We’ve given a lot of thought to how we want our patients to experience their care.  Our practice has always focused on the patient experience as the prime directive of what drives the procedures we perform, the environment we create, and the protocols we follow.  Making sure our patients have an experience that is second to none is the primary tenet of our day to day operations.

When I made the decision to no longer pursue a new location in Beverly Hills, it was a significant crossroads for us. After all, I started my journey in this wonderful little city.  But as time has passed, the concept of Aesthetic Foot Surgery has evolved into a nationwide phenomenon.  Women (and men) from all over the country have visited us for cutting edge procedures.  Surgeons around the country have connected with us and learned the procedures and advanced their practices to incorporate this new way of looking at the patient… the comprehensive way.

So what’s next?  How do we take what we created, and make it even better. Well, that required a complete makeover.

I’m pleased to introduce you to the next generation of our practice, we call it evo.

A synthesis of technology, medicine and premium experience, evo is about setting the standard for excellence in care, and shifting the paradigm in patient access to support, information regarding their surgery and state of the art facilities and equipment.  We commit to provide our patients with the newest technologies available from Fuji CR high resolution imaging to Stryker RemB power, our patients can expect only the latest and the greatest.

The user experience is also part of the evo way.  Which is why later this month we will release out app, providing our patients with unparalleled access to their surgeon, post op information, as well as the practice.

We’re only getting started though.  2011 is the year of evo… we plan on releasing some pretty amazing technologies.  These are projects that I have committed the last 3 years to perfecting and are ready for our patients to experience.  We’re sure that these are game changers and that medicine will be a better place with the incorporation of evo technologies.

As always, thank you to every person who has traveled to our practice, from Celia down the street, to Lani from South Africa.  It’s an honor to be your foot surgeon.

As the sun sets on Beverly Hills Aesthetic Foot Surgery, the future is still very bright.  Evo will provide all the services our patients have come to expect from an innovative practice like ours, and more.  Enjoy…

evofoot.com

Foot surgery has always been reserved for those situations where pain is present.  This is a valid and important principle to adhere to when you are making a decision to treat a patient.  There are situations in medicine however, that warrant treatment before symptoms are present.  These are situations where we know that when the symptoms present, there may already be irreversible damage to the tissues.  One such presentation is in the foot.

Foot deformities such as bunions, hammertoes, wide feet and short toes can present with pain.  But this is usually the case after many years have past and the condition has manifested itself with secondary problems referred to as sequelae.  If you have a bunion deformity, and you have no pain; the chances are you will have pain in the future.  As we age, the surface of the joint where the bunion exists (the 1st metatarsal phalangeal joint) is slowly eroded away.  When the surface is void of cartilage and is exposed bone, DJD (degenerative joint disease) begins (a form or arthritis) and pain begins.  This process is usually inevitable with orthopedic conditions that have dislocation involved like bunions.

Preventing symptoms, and practicing with a proactive rather than a reactionary approach to foot problems, is one of the corner stones of my ideology in foot surgery.  Most procedures allow patients to be back to normal activities within 2 weeks and are permanent. Aesthetic results with minimally invasive incision technique and plastic surgical closure, is another critical component of this revolutionary surgical technique. Together these philosophies provide patients with the most advanced procedures available in Podiatric Surgery today.

To understand more about the tenets which define a real Aesthetic Foot Surgery practice, read my Practice Philosophy article here: http://www.beverlyhillsfootsurgery.com/practice-philosophy/.  Welcome to our site, and to taking the first step to your new feet.

July 1, 2011 marks a special date for us… it’s the ten year anniversary of my practice.  As always, the most important part of this essay is giving thanks to those incredible people that made this journey possible.

It started in 1984.  I was in the sixth grade, and they had a new class in Suzanne Middle School… computers.  I had never seen one of these things before; it was a box with a TV on top of it with a typewriter in front of it.  I’ll be honest… I was a little scared of it!

But the computers and how they shaped me are a different story I’ll tell you later.  We were guided to the “on switch” by Mrs. Castro.  She was the first teacher I had that really believed in me and tried hard to instill the courage to push past the challenges we face in life.  Because of her, I became a computer nerd and foraged on through the education system.  Thank you Mrs. Castro for starting something wonderful.

Fast forward to 1989.  Mr. & Mrs. Sego changed my life.  These two extraordinary individuals not only taught, but dedicated their time to guiding and counseling their students.  They took so much of their own personal energy and instead of “just teaching” they built bonds with their students.  I owe so much of my confidence and creative expression to them.  Thank you Mr. & Mrs. Sego for being compassionate human beings.

Then in 1991 it was a college professor who was actually my high school chemistry teacher that came back to haunt me… Dr. Soloff!  I love this man.  He was so hard on me , but only because he realized that slacking off in AP Chemistry wasn’t my M.O. and he knew I could do better.  Thank you Dr. Soloff, for caring enough to push your students harder because you believed in them.  That “A” I got in your college chemistry was only because I wanted to show you that your investment in me, made me a better student.

In 1993 my mind was opened by Dr. Daruty.  This intense woman introduced me to philosophy, and opened a part of my psyche that has been the most important element in the creation of what I do every day.  Dr. Daruty, an essay doesn’t do justice to the dedication you put into your classes and how much you evolved every one of your students.  It was your passionate teaching of the art of philo sophia, the love of knowledge, that made me the diverse thinker I am today.  Thank you.

In 1999 I was given the final component of my formal education by Dr. Clemente.  This incredible surgeon was the director of my residency program.  Every resident knew that Dr. Clemente was the best of the best.  The detail he put into his surgical dissection, the class he carried himself with (I never saw him without a tie on or cleanly shaven when he was with patients), and the flawless routine of his ways.  I was fortunate enough to not only serve as his resident, but practice as an associate of his for the first 3 years of practice.  Doc, thank you for teaching me that a good surgeon has to have the confidence to improve on their techniques with every surgery, and have the vision to innovate new ones.

Five influential people (among many others), helped shape my future to the next point.  I have much gratitude for what all of you have given me.

In 2004 I started my first solo practice by sharing space with other doctors, today we have grown to provide our patients with our own premium, joint commission accredited surgical facility and a practice that sets the standards in environmental and technologic innovations; not to mention those pretty nifty procedures we’ve designed.

As a marker of this evolution, on 07/01/11 I will announce the new name for our practice.  As much as we loved our beginnings in Beverly Hills, we have evolved past the geographic limitations of a name.

This new practice (for now, I’ll call it “2.0”) will provide our patients with the next generation of advanced surgical practice technologies.

“2.0” is going to change the entire way you experience and interact with your health care.  Check back as we reveal the future…

form.

function.

& beauty.

by ali sadrieh | dpm

It give us great pleasure to announce our 9th lecture at the Apple Store, but this time we’re in New York at the flagship store on 5th Avenue sharing the new iDoc™ Digital Medical Practice Solution designed by Dr. Ali Sadrieh.

With this revolutionary system, taking your practice into the 21st century just got a lot easier.  The most advanced technologies tested and packaged into one simple solution, so you can do what you do best, practice medicine.

In this presentation, Dr. Sadrieh will demonstrate how to:

• take advantage of new goverment incentives to fund the “technologic remodeling” of your practice.

• lose the I.T. guy and become self-sufficient with the most stable office computer system available today.

• reduce the time you spend with documention and billing, and spend more time with your patients.

• make your practice completely paperless without “the pain”.

• access to your medical records on the go… from your smartphone!

• install a secure, back-up system that is reliable right out of the box.

• and a lot more valuable free information that will get you up-to-date on current technology that you and your patients can benefit from right now.

[View with PicLens]

You can register for the event by visiting the Apple Store site at www.apple.com/retail/fifthavenue or by emailing the business team directly at: fifthavenuebusiness@apple.com

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Being part of something bigger than yourself is something very special.  The opportunity to create something bigger than yourself is even more special.

I’m thrilled to see that initiatives like the Environmentally Proactive Practice (epp) have blossomed into a cross industry ethos that is now creating new ways of doing business in medical information and practice development.

The epp initiative was really a product of having the opportunity to build a practice from ground up, without worrying about how to increase revenue.  Rather, the main focus of the concept practice we built in 2007 in Studio City was about how to build a destination that provides the highest quality of care without compromising luxury all while reducing the ecological foot-print to the absolute minimum.

To do this I enacted a policy in my practice that we will constantly engage in the acquisition of new technology that further reduces our foot-print environmentally and improves the quality of care we provide.

It gives me great pleasure to share our recent acquisition of LED Operating Room lights.  LED technology is the next wave of energy reduction standards that will cut our fossil fuel consumption so that our future is a cleaner and more efficient one.

My dedication to our planet and your environment will always continue to evolve and grow.  The cost of the lights is far outweighed by the amount of energy we save.  We perceive that as a direct impact on the quality of your environment.

I have shared before in talks I have given for the iDoc project we started a few months back, that doctors have a special obligation to the fellow citizens.  Doctors take an oath when they complete their education.

This oath compels us to “prevent disease whenever we can, for prevention is preferable to cure”.

It also asks the we remember that we “remain a member of society, with special obligations to all our fellow human beings, those sound of mind and body as well as the infirm”.

Those quotes from the Hippocratic Oath however do not stop in the four walls of the treatment room.  I believe that this “special obligation” extends to our daily lives outside of the office.  What good is the care a doctor is giving to their patients if they are destroying the environment they live in with they’re practices and their life styles.  Hence the philosophic reasoning behind why doctors, of all the various professions, are most obligated to act as stewards of our environment.

I was seeing visiting some post op patients in New York recently as a courtesy “how are you doing” and I had a chance to visit the Museum of Natural History.  The museum itself was wonderful, especially the Astronomy exhibit and the planetarium show on Stars.  But what really moved me was the massive quote on the wall to your left when you walk in the main entrance.  It reads:

There is a delight in the hardy life of the open.

There are no words that can tell the hidden spirit of the wilderness that can reveal its mystery its melancholy and its charm.

The nation behaves well if it treats the natural resources as assets which it must turn over to the next generation increased and not impaired in value.

Conservation means development as much as it does protection.

- Theodore Roosevelt

I hope that our constant pursuit of excellence in environmental stewardship surpasses your expectations.  Thank you for choosing us as your providers.

I am a runner myself.  Running is a special sport because all you need are your shoes and you’re off.  The different conditions provide the runner with different challenges, without the need for extra equipment.  Running a big hill, or a long distance early in the morning are very different experiences.  But the common denominator with all the variations a runner can experience are the shoes.  Runners have to make sure that the shoes they buy are Podiatrically correct and provide their foot type with the best control and biomechanical support available.  If a runner’s shoes aren’t providing optimal support, a variety of functional problems can present, one of which is shin splints.

Most runners are familiar with shin splints; the pain and tenderness that occurs in the front of the lower legs that can be slow to heal. However, you don’t have to be a runner to have shin splits. Tibial shin splints are very common and affect both recreational and trained athletes.  The pain in the lower leg is caused by an overload on the shin bone and connective tissues. Shin splints may also cause mild swelling.  Athletes that engage in a lot of running or jumping are as risk for shin splints. You can also overload your shin bone by training too hard, too long or using improper training techniques.

What is the treatment for shin splits? The number one recommendation is rest. Although you do not have to give up your favorite sport, it is a good idea to switch to a lower impact sport such as swimming while your shin splints are healing. Other shin splint treatments may include applying ice and over-the-counter (OTC) pain relievers in the early stages. A foot and ankle specialist can help treat your shin splits by determining the cause of them.  It should be noted that shin splits are not a diagnosis but a description of symptoms that could be from several causes such as problems of the muscle, bone or the attachment of muscle to the bone. Therefore, it is important to visit your doctor for an examination. In addition, if your pain is persistent and does not respond to rest, you should call and schedule and appointment for consultation and evaluation.

Another issue that runners deal with is pronation.  Pronation is a term that describes the collapse and “outward” positioning of the heel in relation to the ground.  This happens with collapse of the structure called the Subtalar joint.  This is the joint that is directly under the ankle joint and connects the Talus (ankle bone) to the Calcaneus (heel bone).

An excellent video and graphic of pronation is in the August 2004 issue of Runner’s World.  The videos are here for you watch and understand.

Normal Pronation:  The outside part of the heel makes initial contact with the ground. The foot “rolls” inward about fifteen percent, comes in complete contact with the ground, and can support your body weight without any problem. The rolling in of the foot optimally distributes the forces of impact. This movement is called “pronation,” and it’s critical to proper shock absorption. At the end of the gait cycle, you push off evenly from the front of the foot.

Overpronation: As with the “normal pronation” sequence, the outside of the heel makes the initial ground contact. However, the foot rolls inward more than the ideal fifteen percent, which is called “overpronation.” This means the foot and ankle have problems stabilizing the body, and shock isn’t absorbed as efficiently. At the end of the gait cycle, the front of the foot pushes off the ground using mainly the big toe and second toe, which then must do all the work.

Underpronation: Again, the outside of the heel makes initial contact with the ground. But the inward movement of the foot occurs at less than fifteen percent (i.e., there is less rolling in than for those with normal or flat feet). Consequently, forces of impact are concentrated on a smaller area of the foot (the outside part), and are not distributed as efficiently. In the push-off phase, most of the work is done by the smaller toes on the outside of the foot.

Basically the foot is not functioning in the optimal position to transfer the motion forward.  So compensation occurs and joints suffer over time and slowly become arthritic.  It is important to prevent this from happening. Early intervention is very important! A simple visit and weight bearing xrays will diagnose the condition and begin the process of prevenative care that will provide you with years of happy healthy running.

Just remember, one more light pole!

Run for Life…

Infection control is one of the most important goals pre, intra and post operatively.  One of the driving forces behind the new new procedures I have developed over the past 9 years has been mitigation of surgical risk.  Many of these risks can be managed with advanced fixation techniques, new surgical techniques and sophisticated equipment.  But there is one risk factor that will always loom in every surgeons mind… infection.

Infection occurs because of bacterial colonization that exponentially replicates to levels that cause tissue damage and potentially dangerous bone infection.  To reduce this potential growth, surgeons employ many standard protocols.  Some of these include pre-operative scrub of the surgical site as well as the surgeon’s hands.  The use of autoclaved (sterilized) instrumentation and sterile operating room drapes and dressings is also standard procedure.

Post operative infection control is just as important.  This is achieved with oral antibiotics that inhibit bacterial growth while your skin is healing.  Once the skin has healed, the risk for infection decreases dramatically since the portal for infection has been closed.  This however is not the case for procedures that require fixation devices that pierce the skin (like K-Wires, External Fixators and such).  In these situations infection control must be continued until the hardware is removed and the entrance sites are healed.  This is also why all of the procedure I have designed have eliminated the need for external fixation.

But obtaining the holy grail in infection rate (< 1%) is a lot more challenging than that!  As part of our mission to provide the highest level care available in foot surgery, I have incorporated protocols that exceed the standards of most hospitals and surgery centers across the country, so we can meet this exceptional level of care.

Part of maintaining an excellent track record of infection free surgeries is exposing our facility to the demanding standards placed by the largest and most respected accrediting body in the country, the Joint Commission (commonly referred to as JCAHO).  This process requires that we maintain logs and implement infection control protocols that are mandated by the CDC (Centers for Disease Control) and WHO (World Health Organization).  JCAHO accreditation is the norm in most hospitals across the United States however, so I decided to “super-size” our protocols.

To achieve this lofty goal, I made a decision early in our practice to reduce the size of the patient flow as well as the staff in contact with maintaining these protocols.  This way instead of employing what’s found in most facilities (4+ people) in charge of instrument management, and sterilization processes, it’s just my surgical tech and myself. In this model there is tight control of what happens in preparation for each case and quality control can be micro managed.

Another simple factor is volume.  We’ve all learned the correlation between volume and quality: Q = 1/V.  As volume increases (the practice sees more patients per day) quality becomes compromised.  In a perfect world this can be circumvented, but unfortunately that isn’t a reality yet.  This is why we limit our patient volume so we can maintain the same level of excellence for every case.

I’ll discuss the relevance of a small volume practice in a future article and how it relates to our practice philosophy and ethos.

The surgical scrub has been shown to be one of the key components of infection control.  To increase your chances of success, in late 2009 I began to implement the “double scrub”.  With this protocol, we perform an initial pre-operative surgical scrub using Chlorhexidine Gluconate (Hibiclens).  This antiseptic has been shown effectivity against Gram positive as well as Gram negative microbes, and is the scrub of choice for most plastic surgeons.  Once the initial scrub is performed, the local anesthetic block is performed.  This prevents entrance of bacteria into the sterile compartments of the foot.  For more information on Hibiclens visit http://www.hibigeebies.com.

The second scrub is performed immediately before the procedure is performed.  This scrub utilizes DuraPrep by 3M.  DuraPrep has been shown to kill all major pathogens in one minute.  Keep in mind, this is performed after an thorough Hibiclens scrub so not many bugs are able to survive the first scrub, and if they do… we’ll knock them out with the second scrub!

Although this increases costs, my philosophy is how you we put a price on your well being?  You can learn more about DuraPrep here: http://solutions.3m.com

One of the things that always bothered me about hospital based surgeries is the known infection rates in hospitals.  Nosocomial infections (hospital bourn infections) have been discussed in almost every respected medical journal.  Long protocols and algorithms have been described to control this menacing and rapidly increasing phenomenon.

So how did we manage this problem?  It was simple… we invested in our own premium surgical facility, and restricted access to only non-infected patients.  This way, there just isn’t a chance that our O.R. can be contaminated with the scary bugs you hear about on the news.  It also allowed us to bypass the complex bureaucracy found in larger institutions and implement changes rapidly to benefit our patient population.

This is not to say that all hospitals are dirty environments.  Some of the finest facilities in the country like Cedars-Sinai medical center and UCLA hospital maintain some of the lowest infection rates, but the risk is still there since patients go in and out of these facilities with a variety of serious infections.

Having had the privilege of training in diabetic wound care and limb salvage at the Northridge Hospital Wound Care Center, I had a first hand experience of the rapidly growing field of wound care.  The technology in this area of medicine has evolved exponentially since I matriculated in my program.  One of the great yields of this science has been the use of Silver in wound management and infection control.  Silver has found it’s way into a variety of wound products.

As another first, in 2009 we began a universal protocol of using Maxorb Extra Ag+ dressings on EVERY surgical patient.  This advanced Calcium Alginate dressing not only absorbs drainage from the incisions keeping them dry (thus inhospitable to infection) but also delivers Silver ions to the incision site to kill any developing colonization process.  Once again, another expensive but important protocol we use to maintain our incredibly low infection rate.  You can read more about Maxorb Extra Ag+ here: http://www.medline.com/wound-skin-care/maxorb-extra-ag/

Steri-strips are used to further maintain the incision and reduce the tension so that the plastic surgical closure can heal without scarring.  When 3M released their antimicrobial steri-strips… it was a no brainer!

Even with all of the above measures, infection control has to be a top priority inside and after surgery.  That why every surgery is flushed with copious amounts of a Bacitracin Saline solution.  One of the simplest formulas for infection control is taught to every first year resident: “the solution to pollution, is dilution!”

After surgery, every patient is given oral antibiotics to manage bacterial growth.  Combine everything we’ve talked about with a pre-emptive first week dressing change, and we can proudly report a less than 1% infection rate for two years in a row!  Despite this achievement, part of our commitment to you is to continuously raise the bar and set the standard for modern foot surgery.

Dr. Ali Sadrieh

See Dr. Sadrieh featured on the Doctors Show for Fat Pad Augmentation on September 20, 2010.

We’re honored to announce our 7th episode on The Doctors Show… featuring the Foot-Tuck Fat Pad Augmentation™!

You can learn more about the procedure here: http://www.beverlyhillsfootsurgery.com/fat-pad-augmentation/

A lot of my friends have recently heard me saying a phrase over an over again… “Just be excellent.  That’s a persons duty in this world.”

When the doors to this practice first opened, the very core of it’s DNA was based on excellence.  I didn’t care about volume or being the busiest surgeon in the city… I wanted to have a practice that was based on excellence.  That’s why our destination flagship location built in Studio City in 2007 only has two treatment rooms.  The idea is we don’t want to see more than 10-15 patients a day because it’s the formula is unbeatable: Q = 1/V.  Quality is inversely proportional to volume.

Our practice like any other is engaged in the “practice” of medicine, and along with that comes the occasional unexpected result.  But where we differ is that because of our low volume, high quality model, we can pay closer attention to that occasional and unique case and provide that patient with a solution that they are satisfied with.  That will always be my commitment to you.

This is what compelled the creation of the Foot Tuck™ Fat Pad Augmentation procedure.  The reality of the situation is that the concept of the high heeled shoe is not going away anytime soon.  Pretending that this doesn’t exist in the modern woman’s world is neglecting millions of women who have to function in the professional world wearing high heeled shoes every day.

This is such a phenomenon that there are events like the Heel-A-Thon that embrace the high heeled shoe and the women who brave the streets of New York City in them to raise money for charity.  http://bventertainment.go.com/tv/buenavista/regisandkelly/special/highheel/index.html

Creating a procedure like the Fat Pad Augmentation is paying attention to what millions of women are complaining of rather than ignoring it.  Excellence is taking that idea and evolving it to a the safer, more cost effective procedure that redefines conventional medicine.

Thank you to the thousands of women from around the World who have given us their trust to provide them with advanced solutions to their foot issues; it’s because of you that we can innovate remarkable new procedures.

Ali Sadrieh

Announcing our 3rd lecture at the Apple Store… debuting the new iDoc™ Digital Medical Practice Solution designed by Dr. Ali Sadrieh.

With this revolutionary system, taking your practice into the 21st century just got a lot easier.  The most advanced technologies tested and packaged into one simple solution, so you can do what you do best, practice medicine.

In this presentation, Dr. Sadrieh will demonstrate how to:

• take advantage of new goverment incentives to fund the “technologic remodeling” of your practice.

• lose the I.T. guy and become self-sufficient with the most stable office computer system available today.

• reduce the time you spend with documention and billing, and spend more time with your patients.

• make your practice completely paperless without “the pain”.

• access to your medical records on the go… from your smartphone!

• install a secure, back-up system that is reliable right out of the box.

• and a lot more valuable free information that will get you up-to-date on current technology that you and your patients can benefit from right now.

Visit http://www.apple.com/retail/thirdstreetpromenade/ to register for the event

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See Dr. Sadrieh featured on the Doctors Show for The Mini-TightRope Bunion Correction on April 26, 2010.