Transcript
Robert Kirsner, MD, PhD:
Welcome, everyone.
David Armstrong, DPM, MD, PhD:
The wheels are already off the wagon, Professor.
Dr. Kirsner:
I know that. I’m your host, Robert Kirsner. Welcome to the SAWC Difference Makers Podcast, where breakthroughs meet the bedside.
I’m here with the one and the only Dr. David Armstrong, extraordinaire.
David, tell us a little bit about your journey to get to this room.
Dr. Armstrong:
No, to get to wound care?
Dr. Kirsner:
What was your journey to wound care?
Dr. Armstrong:
Holy cats. All right. So I think, as you know, my pop was a foot doctor, and he passed away. Smartest guy I ever knew. First guy in his family to go to college. And now my daughter, as you know, I think is a third-generation foot doctor. Actually, she’s at UT now and going to do a fellowship at Hopkins, not at University of Miami.
With that long-winded prequel, I did grow up in the office seeing a lot of patients, but not as many with diabetes at that time. But it was, I think, my first day as a resident. I had just gotten out of the operating room, and I felt it was such a testosterone-inducing kind of thing. I think I drove a screw across an athlete’s arthritic ankle, and I wanted to see him afterward to change his dressing.
So I was helping out in clinic, and right next door to this giant guy—he was like six foot seven—was this little woman. She might have been four foot nine, five foot. She was Indian, and she only spoke Hindi. She had literally just gotten off the plane with her family. The entire family is in this little room. I mean, there must have been eight people in there. The oldest son was translating. And she has this little wound on her foot.
I’m waiting for them to take the dressing off. The athlete is writhing in pain after this procedure we just did, as he should be. It’s post-op and a lot of pain. And I look at this woman with a wound, peaceful as can be.
I go up and debride the wound, and she’s literally—well, I just did a procedure on her with no anesthesia. It turns out, I look at her hands. She had diabetes, but her hands were burned as well. I asked through her son what she did for a living. She says, “Well, I cook for the family.” She would turn the naan bread over in the kitchen, over in the stove, and she had burned the tips of her fingers off.
And I thought, what the heck? So I’m stepping back, and these two rooms are right next door to each other. I mean, I’m underplaying this, if anything. I’m looking at this guy writhing in pain, and he should be, right? It’s a gift, as Paul Brand teaches us, the gift of pain. And I look next door at this peaceful woman, bleeding after a procedure, with zero pain, and her fingers are burned.
I’m thinking, eeny, meeny, miny, moe. We’re taught to treat and to react to the presence of pain. As clinicians, we’re supposed to look after someone. My shoulder hurts. My foot hurts. My skin is inflamed. Help me. But we’re not taught how to react to the absence of pain and how to treat those things and those patients with tissue loss.
I mean, that was sort of the beginning. I think I read all I could about leprosy and diabetes. This woman had both. I spoke with Paul Brand, visited him, and it was really transformative. That was the first patient I saw.
Dr. Kirsner:
Wow, that’s quite a story. I’m going to ask you a tough question. That’s a tough question, but may I say—
Dr. Armstrong:
Yes. But fair.
Dr. Kirsner:
Okay. I’m going to ask you a tough question that may not be fair.
Dr. Armstrong:
No, it’s horrible. And you know what? I think I’m going to enlist our restraining order that we still have in place.
Dr. Kirsner:
Okay, fair enough. I think we’re six feet apart. I think we’re fine.
Dr. Armstrong:
Three?
Dr. Kirsner:
What advice would your father have, or what would your father say, about your daughter as she follows in the lineage of a family of podiatrists?
Dr. Armstrong:
Yeah. There would be a lot of them. He was full of them. Not full of it, but full of them. There’s a big difference.
I’ll give you another one. I worked in the office. I even made my dad’s orthotics. It was crazy. I had so much OSHA exposure to fumes and whatnot, as you can tell.
Dr. Kirsner:
Hence the restraining order.
Dr. Armstrong:
But I was in the room with my pop when he was treating one time. And I’m going to remember this because I know he would give this advice to her.
I was in the room with my pop when he was treating the mayor of our little town, Santa Maria. The office was right across from City Hall. The mayor came over. He had some problem. My father and he had this conversation, and it was this wide-ranging conversation. I mean, from the politics of the time to local politics to philosophy. It was crazy.
Then my father really quickly spouts off this multisyllabic word. It was something neurologic. I don’t even remember. I was just so impressed with how he made this diagnosis just by glancing at him, just kind of laying hands, but with this entire conversation around it.
We went out in the hallway after seeing the mayor, and I said to my dad, “Holy cow, Dad, how did you know what the problem was? That was crazy. I don’t even know what you said. What was it?”
And he said, “Son.” And I said, “I am really disappointed in you.”
I said, “Did I not shake the mayor’s hand? Did I embarrass the family here?”
He said, “Sure, that’s important. But folks don’t care how much you know until they know how much you care. You totally missed that.”
He said, “You could spend five minutes or five hours.” And I kind of rolled my eyes a little bit. I said, “Come on.” I thought that belonged on some poster or something. But boy, do I understand that now, right? And I think when folks feel like you’re doing something with them and not to them, that’s the thing.
I know you know this. I’ve seen you in and outside a clinic. You are a doctor’s doctor. And people know when you’re doing something with them and not to them.
Dr. Kirsner:
That’s beautiful.
Dr. Armstrong:
Well, thank you. It’s my pop. It would not be beautiful from me. It would be really kind of grunts and unisyllabic.
Dr. Kirsner:
Sometimes children of physicians—some people say maybe they’re entitled. But you’re hungry. What drives you? What provides that spark for you to be energetic and bring your best every day and try to advance care and knowledge and technology and science?
Dr. Armstrong:
I figured that—I know this is going to sound ridiculous—but I feel like my mom and my dad worked so hard to put me through school, my little brother through school, and multiple jobs to get through professional school for them. And I felt like I had no excuses but to pay it forward a little.
And podiatry is this little humble specialty. Or if you’re British, speciality. I’m just going to translate because I know this gets out to a worldwide audience.
Dr. Kirsner:
Oh, yeah, for sure. Those people in India are going to really get this one.
Dr. Armstrong:
Capillary. Umbilicus. Okay, good. Theater. Schedule.
Dr. Kirsner:
Schedule.
Dr. Armstrong:
Touché. Or touché. Where were we?
Dr. Kirsner:
No, we’re doing great. But you really want to pay it forward.
Dr. Armstrong:
That’s it. And again, I know that sounds like it belongs on a T-shirt or a poster, but it happens to be the truth. I see it also, which is pretty great, with our daughters as well. And that is really life-affirming.
I always think that folks will remember you, but no one’s going to remember me in the arc of time, right? But I think what people will remember is the people you taught and impacted. I call it my personal progeny, like the kids, and our professional progeny.
Dr. Kirsner:
For sure.
Dr. Armstrong:
You have trained myriad women and men in nursing, medicine, and surgery over your whole life. And you know the feeling.
Dr. Kirsner:
So I’m going to throw you a curveball.
Dr. Armstrong:
Curveball?
Dr. Kirsner:
A literal curveball.
Dr. Armstrong:
No kidding.
Dr. Kirsner:
The audience may not know that you were a great baseball player.
Dr. Armstrong:
I played a little ball.
Dr. Kirsner:
What things did you learn as a baseball player that you think have translated to your professional career as a physician?
Dr. Armstrong:
That’s a good one. God dang. Okay. Well, first of all, can I just tell you?
Dr. Kirsner:
Yes.
Dr. Armstrong:
I’m a long-suffering Dodger fan. My father was born and raised in Brooklyn, right across from Ebbets Field. Now, no one really—I mean, you guys are going to have to Google this—but Ebbets Field was in Brooklyn. It was famous for the long-suffering Brooklyn Dodgers at the time, the Bums, as it were.
My father used to try to go to the games. He’d stare through the fence. There were all these stories. Who knows what’s apocryphal and what’s not? But he’d try to go with the YMCA as soon as they’d do it for free. I grew up with that love of the Dodgers and played ball all the way through.
One of the things I think is terrific is, when you’re sitting out there, you look at the game. I think most folks now look at America’s pastime as boring. But a person who enjoys baseball—and I know you like basketball a great deal. Basketball is spectacular as well. Again, I’m a Laker fan. I know you’re not, but that’s all right.
The strategy and positioning and thinking about the play ahead of time, all that cogitating—there’s a lot going on. You have a guy out there, or a woman playing softball as well, and if they’re at a high enough level, they’ve thought about a lot of this stuff ahead of time.
Having a high baseball IQ is the same as having, I think, a high clinical IQ and just thinking about a lot of things. There’s pattern recognition. That sort of thing really does help you. When the thing happens and it comes to you, you’re ready for it. You’ve already thought about it, and you’re not going to make that kind of mental error.
Dr. Kirsner:
Throughout your career, you’ve been a teammate to many people in your research career, some very longstanding relationships and close working relationships.
Dr. Armstrong:
And frenemies.
Dr. Kirsner:
And frenemies, yes. Isn’t that the truth? Do you think that stems from your idea of being part of a team?
Dr. Armstrong:
A thousand percent, yes. If it were possible to be a thousand percent, it would be yes.
I realized long ago the extent of my incompetence, and I realized that I have to juxtapose myself against someone else to help that. So forever, I’ve been so lucky. I’m like the luckiest toe doctor on the planet.
There are so many. Of course, you know Larry Lavery. So it started with Larry—I mean, like 100, 150 papers with him. Of course, Andrew, Professor Boulton, was one of my great mentors. Joe Mills, who you know really well. Vince Rowe. Our whole team now. There are just so many folks with whom we’ve worked over the years.
No person is unto herself or himself an island, I would say. I think that’s John Donne, isn’t it?
Dr. Kirsner:
I don’t know. I’m not much of a poet, but I think that is it.
Dr. Armstrong:
I don’t think it’s in the Bible. I think it’s John Donne. I’m probably forgetting this. Everyone’s already bored now on the Donne podcast. The wheels are off the wagon.
Team up with your friend. That’s why we have these teams, like what we call now—we sort of coined “toe and flow,” right? Now we actually even add, with Stephanie Woelfel and our PT wound team, we call it “toe, flow, and go.”
Dr. Kirsner:
That’s good.
Dr. Armstrong:
In the know, it’s toe and flow.
Dr. Kirsner:
We’ve been talking a little bit about your past. You’ve accomplished so much, won awards, had honors and a lot of firsts. There were talks and papers—
Dr. Armstrong:
I found a lot of bowling trophies as well. I just did, no joke.
Dr. Kirsner:
Is that right? I didn’t know you were a great bowler.
Dr. Armstrong:
Well, there we are. I don’t know if I was that great, but Bantam, I got all the way up. I had a pretty good—I was like a 154 average when I was 11.
Dr. Kirsner:
Oh, well, that’s pretty good.
Dr. Armstrong:
That’s where I topped out. I still remember the average.
Dr. Kirsner:
You know, it’s better to peak early in bowling than in medicine.
Dr. Armstrong:
Touché. Mookie Betts, by the way—spectacular bowler, baseball player.
Dr. Kirsner:
Yeah. He’s rolled a 300 game.
Dr. Armstrong:
Though I have not.
Dr. Kirsner:
Yet.
Dr. Armstrong:
Came close.
Dr. Kirsner:
Yet. But when I say “yet,” I do want to think about the future. Because whenever I see you, you are on the cutting edge of technology. If you had a crystal ball and you had to say what the future holds in wound healing or diabetic foot care, what does your future crystal ball tell you?
Dr. Armstrong:
Well, I was just quoting John Donne. Now I’ll quote Oscar Wilde, who said, I think, “Prediction is always difficult, especially when it concerns the future.”
Dr. Kirsner:
I thought that was Yogi Berra.
Dr. Armstrong:
He would not say “concerns.”
Dr. Kirsner:
Okay, okay.
Dr. Armstrong:
That was perfect. Nicely done. Okay, so are we Wonder Twin powers activated?
Dr. Kirsner:
Yeah.
Dr. Armstrong:
I think we broke the internet.
This is such a phenomenally exciting time. In our short lives, there has been so much change in medicine, in science, in computer science—just everything. And that has translated to changes in society. But we are on this astonishing trajectory right now.
I’ll tell you: last week, before I went to a hospital, I was in between cases. I was going to go over to a hospital to visit with another doctor or with an administrator to talk to them about their problem so we could help expand our limb preservation program across the Southland, across Los Angeles.
In the antechamber, in the substerile room, I had my laptop there, and I vibe-coded a zip code lottery website. This guy could go online when I got there and put in the zip code and show his amputation rate, the poverty quartile, and all these things. And that took me an hour. It was nuts.
You see these kinds of things happening. That would have taken a team weeks. You would have to go back and forth. And then I made a national one, taking the American Heart Association data by congressional district. Then I did an international one using IDF data, all with other blocks of about an hour.
The whole thing was done in the amount of time it would have taken just to get started before. These kinds of changes are happening now. When you have one interested woman or one interested man, they can do these kinds of things now by themselves. Obviously, there is a lot of data, and I was aware of the data. Some of the data were ours, but most of it was not. But I could put those kinds of things together.
This is completely transformative.
Look, I was making a joke. I just took a picture of you with these smart glasses. But we were the first to use Google Glass back in the operating theater. Socially, people weren’t ready for these smart glasses. But now, it’s astonishing. You can take calls. You can ask questions. These Sherpas, if you will, are now evolving beside you.
You start to wonder, what is it that makes us us, right? These things are now supplementing our memory. When we enter our dotage and get a little older, it’s probably going to be super easy to ask whatever it is—Gemini, Claude, OpenAI, ChatGPT—“Hey, look at that photo. Remember that?”
Or sitting with our grandkids saying, “Hey, remember when we went to London, and we went to Trafalgar Square?” And then all of a sudden a little thing will be in my ear: “No, that wasn’t Trafalgar Square. That was Sloane Square. And no, it wasn’t this grandkid. It was the other one.”
You wonder how that affects society. I think some of it is going to be transformative and great. Most of it, frankly. But I think a little of it is going to be bad and creepy. So I think it’s going to be creep-tastic, I would say.
These kinds of things change us, and we’re changing so quickly. In a weird way, as a species, just in the last few years, none of us knows directions anymore. We rely on GPS.
Dr. Kirsner:
GPS.
Dr. Armstrong:
I’m going to go to the hotel after this and check in. I’m probably going to GPS it even though it’s like a half block away.
Dr. Kirsner:
I’m in my bedroom. I GPS the bathroom just so I don’t get lost.
Dr. Armstrong:
There you are. I’m glad you do, too. Did you learn that from urology? They’ve been using robots for a long time.
We have lost our ability to circumnavigate, for sure.
I was just giving you examples that are the intersection of consumer electronics, medical devices, and memory engineering. But now you have both world models that are emerging using AI, and then you have, of course, large language models. These have entered the vernacular. These things are emerging now.
You’re going to have home care robots very soon. Once we make them work in dedicated environments like factories first, then maybe in airports and public places, and then finally, the last place is the hardest: the home. But that’s the place we want it the most for our patients, right?
I’m thinking about my mom. I was saying how she’s hard to kill. She’s great, right? And she’s so low to the ground, God forbid, she’s not going to hurt herself or break her hip. But I would like her not to. She doesn’t have a walker yet, touch wood, but she’s 94.
Wouldn’t it be cool if she got up into an exoskeleton and could get around rather than have someone help her, or rather than using a walker? We’ve been looking at working on many of these sorts of things. These sorts of aids, as battery power has gotten better and as intelligence—whatever you want to call it, augmented artificial intelligence—has gotten better, these things are all merging.
It is such an exciting time right now to see all this. It’s going to be like pizza: even if it’s bad, it’s still okay.
Dr. Kirsner:
I know you enjoy a good pizza.
Dr. Armstrong:
I do enjoy it, yes. But even a bad pizza is okay. Although I’m not a pineapple person on pizza. I mean, I like pineapple in general.
Dr. Kirsner:
You don’t like pineapple pizza?
Dr. Armstrong:
I don’t. But people who I trust, and who have never had it, are telling me that it is actually good.
Dr. Kirsner:
I’ve tried it.
Dr. Armstrong:
Well, I understand a savory kind of situation. That’s good. That was also alliterative.
Dr. Kirsner:
Yes.
Dr. Armstrong:
But I do like anchovies. That’s how Tanya and I bonded—my long-suffering, much better half, Tanya, who you know very well.
Dr. Kirsner:
I know Tanya very well, and we’re going to get to her in a little bit. But before we do that, I do have a question.
I didn’t go through a big introduction about you because you are literally the most well-known wound healer in the world. You travel extensively, and you’re on social media. Do you ever feel pressure because of that to be upbeat or to be positive, or that your words have meaning and influence people? Or do you just go with the flow and it’s easy for you?
Dr. Armstrong:
Holy cats. No. I know it sounds ridiculous, but I’m pretty consistent. Like I said, I really love the work, like you love the work, right?
I remember I was asked about 15 years ago to give a social media talk. I can’t believe it’s been this long—actually, longer than that. They asked, “What’s your agenda?” It should be authenticity. When people see that, they know. Like I said, that thing about people not caring how much you know until they know how much you care—it’s genuine. Definitely.
And just ask Tanya. She would just roll her eyes and go, “Oh.”
Dr. Kirsner:
You are—and I think if people didn’t know you before this, which I think everybody does—they would say you have a sense of, you’re a bit frenetic. Is that a good word?
Dr. Armstrong:
That’s a good word. Yes.
Dr. Kirsner:
Your mind is very active. You’re a clinician. You’re an educator. You’re a researcher. You’re a futurist. And as you pointed out, your wife, who lives with you, has to deal with this on a regular basis.
You’re famous for wishing people happy birthday in song. Let’s make believe that it’s your wife’s birthday. If you were going to sing her the birthday song that you sing to many people, what would it be?
Dr. Armstrong:
Well, I’ll tell you what, it’s coming up in like a month and change.
Dr. Kirsner:
We won’t release this video until after that.
Dr. Armstrong:
Okay, very good. Are you ready?
Happy birthday to you.
Happy extra special seventh birthday to you.
Happy spectacularstical.
That’s her middle name. It’s not really her middle name. That’s her maiden name. Armstrong, that would be you. Happy birthday. Big finish.
You like that?
Dr. Kirsner:
I love it. Don’t go changing. That was freaking great. You did not disappoint.
David, I think the world has had enough of the two of us. But I do want to thank you sincerely for joining me on this segment.
Dr. Armstrong:
I’m sorry, man. It’s just a beautiful thing. If we go viral, we can make this a recurring thing.
Dr. Kirsner:
Well, if I’m a podiatrist, we can go fungal.
Dr. Armstrong:
That just happened.
Outro:
The SAWC Difference Makers Podcast is brought to you by the Symposium on Advanced Wound Care, one of the leading forums for advancing wound care education, research, and collaboration, and by Wounds, the official journal of SAWC.