Dr. Armin Tehrany

January 7, 2015

Dr. Armin Tehrany is an orthoscopic surgeon, which basically means that when we suffer physical trauma, he’s the one who puts us back together again. He focuses specifically on shoulders and knees, two of the most complicated and challenging areas of the body. When he talks about the role of the physician, he reminds me of the line from Spider-Man, “With great power comes great responsibility.” He wholeheartedly believes that medicine is the greatest profession of them all, but points out, “Doctors are human too. We can make mistakes. Society expects surgeons to be absolutely god-like perfect, and we’re not. We do the best we can.” That’s certainly food for thought. For more, read on!


So I don’t actually know very much about orthopedic surgery. Can you describe your process and what it is that you do?

I would define orthopedics as the study of the muscular-skeletal system and the bones and muscles of the arms, legs and spine. I specifically only do shoulders and knees, and I specialize even further by doing arthroscopic surgery of the shoulder and the knee.


Do most doctors specialize to that degree?

No. It’s common to sub-specialize within general orthopedic surgery, in which there are many different specialities. To further sub-specialize is unusual, but it’s something I had a particular interest in. I enjoy being a world expert in a certain field, and one of the ways I do that is to limit my practice to only that area. In addition, because of the growth of my practice, I find that it works best because I don’t have the time to see other joints—I focus on only those areas.


What made you select this particular speciality?

The story behind me becoming an orthopedic surgeon is my father. My father is a urologist.


So you come from a fine tradition of physicians.

I do. There are five in our family, and five on my wife’s side.


Is your wife a physician too?

She is a hand therapist in the burn unit at Cornell. Her father, both brothers and two grandparents are physicians. It’s really wonderful. We, unlike many physicians today who discourage their kids from going into medicine, encourage them. It’s still the greatest profession in the world by far.


What makes you say that? I just had dinner last night with a friend of mine who is a doctor. I’m not sure everyone would agree anymore.

They wouldn’t, which is why I look forward to educating them. The reason is although the insurance companies and the malpractice attorneys have tried to turn the profession of medicine into a business of medicine, it still is a profession. It needs to be a profession, because it involves a human being trusting a doctor to heal them. The fact that medicine has become a commodity now, thanks to malpractice lawsuits and health maintenance organizations trying to compartmentalize services into some kind of business, is why it has become less attractive to young medical students who are idealistic and who want to heal the sick. When they realize the amount of money they make has to pay their bills and cover the loans that they have for college and medical school, it becomes prohibitive. And that’s one reason why the medical profession has changed and why parents are worried about their children choosing to become doctors. The reason that I can succeed, aside from the super-speciality, is because I’m out of network, which means that the relationship I have is not with the insurance company, it’s with the patient. Because of that, I can practice medicine the way my father did. So, to piggyback onto the story about my father—I always wanted to be like him. He and my mother got married, and then they came to the United States so he could practice medicine.


Where were they?

Iran. We’re Persian Jews. My father, ever since he was a teenager, not only wanted to practice medicine, he wanted to practice in the United States. Ever since I was seven, I wanted to be like him. I loved to see that he was the patriarch of our family, and he healed the sick. He didn’t care about money, he cared about taking good care of people. All the accolades and great things that come with that are what I continue to strive to be. And then, when I was in medical school, he suggested that I go into orthopedics.


Why is that?

I asked him, because I was like, “You’re a urologist. Why do you think I should become an orthopedic surgeon?” His reply was, “You’re an athlete, and I know you, I know you’ll enjoy that field. It makes sense. You can treat the patients when they’re babies, and you can treat them all the way until they’re in their late 90s. As an urologist, most of my patients are over 65, and they’re all men. It’s okay, but it’s different from the field of orthopedic surgery. It’s a lot of fun, and the success rates with your patients are very high. They’re young, and now orthopedics are so good, the success rates and satisfaction rates are very high.” I said, “That’s great.”


And was he correct in his analysis of your character?

He was absolutely spot-on. In addition, patients enjoy having that close relationship with their orthopedic surgeon.


Why their orthopedic surgeon in particular? Or is that true with any doctor?

Well, men have a good relationship with their urologist, but they’re not necessarily going to talk about it with their friends and family. It’s a private issue, a sensitive issue. But it’s not too personal to talk about a bone being broken or a labrum being torn. So they’re more comfortable having a relationship that is open, which I also enjoy. Within the field of orthopedics I found the shoulder to be the most complex joint, the most difficult joint, and the most challenging joint, which is why I chose that. And I chose within that to do all the surgeries arthroscopically so that I don’t have to cut into the shoulder.


So what is arthroscopic surgery?

There are multiple ways to fix a shoulder or knee. One is open surgery. Another is open surgery where the incision is small, which has better cosmesis—which is how it appears afterwards—and better results. The other is arthroscopic, which means rather than opening the joint, a small camera is placed inside a small keyhole inside the joint. The camera is the size of a pen, and is attached to a television screen. So the surgeon can simply look at the screen instead of having to open up the join to look inside. And through other small keyholes and through other small instruments, the surgery can be done. It’s essentially a minimally invasive surgery. Some would call it laser surgery.


But that must be phenomenally expensive.

It’s more expensive than open surgery in the sense that instruments are required and the arthroscope is required. Plus, the success rates are higher with arthroscopic surgery, so the patient does better overall. The patient also has a fast rehabilitation. So even though the surgery is more expensive, the rehab is less expensive, and the patient gets better faster. Because the lost time from work and the lost wages have to come into play. These things are minimized by the arthroscopic technique. Plus, the infection rates are much lower when it’s arthroscopic. I have never had an infection in my life. When the infection rate is lower, the costs to society are much lower.


When you say, the costs to society, what do you mean? You don’t take health insurance. Isn’t it just the cost to the individual?

Yes. It’s the cost to the individual. However, many patients have insurance that is very good, and that insurance allows them to see any doctor that they want. So the insurance covers most of their cost. But they have to pay a little extra for me, and the better quality surgeons.


How long have you been practicing, and what’s the most challenging case you’ve ever had?

Fifteen years. The most challenging case was an eighteen-year-old baseball pitcher whose mother was a nurse at a hospital I used to work in. He tore his labrum, which is the lining of connective tissue around the socket of the shoulder joint. It’s what helps stabilize the joint. It can get torn in pitchers, athletes or after a fall or trauma. This pitcher had a labrum tear, but when I obtained his imaging test, we also saw multiple tumors inside of the joint. He had about 200 tumors.


Were they malign?

The likelihood that they would be malignant is low, but it’s not safe to keep them in the shoulder, so I told him and his mother that in addition to fixing his labrum, I would take out all the tumors in his shoulder joint. The challenging thing was that one of the tumors was so large that I wouldn’t have been able to take it out of the shoulder without having to cut the shoulder open. And it was very close to some nerves that he would have needed in order to use his arm. When I did the arthroscopic surgery I noted that it would be impossible for me to take out this large tumor using the arthroscopic equipment.


How big was this tumor?

About the size of a baseball.


And he couldn’t feel it?

He’s a big, muscular guy, and it was deep inside. Not in the shoulder joint, but next to it. So I cut the shoulder open, and I went in and I found the tumor. The problem was that the tumor was right next to some nerves and arteries, and I was afraid that by taking out the tumor myself I would destroy the nerves or cut them, and he would lose the ability to use the arm. So I closed the shoulder and I told him and his mother that if it were my son, it shouldn’t be me taking out the tumor, it should be a colleague of mine who I trust, who does cancer surgery exclusively, because this one was unique. My friend was happy to help. He said the tumor was difficult, that it was connected to one of the nerves, so he had to peel it off very gently. He said it was such a complex case that he took slides, and has been teaching medical students and residents for years using that case.


And the kid is okay?

He is doing very well. In fact, he recently injured his other shoulder, which doesn’t have the cancer, thank god, and I operated on him. He’s doing extremely well.


That must have been terrifying. What was it like, looking in the shoulder and thinking, my God. 

I was definitely sweating. And I was also thinking to myself, should I take a chance and take this tumor out, even though every fiber in my gut, in my being, suggested that it was not safe, that I needed to get help, that I needed to get a cancer specialist. That was the hard part, but in many ways it was easy, because I just used my integrity. I said to myself that I would close up the arm and tell the patient and the mom the truth, which was that it wasn’t worth it to take that risk. In this day and age, it’s very important for the insurance companies and the patients to understand that physicians and surgeons have to make decisions. Some of these decisions are very complex, and not everything goes well. Medicine is an art, much more than it is a science, and when you ask me about these complex cases it reminds me how tough it is to make these decisions. There’s so much trust involved, so much integrity involved.

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