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Write for me microsoft office 2018 capstone project capstone power corporation for money soufun holdings annual report hello Courtney I'm dr. Silverberg welcome to my podiatry office hello dr. Silverberg it is very nice to meet you I read many great reviews about you on Google that's great Courtney I see you wrote down that you are having a problem with bunion pain please tell me a little about your problem well doctor I am only 28 years old and my bunion hurts all the time I have pain when I walk and workout I have pain when I wear my cute shoes especially my high heels how long has this been going on for well doctor it has been happening for at least six months but it has gotten worse over the past two months the pain limits my activity and exercise I can't wear my heels what can you do for me well Courtney first of all let me examine you and take some x-rays I see you have arches that collapse when you stand up people with flat feet get bunions when your arch collapses your big toe cannot move through its proper range of motion this causes the big toe to get pushed to the side as you walk run and work out you see bunions are hereditary in that people are born with feet that flatten but not necessarily that big bump sticking out the side of your foot improper fitting shoes make it occur a bit faster but it's mostly hereditary now that I've explained why you got the bunion are there any questions no doctor Silverberg you explain that very well can you show me my x-ray now sure Courtney here you can see that the great toe joint is out of alignment such that the big toe points toward the second toe also you can see the metatarsal bone the bone behind the big toe has moved from being parallel to the other ones doubt and to the side this is the big bump you see on your foot you see the bump is not a growth but rather the bone has moved in this direction the good news is that you came in for a consultation early and did not wait too long and get bad arthritis in the joint some people wait too long and then once the arthritis is bad I have to do more invasive surgery to fuse the joint or put in a joint replacement luckily for you this does not apply to you any questions so far Courtney no doctor you explained that really well I really understand so now will you tell me about the treatment options well Courtney first off all let me tell you about the non-surgical options obviously the only way to get rid of the bunion is through surgery but first I'll tell you about treating the pain that you are having and how to slow down the progression of your bunion as I'm sure you figured out already wearing proper shoes is important when you are having painful days some prescription or over-the-counter anti-inflammatories will help sometimes I give cortisone type injections into the big toe joint to alleviate the pain this lasts anywhere from a few days to a few months but is a temporary fix at best now I will tell you about the surgical options okay doctor I'm ready to hear about it I'm a little nervous about having surgery don't worry Courtney I will explain everything to you and make you aware of everything you need to know so that you can make a decision this is called elective surgery because you choose if and when you have it I tell people to have the surgery if and when they get to the point when they are regularly in pain with normal activity I also tell them it is time for the surgery when the pain limits the activities that they are able to do or if the pain limits the shoe that they are able to wear well doctor I think that I am at the point where I need a surgery please tell me more okay Courtney the surgery is done as an outpatient this means that you do not stay overnight but rather go home the same day you will be given anesthesia from an anesthesiologist this is not general anesthesia however you will be asleep for the procedure you will not hear any saws or feel any needles this is called in laymen terms Twilight sleep you will be very comfortable okay that sounds good so far please tell me more the surgery takes me about 45 minutes to do I make an incision on the side of your foot I like to put the incision over here on the side of the foot so you cannot see the scar when you look down at your foot then I will cut the bone and move and into place I use a small titanium screw to hold the bone in place while it heals correctly once I'm done moving the bone I will do a plastic surgery type stitch that goes beneath the skin and absorbs inside this will make the scar as nice as possible occasionally I will do some plastic surgery type skin flaps in order to reduce the amount of extra skin that was covering the large bunion wow it sounds like you do a very cosmetic job so it looks good and feels good after exactly I will put you in a bandage and give you a boot where you'll need to keep your foot dry for 10 days after the surgery I can give you a shower bag for that you will wear the surgical shoe or surgical boot for about four weeks after the surgery I will see you weekly for follow-up I will give you painkillers and antibiotics to take after the surgery some people have no pain at all and some people have a lot of pain most people have some pain but not very much and the painkillers work very well for this after the four weeks in the surgical shoe or boot you will be able to fit into loose-fitting shoes or open shoes in the warmer weather most people wear the loose fitting shoes for an additional four weeks before they're able to fit into the regular shoes at around eight weeks you're able to do moderate exercise including a stationary bike walking for fitness and possibly the elliptical machine at this point your bone will be mostly healed you can slowly start increasing your activity at this time that's good to hear as I work out regularly I look forward to running again without any pain occasionally I will refer you for physical therapy in order to get increased range of motion of the joint where I operate it most insurances will cover the whole thing including my services the surgery center facility charges and the anesthesia doctors charges that is about all if you want the surgery you will need to come back and see me one more time for a preoperative visit where I will draw your blood give you prescriptions and post-operative instructions if you think of any questions feel free to call me email or just write them down and ask when you come back well doctor thank you so much for taking the time to explain everything in such great detail your Google review said you always took your time to explain things in detail and you did not disappoint there were also so many patients that wrote that they had little to no pain after the surgery and that their feet looked and felt great although I'm nervous about having foot surgery I feel confident that you are the best doctor to do it thank you so much you are very welcome it was a pleasure to meet you Courtney I look forward to seeing you again soon if you decide that you want the surgery please try to give me as much notice as possible my surgery schedule fills up very quickly as I have people from all over the country come to New York to have this surgery done by me feel free to browse my website at WWDC on June 2 eight seven one zero eight zero zero my email is Citi foot care at gmail.com bye you ap capstone digital portfolio student Watson School of Biological Sciences (graduate school).