Improving PAD Lifestyle Changes in your patients: Balancing Mind and Body

August 03, 2022

Information

The American Heart Association recommends four important lifestyle changes to discuss with your patients: following a heart-healthy diet, avoiding tobacco smoke/smoking, staying active and achieving a healthy weight. In this podcast, learn how to help your patients navigate lifestyle changes to improve health and decrease the progression of PAD.

ID7995

To CiteDCA Citation Guide

00:03Welcome to the peripheral Artery
00:06Disease Podcast titled Improving PD
00:08lifestyle changes in your patience,
00:10balancing mind and body.
00:12This is the third podcast in a series
00:15of podcasts from the American Heart
00:18Association PhD initiative and this is
00:20part of the PD National Action Plan.
00:23My name is Kim smultron.
00:25I'm a clinical psychologist and
00:27outcomes researcher at Yale University
00:29and I've spent much of my career.
00:31Studying patients dealing with
00:33the diagnosis of PDD interviewing
00:35several hundreds of patients who
00:37have shared with me their stories
00:40on what it is like to navigate PD
00:42lifestyle changes and how patients
00:44describe that making lifestyle
00:46changes can actually be very hard.
00:48And is it true?
00:49Balancing act in which both mind
00:52and body deserve attention to
00:54successfully manage their PD today
00:57with me are Doctor Carlos Minho,
00:59Tado interventional cardiologist.
01:01Yale University and Steve Hamburger,
01:04patient expert and advocate speaking
01:06about how a big part of PD management
01:09is setting yourself up for success
01:11in making those lifestyle changes
01:13that go a long way in getting
01:16symptoms under control and reduce
01:19people's cardiovascular risk.
01:21To get us started,
01:22I wanted to get this big question
01:24and perhaps counterintuitive
01:26question for an interventional
01:28cardiologist out of the way,
01:29and ask Carlos how how do we
01:32prevent that patients need like
01:34procedures for PD after all.
01:37Thank you Kim for a an important
01:39question and thank you to the American
01:41Heart Association for setting this
01:43series of podcasts that I think will
01:45help many of the patients that live
01:47in our country with this pathology.
01:50You sort of write.
01:51How do you avoid these patients from getting
01:54these procedures or procedures in general?
01:56I think that the cornerstone of the
01:59management of patients with PAD is
02:02lifestyle changes together with exercise
02:05and when I talk about lifestyle changes.
02:08I mean, being able to modify all
02:10the different risk factors that
02:12are associated with PID depending
02:13upon how the patient presents,
02:15which could be either claudication,
02:17which is pain in the leg
02:19or critically moschea,
02:20in which there is usually a severe
02:23pain associated with tissue loss.
02:25Then either revascularization would be more
02:27or less important in those with claudication.
02:30The emphasis is an exercise,
02:33exercise, and exercise.
02:34Certainly doing procedures could help,
02:37but I think that.
02:38That would be a second or 1/3
02:40option in terms of their management.
02:42Those would critically Moschea presented
02:44a more advanced stages of their disease,
02:46and at times those type of patients
02:48will need an intervention upfront.
02:50But if they do,
02:51they gotta be a pair with the
02:54management that I described earlier,
02:56but the major emphasis is not
03:00center around procedures.
03:01Last but not least,
03:03as you will know from the work that
03:05we've done together here at Yale,
03:06the management of patients with PhD.
03:08Is not only multi disciplinary but it
03:11needs to address all the different facets
03:13of the disease that range from diabetes,
03:16hypertension,
03:17smoking and as you have
03:19highlighted in your research,
03:21the mental health burden associated with PhD.
03:24Many of these patients live with depression,
03:27anxiety and in many instances because
03:30they're associated symptoms including pain,
03:32substance abuse disorders,
03:33and unless you address all
03:35these different elements,
03:37you're not really going
03:38to make a significant.
03:39I think the management of this patient.
03:41Thank you Kim for that question.
03:42So what do you say to a patient that
03:44comes with different expectations
03:46though they might look for a quick fix,
03:49but as I hear you talk there is no
03:51such thing like a quick fix for PhD.
03:54So how do you handle that question?
03:56Well, I think the part of the problem
03:58that we face nowadays is the fact that
04:00there is a huge heterogeneity in the
04:03way patients with PD are being treated.
04:05Not only are institution but around
04:07the country and even the world.
04:10Patients present with different flavors.
04:13And therefore the respirations
04:14are very different.
04:15Well, there is a good or a bad thing.
04:17Places with PhD are treated
04:19by multiple specialties.
04:20I think it's a good thing, but with
04:22that different background in training,
04:25it comes different recommendations.
04:26Some of them are more procedural oriented,
04:29some of them are more knowledgeable
04:31about the disease management than others.
04:33I think that whomever is taking
04:35care of these patients are front
04:37need to recognize number one.
04:39The signs and symptoms are
04:41bringing to the table #2.
04:42Their expectations,
04:43I think patient reported outcomes
04:45which you are an expert on the topic
04:48are becoming a major endpoint in
04:50the management of this patients.
04:52You need to listen and you need
04:54to understand what they want
04:55because many of these patients is
04:56about their quality of life.
04:57So you need to understand what they are
04:59bringing to the table counter offer to.
05:00That is what our options are,
05:02which as I described before our
05:05center on medical management,
05:06not necessarily revascularization unless
05:08they present with an existing case.
05:11So management the expectation.
05:13Is critical,
05:14but for you to be able to address that,
05:16you need to have a deep conversation
05:17with the patients and I'm sure Steve
05:19is going to walk us through that,
05:21but only by having an honest conversation,
05:23understanding what matters to
05:24the patient and how this disease
05:27have affected their lives,
05:28we can understand what their
05:30actions are going to be.
05:33Really, building that partnership with the
05:35patient and building that relationship as
05:37to what works for them in the long term.
05:40Disease management for PhD.
05:42So switching now to Steve people tell
05:45me that they've had a hard time making
05:48lifestyle changes in the context of PD,
05:50even when confronted with this diagnosis.
05:53Giving up, smoking,
05:54changing their diets, being more active,
05:57it is not like people don't really know
05:59that this is important for them to do.
06:01It's it's just finding the
06:03motivation to make new habits.
06:04Changing old habits that are so rooted
06:06in our systems that they might need
06:09additional support and and so maybe Steve.
06:11Can you speak to what this
06:13experience was like for you?
06:16You know, with PhD about 14 years
06:19ago I was having a severe pain
06:22in my calves when I was walking.
06:25I probably couldn't walk more than two
06:29blocks without experiencing pain in my caps.
06:31I had stopped smoking about
06:352025 years prior to that,
06:37but I also was a Type 2 diabetic.
06:40Still am a Type 2 diabetic and I
06:43also had high blood pressure issues.
06:46So I I had a number of things
06:48that could could contribute
06:50to the condition if you will.
06:52When I was first diagnosed with it,
06:55I was referred on to a vascular
06:58surgeon from my General practitioner
07:00and I had a TBI test and then another
07:04test that essentially measured the
07:07blood flow to my lower extremities.
07:09It was found that my right,
07:12the artery in my right leg was
07:15totally occluded and mildly.
07:17Included in my left leg and my BMI scores
07:21showed that I had a severe condition.
07:25What prompted me to try to get a diagnosis
07:29was I was experiencing pain at rest at night.
07:34And the pain at rest was the trigger.
07:36It wasn't the inability to walk
07:38so much as I was a tennis player.
07:41And still I am a tennis player,
07:44but it was the pain at rest that really
07:47motivated me to try to find out what
07:50was happening within the context of that,
07:52the vascular surgeon
07:54recommended that we do a bypass.
07:58Or he do a bypass and I asked the
08:01question of how long would that
08:03bypass last and the answer that
08:05I got was three to five years.
08:07And that was not an acceptable answer for me.
08:11So I was lucky enough to go outside
08:15the Medical Group that I was in and
08:18get a second opinion from another
08:21vascular surgeon and that vascular
08:25surgeon essentially told me that
08:28he couldn't improve my quality
08:30of life by doing the bypass.
08:33And he happened also to be a tennis player,
08:36and he suggested that I
08:39implement a walking regimen.
08:41So that was the first time that you
08:43were presented with multiple options
08:45and and also had a better understanding
08:48how this might work longer term.
08:51So that that was when I started to
08:55implement a walking regimen and it
08:58was something that I did overtime.
09:01In other words, I just didn't
09:03walk out and walk a mile.
09:04I start, you know,
09:06at first I would be at two blocks
09:08and then longer and longer until
09:11I could complete the walk and
09:13get about 6000 steps a day.
09:16Was it in a program and
09:18and did you get support?
09:19What helped you to be successful in in
09:22getting through the exercise program?
09:26From my wife, who essentially told me she was
09:29not going to wheel me around and wheelchair.
09:33I also was, you know I had.
09:36I had the concern with regard to.
09:41Everything that I was reading and the out
09:44concern out there concern of amputation.
09:47But more importantly,
09:48I think the thing that motivated
09:50me was the pain at rest.
09:52I you know, I stopped experiencing
09:54pain at rest and my the management tool.
09:58For what I call a balancing act there,
10:01there are a number of things that I do
10:04today to balance my PAD symptoms if you will,
10:08but the the real key indicator
10:10to me is pain at rest.
10:13That was at the same time an alarm
10:16signal that you had to seek care
10:17as you told in the beginning,
10:19but it also was an another symptom to
10:24monitor whenever you had to redirect.
10:28Your program or.
10:30Yeah, whenever I get pain at rest
10:32it's it's further motivator that I
10:35need to keep doing what I'm doing.
10:38And I also, you know,
10:40I'm fortunate enough to different times,
10:42have a personal trainer that I have
10:46a exercise regimen too that I follow,
10:49and so I I do about 1/2 hour
10:52in a gym setting.
10:55Three days a week on the days that I I
10:58don't engage in tennis so that that's
11:02something that I I need to be doing.
11:05You know, in in support of being active,
11:08if you will.
11:10You mentioned a big part of of
11:12the changes that you implemented
11:14was the exercise regimen,
11:16but in the beginning you also
11:18mentioned smoking diabetes management.
11:20So the making one change make it easier to
11:25make other changes in those other domains.
11:28Or did you need extra support for that?
11:30And how do you manage to
11:33multiple areas to to watch for?
11:36I called them regimens so one of the
11:40regimens was dietary and and I did
11:43meet with the dietitian, you know,
11:46with regard to my diabetic condition
11:49and over time I've I've watched my diet
11:53and I also there's another part of the
11:57regimen which is essentially monitor
11:59being able to monitor your health.
12:02And today with technology,
12:04there's lots of things that you
12:06can do in support of that.
12:08So I used to monitor my Type 2 diabetic
12:14situation with my A1C just recently
12:17that in the last year got out of was
12:21out of control and so now for example,
12:25I'm on a 24/7.
12:26I have a monitor that are aware where
12:29I'm actually able to see my glucose
12:32levels and what spiking them and
12:35then try to alter that condition so.
12:37You know one of the regimens,
12:40or you know one of the components?
12:41Also is monitoring whether that be for
12:44your diabetes or whether that's taking
12:47your blood pressure randomly to ensure
12:50that your blood pressure is on on track.
12:53But that is another component of the whole,
12:57the whole process.
12:59That you are playing a really
13:01active part in in managing and
13:04monitoring those risk factors.
13:06Were there any times where you had
13:09setbacks and and what would you
13:11say to patients who experience
13:13setbacks in navigating all these
13:15factors like what got you through?
13:19Self, it was knowing that I
13:22was succeeding with my exercise
13:25program and my my walking regimen.
13:29And that's what motivated me to keep going.
13:32If it was knowing that I was
13:35cheating in my balancing act.
13:37And as the years went by,
13:39now it's it's been 14 years and
13:41so I'm I'm still doing this.
13:45We have formed into habits that
13:47you've been able to adopt.
13:49I think that's really a good description.
13:51You know when? When I say regimens
13:54regimens become habits, right?
13:56And so if you can translate the
13:59regimens and they become habits,
14:02then that's just part of your lifestyle.
14:04And so you've essentially made lifestyle
14:07changes in support of managing PAD.
14:11And I, you know,
14:13I believe I'm an example of a person.
14:15That has been able to do that,
14:18and you know,
14:19I also have a Facebook group that I am
14:24involved in and that that we've grown.
14:27And the reason I do that is
14:30that because I believe I'm an
14:32example of what one can do with
14:35exercise with an exercise regimen.
14:38And not have some form of
14:42surgical intervention.
14:44Of your disease, yeah.
14:46Well, well, thank you Steve for sharing
14:49all these experiences in in your story.
14:51I think that's a true inspiration
14:54for other patients who are
14:56dealing with the same issues.
14:59Going to switch back to Carlos,
15:00I have another question for you.
15:02We have healthcare providers
15:04working in a healthcare system.
15:06You feel like we're equipped to
15:09support patients with PD and
15:11their chronic disease management
15:13needs at sometimes feels like the
15:15system is working against them,
15:18especially as patients have a
15:19multitude of risk factors to oversee
15:22and then maybe on top of that,
15:24as you alluded to,
15:26maybe dealing with mental health concerns so,
15:28so how do you go about?
15:30What do you have to navigate as
15:32you deal with the patient who has
15:34issues in in many domains and how you
15:37come to coordination of their care?
15:40You know that's a very good point, Kim.
15:41So a couple of points to make in
15:43the management of patients with
15:45peripheral vascular disease.
15:46Unfortunately, we are behind other
15:49specialties entities if you will.
15:52If you would in cardiovascular medicine,
15:54have done a much better job,
15:56perhaps because not only the
15:57volume of the page is larger,
15:59but there have been clinical
16:01trials and studies,
16:02Polish and major journals that have
16:05shown elegantly that this care
16:07model with coordination and multi.
16:10Imperial approach is the key
16:11to their success in PD.
16:13They care, unfortunately is very fragmented.
16:16And it's not only fragmented,
16:18but it's highly variable.
16:21So that contributes to the
16:24patients confusion.
16:26To begin with they have a disease state
16:29that is difficult to manage that is
16:32associated with significant disability
16:34and negative affecting their quality
16:37of life is difficult on their families,
16:40which is another dimension that
16:41is incredibly important in the
16:43management of these patients,
16:45and many of them.
16:46Unfortunately,
16:46as you and I know from the studies,
16:48again that we've done living.
16:50Underserved population in underserved areas.
16:53And with all those things come together,
16:55is a perfect recipe for disaster.
16:58So if I can use examples of programs that are
17:01doing a good job or starting to realize this,
17:04I think that the one of the all is a good
17:06is a good program to allow laborate on.
17:08We have a clinic where multiple
17:11specialists come together,
17:12including social work yourself from
17:15the mental health perspective,
17:17but all the other medical
17:18specialties involved,
17:19and when a patient comes depending
17:21upon their clinical presentation.
17:22Where they are in the disease state,
17:24they are evaluated by one or
17:26other specialty at times,
17:28many of them,
17:29and all in an effort to coordinate
17:31their care and get the patient,
17:33the family and their entire support
17:34system on board with what their
17:36needs are and what needs to happen.
17:37Medications are difficult to get,
17:39refills get them to understand them.
17:41They need a prosthesis.
17:43They need wound care.
17:44All that stuff needs coordination.
17:47Patients cannot easily move and
17:48get to this doctor,
17:50and many of them don't have
17:51a way to transport.
17:53So all that stuff is part of the care,
17:55so the traditional view
17:57that I was trained on,
17:59which basically we had someone with
18:00PhD or Job was revascularized them
18:02and send them to the next provider.
18:05Doesn't work you if you are in
18:07the management of patients with
18:09peripheral vascular disease,
18:10you need to get them into a system that
18:13is effective in coordinating this.
18:15I think that soon we'll have studies
18:18showing that this multidisciplinary
18:20approach is highly effective.
18:23And from the cost perspective is very
18:26very beneficial for our health system.
18:29Yeah, I think you touched upon
18:31a few very important points and
18:34that we're seeing the start of a a
18:36paradigm shift as to what PD care
18:38of the future might look like.
18:40And and that is by default team based
18:43care because of the many needs and
18:45changes that need to be implemented.
18:48Steve, I'm going to give you the
18:50opportunity to share any final
18:51thoughts you might have and and.
18:53What providers physicians can learn from you?
18:57How can we make patient care
19:00for PD more patient centered?
19:02I think that the vascular surgeon that's
19:05working with the patient needs to be
19:08able to coordinate with, you, know,
19:11the cardiologist and the the physician
19:14that the General practitioner that.
19:16Is working with that's also responsible
19:20for the patient and today with technology,
19:23with all you know, all of the tests
19:27and information available online
19:32about the patient that they they can,
19:35they can become the focal point, but I
19:38think it's also difficult that there are.
19:40There can be other components
19:45to that medical care team.
19:47For example my case,
19:49the dietician bringing the dietitian
19:51in or bringing someone in that
19:54can discuss their dietary care.
19:56You also want to think that we haven't
19:59even mentioned is just balancing the
20:01medications that might be prescribed
20:04and that the patient might be taking.
20:08To ensure that there aren't any
20:10Contra indicators with the different
20:13medications that they may be taking,
20:15then you have this whole issue of
20:19reinforcement of their exercise program,
20:23whether it's a walking program,
20:25supervised or unsupervised,
20:26and how you, you know,
20:29bring that into play so that
20:32there's reinforcement for that.
20:33I think in the end the reality to me
20:36is it's it's back to the patient.
20:39The patient really has to try to
20:43manage these different components,
20:45but I think part of it too is education
20:48so that the the patient like we're
20:51discussing today is made aware of these
20:54different components of the balancing act.
20:57And in fact that they can manage their PAD,
21:00but I think it's all I think
21:03it goes back to the patient.
21:05To have the initiative to to
21:08manage the PAD with the resources
21:11that are available to them.
21:13And that's for example,
21:15one of the reasons why I think Facebook
21:18shirt and Facebook groups can be very
21:21helpful from both the support point
21:24of view as well as providing links to
21:27to information in one place as well
21:30as the American Heart Association.
21:34The national plan.
21:35If you look if you go today to their
21:38to the website and you resource the
21:42information that's now available
21:44there on PAD,
21:45there is a wealth of information
21:48that will continue to grow there
21:50that one can access.
21:53Important part is is the
21:55action oriented approach,
21:57but also setting up the the patient
22:00for success and and making sure
22:03that the information is there
22:05and the support for the patient
22:07and the family and the care,
22:10coordination aspect and and
22:12hearing what their priorities are.
22:15Thank you Steve for for summarizing this.
22:19Thank you Kim. Two that I'd like
22:21to add is that you know one of the
22:25feedbacks that I got in the Facebook
22:27group was to be sure to mention
22:29that you know patients are diagnosed
22:33at all different stages of PAD.
22:36And some of the things that we talked
22:39about today in terms of the balancing
22:42act and managing, they can still
22:44apply to those different stages.
22:46It doesn't have to be in the
22:50very beginning of, you know,
22:53when you're diagnosed it.
22:55It's really attributable to
22:57all the stages of PhD,
23:00with perhaps even regard to amputation.
23:03You're still going to have to have
23:05certain things that you're trying to do.
23:07Also, as you mentioned before,
23:09the monitoring aspect and maybe a
23:12reevaluation shifting of priorities
23:14and and continuing to oversee what is
23:17important for the patient at that time.
23:20Thank you for for your insights and.
23:25The last thing I will just reinforce
23:27what you just said, you know,
23:29I think with technology today the
23:31monitoring is going to become easier.
23:33For example, you know I said casually I,
23:36you know, I monitor my steps right.
23:38I monitor my steps every day because
23:40I've have an app on my phone that
23:42tells me how many steps I do.
23:44I mentioned that I've got now.
23:46I have a diabetic monitor that's 24/7 that
23:50tells me exactly what my sugar levels are.
23:54You know, I think they'll come a day
23:55when you know your blood pressure.
23:57You'll be able to see that 24/7
23:59rather than going through procedures
24:01to to to see what it is.
24:04But I think with technology will
24:06will be able to also better monitor
24:09in our overall conditions too.
24:12Very good point.
24:14Well, I want to thank our
24:16speakers Steve and Carlos,
24:17and thank you all for listening and
24:20and participating in this podcast.
24:22Today a lot of important items we
24:25discussed as it relates to lifestyle
24:28changes and PD reminding us that
24:31support and resources are key when
24:33navigating multiple lifestyle changes.
24:36As Steve is referring to this as a a
24:39balancing act and that we really need
24:42to take a broader view and that it.
24:45Really needs to take care of both
24:47mind and body motivational aspects
24:49of the family system around it and
24:52other areas in the in the socio
24:55economic environment of the patient.
24:58So this podcast is a part of the
25:01American Heart Association PD
25:02initiative sponsored by Janssen
25:05Scientific Affairs and Novo Nordisk.
25:07And in closing I would like to
25:10remind people if you don't already
25:11do this for your patience,
25:13ask them how they're doing in
25:15regards to your mental health,
25:16what support they need,
25:18and offer referrals for additional
25:20support resources in the Community,
25:23including referral to exercise programs
25:25and mental health support as indicated,
25:28which can all can contribute to a
25:31more holistic treatment plan for
25:33navigating and making successful
25:35changes for one's lifestyle for PD.
25:37Judgment to get additional information,
25:39please also visit HPD website for more
25:42education and a really good resource,
25:45perhaps for your patient might
25:48also be the recently released
25:50HA lice essential eight.
25:52I want to thank you all again
25:53and I hope you've learned more.
25:55Thank you.