I need help interpreting an xray

[Weirdy]

My last post was too bitter. So I bring you this beautiful podiatry tale. Obviously this wasn't inspired by anyone here. This is very clearly all original material.




The soft hum of anesthesia doing a crossword radiates from the top of the bed. Further down, a leg sits exposed in an overly complicated state of prep.

The sprawling OR is full to the brim with 15 different sets of hardware. Additional back tables have been borrowed from all across the hospital. An experienced tech lectures a young protégé.

“…now normally you wouldn’t be allowed in this room, but I thought this could be good for to begin familiarizing yourself with the...”

“Do we usually scrub podiatry cases?” the tech interrupts.

A gasp fractures the air from behind her mentor's mask.

“We scrub FELLOWSHIP trained foot and ankle surgery cases in this OR. Use that word again and I’ll have you in some orthopedic shoulder case trying to figure out what’s happening with a scope that doesn’t point straight…”

The tirade is cut short by the door opening.

A merry, manly laugh cuts the air, “I’m here, I’m here, shut up anesthesia, I’m here. A surgeon is here.”

Dr. Fellowbro strode into the room confidently. Immediately, he is followed by three lady device reps, each more beautiful and expensive than the last, ready to shower him with new indications for their many screws, and staples, plates, and placentas. A lone bro rep also enters, there to share in stories of his doctor’s conquests.

What can we say of Dr. Fellowbro – he is unbent by his many years of training and additional and totally necessary fellowship year. A customized lead apron sits lightly on his shoulders. Close examination would show it is covered in tibias, fibulas, calcanei – the only bones worth operating on as he would say – and dollar bills – what everything he touches turns into. The words “Foot and Ankle Surgeon” are emblazoned, XXL.

“Shall we do our time out?” the circulator asks?

“Of course. Our patient went to see a pathetic old toediatrist who couldn’t even put a needle in their ankle.”

“And what will we be doing today?”

“A TAR of my choice – I have 3 in the room, Koutsy-gots-to-get-paid, gastrocnemius recession with sural nerve obliteration, subtalar joint arthroscopy – anterior and posterior, lapidouchey, a new form of lapidus that makes Paragon and Biomet’s nails look like cavemen with sticks, and then I’ll be placing 4 different toe implants as a form of a controlled trial. I also want to try out a new technique I saw on My Feet are Killing Me… just kidding, gross.”

“Excellent. Doctor, we also have a podiatry resident here who was hoping to scrub in.”

“Ah yes, the residency the hospital started to make more money. I’m surprised they let you out clinic. Welcome. I remember when I used to be a podiatrist. You’ll of course want to do an Arthrex Approved Fellowship when you graduate. Stand here to retract.”

“Don’t you mean ACFAS?”

“No, and also I will need you to round on this patient tomorrow because they are going to be in a lot of pain. Now someone bring me my blade. The one I invented that cuts straight down to the periosteum but avoids neurovascular structures.”

“Doctor”, one of the reps interrupts, “shall I take pictures during the case?”

“Of course my rep – pictures are the lifeblood of my presentations. Why, I remember when I was a FELLOW presenting my attendings’ cases at ACFAS – people just loved it. Nothing like presenting a case you haven’t followed at all that you just know went perfectly. People can really learn from that.”

“Tourniquet up?”

“Of course. What is this – the PI Institute? We’ll need to be efficient today. I have a busy day planned after this case. Yesssss…

I’m starting the day off with a conference call to try and get non-Fellowship trained podiatrists banned from doing ankles. I’ve heard wonderful stories from the northeast of doctors working together to screw young PMSR/RRA surgeons, dinosaurs really, from operating, and I want to help.”

“Great idea.”

“And then, very ironically, I’m going to do some out of network $1000 nail avulsions for patients from Louisiana. Apparently they don’t have podiatrists there or something.”

“Very noble”.

Dr. Fellowbro’s attention returned to the ankle – his precise cuts exposing the anatomy. His skills – legendary – why Schuberth had allowed him to make TAR cuts as a visiting student! But something wasn’t right. The light wavered, the vision changed.

“Doctor?”

Where once there had been an exposed ankle, now a disgusting fungal toenail.

“Hey DOC, you cut the nails too short last time on that toe and left it too long on the other.”

The beautiful scalpel transformed into a pair of nail nippers. The nail exploded in a cloud of dust, shimmering and disappearing into the stale air like dreams in the breeze.”

A curt rap on the door is followed by the face of one of the nurses he couldn’t fire.

“Ms. Blah says you missed a callus and also she needs to come back in exactly 60 days, not 3 months.”

Exiting the room Dr. Sadbro is met by the office manager, his boss’ wife.

“Oh doc, you were asking me about your collections. Yes, they are currently zero because you are still on my husband’s insurance plans. But don’t worry, we’ve got you on a great base salary.”

I am speechless sir.
Will you remember us after your Pulitzer?

---

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[GreenHousePub]

The sprawling OR is full to the brim with 15 different sets of hardware. Additional back tables have been borrowed from all across the hospital.

please make this it's own post

 

[air bud]

We should start a gofundme to show appreciation for this work of literary art....and have all proceeds go to a scholarship for future podiatry students....so this all comes full circle.

 

[deleted1003403]

holy **** lmao

 

[CutsWithFury]

Worst thing about this show is that my diabetic patients want their toenails filed down with a burr. I’m never doing that. EVER.

Thanks Dr. Brad


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[air bud]

Worst thing about this show is that my diabetic patients want their toenails filed down with a burr. I’m never doing that. EVER.

Thanks Dr. Brad


Sent from my iPhone using SDN

Yeah F that. Nail nippers and I try to not create sharp edge. I am not breathing in that crap I don't care what type of vacuum system there is

 

[Pronation]

Worst thing about this show is that my diabetic patients want their toenails filed down with a burr. I’m never doing that. EVER.

Thanks Dr. Brad


Sent from my iPhone using SDN

that’s not happening. They can go elsewhere.

 

[ExperiencedDPM]

Saw another episode of my feet are killing me. The male doctor is a bit of a drama queen. Every time he sees some pathology, he has to announce “I’ve never seen one like this before”. Wow, that’s a confidence killer for a new patient.

And EVERY time he’s in the OR he runs into some issue and states “this isn’t good”. Another confidence booster.

For some reason, he has another DPM in every case he performs. Do you really need another DPM for a digital fusion? Then he performs a digital fusion with a KWire and when he starts the contralateral foot, it shows that 33 minutes have elapsed!! 33 minutes to perform a digital fusion with a K wire? My residents do that in under 10 min.

Pathetic.

 

[deleted1003403]

Didn’t he do his residency in hoboken though? I thought that was a good program

 

[DYK343]

Saw another episode of my feet are killing me. The male doctor is a bit of a drama queen. Every time he sees some pathology, he has to announce “I’ve never seen one like this before”. Wow, that’s a confidence killer for a new patient.

And EVERY time he’s in the OR he runs into some issue and states “this isn’t good”. Another confidence booster.

For some reason, he has another DPM in every case he performs. Do you really need another DPM for a digital fusion? Then he performs a digital fusion with a KWire and when he starts the contralateral foot, it shows that 33 minutes have elapsed!! 33 minutes to perform a digital fusion with a K wire? My residents do that in under 10 min.

Pathetic.

Possible TV requires more time. If they are taking shots for TV I could see it taking 33min for camera angle, etc, etc. That's horrible for the patient due to increased tourniquet time and increase chances infection but I can nearly guarantee that's what took 33min.

I did a midfoot fusion last week with a large C-arm. The operator wasted about 45min of my tourniquet time because she just couldnt figure out how to use the C-arm correctly.

I saw an episode where he treated a fairly large bunion but nothing we dont see on a regular basis. He made it sound as if it was the most rare bunion hes ever seen. TV is TV. All about the ratings and suspense. But I agree doesnt give good confidence to viewers but then again I have had a lot of people in the recent weeks ask me about the show. My general perception is the public finds it interesting and I am getting office visits due to the show. The bunion correction he did did look good. Lapiplasty.

 

[CutsWithFury]

Possible TV requires more time. If they are taking shots for TV I could see it taking 33min for camera angle, etc, etc. That's horrible for the patient due to increased tourniquet time and increase chances infection but I can nearly guarantee that's what took 33min.

I did a midfoot fusion last week with a large C-arm. The operator wasted about 45min of my tourniquet time because she just couldnt figure out how to use the C-arm correctly.

I saw an episode where he treated a fairly large bunion but nothing we dont see on a regular basis. He made it sound as if it was the most rare bunion hes ever seen. TV is TV. All about the ratings and suspense. But I agree doesnt give good confidence to viewers but then again I have had a lot of people in the recent weeks ask me about the show. My general perception is the public finds it interesting and I am getting office visits due to the show. The bunion correction he did did look good. Lapiplasty.

My radiology techs are equally useless. Since I’m podiatrist I always get the least trained tech working my cases. I try to avoid large C-Arm as much as possible for this reason.

The show has raised awareness on podiatry which is a good thing even though the show is ridiculous in our eyes. The public literally has zero clue and most of my patients find it entertaining.

I do take exception to the DPMs on the show stating they are leaders in the profession and instantly being considered some of our top doctors. In this respect it’s a tragedy that guys like Justin Fleming or Shannon Rush were not on the show. I’ve seen both operate and they are wizards in the OR. Now THAT would have been eye opening for not only the public but for MD/DO to see how highly skilled DPMs work in the OR.


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[heybrother]

I sat up when they said 33 minutes. I didn't rewatch it to confirm, but he also made a remark to the effect of - let's go to the other foot and then we'll come back to this one to check fluoro. Wondered ... did he drop the tourniquet on the 1st foot while he did the second?

The lapidus episode made me cringe when he made a remark about finding the joint or about being surprised by how proximal it is. Yeah, its way proximal if your incision starts at the MPJ.

The giant toe episode surgical discussion was only topped in its awfulness by the callus distraction discussion. I spoke to you and gave you choices but I just looked at your X-ray and realized your MPJ is bad so I'm going to back out of my debulking procedure (what did that even mean?) to you you need an amp and then I gracelessly squeeze in you need 4 amps, no actually you need a TMA. You can amputate multiple toes without doing a TMA. The guy apparently dehisced his toe amp so we should be grateful it wasn't a TMA I guess.

My wife is the primary driver of me having to watch this show and she is not a podiatrist. I semi-routinely rant that a lot of foot surgery is garbage and she really felt that way about the brachymet episode. The final clinical appearance - a still very short 4th toe and a huge keloid on a 2nd toe the patient didn't actually complain about (and they showed the X-rays for the briefest of seconds showing no osseous contact in the implant laden toes). Also, how much did that damn case cost. 2 toe implants, a cadaver bone graft, a plate and like 5 screws?

Syndactilization girl? The more she cried about being made fun the more I thought - you don't need a podiatrist, you need a psychiatrist. Imagine how traumatized someone that unstable would have been if she'd lost her 2 toes. Also, all that talk about toes never remain pale for more than 30 seconds to a minute? I don't think that's the case.