoking or don't smoke, that is one of the best things that you can do for your overall blood vessel system and heart system. That's that's number one. Uh, number two is focusing on exercise and movement. Uh, I tell patients all the time, exercise is the fountain of youth. And as we continue to keep your body moving, when you get your heart rate up, when you break a little sweat, all of those are triggers to your blood vessels to start behaving like muscles. And that's what we want to do. We want to keep them behaving like muscles for our entire lives. And then the third thing is, is you are what you consume. And that um includes what type of stress you're consuming, what type of food you're consuming, you know, what are you absorbing on a daily basis? And so really being conscious about what you are bringing into your body and into your life, I think those three things are so important and they can help keep you out of our operating room. Amazing.

SPEAKER_01 1:15:16

Last two questions, um, and then I'll let you wrap up with anything else you're excited to talk about. What is your favorite procedure to do in the operating room?

SPEAKER_00 1:15:27

Oh wow. I I really like so as a vascular surgeon, we are able to do open surgeries, and we're also able to do inside the blood vessel surgeries. So I've got favorites in both of them. I think that one of my most favorite, it's such a basic procedure, but my favorite open procedure is the femoral endarterectomy. It is beyond pleasing to open up that blood vessel, remove all of that plaque and calcium, and then sew this perfect patch right onto the artery. Uh, I love the femoral endarterectomy, whether it's in tune with doing an aortic repair or a bypass, but I love that part of the case. It's very satisfying to me. Yeah, me too. And then endovascular-wise, doing complex limb salvage. I love it when it seems like a puzzle or a challenge to solve how I am going to get through this blockage. And especially in cases where I've got femoral access, or now I'm coming from the foot with a micro stick, and I'm trying to figure out how to get this blood vessel open and what's the best way to treat it. It is so satisfying to me to go from no blood flow to at the end of the case, you know, even my staff is getting excited about it now. We're like, we're like, look how beautiful that looks. Look at that blush around the wound. Like, that is so satisfying to me as well.

SPEAKER_01 1:16:52

Awesome. All right. And now, how about a great book or podcast or something you've consumed recently educationally or for fun that you would recommend to the audience?

SPEAKER_00 1:17:03

I think that anything with Ben Birkin on it, I think did I say his name right? Ben Bickman. Bickman. Ben Bickman. He is a um well-researched um nutritionalist as well as understands about fat metabolism and keto metabolism. But the way he explains it is very digestible. And he does it through stories and he also does it through simple science. I really think that that is a great place for people to start. You could just Google him, look at his books that he that he's um published, or any podcast that he's been on, and his passion for helping people overcome insulin resistance and how diet can, you know, let food be thy medicine. He really embodies that. So I think that that is one easy place for patients to start.

SPEAKER_01 1:17:57

Awesome. Jackie, is there anything else that we didn't cover that you want to say a brief word about?

SPEAKER_00 1:18:04

Well, we had talked about this before, and I've got an exciting update about my AnatomyPad lab. And so one of the things that I do with patients is that I not only talk to them about different, you know, diet and exercise that they need to do, but I talk to them about their anatomy. Where are these blockages? Because most patients, they have no idea where their popliteal artery is. Sure. And so I have now created an app where physicians and healthcare professionals can go and they can download these anatomy sheets and personalize them for themselves and use them in their practice. So that is going live tomorrow. I've got all of the drawings. So it's cerebrovascular system, it's aorta, it's lower extremity. And so this would be great for any person that is explaining these complex disease patterns to the patients about where am I operating on your body? Like, does anybody know where their carotid artery is? And if they don't, it's right here in your neck. And there's a picture and a drawing about how we can repair that and get you onto better health. So I'm very excited to launch that.

SPEAKER_01 1:19:24

Oh, I'm so excited. I want to be one of the first people to download it and uh get it ready for my practice. This is great. Great. Dr. Majors, where can people find you and get in touch with you if they want to know more about your practice? They want to bring you in as a speaker, they want to work with you as a patient.

SPEAKER_00 1:19:40

Uh for professional engagement, I'm on LinkedIn under Jacqueline MajorsMD. So anybody can find me there. You can look up Zenith Vascular and Fibroid Center. There's lots of information on my website. And then certainly on TikTok, you can find me as Dr. Memphis for all things that I'm interested in, whether it's entrepreneurship, it's talking about patient health, and sometimes I'm even talking about what do I wear to a medical conference? What do you wear to a medical conference? Oh, I've got different outfits that I repeat and things like that, but comfort is number one overall. They must have pockets. I don't want to carry a purse, so I can make sure I can shake people's hands. And so I've got kind of like a little recipe of what I wear.

SPEAKER_01 1:20:26

I'm gonna check that one out. Thank you so much for being with us today. This has been an amazing conversation, and I'm sure we'll have to circle back for round two when we get all the comments and questions. Thanks, Lily. Love being here. Have a great day.

SPEAKER_00 1:20:40

Until next time, guys, take really good care.