00;00;00;11 - 00;01;02;15 Cary And now America's health care advocate, Cary Hall. Hello, America. Welcome to America's Healthcare Advocate show broadcasting coast to coast across USA, from Alaska to Florida, all the way to Hawaii. We are 294 affiliates strong. Thanks to all of you and our listening audience. I want to shout out to w l e a 1480 am and 106.9 fm in Hornell, New York. Want to thank Brian O'neill. We are now on there on Sunday mornings at 9 a.m. we're very happy to welcome them in to the America's Healthcare Advocate family. Like I said, 106.9 FM and 1480 AM in Hornell, New York. You once again want to thank Brian O'Neill for making all that happen. All right. Know we've got a unique show to do your day. And I was very fortunate to have the folks from Abbott Labs reach out to us. Joining me on the air today is Dr. Nick West. He is the Chief Medical Officer and Divisional Vice President of Global Medical Affairs for Abbott Labs. We are happy to welcome him to the show. Welcome, doctor. We're happy to have you on board. 00;01;02;21 - 00;01;04;23 Dr Nick West Thank you very much indeed, Cary Pleasure to be with you. 00;01;05;02 - 00;01;58;08 Cary Let me tell you a little bit about Doctor. Dr. graduated from Trinity Hall, University of Cambridge and St Thomas Hospital Medical School London and trained in interventional cardiology at John Radcliffe Hospital, Oxford and Green Lane Hospital in Auckland, New Zealand. His postgraduate research is vascular biology was undertaken at the Department of Cardiovascular Medicine, University of Oxford and Duke University. Obviously, Dr. you certainly know your way around this topic that we're going to talk about today. And the topic we're going to talk about today is PAD. Can you tell the audience a little bit about what PAD is? This is the this is an illness. This is a condition, a chronic condition that really hasn't been discussed before. And that's why I was very happy to have you come on and talk about this, because it hasn't even been recognized by a lot of physicians around the country. So can you tell us a little bit about this particular illness and how it works? Dr.. 00;01;58;22 - 00;03;54;03 Dr Nick West So, PAD or Peripheral Artery Disease is a chronic circulatory condition that gradually and progressively reduces the blood flow to the legs. If it's left untreated, it can result in unnecessary limb amputations. And that's well documented. And in extreme cases, it can contribute to premature death. So the reason it's so important to be talking about it right now, and I know we're just in October, but September is PAD Awareness Month was PAD Awareness Month. And as part of that awareness issue, I've been talking to a lot of people. We at the company are trying to raise awareness in a product agnostic fashion. It reinforced our commitment to fighting this debilitating disease. So as you've pointed out, it's not well-recognised. It's not really something that people or patients recognize being a major problem. Many physicians don't really recognize or are aware of the really adverse health consequences as this diagnosis has. And just to put it in context, PAD affects more than 200 million people worldwide, at least 10 million and maybe as many as 20 million of those are in the United States. And the reason is uncertainty is that many patients in the early stages don't have any symptoms. But the reason it's important to recognize it and make a diagnosis is that these patients have an increased risk of heart disease and stroke. And in those advanced cases, as I mentioned, they have a risk of dying. That's greater than many cancers. The final things I would just say about it is it affects one in three people over the age of 50 who are living with diabetes. And there is a disproportionate effect on African-Americans, Native Americans, Hispanic individuals and also women. So it's a big problem. 00;03;54;17 - 00;04;30;03 Cary Yeah, it is a big problem. And, you know, I think part of the big problem, as you've referred to it, is it's not something it's well recognized. So let's visit that for a minute. You know, if a lot of physicians aren't recognizing this, what does a person do? And we'll talk about symptoms later on in the show, but what does a person do when they think they may have an issue with this? Do they go to their primary care doctor? Are you better off going to a cardiovascular? Doctor Where should you go? Doctor If you think you may be at risk this, especially if you have diabetes or you're African-American, Hispanic, how how does all that fit in? 00;04;30;07 - 00;06;12;16 Dr Nick West We're going to talk about symptoms, but just to think about who are the at risk population. So essentially, this is a progressive, if you like, firming up of those blood vessels that supply the leg with blood. So as with any vascular condition, it gets more common with age. So people over 65 are at higher risk than those who are younger. But the younger patients or younger people, if they either have diabetes or other risk factors for vascular disease, and if you don't know what they are, they include having high blood pressure, having elevated blood cholesterol or lipids or most importantly, being a smoker. And I would say that being smoking is the most important modifiable risk factor. So if you have other risk factors for vascular disease and you're smoking, please think about stopping. So over 65, less than the 65, if you have either diabetes or other risk factors I've mentioned, and in particular if you have a family history of this condition or indeed have vascular disease elsewhere, such as a history of stroke or a history of coronary heart disease, heart attack or angina. So that's where you kind of start from. Am I at risk? And if you're falling into one of those groups, it's worth being either a primary care physician or indeed a cardiovascular specialist for very straightforward screening tools. It's a very straightforward way in the doctor's office, you can have the blood pressure measured in your arm and your last leg. That's called the ankle brachial index. And it gives a very quick assessment of the likelihood of there being compromised blood supply to the leg. 00;06;12;23 - 00;06;32;23 Cary So doctor let's go back to something you said a minute ago and that and that. So if you combine over 65 and you're a smoker, how much greater is the risk to those folks who are over 65 and a smoker if they have this disease or this chronic illness or or the chances of them getting this chronic illness. 00;06;32;23 - 00;07;12;26 Dr Nick West I’ll answer the other way around, if you like, if you have PAD and bare in mind many people don't know they have the risk of having a coronary artery disease event such as a heart attack or suffering with angina or requiring a stent or bypass surgery is six times higher than the general population. So clearly knowing you have this condition is very important. And I would say to anyone who's over the age of 65 and is smoking, you know, clearly smoking is a right. You're allowed to do that. If you so wish. But it does amplify the risk of disease in any vascular bed. And it really is a very powerful reason for smoking cessation. 00;07;12;26 - 00;07;27;01 Cary And I'm guessing we're coming up here on the break in about a minute and a half. But I'm guessing if you throw diabetes into that, then it becomes exponentially greater risk for those people if you combine all of those conditions with diabetes. Is that a correct assumption? 00;07;27;09 - 00;08;08;20 Dr Nick West That's absolutely correct. Diabetes is a very aggressive condition that again, magnifies the impact of vascular disease. In fact, I remember being taught that we should treat all people who have diabetes, whether or not they have a vascular history as effectively already having had a heart attack or stroke in terms of their future risk of vascular event. So that combination, smoking and diabetes, is a very, very powerful combination. And I'm sure that most people with diabetes, any specialists looking after them, will have counseled them very strongly not to smoke. And they will also be keeping a close eye on those on those risk factors. 00;08;08;21 - 00;08;11;16 Cary I think that I'm sure that I'm sure they would. 00;08;11;16 - 00;08;14;23 Dr Nick West Doctor, the thing is, awareness, it is being here is awareness. 00;08;14;23 - 00;08;30;12 Cary It is. We're coming up on the break. We're going to come back to speak with Dr. West more. We're going to learn more about this issue and how to deal with it. He is Dr. Nick West, Chief Medical Officer, VP of Global Affairs for Abbott Labs. If you want to learn more about this, there is a website you can go to. 00;08;30;12 - 00;08;53;27 Cary It's PAD-info.com/us that's PAD-Info.com/us there's a lot of information up there. I was up on that website this morning. We'll be right back after the break. You're listening to America's Healthcare Advocate broadcasting here on the HIA Radio Network. Coast to coast across the U.S., stay tuned. We've got more of the doctors in the house. 00;08;54;07 - 00;09;06;27 Speaker 3 ♪♪Oh tell me darlin’, am I right or am I wrong♪♪. 00;09;07;14 - 00;10;36;10 Cary Welcome back. You're listening to America's Healthcare Advocate show broadcasting coast to coast across the U.S. You can find out more about us by going to the website healthradio.us. HealthRadio.us. My producer day, Mr. Darren Wilhite. I'm your host Cary Hall, joining me in studio. Actually, he's not in studio. He's on the phone and we're discussing with Dr. Nick West, who is the chief medical officer, VP of global affairs for Abbott Labs. He's in Washington, D.C. and he's talking with us today about what is this chronic condition? How do you recognize if you have it? We're going to talk about treatment a little in a little later on in the show, as well as symptoms. But this is an opportunity for you to learn about this illness. And if you're in any of these categories that doctor mentioned, if you're over 50, if you're diabetic, if you're over 65, okay, if you're a smoker or if any of these issues, if you've got a history of stroke, heart attack in your family or any other disease issues that that that can contribute to this, you really need to see your doctor and discuss this with them. As I said, there is a website with a lot of information. You can learn a lot up there. I was on that website this morning. It is PAD-Info.com/us. PAD-Info.com/us. There's a lot of information up there if you think you may be at risk. So Doctor, let's talk a little bit about the trials at Abbott Lab. You just finished up a big one. Let's talk a little bit about what you learned there and the communities that participated in. What was the outcome of those trials? 00;10;36;10 - 00;13;21;05 Dr Nick West Doctor So the trial we've just finished is called Life BTK, and BTK is an abbreviation in this space for below the knee. So this condition had peripheral artery disease. As I've mentioned, it's a chronic circulatory condition. It causes progressive stirring up and blockages of the arteries that supply the leg and the foot with blood. And it can in particular affect those vessels below the knee. Now, there are there are many, many treatments for this condition, and not all of them, I want to stress this, require any kind of intervention. Many of the treatments for this simply require alterations in lifestyle, good medical therapy, which can again be things like diet, it can be medications. But sometimes if the disease is advanced interventions may be required and it may be surgical, but it may be minimally invasive surgical. And by what? By minimally invasive, I mean something called angioplasty, which is a procedure where tubes can be put into the arteries in the leg, little wires threaded down to into the lower leg in the foot. And then the narrows can be stretched open with a balloon. Now, the problem with using a balloon alone in a similar fashion to what we observed in the coronary circulation maybe 30 years ago, is that the results may not be durable in all cases. So we have recently finished this trial like BTK, which explores the use of a stent, which is a bit like the spring in a ballpoint pen that can be inserted into those blood vessels that holds the vessel open, uses a special drug to prevent very narrowing. And after about three years, this stent or scaffold gradually is resumed by the body and goes away, leaving nothing behind. So this is a very exciting technology and we are applying this breakthrough device to a variety of people with risk of foot ulceration and risk of limb loss, a condition that is known as chronic limb threatening ischemia or critical limb ischemia. Ischemia means lack of blood flow to the leg, so we've just finished that trial. One thing I want to say about the trial is that we have made a conscious and intentional effort to reach out to some of the communities most at risk. As you probably are aware, in the USA, African-Americans and Hispanic individuals make make up somewhere between ten and 15% of the population, each of those ethnic groups. But last time clinical trials were examined, less than 5% of clinical trial participants were African Americans and less than 1% are Hispanic. So that's really a massive disparity. And it means that clinical trials don't reflect the population. 00;13;21;05 - 00;14;12;23 Dr Nick West So we made a conscious effort to go to those communities with those individuals in in certain states, in certain cities to try and address this and make the clinical trial look more like real life. And the reason that's so important I mentioned earlier on is that African-Americans, for example, that are twice as likely to have pad as other ethnic groups and we know from other demographics, they're four times as likely to require an amputation. And I want to stress this new therapy with this new stent aims to reduce the need for amputation and to improve patient's quality of life. So we hope that the data for this study and it won't be reporting for a while yet, is not only going to offer insights into a new and revolutionary treatment, but is also going to look at redressing that balance of the lack of clarity and understanding of the effect of this condition in minority ethnic groups. 00;14;13;18 - 00;14;47;16 Cary That's fascinating. And as I listen to you, you know, discuss these treatments, these kind of go back to you know, these treatments that were started with drug eluting stents and balloons. And we're talking about cardio, you know, cardiac care where heart care, when people were having blocked blockages in the arteries, you know, other issues were stents. So basically what's happened, at least it sounds like, is that that technology, that treatment platform, that way of treating this disease mimics very closely what's been done with cardiac issues for a number of years. Is that a reasonable assumption? 00;14;47;18 - 00;15;29;21 Dr Nick West Yeah, that's very similar. That that is a very reasonable assumption. I think the one thing to point out, though, is that in the peripheral artery disease, basically there's lots of muscles and moving parts in the leg. And so there is a general reluctance for the physicians that work in this space, the cardiologists, the interventional radiologist and the vascular surgeon to leave in permanent implants simply because there are so many moving parts down here, there's a high risk of recurrence. There is a perception that we don't want to leave things that are permanent behind. So this kind of technology offers that temporary solution of stenting with that drug solution, as you mentioned, very similar to the coronary space, but leaving nothing behind in the medium term. 00;15;31;02 - 00;15;44;00 Cary So that and the success ratio, when the outcome based ratio successes when this kind of a treatment is implemented in terms of being able to stop amputations and some of these other more severe issues, how how does that play out, Doctor? 00;15;44;07 - 00;16;53;17 Dr Nick West Time will tell. And this study was a is a feasibility trial. It's to get approval for this device and demonstrate its safety and efficacy in a small number of patients. But one thing I will just point out is that, in fact, in the condition that we're studying, which is, as I say, critical ischemia or chronic limb threatening ischemia in general across the US, outside of the clinical trial, only one in four patients presenting with that condition that often break down to the skin ulceration, potentially imminently requiring an amputation. Only one in four of those patients get an angiogram. That's an assessment of the arteries that supply the leg. And this is a very important point. Just the fact you have an angiogram means you're 90% less likely to undergo amputation. And the reason that's important is that if you have PAD and you have an amputation, your chance of dying in the next 12 months is doubled. So just drawing attention to the fact that patients with this condition should have an angiogram, an assessment, see whether treatment is feasible, could result in an enormous reduction not only in amputation rates, but also in overall mortality. 00;16;53;20 - 00;17;56;12 Cary And that is really critical information for people to hear. And I hope all of you listing out there, listening very closely to what doctors are saying and the risk that you incur if you think you have this disease or even chronic condition. You know what you need to do if you want to learn more, you can go to the website PAD-Info.com/us. That's PAD-Info.com/us. We'll be back after the break with Dr. Nick West. He is the chief medical officer and VP of global affairs for Abbott Labs. We're very happy to have him on the air today talking about this issue. Stay tuned. We've got more. You're listening to America's Healthcare Advocate. Broadcasting here on the HIA radio network. Coast to coast across the USA. Stay tuned. Don't go anywhere. ♪♪ 00;17;56;12 - 00;18;12;21 Cary Welcome back. You're listening to America's Healthcare Advocates broadcasting coast to coast across USA here on the HIA Radio Network. You can find out more about us by going to the website HealthRadio.us. Also, remember, you know, I'm sure this show is going to get a lot of interest from a lot of people. 00;18;12;27 - 00;19;49;01 Cary All the podcast platforms we're on, all of them SoundCloud, TuneIn, iTunes, Amazon, Apple. I don't think there's one out there. We're not on any more. Spreaker You go down the list. So the show will be posted up there under Abbott Labs. Dr. Nick West, PAD. You'll see a description of it. But if there's somebody in your family or, you know, a relative or a friend or someone you go to church with or an employee, you know, that you work with, that you want to tell about this. That's a great way to go back and get the show, just like we did it with Dr. West here on the air. So once again, it's on all those podcast platforms. My producer, Mr. Darren Wilhite, I'm your host, Kari Hall. We're going to continue this conversation with Dr. Nick West. He is the chief medical officer, VP of Global Affairs for Abbott Labs. We are very happy and fortunate to have him on the air with us today to talk about this illness that is not well recognized and even among a lot of physicians, it's not that well recognized. So the idea here is to raise awareness and to give you a resource to go to if you think you may be at risk or someone that has it. The website, if you want to learn more and it was on that website this morning, there's a lot of information up there. It's PAD-info.com/us. PAD-Info.com/us. All right. Let's just start out, doctor, with symptoms again and kind of go through. How do you said earlier in the broadcast that you may not even know you have this. So let's talk about what you should do if you think you may be at risk, but you're not showing any particular signs of it. And then let's get into other symptoms, Doctor. 00;19;49;01 - 00;21;48;25 Dr Nick West One of the biggest problems with PAD is that up to half of patients or people suffering from this condition don't know they have it. And even those that do have symptoms may not recognize the importance of those symptoms. So as I've mentioned before, this is a chronic and progressive circulatory condition that gradually reduces the blood flow to the lower leg and foot. And if it's left untreated, it can result in unnecessarily amputation, and it may even progressed to causing or contributing to premature death. So the symptoms, if they are the classical symptoms, may include cramping or pain in the legs while walking or exercising. Sometimes that can be progressive and can occur at rest and it may be associated with ulceration. And ulceration is when the skin breaks down in the lower leg. It can be it can occur spontaneously, can occur at a site of an insect micro, a minor area of trauma. I'm just bumping a leg on a piece of furniture or similar. And because of the lack of blood flow to the lower leg, that ulcer is unable to heal. And as those ulcers continue to grow or fail to heal, there's a risk of infection. And the more ulcers there are obviously, it becomes it becomes tricky to manage those. And this is what leads to that risk of amputation. So the very early signs of this, they are somewhat vague. I think that public health services around the world have done a really great job of informing people that if they get pain in the chest, they need to seek medical care urgent. It could be a heart attack. They know that facial asymmetry, slurring of speech, weakness and numbness down one side of the body that could be a stroke and requires urgent treatment. But a bit of cramping in the leg doesn't ring bells. First of all, with many people or patients and secondly, with many physicians, now, specialists in this space know that these symptoms are a concern. 00;21;49;07 - 00;23;35;08 Dr Nick West But part of our effort, as you very clearly pointed out, is to try and increase the awareness of this condition and drive people to get that diagnosis, to enable early adoption of lifestyle measures, medical therapies that can prevent people progressing to the point at which they will need one of these more radical interventions, such as we've spoken about already, stenting, angioplasty or even a surgical intervention. So you've already publicized the website. One thing I do want to point out, and I think it's very, very important, obviously, I work for the medtech industry, the website that you've mentioned, Kerry Pad dash info dot com slash us has no product information. This is purely informational. It's informational. It's written in very plain English. It's designed to provide a primer, the potential sufferers, their families, their carers, their loved ones to understand what this condition means. To give a bit more information on what the tests might be, on how it's treated, but also to provide a very important resource for primary care physicians, maybe general physicians who aren't aware of some of these awful statistics that I've shared with you already about the the attendant risk of death, premature death from vascular disease, and to streamline that kind of communication that we know is a problem these days in terms of our fragmented health care systems around the world to enable patients to access physicians, to enable physicians to make referrals on to clinicians in this space who can, in fact, diagnostic tests and start therapies that may be required. So this is a silent killer. 00;23;35;28 - 00;24;06;11 Cary Yeah, that's exactly yeah. That's exactly what it sounds like. It is a silent killer. And I have to ask you, because you've mentioned cramping now a couple of times. Is that in other words, if you have a chronic condition of cramping that continues to go on and on and on, then you really should take a look at this and see if you're at risk for this, that this is not like, you know, you have intermediate cramping. Maybe you get up in the morning, you get out of bed, you've got some kind of cramping some, but you're talking about something that is re-occurring on a regular basis. Am I right about that? 00;24;06;14 - 00;24;54;01 Dr Nick West Yeah. Classically, the cramping would occur with exercise and it will go after exercise. And the reason for that, obviously, is that as you begin to exercise, your muscles need more oxygen. Oxygen is carried in blood. If there are restrictions to the blood supply, you're more likely to get the symptoms when you are walking. But it doesn't mean just because you have those symptoms that you have PAD and you shouldn't be scared that it means you're going to need an amputation or you're going to need some invasive form of treatment. In the early stages, there are many treatments that do not require surgery that do not require angioplasty. It may be as simple as lifestyle measures, medication and some exercise therapy. But knowing you have this condition is critically important to avoid that accelerated risk of vascular disease moving forward. 00;24;54;26 - 00;25;27;12 Cary Yeah, and it seems like, you know, and this this is a story that, you know, whether you're talking about heart disease or you're talking about potential for stroke or you're talking about diabetes, you know, all these different issues that we deal with in terms of chronic illness, early detection. And this this applies, you know, specifically things like breast cancer as well, early detection is critical for people. If if you're going to reverse this or catch it and stop it from becoming something much more serious down the road, is that a reasonable assumption? 00;25;27;26 - 00;26;18;13 Dr Nick West It's a very reasonable assumption. I think we one thing that it's very important to get across is that although as a interventional cardiologist myself, but the other physicians in this space, vascular surgeons, interventional radiologist, our stock in trade is treating the end result of this condition. But that is not a cure. It's just dealing with the long term consequences, really at the far end of this condition, if we can make a difference much further upstream, we're going to reduce the likelihood of people progressing to that advanced age and requiring those much more radical treatments. I will just say one thing about cancer, because you've mentioned the risk of of PAd is greater than some cancers. The mortality rate is three times that of breast cancer. So this is a really serious condition. 00;26;19;13 - 00;26;32;15 Cary That really kind of puts it in perspective, doesn't it, Doctor? I mean, for you to say, you know, the risk here is greater for this than it is for those for that particular for cancer in those particular situations. Pretty significant. 00;26;33;00 - 00;27;07;15 Dr Nick West Absolutely. But I think that illustrates the point that people have really progressed a long way down a disease pathway before they get a diagnosis. So I think with earlier diagnosis and earlier medical and lifestyle interventions, maybe that statement I just I just said to you will not be true in the future. I hope it's not true in the future. But the current state of play, by the time people achieve that diagnosis, the you know, the outlook for them can be very poor, no shame because of the risk of amputation and death. But also there's other vascular conditions that are so much more prevalent in this population. 00;27;08;10 - 00;28;30;01 Cary It's fascinating and it's an important message for our audience to hear. And I'm going to reiterate something doctor said, you the website. It's a very good website. There's a ton of information up there it is PAD-Info.com/us. that's PAD-Info.com/us. Now, on that website, he just said there's a primer up there that gives you a set of instructions. It'll tell you this is what you should look for. This is this is who you might want to go see for treatment. These are the symptoms. It gives you information. So back to, you know, if this is somebody in your family, you recognize maybe this is your grandfather, your grandmother, your aunt, your uncle, your father, your spouse, whatever the case may be, if it's anybody within your immediate family and you have a history of, you know, heart issues or stroke, these kinds of things, diabetes, especially if they're over the age of 50, you really should go to the website and take a look at this and take that primer. It tells you, as he said, doctor said, in very plain, simple English, what you need to do. So it's something that can really be a great resource for you. And, you know, again, early detection is the key to stopping this from becoming a very serious illness. We'll be right back after the break. You're listening to America's Healthcare Advocate broadcasting here on the HIA Radio Network. ♪♪ 00;28;30;07 - 00;28;43;19 Cary Coast to coast across the USA. The doctor is in the house us today. Stay tuned. ♪♪ 00;28;43;19 - 00;30;43;02 Cary Welcome back. You're listening to America's Healthcare Advocate Show broadcasting coast to coast across USA here on the HIA radio network. You can learn more about us at HealthRadio.us. That is the website HealthRadio.us. My producer, the always perfect Mr. Darren Wilhite. I'm your host, Cary Hall, joining us by phone today. Dr. Nick West. He is the chief medical officer and VP of Global Affairs for Abbott Labs. We are talking about PAD. This is an important topic. It's not well recognized. There are a lot of you out there in this audience listening this that probably have this and don't even know you have it. That's one of the reasons why we do these kind of shows is to educate and inform. If you want to learn more, the website is PAD-info.com/us. There is a primer up there that gives you literally instructions on what to do, how to recognize, who to go see what, what are the symptoms, what does it look like? That's all that information is there. Take a moment and take a look at it. If you have a family history, if you know of any of these issues in your family, heart attack, stroke, diabetes, any this stuff may well be at risk. And when doctor talks about the consequences, amputation, he's probably said it 15 times. Okay, that's pretty scary. You need to think about that. You need to understand what you can do to recognize this and do something about it. Also, this show is on all of the podcast platforms, so if you want to tell somebody that's at risk you think may be, let them go up and listen to Doctor explain what goes on here. All right, Doctor, you've talked a lot about lifestyle. We've mentioned that about four or five times in the broadcast. Let's kind of get into that a little bit. What lifestyle changes should people make? Okay, if they think they have you know, they're at risk for this. And if they are at risk and they find out they've got the issue, what things can they do in lifestyle to improve their condition? 00;30;43;02 - 00;31;50;16 Dr Nick West Doctor said, That's a great segue because I think it's been I don't want to sound too scary talking about risk of premature death amputation, but I think if we've peaked people's interest and impressed upon them how serious this is, the question now is what can I do about it right now? So as I've already emphasized, this is not all about surgical treatment or minimally invasive surgical treatment. There are so many things that people can do for themselves. So the kind of lifestyle changes we're talking about, the first one has to be smoking cessation. That is the major modifiable risk factor for peripheral artery disease, but it applies to all vascular disease. It applies to stroke, it applies to coronary heart disease, smoking cessation, critically important. I know it's not easy. There's lots of support out there. Nicotine patches, nicotine gum and self-help. But I think it's really worth considering if you are in that age group over 65 or you're young under 65 with other risk factors and diabetes in particular, smoking cessation is critical. 00;31;50;16 - 00;32;08;26 Cary Let me ask you there real quick question. How does vaping fit into that? Is that the same in terms of the effect on this illness as smoking or is that a way to get away from the cigarets or whatever it is you're using and and and not contribute to this issue? Doctor, I. 00;32;08;26 - 00;32;41;08 Dr Nick West Think it's fair to say we don't know enough about the long term effects of vaping. It's not been around long enough. I think as a physician I would say I'd rather people would stop smoking, not use anything. I don't think we have any good long term health data on vaping and many of this is habit forming. The very fact of putting something in your mouth and inhaling. It's better to try and break that, have it altogether. I, I think we'll get further data in due course, but I think the medical advice would be smoking cessation. 00;32;41;18 - 00;32;45;26 Cary All right. That's good to hear. All right. Let's continue with lifestyle then, Doctor. 00;32;46;03 - 00;33;55;20 Dr Nick West So dietary adaptations, I think most people by now know what a healthy diet is. People know that in a in a healthy and balanced diet, you should not be having large amounts of fried food. You should not be having large amounts of processed food with high salt or high saturated fat content. People should be looking to make some very basic choices of balance in your diet of more white meat and fish than red meat, of more grilled or roasted food than fried of more wholegrain breads than white bread, more unsaturated fats in margarines than high fat foods such as cheese and butter. And I'm not saying stop those foods, but just moderate one's diet. Those are things that everyone knows. The other thing that's very, very important is a structured exercise regime. If you are overweight, can lose some weight. But the effects of exercise are not limited to those who are overweight. Even people of a good and normal body mass index will benefit from a structured exercise program. And in fact, it is one of the treatments for the early stages of this disease. 00;33;56;19 - 00;34;57;24 Cary Well, that's Neal. And I think I appreciate you're doing your saying. I think we've given people a lot of information today. And, you know, again, you know, when we talk about you know, we you know, I've mentioned that amputation is still more than one occasion. And the reason I think, as you said, that's important is it's going to get your attention if especially if you're diabetic, because we know type one diabetics are at high risk, this kind of thing. And if you you you add that into these issues with this disease, it becomes an even bigger problem. So, you know, I really appreciate your taking time to do today, to do this today and to educate our audience about Paddy. And I want to thank you for taking the time to come on, because I know you've got an extremely busy schedule and it was great of you to do this. And hopefully, you know, as we go a little further down the road, Doctor, you can come back on and talk some more about, you know, is Abbott doing some more trials? Are there more trials out there? Is there more information that's going to be forthcoming about this? 00;34;58;18 - 00;35;22;09 Dr Nick West There's there are a lot of studies ongoing. And in fact, only last week I was at the Def Con, the diabetic foot conference in Los Angeles. Okay. That's focused on the patients with diabetes. Lots of very interesting data coming out, lots of emphasis on doing the simple things right. And we touched on some of those that I as well as just the surgical approaches. So simple things are very important for this condition. 00;35;22;09 - 00;36;43;25 Cary Well, we will be revisiting with you on that as time goes on. If you want information you've heard Doctor describe all this. He's talked about symptoms. He talked about the interventions that can be done. There are surgical procedures available. There are a lot of things that can be done. You need to go to the website PAD-info.com/us. PAD-info.com/us. Look, if you've got somebody in your family that you think is at risk for this, have them go to the website, listen to one of the podcasts and get a clear understanding of what's going on here and what they may be at risk for. It's far better to catch this early on or even if it's, you know, started and they're not aware of it and stop it from becoming something that could be very, very serious and result in in some really bad situations. And that's why we're doing this show and that's why I want to thank Dr. for coming on and doing your best today. And now, ladies and gentlemen, I leave you with this thought from Dr. Martin Luther King. Americans must learn to live together as brothers and sisters, or we will surely perish together as fools. Truer words were never spoken. Thank you for listening to America's Healthcare Advocate Show, broadcasting coast to coast across the USA here on the HIA radio network. Goodbye, America. ♪♪♪♪