General Practitioners

• Plantar Fasciitis
• Primary Care
  Early detection of hip dysplasia is important to limit malformation of the joint, while early treatment takes advantage of the hips ability to remodel and form properly. The hip examination is a standard part of a newborn examination. The primary care doctor will move the hips in an effort to detect instability. The doctor may describe the instability as a hip click, referring to the sensation of the femoral head moving in the socket. Not all clicks mean there is instability. Sometimes soft tissue passing over a bony prominence may produce a click and have nothing to due with instability. You really want to see if the femoral head is sliding over the edge of the acetabulum. This may better be defined as a hip clunk. If the femoral head does dislocate, it is important to know if it can be relocated or not. The hip is harder to treat if it can not be relocated.
• Electrocardiogram
  Wolf-Parkinson-White syndrome, and a variety of cardiac conduction defects which are predisposed to problems with certain anesthetics, cardiomyopathy, etc.

Ophthalmologists

• Laser Eye Surgery
  Blood loss is close to zero. Hospital stay is just for the procedure. In a series of 800 consecutive patients so treated, only three were admitted. All three were admitted for reasons not related to the surgical procedure. Things that may lead to hospitalization (over 25 years of experience) include hemophilia management, platelet administration in patients with advanced liver disease, other types of surgery done at same time, rooming in (twin has bigger op on same day & single parent), known unstable systemic illness and observations requested for medical reasons. Occasionally a child will have marked and sustained nausea after anesthesia and require stay for IV to prevent dehydration. Toe-head blonds and red heads are the ones most likely to have anesthesia related nausea. There is a higher rate of nausea when eye surgery is.

Neurologists

• Neurology
  Left, we see the skeletal effects of failure to tubulate. The upper vertebral cross section is projected in the left inset. A spinal canal is fully enclosed in a bone tunnel. The lower incompletely tubulated area is projected in the right inset. Not only is the spinal canal bone roof missing, but the vertebral body is more shallow and splayed out. The failure in the neural tube formation also has prempted proper nerve cell formation and proper differentiation. It is not unusual to find islands of wrong tissues along the edges as the defect, where the stepwise unfolding of new tissues and tissue types can get lost. As the peripheral nerves come from the edge tissue, they may or may not succeed in getting formed. If so, there may be no connection to a functional spinal cord, and / or the neural elements (spinal cord precursor) way wind up being a large cystic structure containing odd tissue types. Occasionally small islands of spinal cord do form which are not connected to the rest of the neurologic structures. These islands of neurology generally behave as spastic circuits. You can distinguish them by their reactivity to lower limb stimulus but nothing else. They usually just make trouble.
• Epilepsy
  A defect in the reticular system to adequately supply inhibitory circuits or enough GABA is the basis for hereditary forms of epilepsy. Thoughts are kept alive by circuits recycling. But they may recruit and spread unless tamed. Deficient inhibition, those brain regions with more recycling circuits are more apt to become seizure sources (self recruiting and spreading by recruiting as intensity amplifies). In a very real sense an obsessive thought may be seen as a recycling disinhibited focal process without spread.

Endocrinologist

• Hypothyroidism
  The true cause of SCFE is unknown, although there are many theories. Most likely, SCFE is caused by multiple factors including local trauma, obesity overcoming the physeal plate, inflammatory factors, and possible endocrine abnormalities. SCFE is known to occur in association with hypothyroidism, panhypopituitaryism, gonadal conditions, renal osteodystrophy, and during growth hormone therapy. Endocrine abnormalities should certainly be considered when a child presents with bilateral SCFE.

Radiologist

• Ultrasound
  The stability of the hip joint is best demonstrated using an ultrasound in the infant. The ultrasound can image the cartilage around the hip, which can not be seen in an infant on plain x-ray. Plain x-rays do not give a lot of information about the hip until the infant is approximately three months old. Also, an ultrasound can be performed, as the hip is moved better demonstrating instability. The person doing the ultrasound can watch the femoral head move in and out of the hip joint during the test. The ultrasound can also be done during the treatment to document improvement. After the age of six to eight months, ultrasound is not as effective for imaging the hip because too much of the hip is ossified and that obstructs the view of the ultrasound.
• MRI
  This gibbous is in a toddler. These can go on to angle so severely so as to cause paralysis. In this case we see a deficiency of the entire front of one vertebral body on x-ray. Here, by MRI, we see the x-ray hole as being made of stuff. That stuff is aborted fibrous cartilage tissue. There were x-rays showing this thing getting more angulated. What do you do?
• X-Rays
• Computed Tomography
  If the hip has been dislocated for some time, the muscles around the hip shorten and become contracted. The hip adductors are often lengthened at the time of the closed reduction to take pressure off the hip joint. The spica cast is worn for approximately three months. The position of the hip is checked periodically during that period to make sure it remains satisfactory. CT scans may be used to get 3-D position information.
• Chemotherapy
  Percutaneous surgeries have been used in a wide variety of disorders, from hemophilia, to brain injury, to complications of chemotherapy, birth defects, post trauma contractures, high tension electrocution and so on. Long-standing contractures of joints may require additional interventions.

Surgeons

• General Surgery
  I was a general surgery resident and my chief overheard me asking a sweet teenager if there was even the remotest chance that she could be pregnant. She assured me with great emphasis that THAT was impossible. I continued through the litany of other medical presurgical questions.
• Orthopedics
  But this was palliation, not correction. Orthopedics attacked from two directions: 1) Early manipulative techniques combined with casts and 2) More aggressive surgeries, many of which were made more effective by cast pretreatment. Various surgical strategies all had shortcommings, but the justification was better feet than doing nothing.
• Sciatica
  Facets ) which overlap like shingles on a roof, forming the back surface of the spine when compressed long and hard get gnarly and hurt. That hurt radiates very much the way disc rupture pain does. It is a more common source for sciatica pain than the sciatica caused by disc rupture (about 10:1 ratio).
• Scoliosis Surgery
  Dr. Eduardo Luque of Mexico saddled with many such cases had to secure the spine more firmly than the simple rods of scoliosis surgery at that time allowed. Borrowing the graft looping technique used in neurosurgery he implemented segmental spinal fixation with twist wires looped through the posterior elements of the spine and around paired rods. It is a method which, with many improvements, is still used for serious spinal reconstruction. It is also often also used in combination with newer methods.
• Hand Surgery
• Neurosurgery
• Hip Replacement
  As the child gets older still, the remodeling potential of the hip decreases absolutely, no longer just a question of slower speed. Children greater than eighteen months old often require additional osteotomies of the femur or pelvis to create a structure with enough stability to go the distance. And this then may or may not last into old age. Many of the adult hips with osteoarthritis that come to total hip replacement seem to be untreated degrees of early hip dysplasia.
• Reconstructive Surgery
  How far will people go? In the old days, the options were stark, sobering. It isn't vanity that leads to a woman seeking amputation and prosthetic substitution. That was the best way to get the best prosthesis for function and least notice from others. It wasn't about getting noticed but rather about not getting noticed. That is the essential difference between "cosmetic" and reconstructive surgery.

Plastic Surgeons

• Botox
  Disconnect of emotional display is a sign of schizophrenia (inappropriate affect) or too much Botox injected into the face. That plus a BlueTooth ear piece conversation and who can tell the difference?

Dermatologists

• Corns
  Here's another example. This fellow stumbles because his foot hangs down when he runs or if he tires. He does well with a brace, but wants that brace gone. It isn't cool. He also gets corns on the tops of his toes, especially the great toe. Somebody told him to have the tendons snipped and the corns would go away. True enough. But, look closer (with the aid of high speed ceiling and side wall video cameras). His ankle up-pulling muscle is weak, but the toe muscles are taking over, especially the great toe extensor. Before those muscles (which live in the shin area connected to the toes by long tendons) can raise the foot, the toes have to hit the end of their range. That is why they press against the top of the shoe toe box and get corns. You can see the tendons prominent from the ceiling view.
• Ulcer
  We had one infection. That infection was actually of the surface tissue and caused by a rolled up tight diaper that cut in and made a wound ulcer that infected. The close proximity to the bone grafting made us remove that graft, lest it become a pocket for chronic infection. Large drains were placed and pulled after 2 weeks. The bone had been in place for about two weeks. Interestingly (very), the bone induction was already underway and went on to create a covering anyway. It wasn't as extensive as our intent but it did do the job. The outcome was good.

Podiatrists

• Metatarsalgia
  Interestingly, the Achilles mechanism, itself, is fairly insensitive and also very strong and so is the least likely thing to be hurting. How can you be sure the pain isn't - uh -
• Plantar Fasciitis
  Shin splints, or even knee aches and any of a whole bunch of achy things that merely tell you what is the
• Podiatric Surgery
  The answer turned out to be "Everything". Club foot surgery essentially divides all the ligaments connecting the foot bones and lengthens all the tendons to allow total mobility.