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Published on October 02, 2018

A Team of Specialists Improved His Blood Flow So His Wounds Could Heal

Photo of Richard LaFramboise - PAD patient at MidMichigan Health.

After being treated through the PAD Program, Richard LaFramboise was able to return to his active, busy life.

Richard LaFramboise of Auburn is a very busy guy. He owns a pizza joint in town where he works six days a week. The little time he has outside of work he spends with his family – his wife, four daughters, 14 grandchildren and now a great-grandchild. People sometimes wonder why he still works so much and hasn’t retired from his job yet, to which he replies, “I can still do it, and I enjoy doing it, so why not?”

LaFramboise’s active lifestyle took a bit of a hit recently – literally. About five months ago he dropped a metal shoehorn from a seven-foot height onto one of his toes. It resulted in a cut that bled a little, but the bleeding stopped shortly thereafter so he didn’t think much about it. After a couple of months went by, however, the cut still hadn’t healed.

The situation turned when the wound became infected. Despite trying to treat it, the infection kept growing worse. Eventually, the infection entered the bone, and LaFramboise’s podiatrist informed him that his toe might need to be amputated. Understandably, LaFramboise was not keen on this prospect. If he already had a small wound that wouldn’t heal up, he thought, what would happen if he had a bigger wound that also wouldn’t heal

LaFramboise sought help from MidMichigan Health’s Wound Treatment Center in Midland. The providers there noted that he had the classic signs of poor blood flow – namely, an ulcer that was not responding to standard treatments. He was then referred to MidMichigan’s Peripheral Artery Disease (PAD) Program.

The PAD Program is run by a collaborative team of various specialists, including interventional cardiologists, vascular surgeons and interventional radiologists. Patients can be referred to the program through various channels, such as the Wound Treatment Center. Program Coordinator Tina Mason, R.N., says they offer free screenings to provide patient education, raise awareness and early detection of the disease.

“A lot of patients will think that their symptoms are part of the aging process,” Mason said. “That is a definite myth. Symptoms like pain in your arms and legs, muscle fatigue or having injuries that are slow to heal are frequently overlooked as simply part of getting older when, in fact, they may actually indicate poor circulation, which can be treated.”

When LaFramboise came to the program, he was first examined using an Arterial Doppler Study. Blood pressure cuffs were placed on various locations on his legs – his thighs, calves and ankles. A Doppler waveform measured the blood flow through his arteries as the cuffs were compressed. This test gives a readout as an Ankle Brachial Index (ABI), a ratio between the blood pressure in your ankles and that in your arms. The closer the ABI number is to one, the better the blood flow.

LaFramboise had a low ABI number in his left leg, indicating a blockage in one of his arteries there. To find the blockage, Vascular Surgeon Constantinos Constantinou, M.D., performed an arteriogram. While LaFramboise was sedated, Dr. Constantinou inserted a catheter into an artery in his groin and ran it along various blood vessels in his leg until the blockage was found.

A long segmental occlusion was found in one of the arteries in LaFramboise’s left leg. Plaque buildup had caused the artery to narrow along a section and was restricting blood flow. In cases of smaller blockages, a balloon or a stent can be used at the time of the arteriogram to open up the blockage in a non-invasive manner. In LaFramboise’s case, however, the blockage was too long to be unclogged by this procedure.

Instead, LaFramboise underwent an artery bypass. Dr. Constantinou took a healthy vein from LaFramboise’s leg and attached it above and below the blocked section so blood could easily flow through the leg again.

“I never had any doubts about the surgery, before or after,” LaFramboise said. Nurses helped him manage pain in his leg the first night in the hospital after the surgery, but after that he felt very little pain. “I’m very satisfied with the treatment I received in the hospital after the surgery,” he said.

For six weeks afterward, he was forced to take it easy, stayed seated with his foot elevated. After this recovery time, LaFramboise returned for a repeat Arterial Doppler Study. His ABI number was much higher, indicating improved blood flow in his leg. “I’ve been more than happy with my treatment by Dr. Constantinou,” he said. “He’s a nice guy. The nurse was great, too.”

Mason and the PAD Program Staff kept a careful watch on LaFramboise’s condition after the surgery. She met with him a couple of times afterward and called him at home on occasion to make sure he was healing properly. Once, a nurse even took time to check on his wound when he dropped by the clinic without an appointment because he had a concern he needed addressed.

After his retest showed he had attained better circulation, LaFramboise returned to the Wound Treatment Center. After a short amount of time, his toe finally healed, and the stubborn infection has cleared up. If not for the successful bypass surgery, LaFramboise said he might have lost his leg. Now, he is happily keeping busy at work once again.

Those who would like additional information about MidMichigan Health’s PAD Program may visit www.midmichigan.org/pad.