How the follow button led to vital surgery

A CTO patient, Craig Simon, is grateful that his provider was a social follower of Dr. Lorenzo Azzalini.

If recent history has taught us anything about social media, it might be that in the wrong hands, it can be detrimental. To Craig Simon, it proved that in the right hands and with the right intent, it can also save lives.

At 67 years old, Simon is managing partner at Irvine, Calif.-based Berger Kahn, where he serves the insurance sector as a top-rated West Coast attorney. As an avid snow skier and occasional scuba diver, he lives an active lifestyle. But in 2020, he said, “I could have been doing either activity, and it might have been ‘lights out.’”

After learning that his brother-in-law was facing a major cardiovascular issue, Simon’s wife urged him to get a test for plaque in his chest area. When that test showed a possible problem, he located a top cardiologist, Subbarao Mylavarapu, M.D.,
at Hoag Hospital in Newport Beach, Calif. When a noninvasive exam uncovered the possibility of coronary artery disease, he was immediately scheduled for an angiogram and possible stent-based revascularization. But that procedure was cut short after just 20 minutes.

“Dr. Mylavarapu looked at me and said, ‘What you need is above my pay grade.’” Simon was referred to Lorenzo Azzalini, M.D., Ph.D., MSc, associate professor of medicine at the VCU School of Medicine and Pauley Heart Center’s director of complex coronary interventions.

Just months prior to Mylavarapu’s referral, Azzalini joined VCU Health Pauley Heart Center, where he came to extend his work in complex percutaneous coronary intervention. After receiving his medical degree from the University of Padua in Italy, then continuing his education in Canada and Spain, Azzalini served as co-director of the Chronic Total Occlusion Program at San Raffaele Hospital in Milan, Italy, then spent a year at Mt. Sinai Hospital in New York to further refine his skills in complex coronary interventions. In search of an academic setting, he then spotted VCU Health.

At just 39 years old, as a self-described “eclectic professional,” Azzalini was destined to bring a fresh take to the field, including by use of social media. Recognizing what he sees as an opportunity for connecting students with practice and an open forum for information sharing, he has over 3,000 Twitter followers and more than 5,000 connections on LinkedIn. One of them is Mylavarapu.

Meanwhile, “When your doctor tells you that there’s only one or two people in the country who can do something, I figured when I called one of those two people they would be backed up, disinterested or hard to access,” Simon said.

What he discovered was just the opposite.

After Mylavarapu contacted Azzalini, Simon was headed to VCU.

With a chronic total occlusion of the right artery, two additional blockages and a moderate narrowing of the left main artery, Azzalini’s team was able to provide Simon with a less invasive solution to relieve his symptoms, involving a less-intensive surgery.

Along with Azzalini and his assistant, a team of five saw him through the procedure, all of whom he now calls by name. “These people stood out to me,” he said. “I have vivid memories of everyone introducing themselves, welcoming me and then carefully explaining their roles … They seemed right at home, had smiling faces and made it all feel so routine.”

The morning after discharge, he woke a bit dizzy. Reaching for his phone, he sent Azzalini a text message, then was floored by what happened next.

“A lot of physicians, I think their attitudes are, ‘I do the heavy lifting, but I don’t do the pots and pans,’ so to speak,” he suggested. “It’s like, ‘If you wake up and have dizziness, call my staff.’ But that’s not how this guy works or how he thinks … He was available to me every minute post-surgery,” he said. “You can’t charge or get paid for these things. Guys like this, they’re giving away slices of their lives for free.”

He added, “Dr. Azzalini and the whole university health system are on the cutting edge of technology … It’s fascinating to see how there is an entire community of younger physicians who are sharing information online, questioning one another and discussing how to accomplish things. Watching it just inspires you to want to contribute to their efforts.”

Following the procedure, Azzalini’s team provided Simon with a video overview, including voiceover chronicling each step. “It wasn’t a mystery,” he said. “They didn’t say, ‘Oh it went well and don’t worry, we took care of it.’ They showed me the whole thing … These were standout people and an outstanding team. The whole thing was an incredible experience, from beginning to end. It was like a well-orchestrated ballet.”

As a result of his experience, Simon and his wife, Joan, felt compelled to make a gift of $10,000, establishing the Complex Coronary Interventions Fund. The endowment supports research, education and clinical work in interventional cardiology at Pauley.

“It was very early in my interactions with Dr. Azzalini when I decided I was going to do this,” Simon explained. “I think it was his responsiveness and connectedness … You just felt like you were with someone who was on your side.”