Dr. Tracey Vlahovic is a podiatric physician with Bay Area Foot Care, specializing in podiatric dermatology.
She earned her undergraduate degree in Molecular Biophysics and Biochemistry from Yale University. She went on to receive her Doctorate of Podiatric Medicine from Temple University School of Podiatric Medicine. Dr. Vlahovic completed her residency training at St. Luke’s University Hospital in Allentown, Pennsylvania, followed by a specialized fellowship in podiatric dermatology.
Dr. Vlahovic has clinical expertise in podiatric dermatology in adults and children such as psoriasis, eczema, and other inflammatory disorders, blistering disorders, Pyoderma gangrenosum, Erythromelalgia, Nail surgery, Ingrown nails, Warts/Verruca, Pigmented lesions, nail disorders, onychomycosis, fungal infections, erythrasma, and nail trauma, plantar warts, and lower extremity skin rashes. She is also trained in comprehensive foot and ankle care, providing evidence-based treatment for both routine and complex conditions. Her approach emphasizes thorough diagnosis and individualized treatment plans that prioritize patient comfort and outcomes.
Dr. Vlahovic is board certified in foot surgery by ABFAS® and in podiatric medicine by ABPM®. She is committed to advancing the specialty through clinical excellence and patient education.
Education
- Yale University, B.S. in Molecular Biophysics and Biochemistry
- Temple University School of Podiatric Medicine, DPM
- St. Luke’s University Hospital, Allentown, PA – Residency
- Fellowship in Podiatric Dermatology
Board Certifications
- ABFAS® Board Certified in Foot Surgery
- ABPM® Board Certified in Podiatric Medicine
Peer-Reviewed Publications
- Lipner SR, Gupta AK, Vlahovic TC, Rosen T, Elewski B, Choi SY, Guenin E, Gold LS. Topical Efinaconazole 10% for Onychomycosis: Pooled Phase 3 Analysis in White, Black, and Asian Participants. J Drugs Dermatol. 2026 Jan 1;25(1):67-74. doi: 10.36849/JDD.9384. PMID: 41493257.
- Ricardo JW, Dominguez-Cherit J, Haneke E, Rana J, Richert B, Tosti A, Vlahovic TC, Lipner SR. Evaluation and management of mechanical and structural nail disorders: A clinical review. J Am Acad Dermatol. 2025 Nov 15:S0190-9622(25)03223-2. doi: 10.1016/j.jaad.2025.11.025. Epub ahead of print. PMID: 41242632.
- Curtis KL, et al. Diagnosis and Management of Yellow Nail Syndrome: An International Multi-Institutional Retrospective Cohort Study of 111 Cases by an Expert Panel. J Am Acad Dermatol. 2025 Jul 19:S0190-9622(25)02527-7. doi: 10.1016/j.jaad.2025.07.039. Epub ahead of print. PMID: 40692045.
- Lipner SR, Gupta AK, Joseph WS, Elewski B, Guenin E, Vlahovic TC. Efficacy and Safety of Efinaconazole 10% Topical Solution for Treatment of Onychomycosis in Older Adults: A Post Hoc Analysis of Two Phase 3 Randomised Trials. Mycoses. 2025 May;68(5):e70069. doi: 10.1111/myc.70069. PMID: 40396391; PMCID: PMC12093445.
- Vlahovic T and Freed L. A New Innovative and Transformational Approach to Treatment of Toenail Onychomycosis: An Open Phase 2 Study. Journal of Dermatology Research Reviews and Reports. 2025 February; 6(2): 1-2. DOI: doi.org/10.47363/JDMRS/2025(6)173
- Hill RC, Stubblefield O, Vlahovic TC, Lipner SR. Onychocryptosis Is Associated with Low Income in a Matched Cohort Study Using the All of Us Database. Skin Appendage Disord. 2024 Oct;10(5):421-424. doi: 10.1159/000538969. Epub 2024 May 23. PMID: 39386309; PMCID: PMC11460834.
- Pandit B, Elewski B, Vlahovic TC. Concealing Meets Healing in the Treatment of Toenail Onychomycosis: A Review of Concurrent Nail Polish Use with Topical Efinaconazole 10% Solution. J Clin Aesthet Dermatol. 2024 Sep;17(9):38-42. PMID: 39263266; PMCID: PMC11386970.
- Rivin GM, Vlahovic TC, Hill RC, Fleischer AB, Lipner SR. Senior Podiatrists in Solo Practice are High Performers of Nail Excisions. J Am Podiatr Med Assoc. 2024 May-Jun;114(3):22-063. doi: 10.7547/22-063. PMID: 39058643.
- Curtis KL, Ricardo JW, Shaikh B, Vlahovic TC, Lipner SR. Prosthetic resin nail improves quality of life in patients with retronychia in a single-center clinical trial. J Am Acad Dermatol. 2024 Jun;90(6):1277-1278. doi: 10.1016/j.jaad.2024.01.073. Epub 2024 Mar 12. PubMed PMID: 38483434.
- Rana J, Vlahovic TC. Nails as Dynamic, Not Static, Entities-Rethinking the Approach to Nail Disorders. JAMA Dermatol. 2024 Apr 24;. doi: 10.1001/jamadermatol.2024.0400. [Epub ahead of print] PubMed PMID: 38656389.
- Cain JD, Vlahovic T, Meyr AJ. Special Considerations in Podiatric Science: Translational Research, Cadavers, Gait Analysis, Dermatology, and Databases. Clin Podiatr Med Surg. 2024 Apr;41(2):333-341. doi: 10.1016/j.cpm.2023.07.007. Epub 2023 Aug 12. Review.PubMed PMID: 38388129.
- Lipner SR, Vlahovic T, Ghannoum MA, Elewski B, Joseph WS. Dermatophytomas in Onychomycosis: A Scoping Review of Prevalence, Diagnosis, and Treatment. J Am Podiatr Med Assoc. 2024 Mar-Apr;114(2). doi: 10.7547/22-161. Review. PubMed PMID: 38753536.
- Feldman SR, Vlahovic TC, Joseph WS, Daniel CR, Elewski B, Rich P, Lipner SR. Number of Affected Nails Is the Primary Determinant of Efinaconazole 10% Solution Usage for Onychomycosis. J Drugs Dermatol. 2024 Feb 1;23(2):110-112. doi: 10.36849/JDD.7676. PubMed PMID: 38306131.
- Hill RC, Wang Y, Vlahovic T, Lipner SR. Analysis of Nail Excision Practice Patterns in the Medicare Provider Utilization and Payment Database 2012-2017. Cutis. 2024 Jan;113(1):E22-E25. doi: 10.12788/cutis.0944. PubMed PMID: 38478930.
- Reilly IN, Longhurst B, Vlahovic TC. Surgical Excision of Intractable Plantar Keratoses (Corns) of the Foot: A Scoping Review. J Am Podiatr Med Assoc. 2023 Nov-Dec;113(6). doi: 10.7547/22-044. PubMed PMID: 38175699.
- Vlahovic T, Basatneh R. Addressing the Question of Dermatologic Manifestations of SARS-CoV-2 Infection in the Lower Extremities: A Closer Look at the Available Data and Their Implications. J Am Podiatr Med Assoc. 2023 Mar-Apr;113(2). doi: 10.7547/20-074. PubMed PMID: 32310671.
- Vlahovic TC, Gupta AK. Efinaconazole topical solution (10%) for the treatment of onychomycosis in adult and pediatric patients. Expert Rev Anti Infect Ther. 2022 Jan;20(1):3-15. doi: 10.1080/14787210.2021.1939011. Epub 2021 Jun 30. Review. PubMed PMID: 34106031.
- Lipner SR, Ghannoum M, Hinshaw MA, Rich P, Ruben BS, Vlahovic TC, Scher RK. Deferring Nail Mycological Sampling during the COVID-19 Pandemic: Recommendations from a Multidisciplinary Panel of Nail Specialists. Skin Appendage Disord. 2021 Dec 8;130(43):1-4.
- Lipner SR, Joseph WS, Vlahovic TC, Scher RK, Rich P, Ghannoum M, Daniel CR, Elewski B. Therapeutic Recommendations for the Treatment of Toenail Onychomycosis in the US. J Drugs Dermatol. 2021 Oct 1;20(10):1076-1084.
- Vlahovic TC. Podiatric Dermatology for the Practicing Podiatric Physician. Clin Podiatr Med Surg. 2021 Oct;38(4):xv-xvi.
- An M, Blekher L, Liu M, Pitre M, Shaner R, Silva D, Vlahovic TC. Plantar Melanoma: An Investigation of Its Incidence. Clin Podiatr Med Surg. 2021 Oct;38(4):595-599.
- Abboud A, Blum J, Butta Z, Lindvig EF, Kuruppu N, Wali S, Vlahovic TC. Lower Limb Lymphedema: An Exploration of Various Treatment Methods. Clin Podiatr Med Surg. 2021 Oct;38(4):589-593.
- Barbe M, Batra A, Golding S, Hammond O, Higgins JC, O’Connor A, Vlahovic TC. Pyoderma Gangrenosum: A Literature Review. Clin Podiatr Med Surg. 2021 Oct;38(4):577-588.
- Gorelik S, Leos A, Kuah A, Desai S, Namous A, Onica A, Vlahovic TC. Cutaneous Manifestations of the Diabetic Foot. Clin Podiatr Med Surg. 2021 Oct;38(4):569-576.
- Adeniran V, Cherian A, Cho JO, Febrian C, Kim ET, Siwy T, Vlahovic TC. Shoe Dermatitis. Clin Podiatr Med Surg. 2021 Oct;38(4):561-568.
- Ekladios J, Jolliffe J, Panchigar S, Qureshi R, Shete A, Wellner J, Vlahovic TC. Use of Biologics in the Treatment of Moderate-to-Severe Plantar Psoriasis. Clin Podiatr Med Surg. 2021 Oct;38(4):553-559.
- Romani M, Biela G, Farr K, Lazar R, Duval M, Trovillion V, Vlahovic TC. Plantar Psoriasis: A Review of the Literature. Clin Podiatr Med Surg. 2021 Oct;38(4):541-552.
- Phan K, Kaur K, Wright K, Tran S, Stewart B, Brown M, Vlahovic TC. The Penetrance of Topical Nail Therapy: Limitations and Current Enhancements. Clin Podiatr Med Surg. 2021 Oct;38(4):535-540.
- Castillo C, Masi MF, Mishko A, Sheltzer A, Speer A, Tran H, Vlahovic TC. Biofilms and the Nail Unit. Clin Podiatr Med Surg. 2021 Oct;38(4):529-533.
- Filisio F, Busch S, Wickramage DJH, Hill R, Kabadi S, Van Pelt CL, Vlahovic TC. Disappearing Nail Bed: Review of Etiology, Grading System, and Treatment Options. Clin Podiatr Med Surg. 2021 Oct;38(4):521-527.
- Bhatti A, Chowdhary S, Ferrise T, Govardhanam N, Parish A, Tropper Y, Vlahovic TC. Plantar Verruca and Dermoscopy: An Update. Clin Podiatr Med Surg. 2021 Oct;38(4):513-520.
- Vlahovic TC, Garcia M, Wotring K. Dermoscopy of Onychomycosis for the Podiatrist. Clin Podiatr Med Surg. 2021 Oct;38(4):505-511.
- McGuire J, Love E, Vlahovic TC, Khan K, Labbad ZG, Robinson L, Magodia S, Aljumail A, Adler L, Stewart J. The ABCESS System for Chronic Wound Management: A New Acronym for Lower Extremity Wound Management. Wounds. 2020 Nov;32(suppl 11):S1-S25.
- Martucci J, Vlahovic TC. Perceptions Surrounding Onychomycosis in the Health Professions Student Population: The Disease, Treatments, and Quality of Life. J Am Podiatr Med Assoc. 2020 Sep 1;110(5):Article_9.
- Miner SA, Vlahovic TC. Perceptions of the Podiatric Medicine Profession: A Survey of Medical Students in Philadelphia, Pennsylvania. J Am Podiatr Med Assoc. 2020 Sep 1;110(5):Article_10.
- Eichenfield LF, Elewski B, Sugarman JL, Rosen T, Vlahovic TC, Gupta AK, Stein Gold L, Pillai R, Guenin E. Safety, Pharmacokinetics, and Efficacy of Efinaconazole 10% Topical Solution for Onychomycosis Treatment in Pediatric Patients. J Drugs Dermatol. 2020 Sep 1;19(9):867-872.
- Eichenfield LF, Elewski B, Sugarman JL, Rosen T, Vlahovic TC, Gupta AK, Pillai R, GueninE. Efinaconazole 10% topical solution for the treatment of onychomycosis in pediatric patients: Open-label phase 4 study. J Am Acad Dermatol. 2021 Apr;84(4):1140-1142.
- Khan MT, O’Sullivan M, Faitli B, Mellerio JE, Fawkes R, Wood M, Hubbard LD, Harris AG, Iacobaccio L, Vlahovic T, James L, Brains L, Fitzpatrick M, Mayre-Chilton K. Creating new guidelines on how best to treat foot symptoms in people with EB. Br J Dermatol. 2020 Mar;182(3):e89-e114
- Bloom A, Blanken B, Schlakman B, Arena T, Mironov Z, Vlahovic TC. A Review of Nail Dystrophies for the Practitioner. Adv Skin Wound Care. 2020 Jan;33(1):20-26.
- Ebony Love DPM, Tracey Vlahovic DPM, Lauren Christie DPM. “The role of tinea pedis and onychomycosis prevention in diabetic education: A literature review” The Foot and Ankle Online Journal 12 (3): 2
- Ebony Love DPM, Lesly Robinson DPM, Tracey Vlahovic DPM, Ziad Labbad DPM, Gilbert K Huang BS. Comparing the etiologies, signs and drug treatments of gout: Literature review. The Foot and Ankle Online Journal 12 (3): 1
- Bhatia ND, Vlahovic TC, Green LG, Martin G, Lin T. “Halobetasol 0.01% Lotion in the Treatment of Moderate-to-Severe Plaque Psoriasis of the Lower Extremities” J Drugs Dermatol. 2019 Oct 1;18(10):1029-1036.
- Vlahovic TC. “Diagnosis and Treatment Options for Inflammatory Skin Conditions of the Lower Extremity.” Clin Podiatr Med Surg. 2019 Oct;36(4):685-694.
- Khan MT, O’Sullivan M, Faitli B, Mellerio J, Fawkes R, Wood M, Hubbard L, Harris A, Iacobaccio L, Vlahovic T, James L, Brains L, Fitzpatrick M, Mayre-Chilton K “Foot care in Epidermolysis bullosa: Evidence-based Guideline.” Br J Dermatol. 2019 Aug 9.
- Anselmo DS, McGuire JB, Love E, Vlahovic T. “Application of Viable Cryopreserved Human Placental Membrane Grafts in the Treatment of Wounds of Diverse Etiologies: A Case Series,” Wounds 2018;30(3):57–61. http://www.woundsresearch.com/article/application-viable-cryopreserved-human-placental-membrane-grafts-treatment-wounds-diverse
- Aly R, Winter T, Hall S, Vlahovic T. “Topical Tavaborole in the Treatment of Onychomycosis Complicated by Dermatophytoma: A Post-hoc Assessment of Phase II Subjects.” J Drugs Dermatol. 2018 Mar 1;17(3):347-354.
- Gupta AK, Vlahovic TC, Foley KA et al “In vitro efficacy of tavaborole topical solution, 5% after penetration through nail polish on ex vivo human fingernails.” J Dermatolog Treat. 2018 Jan 10:1-4.
- Rich P, Vlahovic TC, Joseph WS et al “Clinical trial designs for topical antifungal treatments of onychomycosis and implications on clinical practice.” Cutis. 2017 Oct;100(4):259-264.
- Aly R, Gupta AK, Winter T, Zane LT, Vlahovic T. “Tavaborole in Difficult-to-Treat Onychomycosis Cases: A Post-hoc Assessment of Phase III Subjects.” J Drugs Dermatol. 2017 Oct 1;16(10):1016-1021.
- Iorizzo M, Lipner S, Vlahovic TC. “Nail dystrophy due to toe malposition in children.” Eur JPediatr. 2017 Aug; 176 (8):1089-1091.
- Rundell JD, Sebag JA, Kihm CA, Herpen RW, Vlahovic TC “Use of an external vibratory device as a pain management adjunct for injections to the foot and ankle” The Foot and Ankle Online Journal 9 (4): 6, 2016.
- Elewski BE, Vlahovic TC, Korotzer A. “Topical Treatment for Onychomycosis: Is it More Effective than the Clinical Data Suggests?” J Clin Aesthet Dermatol. 2016 Nov; 9(11):34-39.
- Adigun CG, Vlahovic TC, et al. “Efinaconazole 10% and Tavaborole 5% Penetrate Across Poly-ureaurethane 16%: Results of In Vitro Release Testing and Clinical Implications of Onychodystrophy in Onychomycosis.” J Drugs Dermatol. 2016 Sep 1;15(9):1116-20.
- Vlahovic TC. “Plantar Hyperhidrosis: An Overview.” Clin Podiatr Med Surg. 2016 Jul;33(3):441-51.
- Vlahovic TC. “Dermatologic Concerns of the Lower Extremity in the Pediatric Patient.” Clin Podiatr Med Surg. 2016 Jul;33(3):367-84.
- Vlahovic TC, Khan MT. “The Human Papillomavirus and Its Role in Plantar Warts: A Comprehensive Review of Diagnosis and Management.” Clin Podiatr Med Surg. 2016 Jul;33(3):337-53.
- Vlahovic, TC. “Onychomycosis: Evaluation, Treatment Options, Managing Recurrence, and Patient Outcomes.” Clin Podiatr Med Surg. 2016 Jul;33(3):305-18
- Vlahovic TC, Joseph WS, Scher RK, Tosti A, Plasencia J, Pariser DM, Markinson BC. “Diagnosis and Management of Onychomycosis: Perspectives from a Joint Podiatry-Dermatology Roundtable,” J Am Podiatr Med Assoc 2016 Mar;106(2):155-62.
- Vlahovic T. “The Role of Naftifine HCl 2% Gel and Cream in Treating Moccasin Tinea Pedis” J Drugs Dermatol. 2016 Feb 1;15(2):s56-9.
- Vlahovic T et al. “Evaluation of the Appearance of Nail Polish Following Daily Treatment of Ex Vivo Human Fingernails With Topical Solutions of Tavaborole or Efinaconazole” J Drugs Dermatol. 2016 Jan; 15(1):89-94.
- Stein Gold L, Vlahovic T, Verma A, et al. “Naftifine Hydrochloride Gel 2%: An Effective Topical Treatment for Moccasin-Type Tinea Pedis,” J Drugs Dermatol. 2015;14(10):1138-1144.
- Vlahovic T et al. “Candida albicans Immunotherapy for Verrucae Plantaris,” JAPMA 105(5): 395-400, 2015.
- Scher RK, Tosti A, Joseph WS, Vlahovic TC, Plasencia J, Markinson BC, Pariser DM. “Onychomycosis Diagnosis and Management: Perspectives from a Joint Dermatology-Podiatry Roundtable,” J Drugs Dermatol. 2015 Sep 1;14(9):1016-21.
- Vlahovic T, MPharm TM, Chanda S, Zane LT, Coronado D. “In Vitro Nail Penetration of Tavaborole Topical Solution, 5%, Through Nail Polish on Ex Vivo Human Fingernails,” J Drugs Dermatol. 2015 Jul;14(7):675-8.
- Adams C, Athanasoula E, Lee W, Mahmudova N, Vlahovic TC. “Environmental and Genetic Factors on the Development of Onychomycosis,” J. Fungi 2015, 1(2), 211-216; http://www.mdpi.com/2309-608X/1/2/211
- Blutfield M, Lohre J, Pawich D, Vlahovic TC. “The Immunologic Response to Trichophyton Rubrum in Lower Extremity Fungal Infections,” J. Fungi 2015, 1(2), 130-137; http://www.mdpi.com/2309-608X /1/2/130
- Draelos Z, Vlahovic TC, Gold MH et al. “A Randomized, Double-blind, Vehicle-controlled Trial of Luliconazole Cream 1% in the Treatment of Interdigital Tinea Pedis.” J Clin Aesthet Dermatol. 2014 Oct;7(10):20-7.
- Vlahovic TC and Joseph WS. “Efinaconazole 10%, solution for the treatment of toenail onychomycosis in patients with diabetes.” J Drugs Dermatol. Oct; 13(10):611-15, 2014.
- Joseph WS, Vlahovic TC, Pillai R, Olin JT Efinaconazole 10% solution in the treatment of onychomycosis of the toenails., J Am Podiatr Med Assoc. Sep; 104(5):479-85, 2014.
- Elewski BE and Vlahovic T. “Econazole Nitrate Foam 1% for the Treatment of Tinea Pedis: Results from Two Double-Blind, Vehicle-Controlled, Phase 3 Clinical Trials,” J Drugs Dermatol July; 13(7):803-808, 2014.
- Wagoner M, Creech C, and Vlahovic T. “Idiopathic Mixed Small and Medium Vessel Vasculitis: A Case Report” The Foot and Ankle Online Journal, March 2014 http://faoj.org/2014/03/31/idiopathic-mixed-small-and-medium-vessel-cutaneous-vasculitis-a-case-report/
- Stein Gold L, Parish LC, Vlahovic T, et al “Efficacy and Safety of Naftifine HCl Gel 2% in the Treatment of Interdigital and Moccasin Type Tinea Pedis : Pooled Results from Two Multicenter, Randomized, Double-Blind, Vehicle-Controlled Trials.” Journal of Drugs in Dermatology 12(8):911-918, 2013.
- Vlahovic T and Morrow J “Ustekinumab in the Treatment of Moderate to Severe Lower Extremity Psoriasis: A case series,” The Foot and Ankle Online Journal 5(11): 1 2012.
- Rawe IM, Vlahovic T “The use of a portable, wearable form of pulsed radio frequency electromagnetic energy device for the healing of recalcitrant ulcers: a case report” Int Wound J Volume 9, Issue 3, p 253-258, 2011.
- Vlahovic T, Hinton EA, Chakravarthy D, Fleck CA “A Review of Cyanoacrylate Liquid Skin Protectant and Its Efficacy on Pedal Fissures,” J Am Coll Cert Wound Spec 2(4): 79, 2010.
- Lyman TP, Vlahovic T “Foot care from A to Z,” Dermatology Nursing Sept/Oct 2010: online at http://www.dermatologynursing.net/ceonline/2012/articleJ1005.pdf
- Vlahovic T, Klimaz T, Piemontese M., “Plantar Verrucous Carcinoma: An unusual case of bone invasion and osteomyelitis“Advances in Skin and Wound Care Journal 22(12): 554, 2009.
- Vlahovic T, Kemp K, Dunn SP. “The use of a clindamycin 1%-benzoyl peroxide 5% topical gel in the treatment of pitted keratolysis: a novel therapy,” Advances in Skin and Wound Care Journal 22(11): 564, 2009.
- Vlahovic T, Paskey K, Dunn SP. “Herpes Zoster Affecting the Lower Extremity: Two Cases,” Advances in Skin and Wound Care Journal 22(11): 502, 2009.
- Minhas S, Vlahovic, T. “Pedal Kaposi’s Sarcoma as the first sign of HIV: A Case Report,”The Foot & Ankle Journal 1(8): 3, 2008.
- Hadfield R, Vlahovic T, Khan MT. “The Use of Marigold Therapy for Podiatric Skin Conditions,” The Foot & Ankle Journal 1(7): 1, 2008.
- Coates C, Piraino, J, Leonheart E, and Vlahovic T. “Multiple Venous Malformations in the Lower Extremity: A Case Study,”Advances in Skin and Wound Care Journal 21(6): 267, 2008.
- Vlahovic T, Dunn SP, Blau J, and Gauthier C. “Injectable Botulinum Toxin as a Treatment for Plantar Hyperhidrosis: A Case Study,” JAPMA 98(2): 156, 2008.
- Coates C, Boehm A, Leonheart E, and Vlahovic T. “Malignant Transformation of Plantar Verruca” Advances in Skin and Wound Care Journal 19: 384, 2006.
- Lamm B, Ribiero C, Vlahovic, T et al “Peg in hole, end to end, and V arthrodesis: A Fresh Cadaveric Specimen Comparison of Digital Stabilization.” Presented at ACFAS Student Poster Competition, Los Angeles. JAPMA 91: 63, 2001.
- Lamm B, Ribiero C, Vlahovic, T et al “Lesser PIPJ Arthrodesis: A Retrospective Analysis of Three Procedures.” JAPMA 91: 331, 2001.
- Vlahovic T, et al. “A Case Presentation of Peroneal Neuropathy Induced Drop Foot: An Objective Gait Analysis of Correlated and Compensatory Lower Extremity Function.” JAPMA 90: 411, 2000.
Podcasts
- The Spot Check S2 E12: Onychomycosis: What We Miss, What Works, and Setting Realistic Expectations