End the feud
Enough already! I think it’s time to discontinue the weekly platform that you give to the ongoing feud between William Hicks and David Kay concerning the Ballona Wetlands Restoration Project. Their differences of opinion are never going to be resolved in these pages, and I think that it’s time to give this limited space to other readers who want to express their opinion on a variety of other subjects of local interest.
I respect the opinionated volleys from Walter Lamb of the Wetlands Land Trust and Dr. David Kay on what happens to our wetlands well down the road. I feel a much more pressing issue confronting the Ballona Wetlands today is the motor vehicle, tent encampment along W. Jefferson Boulevard just west of Lincoln Boulevard.
We have an ecological, societal and human health hazards occurring now. The misplaced persons settlement threatens the Wetlands with unsightly trash, litter, and undoubtedly human feces creeping into the marsh areas in abundance. I don’t suspect it’s the fertilizer needed for the area.
I hope the city and our council members recognize the plighted area and take action – just as they have done recently to address the crisis at Westchester Park. We need to address this issue and crisis immediately.
Playa del Rey
Failures of the medical system
I read Ms. Redman’s cover story in the November 18 issue of the Argonaut and was shocked and disappointed by the failure of the medical system in treating Ms. Giese’s simple injury. It’s important to highlight this story and how to avoid such disasters in the future.
Despite being the largest tendon in the body, the Achilles is plagued by poor blood supply, making an otherwise simple surgery of repair a risky endeavor. Tendon repairs in other parts of the body are protected by ample soft tissue, bringing about additional blood supply alongside a physical barrier from the external environment. The Achilles has little room for error, with only a few millimeters of soft tissue covering, necessitating careful repair of the paratenon layer over the Achilles for healing, as well as impeccable soft tissue management before, during and after surgery.
While smiling portraits of Ms. Giese show her resilience in this article, it highlights the need for transparency in advertising of physician credentials to avoid such disasters in the future. Twenty years prior to this injury, the American Orthopaedic Foot and Ankle Society had just begun to work on standardizing the foot and ankle curriculum in all orthopaedic residencies. Ms. Giese’s orthopaedic surgeon, who was presumably not fellowship trained in foot and ankle surgery, had last done Achilles reattachment surgeries somewhere between 1990 and 2000, before this curriculum was standardized for the general orthopaedic surgeon.
Even today, many orthopaedic residencies spend only five weeks of the five mandatory years of postgraduate training specifically dedicated to the foot and ankle.
Fellowship-trained orthopaedic foot and ankle surgeons are less common than our sports medicine or general orthopaedic colleagues.
Only 6% of graduating orthopaedic surgeons go on to complete a foot and ankle fellowship. That said, the need for specialty care is apparent.
The story illustrates the need for public education on the meaning of board certification by the American Board of Orthopaedic Surgeons and fellowship training in the appropriate subspecialty.
Many physicians practice outside of their “scope” and there are constant “turf battles” that leave patients understandably confused. Direct-to-consumer advertising leads to significant confusion over the actual expertise of the physician.
Luckily, we do have two signifiers that demonstrate approval by our colleagues. Board certification must be kept current on a routine, with renewal every 10 years.
However, mandatory activities to remain current must be completed on a much more frequent basis, with requirements for continuing medical education, self-assessment examinations, case presentations, and recertification examinations, even after the two-part board examination completed after training.
Fellowship training signifies an additional year after residency for a particular area of expertise. Examples within orthopaedics include sports medicine (which generally focuses on shoulders, hips and knees), arthroplasty (which is exclusive to hip and knee replacement), pediatrics, shoulder and elbow; hand, foot and ankle; spine, trauma and oncology.
Highly specialized fields may require more than one fellowship, such as pediatric hand surgery.
The level of experience and knowledge for a subspecialist far outweigh the general requirements for residency graduation.
General confusion over physician credentials is apparent every day, when patients are referred to me for hand injuries or knee arthritis, or the patients who show up with the mistaken idea that I am a podiatrist. As a board certified orthopaedic surgeon with accredited fellowship training in foot and ankle surgery, I practice below the knee despite the ability to do any orthopaedic surgery of my choosing.
It is in this area that I know my expertise makes me the best physician and surgeon.
I have been practicing in Marina del Rey since 2016 and was the first orthopaedic foot and ankle surgeon here when I joined the specialists at DISC.
I am in solo practice and have gained professional team consultant positions with Red Bull North America, America’s Cup Sailing, the Las Vegas Raiders, and treat individual athletes from many other teams as well.
I have also established the Heal Institute in Marina del Rey to offer specialty care for heel pain, a cluster of diagnoses often pushed aside by specialists who prefer to see patients with problems that can be fixed with surgery.
I appreciate this conversation about the failures of the medical system. Limited ability to organize and advertise causes massive confusion in the system, and patients often rely on word of mouth referrals or advertising by larger hospital systems.
I hope that by sharing Ms. Giese’s story, you can help patients find their way to the right specialists for their needs.
I urge people to seek out board certified, fellowship-trained orthopaedic surgeons specific to the injuries that they have.
Alexis E. Dixon
Board certified orthopaedic surgeon
Foot and ankle surgeon
Marina del Rey