Chapters Transcript Video Keynote Speaker Preventing the Preventable Back to Symposium Uh, but with that I wanna get to the main portion of tonight, and that is my distinct honor to introduce you to, and many of you already know, um, Kim McNicholas. So when Kim and I have worked together and I will say that it's, you know, I spent a lot of time with patient advocates and with patient advocate organizations across the US, and as a lot of you know, you're harder pressed to find a more engaged and really fierce patient advocate than Kim and so I just wanna, um, for those of you who don't know Kim, give you a little bit about her background because it's equally I think impressive and and inspiring. Kim is an Emmy Award winning journalist and a former Forbes contributor who turned her investigative investigative career towards one of the most under-recognized crises in vascular medicine preventable limb loss and undiagnosed and undertreated peripheral artery disease. Over the past several years, her patient advocacy and education initiatives have helped thousands of individuals avoid amputation by accelerating access to vascular evaluation, second opinions, and evidence-based care. She has built the largest global network of patients and caregivers, giving clinicians real, real-time insight into the lived experience of PAD. Kim is the founder of the PAD Leg Saver hotline, a first of its kind patient navigation and education resource. She has also developed the only free structured walking program available globally for both patients and clinicians, along with ongoing dietary education and smoking cessation support programs. She currently hosts the Heart of the innovation. The number one healthcare innovative innovation radio show in the San Francisco Bay Area and the number one women in innovation podcast in the nation where she regularly interviews leaders shaping the future of cardiovascular and vascular care. Known for her ability to bridge medicine, systems of care, and the patient voice, Kim challenges us to rethink how PAD is recognized, communicated, and treated before limb loss becomes the outcome. Please join me in welcoming Kim McNicholas. watch. Hi everyone, how are you doing? Are you enjoying this beautiful Scottsdale weather and all of our friends back east are getting sucked in. Yeah, I feel so thankful to be here. So thank you so much, BD, for having me. Thank you for everyone for entertaining, um, the patient voice this evening. I'm really excited to be here, but before I tell you about the Global PAD Association. You're probably wondering why PAD because I'm not a physician, I'm not a clinician, I'm an Emmy Award winning journalist with credits at Forbes magazine. I've been on CNN. I've been on Fox, and you just name the network and I've been on it, but there were 3 key moments that triggered a complete course change and redefined my purpose in life and my mission in life. So years ago as a journalist, I was investigating life and limb saving devices and how they come to market. I traveled to nearly 12 countries, more than 30 states, watching hundreds of doctors perform thousands of hours of procedures where they were treating blocked arteries mainly in the legs, but also in the heart. It was a lot of work, but one day. I was at a large university hospital in Southern California and. I was watching this patient tackle a very tough CTO in the common femoral artery. Well, I shouldn't say tackle, he was looking at it, he pumped in the contrast fluid and then he stopped. He turned to his team and he said, send the patient to amputation. And I literally froze because just the week prior, I had observed a different doctor with a different set of tools. With the same presentation of the disease, same location, similar length, and he used a laser, a balloon, and the patient walked out that day on 2 ft. So I said to the doctor, I don't understand why amputation. And he said words I will never forget. He said we could do it. But standard teaching protocols dictate that if we don't stent a particular artery, we won't treat it, not can't, not shouldn't, won't. That patient had no idea another option was available nearby. That was the first moment. The second moment, as I'm getting ahead of myself, I get excited, um, the second moment was in Louisiana and I was observing a CL. Operator all day long and he was tackling the most complex CTOs with the ease of wiring Christmas lights and later that day we went into clinic, a man about age 50 hobbling in with a cane looking at about 85 years old, um. I was thinking we were going to get good news from what I'd seen that day. The images came up, severe disease, yes. But the doctor I thought was going to say revascularization, and instead he said amputation. And after the man left in tears, I said to him, I said, I don't understand why you tackled tougher lesions earlier today. And he said words that still haunt me to this day. Why delay the inevitable? He's just a poor black man from the projects, he smokes, he drinks, he won't walk, he won't take care of himself. I've already revascularized him a couple of times over the last 3 years, so why delay the inevitable? In that moment I looked at that doctor and I vowed that I was going to help not only that patient, but I was going to help others, although at that point I didn't know how. It wasn't until the story became personal that the, the light bulb finally went on. It was just months before my dad's seventy-ninth birthday, and he was experiencing some indigestion, and he said, you know what, can you take me to urgent care, I need to get a prescription. And I said, OK, so we go to the urgent care, my dad describes the symptoms, the doctor said, yes, I think it's heartburn. I'm ordering you some Prilosec. And in that moment I was thinking, gosh, you know what, with all I've learned, there might be some underlying disease, especially since his mum and dad both died of coronary artery disease. And so I said to the doctor, hey, how about an ECG or some sort of advanced testing, uh, what do you have, what do you think? And she said, I don't have a diagnosis code for that. And I said, OK, so here's my credit card, can you perform an ECG? And behold, there was an abnormality. Uh, the abnormality was confirmed by a nuclear stress test. My dad was on the table, um, just a few days later, and the doctor said, thank God for you, he was on the verge of a heart attack. And oh my gosh, I had chills that ran down my spine and I thought, oh wow, I think I've just found my purpose. If I can advocate like that for my dad, how could I not do the same for those who don't have someone like me? So those 3 moments a patient abandoned, a patient dismissed, and a patient saved, those became the blueprint for the Global PAD Association. We are on the front lines with patients every single day, providing them with comprehensive personalized education, high touch advocacy, and real-time lifestyle modification support to help them become better partners in their care so they can live a longer. Better quality of life with 2 ft on the ground. We launched in 2019 and we have grown our network to more than 12,000 patients across the globe that we support. Our mix of patients, I would say the biggest mix is between the intermittent claudicants and those with lifestyle limiting claudications, but we do get our fair share of CLI patients, especially those that are coming through our hotline, our legsaver hotline that Caitlin mentioned. Um, that are on deck for amputation. But you know what's interesting, the one thing that was just really surprising. That we've learned in our journey that I really wanted to share with you is something that's really concerning is the level of suffering for people that are considered to have moderate PAD. Now these are the patients, they see their GP or they see the vascular surgeon maybe once and they're told to take their medication, to walk, walk, walk, to stop smoking and to eat better, and they may not see their doctor again for another 1 year or maybe 2 years. And so they leave the office just completely distressed and confused. How do you expect a patient to comply with doctor's orders if they don't clearly understand their presentation of disease? They're told to walk, but walking is painful. It seems counterintuitive, right? Most doctors don't take the time to explain it to them, so they just don't walk. And even worse is, here's the kicker, they go home from your appointment and get. Guess what they do. You've all heard it. They Doctor Google. And what does Doctor Google tell them? The sponsored content that comes up first tells them that they'll be dead in 5 years. Do you expect a patient to comply with your orders when they're gonna say, Why bother? I'm gonna be dead in 5 years, so I'm not even going to comply with your orders. So these patients, what we see every day, they're confused, they're distressed, they're anxious, they're depressed, and with that they are not going to comply with doctor's orders. Non-compliance is not defiance, it is distress, and not only is this distress leading to non-compliance with the doctor's orders. But it's also leading to so many patients falling through the cracks. They're not showing up for, not asking questions. They're literally sitting back quietly deteriorating day by day, losing more and more an opportunity to have their limbs saved and to live a better quality of life. So the next time you see them, they're showing up on the doorstep of the emergency room with a gangrenous toe or an infection on deck for amputation. Just like Mama Joyce, Mama Joyce in Louisiana, her daughter called as she discovered that having a phone number, the Leg Saver hotline, actually helped to reopen a pathway for her mom. Her mom entered the emergency room with a very angry toe. Two failed bypasses, a fem pop bypass and a fem tib bypass, and the doctor came in and said, so sorry, neither worked, the only option we have is amputation. And so we got on the phone with Jay, the daughter, and the daughter said, what do I do? And I said, you need to ask for a hospital to hospital transfer. I've blown out the mic. But you could hear me in the back, right? So, um, they asked for a hospital to hospital transfer, and the doctors came back and said there are no hospitals available, no beds available, there are no receiving doctors available, and, oh, by the way, if you want to take your mom out at all, you're going to have to check her out AMA and you're going to be stuck with the bill for the last two weeks. So she leaves the hospital, she's in the parking lot, she's in tears, and she calls me and she says, there's no hope. And I said this. I swear to God. I said, Jay, you need to stop right there, turn around and get your cute little butt back upstairs and call a meeting of all of your doctors. Put me on speakerphone. And she did. I told the doctors, we have a hospital, we have a bed, and here's the cell phone number of the receiving doctor. Within the hour, the patient was transferred. The doctor got her in for a full vascular evaluation, and turns out she had no inflow. They never checked the inflow. All it took was a wire shock wave and a balloon and a stent, and she was good to go. Amputation averted, or so we thought. As soon as the vascular surgeon left the hospital. He had privileges at the hospital, but he, so he left. The wound care team came in and the general surgeon said, well, now you have too much blood flow and the wounds aren't going to heal, so why delay the inevitable? Let's cut off the leg. So Jay gives me a call. I call the vascular surgeon and he said, some expletives. Um, I'm coming down there and we're going to figure this out because I've never heard of too much blood flow, um, causing an amputation. So he came back, we came up with a plan B. I was able to facilitate getting the patient over to another wound care center where they had. A new FDA cleared product within 3 months. Mama Joyce, she was on her feet again, and she is doing great. But Mama Joyce is not an isolated case. We have had a few on our Leg Saver hotline at 1-833-PAD Legs who have been in Mama Joyce's situation, but most of our patients that have come our way, 85. 5%, a doctor never even tried at all, and if they did try, it was all above the knee. They told the patients that their vessels were too small below the knee to treat. And 35% of the patients who have called our hotline, diabetics, never even told they have PAD, just told the amputation was due to diabetes. And when we sent them for a second opinion, what percentage do you think actually had PAD? 100%, every single one of them, and every single one of their legs were saved, minus a few toes, which was absolutely incredible. Now. We have also had some venous cases and people were, were on deck for amputation because of vein issues. We had Marsha, a CLI fighter in Florida, had opened up all her vessels. She had a very angry toe. He told her to go to the emergency room, get on IV antibiotics. He was confident that she had full flow to her toe. But the vascular surgeon there said no amputation, why delay the inevitable? Basically, she checked out of the hospital, called our hotline, and said, I don't know what to do. Can I get a second opinion? I said, I know your original CLI fighter. Let me just call him. I called him. She went in for an evaluation. Turns out there was no venous return. That was the problem. She lost the toe, but he was able to fix the problem and save the entire leg. But another patient over in Michigan was not so lucky. Diane had already lost one leg, and when she was on deck for another, she called our hotline. We got her in for a second opinion. The doctor called me from clinic after seeing her completely distraught, and he said, this patient does not even have PAD. She does not even have wounds at all. They cut off her leg because she was in pain. She never even, they never even tried to fix the problem. He was able to fix the venous issue and she was fine. It's too bad that she didn't find us earlier than that. But you have all read the headlines where, you know, they're talking about too many procedures to try to save the legs, right? Leading to amputation. In our network, you can see by this poll, that's not really what we're seeing as the biggest problem. Most of the patients that are in our network, they're only offered intervention. Um, you know, for lifestyle limiting, claudication, or something more than that, the bigger problem that we see, take a look at this, too many patients are getting amputated as frontline treatment. The patients are completely unaware of limb saving options that are available. It's just absolutely appalling. I mean that and incomplete, inconsistent care such as in Marsha's case and Diane. Case, as well as Mama Joyce. Too many doctors are still refusing to give up the patient. Instead, they're still giving up on the patient, and that's where we come in. We are there to actually help support the patient in their journey to find advanced evidence-based guideline-driven care. To help them live a longer, longer, healthier life with 2 ft on the ground. But that's not all we do. PAs should not be all about procedures, you would all agree, right? But the fact of the matter is lack of early diagnosis is one reason, right? Why we end up with so many procedures out there. But the second reason is the lack of compliance with critical lifestyle modifications. But you really, we've got to get to. The bottom of the disease with each and every patient and hold their hand and help them every step of the way to comply with quitting smoking, with walking, with eating better, and that's what we do. They cannot, and they will not do it alone. And if you put them in a 3-month rehab program, that's great. They'll do it for the 3 months. But PA is a lifelong journey and that's where we come in with all of our programs. We are with these patients for life. Take Mike right there in the corner, he was diagnosed with PAD. And he, his mom had already had an above knee amputation. He was told, you have PD, go home, walk, walk, walk, quit smoking, and that's all we're gonna do for you. And he's thinking, well, why should I bother? I have bad genes. I'm not gonna walk. And oh, by the way, if I do walk. I, I, my neighborhood is full of hills. If I go down the hill, I'm not gonna be able to go up the hill. So he became a recluse, found us online, called our hotline. We got him enrolled in our walking program on our walking app. We gave his doctor. The dashboard to monitor his progress. He signed up for our weekly seminars, the weekly coaching, accountability, and 6 months later, you won't believe this. He went from not walking at all because of debilitating pain and so much fear. He walked a 13 km without stopping and improved his ABI to almost normal numbers. It was absolutely amazing. But then you have Diane up there in, in the corner, up in the far corner up there. She was a whole different story. You've all had patients with a revolving door procedures, right? So she went for 2 years with a revolving door procedures every 3 to 4 months. And the doctor finally called me and said, Kim, Uh, we gotta do something. Her A1C is out of control, and we're running out of options here. What can you do? So we signed her up for our weekly, uh, diet program. Most of our patients don't have access to a regular dietitian or a nutritionist, so we, our chief medical officer is world renowned diabetes. Reversal expert Michael Danzinger, and he meets with patients every single Monday. We have a book, Food for Thought. We give it to all the patients, and they use it during these office hours and they get real-time support to reverse their diabetes and improve their artery health naturally, and they have accountability. Getting her into this program, getting her onto our walking app, and literally within 3 months her A1C dropped so dramatically that she has not had. Any procedure in more than 1 year. After 5 years, she had different doctors, but 5 years of just this revolving door of procedures. So we also have our smoking cessation program. It's every single Monday. I know I've talked to several of you out here that we have so many patients that literally have quit through our program and we're happy to help your patients as well. We see ourselves as an. Extension to your care, providing additional education, high touch advocacy, and real time lifestyle modification support so we can help reduce the fear, reduce the anxiety, reduce the confusion and the stress and the ultimate distress. That leads to noncompliance. We help your patients to comply with doctor's orders, and we help patients to get to CLI fighters like so many who are in this room. Thank you for all you do to help save life and limb. Let's save life and limb together. Published Created by
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