Limb-Sparing Surgeries Keep Chelsea Barber in Business

Richard "Sonny" Lepore first began cutting hair in 1956, joining his father and grandfather at Morley's Barber Shop in Chelsea. More than fifty years later, at 83, he still finds himself surrounded by "celebrities, pols, clergy and everybody in between" at his home-based barbershop just across town. Carefully outfitted with chair, scissors, hair dryer and other supplies, the space enables Mr. Lepore to continue seeing his loyal customers -- all that's missing is a barber pole.

Sonny  Lepore is open for business three days a week -- more than five years after undergoing two separate surgeries to treat severe peripheral artery disease (PAD), a narrowing of the peripheral arteries (located outside the chest or abdomen).  A leading cause of leg amputations, PAD develops when the arteries that carry blood to the limbs become blocked by plaque, a sticky substance made up of fat, cholesterol, calcium, and other substances This is known as atherosclerosis.

Allen Hamdan, MD, Clinical Director of Vascular and Endovascular Surgery at Beth Israel Deaconess Medical Center and at Beth Israel Deaconess Healthcare – Chelsea performed two surgeries – first to  Mr. Lepore's right leg and then to his left leg --  successfully clearing the severe blockages and sparing both limbs from amputation. Most important, the surgeries enabled Mr. Lepore to continue to enjoy his friends and family, and to pursue the vocation that he loves.

"I just can't say enough about Dr. Hamdan, both as my doctor and as a person," says Mr. Lepore."Thanks to him, I still can do what I love.  He saved my limbs and may have saved my life."

Leg Pain: The First Sign of a Problem

"PAD is not only a leading cause of lower limb amputation, it also increases a person's risk of stroke or heart attack," explains Dr. Hamdan. PAD can affect any of the body's extremities, but, as was the case with Mr. Lepore, most often afflicts the lower limbs.

"In the past we had fewer treatment options to offer PAD patients," adds Dr. Hamdan. "If we could not restore circulation to the limbs, then they could end up undergoing an amputation. Today we have medical, endovascular [minimally invasive] and bypass surgery in our tool box and as vascular surgeons we can employ whatever treatment option is best and safest for our PAD patients."

Sonny Lepore had always been active. His barbering business kept him busy and in his free time he enjoyed cooking his Italian specialties and tending to his backyard garden – all activities that kept him on his feet for long periods at a time.

But in 2008, he says, he began feeling pain in his feet and ankles as he walked.

"When a person's legs are painful, the problem can be arthritis, a back-related neurologic issue, a vascular issue or some combination of the three," explains Hamdan.

The only way to determine the underlying cause of leg pain is to be seen by a doctor. A visit with his primary care physician at BIDHC Chelsea led Mr. Lepore to a consultation with Dr. Hamdan.

After a physical examination and review of a CT scan of Mr. Lepore's legs, Dr. Hamdan confirmed that the problem was vascular and that a narrowing of the arteries had reduced the flow of blood to his legs and feet, a condition known as claudication.

"Claudication is pain in the large muscle groups caused by inadequate blood flow that can severely limit a patient's ability to function and stay fit," explains Dr. Hamdan, adding that claudication is often an early sign of PAD.

"Mr. Lepore had a number of risk factors for PAD," explains Hamdan. "He had been a smoker in the past and he was taking medications for both high cholesterol and high blood pressure."

Dr. Hamdan initially recommended  that Mr. Lepore embark on a  conservative-yet-vigilant "risk factor modification" program that involved a regular walking routine, additional exercise, and dietary changes, including reducing salt and fat in his diet.

Limb-Saving Revascularization

Mr. Lepore followed the doctor's orders, but the pain in his feet and ankles eventually grew worse. In 2011, he discovered that he had developed an ulceration in his right foot, bringing him back to see Dr. Hamdan.

"Over 70 percent of the time we can treat PAD with minimally invasive lower extremity angioplasty and or stenting," said Dr. Hamdan. "In this procedure, a balloon is inserted into a blood vessel and then inflated to reopen the blocked artery, often with the support of a stent, a small mesh tube.

In Mr. Lepore's case, however, an angiogram—an x-ray of blood vessels—revealed that the blockage was severe. This meant that open bypass surgery, or revascularization, was the preferred treatment to prevent the loss of his leg. BIDMC's Vascular Surgery Program is a leader in performing limb-saving  revascularizations.

"Revascularization, or bypass, involved entering Mr. Lepore's femoral artery in the thigh and bypassing the blocked artery that stretches to the lower limbs," explains Dr. Hamdan. "Mr. Lepore was then admitted to BIDMC for five days. Following his discharge he began going for physical therapy at BID Healthcare-Chelsea

"I was a little sore and swollen, but I had faith that Dr. Hamdan had restored my leg," remembers Mr. Lepore.  "I was itching to get back to work."

Within six weeks, Mr. Lepore was indeed  back on his feet – and back to barbering.

 A Second Successful Surgery

More challenges were to follow.  Less than a year later, Mr. Lepore was again experiencing claudication -- this time pain in his left leg as he walked.  Once again, a CT scan revealed a complete blockage and an angiogram confirmed this diagnosis. In this case, Dr. Hamdan performed an endarterectomy, a "roto-rooter-like" procedure in which the diseased material was removed from the inside of the artery to restore normal blood flow to Mr.  Lepore's left leg.

Throughout these two surgeries, as well as a coronary bypass to treat a subsequent heart attack, Mr. Lepore has remained positive. With the help of his daughter Lisa and son-in-law Bill who he says, "have always been there to take me to appointments and look after me at home," and his grandchildren, who make sure he stays active, Mr. Lepore continues to cook his signature macaroni and meatballs, tend his garden and maintain his full work schedule, attentive to both his family and his business.

"As Mr. Lepore's doctor, it's particularly gratifying to know that our surgical interventions have made such a difference to his life," says Dr. Hamdan. "These two procedures meant the difference between him living his life fully versus potentially living out his days in a wheelchair."

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.
Posted February 2017