TLC/My Feet Are Killing Me

[ExperiencedDPM]

I know the TLC show has been discussed on here. I know that it’s supposedly good to expose the public to what we do.

The two DPMs are attractive and seem to be “nice” people. The female is much more articulate and seems to have better surgical skills. She works without an assistant on her cases.

The guy is ALWAYS running into complications intra op and to say he’s dramatic would be an understatement. He ALWAYS has an assistant on his cases.

On the most recent show, he did a Lapidus and had to address the met adductus on the 2nd and 3rd met. I couldn’t watch the entire episode but I know he did fusions or angular corrections.

Regardless, it took him 4.5 hours!!

I have yet to see him do any case unassisted, without drama or without complications. I understand that drama sells on TV, but eventually someone has to figure out that this guy has some issues in the OR.

Having a patient under anesthesia for 4.5 hours for the procedures he performed is a serious concern. If he took that long at a facility where I’m on staff, he’d be sitting in front of a board explaining himself.

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[heybrother]

If you want a high tourniquet time, watch the bilateral lapiplasty episode.

 

[CutsWithFury]

I know the TLC show has been discussed on here. I know that it’s supposedly good to expose the public to what we do.

The two DPMs are attractive and seem to be “nice” people. The female is much more articulate and seems to have better surgical skills. She works without an assistant on her cases.

The guy is ALWAYS running into complications intra op and to say he’s dramatic would be an understatement. He ALWAYS has an assistant on his cases.

On the most recent show, he did a Lapidus and had to address the met adductus on the 2nd and 3rd met. I couldn’t watch the entire episode but I know he did fusions or angular corrections.

Regardless, it took him 4.5 hours!!

I have yet to see him do any case unassisted, without drama or without complications. I understand that drama sells on TV, but eventually someone has to figure out that this guy has some issues in the OR.

Having a patient under anesthesia for 4.5 hours for the procedures he performed is a serious concern. If he took that long at a facility where I’m on staff, he’d be sitting in front of a board explaining himself.

He practices in New Jersey. New Jersey is crap show for podiatry. It’s very common there for podiatrists to have other podiatrists scrub with them. I saw it extensively on almost every case I observed as a student externing at a program in New Jersey way back in the day.

You can’t criticize someone for taking too long. You answer to the privileging committee if you assault someone by performing a poor surgery which caused significant harm to the patient. I’ve seen some ACFAS lecturers take forever to do straightforward trauma.


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[ExperiencedDPM]

He practices in New Jersey. New Jersey is crap show for podiatry. It’s very common there for podiatrists to have other podiatrists scrub with them. I saw it extensively on almost every case I observed as a student externing at a program in New Jersey way back in the day.

You can’t criticize someone for taking too long. You answer to the privileging committee if you assault someone by performing a poor surgery which caused significant harm to the patient. I’ve seen some ACFAS lecturers take forever to do straightforward trauma.


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You can absolutely question a surgeon who takes excessively long. I have been on committees that DID question surgeons. There are many concerns involved. Cost is the least concern. Patient safety is the primary concern. There’s no justification for an arthrodesis of 3 midfoot joints to take 4.5 hours. That shows concern for surgeon competency. The surgeon needs to explain why he/she took excessive time. Was there a complication? Was there hardware failure, was there a delay due to inadequate equipment or supplies in the OR, was it an issue with the C-arm, etc., etc.

Some surgeons are slower than others, but excessive time for cases is something that does require answers. It’s not a lynching, it’s an inquiry.

 

[heybrother]

How about a surgeon who takes too many c-arm shots. Is 200 and then resetting the machine and popping a few more over the top for an Austin+tailor's bunion osteotomy? Cause I saw it once and it was painful, but just thinking about it - I'd love for the surgeon save each shot at one of those places where radiology reviews everything after the fact. Thanks radiology.

 

[Scrantonicity]

You can absolutely question a surgeon who takes excessively long. I have been on committees that DID question surgeons. There are many concerns involved. Cost is the least concern. Patient safety is the primary concern. There’s no justification for an arthrodesis of 3 midfoot joints to take 4.5 hours. That shows concern for surgeon competency. The surgeon needs to explain why he/she took excessive time. Was there a complication? Was there hardware failure, was there a delay due to inadequate equipment or supplies in the OR, was it an issue with the C-arm, etc., etc.

Some surgeons are slower than others, but excessive time for cases is something that does require answers. It’s not a lynching, it’s an inquiry.

I'm sure my 30 minute Austin bunionectomies would take 2 hours if I was trying to explain everything (and be dramatic) and play to the camera. Plus you have to keep moving the back table around for the camera crew to get a different angle. I would probably try to keep the surgery time a better secret though haha...or maybe saying it took 4.5 hours makes it seem much more of an important/complicated surgery to the public. Anyways, I don't know why we try to criticize this show so much--it's a TV SHOW! Totally different world than what we live in. They probably ship these patients in from across the country and make them sign consents saying they are OK about going to sleep for 6 plus hours lol.

 

[DexterMorganSK]

A piece from PM News, it's a shame they didn't mention Podiatry or DPM in the FoxNews article.

The article is: Is your toenail infected? How to spot the signs

 

[ExperiencedDPM]

So last night I was at a friend’s house appreciating a good single malt scotch. His wife called me into the other room to see part of an episode of this show.

The patient was a middle aged male with arthritic deformities of the MTPJs with severe digital deformities.

The patient is a diabetic. I watch the doctor struggle with a first MTPJ arthrodesis.

Then he addresses the lesser metatarsal deformities and makes ONE big ass transverse incision across the forefoot to resect the met heads.

I turned to his wife and said “this isn’t going to end well”. She asked why and I told her that this is not the type of patient who you want to make this type of incision on due to possible vascular compromise.

The next scene is Dr. “Brad” talking in a somber tone. He said that the initial post op looked great and the patient went back home for post op care in his state. And then Dr. Brad informs us that things started going downhill. The toes got black and the end result is that the patient underwent a TMA performed by someone else.

They then show the guy back in his office post TMA and Dr. Brad said the goal of surgery was to eliminate the deformity and pain and now the patient has no pain.

So maybe we should all perform a TMA for forefoot deformities for a more definitive one time treatment.

I have to believe this surgery , which was seen on TV will eventually end up in a lawsuit.

This guy’s surgical skills scare me. I watched him run into complications performing a toe amp WITH an assistant!

If you want to have a show like this it would be great to have someone who is skilled and at the top of his/her game, not just a pretty face.

 

[NobodyDPM]

He practices in New Jersey. New Jersey is crap show for podiatry. It’s very common there for podiatrists to have other podiatrists scrub with them. I saw it extensively on almost every case I observed as a student externing at a program in New Jersey way back in the day.

You can’t criticize someone for taking too long. You answer to the privileging committee if you assault someone by performing a poor surgery which caused significant harm to the patient. I’ve seen some ACFAS lecturers take forever to do straightforward trauma.


Sent from my iPhone using SDN

Bold mine.

LMAO...NJ is not more or less of a crap show for Podiatry than any other state. And no, it's not "very common" across the state. How many Podiatrists do you actually know in NJ? I practice in NJ btw.

 

[air bud]

So last night I was at a friend’s house appreciating a good single malt scotch. His wife called me into the other room to see part of an episode of this show.

The patient was a middle aged male with arthritic deformities of the MTPJs with severe digital deformities.

The patient is a diabetic. I watch the doctor struggle with a first MTPJ arthrodesis.

Then he addresses the lesser metatarsal deformities and makes ONE big ass transverse incision across the forefoot to resect the met heads.

I turned to his wife and said “this isn’t going to end well”. She asked why and I told her that this is not the type of patient who you want to make this type of incision on due to possible vascular compromise.

The next scene is Dr. “Brad” talking in a somber tone. He said that the initial post op looked great and the patient went back home for post op care in his state. And then Dr. Brad informs us that things started going downhill. The toes got black and the end result is that the patient underwent a TMA performed by someone else.

They then show the guy back in his office post TMA and Dr. Brad said the goal of surgery was to eliminate the deformity and pain and now the patient has no pain.

So maybe we should all perform a TMA for forefoot deformities for a more definitive one time treatment.

I have to believe this surgery , which was seen on TV will eventually end up in a lawsuit.

This guy’s surgical skills scare me. I watched him run into complications performing a toe amp WITH an assistant!

If you want to have a show like this it would be great to have someone who is skilled and at the top of his/her game, not just a pretty face.

Obviously you don't know how TV works.

 

[deleted285117]

TMA for a couple hammertoes? Sign me up ✋🤪

 

[Feli]

There are all kinds of crap surgeons out there (in many specialties). It is sad, it does make the competent ones look better and more in-demand in the end. I wouldn't worry about TV/movie stuff though... it's not real.

The worst of all is probably plastic surgery... tons of MD/DOs who are not board cert for plastics and sometimes not even plastics trained or cert in gen surgery - sometimes not even any surgery residency at all... just a "course" or two. They're masquerading as "plastic surgeon," advertising on the radio, and often disfiguring people who are looking to save a buck.

All you can really do is suggest patients get a surgeon who is certified by the appropriate recognized board (ABFAS in our case, or ABMS member boards for MDs)... and then let the chips fall where they may. Most people think a foot doctor is a foot doctor. It can't be helped if people are stupid enough to just open the yellow pages or use FBook or google to find the nearest for a professional service (law, surgery, mechanic, architect, etc). If they're not smart enough to even ask another doc or search the appropriate board website 'find a doctor,' then that's a problem. The 'board certified' docs who write a check to a non-recognized board (with an official-sounding name) to fake credibility to the unknowing public and privilege at smallish hospitals sure don't help either; we are one of the few specialties with fake boards available. Again, it all comes out in the wash... maybe it's natural selection? 🤐

 

[HardRoadPaved]

Dr. "Brad" is foot certified by ABFAS so guess keep him away from those RRA cases! He was trained at even the finest orthopedic/podiatry powerhouse programs in Hoboken! Prolly the good part about that transverse incision is that it kept a good dorsal flap for a TMA rather than the interspace incisions.

The worst of all is probably plastic surgery... tons of MD/DOs who are not board cert for plastics and sometimes not even plastics trained or cert in gen surgery - sometimes not even any surgery residency at all... just a "course" or two. They're masquerading as "plastic surgeon," advertising on the radio, and often disfiguring people who are looking to save a buck.

The plastic surgeon show on E! called Botched shows what trainwreck docs are out there. They always ask if the doc that did their sx was board cert in plastics and they always get a puzzled look from the patient.

 

[Feli]

...He said that the initial post op looked great and the patient went back home ...

Famous and common words of surgeons everywhere. A lot of things look good on the table. Follow-up is always the enemy of "good" surgery.

...The two DPMs are attractive and seem to be “nice” people...

Meee tooooo. I always tell people working at the hospital that good looks are a requirement to get into podiatry school. They nod in agreement.

And I do quality work to boot. Kwayzee.

 

[NobodyDPM]

Famous and common words of surgeons everywhere. A lot of things look good on the table. Follow-up is always the enemy of "good" surgery.


Meee tooooo. I always tell people working at the hospital that good looks are a requirement to get into podiatry school. They nod in agreement.

And I do quality work to boot. Kwayzee.

Well crap. I must have lucked out. I'm ugly AF.

 

[HardRoadPaved]

Well crap. I must have lucked out. I'm ugly AF.

It's ok you live in Jersey

 

[heybrother]

They can make a Dr. Brad Blooper reel.

 

[msuDPM]

So last night I was at a friend’s house appreciating a good single malt scotch. His wife called me into the other room to see part of an episode of this show.

The patient was a middle aged male with arthritic deformities of the MTPJs with severe digital deformities.

The patient is a diabetic. I watch the doctor struggle with a first MTPJ arthrodesis.

Then he addresses the lesser metatarsal deformities and makes ONE big ass transverse incision across the forefoot to resect the met heads.

I turned to his wife and said “this isn’t going to end well”. She asked why and I told her that this is not the type of patient who you want to make this type of incision on due to possible vascular compromise.

The next scene is Dr. “Brad” talking in a somber tone. He said that the initial post op looked great and the patient went back home for post op care in his state. And then Dr. Brad informs us that things started going downhill. The toes got black and the end result is that the patient underwent a TMA performed by someone else.

They then show the guy back in his office post TMA and Dr. Brad said the goal of surgery was to eliminate the deformity and pain and now the patient has no pain.

So maybe we should all perform a TMA for forefoot deformities for a more definitive one time treatment.

I have to believe this surgery , which was seen on TV will eventually end up in a lawsuit.

This guy’s surgical skills scare me. I watched him run into complications performing a toe amp WITH an assistant!

If you want to have a show like this it would be great to have someone who is skilled and at the top of his/her game, not just a pretty face.

Have seen about 15 total minutes of this show and can totally relate to your impression of the show.

Did not see this case, but just dropping in to say that in the right patient/case and with proper dissection, I'm a big proponent of the transverse incision for pan met head excisions. Better exposure, less retraction needed, scar contraction doesn't work against your digital work. BUT....don't kill the toes. Haha.

 

[DYK343]

As bad as that show is it gets me a lot of surgical consults

"I saw on TLC...."

 

[GreenHousePub]

As bad as that show is it gets me a lot of surgical consults

"I saw on TLC...."

Same. People come in commenting on the most benign conditions they saw treated on the show with "I can't believe how some people live"

 

[heybrother]

A guy came in with horrible onychogryphosis the other day. He told me he saw on TLC it could be treated and that he wants a Dr. Brad.

I have him scheduled for a TMA on Monday.

 

[HardRoadPaved]

A guy came in with horrible onychogryphosis the other day. He told me he saw on TLC it could be treated and that he wants a Dr. Brad.

I have him scheduled for a TMA on Monday.

Hopefully that was after you were able to get a laser treatment in first, sell some formula 3, and of course CMOs to help!

 

[heybrother]

Hopefully that was after you were able to get a laser treatment in first, sell some formula 3, and of course CMOs to help!

Of course. Then I spoke to the good people at IPED, bought a treadmill, made him run on it, and then billed a multilevel vascular study. After he got off I turned him upside down and shook out his pockets. If he dehisces at all I'm going to break the global and bill 11042s until he gets his BKA.

 

[Pronation]

Of course. Then I spoke to the good people at IPED, bought a treadmill, made him run on it, and then billed a multilevel vascular study. After he got off I turned him upside down and shook out his pockets. If he dehisces at all I'm going to break the global and bill 11042s until he gets his BKA.

If the wound doesn't heal after a few 11042s then you'll need more aggressive treatment and start applying magic pixie dust 15275

 

[ExperiencedDPM]

Have seen about 15 total minutes of this show and can totally relate to your impression of the show.

Did not see this case, but just dropping in to say that in the right patient/case and with proper dissection, I'm a big proponent of the transverse incision for pan met head excisions. Better exposure, less retraction needed, scar contraction doesn't work against your digital work. BUT....don't kill the toes. Haha.

This was NOT the “right” patient and watching his surgical skills or lack of skills, I’m not confident that his surgical dissection took into account that vascular compromise was a very real concern.

I’m sure he’s a nice guy, but it appears he doesn’t know what he doesn’t know and I believe that he isn’t representing the profession well. I can think of a LOT of high quality DPMs who would “represent” much better.

 

[dtrack22]

Then he addresses the lesser metatarsal deformities and makes ONE big ass transverse incision across the forefoot to resect the met heads.

I turned to his wife and said “this isn’t going to end well”. She asked why and I told her that this is not the type of patient who you want to make this type of incision on due to possible vascular compromise.

the skin incision itself would have no bearing on the vascularity to the toes. If the toes died his deep dissection and actual met head resection was garbage. Or he buried the blade on the skin incision. Nothing deep to the skin would have been affected by a transverse skin incision itself.

None of that changes the fact that he’s not the brightest lightbulb in the box. But he probably makes more money than everyone here despite that, so Frick us I guess…

 

[ExperiencedDPM]

the skin incision itself would have no bearing on the vascularity to the toes. If the toes died his deep dissection and actual met head resection was garbage. Or he buried the blade on the skin incision. Nothing deep to the skin would have been affected by a transverse skin incision itself.

None of that changes the fact that he’s not the brightest lightbulb in the box. But he probably makes more money than everyone here despite that, so Frick us I guess…

Of course I’m not referring simply to the skin incision. I’m confident from the appearance that he continued his deeper dissection in the same manner.

I assure you those toes didn’t become necrotic from tight dressings. Crap deep dissection with no respect for the vascularity combined with the possibility of increased traction of the toes secondary to the kwire, all created the perfect storm.

This patient had deforming arthritis with some probable vascular involvement and is diabetic. And with his indecision in the OR, drama for the cameras and his lack of skill, I’d love to know the tourniquet time.

I would never consider his approach for this patient. And this is from multiple thousands of procedures performed post residency and reviewing several similar legal cases with similar issues.

The bottom line is that this guy walked in with deformities of the metatarsals and digits and ended up with a TMA. Without some vascular event, this should not have occurred.

 

[CutsWithFury]

I have no idea what you guys are talking about and I’m not going to bother to look it up either. The podiatrists on the show are on the show because they are attractive. Both of them were just associates in crappy private podiatry practices doing nothing before TLC changed their lives.

Good for them. They probably get paid well. But we all know 10-20 people we could rattle off in like a minute who have more experience and intelligence than the DPMs on the show.

It’s shameful