Radio Maine Episode 62: Dr. Sunil Malhotra
7/26/2022
Dr. Lisa Belisle:
Hello, this is Dr. Lisa Belisle and you are listening to, or watching, Radio Maine. Today, I have with me in the studio,
Dr. Sunil Malhotra, who is practicing at Maine Medical Center.
Dr. Suhil Malhotra:
That's correct Lisa.
Dr. Lisa Belisle:
And also a big fan of art which is our intersection. Thank you for being here today.
Dr. Suhil Malhotra:
Thank you for having me, Lisa, it's a real pleasure to come down here and have this conversation.
Dr. Lisa Belisle:
Sunil, I'm really fascinated by the work that you do, which is quite different than the work that I do in medicine and primary care. But I think there are a lot of intersections. You are doing congenital cardiac surgery on a pediatric population. So you're, in essence, mending little hearts.
Dr. Suhil Malhotra:
That's correct. So actually my scope of practice is babies, children, and grownups that are born with heart defects. And those heart defects can range from a hole in the heart, all the way to not having a full functioning pumping chamber or a disease of a heart valve that never developed or a narrowing in a major blood vessel. So there's a tremendous amount of variety, tremendous difference in the sizes of the patients I operate on all the way from little premature babies, all the way to, grown adults who may have had multiple surgeries as children, or may have found out that they have a congenital heart defect later in life.
Dr. Lisa Belisle:
How common is that?
Dr. Sunil Malhotra:
Believe it or not, congenital heart defects are the most common birth defect. They occur in almost one in a hundred births. Not all of those defects are serious enough to require surgery, but at least 40 to 50% are.
Dr. Lisa Belisle:
So I think you and I could just go down this medicine rabbit hole for quite a ways. And we will, I promise because I'm fascinated by it. But I wanted to also talk about how you and I first met and that was through the Portland Art Gallery. One day I walked in and I met this person who was in the medical field, who also had a great love of art. And, I remember that you were standing near a Darthea Cross painting similar to the one that's behind us. You have purchased quite a bit of art.
Dr. Sunil Malhotra:
I have. And thank you for helping with my introduction. The gallery was actually my introduction to Portland, Maine. When I first started my position at Maine Medical Center, I was living in an apartment in the Old Port and would walk down to the gallery. I knew that we'd be purchasing a home at some point and I started to have a desire to have a Maine feel, a coastal feel, to our house. I think that a lot of the artists that the Portland Art Gallery represents really reflects a Maine, rugged individualism, but also there's a mood that's generated. That resonates with me with art. I really need to have both the color and the mood that can sort of set a balance if that makes sense to, you know, it's nice to look at these paintings. I have Jean Jack paintings as well. Also Darthea Cross and Helen Lewis and the color use and the emotion that it kind of evokes waxing poetic it sets me on a balance for my day. I don’t know how to quite describe it eloquently, but it kind of rights the ship if that makes sense.
Dr. Lisa Belisle:
I know that you have three children, three boys who are probably very active and energetic given the age ranges all the way from seventh grade to college at this point. Correct?
Dr. Sunil Malhotra:
Yes.
Dr. Lisa Belisle:
So, I'm sure there's a lot of energy in your home. I'm sure you have a lot going on, as we've already said, in your work day. But do you view your home, your space, as your way to come back to center?
Dr. Sunil Malhotra:
Absolutely. The word sanctuary is probably overused but it's really helpful to have that peace and tranquility so that the craziness and chaoticness of my day to day world is balanced
out.
Dr. Lisa Belisle:
I'm going to assume that working with patients who are coming in with something that is actually wrong with their heart, which is very central to us and something that we absolutely cannot live without, I'm going to assume that you are carrying a high level of emotion from their standpoint. How do you balance that out in an encounter with the patients and the families?
Dr. Sunil Malhotra:
Well, that's a huge component of what I do. Obviously, the main purpose of what I am there to do is to go in and fix or repair heart defects and to make the heart work as best as it can and overcome the difficulties that these patients have. But the flip side of that is that there's a patient and more than the patient, there are the families, especially when I’m involved with children. So really the families are your audience and your patients are an extension of your patients. I’m really treating all of them. When I see my patients in the office with their families, it may be that this is the first time they're hearing about heart surgery in detail. So I carry a lot of weight and it's obviously a huge blessing that they entrust the care of their child from such a tenuous time in my hands. So it is a burden, but it's also a responsibility that I cherish.
Dr. Lisa Belisle:
You come from a family that is medical in nature.
Dr. Sunil Malhotra:
I sure do. My father is a physician. He's a retired thoracic surgeon. I grew up in upstate New York and the Hudson Valley. Both of my grandfathers were physicians. My sister is a physician. And then in my wife's family her father and her brother as well as multiple other relatives are all in the medical field. So I would say that, while I didn't always know that I was going to go down a medical pathway, it was that exposure that always kept it in the background. The exposure to these different medical fields and professions were certainly something that was always playing in the background.
Dr. Lisa Belisle:
And as you said, it's a responsibility, but it's also an enormous honor to be part of patient’s lives, to be part of people's lives. And unlike some fields you might choose, it is truly a profession that you dedicate yourself to when you make the decision when you're 16 or 17 year old to go to college, to go to medical school, and to go on through. Is that something that you ever had conversations with your father about, or your grandfathers, or your family members? Or was it just kind of implicit that this is the way that your family was and this is the way that you were going to be?
Dr. Sunil Malhotra:
I'm not sure we had a lot of career counseling at home. My parents were Indian immigrants and they had a very different path in going and achieving their career goals. So the traditional, what I found sort of American way of exploration and education, I guess, journey, appealed to me much more. My parents were of the mind: I should try to go to a medical school that admits you from high school, like a six year or seven year combined medical school. I pushed back a little bit against that. I wanted to have a liberal arts education. I wasn't sure I wanted to go on to medicine, but once I arrived at that journey and it really is a journey because in doing the field that I chose it was 11 years of training after medical school. So I would say it's probably the longest path for any physician or medical specialty. You would have to go. I mean, there were classmates of mine who were brain surgeons who were done four or five years before me. But that being said, I relished the journey I had and it's provided me the opportunity to really follow my dream and that was to be a pediatric heart surgeon.
Dr. Lisa Belisle:
As a result of all of the time that you spent doing this training, you were able to come to Maine and actually start an entirely new program.
Dr. Sunil Malhotra:
That's right Lisa. Pediatric heart surgery had been practiced in various forms in Maine since as early as 1959 or 1960, that might have been the first open heart surgery to repair a child's heart defect. But when Maine Medical had reached out to me they were restarting a program that had been on pause since the previous surgeon had left. But the nice thing about that is that there were so many people who already had experience and had an institutional muscle memory so that coming back and restarting the program and me instituting my vision of what a program should be wasn't too much of a struggle and was actually a lot of fun. It was almost like a startup. The people were very enthusiastic and I should mention that this is a huge team endeavor. There's everyone from the physicians that care for the children, the anesthesiologists, the ICU staff, the ICU nursing. It's a tremendous undertaking and it's really a testament to the real commitment from the administration to put the resources behind doing it the right way.
Dr. Lisa Belisle:
Does Maine have a higher incidence of congenital heart defects than other parts of the country?
Dr. Sunil Malhotra:
Actually it's interesting. I think in Maine a lot of people talk about whether it's more, it's a more aged population or the average age is a little older. So perhaps the birth rate may be lower. We do find that there are regional differences. I find that there are certain heart defects that are more prevalent here than in other places I've practiced. But I'm not sure if there's a higher incidence but it's definitely a real need to have this service in the state, because otherwise you're asking people from all parts of the state to have to go to a regional center like Boston, which is an outstanding institution. It's just very challenging, a lot of hardship for our families to have to, I mean, some of them find Portland challenging. So going to Boston, you can imagine that's a real hardship.
Dr. Lisa Belisle:
Yes. It's true. Where I practice, up in the Augusta/Waterville area, when you tell somebody they're going to Portland it's as if you had said, we're gonna fly you to the moon. Yes. And I think you're right, there's a distance aspect, but it's almost a completely different world to them. And so that much further down to Boston, which is a more urban setting with things like traffic and all of those things on top of this very emotional conversation they're going to be having, you know, related to their heart. I think that would really add up to some stress.
Dr. Sunil Malhotra:
Sure. It's a very stressful time for the families and for us to be able to provide this kind of service here in Maine. I think it takes away a lot of that stress. And it helps towards the healing. And it helps the social situations that a lot of our families are in.
Dr. Lisa Belisle:
You and I were talking before we came on the air about the use of telehealth to reach out to some of these families. Tell me what your experience has been with that.
Dr. Sunil Malhotra:
Yes. So it's an interesting byproduct of our pandemic times. I think that we've found that telehealth goes beyond just being able to see patients that are perhaps affected by COVID. It also enables us to decrease the travel time for some of our patients. If I have to consult a family about an upcoming surgery, I don't necessarily need to be sitting in the room with them. If they have to drive three hours or five hours, it alleviates that and they can be in their living room and we can have the discussion about what, what to expect and going forward, what, what surgery will entail.
Dr. Lisa Belisle:
We've had a lot of conversations about social determinants of health. And this is something that I know I see in, in my part of medicine, the primary care part of medicine but I imagine it also has an impact on the work that you do.
Dr. Sunil Malhotra:
Absolutely. A growing part of our patient population are adults with dental, heart disease, and many of them are children who have graduated into adulthood because our outcomes have improved dramatically with children who need heart surgery. And there are actually more patients now that are adults. They outnumber the children with heart defects. And so what happens typically is as these patients get into their twenties and thirties and they're feeling good, they lose touch with their congenital heart or providers. And the other drawback is, until recently there weren't a lot of opportunities. There wasn't a lot of access for patients who were adults to have adult congenital cardiologists. And fortunately we've developed an adult congenital program, a center for adults with congenital heart disease with two providers that we've recently recruited that are fully boarded adult Conant cardiologists, which is a relatively new board specialty. so that it allows us to bridge that gap for these patients that have had a fair amount of I guess, loss to follow up,
Dr. Lisa Belisle:
Switching gears, back to the art realm having a sister and a brother who are both surgeons and also in-laws who are surgeons. I know that they tend to be very visual individuals. Both with them, both my sister and my brother are orthopedic surgeons, so they specifically are dealing with, you know, bones, joints, muscles. I'm guessing that if you're dealing with what tends to be on the small side of hearts, you also must have a fairly strong visual sense and a pretty strong attachment to kind of the visual way of learning and the visual style of interacting with the world.
Dr. Sunil Malhotra:
You're absolutely right. The the kind of work that I do involves a lot of geometry, a lot of three dimensional thinking when I'm recreating a wall in a in the heart or a blood vessel or making a heart valve work, you have to think in very much a three dimensional way, and you're designing these patches and these reconstructions that really have to work in a organic manner. So it is very much three dimensional thinking. It's three dimensional views of, of how things work – there's a lot of geometry involved. It's all visual. It's, it's, it's all you know, sometimes even visualization before you go into the operating room. Sometimes we print out models using 3D printing to look at how I am going to approach this surgically planning, planning that. So it's an extremely visual field and it's one of the things that really drew me to the field because each surgery is a little different and the variety of the surgeries really keep me engaged. It’s the challenge of being able to do that reconstruction of the heart and make it work in a three dimensional fashion. That is the exciting challenge for me.
Dr. Lisa Belisle:
So when you talk about geometry I can't help but think about the piece behind us and Darthy across, and, and this idea of essentially geometric shapes, I mean, obviously kind of geometric, but in a, a kind of with a twist to the, my guess, which actually is a little bit like a heart because hearts obviously don't have perfect, you know, parallelograms within them. Do you think that this is one of the reasons why when you look at a work by Darthea Cross you think, oh, that's something that really appeals to me
Dr. Sunil Malhotra:
Most likely. I'm not I'm not good at psychoanalyzing myself, but I think if you probed a little bit, you would see that I probably do connect with the almost I would abnormal geometry of some of these, you know, the it's an organic geometry because they're, you're right. They're not perfect squares or shapes, but there are shapes that are a representation of what we see in nature. I think, you know, these shapes are formed by contact with the water or the sea, and these types of shapes are organic. And that's the interpretation by the artist is, is what I find very compelling
Dr. Lisa Belisle:
When you were younger. How did this visual sense manifest itself, how, when you were growing up, did you have an interest in art? Did you have an interest in photography? Was there some way that you were kind of developing as a child that you already knew that this is a direction you were heading in?
Dr. Sunil Malhotra:
Not at all. I honestly I was a horrible artist. I never colored in the lines. I had the most awful penmanship, maybe that was the prerequisite of going into medicine not breaking any stereotypes. But I think during my upbringing, I was always drawn to complexity. For example when I had to choose an instrument in fifth grade to play, I chose the French horn because I was told it was the hardest to play. It was designed with all this tubing and it really required you to, you know, use a special use of your diaphragm to get the different pitches. Needless to say, I wasn't very good at it, but that was the reason I chose it because I thought it was the most complex instrument to try to play. I would say that I never really took the easy classes for better or for worse when I was in college.
Dr. Sunil Malhotra:
You know, I could have majored in anything, but I really loved chemistry and biochemistry. I took physical chemistry and I didn't even take chemistry for pre-meds. I took it for the chem majors because I wanted that challenge and the grades weren't always the best, but it was that. I think it's always that complexity that keeps me interested and keeps me engaged. And I think that's what ultimately drew me to congenital heart surgery, because there are, you know, 20 to 25 different heart defects. There's probably 40 different kinds of operations we can do. The level of complexity and the nuance from patient to patient varies. The problem solving behind how to tackle each one is different. I hope that answers your question, but I think that more than the artistic part is that complex nature of systems is what is always sort of driven me
Dr. Lisa Belisle:
Well, there's I'm, I now feel much more attached to you because as a fellow player of French horn, and, and I would admit extremely bad player of French horn, I had the same kind of experience, which was here's this instrument, nobody else's playing it, we need one, it's kind hard to play, see what you could do with it. And I was like, all right, well, that's fine. Let's jump on in. But, I don't think that that is a normal response. I think that there is more of a tendency towards safety towards simplicity. And in these last few years of the pandemic, we've seen that systems complexity is a very real thing. And I think for some people it's been a time of real fear and anxiety and withdrawal. And for other people it's kind of a moving towards where would you fall on that spectrum?
Dr. Sunil Malhotra:
Yes. So the last couple years have been challenging for society in general. People have had struggles dealing with, from a health standpoint, from a mental health standpoint. I feel fortunate that I have support systems in place, whether it be family, extended family, or my career that have kept me in the structure that, that helps me keep going. But there are obviously – remote work has given people a lot of freedom in ways and that a lot of that maybe long lasting beyond the pandemic. But I was happy to have the structures in place that I had that I think helped me get through what was a challenging time.
Dr. Lisa Belisle:
So given that you had these structures in place, there were probably the same issues that all of us in healthcare had: patients couldn't come into the office. I know that you probably had surgeries that had to be canceled and rescheduled. Did you feel because you had this background in kind of tackling difficult things it seemed somehow less intimidating to you?
Dr. Sunil Malhotra:
Yes. I think we had unknowns around every corner every week. It would be a new challenge and some challenges were insurmountable because of the fixed nature of them such as, because of the pandemic, fewer people going to donate blood. So we didn't have enough bank blood in our store, to do the surgeries, or we'd have to get creative and figure out how to stratify the surgery so that we could do one kind of surgery that would be less taxing on the system first and then try to get the other surgery in the following week. So you had to be able to make decisions on the fly. You had to be able to you know, there were curve balls thrown at us that we didn't even anticipate because of the pandemic, that affected systems that affected supply chain issues. So you really had to be prepared. It was really incumbent upon us to have open communication with all different aspects of the medical center to really plan the best way to be able to treat our patients. And we basically had to pivot from week to week. I'd say because of the teamwork we had, we were able to get through it.
Dr. Lisa Belisle:
You have a very impressive resume, you know, Cornell and Stanford University of California at San Francisco. I mean, the list goes on. So it's interesting that you would say I approached these classes. Maybe I didn't get the best grades, but I think it's pretty important for people to understand that you, you still did very well for yourself. Do you think as part of this education, what you were learning was not just content, but also how to think, how to approach learning and the way that you were going to look at your professional development?
Dr. Sunil Malhotra:
Oh, absolutely. I mean, I always say that the journey that I went on was tremendous for me and my personal growth. There are times along the way where I did things that were a little bit unconventional such as during my general surgery residency. I took two years out to do research in the University California, San Francisco where I was able to do this cutting edge work on fetal heart surgery on looking at the effects of what we were doing on the, the pulmonary vasculature and to be able to think, take yourself out of clinical medicine and go into the scientific method and learn how to construct experiments, how to make scientific models and to do national presentations. That's a whole different skill set that I didn't have. And so all those things add up in terms of how you analyze literature, how you improve your practices. So I think certainly my career development was stronger for it.
Dr. Lisa Belisle:
You also have done research that I find very interesting because I deal with a lot of the after effects of say surgical intervention and this is research in the neurodevelopment, the longitudinal neurodevelopment of patients after heart surgery, which is to say, once you have operated on them, how, how did their brains and their thought processes kind of exist within the world? So why did you get interested in that in the first place?
Dr. Sunil Malhotra:
The reason was because, you know, pediatric heart surgery is in the scheme of medical treatments relatively young. I'd say we've only been practicing modern pediatric cardiac surgery probably for the last 30 years and over the last probably 15 years we've really refined our outcomes. So we actually do a very good job of getting patients through the surgery and having survivors, even with very critical heart defects that would've been lethal 40 years ago. So while we have these survivors that are doing better and better, they're not always thriving after they have their repairs, they have insults to brain development and cognitive skills learning and school higher level executive functioning. A whole branch of developmental neurodevelopmental cardiology came out to follow these kids and really watch what, how these kids develop.
Dr. Sunil Malhotra:
And so some of the research I've done is to look at, is there anything we are doing during surgery that can tell us if there is an impact on brain injury. And so I had looked at some biomarkers that look at brain injury, either white matter or gray matter brain injury and it helped us streamline and inform our discussions with families about what could kind of operations can impact the children and what they can expect growing up and the children after heart surgery still need to be followed in a neurodevelopmental fashion so that we know where their deficits may lie and we can attend to them.
Dr. Lisa Belisle:
So that's, that's interesting because during that same timeframe, we were recognizing that adults who had had issues who had had a cardiac arrest, for example, they'd come out on the other side, they'd have memory loss, they'd have depression. It would really impact them socially and emotionally. And I do believe that it's really within the last say 25 years, that this is something that we've put more of an effort into addressing. But prior to that, it's not necessarily something we would think of, this is in this part of you, and this is in this part of you. So thinking about the patient as a whole person and whatever impact you are making kind of on this part when they're younger and how that moves forward longitudinally that puts an added responsibility on you.
Dr. Sunil Malhotra:
It absolutely does. But it's a responsibility that we have to bear because we are committed to the treatment of the whole patient. And when you're operating on a baby or a child, the rewarding part of it is that you've given them now another 70 years, 80 years of life. But you also want to make sure that they have a quality of life. And I think that's what a lot of our work has been towards minimizing trauma, minimizing social psychological impact of surgery and and minimizing the the effects that we have on the other organ systems, such as the brain.
Dr. Lisa Belisle:
You recently went to Kenya. So you're doing work not only in our wonderful state here in Maine, but also in other parts of the world. Why Kenya and why is that important to you?
Dr. Sunil Malhotra:
Thanks for bringing that up. Lisa, that was a very rewarding trip that our team took back in November. It was a team predominantly from Maine Medical Center that has had a longstanding relationship with Tenwek hospital in Kenya. This is a relatively high functioning hospital that really needs the expertise of both the surgical expertise and the ICU intensive care nursing to be able to handle the burden of doing pediatric heart surgery on this population in Kenya where it's heartbreaking because there's so many patients waiting for surgery that we actually have to really prioritize. We're there for a week we parachute in and then, and leave. But the important thing is, is that we are teaching their local surgeons how to manage these so that if a very sick child comes in, they need to manage it.
Dr. Sunil Malhotra:
They can do the surgery but it was very busy. We operated on twelve children in five days with very good results. And like I said, we participate in teaching the surgical trainees there. We gave them lectures, the nurses taught the nurses that were there. So we're really trying to strengthen their infrastructure so that they don't have to be so reliant on these teams. Unfortunately, many of the teams had to cancel their trips because of COVID and not being able to bring travel to Africa, but we were fortunate to be able to have that impact. And it's a huge impact. It's very rewarding.
Dr. Lisa Belisle
Do you ever think about health equity? It sounds like if by going to Kenya, you're acknowledging and you're participating in creating improved health equity globally. And by being here in Maine and trying to do things for patients around the state, you're thinking about health equity. Is this something that you put any kind of conscious thought into or is it something that you just “live” and do on a daily basis?
Dr. Sunil Malhotra:
I'll be honest, it wasn't something that was top of mind as I was going through my training journey. I think as a physician, who's part of a greater society, that's something that I think I become more aware of. That we have to be cognizant of not only being able to provide access to all groups of patients, but also to be mindful of cultural differences. We have a number of immigrant communities in and around Portland, and Maine, that see things differently. Sometimes there's shame associated with sickness and illness. And we try to acknowledge that and encourage the community that they come from to support them. So there is a lot of emphasis, and awareness now of equity, whether it be with patients that have different sexual orientation, the LGBTQ community or whether it be along racial or socioeconomic lines. I think those are all positive movements in our field to be fully aware of those considerations.
Dr. Lisa Belisle:
Do you think that your own family background helped you to think about equity and inclusion as you moved forward in your own career?
Dr. Sunil Malhotra:
Well, Lisa, I think my experiences as non-Caucasian growing up in, like I said, I grew up in the Hudson Valley. it was a very predominantly white, you know, people weren't necessarily aware of the immigrant experience, at least non-European immigrant experience. So there were certainly instances that along my travels, my journey, that were challenging interactions et cetera. Mostly stemming from ignorance. I think that those experiences informed me and my development going forward.
Dr. Lisa Belisle:
Well, I'm, I'm interested in this and in your experience in particular, because Maine, you know, you, you are practicing in a part of the state that does have some pockets of certainly kind of cultural diversity. I would say that the, you know, a large part of Maine is not particularly diverse except maybe socioeconomically diverse. And so in working with some of the physicians I've worked with up in my part of Maine, I know sometimes there's been some question about whether they are accepted within the community, that is not that diverse. And, I know that sometimes it can be painful because you are working toward the greater good, and you're really dedicated in your life to something that's important. So to feel as if maybe you're not accepted for the person that you are, I've seen a certain amount of challenge in accepting that, is that something you've ever experienced?
Dr. Sunil Malhotra:
It's I think pretty rare in what I do, because I think regardless of your background when you're meeting a physician who's going to be operating on your child and your child has you know, maybe you just received this devastating diagnosis or this challenging situation. I think there's common threads across cultures that we want to be very, very protective of our children. And so what I find is that there's the families just looking for comfort, looking for security, looking that their child will be taken care of and will have quality care. I think that's probably top of mind for them for the patients that I see. There's always nuances with different experiences with different communities which we have to take into consideration. But I think the gravity of the situation that these families find themselves in is, kind of trumps everything else, if that makes sense.
Dr. Lisa Belisle:
So it sounds like the context and the perspective for you is perhaps different than maybe a family doctor who's trying to practice in the middle of Maine. Balso the shared humanity that you're describing is really the most important thing and coming to a place of commonality and trying to understand each other as human beings is probably the most important thing.
Dr. Sunil Malhotra:
I agree with that.
Dr. Lisa Belisle:
Some pretty heavy topics we're talking about for a show that typically deals with art. So I appreciate your willingness to walk this path with me. Your three boys and your wife, how do they like Maine?
Dr. Sunil Malhotra:
They have enjoyed Maine. My wife is getting used to the winters. She has her own studio that she works in. We have a barn on our property that is also her office. She is a brand consultant and a brand photographer. So I think that's nice for her to be able to step out of the house and go to her workspace. And the nice thing is that we need to have a lot of light. So even if it's cold outside a bright light at least can lift your mood when you're working away. And my kids have really enjoyed it. One of my sons is really a sports fan. He's got a job with the Maine Celtics. So he's enjoying the sports scene here. My oldest son came here when he was finishing high school, so he's off at college. And my youngest son is also enjoying Maine.
Dr. Lisa Belisle:
Well, we are very happy to have you here, and I'm really pleased that you were willing to take the time out of your day to come and have a conversation with me. I've certainly learned a lot about you. And it's nice to have a fellow art lover and physician and French Horn player to have a conversation with.
Dr. Sunil Malhotra:
Who knew, Lisa. Well, my pleasure and thanks so much for the opportunity.
Dr. Lisa Belisle:
I've been speaking with Dr. Sunil Malhotra and this is Dr. Lisa Belisle for Radio Maine. Please learn more about artists Jean Jack, Darthea Cross and Helen Lewis at the Portland Art Gallery website. And hopefully you'll come visit someday and you'll get to meet Dr. Sunil Malhotra at one of our openings.
Thank you for coming in today.
Dr. Sunil Malhotra:
Thank you.