The New Digs

Well, it’s been a month since the big office move, and I have to say that I am impressed. The San Francisco office is spacious and lovely, and the staff is excellent. Patients are registered and roomed by a team not distracted by constantly ringing phones, since another group makes appointments and handles most phone calls. Checkout and authorizations are handled by a separate team. My medical assistant is at my side constantly, helping with procedures and paperwork to make my patients’ experience go smoothly. Administrative tasks that used to take up his time are now mostly handled by other team members. We have an excellent fluoroscopy in the office that allows me to get high quality diagnostic images, and an ultrasound for evaluation of soft tissue injuries and guidance for injections.

I am very pleased that I can still maintain a Daly City location and continue to serve my San Mateo County patients. This new location and the staffing provided is allowing me to see patients more efficiently, and decrease the wait time for an appointment in that location.

While there are always a few bumps in the road, my transition team has handled the transfer of my practice with great efficiency and professionalism. The positive feedback I’ve gotten so far shows that we are on the right track. We will continue to focus on efficiency and make the office experience as pleasant as possible while maximizing my accessibility for my patients. If, as my patient, you have any challenges in reaching me or my assistant, please contact me via the website.

Transitions and New Beginnings

It’s been my intention to post about once a month to keep my patients informed about orthopedic conditions and office events. I haven’t posted in a while, and if you’ve been to my office in the past month you’ve probably discovered why I’ve been so busy: I’m moving!

If you follow health care issues in the US, you probably know that our health care delivery systems are changing, and private practices are closing or merging with other practices. My own practice has been considering options and have decided on the plan that works best for us. Dr. C. Arthur Sciaroni will be completing his retirement, and Dr. Missirian will be focusing his practice more on his specialty area of foot and ankle.  I, of course, would like to continue my active and vibrant practice for many years, and I found a great opportunity to do that with the San Francisco Multispecialty Medical Group.

This is a large, multi-location group that developed in the niche of treating work related injuries and have leveraged that strength to grow in management of private orthopedics.  Each of my new offices is within blocks of the old one, making the transition easy.  I will still have locations in both San Francisco and Daly City.  I am thrilled about the move and the benefits to my patients.  I can now offer high resolution fluoroscopy in the office (great quality low radiation x-ray) as well as ultrasound.  For those of my patients that do have work related injuries, the staff are already experts on the complex system of documentation and authorization required.

Starting tomorrow, you will find me at the new locations.  All the contact information has been updated on my website,  I am thrilled and impressed by the great staff at the San Francisco Multispecialty Medical Group and I think the patient experience will be excellent.  There can always be some bumps in transition, so please remember if you have any issues contact me on the website.

Over the Counter Pain Meds – What You Need to Know

We all take an over-the-counter pain reliever from time to time, medications like Advil, Tylenol, or Aleve.  But many people don’t understand the similarities and differences between them.  knowing a little about their function and their risks/benefits can help you decide what’s medication may be best for you – or to decide to use a heat or ice pack instead.  Here’s a link to some helpful information.

Stress Fractures

Early in the year many of us start to plan our upcoming sports goals and events. By the time we reach March or April, some of us start going a little overboard, and people start showing up in my office with stress fractures. It’s important to remember that bone is more than just a structural scaffold – it’s a dynamic living tissue that is constantly remodeling to accommodate the stresses we place upon it.  If we repetitively stress a bone beyond it’s capacity to remodel and don’t rest enough to let it catch up, a stress fracture can be the result.  Here’s some useful information about stress fractures from a reliable source. I hope it’s useful.


Some General Information on Plantar Fasciitis

The information presented below is just that – information.  It is not intended as medical advice.  If you think you have plantar fasciitis and have not been able to resolve the symptoms on your own – consult with your doctor for proper treatment!

A couple of my family members have been having trouble with plantar fasciitis lately, and after sharing some information with them, I thought I would share that information here as well.  I’m seeing a lot of plantar fasciitis in the office lately, particularly since the weather is so warm and a lot of us are out there taking advantage of it, running and hiking more than we usually would at this time of year.

The plantar fascia is a ligament on the bottom of the foot, extending from the heel to the front of the foot and supporting the arch.  Plantar fasciitis occurs when this structure becomes inflamed.  This can happen for a number of reasons, including overuse, tight calf muscles, or shortly after beginning a new activity.  It is not caused by heel spurs – many people have bones spurs in their heels, but few of them have plantar fasciitis!  Your doctor usually doesn’t need an x-ray to diagnose plantar fasciitis, though it is sometimes useful to help rule out other conditions such as stress fractures.

The main symptom of plantar fasciitis is heel pain – particularly tenderness at the front of the heel.  Many times there is immediate pain with the first step when you get out of bed in the morning, but some people may have worse symptoms later in the day, when they’ve been on their feet for a while, and the pain can’t always be localized to just the front of the heel.  If it’s bad, it may not feel that specific.

Initial treatment generally includes a mild reduction in activity – particularly impact activity such as running and jumping – while continuing to engage in light activity to maintain fitness.  This is combined with a program of stretching and strengthening, ice massage, arch supports, and anti-inflammatory medications such as ibuprofen (Advil, Motrin) or Aleve (if well tolerated).  Many times, a brief reduction in activity along with a strong focus on stretching, icing, massage, and proper arch support is all that’s needed.  For tougher cases, there are other options including night splints, PT (physical therapy), and cortisone injection, among others.  Plantar fasciitis can usually be fully resolved without resorting to surgery.