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Ableton On Air is part of the following organizations, the National Academy of Television, Arts and Sciences, Boston, New England Chapter, and the Society of Professional Journalists. Hello and welcome to this edition of Ableton On Air, the one and only program that focuses on the needs, concerns, and achievements of the differently able. I've always been your host, Lauren Seiler. On this edition, we will focus on amputeeism and peripheral audio disease and many other things in relation to that. First of all, we would like to thank our partner in this special episode, Kim McNicholas, an award-winning journalist who has been a patient advocate with her organization called, WaitToMyHeart.org, and she's an award-winning journalist who has been a reporter and producer and entrepreneur for 17 years and has on-camera experience on television and online. We would like to thank her for joining us on this edition of Ableton On Air. Welcome, Kim, for joining us on today's program. Hi there, thank you so much for having me and it's actually, it's an honor. It's been so good knowing you over the past few months that we've been patting back and forth and now for it to come to this and I get to see you in action and be the subject. It is really fun. You're putting me in the hot seat right now. So what the heck is an award-winning journalist doing as a patient advocate dealing with peripheral audio, artery disease, and let's start there. Interesting because when I first started getting into broadcasting, one of the reasons I wanted to get into broadcasting was I wanted to create documentaries that would reflect issues that affect the community. I really wanted to be a changemaker and have an impact on the community and pretty much create the change that I wanted to see just be that changemaker. Fast forward as I got into broadcasting, broadcasting took me in a variety of different directions. I've always been that sort of trailblazer, always wanting to pave a new path. I was the first female sports director and sports anchor in the San Francisco Bay area. They had some sports anchors, but I was the first full-time, was coupled with being in charge of the entire sports department. It didn't matter that I was the only person in the sports department. Wait a minute. Women for many years have been breaking barriers. Diane Sawyer, yourself, and you being the only person in the sports department, I see your point. Even worse, you know, the thing was that someone was actually, and this I feel bad about, but they fired the sports guy to bring me in. The news director actually said to me, if we hire you, then we have to fire the sports guy. So I need a yes or no now. I was like, I don't want anyone to get fired. And he said, oh, no, no, no, it's not a bad thing. We want to take this sports department in an entirely different direction. And so we think you're the person to do it. So I had three sports casts every night. I also became the first person to have a racing show here in the state of California sponsored by a large, it's now called Sonoma Raceway. It's one of the road courses on the NASCAR circuit. And so they sponsored it and it was really exciting. Now breaking barriers, because we all break breaking barriers in our own way. But breaking barriers in the health care field, you have a podcast dealing with peripheral artery disease. You have a wonderful organization dealing with that. So what is Way to My Heart? And how does it help patients with artery disease? And let's go from there. Right. So just to get you to that point of The Way to My Heart dot org, it really was the, you know, I had gotten really far in broadcasting. I worked for Forbes magazine. I appeared weekly on Fox. I was on CNN. You know, I had done a lot of different things. And so I had branched off and decided to become an entrepreneur because, you know, for 15 years I was really covering entrepreneurship, the bust and the reemergence of Silicon Valley, the startups I've interviewed, the who's who. And they taught me so much about building a company, I thought I would go build my own. And at that point it was supposed to be an interview platform where I would train people online to do media. And it was at that time that Sir Richard Branson's team came to me and said, hey, we need some help with some press releases for this new startup competition. What we're doing, would you mind helping? Of course I stepped in, was helping out with it. Then it progressed into, well, we want to see our top 10 finals over at the world's largest consumer electronics show in Las Vegas, CES. And oh, by the way, can you see the finals of the top three on Sir Richard Branson's Island? And I was sitting here going, oh my gosh, I've never built a startup competition before. What would I be doing? And Sir Richard Branson's words inspired me. He said, don't let what you don't know and have never done before get in the way of doing something great. Sometimes it's what you don't know that could be your greatest asset in creating the greatest disruption in any industry and creating the change that you want to see in this world. And so I said, yes. And he said, yep, just say yes and figure out how to get it done. Always say yes and figure out how to get it done. That's when you have the greatest opportunities. And so I ended up doing that. And during that time, I vetted more than 5,000 companies. A lot of the companies that we were looking at were in healthcare. And I ended up deciding that I wanted to launch a radio show that would feature some of these companies. And it was during that time that a couple doctors told me that the biggest disruption in healthcare was going to be in cardiovascular. And there was this new laser that was coming out. So I went to the company and I said, hey, I want to follow your medical device from the beginning, the very first case in the FDA trial. Sleer through the trial. Sleer through global commercialization. I wanted to follow a medical device from the very beginning, all the way through global commercialization. Seeing it go through the testing. Sleer through seeing how doctors adopted it everywhere in the world. And it was during that time I traveled to nearly a dozen countries, more than 30 states, launching thousands of hours of procedures in which doctors unblocked arteries in the legs as well as the heart. Now, when you have blockages in the leg arteries, that's what you were referencing. It's called peripheral artery disease. When it's narrowed arteries, it's in the peripherals. It could be in your legs, it could be in your arms, it could be in your neck, it could be in your head, peripherals. But it's mainly in the legs. It's rarely other parts, but I've seen it happen as well. But these doctors go in and they have advances where they can take a wire and a balloon and they can blow up the balloon. They say dilating. So they inflate the balloon and it pushes the plaque aside. Now what they also have are what you call, and you probably have heard of them saying, oh, they're just going to go in and roto-router it. So they have these roto-routing devices, including the laser I mentioned. They have, you know, devices that will bunch up the plaque, break it up. They have ones that'll sand it down. And so you have different ways in which they can remove the plaque. And those are called atherectomy devices. Atherectomy. That is the physical removal of plaque. Now, in terms of the balloon that you mentioned, is it similar to the balloon situation that they do when they're doing heart operations? Exactly. Exactly. And they call that angioplasty. Angioplasty, yep. Yep. And so they do that in the heart. And then they, a lot of times, most of the time in the heart, they will use a stent. In the legs, it is becoming more rare for a doctor to use a stent. They'll use it in more of the abdominal area, groin area arteries, but they try not to use a stent lower down because it's quick to block back up. Because your legs move in all the time. So, needless to say, everything that I learned during this time traveling the world, I decided that I wanted to bring it straight to the public. And so I started joining a bunch of different social media platform groups that were all about peripheral artery disease and coronary artery disease. But it wasn't until my dad ended up on the verge of a heart attack, he started feeling some symptoms of indigestion. And this is something that's really important to note because so many people have their coronary or their heart symptoms, or what they call angina, brushed off by indigestion. And so they'll treat you with Prilosec. That's my dad's doctor said is, oh, we'll just give you some Prilosec and send you on your way, you on your head. Done. Next. They're sending a person home early without really knowing the symptom, pretty much. Right. Not stopping for a moment and saying, hey, you're 78 years old, which he was at the time. You have a history of heart disease. But here's the kicker for me. When I said to the doctor, doctor, you know, I want him tested for heart disease. I think he might have something more serious going on. His mom and his dad both had heart disease and had plaque buildup in their arteries. And she said, no, his cholesterol is normal. So he is not at risk. And I looked at her and I said, do you realize that more than 40% of people who suffer a heart attack have normal cholesterol in a basic lipid panel? It's that blood panel that you get pretty much in every annual physical that you have as an adult. They measure the good cholesterol, the HDLs, they measure the bad cholesterol, the LDL, they measure your triglycerides, etc. But those can measure as normal even if you are at risk of heart disease. And here's why. That blood test actually measures the quantity of your bad cholesterol, not the quality. If you ask for an advanced lipid panel, it'll measure not only the large, fluffy LDL particles, those ones are not troublemakers. Those are fine. HDLs will take those LDLs and they'll ship them right out of your body. No problem. It's the small, dense LDL particles, the little tiny ones that when you have artery damage in the walls of your arteries, they can sneak right into that damage and push the wall out and create the restricted blood flow and block that blood flow. Those are the ones you worry about and so you need to ask for an advanced lipid panel. But it was through that experience, yes my dad finally got his test, I convinced her, the credit card convinced her that to do an EKG, they found an abnormality, I ended up after that doing a nuclear stress test. It's on the treadmill. You heard of the treadmill, the stress test? What they do at this point is they pump in some more contrast fluid and things like that so they can light up your arteries while you're actually walking. So it was basically through your experience that you ended up doing this big organization. Because I was able to save his life, that I thought, gosh, this type of advocacy is so important. Being able to go in there, not as a doctor, not as a nurse, not someone that's tied to a textbook and drinks the Kool-Aid. Why are you, I'm sorry for laughing, why do you say that, drink the Kool-Aid? Because I think that so many people and they're very well educated, all of the education is based on, they call it evidence-based medicine, which is great, but science evolves. There's always room for more, there's new ideas, new approaches, new tools, new techniques. There are new diagnoses every day. So if there is the possibility of something new, don't you need to be able to come in from the outside with a new perspective? And I think that's what Richard Branson was telling me. It's that outside perspective, one that's not drinking the Kool-Aid, that might be able to see things a little differently. And so that's the value I think I bring to the table, is just being able to see things differently. Sometimes the public is much more smarter than the actual doctor. Because you can have, I'm sorry to put this out there, but I'm going to put this out there, you can have as many degrees, MDs, PhDs and whatnot, and stupid, I don't mean to say stupid, but not know your actual craft. There are just different things that people learn in different ways. To give doctors the credit is, you know, they have to spend so much time. I have one doctor that literally sees 40 to 50 patients a day, heads down in his clinic all day long, one after another, and then he has a full family at home. And he has all the new administrative paperwork that he has to do in order for his hospital to get reimbursed for even seeing the patients during the day and the dictations and the notations and all that. So for him to actually be able to step back and be up on everything new and next, that's really hard, because he just doesn't have the time. And so here we are, we're sitting there Googling all day long, we're seeing the new publications, we're here in the interviews, we're seeing different doctors do different cases. And for me, not many doctors have the chance to go to hundreds of different labs, watching hundreds of different doctors all around the world. And that's an education that even one of the most world-renowned doctors who treats these leg arteries, Dr. Jihad Mustafa, he was saying, he's like, Kim, you could teach doctors a few things about what you've learned. He's like, it's amazing the experience that you've had. You've had more time in the lab than I have with different doctors. It doesn't mean I can do these procedures. It doesn't mean I am so not as smart as these doctors. I just bring a little something different to the table, just a bit of a new perspective. Talking about perspective, you have a video on YouTube. Let's talk about that for a minute. Being your own advocate is so important when it comes to your medical needs and your family's medical needs. Talk about that for a minute. Why is it important to be your own advocate, and since we're talking about advocacy here and the show, why is it important to be your own advocate when it comes to diseases since you're dealing with families? Because my dad would be dead right now if it wasn't for me advocating for him. And that's the serious truth. At one point the doctor said, you know what? You would have had a massive heart attack in the next three months if we didn't get you in here. And that's scary. What's even more scary is we want to like and trust our doctors, and I really think that all of these doctors really do have our best interest at heart. They really do their best to do what they can to treat you in the best way they know. But sometimes the issue is they just don't know what they don't know. And there might be something new. There might be something next. For example, when my dad had his hip surgery, there were different approaches. There was one approach where it would still require where they just really tear you open and go down into the tissue and whatever, versus a newer approach where it was more minimally invasive where they would go in in an anterior fashion and they would just, you know, fix the hip and put in the hardware that they needed to put in. And these were two different approaches with two different doctors that were literally two doors from each other. And so you as a patient or you as a family member of a patient need to ask the questions to determine if a certain procedure or a certain approach is right for you. It might be the only option that doctor offers. It might be the best offer they approach they think is for you or your loved one. But it might not be. There might be a different approach, a different tool, a different technique. And that was one of the things that I learned, you know, going around the world and I'm going to give you an example. And, you know, sorry, I'm not more specific in terms of why you need to advocate. I can get into more specifics after the ways in which to do that. But this is an important story. And I think we also dealt a little bit with this with your personal situation as well. And you know, you didn't know what options were available, but then in your situation as well, you didn't really have the options in your area for something different, right? But in San Diego, I had watched a procedure at a small little office-based lab. And the woman who was the patient had a blockage that was in her common femoral artery in more of a groin area, you know, just at the top of her leg. And this doctor was able to take that laser I told you about and go right through. And she walked out of that hospital three hours later. The next week, I was at a larger hospital about an hour and a half away. And I saw when they pumped in the contrast fluid. So what they have to do is they poke a little hole and they access the artery. And then they put in a catheter and they pump in some contrast fluid. And the contrast fluid pumped into your arteries allows them to see or visualize your arteries underneath the X-ray. And so they can see where the blockages are happening. And they saw the blockage in the CFA, the common femoral artery. And I was thinking, oh my gosh, that looks exactly like the situation the week prior. This should be easy. The next thing I know, the doctor is taking off his gloves, taking off his, they have this big harp thing they have over them. They take that off. And I said, wait a minute. Do you mind if I ask you a couple of questions? And I was in these procedures documenting everything on camera. So the doctors were like, oh yeah, let me talk to you. Sure, I'll talk to you on camera. And so I said, well, doctor, I don't understand. Same presentation of disease last week to this week. That doctor was able to save this patient using that device. Why can't you do it? And he said, I'll never forget this because standard teaching protocols at this university hospital dictate that if we cannot stent, place a stent in a particular artery, we do not treat it. We have to have a foundation of teaching for these fellows or for these students. And so we stent everything. We don't think it's bad for the patients and we think it's really good for these students or these fellows to practice placing stents. And in the common femoral artery, there's not a stent that's flexible enough to really be durable in that artery. So we need to send her to amputation. And I said, but why don't you tell her about the doctor down there? Oh, she already signed the form that gave us permission that if we could not clear this artery that we could send her for amputation. That patient had no idea that just an hour and a half away another doctor might have been able to save her leg. Because a stent actually was not necessary and was not placed in the other patient that we had observed. So it's really important that you as a patient ask the questions, do your research, find out what options are available and say, yes, I like you, I trust you. But I do need to know that in different hospitals, different facilities, different doctors, they might just have a different doesn't mean it's better or worse or whatever. They might have a different option that I feel is best for me and never be afraid to say, I like you, I trust you. I know you're trying to do the best for me. But with my circumstances, my lifestyle, I would rather try a different direction first. And so I'm going to do this, go to this other doctor with this different approach. Now, in terms of being your own advocate, why is it so important to get all the medical records, all the testing, because some things on the medical records are not always there, right? They might be hiding, I don't know what they call it. But why is it so important to get every single piece of paper, every single disc, every single thing? Go ahead. Because I've been a royal pain in your, you're too much over the last few months. Did you get the record? Did you get the CD? Did you get this? Did you get the case notes? Yeah, I'm talking about everybody, not just me, I'm talking about everybody else. Go ahead. So I'll give you an example first. We had a patient that was having open heart surgery in October of last year and the open heart procedure was scheduled for the next day. Well, the hospital's record system got hacked the day before this procedure. So the doctors could not access any of his CDs, any of his charts, nothing. And so he was sitting there in the hospital and they came in and said, well, if we can't access your information, it's not safe for us to do this procedure tomorrow unless we get more, we need time to prepare. And he said, and he handed him this big thick folder and he said, here you go. Here's everything. He had the CDs of every single ultrasound and angiogram and all the case notes, all of his blood work. He wanted all in print right there in this really big folder. And the doctors were like, wow, this is amazing. And he had even more than what they needed, more than what they had in their own charts because he had had procedures elsewhere that also helped give them better insight and the ability to prepare even more strategically for this procedure. And the procedure went on and it was successful while all these other procedures at that hospital were not. Now, secondarily, not every hospital is going to get hacked, right? But a lot of different things can jeopardize your access. Talking about hacking, there have been cases in the past with certain hospitals. This is why hospitals put their records now on computers because people steal records and all kinds of different things. So you want to be actually prepared for anything as it goes forward. And secondarily, you also want to be able to get a second opinion just like that. Because in so many situations, as you discovered as well, that time is tissue. Tissue, especially when it comes to peripheral artery disease, can degrade very, very quickly. It can progress if you have an open wound on your toe. A lot of times with peripheral artery disease, if you have restricted blood flow and you end up stubbing a toe and it breaks open into a sore, you need oxygen to heal that wound. Where does the oxygen come from? The oxygen comes into your lungs, it's pumped into the bloodstream from there, and it's carried down through the arteries all the way down to those capillaries into the little area where your wound is. And it helps to heal the wound. If you don't have that oxygen, it's tough to heal that wound. So you end up with things just going south very fast. So you have to be able to, if a hospital offers you one option, you need to be able to take those test results and the doctor's notes immediately to another doctor to get a second opinion. If that doctor says amputation, more than 90% of all amputations are preventable when it comes to peripheral artery disease, but a doctor at one facility may not have an advanced set of tools, an advanced set of techniques that have only evolved, I would say, in the last five years. So you can't blame the ones that don't have that extra skill set. But it's just important to know that there are different doctors with different skill sets. So you need to have those charts, you need to have that CD in order to get it to another doctor as quickly as possible. They don't always share the records. So what we always tell people is, one, always make sure that you have access to your online portal. Make an appointment with your hospital facility, a social worker, patient advocate at that hospital to sit down during that appointment and show you how to work that portal to help you sign in, to make it easy so that a lot of these portals, they can set them up for you. So it's facial recognition. So anytime you want to access it on your phone, you just click on the app and then it comes up with your face to help you to access it so you don't have to remember pass codes. If you don't want to access it on your phone, you can also work with them on getting it onto your desktop as well. You want to be able to have them show you, how do I access my test results? How do I access my doctor's notes? How do I email the doctor my test results? If you end up going to a different doctor, always make sure that your general practitioner is aware that you went to a podiatrist, that you went to the diapodologist, that you went to a vascular specialist or an orthopedic specialist and send them a message that says, hey, I want to let you know I went to another doctor. Here's what they told me. Would you mind double checking that doctor's notes and making sure you have them in your files as well? Now, beyond the actual portal, you want to make sure that if you do have any sort of test, when you walk up to register for that test, if it's an ultrasound, if it's a CT angiogram, if it's a stress test, whatever it might be, you want to say to the clerk, hey, how do I get a copy? Do I need to sign a piece of paper right now? Can I walk out today if I wait around with a CD of those test results? I need to have a copy because I need to be prepared to get a second opinion from an outside facility if necessary. But a lot of times what they do is they'll say, okay, you need to go to the records department and you need to request it, and sometimes it costs $15 to do it. For low income folks and people with special needs, a lot of times they will waive that. If you go to the hospital social worker, so really get to know your hospital social worker for that. That's really important, but have your case notes. Even if you can't put a CD into your computer like I don't have a CD player, if I need that CD, if I need it played, I can go to another doctor and they can play it on their facility's computer. So that's really important. With blood tests, though, blood tests will go straight to your portal. Yeah, and so let's also talk about, now your website mentions, waytomyheart.org mentions leg saving or saving a limb. Can you explain how important that is? And then we'll go from there. Why is it so important to try to save the limb? Yeah. Go ahead. It's interesting, and I like the way you phrased that question. Why is it important to save the limb? Because there are different schools of thought, as you and I have discussed offline. I really like the way you phrased it because it really plays into the conversations we've had because there are different doctors that really don't think it's important to save the limb. They really think that it's of a person's benefit in many situations, and even more situations than some doctors, that a person is better off losing their limb, stopping a revolving door, they call it a revolving door of treatments, which involve taking the wires and those balloons and roto-rooting as well. Those arteries and keep clearing it out because for many people with peripheral artery disease, it's a progressive disease. And so what ends up happening is, especially in the younger folks, the body ends up having a healing response to any sort of trauma to the vessel. So if a doctor goes in and presses the plaque against the wall, the body goes, whoa, what's that? Oh my God, we got to send in the troops, the facts, the cholesterol. We got to patch that up. And then it starts building again and scar tissue builds. Just like when you get a scratch and it scars, it can do the same thing and you get this scar tissue inside the artery. And some people get it within three months. Some people get it within six months. Some people don't get scar tissue building up for even a couple years, sometimes even three years. But the fact is that it does come, you know, the blockage for the most part can come back. And some doctors believe that that's just a waste of time. Patients, you know, shouldn't have to come back year after year. Let's just chop off the leg and let's move on. The problem with that is that I think some doctors don't realize that those amputations are also a revolving door. We have many patients that come in, you know, and they get their toes chopped off. But then a couple years later, then it becomes below the knee and then it becomes above the knee. What is the difference between above and below the knee and above? In this case. So a lot of doctors think that a patient is better off even if they have blood flow, you know, lower down a little bit below the knee. They'll just want to do an above the knee amputation. They call it an Aka. Simply because they think that it's a lot easier for patients to recover a lot quicker. It's better for the prosthetics. But in my experience with patients, especially if they do have that blood flow, patients, it's traumatic to lose your leg above the knee. It's traumatic to lose any part of your body at all. But what I find is that patients who have a below the knee amputation, they actually have their knee cap in place. And when you have your knee in place, you can actually use a knee scooter to get around. But you're not confined to a wheelchair until you get your prosthetic. You're not confined to a wheelchair if you don't use your prosthetic. And you can use these knee scooters to really, I think, stay a little bit more mobile. So I think that that's an important consideration. You are on deck for an amputation to have that discussion with your doctor and you decide what feels best for you. But the consideration that you need to have is, do I have enough blood flow going through my knee? And there's an artery in there. It's called the popliteal artery. It goes behind your knee there. So you want to make sure you have adequate blood flow going through that vessel into your lower limb, into your calf so that they don't need to do an above the knee. Anytime before an amputation, you always want to make sure that the doctor goes in with those wires and balloons and does the best job they can trying to actually clear those vessels. And even more, you want to make sure that they not only come down from the groin, the top, they put a little hole in that artery up there to access it up near the groin, but also that they try coming from the foot, coming up from the blow, and to try and tackle that blockage to see if they can get through this way, but they can't get through this way before you consider having an amputation. No, in terms of amputations, there's a lot of nasty stuff that, in terms of infections, those that don't know. What causes gangrene and can it be stopped? I know it's black skin, but can you kind of explain a little bit more about that and how we can prevent, how can gangrene be prevented, if anything? So, yeah, and that's a loaded question because there are different ways in which it can develop different situations. It always pretty much starts with a wound, but it's really, you're not getting the oxygen and nutrients you need to that site of where that wound is or where that skin is. So, it's just the tissue dies. It just dies off. And so, unless you get to it quickly, you're not going with, like that blood flow restored, the key is getting that blood flow restored. If you're not getting it restored, then it's just going to keep dying off and it's just going to keep progressing. And so, who is most at jeopardy or at risk of getting this? We find that a lot more diabetics are at risk of gangrene, of wounds that won't heal. Sepsis as well and other stuff. Sepsis is very serious, very, very serious. And that is something that is, you know, you have two types of gangrene. You have the dry gangrene. You have the wet gangrene. And so, just depends on your presentation of disease and if there's infection in there. That's when you, you know, that wet gangrene and that you can become septic. You can also get sepsis. It's an infection in the blood. If you just simply have a wound. So what happens with diabetics in particular is you have a couple of different situations. You have one, you have the neuropathy. So you may not feel your feet. You may not feel if you step on something and you get a cut. Or if you get a blister that ends up popping and then it becomes infected and you just don't see it, you don't feel it. You think, ooh, thank God, I can't feel that hurt. That really hurt. But that's a bad thing because you want to feel it so you can get it treated sooner rather than later. If you don't get that wound treated sooner rather than later, it can progress. It can get more infected. And that infection can spread into your system. And if it becomes systemic, it can be life threatening, not just limb threatening, but it can become life threatening. Now that's one side of it. Then there's the other side for diabetics, but also people who, diabetics who have peripheral artery disease, meaning those diabetics, one sugar molecule, one extra sugar molecule in your blood can scratch the artery. And remember I told you about those small LDLs? One molecule of sugar that is extra in your blood can scratch that artery. And that little LDL can push its way in there and push that wall out and restrict the blood flow. When that blood flow is restricted, again, the oxygen and nutrients are not going to get to where your wound is. It's not going to be able to help try and heal that wound. And so again, it can become infected. The tissue can die. And that's when you're going to also see the gangrene. So it's really important, especially if you're a diabetic, or especially there's also genetic neuropathy. There's also neuropathy that can stem from problems with your lower back. It's important that if you do have any sort of neuropathy on your feet, you check your feet every single day. Make sure you're always wearing socks, a good pair of socks around the house. I always wear at least some slippers around the house. Also, make sure you have a right-fitting pair of shoes, something with a wider toe box, so you're not rubbing. Pay attention to see if there's any blisters forming, any tightness, because especially if you're diabetic, especially if you have neuropathy, you are more at risk of getting these wounds. You want to make sure that you don't get wounds when you're diabetic, or have neuropathy, or have peripheral artery disease, because that increases your risk of developing non-healing ulcers, the gangrene, and ultimately, it would be at risk of getting the disease. Ulcers and corns and other stuff can be more detrimental as well. And especially keeping one's feet clean is also important, because if it's not done, then it can lead to more problems, I'm assuming. Real quick, we have a couple minutes left. Wow, how the time goes. Can you explain about your podcast, which is real important information for people to know? Go ahead. Since my background is in media, I always look at what are the things I can bring to the table that could help in what I'm doing, and especially with advocacy. Remember, I said with Sir Richard Branson, your greatest asset could be what you don't know in a particular industry, but it could be where you excel somewhere else that you can bring, how you excel somewhere else to the table to help create the disruption in another area. And for me, I think one of the biggest issues that we've had with peripheral artery disease is the lack of awareness of the importance of getting tested early and the new treatment options that are available that could avoid, you know, prevent the amputation. And so I got together with Dr. John Phillips with Ohio Health, and he was really interested in building out this idea of a podcast called Save My Piggies, featuring different patients who were faced with the amputation, but they were able to have their legs saved through whether it was lifestyle modifications. And lifestyle modifications are the biggest preventative measure, walking, eating right, smoking cessation, making sure you're taking also medications along with that, that thin your blood or statins or whatever the doctor prescribes to reduce those risk blood pressure medications. So he wanted to do something with that. So we came together, a company called Cardiovascular Systems, it's one of those roto-rooting devices. Remember I talked about the one that sands? Yeah. That was the one that sands. That's one of the devices that actually ultimately helped save my dad's life with his coronary. He had his widowmaker, LAD, cleaned out using that before they used a balloon and then a stent to keep his vessel open. But, and that was in his heart. So he and I got together thanks to CSI bringing us together and saying, hey, you both have this great experience and these great ideas with bringing awareness to this. Why don't you come together? And I love how the universe works. I love how God works. You start putting this energy out there and saying, wow, I really want to do this. And then he just opens the doors, the floodgates just open. And I got a call from my former, the head of my former radio station and he said, hey, you have the number one show for technology on our radio station. Are you interested in doing something again? And I said, how about healthcare innovation? He said, great, we have the time slot for you and we're going to make it happen. So they started the Heart of Innovation and it's 60 minutes that could save life and limb and it's on 860 AM the answer on the radio at 860 AM the answer.com or the heart of innovation.org online, there are the links there for that. But we try to interview doctors. We try to interview entrepreneurs. We interview patients as part of our save my piggies segment. And it's really a candid discussion about, I mean, literally it's very candid because I can't hold back my opinions and my experiences and my frustrations and also what I learn along the way on this show. And I'm even right now because this week I'm so frustrated so you got to get ready if you're going to listen to the show this week because I have a feeling I am going to rant about... It's okay because we were on this show, go ahead. I love it. Let's talk insurance companies delaying life-saving procedures. Right now, if you've seen me look down, I have one of our patients that is in the hospital. We had worked last night getting him to the emergency room. He was at a gas station and I called him and he said, yeah, I'm not feeling too good. Went through some of the symptoms. I said, you call 911. I'm calling the gas station to make sure your car's okay. Let's get you to the hospital. And I called his doctor's office and I said, he's going to the ER. Why did you not get him in for a CT scan last week when the doctor ordered it? And they said because the insurance has not approved it. The insurance didn't approve or had not yet approved an urgent referral for a test for a patient that's experiencing chest pain. They would rather you just wait. Chances are they're going to die. Or, you know, maybe there's a slim chance they'll end up in the emergency room. So we'll just take that risk is how I feel about it. So now they have to pay probably two, three times as much to reimburse the hospital for a CT scan that's done in the ER versus in outpatient. And there is a difference in pricing. Talking about really quick, talking about insurance. Since you said that, I mean, you can rant for a couple of minutes. But why is it that insurance companies like, if you need something like, for example, if you need something in an emergency and insurance doesn't cover it, especially with peripheral artery disease or anything of that nature, what do you do? How do you go about that? Well, the good news is, at least in our system, if you go to the emergency room, whether you have insurance or not, they will treat you. They will do the diagnosis. They will treat you. It has to happen. Whether or not you get a bill afterwards, that's a whole other story. There's a great organization called patientadvocate.org, and it's free. They assign you a case manager that will help you with that bill, help you to work with the hospital to negotiate it down. Sometimes they can even provide resources to financially cover that bill, depending on your situation and whether or not they have grants for that particular ailment. They're really valuable down the road. They can also help you to find an insurance policy that is right for you. We have our patients work with them a lot because I mentioned before that there are, not all doctors, have advanced skills in what we call limb salvage or saving the limb or preventing amputation. In particular, they say that it's not possible to take a wire and balloon all the way down the arteries, clear into the arteries in the foot. They say it's not effective, can't be done, shouldn't be done, every reason why. But there are other doctors that are like, hey, we're saving limbs. So we do that. But insurance may limit your doctor's choice and you may not have an option. For example, in some HMOs, they lock you in to their system of doctors and you might not have any doctors that can get into the foot arteries, those small arteries in the foot, they're going to tell you your vessels are too small. Well, you know what, this wire, it can be as thin as a piece of hair that they use to get down there. So not sure that the vessels are really too small, you just need advanced skills. So with the insurance companies, you need to find a policy that is right for your ailments. So every year it's really important to take note of what do I have going on in my life. Always make sure that your deductible is for emergencies. For me, I think that you should really make sure that's covered. But number two is assess whether, okay, do I have asthma? Do I peripheral artery disease? Do I have a coronary issue? Okay, what are the advanced tools and techniques available for the things that I have going on? What are the different treatment options? Does the HMO have doctors that offer this wide variety of treatments or do they have standard protocols that limit the different options that you have available because they are going to say, hey, most people will respond to this cancer treatment. So we're going to use this cancer treatment for this type of cancer. But if you're an outlier, you're screwed. So you really need to sit down in that moment and understand different tools, different options, different approaches and figure out what's right for you and which policy can actually give you the most options. Now I understand that economics can play a huge role. Especially with low- We're keeping patientadvocate.org. Especially with low-income people, yep. Exactly. But patientadvocate.org, they provide that free case manager and they're really great to help you find a policy that is right for your situation. Okay, well, I would like to thank you for joining and we'll have plenty of other shows together, plenty of other topics. I would like to thank you for joining us on this edition of Abled and On Air. Kim McNicholas, wadetomyheart.org. If you need more information on health policies or insurance or any help with a social worker, you can also go to www... What is that again? What's the... The wadetomyheart.org is our website and we're happy to do that. And then patientadvocate.org is really helpful with health care policies and negotiating bills. Yep. So for more information on today's topic, you can go to www.wadetomyheart.org and also if you need help advocating for hospital bills or a social worker, you can go to www... Patientadvocate.org. That's www.patientadvocate.org. And if you want to find out more information on Kim McNicholas' show, you can also log on to... What is that again? Heart of Innovation.org. The heart of innovation.org. That's www.heartofinnovation.org. Again, I'm Lawrence Seiler. See you next time on the next edition of Abled and On Air. Stay tuned. Major sponsors for Abled and On Air include Washington County Metal Health, where hope and support come together. Media sponsors for Abled and On Air include Park Chester Times, Muslim Community Report, www... 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