When Mike first noticed calf pain while walking on his treadmill in early 2024, he dismissed it as a pulled muscle. Like most PAD patients, he didn’t immediately connect his symptoms to a serious vascular condition. But that pain would lead him down a path that reveals critical gaps in our healthcare systems—gaps that the cardiovascular industry must understand to truly advance PAD care.
In our recent “Save My Piggies” segment on “The Heart of Innovation,” Mike and his mother Debra shared their parallel journeys with peripheral artery disease. Their story isn’t just about blockages in arteries—it’s about blockages in care access, information flow, and emotional support that must be addressed alongside technological innovation.
The Diagnosis: When Google Becomes Your Doctor
“I went on Dr. Google around November last year because the pain wasn’t easing at all,” Mike explained during our conversation. “The first things that were coming up with the leg cramp was PAD.”
For Mike, this Google search was especially terrifying because PAD wasn’t just some abstract medical condition—it was the same disease that had cost his mother her leg in 2014. This personal connection turned what might have been concerning information into a deeply frightening possibility.
This first touchpoint highlights a critical reality: most patients are introduced to PAD not by healthcare professionals but through their own research. This is partly because, as I noted during our show, “More than 70% of people in the US alone don’t even know about PAD.” Even more troubling, “many doctors are even brushing it off as back issues, old age, or just part of diabetes.”
The awareness gap creates a dangerous scenario where patients either don’t recognize symptoms until the disease is advanced or, like Mike, face the terrifying experience of self-diagnosis without proper context or support.
The Healthcare Maze: Navigating Critical Gaps in Care
Mike’s journey through the UK healthcare system reveals problems that extend beyond national boundaries. When he returned to the UK in January, his general practitioner promptly ordered an Ankle-Brachial Index (ABI) test, which confirmed suspicions of PAD.
The doctor immediately started Mike on statins, blood pressure medication, and low-dose aspirin—all standard protocol. But then came the waiting game for a specialist consultation, which in the UK can stretch to 18 months. This gap between diagnosis and specialist care creates what I call the “PAD limbo”—a period where patients know something is seriously wrong but lack expert guidance on what to do about it.
“In the UK, you have to wait sometimes 12 to 18 months to actually see a vascular surgeon,” I explained during our conversation. “And that wait time, you’re noticing every nuance. You’re noticing that little extra burning in one foot and tingling in the other.”
For Mike, the fear of ending up like his mother drove him to take drastic action. Rather than waiting for his scheduled appointment, he went to the Accident & Emergency department (A&E) when he noticed his feet turning “multicolored underneath” after shopping. This emergency visit connected him with a different pathway to care.
“An A&E doctor saw me,” Mike explained. “And she referred me straight away to a vascular hot clinic, which was three or four days after that, where I went in for an ultrasound scan.”
It was during this ultrasound at the hot clinic that they discovered a 75% narrowing in his superficial femoral artery, confirming the PAD diagnosis with specific detail about the blockage’s location and severity.
The vascular doctor Mike saw did provide some basic lifestyle guidance—telling him to quit smoking, start walking, and change his diet. However, this advice lacked the detailed, practical guidance he needed. There was no structured exercise plan, no specific nutritional recommendations, and no clear explanation of how these changes would affect his condition. He was essentially given broad directives without a roadmap for implementation.
This limited guidance highlights a persistent problem in PAD care: even when patients overcome access barriers, they often receive fragmented or generalized advice that doesn’t provide the comprehensive, practical direction needed to effectively manage their condition.
The Online Spiral: From Fear to Empowerment
With only basic guidance and mounting anxiety, Mike turned back to the internet—where things initially got worse before they got better.
“All you have to go on is Dr. Google that tells you that you’re going to be dead in five years with a PAD diagnosis,” I noted during our conversation.
And that’s exactly what Mike found. Websites with alarming statistics like “PAD patients have a 5-year mortality rate of up to 30%” or articles stating “One in three PAD patients won’t survive beyond 5 years after diagnosis” dominated his search results. Without context explaining that these figures primarily apply to the most severe cases with multiple risk factors, Mike—like countless other newly diagnosed patients—assumed the worst about his own prognosis.
This grim outlook deepened his emotional crisis. “I was just lying on the couch every single day, not moving. I was just doing my treadmill and just getting on the couch. And just crying. And just crying and wondering what was going to happen.”
But the internet that first terrified him ultimately became his lifeline when he discovered patient communities. Through the Global PAD Association’s Facebook groups and several other organizations’ online communities, Mike found what his formal healthcare couldn’t provide: comprehensive guidance on improving his prognosis naturally and real-time support from others walking the same path.
“I’ve had loads of decent advice, especially off these guys that are on the chat,” Mike shared, referring to fellow patients in these support groups. “Alan, Douglas and Marie and Josh… they’ve all been massive, massive help to me over the last few months and they brought me away from my depression sometimes with personal calls.”
Through communities at padsupportgroup.org, walkingsupportgroup.com, and other patient-led groups on Facebook such as PAD/PVD and Exercise Regiment for Peripheral Artery Disease, Mike gained diverse perspectives that all reinforced a consistent message: lifestyle modifications aren’t just supplementary—they’re the foundation of effective PAD management. By synthesizing information from these various sources, he crafted a personalized strategy that worked for his specific circumstances.
This peer support filled critical gaps in his care journey—providing emotional support when he was at his lowest, practical advice on lifestyle modifications, and reassurance from those who had walked the same path.
The Emotional Fallout: PAD’s Invisible Symptom
But even with peer support and expert guidance from online communities, the psychological toll of Mike’s journey continues to affect him daily. This is not unusual—research shows that the psychological burden of PAD is both significant and widespread.
A 2025 study published in BJPsych Open found that 26.8% of PAD patients meet clinical thresholds for anxiety or depression, more than double the rate in the general population over age 65. Another study in the Journal of Vascular Nursing reported that PAD patients score particularly low in quality-of-life measures related to self-concept and feelings. This clinical evidence confirms what Mike’s experience illustrates so vividly—PAD is not just a physical condition but an emotional journey marked by fear, uncertainty, and psychological distress.
“When I get up in the morning, I check my pulses. I check my pulses every single morning in my groin, in my ankle, in my feet, just to make sure that it’s still there and I’m not losing any kind of circulation. It’s an OCD thing,” Mike explained.
His mother confirmed the severity of his emotional struggle: “Just worried about him, worried about his mental health for a long time because he did sort of hit rock bottom.”
This psychological dimension of PAD remains largely unaddressed in conventional care pathways. Yet it significantly impacts treatment adherence, lifestyle modifications, and ultimately, outcomes. As the Global PAD Association’s PAD Warrior Task Force Chairman said in our last PAD Leg Saver Hotline episode: “How can you get motivated to walk, walk, walk through the pain, when you fear the pain you are walking into? Even more, how do you quit smoking when smoking is what you do to ease stress and anxiety and a diagnosis like PAD increases stress and anxiety. We need support.”
Psychological support and counseling is something that Consultant Vascular Surgeon and PAD Researcher Dr. Ankur Thapar recently addressed in an interview on our “What’s Up Doc” series for UK patients. He said, “We understand how important it is to support the emotional and mental part of being diagnosed with a chronic illness like PAD and we try to integrate support into our limb salvage program.”
More programs do need to consider doing the same. But hearing Dr. Thapar’s acknowledgement of this aspect of PAD is a big step in care as it’s likely others will see his success and follow suit.
Learning from Experience: The Procedure Paradox
Psychological support is particularly crucial for patients like Mike, whose family history creates an added layer of fear. With proper emotional guidance, patients can find the courage to “take the bull by the horns”—as Dr. Phillips put it—and embrace the lifestyle changes that often render invasive procedures unnecessary. This mental shift from fear to empowerment can be transformative, allowing patients to realize that much can be accomplished through their own actions, without ever needing a needle or knife.
Mike’s apprehension about following his mother’s path is entirely understandable. Yet ironically, her experience offers one of the most powerful lessons about PAD treatment that vascular specialists increasingly emphasize: sometimes the most aggressive interventions can lead to the worst outcomes.
Debra’s experience with PAD, beginning with her diagnosis in 2011, reflects an approach that many patients still assume is best—addressing blockages through immediate interventional procedures.
“I had the stents put in,” Debra recounted. “I had the blockage removed in my artery, had stent put in. Then a year later, had a larger stent. And the year after having a larger stent, then I had the femoral artery bypassed.” Despite these multiple interventions, she ultimately lost her leg below the knee in January 2014.
Dr. Phillips explained why this cascade of procedures often leads to worse outcomes: “As soon as you have one procedure, you’re pretty much guaranteed another one… each time you intervene, you can flick a little debris and it can close one… Now you’ve damaged the arteries past it into the foot. And that’s when people get into trouble.”
This insight has led Dr. Phillips and many leading vascular specialists to advocate for a more conservative approach that prioritizes lifestyle modifications over early intervention. When advising Mike, Dr. Phillips’ guidance was clear and direct: “You need to put off any procedure as long as you can.”
This advice represents a crucial perspective shift that both patients and industry professionals must understand: the first response to claudication shouldn’t be to “fix” the blockage but to help the body adapt to it and potentially develop its own natural bypasses through consistent exercise.
While advanced minimally invasive technologies certainly have their place for patients with critical limb ischemia or those who don’t respond to conservative measures, Debra’s experience demonstrates why they shouldn’t be the automatic first-line response. The best approach to PAD often isn’t the most technologically sophisticated but the most physiologically harmonious.
Lifestyle as Medicine: The Patient’s Power
So far, Mike's comprehensive lifestyle changes are proving successful.
“I’ve changed my diet in a massive way,” Mike explained. “I stay away from any fried food, any pre-made meals… I’ve started eating a lot more vegetables… a lot more salad… a lot of salmon, a lot of white fish… a lot of chicken. I’ve cut back on red meat.”
Combined with his exercise regimen—“an hour and 40 minutes on the treadmill every single morning”—and quitting smoking “cold turkey,” these changes have transformed his health profile. “I’ve had a recent blood test last month, and they’ve come back into range. They’ve practically halved because of everything that I’ve been doing.”
Mike’s mother Debra expressed pride in her son’s response to his efforts: “I’m super proud of him because he gave up smoking cold turkey… And he needed to do, and he’s done the best thing. He’s stopped smoking, he’s walking, he’s exercising, and he’s eating healthy.”
Dr. Phillips also praised Mike for his lifestyle changes.
“I could sense in your voice that you’re a little bit scared, taking it day by day,” Dr. Phillips observed before offering affirmation for his path, “Based on my experience and what you are doing right now and the fact that it sounds like you can feel your pulses still in your foot, that’s a huge indicator that your blood flow is okay… you’re going to be okay.”
The relief in Mike’s response was palpable: “I appreciate that, doctor. Thank you.”
If only he had this type of affirmation from his own healthcare team -- This moment highlights how powerful even brief specialist guidance can be for PAD patients—and how technologies that expand access to such guidance could transform the patient experience during those critical waiting periods to improve adherence to these life and limb-saving lifestyle modifications.
The Path Forward: Comprehensive PAD Care
Mike’s journey reveals a critical truth for all stakeholders in PAD care: our current fragmented approach places an enormous burden on patients. Despite receiving a diagnosis and basic medical intervention, Mike had to piece together his own comprehensive care plan—finding detailed lifestyle guidance through online communities, battling psychological distress largely on his own, and waiting months for expert reassurance about his prognosis.
This gap between what patients need and what our healthcare systems currently provide represents both a challenge and an opportunity for innovation. The most impactful advances won’t come from developing incrementally better stents or atherectomy devices, but from creating integrated care pathways that address the full spectrum of patient needs from diagnosis through long-term management.
For patients with intermittent claudication like Mike, this means prioritizing robust lifestyle support programs that provide structured exercise guidance, detailed nutritional counseling, and psychological resources to manage the anxiety that often accompanies diagnosis. Such programs could significantly improve adherence to the very interventions that might help patients avoid invasive procedures altogether.
For those who eventually require intervention, Debra’s experience demonstrates why we must develop technologies and approaches that minimize the cascade effect of procedures leading to complications. This means not just creating “better” devices, but fundamentally rethinking when and how we intervene—always with the goal of preserving long-term vascular health rather than simply addressing immediate blockages.
Most importantly, these innovations must be grounded in the lived experiences of patients themselves. As Dr. Phillips explained, this is why the Save My Piggies initiative focuses on letting patients “tell their story. We say, you know, your life, your limb, your story.” These narratives reveal gaps in care that clinical trials and imaging studies cannot—illustrating the practical, emotional, and informational challenges that determine whether patients like Mike and Debra ultimately keep their limbs and maintain their quality of life.
So, in my opinion PAD care pathways are at a crossroads. We can continue developing incremental improvements to existing devices and procedures, or we can embrace a more holistic vision that addresses the entire patient journey. Mike and Debra’s story makes a compelling case for the latter—showing us that truly effective PAD care must integrate medical intervention, lifestyle support, psychological counseling, and expert guidance within systems that don’t leave patients to navigate these waters alone.
This is the future of PAD care: not just clearing blockages, but clearing pathways to comprehensive care that empowers patients while providing the support they need to truly thrive.
Kym McNicholas is an Emmy Award-winning journalist and CEO of the Global PAD Association. To learn more about the “Save My Piggies” initiative or to join our support communities, visit padsupportgroup.org and walkingsupportgroup.com.
References
Govekar SG, D’Souza JP, Kotian RR. Impact of peripheral artery disease on daily living: A study on knowledge, contributing factors and quality of life among patients. Journal of Vascular Nursing. 2025;43(2):73-79.
Bergman M, Bergman H, Busuttil A, Abdelkhalek H, White E. Prevalence of Cognitive Impairment and Mental Health Disorders in Peripheral Arterial Disease Patients: Implications for Surgical Outcomes. BJPsych Open. 2025;11(Suppl 1):S23.
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