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When our patients have something nice to say about us, we like to brag about it!

Please enjoy some of the highlights from TSAOG's April 2013 Customer Survey:

• “Dr. Schroder was personable and thorough. He took the time to explain my injury and treatment.”
• “It is a very comfortable and welcoming environment. Everything there is designed with the patient in mind. Love it”
• “Ortho Now is an awesome service. I love their efficiency and the way they take care of everything for you.”
• “Dr. Balldin has awesome bed side manners. He made my kids feel so comfortable and explained everything to them about their condition and everything to expect during the healing process. I will completely recommend him and the clinic to all the parents on my kids’ team.”
• “great locations nice comfortable waiting areas, friendly staff, imaging on site, outpatient procedures on site, i have had more than one of your staff go out of their way to make me comfortable during my visits. I am suffering from sciatica and i am usually in extreme pain by the time i have ridden in the car to get to an appt. They notice and get me pillows or find an empty room so i can lie down. this seems like nothing but it is a big deal to me. thank you!”
• “Dr Bergfeld and Mayra went out of their way to squeeze me in for severe pain from my back injury!”
• “Vanessa & Dr Hennessy are the best”
• “I was confident in Dr. Woodbury performing my hand surgery and I am happy with the outcome.”
• “Dr. Randall Marx is the best physician I have ever had in my entire life. He's polite, but stern (as needed to get a point across), very sincere and makes me feel that he cares for me as a patient.”
• “I was very impressed with the physical therapist, Mr. Trueman, who did my evaluation. He was not at all rushed and was very thorough and had useful and practical advice that I can begin using right away.”
• “What really stands out for me about TSAOG is that the staff is extremely friendly and pleasant while still being professionally. From the time I arrived, the person who checked me in, the nurse, the doctor and the person who checked me out were all extremely pleasant. So much so that I almost felt like asking for an office manager before I left to tell them so. Thank you.”
• “Dr. Brenman has helped me and given me hope and a new life. He cares about helping me and he does an outstanding job doing what he does best. Yall have a winner working for yall.”
• “I couldn't ask for a better Doctor than Dr. Bell”
• “Dr. Ursone took the time listen to me explain the history of my injury vs. having a staff member do so. He did a good job in explaining my treatment options. He is calm natured and expressed an interest in resolving my knee problems.”
• “I have a lot of confidence in the providers. They did not rush into surgery and ensured realistic expectations on my part.”
• “Dr Taber has the unique, very specific knowledge required to fix my hip problem.”
• “My wife is treated as a person with a problem and not a patient with a chart.” (Dr. Ochoa)
• “OrthoNow allowed me to be seen immediately rather than wait a week to schedule an appt. I feel like I will get well faster knowing why I was in so much pain.”
• “I was nervous about surgery but the staff took care of me like family”
• “All of your staff, but especially Dr. Viroslav, are attentive and do their best to please.”
• “Very friendly and ACCESSIBLE staff. Doctors don't hide behind nursing staff.” (Dr. Tolin)
• “I can always be seen without delay. There are so many sub-specialists and I feel that my issues are appropriately addressed.” (Dr. Rowland)
• “The wait time is always very short and my plan of treatment is always explained thoroughly. My questions and concerns are address quickly and thoroughly.” (Dr. Pace)
• “Superb professionalism - they take their work seriously.”
• “I have been treated by Dr. John Hinchey in the past and have used this group since 1956.”
• “I call it the one stop shopping for my fix it shop. I have had foot surgery shoulder surgery and knee surgery there.”
• “Dr Bryan Kaiser has treated both my daughter and husband. I have complete confidence in his recommendation of treatment.”
• “Dr. Jacobs is very thorough, Informative and caring”
• “Liked the DR. Very much. Great attitude and manner.” (Dr. Hibberd)
• “What a blessing to have Dr. Gonzalez on my team!”
• “it was fast, clean and doctor was very clear” (Dr. Garcia)
• “All appointments have been wonderful. Very little wait time. Desk Staff very courteous and professional” (Dr. Galindo)
• “I wish you could teach all my Physicians how people should be treated.”
• “Dr. Drukker is awesome! He has helped me so much. I am very grateful to him.”
• “Dr. Connor and his staff are topnotch. I always get the best of treatment during my office visits.”
• “Dr. Burkhart and PA Haley will always occupy a special place in my heart/life. Thanks to them I have a shoulder that's like new. Will highly recommend them to friends and/or others for top-quality, premium service/care.”
• “[I like] the individual care and attention that Dr Brown and his NP provide to their patients.”

We encourage you to review and rate your experience with TSAOG.  The next time you visit us, please take the time to fill out our customer survey and you may see one of your comments online the next month!

Please note: Spelling and punctuation errors may have been corrected for readability.

During last week’s game against the Chicago Rush, San Antonio Talons quarterback John Dutton ruptured his right Achilles tendon.  This injury ended Dutton's first season with the Talons.  Dr. Marvin R. Brown discusses what an Achilles tendon tear means.

The Achilles tendon is the largest tendon in the body, located on the back of the lower leg.  It is formed by the merging together of the gastrocnemius muscles of the calf and inserts into the back of the heel bone.  The tendon functions by allowing the ankle to flew downward, like you would if you were pushing down a gas pedal.

Achilles tendons are one of the most frequently ruptured (or torn) tendons.  Most ruptures occur in male recreational athletes, aka “weekend warriors."  Achilles injuries occur when mechanical loads exceed the physiologic capability of the tendon. Activities such as cutting, sprinting or jumping place the Achilles tendon in significant jeopardy due to the forceful push off of the forefoot while the knee is in full extension.  

Overuse can also increase the likelihood of tendon rupture as repetitive motions can overload the tendon.  Overuse injuries are seen frequently with running or jumping workouts.  

While most acute ruptures are seen in athletes, there are other factors that make certain people more susceptible to Achilles tendon rupture.  These factors apply mostly to men and include:

• Having a close relative with a history of Achilles rupture
• Having a history of contralateral rupture (rupture of the Achilles tendon on the other leg)
• Having a mechanical malalignment such as a high arched foot or flat foot
• Increasing age
• Obesity

Although the tendon is the largest in the body, ruptures typically occur in an area of the tendon called the “watershed zone.”  This is located just above the insertion into the heel.  This area receives poor blood flow, making tears likely and healing difficult.  With an Achilles rupture, most feel a sudden “pop” or feel as though they have been hit in the back of the ankle.  This is followed by pain, swelling and bruising.  One might also notice weakness when trying to push off of the forefoot.

Non-operative treatment of an Achilles tendon rupture consists of placing the lower leg in a cast for a period of 6-8 weeks.  Casting and immobilization has a lower complication rate in respect to wound healing and nerve injury.  Drawbacks to conservative treatment include calf atrophy, weaker push-off, adhesion formation and risk of deep vein thrombosis.  The re-rupture rate of those treated non-operatively is 18% versus 2% for those treated surgically. 

Those opting for surgical repair typically have a shortened recovery and a quicker return to sports.  Following repair, the lower leg is casted for the first 2 weeks.  Provided all wounds have healed, a fracture boot is given at the 2 week follow-up and early ankle range of motion and aqua therapy are started.  The first six weeks will be non-weight bearing with progressive weight bearing the following 6 weeks.  Barring complications in the postoperative period, sports play can be resumed 6-8 months following the repair.

Dr. Marvin R. Brown is a board certified orthopaedic surgeon, fellowship trained in conditions of the foot, ankle and lower leg.  He treats patients aged 1 year and up and his special interests include Achilles tendon reconstruction and total ankle replacement.  To schedule an appointment with Dr. Brown, please call 210.281.9595. 

When our patients have something nice to say about us, we like to brag about it!

Please enjoy some of the highlights from TSAOG's March 2013 Customer Survey:

• “Dr. Schroder […] is extremely professional, courteous and through. He is an excellent addition to your physician staff. We also thought highly of Debra Mendiola. She was always helpful.”
• “Dr. Balldin was wonderful!! I would highly recommend him to my family and friends!!”
• “So glad to get the help for my back that I needed.” (Dr. Bergfeld)
• “This practice is the first practice that I've been to that is 100% perfect. From the front desk to the surgeons and all the techs and the physical therapist they are all great.”
• “Friendly staff and MDs who opt for the least traumatic therapies as first options.” (Dr. Hennessy)
• “Totally professional service from start to finish. I could not be more pleased with the entire experience. Thank you so much!”
• “Even though I live out of town, it is easy to get to and I always find a parking place. But, more importantly , the office staff and physicians are professional and cordial.” (OrthoNow Urgent Injury Clinic)
• “Dr Woodbury performed surgery on my son's hand. Even my husband (who is hard to please) was completely happy with everything.”
• “The staff in SAOG is wonderful and considering that we live 4 hrs away, we were able to be seen timely. But above all, i was very pleased that Dr. Randall Marx sees his patients from the beginning to the end of the appt., he isn’t one of those doctors that sees his patients and then passes them over to the PA or any other staff member. During our appointment, he seemed very confident in what he wanted to do during surgery and now that I've had my surgery, seeing Dr. Marx explain with total confidence on how the procedure went, gives us faith that we did make the right decision in leaving this surgery in Dr. Marx's hands. I will highly recommend Dr. Marx to all our friends and family!!!”
• “I enjoy coming to Dr. Brenman. He always answers my questions thoroughly and remembers information about me.”
• “Dr Bell is great. The best Ortho Dr I have had. Thanks for all. !!!!!!”
• “Thank you for taking such great care of our son! he even told me that he thought Dr. Ursone was a very nice doctor. If you know my son, that is a big deal, Doctors can be pretty scary for him ;)”
• “Dr. Taber is #1 in my book. He did a hip replacement surgery 9 mo ago and literally gave me my life back.”
• “Dr. Ochoa is very much a realist and he seems to care about my ideas. His knowledge of percentages of recovery and success were astonishing.”
• “I liked Dr. Viroslav and I feel he was very concerned about me and gave me his full attention and answered all of my questions.”
• “Good and truly professional physicians.” (Dr. Valdez)
• “Great Front desk and nursing staff and the physician is outstanding in terms of instilling confidence, diagnostics and follow up” (Dr. Tolin)
• “The Doctors and staff are very friendly, knowledgeable, and helpful. I like the convenience of having all necessary services within the group’s offices - xray, CT scan, surgery center, etc.” (Dr. Rowland)
• “Outstanding professional medical care.” (Dr. Pace)
• “Love your doctors!! They take care of me!!!”
• “The PT staff is the best!!! Phillip Trueman helped me through my first surgery and now and Keli Smith, Phillip, Tiffany are doing a great job for me!!!!!!!!! are helping me again”
• “Dr. Kaiser is top notch in my book. VERY SATISFIED WITH THE KNEE PROGRESS AT 8 WEEKS POST-SURGERY!!!!!!!!!!!”
• “Dr. Jacobs is great, willing to do whatever he can to help you.”
• “I have been with Dr. Hibberd from 2005 and from the start of our association have felt more safe and cared for than with any other physician.”
• “Dr. David Gonzalez and his staff always treat me incredible always answer my questions”
• “I have much confidence in Dr. Garcia.”
• “Dr. M.J. Galindo is a very good doctor he listens to everything you say and does not try to diagnose you fast just to clear the room for the next patient. I feel I am very cared for by Dr. Galindo and the staff. Above and beyond service compared to other doctors’ offices, urgent care, and hospitals I have been to.”
• “I liked everything. To be more specific I like that you do not have to wait too long in the waiting room. I like that you can see the appointments are on schedule. I like that the doctors see you very fast and you do not have to wait forever in a room. The care is specific to your needs and you are treated with a sense of urgency. Checking out is easy. I LOVE the patient portal it is very easy and makes updating medical records a breeze. Also I like the option of being able to pay online that is so AWESOME.”
• “Dr. Drukker was efficient, yet caring. My visit was quick & as painless as possible.”
• “I thank the Lord for my blessings, and for my good doctor. Dr. Connor should be encouraged for his good work.”
• “I hope the staff and Dr. Burkhart know how their help and kindness during this time means very much to the patient.”
• “The excellence of my doctor and the staff, as well as the impression that everyone enjoys working there.  Dr. Brown gives his patients the sense that he is totally focused on them when he is with them.  I never feel as though he is rushing my time, so I can accept the occasional wait.”

We encourage you to review and rate your experience with TSAOG.  The next time you visit us, please take the time to fill out our customer survey and you may see one of your comments online the next month!

Please note: Spelling and punctuation errors may have been corrected for readability.

When our patients have something nice to say about us, we like to brag about it!


Please enjoy some of the highlights from TSAOG's February 2013 Customer Survey:

• “I was VERY impressed with Dr. Brown! While maintaining a professional attitude, he was still very friendly, making me feel quite comfortable for a 1st visit.”
• “I feel that I am receiving attention from professionals who are skilled and up to date.”
• “I am able to see the best of the best shoulder specialist.” (Dr. Burkhart)
• “…Dr. Connor is a GREAT doctor. Dr. Connor is a kind and caring physician. Dr. Connor explains everything clearly and strongly cares about his patients and their needs. More doctors should care for patients and not treat them as the next $ figure.”
• “The entire experience, from check in to check out, was great. Everyone was very friendly, courteous and professional.”
• “I trust Dr. Drukker to make wise decisions and give good advice for my situation. That is huge! Some doctors give reason to be concerned with their judgment and abilities these days.”
• “…Visiting here for the winter months, I broke my ankle, and needed surgery. This is the first time I ever had surgery in my life. Not knowing any surgeons here in town, I lucked out and found you guys through the Web. As soon as I met with Dr. Galindo and he explained what had to be done with my ankle, I was not afraid to go into surgery. He is terrific. Many thanks also to Benny for the great cast, and Kym and Elizabeth for making the admin/financial process easy. The pre-surgery process was very efficient, and the staff was great. Surgery went well. Everything that was going to occur was explained clearly to me before it happened. Post-op process was smooth, and the staff very accommodating. The San Antonio Orthopaedic Group is very professional and efficient...and all staff very friendly and approachable. And you have wireless available in the waiting room! As a Web Developer, I love that! Your Patient Portal is excellent as well. Thank you all so very much for helping me. It is good to be on the mend.”
• “Dr. Hibberd was very professional yet friendly, felt at ease.”
• “Dr. Jacobs is a true professional. I enjoy the doctor-patient relationship.”
• “Dr. Kaiser did an outstanding job on my left knee replacement. Also, he or his staff made all arrangements for my follow-up home care and physical therapy with competent providers.”
• “Everyone was professional and efficient. When I felt light headed after my cortisone injection in my hand and wrist, two staff members had me lie down in a recliner and rest. Then, when I felt better, I was escorted to the elevator to ensure my readiness to leave safely. I greatly appreciate this type of caring” (Dr. Pace)
• “Convenient locations...great doctors”
• “Dr Rowland is excellent”
• “Dr. Tolin and his PA were exceptional! Very helpful and understanding...”
• “Well run organization with the premier docs in the area. On a previous surgery I experienced the cast staff and they are grrrreeeaat!!!!!!!”
• “Dr. Viroslav did a great job with me knee...I will highly recommend him to all my friends in the gym and co- workers.”
• “Always [a] pleasant experience” (Dr. Valdez)
• “Possibly the most professional and courteous medical facility we have worked with”
• “…My surgery and recovery went well just like the Doctor said. I was very satisfied with the attention and service the Doctor provided for me.” (Dr. Ochoa)
• “Dr. Taber listens and is prepared when I visit. I have had multiple health problems and he stays aware of how my current health can be affected.”
• “Dr. Ursone is the best Orthopod in the business”
• “Dr. Bell treated me for my own good and did not try to push me into anything. He gave the option to decide what I wanted done.”
• “So far, [I like the] professionalism and approachability of doctor and therapist. Nice office -- professional, attractive, clean, well equipped.” (Dr. Brenman)
• “The physicians LISTEN to their patients”
• “Courteous staff and caring doctor” (Dr. Marx)
• “Everyone is friendly, polite, and just plain wonderful. Tony, Josh, the secretarial staff and Dr. Woodbury have been fantastic. Even my physical therapists were great. I cannot thank you all enough for a VERY positive experience.”
• “Excellent care by Dr. Hennessy.”
• “I LIKE EVERYTHING” (Dr. Bergfeld)
• “You have several doctors, several locations, courteous staff, I liked that you have your own x/ray-CT-MRI office, I like the electronic portal medical records info. I like the e-mail type info on appointments and charges and I especially like the board that tells you if your Dr is on time or late to see you. Thank you for treating me with RESPECT and not just trying to take my money”
• “Convenient locations, OrthoNow saw me the same day.”
• “The level of professionalism displayed by the staff and the doctor gave me a great deal of confidence in getting my partial knee replacement done ASAP” (Dr. Schroder)
• “Quick professional service. Good doctor bed side manner.” (Dr. Balldin)

We encourage you to review and rate your experience with TSAOG.  The next time you visit us, please take the time to fill out our customer survey and you may see one of your comments online the next month!

Please note: Spelling and punctuation errors may have been corrected for readability.

You may have read in the news that tennis player Victoria Azarenka recently dropped out of the Dubai Championships due to an injury in her right foot, attributed to a bone bruise.  If so, you may be thinking that a bruise doesn’t sound like enough of an injury to make someone drop out of a championship!

TSAOG’s Dr. Marvin Brown tells me why it should.

What is a bone bruise?
The term bone bruise is a misnomer and makes the injury seem less serious than it is.  A so-called bone bruise is actually a fracturing of the inner layer of bone.
Bones are composed of 2 different types of bony tissue, the compact (cortical) bone and the cancellous (spongy) bone.  

• The compact bone is the outer layer of bone and is highly organized, solid, and extremely strong.  When you injure this layer of the bone, it is referred to as a stress reaction or an occult fracture.
• The cancellous bone is the innermost layer of bone.  Unlike the outer layer of bone, it is not arranged in concentric layers, but in plates (called trabeculae) which form an irregular meshwork that is neither as organized nor as strong as the outer bone.  An injury to this area of the bone represents very small fractures to the trabeculae in the meshwork of the bone and may be referred to as a bone bruise.

How does a bone bruise happen?
This type of injury can be a result of repetitive trauma or stress where the inside of the bone is damaged, resulting in bleeding into the damaged area.  It can also happen as a result of acute trauma, where forces are not strong enough to fracture the outer bone, but are strong enough to fracture the inner layer of bone.

How do you diagnose a bone bruise?
We normally use a combination of patient history, physical examination and MRI to diagnose a fracture to the inner layer of bone.  However, injuries to the inner bone will not be evident on xray or CT scan.

What is the normal treatment for a bone bruise?
I usually recommend bracing or other immobilization of the area to allow it time to heal and to protect it from additional injury that can be caused by bearing weight on the injured area.  Activities also need to be restricted during this healing period, particularly sports play, which can result in additional acute trauma, causing greater injury and/or prolonging the healing time.

How long do you normally expect recovery to take?
Recovery can take several months because the inner layer of bone takes longer to heal than the outer bone.

Dr. Marvin R. Brown is a board certified orthopaedic surgeon who has completed additional fellowship training in conditions of the foot, ankle and lower leg.  He treats patients aged 1 year and up for any musculoskeletal issue below the knee.  His special interests include total ankle replacement and Achilles tendon reconstruction.  To schedule an appointment with Dr. Brown, please call 210.281.9595.