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Cheryl Martin (Host): Vascular disease is very common here in the United States. Coming up next, what it is, the warning signs and what to expect when you seek treatment Here, to answer those questions and more is Dr. Erica Mitchell, medical Director of the Vascular Institute at Regional One Health. She's a nationally known expert in vascular and endovascular. This is one-on-one with Regional One Health. Your inside, look at how we're building healthier tomorrows for our patients and our community. Our expert inside empowers you to achieve a lifetime of better health. I'm Cheryl Martin and providing expert insight today as Dr. Mitchell. Delighted that you're here to talk about what patients should know about vascular disorders and treatment options.

Dr Erica Mitchell: Thank you very much for the invitation.

Cheryl Martin (Host): So, Dr. Mitchell, what are some of the more common types of vascular disorders?

Dr Erica Mitchell: So common problems diagnosed and managed by vascular surgeons include cerebrovascular disease. Aneurysms blockages in the blood vessels that supply the brain, the intestines, and the low extremities, traumatic injuries to blood vessels, dialysis access, leg ulcerations, rare veins, and genetic conditions or malformations.

Cheryl Martin (Host): So what types of symptoms do patients usually experience?

Dr Erica Mitchell: I'm going to focus on what we call peripheral vascular disease, also known as peripheral arterial disease. Or you may have heard the acronym, PAD. It's a common vascular condition in which narrowed arteries reduce blood flow to the limbs, particularly the legs. Typically, patients have disease. Of the arteries going to the legs, and as they get more disease, plaque builds up and fatty deposits cause narrowing or blockages of the artery, and that causes a reduction in the blood flow to the legs.

When you walk, you need blood supply to the muscles, and so when you have narrowing to these arteries, you have a mismatch in the supply and demand of blood supply to your legs. So you may experience symptoms. Typically, we call it claudication. And claudication means that you have muscle pain or cramping in their legs with exercise. And when you stop, then that pain goes away. So you can have claudication symptoms in the calve muscles, the thigh muscles, and the buttocks. , but most patients with peripheral arterial disease don't actually have symptoms.

So symptoms range from no symptoms to claudication to more extreme symptoms, and that would be changes in the skin or toenails where you have coldness in your feet your legs you have, maybe you have numbness or weakness. you might not feel any pulses or a weak pulse in your legs, and you may have painful cramping in one or both legs when walking or climbing stairs. And then of course, you can go to the extreme where you actually have wounds that don't heal or you start developing tissue loss. So it's something we call gangrene. And that can be quite extreme in patients with severe multi-level peripheral artery arterial disease.

Cheryl Martin (Host): You've mentioned the symptoms, so is there a profile of someone who's at a higher risk of vascular disease even before they see symptoms?

Dr Erica Mitchell: Absolutely. Typically we think of several classic risk factors for peripheral vascular disease, and that is tobacco use, hyper cholesterolemia or high cholesterol levels, high triglycerides, so that's the fatty acids. Comorbid obesity, diabetes, and renal disease. And of course contributors are the western diet since we have our diet's very high in fat and cholesterol.

Cheryl Martin (Host): So I would assume that what a person can do to manage or reduce their risk would be to change their diet as well as the other things that you mentioned that's in their control to change?

Dr Erica Mitchell: Absolutely. So the number one recommendation is smoking cessation. So if you are a smoker, it's essential that you stop smoking and even chewing tobacco. And if you can avoid secondhand smoke, but eating a healthy diet. So one with fruits and vegetables, whole grains, fish, low dairy products. Control your blood glucoses. You avoid saturated and trans fats and limit your salt. It's essential to maintain healthy weight and of course to manage your blood pressure and cholesterol. And of course, you're not gonna get away without anyone telling you exercises is good for your health.

Cheryl Martin (Host): So walk us through what happens when a patient comes to you to see you at the Vascular Institute. What can they expect in terms of getting to a diagnosis and treatment plan?

Dr Erica Mitchell: So to start with and to make the diagnosis of peripheral arterial disease, we start with a medical history and physical exam. We ask about your symptoms and your medical history. and we also check your pulse exam. If you have peripheral arterial disease, the pulse in the area affected may be missing or weak. So we check your wrist, pulses, your arm pulses, your feet pulses, pulses behind your knee, in your groin. And we also feel your abdominal. pulse to feel for an aneurysm.

So beyond the physical exam and the medical history where we offer the risk factors and maybe even signs and symptoms of peripheral arterial disease, there are some blood tests that we can obtain and those typically assess for high cholesterol and high. Triglycerides as well as an evaluation for diabetes. Then the most common study that we do is something called the ankle brachial index, and that's where we measure the arm blood pressure as well as the ankle pressure, and we create a ratio around that.

So anyone with a normal ankle brachial index that is 0.9 and above, we essentially but say they don't have peripheral arterial disease. Anything lower than that would be by definition an indicator of peripheral arterial disease. And the lower the index, the higher the degree of disease that you have. And some of the other studies we could do is, check your blood pressure, of course, but also obtain an ultrasound of your legs and the blood vessels going to your legs and to your feet. And then of course we can get a CAT scan, and then a invasive study would be an angiogram.

And that's actually inserting a needle and catheters in the artery and injecting dye inside the arteries. And it's sort of the gold standard of defining degree of disease. And typically we only perform that when we think someone has significant disease below the.

Cheryl Martin (Host): Now as vascular surgeons, you and your team do a variety of operations to help patients. So tell us about these and how you help patients address their conditions and also monitor their health to prevent more problems.

Dr Erica Mitchell: So before we start with any Interventions, we recommend medical management and of course that would be managing all the risk factors for peripheral arterial disease. So cholesterol medications, blood pressure drugs, medications to control blood glucose and medications to prevent blood clots. So typically aspirin. Sometimes we may add a stronger medication called Plavix. And then there are. Medications that can thin the blood a little bit, that allow you to walk longer distance. So typically we start with medical management.

When patients have significant and severe disease that's limiting their ability to walk for their normal daily activities, or they have tissue loss or pain at rest, then we'll go to more invasive procedures. And treatments that we can offer are either angioplasty and stenting, so that's going inside of the arteries and opening up the narrowing in the artery with, a tiny balloon and possibly putting a stent in or a bypass. Surgery and the bypass surgery is for when patients have multiple levels of blockages and we are not able to go through the arteries to open them up with the balloon and we would use a vein from their leg or an artificial graft to do a bypass around that blockage.

Cheryl Martin (Host): Any other procedures that you perform at the Vascular Institute?

Dr Erica Mitchell: Oh yes, many. We treat patients with aneurysm, so that would be abdominal aortic aneurysm. So we definitely put in stent grafts for that. we do procedures for stroke prevention or when patients present with the stroke, and that would be cleaning out the arteries in the neck. We do fistula creations for patients needing dialysis. We perform aneurysm repairs for both the abdomen, aortic aneurysm as well as in the chest. And then bypass surgeries for legs, arms, and then of course we open up arteries sometimes with something called an [inaudible].

And then for venous disease, we can do laser ablation where we, eliminate the vein, if you're having a reflex in it. And then we also treat other conditions like blockages to the intestines with bypasses or stents or. other conditions like may Thurner or median aate ligament syndrome. So we have an array. I mean, we have multiple operations that we can provide. So essentially we treat diseases of the artery everywhere in the body, outside of the brain and the heart. So vessels in the neck, chest, the abdomen, and the upper and lower extremity, both arteries and veins, as well as the lymphatic system.

Cheryl Martin (Host): Now on the personal side, tell us a little bit about yourself Outside of work, what motivates you and what are some of your hobbies and interests?

Dr Erica Mitchell: Well, I was born and raised outside of America and all be it I was born to American parents and I have lived all over the world, all the continents, but Antarctica, I developed an interest in medicine as a child growing up on a farm in Zimbabwe, are farm was kind of the triage point for the ill and injured. And I was witness to this and this is what inspired my desire to become a physician. And so I, went to medical school, general surgery, residency, vascular interventional radiology in Colorado, and then I went on to a vascular surgical fellowship in Portland, and I stayed on there for many years in academia.

So I would say I'm sort of a true academic vascular surgeon. I like the aspects of teaching the scientific rigor, clinical studies. . And then of course, the complexity that you get in academic institutions with the whole variety and scope of practices and conditions that often cannot be treated in small hospitals. So outside of being an academic surgeon, which I love, that's who I am. We are surgeons first, and then we are, wives and husbands or friends, whatever. and so I'm married. My husband's a avid fly fisherman, amazing fisherman. However, I don't fish with him, but I certainly travel with him. We love to travel and outside of that we've got some dogs. We enjoy cooking together, reading, watching movies and just hanging out with friends and social.

Cheryl Martin (Host): That is great, and it's obvious that you love what you do and that you are committed to it. Anything else you'd like to add about vascular disease that we didn't cover?

Dr Erica Mitchell: Yes, I do think it's important to understand that a vascular surgeon, we're a little different than some of the interventionalists who provide care in that we really treat the patient from beginning in terms of the clinical evaluation, the medical management, the evaluation of the non-invasive and invasive testing, the ability to do open operations as well as endovascular. So that's procedures inside of the artery. and then to manage patients in the hospital, whether it's being on the ward, in the operating room, in the ICU, and then in the clinic areas.

And we tend to follow our patients alive. So when you think of us, we are different than most surgeons in the sense that we don't take things out of patients, we've put things in patients. So we really follow what we do for lifelong. So it's having a car and getting a car. Tune up. Our patients follow us for life because the graphs or the bypasses or stents that we put in them aren't, designed to last a lifetime. They do have, little things that need to be tweaked adjusted, and that's why we follow our patients for life.

Cheryl Martin (Host): That's great. Dr. Erica Mitchell, thanks so much for educating us on vascular disease and the treatment. I so appreciate your commitment to your patients and to this science for more information or to make an appointment with the Vascular Institute, call 901-545-7222. That's 901-545-7222. If you found this podcast helpful, please share it on your social channels and check out the full podcast library for other topics of interest to you. And thanks for making One-On-One with Regional One Health, part of your journey to better health. Join us next time for the Regional One Health Podcast as we cover another important topic to keep you on the path for a healthier tomorrow.