Checking the Vitals with Dr. Singha

Intro

Today our guest is Dr. Jeeten Singha, an orthopedic surgeon at Connecticut Orthopaedic. In this conversation, we discuss why he chose to go into orthopedic surgery, what the benefits are for working for and seeking treatment at a private practice, and what advice he gives potential medical students that shadow him at his practice.

Transcript

Todd Schlosser: So Jeff, thank you so much for inviting us out to Bowman Regional Airport to interview today here for the podcast. I do like to start off the podcast by asking a similar question every time, and that simply is, what was it that drew you to want to work in the healthcare space?

Jeffrey Allen: Yeah, so when I was a kid, from as long as I can remember, I always wanted to be a doctor. My father died when I was very young, but my mom was very fortunate to remarry a young man who was in medical school and became a doctor, and I think he was a good mentor for me. So I followed in his footsteps. And I can remember even in high school thinking, well, I want to go to a college where it has good medical school admission rates.

Todd Schlosser: Sure.

Jeffrey Allen: And I think the reason was I just thought that would utilize whatever talents I have the best. When I got to medical school, the very first day they gave us a personality inventory and asked us a series of questions and said, what do you want to go into? And then they didn’t tell us what the response was. In medical school, your first few years you’re in general science and so forth.

Todd Schlosser: Start learning the basics before you… Walk before you run.

Jeffrey Allen: Right. I hadn’t really started working and trying to figure out what specialty I would be in, and once I went in, I had met a couple people from that point on. And I thought, well, the only thing I don’t want to be is a surgeon because every surgeon I’ve ever met, I’ve really disliked. And then so I went through my rotations. I did psychiatry. It was fun. I did pediatrics. There was a lot of good rotations, but I just didn’t really find my calling. And I did my surgery rotation and it was over Christmas I remember, so it was cold and dark and I thought this is going to be pretty miserable. And then I actually liked it. And I thought, not everybody who’s a surgeon is unlikable. And the thing about surgery is that it’s very problem oriented. There’s a problem and you fix it. There’s appendicitis and you fix it. Whereas with some of the other specialties like internal medicine, where you’re dealing with a chronic problem like hypertension or coronary artery disease, there are helps, but there are not necessarily fixes.

Jeffrey Allen: So I just always was interested in surgery. And then I was very fortunate to be able to train at the University of Louisville, which is a top notch… Mainly because I was here, it’s really a top notch residency program. I mean, heck, if I would have gone to Harvard Medical School and applied at University of Louisville, I probably wouldn’t have been accepted. But because they knew me-

Todd Schlosser: Because you’re a local, right?

Jeffrey Allen: I’m the local guy.

Todd Schlosser: Yeah.

Jeffrey Allen: Then I was very fortunate to train here. And then once I trained here for five years, Dr. Polk, who was the chairman at the time, he told me, he said, “You know, this minimally invasive surgery, which is a little bit of a misnomer, but laparoscopy in specific has really taken off and we don’t really have anybody at the university of Louisville who’s championing it right then.” He said, “Would you be interested in going and doing a fellowship somewhere out of the country and learning, and then coming back?” And I agreed to.

Todd Schlosser: I did see that you did a fellowship and I think it was in Australia, right? Was it Brisbane?

Jeffrey Allen: Yeah, I was at the Royal Brisbane Hospital in Australia and it was-

Todd Schlosser: So that’s how that whole thing came about.

Jeffrey Allen: Yeah, Dr. Polk. Well, actually I was supposed to go to Scotland with a gentleman named Sir . And so I had all my papers and I was ready to go, and then a week prior to the departure, the, I guess it was the National Medicine Program in Scotland said, “Well, we’ve got some fantastic news. We no longer have the funding to have a fellow.” And so I was a week away from going and Dr. Polk, just kind of shows you his influence, he made a couple of calls and the next thing I know, he called me and he said, “Well, you’re not going to Scotland, you’re going to Australia.” I was like-

Todd Schlosser: That changes the way you pack, but you still pack.

Jeffrey Allen: Changes your outfits, for sure. And so I got an Australian visa very quickly. Went over there and it was just very fortuitous, met some people who were unbelievable surgeons, innovators, and have become really great friends of mine.

Todd Schlosser: And they were innovators specifically in the minimally invasive space?

Jeffrey Allen: Yeah. So like for instance, most people who do upper digestive surgery in the US will use what’s called a Nathanson Retractor, which is a liver retractor. So I trained with Nathanson because of that. He’s the guy that invented the retractor, invented all those things.

Todd Schlosser: Awesome.

Jeffrey Allen: And then in that same group was a gentleman named George Fielding, who was the pioneer in bariatric surgery in Australia. And I had zero interest in bariatric surgery until I went over and met him, basically. And then also Nick O’Rourke, who really was the pioneer of laparoscopic liver surgery in Australia. So I mean, I absolutely fell into just a great situation and I was very fortunate.

Todd Schlosser: It seems like up till that point at least, you had had mentors along the way, sort of guiding you and really helping you focus on what you wanted to specialize in. That’s awesome.

Jeffrey Allen: Absolutely. In any field, if you’re going to be a filmmaker, if you’re going to be an accountant, whatever you’re-

Todd Schlosser: Pilot.

Jeffrey Allen: Pilot.

Todd Schlosser: Sure.

Jeffrey Allen: Whatever your passion is, and I got some stories about pilot mentors too, but whatever your passion is, it is so nice to have somebody who shares the passion and can and can help guide you, and somebody who… I always thought about Dr. Polk, Dr. Nathanson, Dr. Fielding, and some other people that we’ve mentioned, it’s really nice to have somebody whose sole motive is your best interest. I mean, you have other things, you have social and friends and so forth, but what they really want is what’s best for you as a career. If you find people like that, man, that’s what’s really helped me so much in my life.

Todd Schlosser: So when you came back from that fellowship in Australia, how long were you there?

Jeffrey Allen: I was there for a year.

Todd Schlosser: Okay. So you focus on minimally invasive and you come back to Louisville I’d imagine, at that point.

Jeffrey Allen: Yeah, I came back to Louisville and joined Dr. Polk on the faculty at the University of Louisville.

Todd Schlosser: Yeah, you were a professor there.

Jeffrey Allen: I was assistant professor there. And in Kentucky and specifically in Louisville, we were a little bit behind as far as laparoscopy goes. There wasn’t a lot of training. That’s good and bad. We were behind in a lot of technologies that didn’t necessarily take off and weren’t necessarily the best thing. So I think we had a very cautious approach to adopting new technologies. And with laparoscopy we were behind and so I started doing laparoscopic operations such as laparoscopic nissen fundoplication, gastric bypass, common bile duct exploration. We did a lot of laparoscopic, like feeding tubes, enteric access, and so forth. And immediately just got very busy.

Jeffrey Allen: There was another surgeon, Dr. Bob [Kashone 00:07:46], who had trained at Staten Island. He came over and joined just after. And so we were-

Todd Schlosser: It sort of cornered the market on this type of surgery because of your training in Australia.

Jeffrey Allen: Yeah. Correct.

Todd Schlosser: Yeah.

Jeffrey Allen: And so we began training other surgeons, but we were just very busy. And that’s a good thing for a surgeon to be busy.

Todd Schlosser: Yeah, it is. Absolutely. The busier you are, and not just from the capitalistic, financial aspect of that, but also the more practice you get at any surgery, the better and more efficient you’re going to be and the safer the outcomes are going to be.

Jeffrey Allen: Absolutely. And especially when you’re at a university setting, when you have residents, and we also had fellows, then the more of those type procedures that they’re going to get exposed to.

Todd Schlosser: Yeah. So you stayed there for about 10 years, right?

Jeffrey Allen: Correct.

Todd Schlosser: And then I believe it was in 2009, correct me if I’m wrong, clearly, that you transitioned into Norton’s women and children?

Jeffrey Allen: Yeah. So when I was employed by the University of Louisville, I still worked at Norton Hospitals. The Norton healthcare system has seven hospitals here in the city-

Todd Schlosser: Oh, so it’s more than just one location. Yeah.

Jeffrey Allen: Yeah. And so after 10 years of being in the university, I was ready for a change. I have no ill feelings. In fact, residents still come out for the university and train with our group, but I was just ready to kind of go out into private practice.

Todd Schlosser: Sure, kind of expand.

Jeffrey Allen: Expand. And so I went to another Norton hospital, which was is suburban women’s and children’s and started working there.

Todd Schlosser: So with the type of minimally invasive work that you do, do you work with a certain segment of the population that needs to come in and have these particular procedures? And what sort of is that?

Jeffrey Allen: So, I basically do advanced laparoscopy, and that includes bariatric surgery. So obviously with bariatric surgery or weight loss surgery, it will be people who are morbidly obese. The benefits of laparoscopy are fewer infections, fewer hernias, less pain, less time in the hospital, less time in bed. And all those really dovetail nicely with bariatric surgery, because when you take a morbidly obese patient, what you don’t want is for them to get infected or for them to get a hernia or for them to stick around in bed because they have a real risk of blood clots, of pulmonary embolism. So the thing about laparoscopy is it really gets them out of bed and gets them back in a normal routine.

Jeffrey Allen: And so the surgeries where laparoscopy is a huge benefit would be things like gallbladder surgery or anti-reflux surgery, where you make a big incision and do kind of a little operation. Sometimes that’s the same thing with bariatric surgery. So your question was what patient population do I see? So bariatric patients, I see a lot of very large hiatal hernia, and almost all of those people are elderly, over 70. And then just the people who need general surgical care that want it done laparoscopically.

Todd Schlosser: Yeah. And those people who are like struggling with weight loss and they’re looking for maybe like the lap band type procedures, and I realize that’s sort of a shorthand for probably many different things, but is that sort of what you’re focusing on or what I guess you deal with?

Jeffrey Allen: So I do about 60% bariatric surgery, which is weight loss surgery. And that would include gastric band, like you said, lap band. That would include gastric bypass, which is an operation that’s been around since the ’50s but we’re just now starting to do laparoscopically. And also the sleeve gastrectomy, which is an operation that’s really gaining in popularity.

Todd Schlosser: Yeah, so can I ask you a question about that?

Jeffrey Allen: Sure.

Todd Schlosser: Because when you think about weight loss and things like that, the common conception out there is eat right, exercise more and you’ll be fine.

Jeffrey Allen: Right.

Todd Schlosser: Are there people who, they can eat great, they can exercise great, but there just isn’t another option for them and they just still struggle?

Jeffrey Allen: Yeah, I think that weight loss surgery, I always tell people should be a last resort. But weight loss surgery is based on your body mass index.

Todd Schlosser: Right. BMI.

Jeffrey Allen: Yeah, your BMI. So the insurance companies will cover it based on BMI. Medicare, Medicaid. And the cutoff is in general 40, sometimes it’s 30 or 35 if you have a disease related to obesity.

Todd Schlosser: And that’s percentage of BMI, right?

Jeffrey Allen: No, that’s just your BMI. BMI is your weight in kilograms divided by your height in meters squared.

Todd Schlosser: Oh, okay.

Jeffrey Allen: And since nobody in the US knows the metric system, and even if they did, they couldn’t divide and square it in their head, just look on a chart and put your height and weight in pounds and inches and it’ll give you your BMI. It’ll do the conversion for you. So 40 is kind of the cutoff, or 35 with a disease related to obesity. And so, I’ve had people come to me, like one that had rocks in their pockets because they were at a BMI of like 39.5 and they wanted to be 40. Or they would eat a bunch for two weeks and then come see me. And that’s not what we want. If you’re on the cusp and you’re trying to gain weight to have bariatric surgery, that defeats the purpose.

Jeffrey Allen: But to answer your question, I think it certainly is a complex, multifaceted issue. I think a lot of people who end up with bariatric surgery are addicted to food or they’re really food addicts. So you know from addiction medicine, if you’re like an alcoholic for instance, the doctor doesn’t say, “All right, I want you to go home and just have three drinks tonight.” They say “Stop.” [crosstalk] Same thing with cigarettes. Same thing with drugs, although there are some weans.

Todd Schlosser: Yeah, but you can’t do that with food. You have to eat food.

Jeffrey Allen: You can’t do that with food. That’s right, you have to eat. So what you have to do if you’re a food addict is treat your addiction through moderation. And that universally is unsuccessful with addiction medicine. So I think that’s certainly one component of it. There is certainly a genetic component to it. And there’s certainly a component of it’s just so darn easy to eat horrible food right now. You know, when I first started doing bariatric surgery, I’d give lectures and I’d say, “Think how easy it is, you can simply get on your cell phone and call and have a pizza delivered everywhere.” And that was mind-shattering technology in 2000, but now-

Todd Schlosser: It’s easier now.

Jeffrey Allen: Not only can see that we can click an app on our phone, we can pay them through PayPal, we can have them leave it on the door. All we have to do is sit on our couch, do a few buttons and in 15 minutes a pizza is on our door.

Todd Schlosser: All you have to do is walk to your door now. You don’t even have to…

Jeffrey Allen: Yeah.

Todd Schlosser: Yeah.

Jeffrey Allen: Yeah, exactly. That’s the only thing you have to do and it’s just so easy. I think it’s also funny that for whatever reason, in the US our portions are really skewed. If you go to a restaurant and you get like maybe small portions, you’ll give it a bad review on Yelp you say I’m not going to go there because the portions were so small. If you look back, and I know this is kind of a hybrid example, if you look back at the Brady Bunch, Alice was married to Sam the butcher, who always brought these giant things of ground round, and Mrs. Brady and Alice were making meatloaves and they had giant mashed potatoes and gravy, and that’s what they’re eating back then but everybody was skinny. And not just on the Brady Bunch, the obesity rate was much, much lower in the ’70s. But we didn’t have all this food knowledge that we have now, but everybody was thinner, and the point is the portion size.

Jeffrey Allen: And that’s one of the ways that bariatric surgery works. You know, if you start looking about how bariatric surgery works, there’s certainly decreasing your portion size. Because it’s a mechanical thing, if you eat too much with a bariatric surgery, it’s not going to be pleasant.

Todd Schlosser: Because you sort of feel the full sensation sooner, right?

Jeffrey Allen: Well, not only that, but if then you continue to eat, it’ll start backing up into your esophagus. And the feeling when you’re a kid, when you’re on recess and you ran to the water fountain and drank really fast and then you got the spasms in your…

Todd Schlosser: Yeah.

Jeffrey Allen: That’s kind of what you’re feeling. Or worse, they’ll vomit.

Todd Schlosser: Yeah.

Jeffrey Allen: So portion control is one of the real ways that bariatric surgery works.

Todd Schlosser: Yeah.

Jeffrey Allen: I got way off on a tangent.

Todd Schlosser: No, that’s fine though, because it’s beneficial information. And minimally invasive as a surgical technique has been around for awhile. Are there innovations happening within that field? And what are those innovations that are?

Jeffrey Allen: Yeah, I think there’s a number of innovations. So I think one of the main focuses, one of the things that I’ve seen just in the last five years is improvement in the image quality.

Todd Schlosser: Just sort of the improvement of cameras?

Jeffrey Allen: Improvement of cameras, improvement of software. Different ways you can take one camera and change the settings, the contrast, and so forth and get a get a high definition, almost three-dimensional picture.

Todd Schlosser: Oh, wow.

Jeffrey Allen: And if you look at the picture that I see everyday in the OR compared to what I saw when I first started, I would look back and I’d say, “I can’t do the operation the way this is.” But I think I’m just spoiled. But yeah, the whole picture. The ergonomics of the operating suite. We now have dedicated rooms where things are on booms. And it used to be we were carting… Or we weren’t, but everyone else was carting, well, sometimes we were, carting monitors in, and it looked like an old Radio Shack where there’s all these things going and people trying to put… But now they have kind of integrated components. And then plus, the tools. For instance, common bile duct exploration is an uncommon operation, but there are a couple tools that you can use that make it so much easier.

Jeffrey Allen: And so examples of really procedure-specific tools. And for instance, when the band came out or the sleeve came out, manufacturers were starting to make band closure devices and things to facilitate doing a sleeve. And so whenever a new operation kind of comes along or whenever a new technique comes along, then the manufacturers are shortly behind, trying to make it easier for us.

Todd Schlosser: I think I have to transition to sort of what we’re here around right now. You have your own plane and obviously you have a love for aviation. So where did that begin?

Jeffrey Allen: Well, first of all, having your own plane, it used to be kind of a status symbol. “Oh, he’s got his own plane.” But now planes are really inexpensive. Now it’s a lot cheaper to have a plane than a boat in most cases.

Todd Schlosser: Oh, yeah?

Jeffrey Allen: Yeah. And so every now and then people say, “Oh, he’s so rich he’s got a plane.” Well, no. If I was rich, I’d have a big boat. I always enjoyed to fly when I was a kid. My mom shipped me off with my grandmother to Germany. I remember in a PAN AM 747 and I enjoyed it. And then on my 21st birthday, my father was taking me out to Las Vegas on kind of a coming of age trip and we were in a DC 10 flying out of Dallas and had an engine failure and really a rough ride-

Todd Schlosser: In flight?

Jeffrey Allen: Well, right after takeoff, which happens to be the worst time for an engine failure.

Todd Schlosser: Yeah.

Jeffrey Allen: And so, had a rough flight. It was a lot of people crying. I might have been one of them. And so we landed and it was one of these things where you kiss the ground. I said, “I’m not getting an airplane ever again.” And for a long time I didn’t. They sent us this thing and said here’s free first-class airfare wherever you want for two years. And we didn’t use any of those coupons. And so I was really afraid and I had a good friend named Delmer O’Dell and he was a counselor, and he said, “You know, you’re not really afraid of flying, you’re afraid of not being in control.”

Todd Schlosser: Yeah.

Jeffrey Allen: I don’t know that that was true, but it was kind of an immersion technique to get over the fear of flying. So I took lessons, I took lessons on race track winnings, which is kind of a sordid backstory. But I want a bunch of money one day at the track and said, “Well, I’ll put this to good use. I’ll learn to fly.” Much to the horrification of my mother, who was sure, and is probably still sure that I’m going to kill myself in a plane crash. And so I learned to fly. Kind of conquered the fear. I still wasn’t a completely at-ease flyer, but I was able to get on an airplane without any pharmaceutical assistance. I got my pilot’s license when I was just finishing up medical school.

Todd Schlosser: So this was a little while ago.

Jeffrey Allen: Yeah, it was a long time ago. So then during my residency I certainly didn’t have any time to fly, so I kind of let it lapse.

Todd Schlosser: That’s a busy time.

Jeffrey Allen: When I started at work at U of L, University of Louisville, I wanted to get back into flying, but the stakes were raised a little bit and I found out that our disability policy at the U of L wouldn’t cover a private airplane crash. And I figured I’d probably mame myself just enough that then I wouldn’t have a job. So, then when I moved over to Norton, they didn’t have such a policy, so it just happened really well that I immediately got into flying. As we talked about before, met a mentor and I started renting one of these 172s over here, which are fine airplanes, but you’re-

Todd Schlosser: That a Cesna?

Jeffrey Allen: Yeah, it’s a Cesna.

Todd Schlosser: Yeah.

Jeffrey Allen: You’re going to pay $120, $130 an hour probably to rent one. And I started adding it up. And I like flying about every day and that’s a lot of money.

Todd Schlosser: Oh, yeah.

Jeffrey Allen: So I foolishly convinced myself that it’d be cheaper to buy a plane. And it actually, it is if you fly it a lot, which I do. And so I bought this plane behind us, which is a Mooney.

Todd Schlosser: Now, when did you get that one?

Jeffrey Allen: That was about five years ago.

Todd Schlosser: Okay.

Jeffrey Allen: And so started flying it a lot and then started looking for excuses to fly. And that’s when we started doing the pet rescue flights.

Todd Schlosser: So how does that work?

Jeffrey Allen: Yeah, so there’s a number of organizations. The biggest one is Pilots and Paws, and they simply put on their webpage or I’ll get an email, I’ll get a daily email that said, “Hey, there’s a dog in Minnesota that needs to go to Florida.” And I’m not going to fly to Minnesota and take it to Florida, but I’ll certainly fly my leg. And so they said, “We can have the dog at Bowman Field here on Friday at four o’clock. Can you take it to Atlanta?” And then I would. Sometimes you actually get to deliver the dog instead of just hand it off. And I gave you some pictures you can see of videos and the hundreds of dogs. I didn’t realize how many it was. Just so many dogs that we’ve flown.

Jeffrey Allen: And then there’s a local organization called The Arrow Fund, and Rebecca Eaves runs that. If you’re looking for a charity, that’s a great charity to support. She takes dogs that are in the state of Kentucky that have some compelling circumstances where they are injured, or usually abuse cases. And she says she’s going to take them in, she’s going to give them medical care, and she’s going to adopt them out. And so sometimes she’ll call me and say, “Hey Jeff, what are you doing this afternoon?” And if I’m free, she goes, “Can you go down to,” I’m just going to pick a city, “Pikeville and pick up a dog who got hit by a car. And they’re going to put it down, but they say it doesn’t necessarily have life threatening injuries, but if you could bring it here.” And so I’ll almost be on call for her. If I’m available, I’ll do it, and if I’m not available, I’ll forward it to my wife. And if she’s not available, we’ll find one of the other our friends here.

Jeffrey Allen: And that’s been a very good way to give something back and fly all the time. And everybody says, “Well, that’s stupid. That’s a waste of resources. You could fly people.” And we do flat people quite a bit, but they say, “If the dog is going to Minnesota to Florida, you can just drive it there. You don’t need to fly it.” Well, that’s true. That’s about a 20-hour drive and nobody’s standing in line to give their car a workout, where there are pilots who are standing in line to give their plane a workout.

Todd Schlosser: You have been guided by a lot of mentors throughout your career, in both aviation but also surgical. And then you took a position where you were an assistant professor. So I’d imagine there were a lot of people looking to you as acting as a mentor for them. What advice do you give people in that position, where they’re looking to you as a possible mentor? And especially with minimally invasive and that kind of world?

Jeffrey Allen: Well, I take that job very seriously and I do want to teach. And you can carry on through people that you teach. But the best advice is, Dr. Polk who was one of my mentors… My sister was in nursing school and I was with Dr. Polk, I think we were eating supper, and she called me and she said, “I’m very upset because I’ve got this person that I’m shadowing and she does everything wrong and she’s mean.” And I was talking and hung up. And Dr. Polk said, “What was that all about?” I said, “Well, that’s my sister. She’s in nursing school and her person that she’s following is giving her troubles and so forth, and she’s not very professional.” And Dr. Polk said, “Well, listen, here’s the thing. If you have somebody who’s working under you, they always learn something. Sometimes they learn what not to do. Make sure that’s not what you’re teaching them.”

Jeffrey Allen: And that’s great advice when you’re teaching somebody. And a lot of times you’ll say do what I say, not when I do. You want to make sure they know what the right thing is to do. In airplanes, I mean, you talk about learning from UPS captains, you talk about learning from surgeons, whatever, they’re always watching you.

Todd Schlosser: I’d imagine in both aviation and surgery, you want to learn what to do and not what to do.

Jeffrey Allen: Exactly.

Todd Schlosser: Because they’re both high stakes situations.

Jeffrey Allen: Yeah, it is. Absolutely.

Todd Schlosser: Excellent.

Todd Schlosser: Well, thank you so much for being on the podcast with us.

Jeffrey Allen: I enjoyed it.

Todd Schlosser: We really appreciate you.