First-year UNC medical student and Albert Schweitzer fellow Vinayak Subramanian works with UNC REX cardiologist George Adams to improve the care of patients with peripheral artery disease, a condition that is not well understood.

Vinayak Subramanian is quick to tell you all the things he doesn't know. He did, after all, just complete his first year as a UNC medical student. But spend a few minutes talking with him and it's clear that his humble nature belies an incredible list of accomplishments – multiple publications, patient engagement programs, a photo sharing app that can help patients and providers – and the promise of countless more.

He has the mind of an engineer, possessing the ability to not only diagnose problems but to conceptualize and then build the systems to solve them. A graduate of the joint UNC/NC State Biomedical Engineering program, Subramanian could have put that mind to work developing innovative products and devices. Instead, he's choosing to practice medicine.

"With engineering, the intellectual component was there and it was stimulating and interesting, but I just didn't want to be that far away from the people who would benefit. It's all about the people," Subramanian said.

As a child, he was intrigued while watching his grandfather deal with diabetes, watching him constantly check his blood sugar. Later, his father developed the condition.

"When I was growing up, I thought the natural process was you turn 40, get diabetes, and you have to stop eating sweets," Subramanian said. "As I learned more and about medicine, it's clear it's not like that. It's more about what you do before you get there."

He shares these lessons with his father and the patients he works with at UNC REX Healthcare. Since his time as an undergraduate at NC State, Subramanian has worked closely with George Adams, MD, a cardiologist at the North Carolina Heart and Vascular Hospital. Adams specializes in complex vascular interventions, working with patients suffering from peripheral artery disease – a condition marked by the narrowing of the arteries that extend to the legs, as well as arms, stomach, and head. Many patients have been told amputation of a limb is likely. Adams works to find other solutions.

"These patients are probably 10 years down the road from someone like my father," Subramanian said.

The complexity of treating these patients has limited their options. There is just not a wealth of conventional guides on treating their advanced vascular disease.

"This field is like Alaska," Subramanian said. "There's so much that has been unexplored, so much more to understand."

Adams is a leader in the field, and working closely with him has allowed Subramanian to learn on the leading edge of the discipline. Adams also serves as a model for the career he'd like to build.

"I always thought that innovation, clinical care, and education were different silos, and you picked one of those three to focus on. Dr. Adams has shown me the ways they all connect," Subramanian said.

And while Adams is definitely a mentor, he says the work with Subramanian is a true collaborative partnership.

"Vinayak has done exemplary work. He's really proactive and has the great ability to creatively design projects that help answer questions and solve problems important to patients," Adams said.

Two complementary projects fit that description.

Subramanian won an Albert Schweitzer Fellowship to support his efforts to help patients develop individualized exercise and smoking cessation plans.

It's common for physicians to advise 30 minutes of walking. But that can prove incredibly challenging for patients with peripheral artery disease.

"As they walk, the demand of oxygen to the legs increases and they will eventually experience severe cramping, which limits the amount of exercise they can do," Subramanian said. "It's a vicious cycle, though, because the less exercising they do, the more severe their disease becomes, and the less independence they have in their lives."

Subramanian works with patients to log their activity, telling patients: if they can't get through 30 minutes, that's all right, do what you can, log it, and then work with the care team to come up with an individualized plan to meet that patient's needs.

"These patients will need multiple interventions," Subramanian said. "On the medical side, biomedical engineers are developing new types of stents, new balloons, you name it. And that's great. But, the nonmedical side, which is so important, is often ignored," Subramanian said. "Convincing patients of the importance of good diet and exercise habits can often be one of the hardest things we do."

Those devices also don't work as well in the legs, where clots have different characteristics than those in the heart.

"With this disease, there's still a lot of work to be done from a technological standpoint," Subramanian said. "The arteries in your legs are different from those in your chest. They are turning, twisting, there's a lot going on and many of the devices that work in the heart don't work there."

He's also collaborating with a company in Raleigh on a project to deploy a photo sharing app – CarePics -- which will allow providers to share photos to evaluate patients. The goal is to exchange information quickly, hopefully cutting down on appointments for patients who are often sent back and forth to multiple providers during the period of diagnosis and care.

Commonly, a patient starts at a podiatrist with sores on their feet. Using the photo sharing app, multiple providers can view and evaluate the wound.

"The best case scenario would be that the patient's podiatrist shares a photo of a sore with the patient's cardiologist, who, after evaluating, decides it is nearly healed and there is no reason for the patient to come in. That's one less appointment for that particular patient, and also opens a spot for someone else," Subramanian said.

Down the line, he also hopes to connect patients through support groups, building a community of patients who he sees as previously under recognized.

"The medical community is working more and more toward treating the whole person. And I hope vascular surgery continues to shift to a more holistic style," Subramanian said. "What happens when patients go home? What are their individual barriers to care? How can the system evolve to answer those questions?

It will be really exciting to see where everything ends up eventually."

And Subramanian, the doctor with the mind of an engineer, is excited to be part of it.