BigFaker's consultation with Dr Sarin, some interesting details.
"As far as I know, Dr. Sarin's medical knowledge has never really been called into question. His C-cut procedure? Yes. His patient aftercare? Yes. His ability to delegate and prioritize his responsibilities as an LL surgeon and those of people he hires? Oh-Goddamn-For-Sure-Hell-YES!
So we began to talk about my specific case.....and this is where he really surprised me. Remember this phone call earlier this year?
ANSWER #1: "No problem."
ANSWER #2: "Don't worry."
ANSWER #3: "No problem."
ANSWER #4: "Don't worry."
ANSWER #5: "No problem."
He said, because of my age (39), the most I could hope to do was 5-6 cm. This was really the first morsel of caution I had ever heard out of the man......and in hindsight, especially considering the rest of the time he was pitching me, this was really unexpected. He told me of the various cases he has had in which older guys were not able to lengthen more then 5cm. I started to argue my case about good family genetics and such. He said it is not biological age or physiologic age, it is anatomy. One 50-year-old had to stop at 4.5. He also said, that with older patients, mental determination is not as good. Most of them, they have given up the middle. This is where I smiled inside a bit. You see, when I set my mind to something, I do it, then I do it again, and again, and again, then I do it one more time to rub it in your face.
We talked about weight bearing. Again, he said in my case, it would be difficult.
"With standing and walking, the complication rate increases once you are overweight"
Dr, Sarin said that for me, the consolidation time would also increase because of weight. The issue is not the frames, nor the nails, but the screws, which are only 3.5 mm.or 4.0 mm thick. The nails are tested to withstand 2000N (newtons). The screws don't take more than 800N.
BALLERINA
I asked how we would combat Ballerina without the standing and/or walking.
"What we do is we put a dedicated physiotherapist, who gets you the physiotherapy done repeatedly in the day, reduce the distraction time, uh...size" (not sure what he meant by that) "And...at night, we keep the sandals very tight". He added, if we see ballerina, we stop lengthening. You do in "pulses", as he termed it.
Dr. Sarin said he no longer locks the ankles -- because there is a single muscle running down the lower leg (not sure if he meant Tibialis Anterior, Gastrocnemius/Achilles combo, or something else) -- it causes knee-bending issues, which he says are much harder to correct than Ballerina. He said that they still used methods like sandbags on the knees, but despite their Ballerina-fighting efforts, "people tend to....get it"
AFTERCARE
I asked about Physical Therapy.
"We have four physiotherapists and they are available for whole day." [sic] Then he threw me a little: "We are changing the system now, one thing which will reduce the cost also, [in] that you will have a dedicated physiotherapist only for you."
Now at first, I thought this meant he was going to be hiring enough PTs to have one dedicated for each patient, but I am sure what he meant was that each patient only sees on PT regularly to develop a connection and rapport. He went on:
"I would like to put people in the hotel and give different kind of options, a charging plan, so the cost also comes down."
At this point, the doc really started to turn it on. Now in my lifetime, I have bought cars, boats, houses, insurance policies, lots and lots of big ticket electronics, so I know when someone is trying to hustle me. Dr. Sarin was in full sales pitch mode now and, aside from little query here and there, I just let him talk:
"It won't be very expensive, all the facilities in there, the servants we will provide, the physiotherapists will be there, the food you have a choice that like...you know, in my experience with running...so many....it really gives a problem with the food."
He then talked for a couple minutes about past guest house problems with monotony, catering to people of different ethnicities, from all over the world, how "somebody doesn't like this" and how "you will get bored eating the same thing every day".
OK, it's great that he cares so much about patient care...down to the food, but doesn't this go right back to what we've read in diaries before, about Dr. Sarin's over-involvement in Guest House Issues? I mean seriously: if I'm on a transatlantic flight aboard a giant Airbus A380, do I really want the pilot worrying about whether the guy in 35C got his f*cking peanuts?
But "Captain Sarin" went on:
"So what we do, it's freely available, we give you 20 menu cards, whatever you want to eat, take an order day before, they make it for you accordingly, so you save money also, your taste is maintained"
Wow, sounds great, I wanna live here forever! When can I move in?
I asked about the problems patients had, earlier this year, when he had people split between the guest house and the hotel:
"No, that was a transition phase...we were changing the thing. Some people are very comfortable in the guest house and some people are very comfortable in hotel.
He said he was in the "planning of closing down this guest house"
And despite all of these domestic issues he had just gone on about, he actually then said
"You see, I'm a surgeon. I'm not here to run the place"
I asked about why he gets so involved in trivial, non-medical house matters
"No, but I have to, but it is my responsibility. This is what happening, as you know it. The people hijacking me from, uh United States"
At this point, Dr. Sarin starts to throw out some really ugly claims against SysOp and old forum and really what can I say about it?
Anyway, Dr Sarin then alleged:
"The website owner wanted to control the guest house, like he wanted to manage and he should be getting money. You know, basic issue was: they wanted to control this guest house, they wanted the money, this is the way they will run. Now suppose, there are 15 patients. They have taken the money and they run away...who's responsible for that? And it was totally unethical, like he puts a good post on his website, everything is good, but inside he is involved and I am involved. I said 'I'm sorry, it is my responsibility and I'm not going give that. I'm not going to make it a commercial thing'"
He went back to the subject of living in the house, touching on the fighting in the guest house and the drinking.
"They think it is a party going on. It is not a party going on, and what the person is doing, the other person starts doing the same thing, and the tantrums and this and that"
This was maybe the funniest thing he said all day:
"...and eventually, to be very frank, 4 months lying in the bed and all this thing, the people go cuckoo. Right?"
I think maybe it was just me, or hearing him say it in his accent, but it was just damn funny to me
He stated that these type of things led to his decision to just keep patients in the hotel from now on.
LL CREDENTIALS
I had my standard list of LL questions for him. About the difference, in his opinion, between reconstructive and cosmetic LL:
"It is a mode of responsibility, more than anything. Reconstructive, the person is ill, and he is already having a problem. Here, the person has walked in from some other country, and I'm breaking his bones. So, it's more of a responsibility."
And which are more difficult to treat?
"Reconstructive ones are more difficult, but easy thing is: it's a single leg".
He did acknowledge that cosmetic patients are much more demanding.
I proferred that he probably had more cosmetic LL experience than most doctors in India:
"Not most of India, most of the WORLD"
Wow. No wonder they needed a new guest house. His ego probably couldn't fit in the old one.
He went on to question the credentials of many of the surgeons practicing LL around the globe.
"There are certain guidelines to do some things. You are doing one of the most complex kind of orthopedic surgery, right? That complex orthopedic surgery is a superspeciality in itself. Most of the world, the people who call themselves limb lengthening surgeons, they have to have background in Ilizarov, right? Either they have to be trained, they have done some fellowship, under some authentic guy or they are self-styled -- with experience they have become like that, which is not possible, right? There are only few centers in Russia where, you know, this thing has done [sic]. So, the most authentic part is you go there and you learn the technique. And problem with the technique is, if you go and learn it you need at least six months of [time] to be there, right? They speak in Russian, every literature is in Russian, right?"
This was, to me, probably the most impressive part of the day, as he discussed his first studies in Ilizarov (presumably at Vinitssa), briefly went over the many complications possible, and how a qualified LL doctor needs to have experienced these. He then slammed, rightly so, the charlatans who claim to be trained in Ilizarov (and contrasting it with his own resumé):
"What people are doing, everywhere in the world...they just go for 15 days, with Dot Shot they will click a picture that 'I am trained here, I am trained there', right? And if you see the profile of people, right? I would not take the name and all this thing...they have not done even six months of residency in the thing! Right? When it comes to my profile, I am a postgraduate in a subject. It's not that I have been learned or seen something, right? I'm a postgraduate in that particular field...in that superspeciality."
In Russia, I confirmed?
"Right. I speak Russian, I write Russian, I spent three years of my time there, right? So that makes you authentic kind of a surgeon, that otherwise, going by profile...."
"For example, I'll give you the biggest example, because the war is open between the Betz and me. If you see his credentials, it doesn't say that he's an orthopedic surgeon! And where he writes down The Betz Institute, it is a residence address!"
OK, this already sounded a little strange when he said it that day (early December) and admittedly, I didn't look up Dr. Betz's website until today, but still...WTF?
I brought up Dr. Mahboubian, whom I might see when I get back to California, and my slight concern that he is not an MD:
"See, but do you see what credentials he has, where he has it, under whom he has learned, right? Have you learned under a person who is an authentic cater of this thing or are you learning from a person who just did six months of residency? So there are very few surgeons available in this world and there are very few surgeons who will take this responsibility."
I mentioned how Dr. Parihar takes on so few cosmetic patients, and doesn't actively seek them out, as in trying to draw them.
"No, he doesn't. He would say that he would do it, but he doesn't want to take the responsibility. It's not easy, it's a serious thing."
THE KNEE
I asked whether he cuts the patellar tendon for the osteotomy. He said no, what he does is a standard procedure by the AO (Association of Orthopedics):
"It should be a vertical incision. It's difficult to work with a transverse incision, right?. We can do it, we've done it when the patient insists, I've made a horizontal incision, but even with the horizontal thing, inside there's a vertical. It's only on the skin you have a horizontal, but inside the patellar tendon...you cannot cut it like this [pantomimes horizontal incision]. You have to separate it and you don't cut it....so what you do is separate the fibers and make a place and just go from the middle."
The INFAMOUS C-CUT
So whaddaboutit, Dr. S?
"No, I stopped it. I stopped it."
Was that a medical decision?
"No, no...I will tell you the many things that have been changed in all thing. If you make a C-incision, your osteotomy is very high up, right? And it unites very fast. The union is pretty...good. The higher you go for the osteotomy, the bone union is faster. Suppose it is going to take 7 months in the lower part of [the tibia], it will be in 5 and a half months, it will be fine. But doing an osteotomy, just with a small incision, at that level, is very dangerous. So you made a C-incision and open it and look into it and what's happenning it's under vision, you do it"
Dammit, if I had been on my game, I would have asked if any kind of arthroscope is used. Sorry, Guys. I suck. He went on:
"But a lot of people say 'No, the scar, scar, scar', so I've gone a little down compromised it and now we do it with the one little thing...I could show you, there's a guy here...it's just one stitch. "
I didn't get to go up and meet patients until a good 30 minutes later (yes, we talked tor a LOOONG time!), and F*CK, I was too busy looking at the frames and the rooms and the guys legs overall to notice the scars"
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Topic: Dr Amar Sarin ( New Delhi, India) (Read 134297 times)