Colonoscopy and colon cancer screening

The first method is a stool test that checks your bowel movements for blood. The second method is a sigmoidoscopy exam, which looks at the lower part of your colon. The third option is a colonoscopy. It is similar to a sigmoidoscopy but with one important difference; the entire colon can be viewed.

Colonoscopy is the endoscopic examination of the large bowel and the distal part of the small bowel. It provides a visual diagnosis and grants the opportunity to find ulcers, colon polyps, tumors, and areas of inflammation or bleeding.

A colonoscopy can be used to:

  • Collect tissue samples
  • Take out abnormal growths
  • Screen test to check for cancer
  • Screen test to check for precancerous growths in the colon or rectum

Men and women 50 years old and older should have a colonoscopy every 10 years.


Minimally invasive parathyroidectomy

MIP is typically performed through a smaller incision than the bilateral exploration, usually 1-3 cm. This technique allows for a much shorter surgery when compared to the traditional surgery that explores both sides of the neck.

MIP is not just one procedure, but a variety of techniques that can be used either alone or in combination. Central components include pre-operative localization, intraoperative PTH testing, radio-guidance, and local anesthesia.

There are several potential advantages of MIP over a bilateral neck exploration, including but not limited to:

  • Smaller incision
  • Improved cosmesis
  • Shorter operative time
  • Creation of less scar tissue
  • Fewer problems with low calcium levels after surgery
  • No risk to nerves and other structures on the “normal” side of the neck
  • Less invasive operation means less pain
  • Less recuperation time needed
  • Less expensive than the standard operation
  • Cure rate is higher than the standard operation
  • No risk of hypoparathyroidism


Overview  PAGE


Ophthalmology is the branch of medicine that deals with eye physiology, anatomy and diseases. A specialist in this branch of medicine is called an ophthalmologist. The Department of Ophthalmology at La Peer not only offers breakthrough eye surgeries but rather a medical program beginning with consultation, moving through diagnosis and treatment, and high quality aftercare to ensure that your eyes remain healthy and conditions do not develop or reoccur.


The ophthalmologists at La Peer offer the latest eye surgeries including cataract surgery, vitrectomy, tear duct surgery, orbital surgery, and cosmetic eye surgery.

The doctors of La Peer are extensively involved in medical research and clinical trials. Our aim is to be at the forefront of patient care and to ensure our physicians remain at the forefront of medical innovation.

La Peer Health Systems was also named one of the 100 Greatest Places To Work by Becker’s ASC Review. We take great pride in our professional and courteous staff and are honored to be included on Becker’s 2013 ASC Review.


Medical Conditions

●     Age-related Macular Degeneration

●     Cataracts

●     Conjunctivitis

○     Allergic conjunctivitis

○     Bacterial conjunctivitis (pink eye)

●     Glaucoma

○     Open-angle glaucoma (chronic)

○     Acute-angle closure (acute)

○     Secondary glaucoma

○     Congenital glaucoma

●     Graves Disease

●     Endophthalmitis

●     Flashes and Floaters

●     Macular Puckers

●     Diabetic Retinopathy

●     Pterygium

●     Ptosis

●     Retinal Detachment

●     Strabismus


Medical Procedures

●     Cataract surgery

●     Refractive surgery

●     Vitreo-retinal surgery

●     Cosmetic eyelid surgery

●     Ptosis repair

●     Orbital Surgery

●     Pterygium Excision

●     Central Serous Choroidoretinopathy

●     Retinal Detachment Surgery

●     Intraocular Medication Injections

●     Diabetic Retinopathy

●     Central Serous Choroidoretinopathy

●     Peritnial Retanothopy

●     Indocyanine Green (ICG) Angiography

●     Retinal Angiography

●     Fluorescein Angiography

●     Retinal Angiography

●     Implantable contact lenses

●     Epikeratophakia

●     Limbal relaxing incisions

●     Corneal transplant surgery

●     Anterior vitrectomy

●     Pars plana vitrectomy

●     Retinal detachment repair

●     Pneumatic retinopexy

●     Retinal cryopexy

●     Retinal cryotherapy

●     Partial lamellar sclerouvectomy

●     Partial lamellar sclerocyclochoroidectomy

●     Partial lamellar sclerochoroidectomy

●     Scleral buckle

●     Laser photocoagulation

●     Macular hole repair

●     Posterior sclerotomy

●     Canthectomy

●     Canthorrhaphy

●     Lateral canthotomy

●     Epicanthoplasty

●     Tarsorrhaphy

●     Transposition / repositioning procedures

●     Canthal resection

●     Canthopexy


If you have an eye complaint, or believe that you need treatment for an issue pertaining to your eyes or vision then please get in touch with us. You can do this via the online contact form or via phone or email. You can also visit our Orbital Surgery Center of Excellence department website for more detailed information about our eye plastic and reconstructive surgical procedures.


La Peer Health Systems Department of Ophthalmology

(855) 360-9119

8920 Wilshire Blvd Suite 101

Beverly Hills, CA 90211

[email protected]



Anatomy of the Eye Page


Cornea – The cornea is the transparent film that covers the iris and pupil.


Conjunctiva – The conjunctiva is a thin membrane on the outside of the eye.


Iris – The iris is the colored portion of the eye. The iris controls the amount of light let into the pupil. When there is an increase of light, the iris contracts and the pupil gets smaller. When it is dark, the iris relaxes and lets more light in.


Pupil – The pupil is the portion of the eye that allows light in. The pupil is located in the middle of the iris and in front of the lens.


Lens – The lens is a structure in the eye that works with the cornea to refract light from the pupil to the retina. The lens is located in the front portion of the eye behind the cornea and pupil.


Vitreous – Vitreous is the fluid that fills the middle of the eye. This fluid is attached to the retina.


Macula – The macula is a small part of the retina located in the middle of the retina near the optic nerve. The macula is what allows you to make out small details, whereas the rest of the retina is your peripheral vision.


Retina – The retina is the tissue at the back of the eye. This tissue is sensitive to light and converts light into impulses for our brain to form into images.


Optic Nerve – The optic nerve is the bundle of nerves at the very back of the eye that transmits the impulses from the retina to the brain.




There are a variety of conditions that can affect the eye, both cosmetic and functional. The doctors at La Peer treat both functional eye conditions along with cosmetic eye concerns. Here is a list of the conditions treated at La Peer:


●     Age-related Macular Degeneration – This condition is where the macula deteriorates as a result of the aging process. There is no cure for macular degeneration, but one can slow the progression of the disease. Certain vitamins and minerals have been shown to slow the progression of the disease. It is advisable to visit an ophthalmologist to discuss treatment.

●     Cataracts – Cataract is the degeneration and clouding of the lens. Most cataracts are associated with the aging process. The progress of cataract causes vision loss and potential blindness.  The symptoms of cataracts are blurry or dim vision. Some people say that objects don’t appear as bright as they once did. The treatment of cataract is to surgically remove the clouded lens and replace it with a clear, artificial one.

●     Conjunctivitis – Conjunctivitis is the inflammation of the eye membrane called the conjunctiva. There are a few different types of conjunctivitis including allergic, bacterial, or viral.

○     Allergic conjunctivitis (Eye Allergies) – Allergic conjunctivitis can occur after exposure to pollen, pet dander, smoke, perfume, and sometimes food. The most common treatment for eye allergies is avoidance, eye drops, immunotherapy shots, and antihistamines. It is best to avoid the substances which cause reactions. Clean your home and bedding regularly to cut down on the contact with dust mites and other allergens.

○     Bacterial conjunctivitis (pink eye) – This is a very common condition where the inflammation is caused by bacteria. It is highly contagious and spread through direct contact. The symptoms include red, itchy eyes, or pus. This is easily treated with antibiotic eye drops.

●     Diabetic Retinopathy – Diabetic retinopathy is a condition where abnormal blood vessels form on the retina which can leak fluid or close off. This condition is very common among diabetics and often shows no symptoms in the early stages. If this condition is left untreated, it can eventually cause blindness. Symptoms of proliferative retinopathy include blurred vision, spots in vision, vision changes from blurry to clear, deteriorating night vision, change in appearance of colors, or vision loss. There is no cure for this condition, but it can be managed with surgical treatments and medication. It is important to be checked for this condition if you are diabetic. If you are not diabetic, it is important to control your blood sugar regularly.

●     Glaucoma – Glaucoma is a condition where the pressure on the optic nerve has increased. The increased intraocular pressure (IOP) is caused when the eye is not properly draining. There are different types of glaucoma:

○     Open-angle glaucoma (chronic) – This is the most common form of glaucoma. This form of glaucoma typically develops slowly over time.

○     Acute-angle closure (acute) – This form of glaucoma is caused by a sudden blockage in eye. The fluid cannot drain properly and builds up and places more pressure on the optic nerve. The symptoms of this are a sudden increase in pressure and pain in the eye. If you are experiencing this, it is very important to see a doctor immediately.

○     Secondary glaucoma –  Secondary glaucoma is caused by injury, certain medications, or other eye diseases. If this is the cause of glaucoma, it is important to manage the other conditions to treat the glaucoma.

○     Congenital glaucoma – Congenital glaucoma is present at birth and typically caused by an eye abnormality. The doctors will typically address the problem at an early age.

●     Graves Disease – Graves disease is actually a thyroid condition, but it can lead to eye complications. It can cause blurry vision, eye irritation, or push eyeballs out farther than it should. The treatment for Graves disease is medication to regulate thyroid activity or surgery. If the eyes have been extremely affected by the disease, surgery may be used to return the eye position to normal.

●     Endophthalmitis- This is a serious condition that involves inflammation or swelling within the eyeball. This is usually caused by infection or bacteria. Symptoms of this include pain, decreased vision, swelling of the eyelids and redness.

●     Flashes and Floaters – Floaters are small specks in one’s vision. These are caused by cells floating in the vitreous. Flashes are flashes of light. This occurs when the vitreous pulls on the retina. These are commonly experienced as we age. As we age, the vitreous shrinks and pulls away from the retina. This can cause flashes. It can also occur in those who have had YAG laser treatments on the eyes, are nearsighted, have had cataract surgery, had an eye injury, or swelling of the eye. Flashes can be a symptom of a detached retina. If you are experiencing more flashes and floaters, it is best to see an ophthalmologist to ensure the underlying cause isn’t serious.

●     Macular Puckers – When the vitreous shrinks as we age, it can pull on the retina. Sometimes the retina can tear, but it can also tear a tiny bit and heal itself. Scar tissue forms around the torn retina creating a macular pucker.

●     Pterygium – This is a non-cancerous, triangle shaped growth that occurs over the white of the eye. The treatment for a pterygium depends on the size. If it becomes large enough, it will have to be surgically removed so it doesn’t cover the cornea.

●     Ptosis – Ptosis is when the upper eyelid droops over the eye. This condition can be mild or severe enough to block one’s sight. Ptosis can occur at birth or occur as one ages. Ptosis can be repaired through a surgery called a ptosis repair. It is important to fix ptosis in young children because it can permanently hinder the development of the child’s eyesight.

●     Retinal Detachment – The retina is the tissue that converts light into impulses for the brain to decipher. As we age, the vitreous in the center of the eye can shrink and shift. For many, it simply shrinks and moves away from the retina. In others, it can actually pull on the retina so much that the retina can tear, called a macular hole. This fluid can seep behind the retina and detach it from the back of the eye. The symptoms of a detached retina are blurry vision, severe floaters, flashes, decrease in sight, and blindness. The treatment for retinal detachment is surgery.

●     Strabismus – Strabismus is the condition where there is a lack of coordination between the movement of the eyes. This condition can be caused by a lack of muscle coordination or the brain is not properly telling the eyes where to move. The treatment for this condition depends on the underlying cause. If the cause is from the ocular muscles, then the muscles can be trained to work together through exercises, glasses, or surgery.

Erectile Dysfunction

Erectile DysfunctionErectile dysfunction is characterized by the inability to develop or maintain an erection, and affects an estimated 18 million men in the U.S. alone. For most, the thought of erectile dysfunction (ED) is unsettling. However, with the various treatment options available today there is almost always a solution for ED, regardless of the cause.

Our team of Beverly Hills urologists consists of leading experts in the field. At La Peer Health Systems, our doctors take great pride in providing confidential treatment plans for patients with erectile dysfunction. To make a private appointment with one of our highly regarded urologists, please call us today at (855) 360-9119.

What Causes Erectile Dysfunction?

Erectile dysfunction can come about from both physical and psychological conditions. A urologist will perform a complete physical examination and personal history to identify the cause of a patient’s ED. The most common causes include:

  • Chronic kidney, vascular, or neurological disease
  • Common medication used for blood pressure or depression
  • Surgery in and around the nerves that control erections
  • Psychological factors

What Treatments Are Available?

After diagnosing the cause of the ED, the doctor can recommend a treatment plan. The first step toward correcting ED often includes lifestyle changes such as reducing stress and exercising regularly. For chronic or more severe cases of ED, the following treatments are available:

  • Oral Medication: Medicine for erectile dysfunction, like Viagra, Levitra, Cialis, and Staxyn, increases the blood flow to the penis to initiate and maintain an erection firm enough for sexual activity. The type and strength of oral medication needed is based on the patient’s unique situation.
  • Vacuum Erectile Device: A vacuum erectile device (VED) is a medical grade vacuum pump with a cylinder that fits over the penis. It draws blood flow to the penis using vacuum pressure to stimulate an erection. After an erection occurs, a constricting band is placed at the base of the penis and the cylinder is removed to allow for sexual activity. The band can be removed after intercourse.
  • Injectable and Urethral Medication: A combination of medications is directly injected into the area of the penis that becomes erect. The injections increase penile blood flow and an erection is usually achieved within 15 minutes at lasts between 30 – 90 minutes. Some of these medicines can also be inserted with along with a local anesthetic into the urethra.
  • Penile Implant: When the previous treatment options do not work for a patient, surgery is an option. A penile implant or penile prosthesis, in which penile “rods” are placed within the corpora cavernosa and a control is placed within the scrotum above the testicles, allows patients to pump the rods into an erect position for sexual activity and simply deflate the device when finished.

Erectile dysfunction can be difficult to cope with. It is important to communicate effectively with your partner as well as your doctor to promote healthy management of ED. Stress and depression are both contributing factors and possible side effects of ED. Maintaining intimacy before and after treatment can reduce stress or depression brought on by erectile dysfunction. Our doctors can also recommend lifestyle changes to optimize your treatment.

Erectile Dysfunction FAQ’s

Q: How can I tell if I have erectile dysfunction?

A: Occasional inability to have an erection is normal and may not be a sign of ED. If you have noticed that erections are becoming infrequent and more difficult to maintain, or that you are unable to achieve an erection in certain situations, you should consult with a urologist to determine a diagnosis and available treatment options.

Q: With so many options, how do I choose which treatment is right for me?

A: Treatment will vary depending on individual health and whether the ED is attributed to physical or psychological problems. The urologists of La Peer Health Systems can walk you through various treatment options and will develop a personalized treatment plan based on your specific condition and desired outcome.

Q: Can treatment for ED restore intimacy to my relationship with my spouse or partner?

A: Yes, most ED treatment is successful at restoring intimacy and sexual satisfaction. Your doctor can work with you and your partner to overcome the barriers to sexual intimacy that any erectile dysfunction has produced.

Contact a Urologist in Beverly Hills

We understand that erectile dysfunction can be an extremely sensitive topic and one that most men would rather avoid in conversation. Millions of men suffer from ED, so you are not alone. If you are experiencing erectile dysfunction, contact the urologists at La Peer Health Systems confidentially at (855) 360-9119 for more information about treatments and our medical team.

Postoperative Care for Minimally Invasive Spine Surgery

The management of the needs and activities following a minimally invasive spine surgery evolve with time. Patients will have some expectations during this stage. The spine surgeon will have various recommendations based on his or her preference, the need of the patient and the type of minimally invasive spine surgery. Immediately after the surgery, pain medication is administered. This is usually given by injection or in the vein. Within two days, as the pain lessens, this can be modified to oral medication.

Recovery in preoperative symptoms is attained in 80% of patients. Back pain and function improvement continues up to a couple of years following the minimally invasive spine surgery. The basis for the improvement would be:

  1. nerve compression recovery
  2. continuing fusion mass maturation
  3. muscle conditioning after the surgery

Recovery after a minimally invasive spine surgery can be affected by smoking. Nicotine is like a bone poison that inhibits bone fusion. According to a study on bone mass fusion with spinal fusion patients depicts that there is lower nonunion rate to patients who do not smoke than those patients who smoke. The nonunion rate for those who quit smoking is slightly higher.

Occupational therapy, exercise and physical therapy may be needed to aid patients in regaining strength and function. This could start in the hospital or be suggested at a later time

Like other forms of back pain treatment, the more effort exerted by the patient, the better the whole result of minimally invasive spine surgery.

Non Surgical Treatment Options for Gastrointestinal Problems

There are a number of problems that usually affect the gastrointestinal tract. A few of them are often short lived; however, they cause discomfort and usually distressing. A lot of problems that affect the gastrointestinal tract can be resolved by improving the lifestyle and following doctor’s prescriptions.

Diarrhea- This disorder is treated while ensuring that dehydration will not happen again and decrease the rate of food movement through the bowel.

  1. Kaolin- This is a known remedy due to its reputation. This medication is available in tablet or liquid form. Anything in the bowel that may cause diarrhea is absorbed by the kaolin.
  2. Oral rehydration sachets- This must be the main treatment for diarrhea. Only these sachets replenish the salts in the body that it lost along with water during the disorder.
  3. Loperamide- This functions like Morphine but it is more effective. An episode of diarrhea can usually be treated with a couple of capsules as one dose.

Constipation- The main goal of treating constipation is to make some improvements in the bowel movement. This is made possible by taking in laxatives. Laxatives come in different types.

  1. Osmotic Laxatives- These functions by pulling water into the bowel which will soften the bowel content and minimize constipation.
  2. Stimulant Laxatives- These medicines are helpful in leading the passing of a movement and relieve constipation. They will irritate the bowel lining and cause bowel muscle contractions.
  3. Lubricating Agents- These agents line the bowel with lubricants to ease the passing of a movement.

Indigestion-Treating this disorder will vary according to its symptoms. Its treatment is aimed at removing the excess acid. Here are several ways to do this.

  1. Alginates- They react with acid and come up with a rafting effect. They are available in liquid or tablet form.
  2. Antacids- They contain ingredients that neutralize stomach acids

Gastrointestinal Problems: Surgery

Hand-assisted laparoscopic surgery (HALS) and laparoscopic surgery are minimally invasive procedures that are usually used to diagnose disorders in the gastrointestinal tract.
Some of the conditions that are treated at La Peer Surgery Center are as follows. Please contact us if you think you might be suffering from any of the signs and symptoms listed above.

Medical Conditions
Cirrhosis of the Liver
Inflammatory Bowel Disease
Fecal Incontinence,
Colorectal Cancer
Peptic Ulcer Disease
Ulcerative Colitis
Irritable Bowel Syndrome
Chronic Viral Hepatitis
Constipation treatment
Celiac Diet
Lactose Intolerance
Anal Warts
Pancreatitis treatment
Inflammatory Bowel Diseases
Hemorrhoid treatment
Severe Constipation

Orthopedic Surgery


To correct their musculoskeletal deformities such as fractures and fragile bones, patients who experience these kinds of conditions resort for an Orthopedic Surgery. It is a surgical treatment performed by a medical specialist specifically an orthopedic surgeon, who assesses and cures problems involving the bones, joints and the ligaments. Common surgical procedures include ORIF (Open Reduction with Internal Fixation), Closed Reduction with Internal Fixation and Arthroscopic surgeries of the knee. It may also treat problems involving the nervous system such as Muscular Dystrophy and Cerebral Palsy. It also remedies different skeletal deformities in the spinal cord, such as following an injury. These problems may be congenital in nature, through an injury or declining function associated with age. It could be classified as acute, where an injury or trauma causes the alteration of function, or chronic such as age-related changes.

In the past, orthopedic surgeons treated spine and leg irregularities in children where they apply braces to strengthen the bones of the child. It was where the name Orthopedics originated, from two Greek words “ortho” meaning straight, and “pais“, the Greek name for child. Through the advents of anesthesia and the application of aseptic techniques, the work of orthopedic surgeons gradually shifted to associated nerves and tissues of different bones.

Although several orthopedic surgeons undergo specialization in particular surgeries such as spinal disorders and in hand and joint replacement surgeries, most of them are still practicing general surgery. Others might specialize in treating injuries in trauma units and emergency rooms, a field called as trauma medicine. Some of them might even go beyond their field and collaborate with podiatrists, geriatric specialists and other related medical allied groups. An emerging field of orthopedics is Sports Medicine, which are composed of board certified orthopedic surgeons.

A variety of extensive procedures are offered by orthopedic surgeons, such as amputations, traction, spinal fusion, hand reconstruction and joint replacement. Strains, sprains, dislocations and broken bones are also treated by orthopedists. Specific procedures are done by orthopedic surgeons such as arthroplasty, arthroscopic surgery, fracture repair, traction, fasciotomy, and bone grafting, to name some of them. Different hospitals provide work for these orthopedists and incorporate them as part of the surgical team along with the surgical nurse and anesthesiologist. Before the orthopedic surgery is done, a choice of general, regional or local anesthesia could be used. A surgical team may compose of a solo practitioner or a group of two to six orthopedists.

The orthopedic surgeons’ job includes adding screws, wires, nails, pins, prosthetics and tongs inside the body. In this way, proper alignment of the skeleton is achieved and damaged bone or tissue is substituted. Enormous strides have been made with the introduction of recent devices such as artificial limb and joints with the availability of new materials used to restore damaged bones and connective tissue. Advancements in plastics and metal technology enable orthopedists to mimic the natural functions of bones, joints and ligaments and achieving greater accuracy in restoring damaged parts to their original range of motion.

Orthopedic surgeons make use of physical, medical and rehabilitative methods. In order for them to remove dead cartilage and other debris in the affected area, they often resort to laser surgery. If the fracture or dislocation is sports-related, these surgeons would elect to procedures such as shoulder arthroplasty when the fractured part is on the shoulder, or replacing the ball and socket joint for osteoarthritis.

Diagnosis and Preparation

Other doctors such as emergency doctors and primary care physicians may refer their patients to an orthopedic specialist, preferably a surgeon. They work alongside other healthcare teams that include family physicians and rheumatologists. Before the orthopedic surgery is done, candidates for the operation would have to a screening procedure to determine the appropriate procedures to be done. The procedure to be done greatly lies on the patient’s age, underlying orthopedic condition, physical health in general and the impact of joint disability to the patient’s daily activities of living. To ensure greatest function, the timing of the procedure must be crucial. Surgery should be performed before surrounding muscles become contracted and atrophied and the occurrence of serious structural abnormalities. The orthopedist makes a thorough evaluation of the client to ensure that the correct procedure is to be performed.

A series of diagnostic tests include X-ray, Computed Tomography Scans and Magnetic Resonance Imaging (MRI), along with series of blood tests for donor compatibility, diagnostic arthroplasty and myelograms. The history of the deformity together with the patient’s history of treatments is determined by the orthopedist. Allowing the affected area to rest prior to surgery may be carried out. Patients who will go through orthopedic surgery must also pass standard serum and urine tests prior to the operation, and may undergo electrocardiogram (ECG) and other necessary tests before the surgery commences. Patients scheduled for an operation may donate their own blood to make it as a reserve for major surgeries, since blood loss is common. It also minimizes the risk of blood transfusion reactions.

Minimally Invasive Spine Surgery: Description

Minimally invasive spine surgery is an endoscopic operation that utilizes specialized instruments that are entered into the abdomen or chest through tiny incisions in order to reach the spine and do the required surgery. This procedure involves the use of a specialized video camera as well.

For decades, endoscopic methods have been utilized but to diagnosis certain conditions only. In the later part of the 1970 and early part of the 1980s, there were advancements made to endoscopic techniques which allowed a diagnosis to be made and the disorder could be remedied. These techniques that are adopted in other surgical requirements have been developed to treat spine disorders.

However, a minimally invasive spine surgery is not perfect for everyone. A surgeon must completely assess each patient to identify their qualification for the surgery. In some cases of scoliosis, degenerative discs, kyphosis, herniated discs, fractures and infections, minimally invasive surgeries may accelerate recovery, alleviate post-operative pain and enhance the final result. The different types of minimally invasive spine surgeries are:

Spinal Tumor Decompression– This is performed to remove the whole tumor or part of it from the spine. This procedure decompresses or relieves spinal cord and nerve root pressure, thereby alleviating pain and other potential symptoms.

Minimally Invasive Lumbar Spinal Fusion-This procedure is aimed at fusing the two vertebrae to stop any motion between them. Removal of the intervertebral disc or bone spurs may minimize nerve pressure. When the two vertebrae are fused, the bone spur formation will be stopped at that certain location, further alleviating possible nerve injury and pain.

Discectomy is a procedure that is a removal of a herniated disc material that presses on a nerve root or the spinal cord. Before the removal of the disc material, a tiny piece of vertebral bone is removed. This is to enable the surgeon to have a better view of the herniated disc.

Benefits of Minimally Invasive Surgery
Compared to the conventional spine surgery that needs long incision and recovery period, minimally invasive surgery utilizes an endoscope that is inserted into a tiny incision. The endoscope is attached to a small video camera that projects the inner view of the body onto the operating room’s television screens. After the procedure, sutures are used to close the tiny incisions which will be covered with surgical tape. They will be almost invisible after a few months.

The fact that minimally invasive spine surgery holds a minimized risk of complications and alleviates the need for a longer stay in the hospital indicates that there could be cases that such surgical procedure can be performed on an outpatient basis. Obviously, this demonstrates substantial advantage for both patient and doctor in terms of cost effectiveness and safety. These procedures have become popular due to these mentioned advantages.

Minimally invasive spine surgery techniques use cutting-edge technology to make corrections to chronic spinal conditions without triggering undue injury to the soft tissues that surround it. Because of these highly specialized instrumentation and tools, guided by enhanced features like nerve monitoring and computerized navigation, spine surgeons are able to perform the surgery safely and effectively.

Compared to posterior lumbar fusion (PLF), a minimally invasive spine surgery like transforaminal lumbar interbody fusion (TLIF) provides the same postoperative fusion rates and alleviates the quantity of spinal muscle iatrogenic injury. The benefits of minimally invasive spine surgery include:

  1. Lower infection risk
  2. Minimized post-operative  pain
  3. Alleviated blood loss
  4. Minimized scars
  5. Less body trauma
  6. Shorter recovery period
  7. Reduced or eliminated general anesthesia time
  8. Enhanced post-surgical mobility and function

Risks and Complications of Minimally Invasive Spine Surgery

Like any surgical operations, minimally invasive spine surgery has both procedure-specific and general risks. There are also cases that the original planned surgery will not be completed and must have a round of operation or a diversion from the minimally invasive technique to a full open approach.
General Risks:

  1. Adverse reactions to anesthetic
  2. Leg blood clot that can travel to the lungs causing pulmonary embolus
  3. Post-operative pneumonia
  4. Surgical site infection
  5. Blood loss that will require a transfusion

Procedure-specific risks:

  1. Spinal cord or nerve injury that results in pain and paralysis in severe cases
  2. Possible breakage and malfunction of the instrumentation used that may irritate the surrounding tissues
  3. Surgical pain

Surgeons who are performing minimally invasive surgery usually would say that there is a limited opportunity to learn this technique. Post-operative and intra-operative problems are higher when the surgeon is obtaining experience. The technical challenges may be overcome with practice and training but it needs time.

Minimally invasive spine surgery requires advanced techniques, demands specialized equipment, offers decreased visualization and is linked to a limited learning curve.  Compared to conventional surgical methods, this type of procedure is also related to minimized fusion rates and insufficient decompression.

The procedure does not need the utilization of fluoroscopy. This means a low chance of exposure to fluoroscopy. Actually, the risk is more for the part of the surgeon and staff in the operating room who are exposed to every patient. In minimally, invasive spine surgery, there is usually a risk of bone fracture, nerve damage, screw malfunction and blood clot formation.

Hernia: Signs and Symptoms

Hernia symptoms vary according to the structure and cause involved. A lot of hernia cases start as small and unnoticeable breakthroughs. It may occur as soft lumps found under the skin at first. Usually, this stage does not involve any pain. However, there will be gradual increase of the pressure in the internal content against the weak wall and the lump size increases. Other symptoms of hernia include:

Pain- Hernia comes with pain due to some reasons that include stretch of the tissue around and at the hole. This is also likely to occur due to damage and irritation to nerves in the area as a result of the pinch and push of hernia nerves.

Bulge- This becomes evident when abdominal cavity contents are pushed through the hole or the hernia defect. This location of the bulge will vary based on the location of the defect or hole and the hernia type.

Localize pain– This kind of pain is often the result of tearing and stretching of the abdominal wall tissues like the tendon and the area muscle. When the bulge increases, the pain is also expected to get more intense.

Generalized pain– Due to the incarceration or entrapment of hernia contents, the blood supply of the intestine is likely to shut off or be compromised. The tissue contained in a hernia will then be strangulated causing the tissue to die and cause additional pain that will become generalized pain throughout the abdomen. The pain is expected to be unremitting and severe.

Hernia Description
Hernia causes discomfort and pain as well as lessens general mobility. It is not a type of disorder that does not heal by itself despite curability of other forms using external manipulation. A hernia is likely to cause complications that are risky depending on the structural solidity through which it is protruding and the nature of the protruding organ.

There are different types of hernia’s as follows:
Abdominal wall hernia– This type of hernia is also called a ventral or epigastric hernia. This is not a very common type of hernia. This type also includes umbilical and inguinal hernias.

Direct inguinal hernia– This type of hernia can affect both men and women. The intestinal loop makes a swelling in the inside part of the groin’s fold.

Indirect inguinal hernia– This type is possible in men only. An intestinal loop passes through the canal from where a testis goes down the scrotum during childhood years. If this hernia is ignored, it may increase in size progressively and cause the scrotum to expand.

Umbilical hernia– Both men and women can be affected by this type of hernia. A loop in the intestine protrudes through a weak abdominal wall at the navel.

Hernia: Causes
Although some abdominal hernias may occur since birth, other types of hernias are developed at a later stage in life. There are those that include pathways created during fetal development, existing abdominal cavity opening and abdominal-wall weakness areas. A hernia can form and become worse by any condition that may increase abdominal cavity pressure. Some of these conditions include:

  1. Heavy lifting
  2. Chronic lung disease
  3. Obesity
  4. Straining during urination or bowel movement
  5. Abdominal cavity fluid

Hernia: Diagnosis

It’s likely that hernias are painful and definitely affect the quality of life. Because of this, it is necessary to visit a physician immediately once you can feel the potential presence of a hernia in the groin and abdominal area. The doctor will use various ways to identify if there is a need for hernia diagnosis so they can continue with an efficient and effective treatment course.

In various cases, hernia diagnosis is needed based on simple physical examination. While considering the type and size of protrusion, the physician may diagnose the condition by pressing gently on the affected area.  However, when a hernia is not simple enough to be identified by a physical examination, the physician may use other methods to identify the order of hernia diagnosis. These methods may include ordering a computerized tomography (CT) scan and magnetic resonance imaging (MRI).

Together with these tests, a diagnostic laparoscopy can also be considered by the physician before finally settling on a diagnosis. This test is a minimally invasive procedure that uses general anesthesia. The abdominal cavity will be directly placed with a scope enabling the physician to perform an examination of the abdominal walls. Typically, this method is only used when there are no conclusive results provided by other procedures of assessing the potential presence of a hernia. Moreover, ultrasound can be utilized to detect a femoral hernia and abdominal X-rays can be ordered by the physician to identify the presence of a bowel obstruction.

When the physician has diagnosed a hernia presence, it is likely to start administering the right treatment for the disorder which will vary according to age, size and location of the hernia and the level of discomfort.

Hernia: Treatment

Hernia: Treatment

Hernia treatment can be surgical or non-surgical based on its severity. Usually, non-surgical treatments help ease the discomfort and pain that resulted from a hernia while surgical treatments are used for extreme and severe cases of hernia.

Non-Surgical Hernia Treatment

  1. Henria Belts– These are lightweight belts that are made to give easiness movement during recovery. They are designed to be worn over belts with straps that can be adjusted and are lined with foam for additional comfort.
  2. Trusses- These come as umbilical and spring trusses. The umbilical truss is worn around the midsection while the spring truss is used around waist to act as a support.
  3. Hernia Briefs– These types of briefs look just like any ordinary briefs except that they are made with foam pads and spandex to give additional support.
  4. Bindings- Bindings for the abdomen are elastic and offer constant compression and abdominal muscles support.

Surgical Hernia Treatments
The surgical operation for hernia involves the replacement of hernia contents in the abdominal cavity and repair of the defect. Usually, a prosthetic material must be fitted to allow the safe repair. The operation needs anesthesia administration and it is likely that after or during the operation, blood or blood products might be used.
If you would like to come in to La Peer for a consultation, please contact us via the contact form or give us a ring.

Hammer Toes: Treatment


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In children, mild hammer toe can be treated by manipulating and applying a splint in the affected toe. Changes in footwear such as the following tips may help relieve the symptoms:

  1. Wearing shoes that best fit the toe or opting to choose for shoes with wide toe boxes for comfort, and to avoid further progression of the hammer toe.
  2. Avoiding high heels as much as possible.
  3. Wearing insoles might help relieve pressure in the toe.
  4. Using corn pads or felt pads to protect sticking out joints.

A foot doctor (podiatrist) can make foot devices such as straighteners and hammer toe regulators as part of the treatment regimen. These could be bought as well.
Having an exercise regimen could help. Gentle stretching exercises can be done if the toe is not in a fixed position. Picking up a towel with the use of your toes can aid in stretching and straightening the foot’s smaller muscles.

For a severe hammer toe, an operation called osteotomy might be done to straighten back the joint.

  1. The surgery to be done might involve cutting and moving tendons and ligaments.
  2. Sometimes the bones on each joint are needed to be fused or connected to each other.

In most cases, this is an ambulatory surgery and the patient is allowed to go home on the day of the surgery. right after it. A feeling of stiffness may be present in the toe, yet it may go away in a shorter amount of time. If the underlying condition is treated early, surgery is oftentimes unnecessary. Necessary treatments are done to reduce pain threshold and eliminate walking discomforts. If hammer toe is suspected, an appointment with the physician regarding the best treatment options for pain and walking discomforts could also be done. For prevention purposes, shoes that are too short and narrow must not be worn. For children, regularly inspect foot growth if it coincides well with the current shoe size of the child.

The toes could still be moved at first. But over time, the person might find it hard to move his bigger toes, especially his middle toe.

Presence of Corn
A corn appears in the affected toe. It is caused by rapid cell growth in the toes that is caused by an occurrence where a healing blister leads the formation of a corn as the produced scar tissue is thicker than the normal skin. On the top, a solid corn may emerge and a distal corn at the hammer shaped side.

Callus Formation
A callus, or a thickened portion of the skin, appears on the sole part of the foot.

With the presence of corn and callus, when tight shoes are worn, it presents a painful experience, more so when walking around. Wearing poorly fitted footwear such as narrow, pointed toe shoes might predispose one to the symptoms, with pain as one of the late signs.

Nail Changes
The nail might split into two or may converge inwards.

Hammer Toes: Description
A Hammer Toe is marked by the contracture of the tendons, ligament laxity and angulations of the second and third phalanges of the toe. It composes of flexion deformities in the proximal interphalangal (PIP) joint of the toe, with a hyper extended metatarsophalangeal (MTP) and distal interphalangeal (DIP) joints. As one of the most painful toe disorders, hammertoe is traced from wearing pointed, narrow toe footwear. Women are more prone to hammertoes than men. Female shoes for most of the time have pointed front portions, and not much wide enough, thus making the foot look round. Hammertoe is created from a blend of factors such as narrow shoes and wider foot or pointed footwear and a rounded foot.

Compression of the feet and constriction of the toes depends on the shoes being used. These may eventually lead to muscle wasting, and decreased motions in the toes. And the result is the toes may have little room to operate. In an ill-fitting shoe, the toe seeks room anywhere it can be found. The pressure is increased, thus leading to the hammer-like shape of the toe.

Due to continuous PIP joint flexion deformity, the occurrence of MTP and DIP compensatory hyperextension might occur. The hyperextension of the MTP joint and the flexion of the PIP joint make the PIP joint move dorsally. This prominence is rubbed against the patient’s shoe, thus the pain is felt. The deformity is flexible and could be passively corrected early but eventually could be corrected as time goes by. Progressive deformities may eventually lead to dislocated joints.

Most causes of hammer toes come from the person’s selection of shoes, yet other factors also play a role in its formation.

The choice of foot gears, not only just shoes but also ill-fitting stockings, tapered toe shoes, pointed toe shoes, tight leotards and snugly pantyhose could all lead to a painful hammertoe. There could even be a possibility of getting hammertoes foot in both feet, since basically these things are worn in both extremities. It might also lead to nerve and joint damage.

Genetic Factors
Some people might be born with a hereditary contracture, but the only thing that increases the risk of familial tendencies is wearing ill-fitting shoes, even though an individual is predisposed to such as a systemic disease like arthritis.

Usually, a physical examination is done to confirm the presence of hammer toes. The health care provider, such as a physician might find decreased and painful movement of the toes. The patient is asked with the following questions as part of the initial assessment:

  1. A presence of fever or localized erythema. An erythema might suggest phlebitis, gout, osteomyelitis, cellulitis, ingrown toenail and paronychia. Fever may present signs of infection such as osteomyelitis and cellulitis.  
  2. If there is an associative foot deformity. Aside from hammertoe, hallux vagus, hallux rigidus, arthritis and displaced fractures are other foot deformities also assessed.
  3. The presence of palpable peripheral pulses. Diminishing arterial pulses would be a conclusion of arterial embolism, peripheral arteriosclerosis and diabetes.
  4. An associated neurological finding. The presence or loss of sensation of touch and pain should make one a possibility for peripheral neuropathy or carpal tunnel syndrome. Morton’s Neuroma is also associated with numbness or loss of sensation in the 3rd and 4th toes.

Diagnostic Tests
A series of routine tests are done, including a CBC, sedimentation rate, chemistry panel, VDRL tests and X-Rays of the foot. If there are diminishing peripheral pulses, Doppler tests and angiography are measured. Venography is done if there is a presence of diffuse swelling and erythema. Bone and CT scans as well as arthroscopy are considered if results are found out to be negative. To diagnose stress fractures, a MRI may be needed. With the use of quantitative scintigraphs, abnormal weight distribution in the toes may be diagnosed.


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In children, mild hammer toe can be treated by manipulating and applying a splint in the affected toe. Changes in footwear such as the following tips may help relieve the symptoms:

  1. Wearing shoes that best fit the toe or opting to choose for shoes with wide toe boxes for comfort, and to avoid further progression of the hammer toe.
  2. Avoiding high heels as much as possible.
  3. Wearing insoles might help relieve pressure in the toe.
  4. Using corn pads or felt pads to protect sticking out joints.

A foot doctor (podiatrist) can make foot devices such as straighteners and hammer toe regulators as part of the treatment regimen. These could be bought as well.
Having an exercise regimen could help. Gentle stretching exercises can be done if t
he toe is not in a fixed position. Picking up a towel with the use of your toes can aid in stretching and straightening the foot’s smaller muscles.
For a severe hammer toe, an operation called osteotomy might be done to straighten back the joint.

  1. The surgery to be done might involve cutting and moving tendons and ligaments.
  2. Sometimes the bones on each joint are needed to be fused or connected to each other.

In most cases, this is an ambulatory surgery and the patient is allowed to go home on the day of the surgery. right after it. A feeling of stiffness may be present in the toe, yet it may go away in a shorter amount of time. If the underlying condition is treated early, surgery is oftentimes unnecessary. Necessary treatments are done to reduce pain threshold and eliminate walking discomforts. If hammer toe is suspected, an appointment with the physician regarding the best treatment options for pain and walking discomforts could also be done. For prevention purposes, shoes that are too short and narrow must not be worn. For children, regularly inspect foot growth if it coincides well with the current shoe size of the child.

Symptoms of Hammer Toes

Podiatry ExamFeet are incredibly important, in that they help you get from place to place. Additionally, in a warm climate like Los Angeles, feet are frequently on display in sandals or at the beach. If you’re suffering from hammertoes, you may experience not only pain or imbalance when walking and performing other activities but also displeasure over your foot’s appearance. This is where the board-certified podiatrists at La Peer Health Systems can help.

Feet are incredibly important, in that they help you get from place to place. Additionally, in a warm climate like Los Angeles, feet are frequently on display in sandals or at the beach. If you’re suffering from hammertoes, you may experience not only pain or imbalance when walking and performing other activities but also displeasure over your foot’s appearance. This is where the board-certified podiatrists at La Peer Health Systems can help.

Hammertoe Anatomy

Hammertoe is a deformity of the foot in which an enlarged middle toe joint causes the toe to bend in a downward direction. It is called hammertoe because the bent toe can resemble a hammer in its shape. Other people will observe that their toe has a claw-like appearance. As the condition worsens, the joint can enlarge further, stiffening as it comes into contact with the shoe.

Causes of Hammertoe

Many cases of hammertoe are caused by improper footwear. Shoes that are too narrow or too high in the heel may cause the toes to bend. Over time, the toes can become fixed in these unnatural positions, and the foot muscles are unable to bend them back into place. Hammertoe can also result from muscle imbalances and other factors, so it’s important to see a skilled podiatrist about your condition.

Hammertoe Diagnosis

Hammertoe is a simple condition for an experienced podiatrist to diagnose. The doctor will examine your foot, looking for toes bent into a claw-like position. Hammertoe may affect any toe on the foot, but it usually impacts the second toe. The doctor may also order x-rays, as hammertoe can involve bone deformity.

Hammertoe Treatment

Hammertoe can be treated with a simple outpatient surgical procedure. The surgeon will relax the tissue of the foot and help reposition the toes to a more normal setting. This relatively easy procedure can relieve the pain and unsightly appearance associated with hammertoe, while leaving the patient free to return to normal activity the very same day. Learn more about hammertoe surgery on our Foot and Ankle Surgery Center of Excellence website.

Hammertoe Surgery Recovery

Hammertoe surgery is an outpatient procedure with a remarkably fast recovery rate. Generally, patients can walk again on the same day they have surgery with the aid of a protective boot. Pain from hammertoe surgery is usually minimal, lasting only 48-72 hours, and most patients tolerate it well with the help of over-the-counter pain medications.

Contact a Surgeon at La Peer Health Systems Today!

From walking to dancing, we use our feet in a multitude of ways, and for this reason proper foot health is essential to living a full and meaningful life. If you think you may be suffering from hammertoe, it is crucial that you contact a skilled podiatrist.

At La Peer Health System’s Podiatry Department, we employ a highly experienced team of doctors and nurses to help with all your foot health needs and are widely regarded as one of the best foot surgery centers in the country.