Ingrown Toenails Treated in Your San Francisco Home One Hour from Now

Ingrown Toenails Removed in Your San Francisco Home in only One Hour.

As a podiatrist in San Francisco, ingrown toenails are one of the most painful problems I treat. I actually love fixing ingrown toenails, mainly because people are so happy when the pain is gone. They just think I am the best podiatrist in San Francisco.

The truth is that San Francisco has many great podiatrists. But when an ingrown toenail develops, it gradually gets more and more painful. Most of the time the toe is really painful, red and swollen by the time the patient calls a podiatrist to get an appointment.

The first time I realized that ingrown toenails should be treated as an emergency was when another doctor actually called me for help after hours. He had been kayaking all weekend. He thought that he bumped the big toe on the inside of his kayak and started the ingrown toenail. He said he just couldn't wait to be seen. So I saw him that night.

He was so grateful to have that painful infected piece of toenail taken out that I realized more podiatrists should treat ingrown toenails as emergencies. Now I am willing to see anyone day or night to fix ingrown toenails.

The best news for anyone in San Francisco suffering from an ingrown toenail is that I can usually be at their home and fix an ingrown toenail right then and there. They don't even have to go to the podiatry clinic. By removing the painful piece of nail, you get relief right away. So for most people who call us, they will get relief from an ingrown toenail pain in about one hour from the time they call us.

Dr. Christopher Segler is a podiatrist who practices podiatry house calls in the San Francisco Bay Area. He can be reached directly at 415-308-0833. For more information about ingrown toenail casuses and treatments see www.DocOnTheRun.com or www. AnkleCenter.com

San Francisco Medicare Patients Need to Brace for Worsening Customer Service at Doctor Appointments

Medicare Cuts of 21.2% can only spell longer waits and less time with the doctor.

On 2/26/2010 is was reported that nothing short of a political miracle in Congress can prevent a scheduled 21.2% pay cut to doctors across the San Francisco Bay Area and the rest of of the U.S. The fact is that the extraordinary cost of living, rent and office space in the San Francisco area can only have one reasonable effect... poor customer service in doctor's offices.

For the past several months, Democrats in Congress have attempted to get legislation to pass and avoid the massive pay cut, which was written into law by the old "sustainable growth rate" formula Medicare uses to determine how much physicians get paid for treating patients. However, this week Sen. Jim Bunning (R-KY) effectively blocked the bill that would have extended the deadline by 30 days.

The big problem with this situation is that many doctors cannot make a living by seeing Medicare patients for less money. Others find a way to survev, but are forced to ration care and perform "assembly line medicine." If physicians are true to their warnings and quit seeing these people, Medicare beneficiaries might experience difficulty making an appointment with any doctor or podiatrist who takes Medicare. One poll among neurosurgeons showed that about 40% would cut back on seeing new Medicare patients if reimbursement continues to decline, while 18% would quit accepting new Medicare patients into their medical practices altogether. Another 27% said they would treat fewer Medicare patients who were already in their practices.

The fact is that all doctors in San Francisco went to medical school so they could spend their careers helping people. But when it comes to continual decreases in pay with continual escalating costs of seeing patients, something has to give.

There are really only a couple of ways doctors can deal with the 21% cuts in Medicare reimbursement that will take effect Monday morning. One option is for doctors to stop taking Medicare. That means they just don't schedule your appointment. Or you have to pay for the visit yourself. Very few doctors have had the courage to do this. However those that do, find they can provide more time, attention, and personalized care with each patient.

The other option is to just see more patients. Its just math. A doctor that was seeing 50 patients a day, will now need to seen something like 70 per day. With all of the rules and regulations about what has to be documented in the medical record for each visit, that can only translate to very short visits.

Don't be surprised if you go to the doctor on Monday and are told "we'll have to tall about that problem at your netx visit, we just don't have time for more than two problems during your visit today." But don't take it personally of you can't get in to the San Francisco podiatry office to treat that diabetic foot infection or remove that ingrown toenail... it's just math.

Dr. Christopher Segler is a San Francisco Podiatrist and Foot Doctor who stopped accepting Medicare so he could practice Direct Medicine. He provides housecalls and is a podiatrist who will go to your home so you don't have to wait in some dingy waiting room all day. He practices podaitry in the San Francisco Bay Area and treats urgent foot problems 24/7 in the Bay Area. You can use the “foot pain finder” to learn more about foot problems at www.AnkleCenter.com and www.DocOnTheRun.com.

More Reason for San Francisco Residents to Choose Concierge Care

San Francisco News: Anthem Blue Cross Under Fire

San Francisco patients, podiatrists, primary care doctors and other many medical providers have had enough. Doctors and patients alike have felt for years that big insurance companies like Anthem Blue Cross of California are taking advantage of the public bilking patients and doctors out of hard earned money. Now it appears that the California Insurance Commissioner may agree.

On February 22, 2010 Steve Poizner (the California Insurance Commissioner) announced that he had reviewed consumer complaints against Anthem’s claims handling practices from 2006 to 2009 resulted in the 732 violations, including 277 violations of failure to pay claims to doctors as obligated.

All of this of course comes to light during hard economic times. And in the midst of these hard times, Anthem has decided to raise insurance premiums as much as 39%. On the local evening news in San Francisco last night Poizner explained that they only usually prosecute insurance companies that are "belligerent" and show a pattern of refusing to cooperate or comply with the law.

This sort of insurance company misbehavior is precisely why doctors and patients alike are opting out of the Big Insurance Losing Game. Many patients are now seeking medical care in the comfort of their own homes and paying out of pocket. Doctors who have stopped accepting insurance are now free to spend more time with patients, offer house calls, and focus on preventative care instead of crisis management.

With Anthem continuing to log complaints with the California insurance commissioner, it seems that concierge medicine will continue to grow.

Dr. Christopher Segler is a San Francisco Podiatrist and Foot Doctor who treats ankle sprains, foot pain and diabetic foot problems. His San Francisco Podiatry practice offers emergency housecalls for busy people with foot injuries and ankle sprains in the Bay Area. You can use the “foot pain finder” to learn more about foot and ankle sprains at www.AnkleCenter.com and www.DocOnTheRun.com.

Is Your San Francisco Bay Area Hospital Prone to Infections

Last night I saw a news story on televsion about reported infection rates in San Francisco Bay Area Hospitals. Given that I am a foot surgeon who is always worried about patients getting dangerous infections during or after foot surgery in the hospital, it seems it is worth reiterating the findings reported in the news.

This past week www.ConsumerReportsHealth.org provided a detailed analysis of central line infection rates in the San Francisco Bay Area. The results vary, but are worth examining if you or a loved one needs surgery or hospitalization.

Three hospitals in San Francisco had zero (0, zip, zilch, none!) central line infections. St. Mary's Medical Center, St. Luke's Hospital and Saint Francis Memorial Hospital were the only ones in San Francisco with none of these costly and often deadly infections. California Pacific Medical Center-Pacific Campus and Kaiser - San Francisco also had high marks with a rate of infection 43% and 40% better than the national average, respectively. The big surprise was that the city's highly aclaimed academic medical center (UCSF Medical Center) was the worse performer with a rate of infected central lines 80% higher than average.

Also in the Bay Area, Kaiser Foundation Hospitals in Hayward, Santa Rosa, Vallejo, and South San Francisco all also reported no incidences of central line infections for the study period.

It should be noted that not all Bay Area Hospitals reported how many central line infections they had. A law has been passed in California to disclose this information, but facilities aren't actually required to report until 2011.

Many people will be suspicious of the hospitals that have refused to report their data.

So why is this important to you?

If you have surgery or become ill and end up in the ICU (Intensive Care Unit), you have a good chance of getting a central line. A "central line" is basically like a big I.V. (intravenous catheter) placed in one of the large veins of the neck or sometimes the chest or arm. They are very important if you are very ill. A central line is the best way to get medications, I.V. fluid, and antibiotics into your system as quickly as possible. If you need it, you can't do without it.

The problem is that central line catheters are also a way for bacteria to get into your bloodstream. A bloodstream infection is referred to as "sepsis" by doctors. Sepsis often leads to septic shock and is frequently fatal. So obviously you would prefer to avoid getting a deadly infection.

People at risk of central line infections are usually very sick. Many of these people are in the ICU because they have been seriously injured, have been battling a prolonged illness or have had a complication following surgery.

For example, if you are diabetic and develop gangrene, you need surgery. The foot surgeon MUST surgically remove all of the infected tissue, or it will spread. If it spreads, you could get sepsis and die.

So off to the operating room you go for emergency diabetic foot surgery. If you are in poor health, you still go to surgery, because the risk of not doing surgery is that you might die anyway. If you are in very poor health, you might need to go to the ICU for monitoring after your foot surgery. If you have trouble waking up from anesthesia you might need to go to the ICU after your foot surgery.

And in the ICU, the surgical team might need to place a central line to deliver enough fluids to keep your blood pressure up, deliver powerful antibiotics, etc. But you don;t want that central line delivering any germs.

So if you choose to have foot surgery in a San Francisco area hospital, what do you do? The fact is that Hospitals that perform foot surgery in San Francisco, Hayward, Santa Rosa, Vallejo, and South San Francisco have reported zero central line infections. But that doesn't exactly mean a guarantee. On the flip-side, if your hospital reports very high rates of infection, there may be a higher risk that you may get one of these infections.

Regardless of which hospital you choose, you (as a patient) can and should, ask the doctor, surgeon and nursing staff what steps they are personally taking to make sure that you don't get a central line infection.

Here is a list of some of the Northern California hospitals who didn't "choose" to report their infection rates. I am not saying that their infection control practices are any better than UCSF or any worse that St. Mary's Medical Center. I'm just sying they didn't seem to think it is important that you as a patient know...

Alameda County Medical Center - Highland Hospital, Oakland, CA

Alameda Hospital, Alameda, CA

Alta Bates Summit Medical Center - Alta Bates Campus, Berkeley, CA

Alta Bates Summit Medical Center- Summit Campus, Oakland, CA

Community Hospital Of Los Gatos, Los Gatos, CA

Community Hospital Of The Monterey Peninsula, Monterey, CA

Contra Costa Regional Medical Center, Martinez, CA

Dameron Hospital, Stockton, CA

Eden Medical Center - Eden Campus, Castro Valley, CA

Eden Medical Center - San Leandro Hospital Campus, San Leandro, CA

Hazel Hawkins Memorial Hospital, Hollister, CA

Northbay Medical Center*, Fairfield, CA

Northbay Vaca Valley Hospital*, Vacaville, CA

Novato Community Hospital, Novato, CA

Petaluma Valley Hospital, Petaluma, CA

San Francisco General Hospital Medical Center, San Francisco, CA

San Mateo Medical Center, San Mateo, CA

Santa Rosa Memorial Hospital, Santa Rosa, CA

Valleycare Health System, Pleasanton, CA

Washington Hospital Healthcare System, Fremont, CA

Sutter Solano Medical Center, Vallejo, CA

Sutter Warrack Hospital, Santa Rosa, CA

Sutter Medical Center Of Santa Rosa, Santa Rosa, CA

Sutter Delta Medical Center, Antioch, CA

St. Rose Hospital, Hayward, CA

A complete list can be found at http://www.leapfroggroup.org/decline

Dr. Christopher Segler is a podiatrist and award-winning podiatrist who practices in the San Francisco Bay Area. He offers House Calls for Diabetic Foot Exams, Diabetic Foot Emergencies, and Diabetic Foot Wound Treatment. Serving San Francisco, Marin, Palo Alto, and Walnut Creek. You can learn more about house calls as solution to foot pain at www.DocOnTheRun.com and www.AnkleCenter.com.

New Research Confirms Diabetics at High Risk of Surgical Infection

I'll never forget the day that Mrs. Williamson looked me in the eye, waving her finger and said, "I want you to promise me that you won't cut off any of Warren's toes."

Warren Williamson was the father of my sister's best friend when I was growing up. And he was a diabetic who had developed neuropathy (numbness in the feet from diabetes). He had a "spot" on his foot he was concerned about and wanted me to make a housecall to check his feet. But Mrs. Warren was fearful. An uncle of hers had died after a toe infection led to an amputation. All she new about that episode was that her uncle was diabetic, he got a minor toe infection, then he needed a toe amputation and now he is dead.

As a longtime friend, and a diabetic foot surgeon, I was taken aback by her fear. So I looked her in the I and said, "I promise I will do everything in power to make sure you husband leaves this world with all of his toes." I could see the relief, as her expression changed.

As it turns out I kept my promise. But unfortunately Warren did ultimately die of a post-operative infection. Only it was after back surgery. The growing population of diabetic patients is leading to more and more surgical infections.

This month a new study was published in the Journal of Bone and Joint Surgery which shows that diabetic patients are significantly more at risk for surgical infections than non-diabetic patients. The article is entitled "Postoperative Infection Rates in Foot and Ankle Surgery: A Comparison of Patients with and without Diabetes Mellitus."

The researches set out to determine whether or not patients with diabetes are really at increased risk for infection following foot and ankle surgery, or not. To find out they reviewed the charts of 1000 patients who had orthopaedic foot and ankle surgery. The recorded whether or not any of those foot surgery patients had a diagnosis of diabetes mellitus, if they had a postoperative foot infection and information about the severity of infection. They also recorded whether the surgery was inpatient surgery or outpatient surgery, whether or not they used of internal fixation (like screws or plates to hold the bones together) or external fixation (like rods attached on the outside of the foot or ankle), history of tobacco use, history of organ transplantation, history of rheumatoid arthritis, the total length of surgery, follow-up time in weeks, and other medical conditions that might contribute to the foot surgery infection.

What they discovered was that 52% of all foot and ankle infections occurred in diabetics. But diabetics accounted for only 19% of all patients who had foot surgery or ankle surgery. They found that of those patients having foot and ankle surgery, those that had diabetes were about 4 times more likely to develop a post-operative infection following foot or ankle surgery.

Even worse, we know that diabetics get more severe infections. The study confirmed this and showed that diabetic patients were 5 times more likely to develop the sort of severe infection that might lead to prolonged hospitalization, a foot amputation or death from the infection.

Interestingly, there was no real difference in foot infection rates between those without diabetes and someone with uncomplicated diabetes (a mild case of diabetes). However, those with complicated diabetes (a bad case of diabetes) did have much higher rates of surgical foot infections than those with uncomplicated diabetes (a mild case of diabetes).

So, if you or someone you love has diabetes and is going to have foot surgery, make sure the surgeon understands all of the implications is taking precautions to prevent the infection. Ask questions. Ask whether or not the patient will get antibiotics at the beginning of the surgery. Ask in the surgeon covers the toes with ioban. Ask the surgeon for a scrub brush with surgical soap to scrub the foot the night before surgery. Ask the surgeon how often his diabetic foot surgery cases go bad.

It is your foot and you have the right to know. If your diabetic foot surgeon thinks he or she doesn't need to take the time to answer all of your questions, find another surgeon.

Dr. Christopher Segler is a podiatrist and award-winning podiatrist who practice in the San Francisco Bay Area. He provides House Calls for diabetic foot exams, diabetic foot emergencies, and diabetic foot wound treatment. Serving San Francisco, Marin, Palo Alto, and Walnut Creek. You can learn more about house calls in San Francisco as a solution to foot problems at www.DocOnTheRun.com and www.AnkleCenter.com.

Concierge Medicine: Convenient and Affordable Care - Brief Analysis #687

Concierge Medicine: Convenient and Affordable Care

The National Center for Policy Analysis (NCPA) published a report this week which shows that "Concierge Medicine" may help alleviate long patient waits and difficulty with access to high quality, timely healthcare.

Although many have thought (or erroneously believe) that concierge services are out of reach, there is a growing trend for doctors of many specialties (Primary care, Emergency Medicine, Podiatry, Pediatrics, and even Diabetes Care) to provide On-Demand medicine.

By offering these services, patients ain areas like San Francisco, Marin County, the East bay and Silicon Valley are getting the care they need. Often times the ones arranging care are adult children who are simply too busy to take their aging parents to doctor's visits across town.

Lets face it, a busy executive, working mom, or someone who runs a home-based business really can't afford to lose half a day just sitting in a podiatry clinic waiting room while Dad has his toenails trimmed. Now the podiatrist can come right to your Dad's house and cut those toenails.

This emerging medical model is arguably delivering better care through increased access. No one can argue that the convenience has no comparison to standard medical practices. With more and more doctors choosing this model, medical care at home is become much more affordable. In fact, in San Francisco, you can get a doctor housecall visit for less than the cost of many pedicure spa treatments.

Dr. Christopher Segler has published over 70 scientific articles, abstracts and book chapters. He has won awards for research on foot and ankle injuries from the American College of Foot and Ankle Surgeons and the American Podiatric Medical Association. His practice specializes in house calls in the San Francisco Bay Area and Marin. If you need a Podiatrist in San Francisco to come to your home or office visit www.DocOnTheRun.com and www.AnkleCenter.com.

Doc On The Run - San Francisco Podiatry House Calls - Now Accepting Urgent Appointments

In an effort to bring the very best care and convenience to those who need it most, Doc On The Run is now accepting new patients.

Because so many people in San Francisco need care at home, Dr Segler is now offering Houscalls for urgent foot problems like infected in grown toenails, ankle sprains, diabetic wounds, and ankle sprains.

For those who care for their elderly parents at home, we also offer the convenience of bringing the podiatrist to you. Home visits are even offered for minor services like trimming of toenails, cutting thick painful toenails, and medical pedicures.

No more need to sit in the car or wait at the podiatry clinic all morning or afternoon. We can bring the expert right to your door.

To schedule a Podiatry Housecall in San Francisco, Marin, the East Bay or the Peninsula, just call (415) 308-0833. Or visit www.DocOnTheRun.com.

Dr. Christopher Segler is a foot doctor and award-winning foot surgeon. He makes podiatry housecalls in the San Francisco Bay Area, Marin, East Bay and Peninsula. No need to wait to see the Podiatry Clinic for an ingrown toenail, or thick painful toenails. Learn more about Podiatry House Calls for foot pain at DocOnTheRun.com or AnkleCenter.com