The Cajun: Alton Johnson Jr., DPM, DABPM, FACPM, FASPS, CWSP

[0:16] Music.

[0:21] Welcome to the Prescription for Success Podcast with your host, Dr. Randy Cook.

[0:28] Music.

[0:51] Hello everyone and welcome to Prescription for Success. I’m Dr. Randy Cook, your host for the podcast, which is a production of MD Coaches, providing leadership and executive coaching for physicians by physicians. To overcome burnout, transition your career, as a leader or whatever your goal might be, visit MDCoaches on the web at MyMDCoaches.com because you’re not in this alone. And don’t forget that CME credit is available when you listen with us. Just look for CMFI in the show notes to learn how. My guest today is a clinical assistant professor of orthopedic surgery, specializing in foot and ankle disorders at the University of Michigan Medical School, and a recent appointee to the executive board of the Save a Leg, Save a Life Foundation. So here’s my conversation with Dr. Alton Johnson.
Really looking forward to my conversation today with Dr. Alton Johnson. Although he may not know this, I share a passion for wound care, which is something that he’s very interested in. So Alton, first of all, let me say thank you so much for being here with us today.
It’s really an honor to have you on Prescriptions for Success, so thanks for coming.

[2:12] Alton Brown Thank you for having me. I’m very excited to be on here.
Always been a long-time fan of the podcast.
Dr. Miller We’ll have you, really. Alton Brown Yeah, yeah. So I’ve been listening to it every once in a while, once it first started.
So it’s pretty cool.
Dr. Miller Well, I’m honored. Alton Brown Yeah, you have a great radio voice.
Dr. Miller I really appreciate you being a part of the fan base.
Well then you know, Alton, what we like to start with is the origin story.
So tell me a little bit about your early life, where you grew up, and what your family life was like.

[2:44] Yes, yes. I grew up in a single family household initially before my parents had got a divorce.
So I was born in Baton Rouge, Louisiana. So I’m a southern boy by trade. Wow. Yeah, you are.
Yeah, even though now I’m in the Midwest, but we’ll get into that.
But yeah, so I grew up in Baton Rouge, Louisiana initially, well, born in Baton Rouge, Louisiana. Grew up in Houston, Texas. So my parents got a divorce maybe when I was around about three or four years old. My mom wouldn’t change. So right around first grade when I finished my pre-K and kindergarten, she decided she wanted to move to the big city of Houston, Texas in the early 90s. So that’s where it all started.
That is a big city. Yeah, yeah. So we moved to Houston, Texas. She and I, she went to get her apartment first and.

[3:27] She got everything situated. I was with my grandparents while she did that.
She had everything set up for me to start my school year in the first grade. And I think we had one piece of furniture, or two pieces of furniture and a bed, which we shared at the time, and we had a couch. And so we made it happen. Yeah. So we made it happen. And the rest kind of becomes history. We could get into those details as well. But so yeah, I started primary school there. Was pretty much did most of my education out in Houston, Texas when it came to, you know, primary, middle school. And I ended up picking up some instruments, decided I wanted to do woodwind instruments. So I picked up the flute and started playing. So you’re a musician.
Yeah, a little bit to a start. Flute, clarinet, some saxophone on there. And then I decided to pick up a passion for baseball. So I played baseball a lot in high school and she put up with me during those times. And eventually she actually did end up getting remarried right before I started high school. So she had her own life started as well when I was starting to get my own adulthood started right when high school started. And yeah, that’s kind of how it was. So It’s been most of my childhood in Houston, Texas, but was originally born in Baton Rouge, Louisiana.
During those early years Did it ever occur to you that you might have a professional life in medicine or was it something that came along later?

[4:44] Let my mom tell it every time I Had a job talk or something like if I would see the the garbage man dropping off garbage cans I want to be a garbage man Things like that, but I would say it didn’t become really if heart saw heart You know for me when I was in high school because I did like the you know what they call it, the International Baccalaureate Program and AP classes.
So I got more exposure and started interacting more in the hospital aspect and hang out with Candy Stripers.
I wasn’t really with the Candy Stripers, which I don’t know if the newer generation knows, but it’s like essentially the hospital volunteers, which I know you know what they call it.
But yeah, so like the hospital volunteers, but really to answer that question, it came on a field trip that I went on when I knew like, okay, medicine was gonna be it and I’m gonna take it serious.
I was in my junior year, this biology teacher, one of our advanced biology teachers was like, guys, we’re going to the Texas Heart Institute, you guys are gonna see an open heart surgery.
And then I go, yeah, you know, like the ones that you see on TV where you get into the observation tower and everything.
So go get excited. Like, mom, I think, you know, like I’m ready to go to like see this stuff and go and do it and see what’s going on.
So eventually we get to the field trip and it’s more than an open heart surgery.
Now that I know more about surgery, was an aortic replacement, which is a lot more.
Yeah, so they’re basically replacing this gentleman’s aorta.
It was a big operation.
Yeah, and they had probably started, I think we got there probably about 10 a.m.

[6:13] And they probably had started at six o’clock that morning. So there were like four or five hours in the procedure by the time we got there.
And I get in and we, in the observation tower, and we’re just watching like a theater, like the old school theaters where you just watch the surgeon do their thing.
And I was like, this is it. This is the moment where I’m gonna do whatever I need to to officially become a doctor and whatever grades I need to get and whatever I need to do to be competitive, to compete.
And then that was where I got the taste for surgery too, was in there.
That is so cool. Yeah, so that was it. So cool. So exposures is everything for sure.

[6:49] Yeah, but you wound up in undergraduate school down near Miami, is that right?
Yes, yes, yes, that’s a good, yeah. How’d that happen? That’s a long way from Houston.
Yeah, so around that time, yeah, I know, my grandparents weren’t too happy about that.
So my grandparents were living in, yeah, my grandparents were still in Bain Rouge, Louisiana then, so they’re thinking, oh yeah, I’d come home back to LSU, you know, come to Louisiana State University or something.
But at that time, I had finished high school, Katrina had hit Louisiana, and Louisiana wasn’t the state, yeah, it wasn’t the state that I had grew up going to every, I spent every summer going to Louisiana up until I got, you know, high school age and had to do like baseball camps and stuff like that.
And it wasn’t the same, like, I remember going there, like, because I think Katrina had hit.

[7:34] That summer, and applications are usually due in the winter.
And I went to go visit Louisiana, and it wasn’t the state, it wasn’t the same place.
It’s a lot better now, and I was like, you know what, I’m gonna keep my mind open.
So I applied to colleges in Florida. I did a couple back in Texas just for like safety schools, but I knew I wanted to leave the state just because I wanted to have that experience, at least for my personal self development.
And like I said, my mom was starting to get her own life, so I was like, I want to have my own situation going.
So that’s kind of how I ended up in Miami, Florida, getting into that as well.
But yes, I ended up going to a small Catholic school out in Miami.
Probably was the best choice that I had made in my life, honestly.
How did you happen to make that choice? Yeah, so I knew, yeah, so I had already knew people who had gotten into medical schools from going to that school because it was kind of competitive for medical school curriculum.
Because it was interesting, because one thing I didn’t realize about Florida until I moved there is everybody from, at least in South Florida, they’re not originally from Florida.

[8:32] Exactly, nobody. Yeah, especially in South Florida. So they were down there.
So I had professors who had went to like Princeton, went to Harvard, went to Yale, but they all wanted to be in that climate. So it was like professors was what made that school and made that department, the biology department, which I end up getting into eventually, like I said, did clinical research and basic research at the institution. But yeah, so that’s where it was and that’s where I knew I could get groomed into being the student, no, really the position in the surgeon that I am today. It all started in those roots.
And what actually, what was your undergraduate major? Oh yeah, I actually decided to major in biology, which I stuck with, and then I actually picked up a chemistry minor while I was there.
You must have been a pretty good student. Yeah, yeah, I guess I was.
I mean, I was 17 at the time I started college, which is weird, but I had report cards.
You still had report cards then, and your report card was going to my mom.
She’s like, what are you doing down there in Florida? I was like, I guess I should probably take it serious.
So my first semester, my first semester was a kick in the butt, but it was fine.
It wasn’t like anything crazy, obviously, because I bounce back, but it was like, yeah, so yeah, that’s where it was.
But yes, I was a pretty good student, I would say. Hi, I’m Rhonda Crowe, founder and CEO for MD Coaches.
Here on Rx for Success, we interview a lot of great medical professionals on how they grew their careers, how they overcame challenges, and how they handle day-to-day work.

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[10:49] We’ll get back to our interview in just a moment, but right now I want to tell you a little bit about Physician Outlook.
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And now let’s get back to today’s interview.

[11:57] And so it sounds like even when you started undergraduate school, you knew that, some sort of medical education was going to be in your future.
Dr. Michael McBride Correct, correct.
Dr. Reagan And it ultimately turned out to be podiatry. And I bet there is a story to how that evolved. You want to share that with us?
Dr. Michael McBride Yeah, I don’t want to steal your thunder.
I knew you would want to ask that question. So, yes, so like I said, if somebody would have told me when I was 17 or 18 at the time that, oh, you’re going to be a foot doctor, I would have laughed at them because I never thought I would be a foot doctor.
Not that obviously I have a problem with it, but just never thought that would be the specialty that I would land in or fall in love with.
So at my institution, which in Florida, Berry University, they have a podiatry school. They do, they do.

[12:47] Yeah, they do. which had been around, I think, so I went to there in the early 2000s.
I think that school, I think Berry might have opened their podiatry school in the early 90s, or late 80s or early 90s. I know some of their faculty very well.
Dr. Rod Schneider is a good friend of mine.
Yeah, yeah, yeah. So they had just may have been open about 20 or so years at that time, but just like any other campus, campus, even though it’s a small school, it’s not as interactive just because they’re in a graduate school and everything.
But so what happened, I was in the, I did a lot of volunteer projects, just trying to.

[13:20] Just like I said, if I was going to do college, I wanted to do it right.
And I had ran into a couple of podiatry students and that was their podiatric medical students, and which is funny enough too, because now I actually do stuff with them.
But I kind of ran into them and we’ll hang out. But it’s interesting because like when they’re hanging out, they never really talked about what they did because I think just because of the stress of it, they just never really bothered.
So, we really never really talked about the curriculum or anything.
So, I really didn’t know, I knew the curriculum was, but just because I’m a reader, but they never told me like, oh, I’m going through this.
And I’m actually studying the entire body, not just the foot, and things like that and all of this.
And so I never really bothered them because I knew, I guess, whenever time we’re hanging out, they don’t really want to bother them with that. So it really wasn’t until the moment I had finished at Berry University and I joined AmeriCorps, and I actually got an assignment back into my hometown in Baton Rouge, Louisiana. Because at that time, my grandmother had already passed away and my grandfather was living alone. And I was like, you know what, I want to spend some time with him and you know kind of get him to know him. He had recently got diagnosed with COPD and prostate cancer. So, I was like I know his time is going to expire soon. He ain’t going to be here forever. So, I was like let me build a decent relationship with him. So, I decided to go back to Baton Rouge and spend time with him. But at that time I got appointed to a multi-specialty clinic or what they call FQHC. So, a federally qualified health center and they had every.

[14:41] Specialty there. They had infectious disease, podiatry, dentistry, even sometimes optometry would come by, OBGYN, basically any specialty you could think of under one roof.
My assignment then was to be a community outreach person, so I was really wasn’t a clinical person at the at the clinic, but I knew the clinicians, but one day I was walking down the hall and I hear this guy grunting and yelling, I’m like, what’s this guy, and I go and I see it and it’s Dr. Trotter, he’s the podiatrist at the clinic, they only had one podiatrist at that particular location, and he’s yelling for somebody to help him grab some sterile instruments.
And I’m like, what’s this guy, what is he doing? He’s a podiatrist, all he’s doing is doing some type of ingrown toenail procedure or something, he doesn’t need any assistance.
So I go in and I guess his MA was busy or something.
And he’s basically midway doing a toe amputation on this lady with a gangrene toe.
And that was the moment, that was the aha moment. And I was like, this is freaking cool.
So we go through it and he tells me how to sterilely open packages and hand them stuff so we can get this done.
Meanwhile, I’m kind of just taking in that, oh, he’s doing more than just a nail procedure or something.
He’s actually doing surgery in the office.

[15:52] And that was it. I had fell in love at that moment. And that was kind of where I knew I wanted to do podiatry. And I want to make sure I understand exactly where you were.
You had completed your undergraduate degree at this point. Yeah, yeah. I was in like what they call it, you know, so now they call it gap years. They call it gap years. Yeah, now gap years are pretty well accepted. Back then, gap year wasn’t that well accepted. Not that it hurt me, but back, then it was the opposite. Maybe 10% of people did gap years. But I did a gap year. Smart idea.
Yeah, working at Ameri… So I was a part of the government, the federal government AmeriCorps program. They call it the Community Health Corps. And it was essentially just getting people in high need areas. So Baton Rouge has high HIV rate, diabetes and everything. So I ended up…
This all happened, it was my hometown too. So I got appointed there. But yeah, so I go and I help him with it. And I talked to him and he already knows that I went to Barry and stuff. And he’s like, dude, did you not talk to anybody about this or whatever? I was like, yeah, a little, But I was like, yeah, you’re like, we’re 20 year old guys.
You think they’re really going to talk to me about career trajectory and stuff like that. You know, like we hanging out, we’re trying to have fun or talk about some sports, talk about LeBron and Kobe and stuff like that.
So we really never got into the whole career aspect. Right. He’s like, true.

[17:03] So he tells me about the curriculum and he’s like, Oh, I went to a school in Ohio.
I was like, Ohio has a podiatry school.
He’s like, yeah, it goes, um, that’s where I went, you know, in the 80s and everything.
He’s like, you know, my brother is, you know, podiatrist too.
And I was like, yeah, I know he is. And he’s like, so he had a twin brother that was funny enough.
So Marvin, who’s the one that I shot at rented to at the clinic, he has a brother named Melvin and Melvin was, um, actually a smarter brother.
He would admit that because he was the one that went to podiatry school two to three years before him.
And then he got Marvin to eventually go to podiatry school as well.
So he had already had his own practice and everything in the area.
So he was like, yeah, you should shout on my brother.
I was like, all right, I’ll shadow him. This happens on a Wednesday.
I kill up his brother on a Thursday night-ish, and I call him, and I’m like, Dr. Trotter, your brother told me that you’re in private practice and have a little bit more surgical cases going on and stuff.
He’s like, Alton, I hate to tell you this, but this is Bain Rouge, Louisiana, and tomorrow’s Friday.
I said, yes, sir. He said, I will be at the golf course. I was like, what?
He’s like, yeah, I’ll be at the golf course, but Monday, he goes, but Monday morning, you can shadow me.

[18:16] By that time, so Saturday, I had already had all my prereqs and everything submitted to the exact school they went to.
And that was it. I was like, they have the lifestyle I want, the personalities I like, and the rest kind of becomes history.
I ended up eventually interviewing at podiatry schools, interviewed at Berry, interviewed at the one in Ohio, and decided to go to the one in Ohio and canceled all my other interviews across the nation after that.
Yeah. Do you have any idea what it was about Kent State that appealed to you?
Oh, 100%. Yeah. So, I mean, obviously, yes, those two Trotter twins, which they do have their own legacy at the school, too. Funny enough, I had the same faculty that they had.
But it was just something about the moment I got to Kent. They had just recently bought a bigger campus, and the campus was just immaculate. It was clean, parking was not an issue, and it was.

[19:07] Solely dedicated, and the same campus is there, but it was solely dedicated to just the podiatric students and the faculty.
Wow. So you get in there, it’s very clean. It used to be an old bank corporate building.
So you get there and the campus is just the building, the structure, the architecture of the building is beautiful.
But you get in and the people match it. You start to meet the admissions committee and people already know about you, asking you questions about your CV. in like a…
Derogatory way, but more so like curiosity, like how’d you end up becoming like interested in our school?
Because especially back then, Cleveland had just lost LeBron James. So not people, not too many people.
So luckily he ended up coming back towards the end of my career.

[19:49] Yeah, he loves, you know, LeBron James wasn’t there. So not many people was, you know, from out of state was going to Cleveland unless there a legacy coming from that school or they have some type of personal ties. But you start to meet the staff and the faculty and you start to see why all these faculty have been here 30 or 40 years or three to four decades. That’s literally how my my career kind of launches off because you know that people invested back in me the same amount of time and money that I put in them which is it’s rare. It was almost like even I was out at Berry which is a small Catholic institution, even at Kent, which at that time it was Ohio College Podiatric Medicine, but Kent State ended up absorbing the school the same year I started.
It was still like that wholesome private school vibe, except this is a state institution.

[20:38] Dr. Darrell Bock Yeah, I think it’s really unusual in any educational program, and particularly in the sciences, which is the only thing that I have any real experience with.
You know, once you land that faculty position, the name of the game becomes, how high can you fly?
You play the game of, well, if I’m not going to get promoted, where can I find a full professorship and things of that nature?
But it sounds like you didn’t really see any of that, did you, Kent?
Am I misreading that or not?
No, it’s 100% true. I mean, now that I’m, like, yeah, the roles have reversed.
I’m a clinical assistant professor at a very large state institution well known throughout the nation.
Yes, it’s true. I mean, obviously, they definitely enjoyed medical education, but they also enjoyed the specialty.
And we had, like, our faculty is made up of at Kent. Now I’m on the board of Kent, which is kind of a full circle moment.
Just speaking of it, when you ask the question about how did I choose that school, but yes, at Kent State University College of Podiatric Medicine, yeah, we have professors that are.

[21:43] PhD, MD, DPMs, and the kind of, especially for our core curriculum, we have to have the PhDs and the MDs create that stuff.
Darrell Bock I love the story, and it sounded like you never even came close to a moment where you thought, gee, I wish I’d done something else or been something else. You were just all the way through.
Jullien Gordon So it’s funny enough, I guess the only difference would have been I would have went to Barry because I would have just went straight through, but I was like, why didn’t I just go straight through and things like that, because you start to think about how much time and stuff you put in, but.
But I bet looking at it retrospectively, you probably think that that time that you spent.

[22:22] Seeing other places, meeting other people, and moving around was probably as educational, if not more so, than the actual academic studies. Would you agree?
A hundred percent agree. And that’s exactly what it is.
Good for you. Good for you. Well, with that story in mind, I’m a little surprised that you decided to pick up and go to Michigan. How did that happen?
Good question. So yes, I end up in Kent State. So eventually my wife, who I met in undergraduate, we, so she relocates to Ohio once we got married my first year of podiatric medical school.
And then we ended up having our first daughter around that a year after that. And then And throughout, I think I had my son, maybe two or three years into it.
So another, then we had two kids. Oh no, I had my son my last year of school.
So I had my son, my fourth year of podiatric medical school.
So we had two kids and we’re pretty young. I mean, I was 20, 27, 28 then.
So I’m like, I think we’re gonna need some help. So I ended up trying to figure out a way to get closer to at least some family. So we actually ended up getting a match back Miami, Florida, which is where her parents lived at the time, and then her sister lived there.

[23:38] I said, all right, as long as I can figure out a way to get a match in Miami, Florida area, South Florida area, we should be fine. So I ended up getting a match down there, at the time it was a small Jewish hospital called Aventura Hospital. So I ended up training down there and got a residency down there. Actually, one of the few residencies led by a female program director, Dr. Williams. Yeah, and she was also a Kent alumni, which is funny. So it all comes full circle. So she was a Kent alumni. She’s actually good friends with the current dean of Kent State, which is Dr. Alan Boyk. And so I ended up training it under her. She gave me the skills that I needed surgical wise.
Clinical decision wise and all the attendings down there equipped me.

[24:22] And so your residency training was focused in what particular area?
Yeah, so you do a three-year surgical residency in podiatric medicine and surgery. Her specialty was, to be honest, she was like a trauma surgeon, but she also was a limb preservation doc, so that kind of gets to the next phase. So she taught me a lot about wound care and limb salvage.
One thing I realized too as a podiatrist, not every podiatrist knows limb salvage and I thought that was kind of inherent but it’s not necessarily true.
Not every – I’m sure other podiatrists will admit the ones that don’t know it, they don’t know it.
But wound care and limb salvage is kind of a niche within podiatry and that’s what she did.
Dr. Justin Marchegiani I know a lot of vascular surgeons that don’t know a lot about limb salvage but go ahead.
Dr. Tim Jackson Yeah. Yeah, yeah.
So yeah. So she was in – so she knew flaps and all this stuff and she trained me and also at At the same time when I was down there, there was this big-time plastic surgeon, Dr. Arthur DeRosiers III, you have to say that part, and he was a big-time craniofacial surgeon.
But what he did was he would volunteer his one weekday a week doing basically almost.

[25:26] Call it pro bono surgeries for patients with diabetic limb deformities and do different flaps, split thickness skin graft, free flaps and all of that.
And what he would say is, I need a resident to help me and nobody wants to help me.
So one day, he saw me in the OR, like locker room, I was just waiting on cases.
I used to just, because I was like, if I’m in residency, I’m going to do it right.
So I would just wait, see what doc will come through, see what type of cases will come.
It didn’t even have to be a lower extremity case, it would be whatever, it could be a hand case or whatever. That is so smart.
Yeah, so he would pick up on it and one day he was like, Austin, can you join me?
You know, it’s like cockslipe.
I would love to, like, I was, it would be a pleasure. And literally for the next 12 months, I basically became almost like his, you know, secondhand man when it came to those type of cases.
And I learned so many different things when it came to wounds and flaps, and skin care, and plastics.
And that’s where I fell in love with wound care and lumb salvage.
And I realized I could do this and I could actually enjoy it, like I enjoyed it.
It brought a different perspective for me when it came to podiatric medicine and surgery.
Because it was like, I knew this world existed, but I didn’t realize it was almost like this was in a totally different world than I had been exposed to, even as a student in podiatric medicine and surgery.

[26:42] And that’s where I decided to apply to a fellowship in wound care and ended up actually getting a fellowship at the University of Pennsylvania as well. So I ended up going there, accepting there.
And oh, you mentioned about the Michigan. So, funny enough, I did apply to the University of Michigan’s fellowship and actually got denied.
So, that actually would be a good talk for you. Yeah, I don’t know if you know about that piece.
Yeah, that’s in my, any of my paperwork, so we could expand on that.
So, I got denied and ended up completing a fellowship in wound care and podiatric medical research at the University of Pennsylvania, so Ivy League trained, learned clinical research, how to design studies, how to actually get clinically sound products on the market for Wound Care and everything.
What a great experience. Yeah.
So full circle moment, right when it’s time to graduate from fellowship, I get a call from the University of Michigan.
And I was like, this is funny. So they’re like, so we’ve been keeping up with you.
And I was like, yeah. And I published a lot of stuff.
I was going to say, you probably had your name on a few publications.
Yeah, yeah. I published a lot of stuff. They’re like, you’ve been busy the last two years.
And I was like, yeah.
I was like, yeah. Like, what do you want me to say? What do you want me to say?
You guys made your decision and it was fine. And they’re like, well, we’ve got a different proposal for you.

[28:01] And it’s like, yes.
Would you like to come to the institution but as a faculty member?
And I was like, only if you guys apologize for denying me. I just troll them.
I didn’t really think too much of it. Like you said, it goes back to what you said, where all the experiences are the experiences, right? You can’t really buy those experiences or regret any of them. So yeah, so we eventually work it out.
And they recruit me to the internal medicine department under the umbrella of endocrinology and diabetes podiatry at the institution. So I joined six other podiatrists, surgical podiatrists at the institution.
So they were looking for somebody with a particular interest in limb preservation?
Is that where this was headed? In limb preservation, yep, exactly.
So limb preservation and wound care.
Part of the deal was I wouldn’t do it unless I had a dedicated wound care day.
That ended up working out into almost two days, but yes. And that was like part of it.
It was like I wanted to do the wound care and have the patients that need my skillset, right?
This, I wanted to serve that. Like I said, I had that unique experience in residency, then actually decided to do a fellowship. And fellowship is obviously elective, so that lets you know how much passion I have for it.

[29:13] It is amazingly rewarding, is it not, this phenomenon of limb preservation, which I have to tell you, and I understand that I’m a very, very old man, But in the early days of my practice, it was just not considered.
If there was no perfusion, it was over, and the limb was amputated, and that was that.

[29:32] So can you talk a little bit about the self-satisfaction of taking a limb that is on the verge of being, just tossed aside and bringing it back to life?
Every patient with the limb issue, that trying to preserve their limb, has their own subset of situations, whether it’s a social, a mental health situation, or financial situation, you know, it’s everyone has a different subset of issues that you have to address to get this done.
Like I tell patients, I could probably save every limb that walks through, but I can’t tell you how long it would take me, or I can’t tell you how much it would cost me to save them.
I could get it done. It’s definitely fulfilling, like it’s weird, like I’ve only been out of residency less than 10 years, but I already have that satisfaction, like if someone were to take my skill set away from me, or a car accident or something to take, I would still be proud of the work that I’ve done.

[30:26] Which is.
Interesting. I can tell that. Yeah. Yeah.
But it’s interesting because I’ve been there and I’ve been in the distance and I’ve cried with the patients and I’ve lost limbs, but luckily I’ve saved more than I have.
But it’s almost like a trauma surgeon where they know. So I’ve been in those situations, but I’ve also been on the other side where these patients make their, walking on their own limbs with their grandkids and things like that. It’s pretty cool.
It’s a great feeling. In your practice situation today, as I understand it, you are a clinical faculty at University of Michigan, is that right? And does that mean you also operate a private practice as well?
Oddly enough, I started at the University of Michigan in the internal medicine department in 2021.
Just now, this month, after multiple negotiations over the last year, I transferred my skill set over to the orthopedic department.

[31:19] Of what you mentioned, they are ready to get on board of saving limbs as many as possible versus amputation. So, this has to be a university-led initiative and I guess I’m the one that’s on the forefront of that. But to address to how my practice is set up, yeah, I’m an actual employee of the University of Michigan, actually part of the medical school. So, my clinical appointments, clinical assistant professor at the medical school under the Department of Orthopedic Surgery. So, I have a private practice that’s basically mostly second opinions and consults from around the state.
Sometimes you get a couple of Canadians around the nation. Yeah.
Canadians, um, as well, and basically just coming in for second opinions for limb preservation efforts, um, as well.
And then I have surgical days.
So orthopedic was able to support my, have more surgical time.
And that’s kind of why the university wanted this to move forward.
So it’s two surgical days a week, both at the hospital and at the surgery center.
Then the wound care center days as well. Then I have academic days where I get to do things like talk to you and catch up on other grants, proposals, and things like that.

[32:25] You’re a pretty busy guy. Yeah.
Well, that being the case, let me ask you how you felt that you had the time to devote to my old friend Desmond Bell and Save a Leg, Save a Life.
Save a Leg, Save a Life Foundation.
It’s a great organization.
Desmond, I mean, he was one of the pioneers of limb preservation in podiatry.

[32:49] I mean, I don’t want to misquote him, but I’m pretty sure at some point of his clinical career, all he did was limb preservation, which is how I’m trying to basically tailor my career almost after his for decades was all he did was limb preservation.
You know, podiatrists were known for doing our bunions and hammer toes and all of those other type of procedures, but limb preservation was all he did for a couple of decades and that’s why I’m trying to gear towards it.
So yeah, he had approached me saying that they’re going to reignite the Sal-Sal, and I was aboard.
I was happy to be one of the doctors of podiatric medicine on the board to help reignite this.
Now we have a new president, Frank Alvarez, because he was just a founding member, Desmond was at the time.
But yeah, the main thing is basically be a fiduciary board and try to educate and empower the public about what’s going on, and mainly try to supply supplies, finances to the patients that need to go through lung preservation efforts.
Like I said, it’s a very costly endeavor, unfortunately, and a lot of, depending on what insurance plans patients have or financial situations, can be costly.
I mean, some of these patients have to see me two, three times a week, unfortunately.
Dr. Darrell Bock Yeah, the public awareness is something that I think is profoundly lacking, and that’s one of the things that Sal Sal and other organizations are helping with, I think, and you hear a lot about the financial cost of limb preservation.

[34:16] But if I’m not mistaken, the cost to the medical system is actually greater if the limb is lost.
Is that not your understanding?
Yeah, so that’s a loaded question. I like it. Because it’s like, right, because I’m on the side where I want to keep it on, and then I want them.

[34:35] You know, have them do whatever. If they need to see me every week, every day of the week to save their limb, then insurance probably would say opposite, that I cost them more.
But to answer that particular question, yes, complications from limb preservation efforts, such as infection, bone infection, management procedures, become very costly to the healthcare system.
Which is why we’re trying to get vascular centers, wound care centers, to be more of the forefront of managing these efforts versus the actual hospital admission and the emergency department, because that can become very, very costly to all of us involved, because you’re paying taxes for it, then you’re paying your insurance plans too, your premiums to cover these patients.
So that can become costly. And then yes, to answer, yes, a actual amputation itself with the prosthetic, with the rehabilitation can be at least a six-figure endeavor, right?
And if that happens all the time, And that’s why insurances are now willing to pay for these grafts and pay for hyperbaric oxygen, pay for vascular procedures to get this done because we try to, of course, complications from cardiac issues from below knee amputations are a case as well.
Dr. Darrell Bock Well, one of the things that I think often gets overlooked, and I’m going to be interested to see if you agree or disagree with this, is that we tend to think that a relatively early amputation.

[35:58] And fitting with a prosthesis seems to be a relatively finite and you would think relatively affordable method to deal with a limb that’s imperiled.
But I think what people don’t factor in is the social cost.
When a person loses a limb and becomes practically unemployable, and the pressure that that puts on social services and those safety nets that are really not in a good place to absorb that.
So, if you consider those things, it seems to me, and I just happen to be a little prejudiced just like you are, that all-out warfare to save limbs is a good idea.
If you consider those things, it seems to me that the balance sheet probably works out at least even.
I think it’s unfair to say that it’s more costly to save a limb than it is to do an amputation.
Yeah, before I would say that was the standard of care where early amputation, depending on what’s going on with the patient’s situation, and if their heart could even bear amputation.

[37:06] To try to get it done, get them on a prosthetic and call it a day.
That is the case, but there’s also been that battle where they say, you know, people like me, Dr. Johnson’s causing the patients to spend more money because they have to come get transportation to be seen, they have to get grass put on, they have to get dressings, they have to get nursing care, and all of those do factor in too.
So there’s both sides of it, but at the end of the day for me, what my end point is where is so it’s quality of life, right?
So you bet. Exactly, so, if a patient tells me I’m causing their decrease in quality of life by all of this and even after we get it healed, they say I’ve already lost my job and I’ve already lost that.
Then I will, you know, tell them maybe we need to get the second opinion for amputation.
Hopefully, not a full limb amputation but something we call, you know, the transmetatarsal amputation which I perform or something like that can get them at least to some degree of mobility in less time in wound care.
But that’s not always the case and yes, it’s not always cut and dry.
And I always tell, it’s for me if it was to go back to the beginning of the question, it’s patient, it’s patient, it’s case by case basis.
You know, some cases it may be fine for the patient, some cases it may not be fine and this could cause a lot of depression in the patient whether it’s chronic wound care or amputation.

[38:30] So, you have to be, you have to be very fine balanced and have to meet patient expectations and keep the care patient-centered is how I’ve navigated these roads.
But most times when we have, when I first meet these patients, it’s like even now, I remember we were discussing in my previous department about, should we like have a patient contract? Like, not to make it feel like they’re obligated, but let them know, like.

[38:53] This is also a commitment from them on this end as well. And not to make them feel bad but let them know that this is a journey.
It’s not a cut and dry situation.
But yes, I always start to mention to the patient very early in the conversations that this is an alternative to amputation and I’m trying to do my best to prevent it.
I’ll go to toe, I’ll appeal to insurances, I’ll do peer-to-peer reviews, I’ll do whatever they need to get the products in hand to get them healed.
And not just my patients with diabetes and PAD, patients with acute car crash injuries and all that stuff, they all battle it, right? They all battle it.
It’s kind of crazy how insurance companies view it sometimes.
But yes, I try not to really see the dollar amount I really to be, but obviously I know the healthcare system cares about that, but it’s like, I’m here to save this patient’s life and keep them back and keep them contributing to society and let them contribute to their household.

[39:49] How they like to.
Yeah, it’s good to always remember that you’re the patient’s advocate.
And Alton, I really enjoyed the conversation.
It sort of brings me back to the final days of my career in which I was very invested in wound care.
And it sounds like since I’ve retired that you all have continued to make a lot of progress, thanks to people like you.
And on behalf of those people who are benefiting from it, I’ll say thank you for that effort because it really is a great blessing for those people that find themselves in peril.
I have really, really enjoyed this conversation, and I could probably carry it on for hours and hours. I don’t know if we could maintain the audience for that long, but what I’m going to do now is what we came for, and that’s get out of your way.

[40:36] And audience, I’m going to close my mic, and Dr. Alton Johnson is going to give us his personal prescriptions for success.
Yes, I only have three prescriptions for success, but essentially, the first one is always bet on yourself. One thing I’ve learned is self-exploration is definitely needed at some point in your life. Most of us try to get it done in our 20s.
Some of us get it done in the 30s, 40s, some times in the 50s, but you try to do as much self-exploration and discovery as possible because you’re trying to figure out what’s your strength and weaknesses.
One thing I’ve always learned to do is to try to use my weaknesses as my strengths, which is weird, but it’d be little things.
Like I know if I don’t want to get something done when it comes to the checklist of today’s task, I try to get that done first, because otherwise I know I won’t get it done.
So it’s like, you got to know yourself and got to know your limitations and try to take advantage of it.
Also, it’s like, if I know, and it comes to financial talks or something, negotiating with a company or something, when it comes to that, and I don’t like doing that, maybe I need to hire someone or solicit those services so they can do it.
Otherwise, I could be also…
Being undervalued myself or underestimating my abilities. So that’s what I mean by ignoring your weak strengths and weaknesses and personality traits and things that you like to dodge and advert because all it does is catch back up to you and just push you back in this ruckus of.

[41:57] Not getting to where you want to be. You may not get there, but you may not get there in a timely manner. And especially now, it’s really no excuse for that. They have so many applications and fees for services out there that you could actually succeed to get to where you want to be in a timely manner depending on what the goal is.
Then, of course, the second prescription success for me is another cliche, like I said.
So, I always tell people trust the process.
Like I tell people, I never thought when I was a teenager that I’d be a podiatric surgeon, a clinical professor out in the Midwest talking from a southern boy who, you know, used to go to Baton Rouge every summer and grew up in Houston, Texas to now I’m in the plains of the Midwest out here in the Great Lake area.
So it’s like, you never know, and never be closed-minded. Try to be as open-minded and optimistic as possible, because you never know where things will lead.
And there’s a lot of different stories that I didn’t get to get into with Randy today.
But it’s little things, just saying yes.
I had a year where I would just say yes for 18 months. It truly changed my life.
And now I can say no to certain things, but just saying yes to everything that came by that was a positive impact to my life.

[43:08] Or things that put me out of comfort zone, speaking, traveling, all of that, I learned to take advantage of it and it kind of made me the person that I am today as well.
You know, I said my last prescription of success is there’s no such thing as failure.
I mentioned one of my brief failures with Randy in the talk today, but we don’t even call it a failure because it’s really just kind of how life goes, but it’s just those things that we define as failures, which usually comes from an internal feeling, it’s nothing wrong with it.
I mean, you never know what it’ll lead. And usually without failures, that means you didn’t take any risk and you have to take risk.
And it goes to that ultimate cliche, with no risk, there is no reward.
So you have to take some risks sometime, especially if you wanna be successful.
And if you’re one of the listeners of this podcast, then of course, you’re one of those risk takers.
So don’t undervalue yourself. And it goes back to that, essentially that leading one where I say, always bet on yourself.
But with that being said, those are my prescriptions for success.
Alton, I really appreciate that. I appreciate your brevity and your succinctness. You’ve got to bet on yourself every time, trust the process every time, and there’s no such thing as failure. That really wraps it up about as well as I have ever heard it, and I’m very encouraged to hear that kind of wisdom from such a young man as yourself. You mentioned.

[44:29] Your contact information. Would you like to share with our audience where they can find you if they’d like.
Yeah, so I’m on the Twitter. So my Twitter is AJDFootDoc. Then of course my Instagram, or people call it IG, Instagram is the same thing.
AJDFootDoc.
And then my Gmail, if you want to just email me directly, is the same thing.
AJDFootDoc at gmail.com. Kind of keep it simple.
If anybody have any questions, inquiries, or even if you have some patients that they’re stuck with, reach out. I’ll see them for you. Send them to Ann Arbor, Michigan.
I would love to give a second opinion on them, do the best I can to help save this patient’s life as a problem. As Sasa would say, save a leg, save a life, so that’s what we’re here to do.
Dr. Alton Johnson, it has been a real pleasure spending some time with you today.
Thank you so much for being on Prescriptions for Success. Thanks for having me.
I appreciate it. Thank you so much for listening today.
If you enjoyed the show, you can help us reach more listeners by leaving a rating and a review, especially on Spotify or Apple Podcasts.
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[45:43] You can also help by becoming a Patreon member. That link is in the show notes, and we hope you’ll also follow our companion podcast, Life-Changing Moments with Dr. Dale Waxman.
Special thanks to our producer, Craig Clausen, our Promotions Manager, Mariana Rotabaugh, and to Ryan Jones, who created and performs our theme music.
And remember, be sure to fill your prescription for success with my next episode.