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       Hundreds of Michigan patients have kept their legs or arms because of the cooperative medical work of Mahir Elder, M.D., and Don Tynes, M.D. Elder is an interventional cardiologist at the Detroit Medical Center's Cardiovascular Institute, where he has pioneered a minimally invasive procedure for patients with circulation problems.Each Tuesday, Tynes, an internal medicine physician in Benton Harbor, travels more than 200 miles to bring four to seven of his patients -- most on Medicare or Medicaid -- to Elder at the DMC for revascularization treatment of their peripheral arterial disease or their poor circulation. "Traditional care for those patients is bypass surgery. But if bypass fails, (doctors usually) have to cut off the leg," said Elder, 41, program director of the Wayne State University School of Medicine's interventional fellowship program, where he teaches doctors cardiac procedures."I thought there has to be a better way. What I do is an alternative to bypass, or if bypass fails, we do this" procedure, he said. Over the past 12 years, Elder said, he has performed more than 4,000 procedures on patients who have suffered a stroke or have diabetes or heart or peripheral arterial disease -- about 15 to 20 per week. The procedures, he said, save limbs, reduce mortality and improve patient care. It works like this: Circulatory problems caused mostly by diabetes narrow arteries, restricting blood flow. The heart catheterization procedure Elder performs involves inserting a small plastic tube, or catheter, into the clogged artery, where a drill or expansion device removes the blockage. Elder said only 30 percent of patients with peripheral arterial disease have symptoms or complaints, making diagnosis challenging. Patients may have pain that can be diagnosed with a blood pressure test of their legs, he said. Risk factors include smoking, diabetes and leg pain when walking. "What is important to understand is that once a patient loses a limb, there is a 50 percent chance they will die in the next two years," Elder said. "If we prevent amputation, the mortality risk is gone." There also is cost savings from avoiding the usual one-week hospital stay of $5,000 to $10,000, he said. Tynes, 53, also is an assistant clinical professor at Wayne State, where he and Elder met in the late 1990s. Using his wife's van, Tynes has transported more than 100 patients for surgery at the DMC. "The most important thing for us is the patient. We love them, we mentor them, we counsel them. We are here to take care of them," said Tynes, who also is an ordained Christian minister and runs the Benton Harbor Health Center PLLC, a faith-based clinic.Each Tuesday, Tynes arrives with patients around 6 p.m. at DMC Sinai-Grace Hospital. Elder operates on the patients. They rest and leave the next day with Tynes about 1 p.m."We are there with the patients at the bedside the entire time," Tynes said. "We are taking a technology and applying it to a philosophy" of never turning away or giving up on patients. On the way back to Benton Harbor, Tynes said, he talks with the patients about lifestyle changes, including exercise and diet, which can aid in recovery and health. "Talk is cheap. What they see is a commitment from two men and the nurses who go out of their way to help them," Tynes said. "That means something. It is not the talk, it is the walk. This gets through and helps with the change." Elder said more physicians are learning of the limb-saving procedure, but change in the medical community is slow. Too many patients lose their limbs each year because physicians don't understand their options, he said. "There are still physicians out there who think the only option is bypass," Elder said. Each year at DMC's residency program, Elder trains five residents or fellows in the technique. "Word is getting out. We also train doctors from outside the country who come in for one to three days," he said. Elder and Tynes stress they help patients regardless of their ability to pay. Over the past three years, Elder and his two partners have given away $400,000 in free care, he said. "I am gratified when a patient is scheduled for amputation and the foot is cold," he said. "Afterward, the foot is warm and you know you've saved it." Jay Greene: (313) 446-0325, jgreene@crain.com. Twitter: @jaybgreene