Kind: captions
Language: en
today I'm going to tell you how your
legs and feet can warn you about your
health I'm a medical doctor and I
trained an internal medicine which means
I take care of men and women young and
old and healthy and sick and I'm also a
scientist who studies blood vessels and
blood vessels and what they do actually
lead to those signs in your legs and
feet that tell you if you got a heart
problem so I'm an expert on circulation
and what I'm going to tell you today
will help you pay attention to what's
going on in your legs when it comes to
your circulation now your blood vessels
bring oxygen and nutrients and all the
oxygen that you breathe the nutrients
that you eat right to uh the cells
muscles tendon and Bone uh in your legs
uh uh and in your feet when those blood
vessels are working well you're actually
going to be able to walk around and run
and do all the things that you normally
do in life without a problem when those
blood vessels have a problem one of the
common problems is that they get blocked
up with aosc lotic plaque they narrow
down now think about it it's like a
drinking straw that you cut in half
what's going to happen you're not going
to get as much fluid in it just like if
you had a half the size of drinking
straw same amount of sucking uh up the
liquid it's going to be a lot harder and
you're going to get a lot less now
that's frustrating when you're actually
drinking out of a small thin straw but
it's actually terrible when it actually
happens in the legs when your legs don't
get enough blood flow because your blood
vessels are narrowed then you actually
have a crisis in your legs right because
your muscles when they're Contracting
need oxygen and they also need energy
they need glucose they also need all the
other things that are actually happening
uh that your blood is carrying so what
happens when there's a compromise well a
sign that something's going on with your
legs and feet is when you got cramping
now we've all had cramping before but
I'm talking about the cramping where you
just walk like a 100 yards and all of a
sudden you can't walk anymore like
you've got this terrible cramp and it
can get worse and worse where you then
walk even 100 feet or if you were in a
shopping center from you know one part
of the store to the next you can't
actually continue because you get
terrible muscle
cramping that's actually not normal
that's a warning sign that you're having
uh blood flow problems right in your
legs without enough blood flow your
muscles cramp up all right
and you got to stop so cramping is one
of those warning signs Telltale warning
signs that there is something actually
going on because your muscles are
carrying around your frame they H do a
lot of work and then when you're
actually walking around uh they consume
a lot of energy and if they're not
getting that energy they're not getting
that oxygen they're going to seize up
and you're going to actually have a
cramp now this is the condition that's
called Peripheral arterial disease
peripheral because it's not Central in
your body all right it's uh certainly in
your periphery your legs are considered
to periphery your legs and feet for sure
um Peripheral arterial so this means
that the arteries are getting narrowed
right um and disease obviously p a is
what we call it pereral arterial disease
um if you were in England they call it
PA aod pereral arterial occlusive
disease occlusive means it's actually
getting very very narrow and this is
actually a problem because that I know
about
because what you really want to do is to
stimulate new blood flow in order to
grow around the blockage to restore
blood flow right now what happens if you
have this type of cramping a surgeon a
vascular surgeon will do all the studies
to to Define exactly where the blockages
are and they can take a catheter through
your groin and stick a balloon all the
way down into where the blockages and
blow the balloon
up press the plaque out or just actually
rotor rotter out um the blockage and put
maybe put a stent in okay this is like a
wire basket that pops open and Pops that
blood vessel open where it was narrowed
and now you've got blood flow again so
you can actually solve this problem of
Peripheral arterial disease with a stent
or angioplastic which is actually where
you blow up the balloon um to be able to
open up uh the blood vessels now listen
this is not a local problem people with
peripher arterial disease have a
systemic problem so it's narrowing of
the blood vessels everywhere these are
the people that have narrow l blood
vessels in their organs uh in their
brain so they can also have basically uh
narrowing of the brain blood vessels and
that can lead to cognitive issues uh
memory problems and in fact ultimately
vascular dementia vascular dementia is
much more common in Alzheimer's disease
it's actually something that we see as
blood vessels get harded okay um so now
you learn about one warning sign uh that
is actually cramping uh in your leg now
a warning sign number two that you
should be aware of is when you actually
have a wound on your feet that doesn't
heal now look most people if you cut
your feet on something like step on a
piece of glass step on a nail hopefully
you had your tetno shop but let's say
you cut yourself what's going to happen
first you're going to react in pain ouch
pull your feet back and then you're
going to lift your foot up okay uh
you're going to see if it's bleeding and
if it's bleeding you're going to rinse
it off you're going to wash off all the
bacteria that might be on there could
put a bandage on it right and basically
um as long as you keep that clean uh and
it's not too deep and you've removed all
the foreign material uh that's there
which is why you want to really wash it
off well that wound will heal up I mean
it starts to heal as soon as it forms
but by a week to 10 days your wound will
actually do pretty well the foot the
bottom of the foot especially is a very
dirty part of our body because it's in
contact with the ground or the inside of
your shoe you know we wear shoes so we
don't actually get our feet dirty but
you know how dirty the inside of a shoe
is nasty inside of an old tennis shoe or
you know an old pair of work shoes that
you're actually wearing every single day
not good so if you're going to actually
cut your foot normally uh you know wash
it off put a Band-Aid on you might want
to put a sock on before you slip it into
a shoe and a lot of people say well just
walk around flipflops well be careful
because then your the bottom of your
foot's exposed to everything so put a
bandage on check it change that Band-Aid
uh after a day or so take it when you
take a shower take a little bit of soap
and clean off uh the the cut area as
well believe me if you're if it's normal
a cut on your foot will actually heal up
but that's not the warning sign the
warning sign is actually when the wound
that's on the bottom of your foot
doesn't heal in other words the wound
you get a cut uh the cut may not even be
painful but it's there and it stays
there uh more than a few days more than
a week it's there two weeks later what
it's not healing yet it's 3 days later
still not healing a lot of people don't
even know that they actually have a foot
wound uh particularly they've got
diabetes because the nerves in in some
conditions like diabetes um are dying
back if you don't have enough nerves in
your foot you're not going to feel when
you actually cut your your foot right
now those nerves are dying back because
the blood vessels uh that support the
nerves are also are damaged this is one
of the issues with diabetes you've got a
diabetic neuropathy which is actually a
problem with the nerves dying back so
diabetics have difficulty feeling the
bottom the soles of their feet very easy
to step on a piece of glass all right
and be cut and you don't even feel it
all right now one of the reasons that
the nerves are dying back is that the
blood vessels feeding the nerves are
insufficient or they're blocked up all
right so every nerve has its own blood
supply feeding it makes a lot of sense
right you got a telephone line that's
going from pole to pole along the
highway you're going to have to have a
support line going along with it and
those blood vessels are the support
lines bringing oxygen and nutrients to
the nerve along its entire Journey on
the bottom of your foot now I I told you
that in diabetes there's blood vessel
problem s and those blood vessels
feeding the nerves are not normal they
they're dying back and now without
oxygen and nutrients the nerves die back
and now you have an understanding of
what diabetic neuropathy actually is
problems of the nerves start with
problems of blood vessels and that's an
area that I study so that's why I'm
going to give you this level of detail
now when you cut yourself you need blood
vessels to grow back that's a process
called angiogenesis angiogenesis angio
blood blood vessels Genesis is how they
grow and uh this is actually uh very
very important from your entire over
your entire life that your body is able
to use this process of androgenesis one
of the health defense systems to make
sure that all the tissues in your body
have the right amount of blood at all
times all right and you get you got
right amount of blood flow so in
diabetes you wind up having damaged
blood vessels it's the lining of the
blood vessels the endothelium is what we
call it is damaged all right and when
that's damaged the blood vessels
actually more easily uh clog up okay and
also clot and when you have those uh
ever narrowing blood vessels that
happens in diabetes uh when it's when
those are the blood vessels that follow
the nerves and support the nerves when
those blood vessels go guess what the
nerves go so diabetic
neuropathy diseases of the nerves are
partly caused by diabetic
vasculopathy meaning that diabetes
causes a problem in the health of the
blood vessels bad blood vessels to
nerves bad nerves right so this is what
actually happens in the feet um uh of
people with diabetes so they don't even
feel it when they step on a nail when
they step on a tin can when they step on
a piece of glass and that cut that
occurs actually uh you can be dragging
it around for a long time if you're not
checking the bottom of your feet if you
don't feel a pain remember I told you
normally you step on something you cut
yourself boom you pull your leg back and
you go check your foot that's the
Natural Instinct but if you don't feel
it now you're just going to you know
after the cut you're going to just slide
your foot back into the your Barefoot
back into the shoe and and Tool around
and you might not even know that you
actually had a cut and in fact some
people with diabetes winding up having
these uh uh foot wounds don't even know
that there's an injury until days later
maybe weeks later um they start smelling
something really foul coming from their
body and it turns out to be coming from
their foot because now they've got
rotten tissue that wound is not healed
and that's the warning sign a chronic
wound that doesn't heal this is actually
something that's pretty common
unfortunately in diabetes and also it
can also happen with pereral arterial
disease um but uh it's kind of a silent
epidemic people don't like to talk about
holes on the B and the feet that don't
healing that aren't healing and doctors
actually don't know most doctors don't
know how to actually handle a diabetic
foot ulcer now I happen to be one of the
people who've led to charge both
research treatment uh policy uh wise uh
to figure out how to actually heal these
chronic wounds because you know what
happens if you don't have heal that
chronic wound unfortunately that wound
will get deeper and deeper because it's
not healing the bacteria will kind of
get in there and you'll start it'll
start losing pus all right and then the
tissue will start to die in that area uh
and eventually you could actually get an
abscess the bacteria can get into your
bloodstream you could get septic and by
the time uh many people many patients
actually you want them going to their
doctor and their doctor goes hey I don't
know what to do with that finally they
get the patient gets referred to a wound
clinic all right there are you know
several hundred wound clinics around the
country not enough of them by any means
compared to the number of people
diabetes and those special wound clinics
have uh trained staff and experts
clinical experts that know how to
actually apply Advanced Technologies to
be able to start healing that wound if
you don't go to the doctor all right
you're going to be walking around with
basically a rotting piece of your foot
that's going to get worse and worse and
when that rot continues to go bad you
can get gang GRE so the treatment for
diabetic foot ulcers when it's detected
early on you know will clean out the
wound we maybe even cut out the
non-healing wound to kind of get a fresh
margin um and then there's all kinds of
different tricks of the trade that can
be applied that actually work really
well everything from putting a a living
skin equivalent it's kind of like a
living bandage on it to help heal
there's a growth factor it's like a it's
called ranic by Capman it comes like in
a small tube like a travel tube of
toothpaste you squeeze some on there
it's a protein that stimulat Ates
angiogenesis so it stimulates healing
that's already way too slow um in the
diabetic foot somebody with diabetes so
just go ahead and stimulate it and in
fact this growth factor gel the thing
that comes in a toothpaste called bapin
was FDA approved because clinical trials
showed that it actually sped up the rate
of wound healing what does it do it
stimulates
androgenesis more blood vessels growing
guess what not only is it healing the
wound repairing the wound but the other
thing that it's actually doing is that
it's also um helping to restore the
nerve function as well and nerves will
grow back nerves will grow back if you
allow them to grow um by right eating
the right Foods by um not killing the
nerves some more nerves grow back about
one millimeter a day that's about a
millimeter right there okay a tiny bit
then the next day then the next day and
then next day you can actually grow
nerves back pretty quickly All Things
Considered all right so the warning sign
we're talking about here are chronic
non-healing wounds that might be on your
foot you should always check your feet
if you've got diabetes before you go to
bed you should you know cross your legs
look at the bottom of your foot on the
right take a look at the bottom of your
foot on the left check around your
ankles make sure there's no wounds um
and if you're actually taking a shower
that's another example another
opportunity to be able to take a look
look at your uh skin on your foot uh and
also keep it nice and clean all right
soap up your foot uh that's actually a
really important little tack I would
actually say in order to be able to
avoid the problem but if you actually
have a non-healing wound time to see a
doctor all right you're probably going
to be need to be seeing a wound
specialist somebody who works in the
wound clinic but don't be afraid to
advocate for yourself and ask your
doctor to refer you to a wound care
center all right they're around and they
have all the technology all the tools
Hyperbaric uh living skin equivalents
growth factors um uh all kinds of
different things and most most
importantly the experience of actually
getting a wound to actually heal back up
if you don't I'm just telling you these
wounds will get worse and worse they'll
get infected um your immune system and
diabetes is also lower so now you've got
poor blood vessels poor nerves uh and
now you got an infection and your immune
system is also down this is why uh
diabetic foot ulcers are a common reason
uh that doctors wind up amputating the
the feet and the legs of of patients who
have these chronic wounds so you don't
want to be there I trust me on this one
all right so uh that's a second tell
warning sign which would be actually a
wound on your foot that doesn't heal all
right now Telltale sign number three
major swelling in your feet and ankles
and into your calves right and you've
probably seen this recognize this I mean
you know you've seen somebody maybe
they're on a bus or in a Subway they
might even be on a plane uh maybe on a
beach but somebody who's got you know
really really swollen uh calves and
ankles and foot and the foot is sort of
um kind of like pillow-shaped really
really swollen and it's actually filled
with fluid now swelling in the feet can
actually happen for a lot of different
reasons all right some of the reasons
that are harmless are for example uh if
you're on a long plane flight so you're
flying across the country flying across
the ocean to Asia or uh Europe you're
sitting there for a long time and even
though an airplane has a pressurized
cabin they artificially um put air
pressure in the cabin it's a lot less
than when you're actually noted an
airplane standing on the ground all
right so with lower cabin pressure
compared to what is on planet Earth when
you've got your feet on the ground less
uh pressure means that the water inside
your body can seep out Under the Skin
not through the skin under the skin from
your blood vessels out into the tissue
out towards the skin and the leg the
calf ankle swells up the foot swells up
all right that's called pedal edema p d
l pedal edema and the fluids pooling
into them connective tissue uh in in
your under your skin now we test for
that to see what if it's really fluid
that is just oozed out by pushing a
finger into the uh swollen foot or ankle
or calf when you push in it's kind of
like the Pillsbury Doe Boy or pushing
into a ball of pizza dough you're going
to get a print a fingerprint in there or
a thumb print if you use your thumb uh
right in there okay and you'll see the
indentation will stay there for a little
a while before the fluid comes right
back out and actually uh uh removes and
fills back out uh your fingerprint or
thumb print that's pedal edema and it
can actually happen a little bit when
you're flying on a on a very long long
haul flight not enough air pressure and
so for some people not everybody for
some people uh the fluid actually comes
out and that's a relatively harmless uh
situation you know once you if you're
taking a flight once you land you know
you might have a little more problem
than than you'd expect by putting on
your shoes but then once you're walking
around okay you know you get your
luggage from the overhead you walk off
the plane now you're walking through the
terminal to the baggage claim or
wherever you're going all right that
physical activity back on Tera Firma on
regular Earth okay with higher uh
pressure is going to push that fluid
back into your blood vessels and then
your veins will actually take it all all
back into your heart um and now it's out
of your ankles and calves and and feet
back into your body all right so that's
the harmless kind of swelling but if you
have it you want to pay attention to it
because you know it's something that is
in it's just one of those telltale signs
that something is going on um in under
normal conditions it's just less air
pressure around you okay um but it's
hard and that's particularly harmless
however there are situations where edema
can signify something something really
really severe all right lower extremity
edema is what we call it all right now
this is now one of the things I told you
about is these really fat swollen feet
and ankles and now when you actually put
your finger on it pitting edema you can
it's it's like like I said like like
poking a piece of pizza dough you'll see
the hole where your finger was and it
will take a long time before it actually
fills back out again all right and this
can actually go all the way up your
shins all the way up to the calves as
well all right you get that dimpling if
you actually put your finger on it all
right now that's the kind of fluid that
has actually come out and uh it's and
the fluid is not going back in the blood
vessels to the heart so this pitting
edema is actually not a normal situation
and it can actually happen when you have
congestive heart failure so pitting
edema all right big fat calves ankles
and feet all right uh might be a sign
that you have have congestive heart
failure and that's why when you have
edema uh that doesn't go away time to
talk to your doctor and get some
attention to it you know even though
we're talking about the foot that might
actually be the tip off that there's
something going on with the heart and a
doctor can actually use an ultrasound
and do a stress test and do all kinds of
different types of testing in order for
you to be able to actually um check the
uh the Vitality of uh your uh heart all
right now how does heart failure cause
leg swelling
well you know our circulation is a
closed system so the heart right here is
pumping pumping pumping jetting blood
out through the artery the big arteries
called the aorta right over the top kind
of like a a fountain like The Fountains
of balagio squeeze pump blood goes out
the heart all right and the arteries
take it to all the rest of the body um
but what happens is that uh it has to
return the the blood has to be returned
on the other side through the Venus or
vein system all right now if the heart
is not doing vigorous pumps but it's
getting blood out there and the blood is
coming back to the heart but the heart
can't accept it fast enough so you're
pumping out and now it's like wiggly
jiggly it's not ready to accept more you
yet more flute is coming back yep well
okay we'll get we'll get it again let's
do another pump and it becomes kind of
like a feeble half-hearted pump what
happens to the water the blood that was
supposed to come back the blood backs up
okay it's like a toilet that's not
flushing completely the fluid backs up
uh and then when it backs up from your
heart it backs up all the way in the
other side of your veins right you're
not moving fluid through your heart
that's supposed to fluid comes into the
heart fluid is pumped out of the heart
that's how it's supposed to work but if
the fluid isn't going out of the heart
as quickly it backs up and when it backs
up you know what it backs up and goes
down the column of fluid that's called
gravity uh in your uh Venus system in
your body and then it builds up in your
legs and feet because those are the
lowest parts of the body all right
unusual severe swelling that when you
poke it you leave a dimple in it could
be a Telltale sign that there's actually
a heart problem so this is basically how
legs and feet can tell you something
very important about something that is
not below the waist all right and if you
actually suspect you've got congested
heart failure it is time to go see a
cardiologist and your primary care
doctor should be right on it okay this
is not difficult stuff this is common
sense stuff when the pump's not working
well the blood's going to back up uh
because you're trying to Jet it out it's
not working efficiently enough so the
blood backs up that fluid goes down the
column of your body leaks out through um
the blood vessels accumulates within the
muscle and tissue of your uh lower
extremity your calves your ankle your
foot and then your and they swell up and
you can dimple them all right now that's
a warning sign okay let's talk about the
next warning sign and these are uh
called Venus leg ulcers it's also a kind
of wound but it's not like a diabetic
wound which is kind of round and deep
Venus leg ulcers are kind of they're
they can take any shape they kind of
look like the map of uh the United
States for example uh or an island from
Outer Space if you look took a picture
from a satellite it's an interesting
Geographic shape and not very deep this
is not a deep wound but it can actually
be a very large wound in terms of the
surface area it's just a shallow uh uh
sea like kind of like the Salt Lake in
Utah not very deep but really wide and
it's got really irregular borders that
could be a Venus leg ulcer and if you
haven't heard about Venus leg ulcers
don't worry most doctors your your
general your GP probably doesn't really
know what one is either the PR common
but uh the regular doctors your GP your
primary care doctor probably doesn't
know how to manage it now so let's talk
a little bit about these shallow wounds
that can form around your uh calves uh
near your ankles on top of your foot but
it's generally sort of between your knee
and your ankle all right they're not
deep they're very shallow and what's
happening is again this is let's go back
to the blood vessels you have something
a problem called Venus in sufficiency
all right Venus meaning veins right
arteries are the blood going out of the
heart veins are the blood coming back
into the heart and the blood vessels
that bring the blood back are called
veins and the V veins are insufficient
all right that's Venus insufficiency
what is it about those veins what part
is
insufficient uh well let me explain to
you so when the blood is actually
finishing the arteries and it's going to
go back to the heart it gets you know it
goes down to your legs it's got to get
pumped all the way back to your heart
and remember I told you is that the
blood when you're standing up the blood
can pull very easily so the way that
mother nature designed the return system
it's that blood that's that was pumped
out that's collected back uh into the
veins and gets and that vein starts to
bring the blood back to your heart now
in order for that blood column not to
sink and cause your legs to swell the
fluid to leak out and swell there are
valves in your veins all right and these
valves allow the blood to get pumped up
and then the valves open up like this
okay and now the blood can't go back and
the whole water column is trapped and
then the next pump pumps that column of
water a little bit higher oh another
another another valve system traps it so
it can't fall back down okay another
pump Boom the blood column goes up and
then it falls back to another valve and
these valves actually keep the blood
going up up up up back to your heart
all right very very important concept so
Venus insufficiency all right what do
you think happens when those valves
don't work or one of the valves don't
work let's say if there's a failure of a
valve well that column of blood on its
way back to your heart isn't going to
actually stay in one place because
there's nothing that's propping it up so
it's going to fall back down and just
like kind of like a like a dominoes the
next one falls down the next one falls
down and now you've got blood that's
actually pooling again and you're like
kind of like congestive heart failure
but in this case the ticker is okay but
the valves in the veins are failing okay
they're insufficient so this is called
Venus insufficiency and what happens is
that in your leg so let's call it below
the knee that back up of fluid that then
leaks into Under the Skin okay and
creates that big fat leg and dimpling
effect that I told you about well look
in uh uh Venus insufficiency it's really
the superficial area the thin part of
the skin that wears down all right uh
and a little little hole will actually
get bigger and bigger and bigger usually
it doesn't bleed actually it's just kind
of like area of the skin that's breaking
down so much fluid is out stretching the
skin the Skin's not getting enough
oxygen all right and all it takes is for
a tiny little thing a bump uh you know
on the side of a table or tripping on a
branch or something like that and now
you're actually going to scrape off some
of the skin and Venus like ulcers start
to form just because there's so much
fluid all right when they start forming
as I mentioned you they're not deep
wounds they're very shallow woundes but
they can actually cover a huge area and
that is called Venus
insufficiency so you tell your doctor
your doctor may or may not know what to
do with it all right um and if they
don't if not sure you should ask your
doctor to refer you to a wound clinic
they're all over the country all right
but they're really really specialized
these are a Navy SEAL Navy seals for
wounds they know exactly what they're
doing and uh in ways that your regular
doctor are not going to know and if they
don't know if your doctor your own
primary doctor doesn't know a wound care
specialist that's fine just uh go online
and go ahe and look up wound
associations there's a few of them out
there I'm on the board of one of them
and uh uh some of them actually have
lists of providers or Healthcare
Providers or wound clinics you can
actually go to there are some really
really good ones and by the way uh a
conference that uh you know I have gone
to for many many years uh with nurses
and doctors and surgeons all going to
this conference it's called the
Symposium for advanced wound care s
AWC all right and that's where a lot
takes place twice a year uh different
cities and that's actually where you can
meet some of the wound care provider so
I know that in the past when I've been
at that meeting sometimes patients will
show up all right right they hear about
their meeting they show up and guess
what they are suddenly right in the
middle of all the experts in the country
uh for wound care and they can you know
introduce themselves and often get help
that way so if you got a Venus leg ulcer
uh you want to let your doctor know if
your if your doctor doesn't know how to
deal with it uh and they should refer
you if they don't know how to refer you
well you might be actually stuck looking
for it yourself uh uh but uh you're
looking for you're searching for wound
clinic
in your ZIP code or in your city so
Venus leg ulcers are another warning
sign shallow wounds uh in your legs your
lower legs all right this is very common
in older people they generally are hard
pretty hard to heal but if you see them
I'm just going to tell you because I'm
one of the experts in this area um what
to do for wounds uh wrap it there's
compression uh and what you want to do
is kind of keep enough compression there
because guess what valves aren't good
enough to keep the fluid going forward
well maybe we need to squeeze in a
little bit uh you know that old ace
bandage you can wrap it around the leg
not loose pretty tight because you want
to actually you know kind of force the
blood to go back into the system uh and
and uh and that'll actually be helpful
in terms of the healing uh as well all
right so compression is the primary way
of closing or healing these wounds but
if it's still not healing again a wound
care provider might put some growth
factors on there might put a living skin
equivalent on there Amic membrane uh
they might give you hyperbaric oxygen
this is where you go into a little
chamber originally developed for deep
sea divers who come up too fast and get
that bend so this Hyperbaric HBO is
intended to help people divers avoid the
bend but guess what um it actually could
be useful for healing the wound so I'm
going to tell you exactly what happens
if you um pop into one of these HBO's
hyperbaric oxygen uh centers so at a
wound center they might actually put you
into a hyperbaric chamber uh and uh what
this hyperbaric chamber does is it uh
puts lots of oxygen under a high oxygen
pressure to flood your uh body but
especially the wounds with high oxygen
right so I just told you these chronic
wounds occur because they're not getting
enough oxygen so let's go and flood the
area of the oxygen uh in order to be
able to get more oxygen which is
necessary for healing and you think that
well you keep on doing Dives and every
time you're getting the oxygen the wound
is healing a little bit actually that
that does happen a little bit but what's
really happening and this is where I'm
coming at this from a researcher kind of
an expert in this field is that you're
training under every time you go into a
dive chamber a hyperbaric chamber you
are um pumping the wound full of oxygen
during that 1H hour dive let's say 20-
minute dive the tissue your own tissue
where the wound is is uh getting used to
the party of actually having a lot of
oxygen all right uh so then when you
step out of the dive chamber all right
you're going to get back in your car and
you're going to drive home the visit's
done well actually it's what happens is
that when you're actually out of the
chamber before the next time you go into
the chamber your wound not after the
first time not after the second time
maybe starting up the third time you do
a dive when you come out of the chamber
it's so used to having a party with a
lot of oxygen around that when you step
out and you get into the car into the
parking lot your wound Felix is choking
oh man I'm not get enough oxygen all
right and then this is the setup for
what actually happens because when a
wound when tissue feels oxygen starved
all right this is called hypoxia or
relative hypoxia I mean it's look it's
just in regular air so it shouldn't be
start of oxygen but it's been trained to
be addicted to high oxygen that's how
HBO works this addiction now the wound
goes well we don't have enough oxygen
let's go ahead and create proteins and
release proteins ourselves in the wound
like vascular endothelial growth factor
VF this is an angiogenic growth factor A
protein that causes blood vessels to
sprout it's like pouring putting Ser
fertilizer um on the ground all right
and then putting some grass seeds on
what's going to happen you're going to
actually grow lots of grass and this is
what happens after between Dives is that
your wound senses it's not getting as
much oxygen as would make it happy all
right because you've trained it and now
it sends out these proteins to grow new
blood vessels and once you have
androgenesis and you turn on the genes
for healing now the that Venus leg Al
will begin to actually close meaning
that the skin grows over less wound is
exposed less the less wound that's
exposed the less chance there is for
infection all right so a lot of ways to
actually deal with vus leg ulcers um but
that's another warning sign so what do
we talk about we talked about um
cramping we talked about uh swelling
right uh we talked about uh wounds that
open up we talked about diabetic wounds
we talked about Venus wounds all right
so these are all uh things that we
should be paying attention to these are
these are the warning signs on your legs
and your feet that you have actually a
problem uh uh and then here's another
one all right uh and this is the last
one I'm going to talk about the fifth
warning sign if your toes become black
black toes all right and I'm talking
about black like burnt hot dogs all
right and this again is a sign of
Peripheral arterial disease this is the
condition where blood vessels get
narrowed or blocked and now the the the
the tissue in this case the toes are not
getting enough oxygen and when it gets
severe enough basically the meat of your
toes the Flesh of your toes the muscle
in your toes the bone in your toes just
basically dies all right it's just not
getting enough oxygen all right and when
that actually happens when that tissue
dies it turns black and it'll actually
dry out and you'll wind up getting gang
GRE that's what it is when your toes
turn black all right now remember I told
you this is the process this narrowing
of the blood vessels is the process not
just in the Toes or the feet it's
happening everywhere the narrowing is
happening in your heart it's happening
in your lungs it's happening in your
liver it's happening in your brain so
this is a Telltale sign if you wind to P
me black toes you're probably having
narrowing of the arteries elsewhere in
your body as well you got a problem not
just of the toes that's serious enough
in your toes but there's a tip this is a
tip off that you better go have the rest
of your body checkout so who actually
does a checkout well vascular surgeons
are uh that's this is their domain this
is their belly Wick they're supposed to
know that's what they do how to assess
your circulation all throughout your
body but the black black toes that's a
great uh sign uh to be able to pay
attention to all right if you don't have
enough blood F blood flow to your foot
the toes can turn black you don't have
enough blood flow to your heart you can
get a heart attack not a blood flow to
the brain you can actually start to lose
cognitive U power you're actually you
become dull
as opposed to
Sharp s mentally that's not what you
want and that's the problem that's
actually happening everywhere black toes
a clue you're not getting enough
circulation uh to any part of your body
and in the toes when the skin dies it
actually turns black now that black is
called Gang Green and Gang Green is a
very dangerous condition because
essentially not only does it tell you
that your circulation is compromised all
over including your brain and your heart
but the fact of the matter is that uh
eventually that ganger can spread to the
rest of your foot all right you might
have to amputate your foot it can spread
up even further and you might need to
amputate up Upstream uh your to the rest
to the upper part of your leg uh as well
all right so this is Peripheral arterial
disease leading to less blood flow all
right all the way down to the tippy toes
literally and the when the toes the meat
of the toes the muscle the flesh the
bone connective tissue don't get enough
oxygen they basically die and when they
die they turn black so black and Toes a
sign of danger that's helping happening
elsewhere in your uh body time to see a
doctor who should be referring you to a
surgeon not just any surgeon but a
vascular surgeon because one of the
things that they'll do is they'll do a
scan all right uh an an angiogram and
this is basically like a kind of an
x-ray but they inject a Dye into you
that circulates all throughout your body
and and and basically they can are able
to map out where the narrowing is
occurring in your legs all right and if
they once they actually pick out where
that narrowing is guess what they can
send in The A Team to try to see if they
can open up the blockage now I told you
this is happening all throughout the
body so it's very unlikely it's just one
area uh and so vascular surgeons have to
assess this by squirting the dine is it
one area they can get to or is it defuse
meaning it's a little bit of narrowing
everywhere
which is often what's actually happening
with Peripheral arterial disease now I
took part in efforts years ago to be
able to develop uh lots of treatments to
actually TR uh be able to get around
this pereral arterial disease uh to
avoid black and toes and to heal uh the
wounds these arterial ulcers is what we
called them I can tell you one of some
of the most impressive work that still
isn't ready for prime time but I'm just
sharing an experience with you is uh
doing gene therapy to deliver the gene
the DNA that codes for one of the growth
factors that help stimulate speed
androgenesis and healing um and what we
did is you know there was a big clinical
trial uh the the gene was injected into
the muscle of the leg all right all over
and uh lo and behold what we found is
that blood vessels would grow in oxygen
starve legs so we could actually
stimulate androgenesis by delivering
genes through gene therapy I mean this
is pretty futuristic stuff right yeah
well look I took part in it I can tell
you although that it's still early days
of development but in the clinical
trials I will tell you that there were
some patients for whom it was a home run
all right we haven't been able to repeat
that enough to enough people to really
call it a wind so that's why it's still
research area but I can tell you you
know the the world of discovery
Innovation and breaking new ground you
know if you want to be a path breaker uh
particularly medicine all progress
begins with one patient and so I can
tell you I've seen that one patient
respond
beautifully when you do androgenic gene
therapy and now it's still in
development because it's a steep Road uh
to solve it how do you design the trials
etc etc in any event uh that's actually
for the future all right you go see a
vascular surgeon and they'll actually uh
take some dye inject it in see where the
blockage is and they might be able to go
snake in a catheter right up to the
blockage put a balloon in it poke it
right through the blockage blow up the
balloon when they blow up the balloon
the pla plaque it'ss pressed back they
can even suck out the plaque if they're
drilling through it suck it out all
right put into a bucket on the other
side uh this is all going through your
groin um they can put a stent a basket
and it goes deploys open and now the the
the art The Vessel
the artery won't close down can't shut
down all right and that's actually a way
of actually opening up uh the blood
vessels to restore blood flow now if you
can't sometimes the blockages are so
serious or the anatomy is so difficult
that the vascular surgeon can't quite
get to uh that area I can't kind of get
through that area um so now what do they
do now you can actually undergo bypass
spheral arterial disease can be treated
with bypass surgery so basically what
you do is you just the surgeons once you
take a a vein and just plug it on one
side that has good blood flow and then
pop P patch it in right beyond the area
that's blocked said you know what we
don't even need that blocked area we're
just going to go right around to supply
uh the tissue and so uh uh bypass
surgery is uh a very uh important and
still common way of actually dealing
with this we don't have gene therapy yet
but um sometimes the basket uh can open
up uh an anoplasty to suck out the bits
that can actually work as well now
what's really interesting is that
there's some foods that look like they
can be helpful uh to improve better
blood flow so let's talk a little bit
about those how do blood vessels that
are narrow um dilate well you know you
actually have something called nitric
oxide actually a gas a normal gas in the
body when you got nitric oxide you take
that blood vessel and the nitric oxide
the gas actually causes the blood vessel
to um dilate expand now you got better
blood flow right through it right narrow
blood vessel add nitric oxide and now it
opens up now blood can actually flow
right through it so nitric oxide is not
something that most doctors are using
routinely but guess what there are
medications that can actually stimulate
nitric oxide one of them is Viagra now
you know that Viagra is used for uh
retile dysfunction what's a rectile
dysfunction not enough blood in the
penis right not enough blood flow tra
captured in the penis for during an
erection so um the same thing that can
actually happen in the brain in fact
there was a clinical study that showed
that men who were taking uh Viagra for
erectile dysfunction actually had a
lower rate of developing dementia partly
because the blood vessels uh feeding the
brain were opened up and bringing better
blood flow okay so that's a drug not
everybody wants to be on viagra for
example you know like you get you'll get
that like side eye from the pharmacist
when you're uh filling that prescription
for something that's not a rectile
dysfunction um but what foods can
actually do that well turns out spinach
and beets spinach and beets are two
foods that actually can create that
nitric oxide help your body create that
nitric oxide widen your blood vessels um
and actually help to deliver better
blood flow which could actually help all
right it's not a Magic Bullet but it
could actually help to Stave off
amputation to uh give you better give
you some more better blood flow prevent
more Gang Green from actually happening
it's not the complete solution all right
you really need a surgeon to be able to
take a look at it but I'm telling you
this is a tool in the toolbox that your
doctors is not going to be prescribing
you and if you are to facing such a
serious condition where you've got black
toes and maybe your whole leg needs to
be amputated want to stay away from that
you want to do what you can at home to
be able to save that tissue all right
I.E your leg check this out I got a free
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enjoy so spinach uh and beets these are
produce that grow uh close to the ground
and and the soil has a lot of nitrogen
so these plants absorb nitrogen into
their into the root in the case of uh
beetroot uh and into the leaves in the
case of spinach and when you actually
eat spinach or beets all right and and
you chew it so I'm I'm I'm telling you
savor it make sure it's cooked in a way
that you actually enjoy all right I'll
tell you how I enjoy it I love here's my
one of my favorite spinach dishes um
it's actually I I was inspired by Spain
you get um uh spinach you sauté it in a
little bit of extra virgin olive oil
some garlic all right to get this
fragrant uh uh smell then you uh add
some golden raisins into the mix little
splash of white wine the alcohol will
burn right off and then you toast some
pine nuts and then throw them in there
turn off the heat mix it together and
now you've got this
wonderful um spinach dish that tastes
amazing now why am I telling you about
making the food taste amazing is because
when you have the spinach you want to
chew it Chew Chew Chew Chew Chew Chew
choo choo choo and the reason that you
want to do that for vascular Health
blood vessel health is that the microbi
on your
tongue okay healthy bacter on your
tongue when it's in contact with spinach
that food that absorbs nitrogen from the
soil and now you're chewing it all right
um and and you're and you're loving it
because it tastes great now you're
chewing it and the longer you chew the
more contact the spinach has with your
tongue
microbiome all right and when that
actually happens the uh bacteria convert
the nitrogen from the spinach into a
form that when you swallow it gets
absorbed into the bloodstream as nitric
oxide the same thing that Viagra creates
it's also all throughout your body and
we know it actually works because within
a few minutes after eating spinach in
the manner in which I described the
blood vessels dilate everywhere in your
body and in fact your blood pressure uh
goes down a few points all right now
this is actually quite impressive
because normally you've got to give
cardiac blood pressure meds to able to
do the same effect spinach will have
that uh type of effect as well but it's
Kinder and it's gentler in order to be
able to do that okay now uh beets same
way right so I love roasted beets uh
little extra olive oil you want to let
the beets cool uh what else could you do
you can get some orange slices Mandarin
slices beets and uh uh orange slices are
really good uh you could put some
balsamic vinegar on it there's a lot of
different recipes you can do with beets
makes a great beet salad for example uh
and if you don't know how to actually
cook something like
beats type beats uh uh into Google uh
type recipe and then type video and up
will pop all these videos and you can
actually play it and have somebody who
knows what they're doing meaning they
know how to make a delicious beet dish
they will teach you how to do it and if
you do if you do this in a grocery store
by the way in front of the beat section
and and you're like M what do I do with
this like dark red ugly kind of dirty
looking thing just take a few minutes in
a video at a store and and watch they'll
show you the exact technique of how to
actually create a delicious beet dish
and then usually they also talk about
all the other ingredients you actually
need to buy as well oh and here you're
in the store that's really convenient
now you know it can make your own beet
salad but beets when you chew them the
same thing as a spinach Chew Chew Chew
Chew chw Chew the healthy bacteria in
your tongue will interact with the beets
the nitrogen in the beets that came from
the soil change it chemically in a form
that when you swallow the beets um and
the nitrogen it's in a form that is
absorbed into your bloodstream as nitric
oxide dilute dilates the blood vessels
blood pressure comes down and by the way
it's even be studied it even been
studied that beetroot juice you know
this is this kind of like um really
intense red juice uh uh by the way you
can make a rotto using that in the juice
and you get this beautiful beet red
risotto rice dish but back to the leg
and getting blood flow into the leg
beetroot juice has actually been shown
to also be beneficial all right uh so
that's actually uh a little food tip for
you uh spinach and beets can be helpful
in dilating the blood vessels to improve
blood flow to your leg uh in Peripheral
arterial disease and if you wind up
actually uh having black toes this would
be something that as you're working with
your doctor how can you get out of this
Jam well there's something you can do
for yourself at home spinach and beets
are there now some people will say what
about um uh you know oxalates and and
spinach and you know beets and things
like that what do I do about that I
don't want to have kidney stones I don't
want to have gout look you're you're
balancing things we're really talking
about saving your leg let's focus on
that um if the dietary approach isn't
for you well maybe you need to ask your
doctor or the vascular surgeon for other
medications that you're probably going
to be given um maybe to dilate the blood
vessels a little bit all right um and
again I'm not giving medical advice here
I'm I'm giving information that you can
take and do some more research on it ask
your doctor about might give you give
some medicine to dilate your blood
vessels all right because you can have
nitrates um it's kind of medication uh
that actually turns into nitric oxide as
well or or even Viagra all right so
again uh the other thing that the
vascular surgeon will probably do is
give you um some blood thinners uh which
might sound uh scary but many people are
on them it's actually pretty safe as
long you don't you know get in the car
wrecks and slam your head on the on the
tile floor in the shower or anything
like that um you got to be a little
careful not to have accidents physical
accidents that could cause more bleeding
but otherwise these blood thinners
actually keep your blood nice and smooth
and actually it's a way of salvaging the
and preserving your leg in fact there's
a whole uh kind of dis subdiscipline in
wound healing called limb preservation
that means don't cut off the leg all
right so if that sounds severe I'm just
telling you it's like pretty common uh
as somebody who works has worked in the
wound healing area um there's more
people that uh wind up having gang
greine and black and Toes than you'd
actually think all right uh and by the
way this last example of the food is
also showing you how the gut microbiome
with a gut this time in the mouth mouth
is part of the gut how it interacts with
uh uh the food that we eat to be able to
um help uh support your health now
there's another way of actually
stimulating uh healing uh and actually
growing blood vessels in your legs uh
and this is again I know I this you know
I I talk about food a lot but I also
think that this is an area that many
people suffer from but they may not know
how an experienced uh physician or an
expert would actually approach it so I'm
sharing with you some Pro tips that you
can get armed and do research on and
then bring it to your own doctor or
vascular surgeon to advocate for
yourself and say hey how about this I'd
like to get that now one of the other
devices that can actually um stimulate
blood vessel growth to uh preserve and
protect your leg all right this whole
video is really about problems in your
uh uh feet and your legs that signifies
something else is going on so let's
stick to that doesn't have to be food it
could be anything goes right to save
your leg so there are now devices that
actually deliver energy to your leg
you're right you you heard me correctly
there are devices that deliver energy to
your feet that goes into your leg to be
able to stimulate angiogenesis blood
vessel growth and healing amazing right
so these are electrical pads right um uh
that that don't shock you but they're
flat pads you put your feet on them you
you kind of if you're sitting in a chair
the perfect thing is that they you can
put them sort of where your feet are and
you can just rest your feet on it and it
actually delivers electrical currents
right through the bottom of your foot
the balls of your feet all right and
those electrical currents send signals
to your blood vessels and it actually uh
uh somehow these signals travel up the
leg the lower extremity leg and they
activate the leg to grow new blood
vessels quite amazing uh I've I've
worked with people who have used it it's
actually quite dramatic in terms of it's
the benefits that can occur and it's a
way if you got black toes maybe to
actually avoid going towards the major
surgery route all right um buy you some
time uh but also something you can do at
home so if you have an office you could
put one beneath your desk in your office
at home you can put one you know in
front of the couch or maybe the dining
room floor so when you're eating you can
actually be on this current device and
it doesn't sh elect give you electrical
shock it's like low voltage low current
going into your leg and that electrical
therapy all right and you know listen
this is pretty amazing that like wound
therapy can use electricity they're even
inventing electric bandages by the way
you know like not the brand Band-Aid but
but you know that the little square in
the middle of the bandage they're
actually making electrical signals that
can beam out as well so electrical plate
uh that can actually do electrical
signaling to stimulate androgenesis is
another way of actually um addressing uh
a problem that you might actually find
uh in your feet that signify a much
bigger problem of circulation throughout
your body and that's been the theme of
this video uh I study androgenesis your
blood supply our body's got 60,000 miles
worth of blood vessels 400 miles are in
your brain the rest of it is distributed
there's a lot of blood vessels Muses
beneath your uh waist in your legs in
your muscles around your knees going all
the way down to your calves and then
into your feet when there's problems
with those circulation it's a signal
that other things are going around but
you might see uh the cramping the
swelling the wounds that aren't doing
doing so well uh the the black and toes
all right these are all warning signs
that something else in your uh body is
going on your feet and your legs are the
tip off uh that you need to actually go
see medical attention all right now hope
you learned something new I'm pretty
sure you did this is I gave you a lot of
information from the perspective of a
vascular blood vessel researcher and a
doctor who works in this space including
some of the clinical trial things that
we've actually been doing so I hope you
learn something from this uh and thanks
very much for watching I will see you on
the next
video hi there have you enjoyed watching
this video I know you'll love the next
one stay here and check it out and I'll
see you you there