Amanda Wilde (Host): Vascular doctors regularly see some of the most common and severe diseases in the United States. We're talking about vascular health and when to see a vascular physician with Vascular Surgery nurse practitioner Josh Riggs. This is Memorial Health Radio with Memorial Health System Ohio. I'm Amanda Wilde. Welcome, Josh. Thank you for being here.

Joshua Riggs, NP: Oh, thank you very much.

Host: When a person is referred, what should a patient expect when they first come to see a vascular physician?

Joshua Riggs, NP: Our office appointments are going to be very similar to other providers' office appointments. We check vital signs, we'll do a physical exam, we'll talk about symptoms or review testing the patients had. The biggest difference is our focus is going to be placed on vascular problems, the circulation and kind of get into those details of those conditions.

Sometimes we'll do additional testing after the appointment or talk about medical treatments. And for those that need it, we'll talk about operations or surgical procedures that we can do to help folks out.

Host: You sort of assess the situation and lay out options.

Joshua Riggs, NP: Exactly. Yes.

Host: I mentioned that you treat some of the most common and severe diseases in the United States. What are some of the top diseases you treat?

Joshua Riggs, NP: We do. We treat quite a long list of problems and vascular diseases. I would say the most common things that we see and that folks have problems with is carotid artery stenosis, blockages in the arteries of the neck. Aneurysms, which is a weakness or a bulging of an artery, typically in the aorta, in the chest or abdomen. We'll see a lot of peripheral artery disease, which is blockages in the arteries in the legs that'll cause problems. We see a lot of vein diseases, venous diseases, and that's where you get your deep vein thrombosis or blood clot in the leg, venous insufficiency. And then, we also do a lot of dialysis work. We can place dialysis catheters. We can create dialysis fistulas, or dialysis grafts, peritoneal dialysis catheters. We certainly see a wide variety of things and we can treat those medically or surgically, whatever the case may be.

Host: With all those possible diseases and blockages, I'm wondering, are there lifestyle changes a person can make that will benefit them in the future or help prevent vascular disease?

Joshua Riggs, NP: Absolutely. There's several risk factors for vascular diseases, and a lot of risk factors can be mitigated or reduced by lifestyle changes. That's eating a healthy diet, low fat, low cholesterol diet, or at least in moderation. Exercise is always a good recommendation for folks.

What we really like to see is good control of diabetes for the folks that are diabetic. Good blood sugar control is going to do a lot in the long run. And then, smoking is very hard on the arteries. Folks that are smoking, they certainly have very high risk to develop vascular disease and that could be anywhere in the body. So, for those who are smoking, whatever they can do to cut back and quit is really going to benefit them in the long run.

Host: So, there are ways you can be proactive, but how do I know if I need to see a vascular surgeon? Are there warning signs that I should watch for?

Joshua Riggs, NP: Sometimes there are in certain vascular diseases or conditions. A common thing that we see a lot is peripheral artery disease. Again, that's blockages or narrowing of the arteries. in the legs. And a lot of those folks, they'll start noticing pain in the legs or cramping in the muscles of the legs. It's usually very consistent. I walk a hundred feet and every time I walk a hundred feet, my legs start hurting or whatever the distance may be. And some of those things you do, you get warning signs like the pain or you'll develop a wound that you're having trouble getting to heal up in a reasonable amount of time. But some diseases are carotid disease in the neck. The thing you always worry about with that is a stroke occurring, aneurysm disease, a lot of those are asymptomatic or silent. And that's why screening is very important. Folks can talk with their primary care provider about screening. And then, the hospital offers a lot of screening programs as well.

But certainly, folks that have risk factors, they smoke or have family members that have had problems with vascular diseases, they should certainly be getting screened so we know early on in the stage of the disease about it, and we can follow it, and we can kind of mitigate those risk factors, like we talked about the lifestyle changes and medication. Or if the screening shows that something is severe enough, we can fix that before it starts causing a problem.

Host: if you have any risk factors, you should get referred for screening, at least to get a baseline.

Joshua Riggs, NP: Yeah. And there's a lot of different risk factors out there. I would say the biggest ones that, if you have them, you should be talking to your family provider about screening, and that's smoking or family history of the vascular disease. Age certainly plays a part in those risk factors as well, but anybody over 65 that hasn't been screened should be screened, but folks that have had those other risk factors, a lot of times, should be screened much earlier than that.

Host: Some people are already seeing their cardiologist, and I think it'd be helpful if you could describe the difference between what a vascular surgeon does as compared to general cardiologist.

Joshua Riggs, NP: There is some overlap. The risk factors for heart disease are the same risk factors for vascular disease, and even treatments like medications and stuff. Some of them that are good for the heart are also good for the arteries. But I think the biggest difference between Cardiology and Vascular Surgery, Cardiology often, they focus on the heart. They're looking at the function of the heart, the electrical rhythm of the heart, the structures of the heart. In Vascular Surgery, we focus on the arteries and veins outside of the heart. So, every other artery and vein in the body we're taking a look at, whereas the cardiologist focus right there on the heart.

Host: It sounds to me like you have several different choices for modalities of treatment. Do you see those improving in the future?

Joshua Riggs, NP: Yes. Of course, medicine in general is always making advances, in treatments, in testing, and in all these different areas. And vascular surgery is certainly the same. We're always making advances, new, safer, less invasive procedures. And you bring up a good point there, just because someone's coming to see the vascular surgeon doesn't necessarily mean that we are signing up to go to the operating room. There are certainly times where surgical intervention is appropriate and kind of the best option, but there's also times where managing things medically with medications and different treatments is also the most appropriate option at the time.

 They don't just say yes or no, you need surgery. You come see us and it's a lifelong relationship. We monitor those things over time. We do everything we can to prevent the disease from getting worse and requiring surgery. And for those folks that do require surgery or eventually end up needing surgery, it's still a lifelong relationship with surveillance and watching things, make sure we're still good, even long after the surgery. So, it's not just, we see you and you heal and we're done. We want to follow with you for the rest of their lives and build that relationship. And then, we decide on those treatment plans together, what makes the most sense safety wise, what makes the most sense treatment wise, and what fits with the patient's wishes as well.

Host: These are great takeaways. Josh, thank you so much for sharing your insights and educating us on vascular health.

Joshua Riggs, NP: Oh, yes. Thank you for letting me talk with you.

Host: That was vascular surgery nurse practitioner Josh Riggs. Find out more at mhsystem.org/services/heart. And that wraps up this episode of Memorial Health Radio with Memorial Health System. Head on over to our website at mhssystem.org to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all other Memorial Health System podcasts. Thanks for listening.