By Kym McNicholas, CEO of Global PAD Association
Peripheral Artery Disease (PAD) affects millions of Americans, yet many patients receive incomplete information about their condition. In a recent episode of Next Gen MD, I spoke with vascular surgeon Dr. Lily Johnston about the uncomfortable truths patients need to hear – even if they might offend.
Dr. Johnston combines vascular surgery with metabolic health expertise, addressing root causes of arterial blockages rather than just symptoms. Her approach reveals critical insights many PAD patients never hear.
“The first thing I would tell you if I weren’t afraid to offend you is please pay attention to your symptoms and if they’re getting worse, get seen,” says Dr. Johnston.
Many patients wait until symptoms become unbearable before seeking care. Dr. Johnston describes patients who wait years before addressing symptoms, eliminating opportunities to:
- Target root causes
- Avoid invasive procedures
- Implement early lifestyle modifications
While fear keeps many patients away from doctors—particularly in communities with historical medical mistrust—early intervention remains the best path to limb preservation.
“I cannot promise your physician will tell you something good,” Dr. Johnston acknowledges. “But I can promise your best chance of a good outcome is to go in as soon as you know something’s wrong.”
2. Your Stent or Bypass Is Not a Cure
Interventional procedures provide immediate relief but don’t address the underlying disease process.
“Your stent, your bypass, your atherectomy is not a cure for the disease you have,” Dr. Johnston emphasizes. “It is a stopgap solution for one blood vessel or one extremity, but plaque formation in the artery, atherosclerosis, is a systemic disease.”
This systemic nature affects blood vessels throughout your body—not just where symptoms first appear. PAD patients often don’t realize that despite successful interventions:
- The leading cause of death remains heart attack and stroke
- Plaque continues forming in other vessels
- Future procedures may be necessary
At the Global PAD Association, we remind patients it’s not if a stent or bypass will fail, but when. The procedure’s purpose is to heal wounds or relieve pain so you can walk and build collateral vessels—natural bypasses for when interventions eventually fail.
3. Success Requires Equal Work from Doctor and Patient
The third truth may be hardest to hear: medical interventions alone aren’t enough.
“There is no pill, no procedure that is as good as the lifestyle and behavioral things that you as my patient do every day,” Dr. Johnston states. “There is as much work on your end for the perfect outcome as there is on my end.”
Patients often want an “easy button”—a single procedure or medication to solve everything. The reality requires daily commitment to:
- Dietary changes
- Regular walking or exercise
- Stress management
- Sleep optimization
- Diabetes control
I’ve witnessed this reality firsthand with patients whose surgeons considered amputation because repeated procedures failed. One patient’s blood was “thick, sticky and clotting” due to uncontrolled diabetes. After focusing on diet and lifestyle, she went from needing interventions every six weeks to going a full year without procedures.
4. Perfect Lifestyle Doesn’t Always Eliminate Medication
Even health-conscious patients may need medication—a truth that often offends.
“Just because your lifestyle is perfect doesn’t mean I might not recommend medication,” Dr. Johnston explains. Many patients who have transformed their health through diet and exercise resist medication recommendations, viewing them as failure.
Dr. Johnston clarifies: “I am so excited that you have taken your health by the horns and done everything you can to optimize it. And still, we may need to add on some medication or even a procedure if there is residual risk from your family history.”
Medications like statins provide benefits beyond cholesterol reduction, including crucial anti-inflammatory effects. This represents a nuanced medical decision based on individual risk factors, not a one-size-fits-all approach.
5. Your Health May Not Be Your Fault, But It Is Your Responsibility
The final truth addresses personal accountability while acknowledging complex factors beyond patient control.
“Your health may or may not be your fault, but right now, in this moment, it is your responsibility,” Dr. Johnston states. “It is your responsibility to take ownership of where we are today and what we can do together as a partnership going forward.”
Family history, trauma, socioeconomic factors, and other medical conditions contribute to vascular disease risk. While these factors aren’t your fault, improving outcomes requires focusing on what you can control today:
- Following treatment plans
- Making sustainable lifestyle changes
- Participating actively in care decisions
- Building a support network
“We have one short and precious life and one short and precious body,” Dr. Johnston reminds us. “Please be my partner in helping me get your legs back to where they want to be.”
Moving Forward with Empowered PAD Management
These five truths may be uncomfortable, but understanding them empowers patients to take control of their vascular health. The most successful PAD patients combine medical interventions with personal responsibility, creating partnerships with their healthcare providers rather than passive relationships.
Early intervention, understanding the systemic nature of vascular disease, committing to lifestyle changes, recognizing when medication adds value, and taking responsibility for your health journey—these principles form the foundation for successful PAD management.
Resources:
- Global PAD Association Leg Saver Hotline: 1-833-PAD-LEGS
- Website: padhelp.org
- Support Communities: padsupportgroup.org and walkingsupportgroup.com
DISCLAIMER: Always consult with your healthcare provider before making any changes to your treatment plan. The information in this article is for educational purposes only and is not intended as medical advice.