Melbourne resident Bobby Hager, 69, spent Memorial Day weekend on a boat with his family, watching his grandchildren play in the water. He noticed his leg bothering him early in the day but didn't say anything.
"My pain gradually came on," Hager said. "And as the day carried on, the pain got worse, and I thought it would pass, but I didn't say anything."
By the time the family got back to shore, the pain hadn't gone away. Hager stopped at his daughter Holly's house and lay down. That's when Holly alerted her husband, Dr. Robert Ford, that something was wrong.
"Dad is in a lot of pain in his leg," she told him. "I wonder what's wrong."
Ford, an emergency medicine physician who serves as EMS medical director for Brevard County Fire Rescue and emergency department medical director at Orlando Health Sebastian River Hospital, went to check on his father-in-law.
"He was just saying that he had this constant pain even while he was at rest in the bed," Ford said. Hager had experienced leg pain before — the kind that comes on while walking and eases with rest — but this was different. It didn't go away.
Ford examined the leg. It was pale and cool to the touch compared with the other leg, though Hager still had motor function and sensation. Ford recognized the signs of acute limb ischemia — a sudden loss of blood flow to the limb.
"It's actually no blood flow to the leg, kind of like a heart attack to the leg," Ford said.
He explained that the condition is often preceded by claudication — pain during exertion that resolves with rest — along with hair loss, numbness or skin changes. Hager had experienced those symptoms years earlier, which led to a bypass surgery. But the constant, unrelenting pain at rest signaled something more urgent.
"That's when it really becomes a major emergency," Ford said.
The family took Hager to Orlando Health Melbourne Hospital, where staff met him at the entrance and moved quickly. Doctors placed an IV and sent him for a CT angiogram, which uses injected dye to trace blood flow through the vessels and locate blockages.
The scan confirmed a blockage, and a radiologist reviewed the images immediately. An interventional vascular specialist performed catheter-directed thrombolysis — threading a catheter to the clot and delivering clot-dissolving medication directly to the site.
The clot didn't clear on the first attempt. Doctors left the catheter in place overnight to continue delivering medication, then reassessed the next day.
"When they looked the second time, it looked great," Ford said. "Everything was wide open, and Bob was actually feeling much better."
Hager went home after two days in the hospital.
"I'd be dead, man, right now," Hager said of the family's decision to seek emergency care that day.
Ford said age is a risk factor for the kind of vascular disease that led to Hager's earlier bypass and this latest emergency, but several other risk factors can be managed: smoking, high blood pressure, high cholesterol and diabetes.
"Age is something we really can't control," Ford said.
Hager said quitting smoking has been one of the hardest parts of his recovery. "That's one of the hardest things you can do in your life," he said. "Which I'm doing good at, I think."
Ford said staying on prescribed medications — including anti-platelet drugs that help prevent clots from reforming — is critical for patients with vascular grafts like Hager's. Part of what led to this emergency, Ford said, was that Hager had run out of his medication and hadn't refilled it in time.
"That's another lesson to patients: Make sure you're getting your medications refilled," Ford said.
Ford said distinguishing ordinary aches from a medical emergency can be difficult, and some patients wait too long.
"I think some people will wait until it's too late, to the end where you're having a major emergency that you need to get to the emergency room now," he said.
He urged patients to watch for pain that comes on with walking and eases with rest, along with skin discoloration, hair loss or numbness in the legs — and to see a doctor before symptoms escalate.
"If you are having some of those things, it's probably worthwhile to go ahead and get to your doctor," Ford said.
Hager, for his part, said the experience changed his outlook.
"Opened my eyes up, definitely," he said. "If you have any problems like this, go to the hospital, get it checked out."