What Leg Pain Reveals About Your Blood Flow & Heart Health | Vascular and Interventional Radiologist

What Leg Pain Reveals About Your Blood Flow & Heart Health | Vascular and Interventional Radiologist

Author Name:Dr Pal

Youtube Channel Url:https://www.youtube.com/@DrPal

Youtube Video URL:https://www.youtube.com/watch?v=OJEqU_fZk9k



Transcript:
(00:00) What is leg attack? Sudden pain in the legs, go to the nearest doctor. >> Can we say it is heart attack of the legs? >> Yes. >> The leg attack >> can lead to amputation. >> Smoking causes decreased blood supply everywhere, and impotence is one of the thing. >> Yes. >> Have you seen cases? >> In Africa, you smoke a lot more.
(00:18) So, there's a lot of African males who require penile implants, and they come to Delhi. >> We talked about people sitting. How about people who are standing? What are the problems that they can have? >> The second heart of your body is your calf muscle. When it's not doing its job, then blood starts pooling in your legs.
(00:37) And from that point, at the very minimum, you require an ice pack machine. >> There is a sudden increase in heart attacks. >> 25 to 30% of Indians have varicose. Clots form in the leg, and they migrate to the heart. It does cause >> Before we dive in, can I be honest with you? It blows my mind that 63.1% of you who listen regularly still have not subscribed to our channel.
(01:07) If you enjoy the podcast, the stories, the science, maybe even laugh at our jokes, could you do us a small favor? Hit that subscribe button. It takes only 2 seconds and helps us keep bringing you better guest and episodes every week. I'm truly blessed to have all your support, and I'm sure you will support me in the journey.
(01:25) Now, let's get into today's episode. Hello guys, this is Dr. Pal Manickam. Welcome to another episode of our podcast series Gut Feeling with Dr. Pal. In this episode, we are interviewing Dr. Raja Gopala, my friend from US. He was in the US initially, and he got trained in interventional and vascular radiology, and he moved to India, and he opened up all these centers of vascular interventional centers throughout India, and he's doing a wonderful job.
(01:50) So, this podcast is for people who wants to know more about science. You must have heard about heart attack. In this podcast, we're going to discuss about leg attack. Why there is blood clot being formed in the legs, what does that do to your legs, and what does smoking does, what does alcohol does, and we talked in depth.
(02:10) If you are interested in science and if you want to know more about any kind of blood clots, not only in your heart, but all over your body, and if you want to know what causes that, this podcast is for you. So, Dr. Raja, thank you so much for being in my podcast. >> Thank you so much, sir, for calling me, please. Thank you. >> it's it's a pleasure, and uh right off the bat I'm going to ask you this question.
(02:30) You are a vascular doctor. >> Yeah, right. >> So, vascular doctor means you deal with blood vessels. >> Correct. >> So, the first question I'm going to ask is what is your take on why there is a sudden increase in heart attacks among Indian people, and there has been a lot of awareness from a vascular angle, what will be your take on that? >> We used to always imagine that this is more common with uh with, you know, particular risk factors and all, and of course risk factors are very important for us.
(02:56) But along with that, I believe there's a lot of inflammation, some degree of diet-induced inflammation that's going on. Unfortunately or fortunately, we are very carb-rich and also fried food-rich in this country. Almost, you know, 60% of the or 70% of snacks we eat have fair amount of inflammatory food products in that in the form of fried or re-fried oils and so on and so forth.
(03:20) So, I think there is that challenge, and that needs to be probed further. The amount of Western literature we have on this sort of thing is not enough, and there is some other angle there. But also equally, I was very impressed when I actually read a paper in December about increase of heart attacks in Delhi uh during the pollution peak at peak times.
(03:40) And I this sort of validates what I've been thinking, you know, definitely that degree of AQI, that is bad pollution that's literally prevalent everywhere. In place like Chennai and all, we don't see much because sea breeze blows it over, you don't see that kind of a crazy pollution, but you do have a lot of pollution still.
(03:55) >> Mhm. >> And that also causes more of cardiac events, I'm sure, and there's enough evidence now to say that, you know, high poor quality air that we breathe, high pollutants, do cause more inflammation and and and and deaths because in many ways the COVID opened our eyes towards this diffuse inflammation concept, right? It was a diffuse inflammatory disease, and so many heart attacks came because of that.
(04:17) So, that sort of you say if you extrapolate some of those concepts into this, definitely a lot of younger heart attacks that we're seeing have a strong correlation with the amount of food or the bad food we are eating, the bad pollution we're getting, along with other risk factors like, you know, hypercholesterolemia, overweight, hypertension, diabetes, all that stuff, along with that, but this all as well.
(04:37) >> People think when we say vascular, they only think about mainly heart. >> Correct. >> Okay, educate the audience what else vascular is. >> So, this is a very good question, sir. Um basically, vascular the heart is just a part of the vascular system. There is all the vessels that go to your brain. And in fact, now we have enough evidence to say that how we fix the heart as a first event, we should also fix the way brain blockages as a primary brain angioplasty should be performed, right? Or the clot removal should be done. So, that's
(05:07) anyway this part of it, the brain part of it. Then we have vessels that supply your kidney, they supply blood vessels up your legs, blood blood vessels that supply your liver, and all the other organs, hands, everything, right? So, all those blockages, so the blockages of the heart typically cardiologist takes care.
(05:24) Blockages that go to the brain typically neuro interventional doctor takes care. And the remaining blockages all, we all clump it into one area, and vascular interventional radiologists like me take care of that. And that's why we we talk about blood vessels. So, yes, you can get blockages of the legs, blockages of the kidney vessels, blockages of the arm vessels.
(05:45) >> So, every organ has a blood vessel supplying blood supply to it. >> Correct. >> And that can get compromised mainly because of a micro blood clots lining up the blood vessel. >> Correct. So, the blood vessels are lined by thing called endothelium. It's a lining. And uh sometimes under that there is cholesterol deposition.
(06:04) >> Mhm. >> And that can either break that causes sudden blockages or it can progressively get more and more and more and cause chronic blockages. So, or or a chronic blockage can become an acute blockage also. So, all those things can happen. >> So, as a layman who is listening to this podcast they know that okay, when there's a heart attack, there is a block, they go in, they put a stent.
(06:26) And then similarly, now awareness has been increased that there could be a heart attack of the brain. >> Correct. >> Where there could be a blood clot decreasing the blood supply and then, you know, within minutes or within seconds they need to go and then remove the clot. Can explain a situation similar to that? Can we say it is heart attack of the legs? >> Yes.
(06:45) In fact, in US when we were there, we still we coined the word leg attack. >> Leg attack? >> Yes. >> What is leg attack? >> So, leg attack is sudden unexplained pain in the legs. Go to the nearest vascular doctor. In fact, we used to have 1-800 number with a big billboard >> Mhm. >> saying the same thing. So, basically what we're trying to tell you is See, one small difference is when the vessel to the heart gets blocked, it's a very big emergency because heart may stop.
(07:08) >> Mhm. >> Now, if the vessel to your legs gets blocked nothing really stops immediately, but your legs are chance of getting cut off or jeopardized eventually over next 8, 10, 14 hours. >> I don't know. Educate that a little more. So, you're saying that then what happens when there is a decreased blood supply to the legs? >> Decreased blood supply to the legs is compromised it is the the process is not as fast as the heart attack. It's a little slower.
(07:32) Because it's a little slower, a lot of people ignore it. Okay, leg pain leg pain >> But what happens if they ignore the the color of the leg changes? >> Color of the leg changes. Legs may swell up or legs may become very black. Color changes. They may have excruciating pain, severe pain, and eventually you may lose a limb also.
(07:50) >> It can lead to amputation. >> Leads to amputation. And in for example, when we were in US, an average amputee costs $95,000 to the US tax economy. Now, this is in a structured society where you're measuring everything. In India, can you imagine? An average amputee, somebody else has stopped his work for to take care of this gentleman.
(08:12) Then every time you have to go out, there's so many more things that you have to spend or whatever take care of. So, it's a it's a huge burden on the society. >> So, not only on the patient, the caregiver. >> Caregiver. In fact, I know of caregivers they have themselves stopped going to their jobs to take care of the amputee because who else will take care, right? We are very loving society, very emotional society.
(08:31) We'll never I mean, usually we try our not to put our parent in the hands of some outsider and then we go off to our work, right? So, we are in because of our emotions or because of our nature, a lot of people actually I've seen that, thousands of patients actually, where you know, this gentleman anyway went through a bad phase and he's lost his limb or something, but the name his his family member also is now virtually with him or her, right? So, so that's all the challenges that we have with vascular.
(08:58) >> So, in like say that patient has, you know, leg amputation, what is the most common predisposing factor that he must have had in your practice? >> In my practice, it is badly controlled diabetes. >> These with arterial problems. Yeah, so diabetes always plays a role in this. >> Can you educate how diabetes causes a leg attack? >> Well, diabetes is very commonly causes leg attack.
(09:21) So, diabetes primarily the disease itself causes the vessels to narrow. It is a very high on the risk factors. Actually, it is equal to smoking if you ask me. Smoking, hypertension, diabetes are equal in the risk ability to produce arterial blocks, first of all. >> So, diabetes can cause blood clot in the arteries. >> The blood vessels.
(09:38) >> blood vessels to narrow and get clotted. Along with that, the high sugar levels in the body predispose you to get early infections. So, when the blockage happens, that area further to that gets more infected. Along with that, when you give antibiotics or something to cure it, the sugar levels actually fight against that.
(09:59) Right? And with the body's stress response, more sugar is produced. Right? So, all this creates a very, very like a storm, like a perfect storm. Like you know, everything is working against you. Right? High sugar level is causing blockages, blockage is causing infection, infection is again getting worsened by sugar level, and more infection is producing more sugar levels.
(10:21) So, it's like everything is going down the drain, like that in a spiral. And from that point, at the very minimum, you require an ICU admission. And in a prolonged stay in the ICU, at the maximum, you may lose a limb or or even something more fatal. So, I think instead of going that far, early detection, going to the doctors early, finding early about this, taking a care about it early is very, very important.
(10:45) >> For diabetic patient, we recommend to check their eyes once a year. They also recommend to check their foot once a year, right? Can you educate that? >> So, foot care for diabetics is most important. So, what is the check involved? So, check involves a close examination to look for any cracks, fissures, and all that.
(11:03) So, physical examination. Along with that, a good advice, which is basically wearing some form of footwear even at home if possible. >> And the reason is that because they will not be able to sense the pain or the hot? >> Because one, your your your nerves start dying and you don't sense things very well. Two is the same story.
(11:22) Lot of them have compromised blood supply also. So, it's a nervous thing as well as a vessels thing. When you have compromised blood supply, your defense cells are not coming in a rapid way to the injury to to heal that. >> Mhm. >> Right? That's basically the bottom of it. So, that's very important. So, maintaining a proper foot care is very important.
(11:42) So, that's a very important part of the yearly and monthly or physical examination that we do for diabetics, always examine the feet. >> I mean, we didn't give attention to smoking. >> Correct. >> So, can you just tell us what happens with smoking? >> Smoking is um probably the most terrible thing that is government approved in the world.
(12:00) See, drugs are very bad, but that is not approved. So, at least there is some defense for that. And we we have various defenses for this saying, you know, smoking is tax revenue. That with that I It is absolutely no-brainer. It's a useless thing. It's a bad thing and it's bad bad bad. Now, it's bad in a million ways.
(12:17) Um and that alone will be 2 hours of discussion. >> Yeah. >> [laughter] >> But simply speaking, for us as doctors, as vascular doctors, I have a problem is that with every cigarette you smoke, your vessel diameter drops by one in four times. That means it becomes 1/4 of it of what it is now. Let's say if you have a 10 mm vessel, it becomes 2.5 mm.
(12:39) And this happens across the board. Technically, that is what gives you the little buzz in the brain because the vessel is smaller, it you know, that kind of that >> Oh, so when the vessel gets shrinks >> shrinks >> So, the >> constricts. It gives you the rate goes up and it gives you a little buzz. Right? That's what makes you feel that you're concentrating more or studying better for exam or something.
(12:59) But that plays havoc with that contracting expanding contracting explosive spoke 20 cigarettes. Every time this will happen every time it will go up. It's a big problem, right? It's It's unduly contracting. The second thing is free radicals. It produces enormous number of toxins. Free radical simply speaking is a toxin that should not be there in your blood.
(13:19) And that can make your plaque rupture. So, all of us all of us, except if you are a a very fit person, will have some degree of plaque formation. In fact, they say the plaque, which is that cholesterol deposition, happens from the second year of your life. In fact, the chubby baby we say is actually getting a little bit of cholesterol at that stage only, unfortunately, sadly speaking.
(13:42) So, we all were chubby babies maybe and probably still continue to be chubbies. So, we do have some cholesterol, which will which will organize itself. >> Mhm. >> That can get ruptured if this free radical, these toxins are going all over the place. >> So, that's another problem. So, that's why a lot of smokers will get sudden heart attacks >> Mhm.
(14:01) >> and sudden leg attacks or anything you speak. >> What other thing that is related to your field is that smoking causes decreased blood supply everywhere. And one of the main thing is the reproductive system. And impotence is one of the thing >> Yes. >> that is very >> Impotence is very common in smoking. And impotence is very common in diabetics who smoke.
(14:20) Diabetes itself causes significant amount of impotence. So, when you put them together, it's a perfect storm. >> Mhm. >> It's like a storm, you know, together. So, that's something to remember. Have you seen cases? Oh, yeah. I mean, we we we do a lot of angioplasty for the penile artery for the arterial incom- arterial input cause of impotence.
(14:38) We do a lot of small vessel and we do some balloon plasties. So, we do get a lot of those patients. But very often, um that cannot be fixed also. The smoking-induced impotence is actually fairly permanent. So, um a lot of hospitals that do Western African patients as medical tourism in India, they'll be doing at least five penile implants a day.
(15:03) >> [laughter] >> Wow. >> Because the impotence is so bad because in Africa you smoke a lot more. >> Okay. >> So, there's a lot of Afro-American males who require penile implants and they come to Delhi, for example. Delhi there's huge penile implant centers actually. So, that's all because of, you know, smoking is terrible, terrible for you.
(15:22) >> We talk about a lot about people sitting. Sedentary lifestyle, we know what is happening. So, you deal with that as well. Sedentary lifestyle causing diabetes, diabetes causing decreased blood supply, and then we talked about the peripheral vascular disease. How about people who are standing all the time? What are the problems that they can have? >> So, prolonged standing, basically what it does is you will have this heart.
(15:46) >> Mhm. >> The second heart of your body is your calf muscle. >> Mhm. >> Okay? >> Mhm. >> That So, this heart will take the blood down. >> Mhm. >> And that second heart is to send the blood back to the heart. >> Mhm. >> When it's not doing its job, then blood starts pooling in your legs. >> Mhm. >> So, how do you do that? If you're standing and not moving your legs continuously, the calf muscle is in one position.
(16:08) So, the complex medical term for that is resting ambulatory pressure rise, we say. But, basically what we're saying is if the calf moves more, then blood is pumped back. >> Mhm. >> You stand like that and don't do much. Like, for example, our cameraman will stand for 2 hours now, right? >> Mhm. >> Or even like this, even when we sit and do this, there's nothing happening in the legs.
(16:28) In fact, if you ask me, sitting is the worst thing that was discovered in the mankind. >> Is that right? >> Yes. >> Why sitting is that bad? >> Sitting is the new smoking, if you ask me. Yes. In fact, most of Stanford, they do mock views. So, interviews are done by walking in the farm in Stanford. So, so So, there's a lot of stuff happening now.
(16:45) So, whatever be the cause, prolonged standing or sitting without moving, maybe you're an IT employee, 8 hours you sat and done some coding, let's say. This blood is pooling in the legs. And this pooled blood struggles to come back. The more and more blood is pooling there. And when it struggles to come back, it starts producing what's called as venous incompetence.
(17:07) Long story short, the veins are not competently sending the blood back to the heart. >> Because the load is too much. >> too much. And the muscle contraction is very poor quality. Hence, you get varicose veins, which is basically veins blood pooling in the veins. Or you may even get deep venous thrombosis, whatever.
(17:26) Both together now we put under one group called venous incompetence. >> So so when the veins are not working properly, the legs swell up. >> Legs swell up. >> How do we know whether we have varicose veins? >> Legs swell up for various reasons. >> Correct. >> So you can do a bunch of tests, but I believe very early in the course of a leg attack, like I said, sudden pain, sudden swelling, sudden color change, something like that.
(17:50) When you get that, very early you should do a test called a Doppler. This Doppler test >> It's It's like an ultrasound. >> Ultrasound. It will tell you very simply whether the blood is pooled or not. Simple ultrasound is available in every small village in this country. It will easily tell you whether you have varicose veins or not.
(18:08) So bottom line, pain or swelling in the leg, always get a Doppler in standing position to check if you have any vascular problems. This is something that you should probably should write down and underline. >> Only if you have diabetes or any risk factor, anybody? >> Anybody. >> Anybody. >> Anybody. >> Obesity? >> Obesity. Um for me, if you ask me, there is risk is just a standing profession itself is a risk.
(18:32) If you're a hairdresser, let's say you're >> Hairdresser. >> Yeah, you're doing like what, an hour cut and the next guy is sitting another hour one hour cut to blow dry and all. So all this will make you make a lot of blood pool. That's itself is a risk factor. Such a person, if he has any leg pain or leg discomfort, should definitely get a scan early in the course to identify the problem.
(18:51) >> And what happens if we don't do anything about it? >> So a lot of things can happen. So to be frank, I was shocked when I came back, you know, I never thought there'd be so many varicose veins, right? So then I did some literature research and in when I was in US we did and bother, you know, and bother so we were so so busy life also.
(19:08) 25 to 30% of Indians have varicose veins. So first of all, the total number of people it's more common than cataract. >> Seriously? >> Yeah. Now, not all of them will have symptoms, so not all of them require treatment. That's a different discussion. You know, only even if 10% have symptoms, you still are talking about 180 million Indians, right? Because our population is huge.
(19:31) So, we do have a lot of people with varicose veins who are not treated. And if you don't treat them, you know, initially these veins can swell up and it can become a look like a bit of a cosmetic problem. But once it once it crosses that phase, and very often it does, and there's a only one study called Bonn Vein Study out of East Germany, it says that 17 to 20% of them will go to next stage and next stage.
(19:54) And so, out of the 70% will be like that only. Remaining percentage of them will go to the next stage. The next stages are color changes. Legs become black in color. You'll get ulcers in the leg. You will get you know, easy bruisability. Small injury also will not heal. >> Because there's no blood supply. >> And the worst possibilities is clots form in the leg and they migrate to the heart.
(20:16) It's very rare, but it does cause emergencies. Okay? And sometimes you can get frequent infections and they become cellulitis and septic, you know. So, bad infection is called cellulitis. So, that can also happen. All these are very avoidable complications, you know, with nowadays >> I I have a patient story.
(20:33) He's around like 68 year old. He's a diabetic. He visits US, his friend. I'm sorry, his son. Because of course, his son is having a son. He's going to see a grandson. His 6 months term is coming right now. >> [laughter] >> So, he's traveling from Hyderabad, I guess. Hyderabad, he's going to Dallas. >> Yeah. >> In the airport, as soon as he's stepping out of the plane, he's having shortness of breath.
(20:55) >> Correct. >> And chest pain. And then when we we we did all this analysis, he has a big blood clot in the legs, as you said, you know, it traveled all the way to the lungs. Compromise the blood supply to the lungs and started having what we call pulmonary embolism which resulted in shortness of breath and chest pain.
(21:12) But I think one of the risk factor is not moving in the plane for more than 8 hours. >> Absolutely. Not moving in the plane. One. For a long time and not moving anywhere. In the planes what makes it worse? Is the humidity is artificially kept at 20%. Artificially. Because if it's very humid all the droplets will come because of cold weather. Drop on your head.
(21:35) So they'll they'll reduce the humidity which basically means even though temperature is very cool. In a plane you get very dehydrated. You get very dehydrated. >> Correct. >> On top of that one or two bored persons who get bored because of long journey will have one little peg. >> Alcohol, correct. >> That is further dehydrating.
(21:53) >> Right. >> Right. It is just making the perfect storm of hypercoagulability. That means your blood is more coagulable now. It's getting thicker. Why? The sitting. Not moving. So this is a perfect triad. It's called Virchow's triad. Your blood is not moving. Your blood is getting thicker also.
(22:11) Okay? So this is a in when I used to travel back and forth for almost 12 years to US. I've seen I think four pulmonary embolisms. My career in the flights. And I knew it. The minute this guy is breathless I know it is that. Because I'm a vascular doctor also. So this is very very common unfortunately. But we have to be very careful.
(22:28) >> What kind of treatment that you can offer uh for the varicose veins? >> True. So basically now all vascular care and this is something that I should probably tell that for people's you know benefit as well. Virtually most vessels can be fixed from inside. So the whole world has moved towards a concept called endovascular first.
(22:48) >> So no surgery? >> No surgery. So effectively you don't have to open up and do anything until needed. I mean of course there are circumstances where you have to open up and do it but that's very very rare and becoming increasingly rare. In the world especially if you see advanced countries. So what we can do is called endo That means inside vascular or venous.
(23:08) >> Mhm. >> Some way of burning the vein, which is laser ablation. Now, we do what's called as a glue ablation, which means you go inside and put a gum. And the gum will just freeze the whole vein or just >> What do you mean by ablation? >> Ablation means burning. >> Burning the whole thing. >> Burning the vein.
(23:25) Okay? >> Not painful? >> It's not painful at all because uh again, good doctors are very precise in what they burn. So, they're not burning the whole thing. >> Mhm. >> And they're not burning the deep veins or any vital structures. Equally uh we give some little insulation around that vein. So, that should make sure the burn is not touched by other area.
(23:44) It doesn't touch the other areas. So, I think that's also So, so it will not hurt if the doctor is very capable. >> But what happens when it when it burns? >> When it burns, this extra useless vein is removed. >> It gets destroyed. >> Correct. You have the highway. >> Mhm. >> You have the service road. >> Huh. >> Highway is going well only.
(24:03) Everybody is coming in the service road and crashing each other. >> Ah. >> So, what this endovenous laser is, I'm shutting the service road and saying everybody go one way in the highway normally. Properly. >> Okay. >> We're just removing one accessory road. >> Okay. >> Which we have identified as not good on scanning. We don't remove normal veins.
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(25:23) This is my passion. If I change one person's life, I know [music] I'm changing the whole family. Link is in the pinned comment. Now, let's get back to the podcast. >> So, we're going to show you some pictures. >> Sure. >> Okay, and then see what is your thought process about it. >> Absolutely. >> Okay, the first picture is >> Yeah.
(25:41) >> You can look and let me know what this actually means. >> This is 100% varicose veins. Okay, this ability of the ulcer to form near this ankle it's called perry garter ulcers called is equal to varicose veins. And this is a dry ulcer because she's probably put some So, in India, they put a lot of creams and ointments.
(26:03) Coconut oil, all sorts of things. So, that modifies the disease course. Typically, venous ulcers will be weeping. They'll be like some liquid-like thing on this little drier. That's only because she's applied something on it. It's a bad venous ulcer. She requires a procedure. >> What kind of procedure? >> She requires an endovenous laser ablation.
(26:22) >> Endovenous laser ablation. >> ablation >> Can you break >> it down? So, basically, we go endo, which means inside vein, use laser to burn the vein. So, that the pressure, the venous pressure reduces, and the ulcer starts healing. >> The second picture. >> Yeah, second picture is an older lady. So, this is what I mean by bad calf function.
(26:44) Her calf is so poor that there's some edema in the leg. That is swelling in the legs. There's a lot of varicose veins and this black color. So, this lady will require the procedure also, but her healing will be little slow and she requires some support from outside with the form of stockings. >> And this can happen with obesity? >> This can happen with obesity.
(27:03) In fact, obesity is called In fact, it's called obesity-induced stasis edema. So this obesity is causing stasis, which means not movement of the blood. And this is very typical. So these are two major things that directly affect the vessels. And of course, there are a million things that indirectly affect you, which is, you know, gastric reflux, lung problems, yeah, smoke, everything.
(27:23) >> So I am inspired by you that you were practicing in the US and then you want to come back to India and then I know provide your service over here and then you've been doing this for the last like 11 years. And you have your own center called Avis. >> Correct. >> Why did you come to India? >> [laughter] [gasps] >> I don't know.
(27:42) There are two, three reasons. One I I was very very interesting. We had a Chinese fellow who was in the US and he was training with us. And then he he wrapped up whatever and he did even though a lot to come into US and all. He was joined and became a nurse in California and then as a doctor, he became a nurse first and then became blah blah blah.
(28:05) So he nearly spent 8, 10 years. And then when he finally finished his training, he one day said, "I'm going home." He said, "Uh you're going home after all this? Come on, you went through hell." And initially when we joined residency with us, he had trouble with English and we really helped him out. He's a really dear friend of us. And I said, "Why are you going back?" And he said um very simply, and you know, he still struggles with English even at that point.
(28:25) He said, "Because it's home." And he And he's for him it sounded so obvious. Because it's home. And I think that really struck me. You know, I There was He said it in a probably very matter-of-factly way, but it was very emotional for me the way he said it. And uh so that was like, you know, something that I always thought about.
(28:42) Okay, so there is home and this home is somewhere else and why Why right? And there's something to think about. Equally, I think from a career point, if you see the unemotional reasons also, uh there's a huge shortage of my field, you know, vascular interventional radiology was not there much in India then. In Atlanta alone, we used to have 80 people meet for the monthly IR Atlanta meet, okay? And here, you know, hardly seven or eight used to come for that.
(29:08) State to meet, by the way. >> Wow. >> At that point in time. So, there were hardly anybody formally trained. I was formally trained. So, so there was a shortage. I thought this is a great time to, you know, go back and see that. And finally, what is it? We came with two suitcases and one visa. >> Right. >> So, we don't need the visa to go back.
(29:26) All we have probably for two more suitcases and maybe two more children. And that's it. And that's it. Just pack them and get them make them sit on the seat and put the seatbelt and you're back here. >> Pack the children in the suitcase. >> [laughter] >> Suitcase and we brought them. Of course, they were initially they were they went through some shock waves and they came.
(29:42) So, that I think that was there was no doubt in my mind that, you know, it was a great thing that we went there and we got a lot of knowledge, a lot of I know, seen the world. >> Mhm. >> But home is where home is and you should always go back home. And um one one really selfish reason also was that, you know, when you go first to US, right? They get paid some $45,000 as this thing and you don't pay much taxes on that $45,000 or $50,000.
(30:09) So, US gives you a lot in the first four, five, six, seven years. Subject knowledge, friendships, friends. And you don't pay much anything and then, you know, get a lot of state of that. And then once you start earning, it takes a lot to back. It takes 30 to 35% back as taxes. I said, "So, I said if I'm paying 35% of money into into some government, might as well pay my government so that it might benefit my guy, right?" Some selfishness there.
(30:33) Instead of paying them, there's that angle also. So, anyway, you have to pay that you see you earn well, you pay 35 to 40% tax in any country. >> Right. >> So, if you pay that in India at least one Indian will benefit from that or somebody will benefit or some road will be built, hopefully. So, there's some selfishness, some emotion, and and definitely some practical thought behind it.
(30:52) >> What is your goal? >> What I think should be the headline for me when I retire, maybe 10 or 15 years down the line, is [clears throat] I made this completely come out of the big hospitals. I made this a day care surgery. I made sure there is no incentive to keep the patient 1 minute longer, also. Right? Now, the bigger hospital, why would they send you to home same day? I mean you have paid parking fees, you are drinking 400 rupee coffee, there are four types of pillow options, then you are walking around and if by ti- by by
(31:23) by mistake by 7:00 p.m. the varicose patient says, "I have a little headache." Then immediately neurologist comes and orders a brain MRI. So, there's a huge you are this perpetual ATM. But for 5 days, 4 days, 6 days, 7 days. I mean, look, I had a patient even my own aunt 3 weeks ago who had a thyroid surgery.
(31:43) Obviously, large a bit of thyroid was removed. And I met went met her at 6:00 p.m. I said, "Okay, auntie, you're fine." You know what happened? Then she said, "Amma, a lot of headache." I said, "I think I'm That's because you didn't eat in the morning and then you went through a surgery. What else? You relax." I said, "No, no, I have a lot of headache.
(31:56) " And of course, my uncle got stressed. They called by 11:00 p.m. Okay? MRI MRI a brain, this thing, that thing, that thing. 17 tests are done. 1.8 lakhs is additional investigations for this headache that was incidentally seen after thyroidectomy on same day evening. Right? With no neurological disorder, nothing. I mean, whatever.
(32:18) So, what I'm saying, I'm not blaming anyone. I'm just saying if I were running a huge hospital, also I'll think in that lines only. Right? You have a capacity and why would you not use it? >> Correct. >> So, that's something I wanted to change, right? I think easy cases should be done easily and sent back easily. Right? Why would a guy with a little sinus sinus problem have to wait, right? I mean, why does a guy with a cataract have to wait? So, they they should be done and gone home.
(32:41) And that's what we did with varicose veins. I think that's the story, the headlines. >> Tell me an emotional story that really stick with you in the last 11 years. >> [gasps and laughter] >> Lot of emotional stories. I think I think the the real emotional story is not about the procedure itself because as you know, you do enough procedures, that becomes like your spine.
(33:00) It's a patient's story. So, same thing. I mean, I it's a story of sacrifice, you know, young guy. Varicose veins, ulcer, literally an outcast in the house. So, >> Like he was diabetic, obese, diabetic. >> Obese, diabetic with a venous ulcer. So, had five failed surgeries in the local hospital. >> For varicose >> For varicose veins.
(33:23) And all of them failed. So, family's getting increasingly tired of him. And one fine day he had this severe infection in the leg. And then I've never seen this before. What he got was a bacterial endophthalmitis, which basically means this bacteria went from here to his eye and he became blind. Now, So, imagine this guy with a stinking ulcer, buffalo, and then now he's blind.
(33:43) So, his dad, mother, brother kicked him out of the house. They said, "You can't stay. What can you do here? It's no point." And I didn't know all this, of course, you know, they they they happened in the house. And then he came with one lady and I said I said, "Okay, who are you now then? You know, parents are gone.
(34:00) " "I'm his brother's wife." And this boy is 10 years younger to me. He's like my child. And today this his own family is not taking care. Okay, then what do So, they said, "You also don't come back if you go with this." I mean, take this boy to a doctor. Okay. I sold my gold and everything and brought him because the boy cannot live like this.
(34:19) Right? And I did that free because I I also could not bear it because if she is so sacri- she has sacrificed everything. >> Correct. >> What how much is my Yeah, we have to contribute. And interestingly, this boy got better. And then went back to the same family. And um so when he came for review, he came with the brother who who kicked him out.
(34:40) And I blasted him. I said, "How can you You know, this is your family?" And he actually said that, you know, "Sir, I don't know what it is, but you got us together. You made this family come back." Right? And this is a story that you'll not forget, right? I mean, you I mean, I've done fiber ablation and somebody comes here after 15 years.
(34:56) I've had stories, a lot of good stories. >> Right. >> Somebody wanted to name their kid Raja >> Because >> Yeah, yeah. >> Somebody got better and they wanted to put my name. And I have stories like that. But this was something that that appealed to me that somebody else's family got together because we did something.
(35:10) Of course, it initiated in their house only. But that lady, I think is a great lady. And I think we contributed. So, there are nice stories like that. >> I understood. >> Nice, nice. Well, thank you, sir. Thank you so much. You've been a wonderful, I think, one of the most ethical, professional vascular surgeon I've ever met.
(35:26) And your story from US to India transition is also very relating to me. So, best wishes for everything. And thank you so much. Thank you so much.