PARADISE VALLEY, Ariz. » The aging patient, prickly and stiff, loomed over the doctor, showing a number of troubling signs. The doctor noted poor posture, callused skin, limbs pocked with deep scars. He feared survival would hinge on drastic action, maybe even an amputation.

A saguaro, that succulent symbol of the southwest, was in need of medical attention, and Rilie Leblanc — otherwise known as the "cactus doctor" — is the specialist cactus owners turn to around here.

He considers his bond with the plants to be something spiritual, and on a recent morning, he examined the saguaro, trying to divine what ailed it. It stood nearly 30 feet tall, weighed some 12,000 pounds and leaned dangerously close to a home. Leblanc looked at the thick skin at its base and estimated it was more than 100 years old.

"They all have personalities," said Leblanc, 66, wearing a newsboy cap and squinting in the sun’s glare. "They all have separate problems. You can’t lump them all together."

These days, the desert plants for which Leblanc cares so passionately are in the midst of a renaissance in Arizona, their popularity bolstered by the promise of sustainability and relief from water bills driven up by drought. Many northerners who migrated here tried to import the lush landscapes of their hometowns, only to discover that the desert — or their budgets — had other things in mind. They turned instead to cactuses and other succulents.

But homeowners’ knowledge of the plants has not kept up with the trend, leaving Leblanc and his crews with plenty of plants made sick by overwatering and overcrowding. Driven by demand and by Leblanc’s obsessive connection to cactuses, his crews work every day of the year. On New Year’s Day, he pointed out almost gleefully, they had a full 10 hours of work.

"We’re here to save your cactus, no matter what the problem is," Leblanc said, his sales pitch interrupted by his ringing cellphone: "Hello, this is the cactus doctor."

Known to his friends and co-workers as Frenchie, the cactus doctor is a man of few words and fewer passions: His wife of 26 years, his collection of bebop jazz albums, and — of course — cactuses. His French parents fled the conflicts of colonial Vietnam for Thailand, where he was born and raised and caught what he calls "cactus fever" at age 11.

The one subject sure to draw him out is the special nature of his patients.

"They’re full of so much character," Leblanc said. "The way they’re shaped, the texture of the flesh, and the flowers are some of the most beautiful in the world. You could put a cactus here and just meditate on it for a week."

He worked for a time for the government of the Philippines, helping poor farmers raise more profitable crops. In 2002, his professional calling led him to Arizona to study the saguaro, attending the Desert Landscape School, then a nine-month training program at the Desert Botanical Garden in Phoenix. He certainly made an impression. At his graduation, one instructor recalled, he pulled off his cap to reveal he’d dyed his hair green.

He entered the field as the popularity of desert landscaping was on an upswing, and the pendulum swung away from lawns copied out of the Midwest.

"People are seeing the beauty of the desert and what it can provide and offer," said Sonya Becker of the Arizona chapter of the Association of Professional Landscape Designers.

But in the wrong hands, desert plants can be mistreated.

"We want the desert landscape to look lush, and we want it to look lush tomorrow," said Chris A. Martin, a professor of horticulture at Arizona State University. "These plants are pruned into oblivion."

The work can be painstaking and dangerous. Leblanc has performed surgeries 30 feet in the air, erecting scaffolding just for the procedure. Other times, his crew works on limbs, weighing hundreds of pounds, that can easily snap off. An entire morning can be consumed by the tugging and adjusting required to shift a leaning saguaro just a few degrees.

Straightening a cactus typically costs about $700, and more invasive surgeries or replanting a cactus can cost upward of $1,000.

"This is a project, huh?" Ray Olivas, an 84-year-old retired maintenance man, said as the crew cranked the cactus outside his house into place. "It’s like building a house here."

When he’s not trying to heal a cactus, Leblanc is planting gardens of them, like one at a home in Phoenix he decided to pop in and visit unannounced. As the owner’s shar-pei barked through a window, the cactus doctor climbed into the garden to check out the prickly pears, firesticks and a collection of barrel cactuses, which he called a "golden mountain" for how they glowed in the sunlight.

Leblanc doesn’t sketch anything out when he plants a garden. Rather, he will come with a trailer loaded with plants and meditate in the space for hours, then put in whatever connects with him.

"It’s just like an artist does — you see it in your mind," the garden’s owner, Mike Stein, said after he pulled into his driveway and saw Leblanc. "I think the proof is in the end product."

At the job in Paradise Valley, a suburb of Phoenix, Leblanc’s crew of about a half-dozen men had spent the morning digging a trench around a cactus, slowly descending deeper into the earth. Meanwhile, the trunk of the plant was being hugged by a tow truck-like vehicle capable of picking it up.

"This is definitely a big boy," said Ryan Willbanks, one of Leblanc’s foremen.

The doctor’s initial prognosis was not good. The huge cactus leaned precariously, just inches from the roofline of a carport. He thought his crew would have to pick it up and replant it a few yards away, probably amputating part of an arm so it didn’t break off during the move.

Yet as the morning went on, the arm proved stronger than it had first appeared. Once the crew had dug enough to uncover the cactus’ ball of roots, it too proved quite sturdy.

This cactus was a "survivor," Leblanc said. No amputation would be needed, and soon, he decided, neither would the move itself. It would only need to be straightened and stabilized.

He said the cactus had sent him a message: He saw signs of growth.

"You know, he could have fallen," Leblanc said, marveling at the resilient saguaro, the king of cactuses. "You can tell he really wanted to be saved. He’s saying, ‘I’ve got more life left.’"