Powerful Insights From a Leading Vascular Surgeon
Joseph Fulton, MD
What inspired you to become a vascular surgeon? What do you love about what you get to do?
I had a true epiphany. While in college, I was spending Thanksgiving at the house of a roommate whose father happened to be a surgeon. He got called in for an emergency surgery, and I was actually able to scrub in on the case. I was hooked. Until then, I really hadn’t even considered medicine; I was an electrical engineer.
As described by the American Board of Surgery, vascular surgery “encompasses the diagnosis and comprehensive, longitudinal management of disorders of the arterial, venous, and lymphatic systems, exclusive of the intracranial and coronary arteries.” What makes it challenging has also made it rewarding. We perform a variety of complex operations involving all parts of the body, except inside the skull. We operate in the chest, the belly, the neck and the extremities. We can treat things either with open procedures through incisions, or from inside the blood vessels through needle access. We operate on infants to geriatrics. Our days can run the gamut from doing simple aesthetic procedures such as sclerotherapy for varicose vein, to complex work fixing a ruptured aneurysm. Vascular surgeons need to be technically precise and cool under pressure. Along with these reconstructive surgical and endovascular techniques, a vascular surgeon should be knowledgeable of all aspects of vascular disease, including diagnosis and medical and lifestyle therapies.
That being said, I think that most surgeons, even though we relish the excitement of the operating room, get our true satisfaction from interactions with patients and their families. Due to the chronic nature of most vascular disease, we are often following our patients over a long period of time, and we get to know them well.
How do you train to become a vascular surgeon?
Following completion of medical school, there are currently two routes to become certified in vascular surgery. The traditional route is to first complete a residency program in general surgery, which is typically 5 years, and then to complete 2 years of additional vascular surgery. You would then finish being eligible for board certification in general surgery and vascular surgery. Starting in 2006, a second pathway was established for those medical students wanting to go right into vascular surgery training. This is called the 0+5 track—it’s a 5 year track in which a total of 3 years are devoted to vascular surgery and 2 years to core surgical training. One would then only be eligible for board certification in vascular surgery and not general surgery.
How have surgical techniques, tools and processes evolved since you started practicing?
I finished training during the explosion of percutaneous, or endovascular, techniques and therapies, such as balloon angioplasty, atherectomy (plaque excision), stents and stent grafts, and catheter based venous treatments. While other specialists, such as cardiologists and interventional radiologists, can perform these endovascular procedures, a vascular surgeon has the unique advantage of being able to treat a vascular problem either with endovascular methods or open surgery and therefore offer the best option for each patient. Technological advances in imaging, such as MRI, Cat scan, and ultrasound have really helped facilitate these advances. Another exciting area of ongoing research is the use of growth factors and stem cells to help stimulate the formation of new vessels to treat patients with critically low blood supply to their legs.
What are some of the challenges of post-op care?
Most of the challenges of post-op care come from the prevalence of other comorbidities that most of our patients have, such as coronary artery disease, diabetes, high blood pressure, and kidney disease. These put them at higher risk than most post surgical patients for things such as heart attacks, strokes, and wound complications.
What can people do to take better care (in general) of their vasculature?
The most common etiology, or cause, for most of our patients’ complaints, is atherosclerosis, which is plaque that builds up inside the layers of an artery and causes the opening of the artery to narrow. There are many different causes or risk factors for the development of atherosclerosis—and several things that most people can do to slow down or stop its progress.
First: if you smoke, stop. Period.
Secondly, nutrition. Many people overlook the importance of nutrition, and debate abounds about what the ideal diet should be (e.g. vegan vs. low carb vs. ketogenic, etc.) I don’t believe that there is one ideal diet that is best for everyone, but I can offer some general guidelines. Restrict processed foods—foods that have had something bad put into them or something good taken out. Restrict or eliminate added sugar. Good fats, such as nuts, avocados, ghee, are not bad. Vegetable oils, especially cooked at high heat, and margarine are bad. Avoid buying foods that say low-fat or diet. Where your food comes from is sometimes as important as what it is. I believe that grass-fed beef, free-range chickens and organic fruits and vegetables are better for us. Most of our calories should be plant-based. Practice intermittent fasting, periods of time without eating. Only recently in our history have humans eaten 3 or more meals a day.
Thirdly, get active. While walking is usually the most frequently advised exercise, anything that you enjoy doing that gets you active and moving is effective. This could be swimming, biking, hiking, working out at the gym, gardening, etc. Mixing in short intervals of high intensity training (HIIT) and resistance training (i.e. lifting heavy things) is also good for most people regardless of age.
It is advisable to consult your doctor prior to initiating any new diets or activity, but it is also advisable to educate yourself and be as participatory as you can be in your own health and well-being.
Joseph Fulton, MD
MidHudson Regional Hospital
1 Webster Ave, Suite 306
Poughkeepsie, NY 12601
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