My Leg My Choice

My Leg My Choice

From Luis Leon

To raise awareness of Peripheral Artery Disease (PAD) through My Leg My Choice Foundation. To challenge myself in the Tahoe 200 Miler and ultimately run for those who cannot.

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My career path was strongly influenced by my father, a very successful surgeon who still practices surgical oncology in Lima, Peru, my country of origin.  My family has a strong surgical background with several relatives practicing surgery and many others in nursing care. One of my most vivid, early childhood memories was driving through shantytowns in Peru sitting in the back seat of our family’s car. My father would always say while driving, pointing at one of the poorest shacks: “If you don’t study, this is where you will end up living… but if you do study, you will become a surgeon in the United States (US)”, a statement arguably expected from a Latino surgeon addressing his first born male. 

Growing up in South America, I was given the impression that US medicine was the most advanced in the world.  The US was where the bar was set at the highest, where medical development and progress were always up-to-date. As a result, most of my classmates and I had one idea in mind throughout medical school: to ultimately migrate to the US. Hence, my career path was forged and I began English classes and multiple trips to the US. 

For many international medical graduates (IMGs) like myself, coming to America to train and practice is no easy task. Yet, in spite of the many financial and political obstacles we face, IMGs account for a quarter of the US physician workforce. After completion of training, most practice medicine in rural and undeserved areas, as well as Veterans Hospitals, where medical professionals are desperately needed. In my case, the Southern Arizona Veterans Affairs Health Care Services (SAVAHCS) in Tucson was my ultimate destination. If it were not for physicians trained abroad who are willing to practice in these areas, many of these positions would remain vacant.

After completion of General Surgery training in 2003, I chose vascular surgery as my sub-specialty of choice. This was against my father’s “suggestion” for me to choose surgical oncology, just like him. I had two main reasons as to why I chose vascular surgery.  First and foremost, my father himself was diagnosed with diabetes. This disease has taken a severe toll on his health, affecting his eyes, kidneys and blood vessels as it typically does. Learning about diabetes early on in my career made me realize that my father would eventually require this type of care in his future, especially since he is not a very compliant patient with his diabetes management (far from it). We have several members of my family who have dedicated their lives to the care of the patient with cancer, including my brother and several cousins, but no one in the vascular surgery field. Second, I truly enjoyed the management of vascular disease. I was drawn to the fact that performing vascular surgical interventions demanded a high level of perfection. The proper performance of a surgical procedure requires every step of the process to be perfectly done, with no room for mistakes.

In 2004, fate had it that my father would require surgical care when foot gangrene set. He required a minor amputation, which fortunately healed without major vascular interventions. My father had to fly to Chicago to undergo assessment and several tests, which all concluded that he would go into successful wound healing without needing additional interventions, such a surgical bypass. Later on, he required open heart surgery after a cardiac arrhythmia was diagnosed, which led us to learn that two of his major heart blood vessels were occluded. Fortunately, after a short period of dialysis, he (and his kidneys) recovered and did ultimately well.

Just a few months ago, my father developed foot gangrene again. This time, the status of his leg circulation was so poor that, he now required revascularization. Fate also put me in the unfortunate position of having to perform his revascularization procedure. It is not advisable for a surgeon to perform surgical procedures on close relatives, and I was certainly fully aware of this. However, after a long struggle with myself, I decided that no other surgeon would handle the tools needed to revascularize his leg as gently and as carefully than the patient’s own son. I performed the procedure and it was a success. He ended up having another minor toe amputation, which has healed at this time.

In the midst of these difficult times, I found that running became a key companion for my mental well-being.  I suspect that playing soccer, a big passion of mine and of my father as well, gave me a solid foundation for my current running activities. I grew up playing soccer, first at a park nearby my house in Lima, and later at an indoor soccer field that my father built in the same city, where he, his friends and I religiously played every Saturday. I, literally, played soccer every day of my life for 27 years.  Upon my arrival to the US, I still desired to play, but the time available to do so vanished. The need to be at Harbor-UCLA at very early hours in the morning (often around 3 am) made it impossible to enjoy this sport any longer. Therefore, I had to look for an alternative activity, now an individual one and not a group sport, to keep fit and distract my mind from surgery. Running came as an obvious and natural option.

Running did become an immediate new passion and obsession and my first race got me completely hooked.  I drove over two hours participate in a 5K at Pier 39 in 2001, hosted by the Bubba Gump restaurant in San Francisco. I do not remember how I did, but I do remember loving everything associated with the activity, the race t-shirt, bib numbers, goody bags and a free shrimp meal and drinks inside the restaurant after completion of the run. After two hours of my drive back home, I was now planning my next race.

Over the years, I continued to run and became passionate about triathlons. Then, while on vacation in Maui, Hawaii, long distance running came to me in a very unsuspected manner. I learned about a marathon, a 26.2 mile race.  Only a small percentage of the general population has ever done one and it typically takes several months of training in order to complete. After short contemplation about my lack of training and researching my return flight to California, which left the same afternoon as the Maui Marathon, I took a wild chance and registered.

I bought new running attire, took a 16 mile run along the ocean shore, my longest distance so far, and figured I could muscle my way through the other 10 miles because my enthusiasm was intact.

On Friday, I attended the carbo-load pre-race party, where I met some seasoned, experienced marathon runners. They told me about their running feats and eventually asked me about mine. It was amusing to tell them that this was my first marathon and that my training had consisted of a 16-mile run 24 hours prior. The look in their faces was that of disbelief and pity. 

To make a very long story short, I experienced 4 hours and 29 minutes of misery, whole body pain and agony and had serious discussions with myself about the reasons why I was doing this run and the smart decision to call it quits. Perhaps it was my pride, stupidity or stubbornness that shut down those thoughts of quitting and helped me cross finish line and receive my very first marathon medal placed around my neck. What was also miserable was the 5 and a half hours plane ride back to California, when cramps and tears accompanied me all the way through. Luckily, despite all that, I was hooked.

Thirty marathons or so later, as well as many other shorter running races and triathlons, I learned about ultra distances and somehow, this was much more appealing to me than marathons. This happened when the famous ultra-runner, Dean Karnazes, completed his 50 marathons in 50 consecutive days in 50 different states, back in 2006. I was lucky enough to join him when it was his turn to run in Arizona, where my professional career path had taken me. I drove to the town of Surprise, where I joined Dean and about 15 other runners to complete another 26.2 miles. I remember admiring his feat but also wondering if a regular, common human being like myself would be able to do such a thing, or if Dean is made of extra-terrestrial matter so that him and only a few other gifted ones could dream of doing such a thing. Back at home, I took as a new goal to run consecutive half-marathons (only 13.1-miles), daily but in double the time (meaning 100 consecutive days), allowing me that privilege since running is Dean Karnazes’ career whereas for me, vascular surgery was my career and running just a hobby. After 100 days, I found that this was not only possible but enjoyable, so that I extended this goal for a total of 2 years. I ended up my streak of consecutive 13.1-miles after completing Tucson marathon in 3 hours and 18 seconds back in 2011, my fastest marathon time to date. This is a known downhill marathon, which tasks the quadriceps muscles in a different way. Muscles that are not usually trained are heavily tasked during a downhill run. I was unable to even walk normally the day after this marathon, which obviously made impossible to run 13.1 miles the following Monday.

This experience helped me realize two things: first, I love ultra-running; and second, that it seems the sky is the limit as far as the distances that a regular, common human being can accomplish. A new reading topic of interest and a new group of role models have invaded my mind during the last few years. Born to Run, Running with the Mind of Meditation, Running on Empty, Finding Ultra, Running with Kenyans and such are seen now in my home bookshelves. Running Across America, Running the Sahara and similar DVDs are often played and replayed. Scott Jurek, Killian Jornet, Ann Trason, Pam Reed, Marshall Ulrich, Marco Olmo and others are a great source of current inspiration. Several ultras after, including two 100-milers, I have set my mind on completing my first 200-miler at Lake Tahoe this September and only 2 weeks after, the Grand to Grand Ultra, a self-supported, 175-mile staged in the Grand Canyon. With the usual doubts about my ability to complete this, but with ever growing enthusiasm, once again I cannot wait to begin this new adventure.

The marriage of my professional and non-professional interests led to a new life goal. Recently, I was highly honored to be named Chairman of the My Leg My Choice Foundation, which perfectly combines these two passions in life. The My Leg My Choice Foundation is a non-profit organization dedicated to raising awareness of unnecessary leg amputations by providing education to empower patients, families and caregivers to have a voice in their choice of healthcare options available.  The foundation is committed to educating patients and their families that have been diagnosed with peripheral artery disease (PAD) or are at risk for lower extremity amputations about their options. My father is one of these patients.

We have become fairly active in the vascular surgery world, and we actively organize several activities that relate to PAD awareness, usually during a major vascular surgery meeting. For instance, following this year's Tucson NCVH first meeting we hosted our first special event, My Leg My Choice Foundation 5K Run/Walk this past January 2014.  We had a fantastic participation from all NCVH meeting attendees as well as from many of our faculty and special guests who took part in this event. Given my running background, I can tell you that the level of organization and quality that our 5K race had was among the best that I have ever seen, with professional timing, bib numbers, race awards, goody bags and every possible detail that major organized races offer. We also held a weekend’s Community Health Screening immediately following the race, where the general public came and were assessed for peripheral arterial disease by volunteers from our institution. Venous and arterial screening were offered, through visual inspection of lower extremities and ABI measurements for patients with pertinent symptoms.  

I believe that we can all benefit from this effort. I consider that we are on the verge of a true, unbiased national campaign to raise awareness of amputation prevention and (in layman’s terms) do for our cause what Susan G. Komen did for breast cancer awareness. Join me in creating PAD awareness as I run the Tahoe 200 Endurance Run, not only for me, but for my father, my patients and to spread awareness of PAD, its affects and options that can be made available to help those in need.  I have the great privilege to run and to run for a worthy cause!  

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