Click here for our American Heart Association podcast “Health Disparities in PAD: Solutions Across Diverse Communities” Featuring Lee Kirksey, MD, MBA; David G. Armstrong, DPM, MD, PhD; Carlos Mena, MD, FACC, FSCAI, FSVM; Kirsten Concha-Moore MD; Chloé Powell, MD
The transcript for the podcast is here
Health Disparities in PAD: Solutions Across Diverse Communities Page 1 of 10
Lee Kirksey (00:10):
Welcome to the peripheral artery disease podcast titled Health Disparities in PAD, Solutions Across
Diverse Communities. This is the sixth podcast of a series of podcasts from the American Heart
Association PAD initiative and it’s part of the PAD National Action Plan. I’m Dr. Lee Lee Kirksey. I’m a
vascular surgeon at the Cleveland Clinic and the vice chair of our vascular surgery department. I’m very
excited to have my esteemed colleagues who are renowned for their respective expertise in PAD.
(00:44):
They’re joining me today for a robust discussion around some critical issues. PAD is unique in the
disproportionate impact that it has on vulnerable communities across various dimensions, including lowincome Americans of all races, the indigenous American community, and Black and Hispanic
communities, as well as geographically rural and female gender members of our society. I’d like to have
the members of our panel today introduce themselves. So would you please go ahead?
David Armstrong (01:16):
Well, typically, it’s ladies first, but since it’s alphabetical, I’ll make an exception. I’m David Armstrong,
professor of surgery and I run our Southwestern Academic Limb Salvage Alliance, or SALSA here at the
Keck School of Medicine of USC in beautiful, sunny Southern California where even when it’s not sunny
like today, it’s still sunny.
Lee Kirksey (01:39):
Dr. Mena.
Carlos Mena (01:41):
Thank you for having me. My name is Carlos Mena. I’m an interventional cardiologist by training. I am
the director of vascular medicine at Yale University. Thank you very much.
Lee Kirksey (01:51):
Dr. Powell.
Dr. Powell (01:53):
Hi. Thanks again for having me. I’m a fifth year vascular surgery resident at the University of Michigan.
Lee Kirksey (02:00):
Concha-Moore.
Dr. Concha-Moore (02:02):
Hi, my name’s Dr. Concha-Moore. Thank you so much for having me today. I graduated from the
University of Arizona College of Medicine in Tucson, completed three years of integrated vascular
surgery residency at University of Washington, and I’m currently back at the University of Arizona in the
vascular surgery department doing a year of research.
Lee Kirksey (02:26):
Maybe first, we can kick it off. We know that we have differing communities, differing barriers and
challenges to identifying PAD. So maybe Dr. Powell, we’ll begin with you. What are some examples in
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your experience, you’ve done a lot of research in this area, of opportunities to increase community
awareness?
Dr. Powell (02:47):
Yeah. So I think about this a lot because I don’t think the lack of awareness is due to a dearth of
information. There’s so much information on the internet, but I think we have to question how
accessible is it and who’s accessing it. I was just at SABS in Puerto Rico and someone had presented
about how health literacy among vascular patients was poor overall, but particularly worse for Black
Americans and Hispanics, and considering that there’s also some studies looking at the fact that many
popular vascular surgery websites are written at a college level.
(03:26):
But they should be written at a more sixth grade or even eighth grade level. I think that’s low hanging
fruit to adjust how accessible even those websites are, but then also there are communities that have
no internet access or no technology, and so I think really thinking about how can we leverage and
thinking about the community aspect, how can we leverage some of the establishments within the
community? So a lot, I think, has been done in the stroke world or even in the general cardiovascular
health world around partnering with churches or even salons.
(04:03):
Places that those of those communities value to lead some of the educational sessions or community
fairs, and even if we’re not partnering with establishments, thinking about are there people or
connectors who we can partner with who have leverage within their communities to spread awareness,
and all of this is on the patient side of things, but I think many of the same approaches could be used for
the provider where we look at who is accessing all of the AHA website information from a provider’s
standpoint. Are there more effective ways to increase awareness among providers?
Lee Kirksey (04:45):
Yeah. I think you raised some very important points. The message is important, the messenger is
important, and the format of the delivery of that message is equally important. Maybe we can think
about this idea of our varying communities. Dr. Mena, maybe you can pipe in here. The Hispanic
community, what do you think are some challenges that exist within our traditional way that we
approach and enter a Latinx community?
Carlos Mena (05:18):
Yes, excellent question and is a very complex question. The first part is that the Hispanic community is
not uniform. We are very heterogeneous and it depends on which part of the world we’re coming from.
The background or upbringing and our heritage is very different, and that’s the first mistake that is often
made. Just because you speak Spanish, it doesn’t mean that your perception of your disease and the
way how you manage or deal or prioritize things are the same. Second, obviously, the language barrier.
Our first language is Spanish and now because we’re here, we all speak English and it’s a real problem
because if you can’t communicate, you cannot really say things.
(06:10):
Obviously, you won’t be able to be careful. The Hispanic community are very sensitive to the providers
and they often prefer providers who are Hispanic as well, and the reason is number one and number
two that I just mentioned. So the problem is that sometimes those issues are not recognized and
providers in the US sometimes they feel that, well, they don’t really talk, they don’t really say much, they
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don’t really take care of themselves, but it’s all this cultural background what is in the middle, and unless
you make an effort to try to understand it, to try to be compassionate, not compassionate in the sense
of listening to the patient per se.
(07:00):
But compassionate about all the social issues that they bring to the table because it’s not often the
patient itself, he or she, but it’s also their family. In our culture, when someone gets sick, it’s just not
that person. We bring the entire family into it and it is a little bit more dramatic, if you will. I can say that
because I’m Latin myself growing up in Colombia, so it’s just very different. So as it relates to PAD in our
culture, PAD is often overlooked. You have a wound in your toe. Well, it doesn’t matter. I just change my
shoe and I figure it out. It’s the fact that we don’t fully understand the implications, the needs and the
management associated.
(07:51):
As you all know, if you have PAD, you’ll likely have coronary artery disease and [inaudible 00:07:56]
vascular disease and is often until you bring those issues up, they don’t realize that that little small
wound in their toe is actually very meaningful and they need care, and that’s how things begin. So the
cultural sensitivity around the Latinx community is incredibly important and if I can just make a plea, the
one thing that is important is not all the Hispanic people are the same. We are very heterogeneous and
you need to make an effort to understand that concept. I’ll pause there.
Lee Kirksey (08:27):
Well said. The idea that all of our communities, whether it’s the indigenous community, the Black
American or the Hispanic American community, they’re different subsets, different economic issues,
social challenges within the respective subgroups of those communities. So that does raise an issue
about community health workers and the role that community health workers may play, and maybe as
we get into some of the clinical trial barriers to enrollment, we can touch on that topic of community
health workers and the role that they may play in bridging this gap. How about Dr. Concha-Moore? Will
you comment a little bit on what you think the unique challenges to entry, awareness, treatment within
the indigenous American community may be and how those are addressed?
Dr. Concha-Moore (09:20):
Yeah. Piggybacking on what Dr. Powell and Dr. Mena are saying, I think all of us come from communities
that have such variability and you can grow up in one community and be part of the larger, say, Black or
Hispanic community, but you may not necessarily understand that whole community, and I think that’s
where we have to talk about. There’s a lot of emphasis on cultural competency and I don’t think any one
of us in medicine is actually truly culturally competent, and sometimes I like to transition and use the
word culturally safe or culturally aware so that we are just cognizant of the many challenges and
differences when we approach our patients.
(10:01):
I think one thing that’s really important from my own community is to recognize that there are 547
federally recognized tribes in the American Indian tribes in the US and even 228 federally recognized
tribes in Alaska, and that’s not even to include our relatives to the north in Canada who identify as First
Nations, Inuit, Matisse, and all the aboriginal and indigenous communities across the world, and so I
think all of these communities for generations have already had their distinct languages, cultures, and
traditions, and we just have to be very cognizant of how we approach each patient and be respectful for
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each patient when we provide them care, no matter what clinical facility or background you’re coming
from.
(10:52):
I think for many challenges in the American Indian community, particularly in the US, is that the US
actually has a federal trust obligation to provide care to American Indian tribes, which goes all the way
back to the tribes being recognized as sovereign nations back in our constitution. However, we still have
some of the highest health disparity rates among all minority populations, and we’re here talking about
peripheral arterial disease today.
(11:22):
But I think there’s a lot of, oftentimes, we’re left out of the conversation because we’re a smaller
minority compared to others in the US, but I think we still have to be aware that we have some of the
highest rates of diabetes of all people in the United States, which lead to diabetic foot infections,
amputations, and lower life expectancy overall, and so I think many of us here have seen it, but I think
it’s just, it’s good to be aware that we just have to be culturally safe when we enter in a community and
be respectful of all the patient’s backgrounds when we try to create ways to help improve their health.
Lee Kirksey (12:06):
Excellent comments. Dr. Armstrong, you practiced in multiple communities of the southwest and at your
SALSA facility, worked with the indigenous American community. You guys identified some very
important strategies to addressing some of the challenges. Maybe you can comment on those and some
of the learnings that you’ve had.
David Armstrong (12:33):
Yeah. If by learnings, you mean just mistakes, and our patients, they’re like our family, but meeting them
where they are, and this sounds so easy to do on the podcast, just meet the patient where they are, but
I was listening to Dr. Concha-Moore talk about, and she’s back in Arizona now and there’s like, we were
working with 22 different Native American nations back when I was there just a few years ago and these
are different nations, each one with different problems, just like a sovereign nation would’ve different
problems anywhere else in the world, and while there are some similarities, there are also a lot of
differences.
(13:13):
And meeting those differences where they are with not only folks within that community but without
the community and trying to harmonize this is really a massive challenge. Now, I’ve moved from the
desert to another kind of desert. You have food deserts, you have urban deserts where it’s really hard to
get consistent care across a region. I’m in Los Angeles County and there’s 10.1 million folks here in LA
County, a massive richness and diversity, not just diversity in terms of ethnicity, but diversity in terms of
economics. You look at PAD, you look at amputation, there is now a tenfold difference in amputation in
people with PAD and with diabetes, depending on your zip code.
(14:07):
It is a zip code lottery now in LA County, and so based on you roll into one zip code versus another, but
so that tells you there’s maybe some top down stuff that you could control, but then you zoom in
further on your Google Maps of disparities and you go into just an individual neighborhood like where I
am right now. I’m 0.7 miles from three or four different hospitals. There is a sixfold variation in
amputation in these hospitals around me right now, and so what that says is not only top down policies
can make a difference, but bottom up ones can make a difference. An individual nurse, an individual
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promotora if you’re a [inaudible 00:14:57], an individual teacher, a barber, a physician, surgeon can
make a difference just as well as a health minister. So I think there’s a lot we can do.
Lee Kirksey (15:10):
Thanks so much. So I’m going to do a quick round-robin, please, and I’d like for each of you to offer
maybe an idea about how to better increase awareness, diagnoses within one of the key demographic
communities that we’re talking about here, just focusing on the diagnoses and awareness. How do you
get out into the community and make a meaningful improvement in awareness and diagnoses? We’ll
begin with Dr. Powell.
Dr. Powell (15:39):
That is tough. I’m going to hijack an idea that my mentor recently came up with, and certainly not of his
own, but adopted from the public health world, but identifying, like I said, these connectors within the
community. So people who do have access to the health system, which obviously, in and of itself is a
privilege and trying to understand whether or not there are people who they know.
(16:12):
Who they can identify who have PAD or at least risk factors and seeing how we can then loop in their
network and who they know to bring awareness to the people who they are around. So trying to use the
health system as a point of contact or at least an in to a community recognizing that that is not perfect,
but at least they might be aware of those who that privilege or don’t have that access. So we can at least
a little bit more readily pinpoint how we can bring some of our interventions or expertise and partner
with those in that community.
Lee Kirksey (16:47):
Great answer. Dr. Concha-Moore.
Dr. Concha-Moore (16:52):
I would echo also what Dr. Powell is saying is if you empower people from the community with
knowledge and they are the ones who are able to access those communities. I think like I was saying,
there’s so many different tribal communities, not just in Arizona, for instance, where I’m living now, that
have people who understand the challenges, the barriers, the terrain of how to access the tribal
members and also have a cultural way of going into that community that builds trust. I think a lot of us
who work in these ivory towers, who we have an immense amount of knowledge and access to medical
knowledge and care facilities, but being able to translate that out to a community, sometimes you have
to go in in a way to empower the community to empower themselves.
(17:48):
And I think they have many ways that they have that are already in place to heal those communities,
and I think bringing in that knowledge and building relationships over long periods of time because I
think also that really does matter of building long-term relationships, being consistent, being reliable,
and making an open two-way street for people to have connections to an institution, but as well as to
the tribal communities that they can trust and rely on you as somebody who’s working, say, from in a
higher institution or somebody who’s a tertiary care center. So I would say that would be my biggest
thing is empower communities in a cultural way.
Lee Kirksey (18:33):
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I like the idea of elevating awareness to the outside community of these connectors and these groups
that represent how we respectfully access the community, and I know working with the Strong Heart
team, I’ve learned a lot about how the indigenous American community and the tribal leaders work in
terms of the process because it really is a process of respect and trying to work with that community. Dr.
Mena, maybe some comments about, I know you and Kim [inaudible 00:19:09] have done some great
work on community health workers.
Carlos Mena (19:14):
A couple of comments. I agree with what has been said, but speaking specifically about the Hispanic
community and using this podcast and the American Heart Association as a platform, I think that there
are substantial changes that need to be made at the political advocacy level, the Hispanic population,
we look and we published this in the Journal of Vascular Surgery, and we look in the NIS sample over the
last 15, 20 years, and the main place where Hispanics with PAD, critical ischemia seek attention is
emergency room, and there is a variety of reasons why that is. So they use the emergency rooms as
their primary care and that is totally and fundamentally wrong because that’s the wrong place to go in
someone who has PAD.
(20:08):
Obviously, they have an acute issue, it’s different, but for long-term chronic care. So our politicians, our
health system, a lot of the things at that level need to change because we can educate them as much as
we can, but if they don’t have a way to get access to a provider who can actually care for them, give
them medications and do necessary tests, then all these efforts are going to be for nothing. So I would
strongly invite that idea of influencing our politicians or health systems to try to incorporate changes
that are inclusive because many of the minorities, Hispanics in this case, for instance, are here in an
illegal base, but they’re here. So it is what it is and we got to figure out a way to care for them because if
we don’t do it upfront, we’re going to pay in the back when they are receiving amputations, complex
interventions of any nature. So we have to figure this out because at the end of the day, it’s a human
being looking for attention. So I’ll pause there.
Lee Kirksey (21:19):
Absolutely. And that’s a lead into a plug to reinvigorate the Amputation Reduction Compassion Act that
was championed by Congressman Payne to improve the resources for access for patients because as you
said, if the awareness can improve the diagnoses, but if these patients don’t have access, appropriate
and timely access, where are we going with this effort? And finally, let’s cap it off with Dr. Armstrong
because I’m sure that he has not only humor, but he has a valid.
David Armstrong (21:57):
Well, I’ll start with a couple of things that are happening because I was listening to what everyone was
talking about and everyone, there’s so many great ideas here and call to improve care away from the ED
and more toward maybe the home, and I see some of the challenges that are happening in literally my
backyard right here at our Los Angeles County Hospital at LAC. It’s one of the biggest county hospitals in
the country and one of the busiest emergency departments for sure. What has happened here out of
necessity, but also I think there’s been a really progressive benefit here, is that the emergency
department has been developing now an urgent care center, which is run by my friend, Carla Gonzalez.
(22:39):
She’s awesome, and so a lot of patients now with PAD, with maybe diabetes, lower extremity
complications are getting kicked up to there to an urgent care center, which is more just like a clinic.
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Those patients now, if they’re relatively well, are getting sent over now to the first ever, it’s really this
cool wellness center, which is part of our old county hospital and it’s really just a community gathering
place. If you’re Black, if you’re Latino or Hispanic, you are able now to go to this facility as well, and you
will see people and meet people that not just literally and figuratively speak your language, but
culturally, this is meaningful and this is happening in a county hospital.
(23:31):
In addition to this, Brad Spielberg, who’s our CMO, got a guy named Chris Lynch who’s an ID doc to start
this program called Safer at Home During the Pandemic, Safer at Home. Now, the most common people
that are being treated at Safer at Home are people with diabetes, lower extremity complications, and
with PAD. So this now is happening, so patients are getting treated in their home and virtually, every
single patient is a patient of color that would normally never get this level of care, and this is happening
now in these county run facility. So that’s great, but then I’ll just tell you, one other thing I’ll tell you that
we’ve been doing.
(24:11):
We got a grant from the UniHealth Foundation to do this where we’ve been out in the community
increasing awareness about lower extremity complications, not only of diabetes, but of peripheral artery
disease. We started something called the Foot Selfie program and we’re having people just send a
picture of their feet in if they have any questions, and that goes into a central area, and then once a
week now, we have collectively foot selfie rounds, 7:00 every Monday morning and we get through 100,
200 photos. It’s amazing, super fast, and now we’re adding, of course, AI onto this too. So it’s pretty
exciting, and that’s such a super simple thing because it’s free and this kind of thing can, to overuse the
word scale, it can scale. So here’s to that and here’s to making a difference.
Lee Kirksey (25:00):
Those are great ideas, thoughtful ideas that are able to be implemented readily. As you said, no one
needs to go to the CFO to have a patient submit their selfie. Let’s shift now to the healthcare setting,
patient in the healthcare system. They’ve been diagnosed. We know that not only are these vulnerable
communities diagnosed in a less timely fashion, more likely to present in a delayed fashion for all of the
access issues and other variables that we described.
(25:33):
But once in the hospital, the outcomes for these vulnerable communities are not the same as they are
for the more resourced comparator, and so we know that there’s some implicit bias or call it across
class, across race, ethnicity, gender that exists. What do we talk about as a community about some ways
to name this first, and then to address this? So maybe Dr. Concha-Moore, maybe you can speak about
this, some of your thoughts about what happens to the individual, high risk in the hospital? Why are
some patients undergoing primary amputation without any revascularization attempt?
Dr. Concha-Moore (26:19):
Yeah. I think some of these are, we have to look upstream in terms of what are the social determinants
of health that lead our patients to present late, present with a worse diagnosis, a worse foot ulcer that’s
non-salvageable, that’s leading to our amputations. Are our patients getting adequate primary care? Are
their diabetes being controlled, and if not, what are the problems that are leading to them to have
earlier complications, presenting at an earlier age, presenting with worsening PAD and peripheral
vascular disease leading to ultimate amputation, which as we all know, it happens and it’s life altering
for patients.
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(27:04):
And the morbidity, mortality is devastating for not only the individual, but the family who’s taking care
of that individual, for the community. The loss of language and culture from my community when our
elders have such severe consequences is really devastating because you lose out on so much. I’ll just tag
in that I’m a true believer in experience and education, and we all know that bias exists within the
healthcare field, and one thing that I really wanted to mention is that we need to be really cognizant and
vocal about making our fields, whether it’s medicine, vascular surgery, podiatry, more inclusive for racial
ethnic minorities to feel supported to pursue healthcare fields.
(27:53):
I think it takes mentorship and sponsorship, and it’s hard to pursue a field if you don’t feel represented
in that field or see anybody who looks like you in that field, but on the flip side, it is also frustrating to
know your community, who’s suffering from worse outcomes, are not being taken care of by providers
who don’t come from those same communities or look like those patients, and so I think that is one way
that we can all pitch in and support students, pre-med students, medical students, to pursue the career
fields that are going to make an impact in peripheral arterial disease.
Lee Kirksey (28:26):
Thank you. Dr. Powell.
Dr. Powell (28:29):
Yeah. This is something that I feel like I have a challenge with in trying to figure out ways to best
address, and ultimately, I think there’s just no one right answer. One thing that I’ve been thinking about
is the use of enhanced recovery protocols or at least more standardized care, recognizing that
standardization doesn’t necessarily mean trying to take autonomy away from the provider. At least it
provides some sort of metric with which you can reflect on, am I following these certain protocols? I
think in the cancer world, some institutions have found success that way.
(29:09):
But going back to Dr. Mena’s comment about the system, it’s hard to have a system level approach to
some of this when it is the outcomes are the result of systematic failures or systematic racism, classism,
sexism, all the things, and so how do we take it up another level to address it at the system such that
patients don’t have to go to segregated hospitals that then only treat them a certain way where
outcomes are worse or go to low resource hospitals, and so I said I don’t think there’s any one answer,
but perhaps a system level, policy level approach at least might have some trickle-down effect that way.
Lee Kirksey (29:57):
Yeah. No, personally I’d love to see one day where just like we have accredited stroke centers, where if
you don’t have a multidisciplinary team, including a stroke interventionalist, a neurologist, a neurointerventionalist, that you just can’t treat stroke patients and that raises some challenges in terms of will
patients receive timely care in under-resourced centers while they’re waiting to be transferred, but
somehow, we figured it out when we figured out what quality metrics are within respective areas.
(30:35):
And I think that should be a goal of our peripheral artery disease and our diabetic foot because we can’t
forget that patients lose their limbs without peripheral artery disease for diabetic foot problems, but if
we can find some quality metrics that we can hold ourselves and our community accountable for, it
Health Disparities in PAD: Solutions Across Diverse Communities Page 9 of 10
seems like we’ll have some standardized benchmarks. Dr. Mena and Dr. Armstrong, comments on this
idea of how we do better when patients are within our system.
Carlos Mena (31:08):
Well, the only thing that I would add to what has been said is that the medical community, we need to
decentralize the efforts. We need to go into the communities, infiltrate the communities, and familiarize
ourselves with what they want, what they need, and what their problems and priorities are and why
they are thinking one way or not the other. I say that because when we started our vascular medicine
program, the traditional thinking here at Yale was that, well, all the patients with PAD should come to
the main clinic in the main campus, and I started looking at that and I realized that there were so many
barriers to that. There’s no parking.
(31:56):
Well, these people have PAD. How are they going to walk into the clinic, and we starting to uncover why
people were not coming to these clinics and people would say, “Well, there’s no PAD in New Haven,”
and I said, “That can’t be it.” People, they’re just not coming. You got to figure out why. We
decentralized all our clinics, and at the beginning, everybody thought that I was crazy because I was
making the drive around and into clinics outside the Yale main campus, but then suddenly, all the
patients are starting to come in and our volume of patients with PAD and CLI increased, and we went
into these communities and we put ourselves out there.
(32:40):
We had conversations, we talked with ambassadors that you guys were mentioning earlier. The only
way how we can tackle this bias and such is to let a white guy understand why this Black guy doesn’t
want to come to clinic or this Hispanic guy who doesn’t speak English thinks that rice is the best thing in
the world, but he will never understand if he doesn’t go into those kitchens and understand why is rice
the most important piece of their meal? We say now it’s full of carbohydrates and your A1C is going to
go through the roof. They don’t care. They grew up eating rice. So if you don’t take the time to
understand, but really understand, not just saying it, we’re never going to change it.
Lee Kirksey (33:27):
Well stated, well stated. So Dr. Armstrong, maybe a couple comments for those non-medical listeners to
the podcast today that they may hear these calls for more interventions, more peripheral. We spend all
of our conferences talking about revascularizing patients and we can obliterate the amputation
epidemic if we just can get better widgets and tools and revascularization instruments that we forget
about that 50% of patients that are purely amputation from diabetic foot ulceration and the
complications there. So what are some challenges and what are some solutions in that realm?
David Armstrong (34:13):
Well, look, I was just with one of our trainees a few minutes ago in the operating room and they had just
put on a big external fixation device, a big testosterone inducing big device that looks tall and it was
really nice repair, and I looked at her and said, “Nothing ruins a good surgical result like follow up,” and
either the repair is going to go down eventually or the person will, the patient will, and you should be
around with her or with him when that happens, and when the patient knows, when she, he knows that
you’re going to go to the mat for them, that transcends a lot and that kind of thing is really important,
and it’s not about being in the operating room or outside of the operating room. So that’s the patient to
patient, that’s the person to person action.
Health Disparities in PAD: Solutions Across Diverse Communities Page 10 of 10
(35:11):
But as regards, so much that can be done now outside the operating room that doesn’t require a
balloon, a stent, whether it loots a drug or not, or a big external fixation device. If you just see your foot
doctor along with another member of the diabetes team, I’ll give you an example, your risk for getting
an amputation in the next six years reduces anywhere from just under 20% to just under, no kidding,
just under 8-0, 80% depending on the data that you look at, and usually, the more severe the problem,
in this case, the better the response and the better the action. Here’s some more data. We have just
found, and this is from one of my mentees, Tze-Woei Tan, who’s a vascular surgeon here, the expansion
of access to people of color when they usually hear so much bad stuff about a limitation of care.
(36:18):
But these data were just published this last year, expansion of access to foot care for people of color
now in early adopter states reduced high level amputations by 33% if you’re Black, if you’re a Native
American, or if you were Hispanic and Latino, and so this now is good news that’s coming out of some of
this, not a lot of bad stuff that you often hear, but some of the things I’d say for you, man. If you’re going
in to see your doctor, whatever her or his specialty is, or if it’s not a specialty or if it’s a nurse or anyone,
just knock your socks off. Get those shoes and socks off. Let them see your feet and that’ll force them in
that five or 10 minutes that they have only to spend with you to have a look at that, and I know that’s
going to make a difference for someone somewhere across the United States listening to this.
Lee Kirksey (37:15):
Thank you for those closing comments. I appreciate the time all of you have committed to this very
important topic. It’s pretty clear that you’re not only knowledgeable, but you’re passionate about this
vulnerable community that we care for. Thank you all for participating in the podcast with me today. A
lot of important points. This podcast is part of the American Heart Association PAD initiative sponsored
by Janssen Scientific Affairs, LLC and Novo Nordis Incorporated.
(37:46):
And in closing, I’d like to remind everyone listening to encourage your patients to play an active role in
their medical care by advocating for themselves and their family members. The views and opinions in
this podcast are those of the speakers and reflect the synthesis of science. Content should not be
considered as the official policy of the American Heart Association. To get additional information, please
visit AHA’s PAD website for more education. Thank you so much for your time and your attention.
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