The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

February 05, 2009 #3,463 Publisher-Barry Block, DPM, JD

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NY Podiatrist Has Success with HBOT For Wound Healing

Louis R. Cappa, DPM is the medical director of St. Luke's Cornwall Hospital's Center for Wound Healing and Hyperbaric Medicine. The medical pavilion on the hospital's Cornwall campus is the only site in Orange, Ulster or Sullivan counties where hyperbaric oxygen therapy (HBOT) is available. This therapy has shown great success in healing chronic wounds, including those in which the infection has gone to the bone or an entire extremity that's been crushed in an accident.

Dr. Louis R. Cappa

It works, says Cappa “(because) the air we breathe is about 20 percent oxygen. During HBOT, the patient receives 100 percent oxygen at two atmospheric pressures, which forces the higher concentration of oxygen into the lungs. The oxygen-rich blood and plasma then travel throughout the body. There is also some indication that the exterior oxygen may act directly at the wound site.

Cappa said that the treatments are not painful “The experience is similar to going up in an airplane. Your ears clog and you swallow to relieve the air pressure. Once you're at pressure, you don't feel anything. Most of our patients fall asleep, although each chamber does have its own TV. Each treatment is an hour and 50 minutes, and patients are monitored by a nurse at all times. We typically start with 30 consecutive treatments, Monday through Friday."

Deborah J. Botti, Times Herald-Record [2/4/09]

Stone Selected as Scholl College Alumnus of the Year

Kathleen M. Stone, DPM, has been selected as the 2009 Alumnus of the Year by the Alumni Association of the Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science. Dr. Stone received her DPM degree from Scholl College in 1985 and has served on the Rosalind Franklin University Board of Trustees since 2005.

Dr. Kathleen M. Stone

Dr. Stone maintains a private practice, Thunderbird Footcare in Glendale, Arizona and has a distinguished record of service to her profession. Dr. Stone was President of the American Association of Women Podiatrists from 1990-92, and was President of the Arizona Podiatric Medical Association from 1993-95. In 1999, Dr. Stone was elected to the Board of Trustees of the American Podiatric Medical Association (APMA), upon which she presently serves as Vice-President. Dr. Stone chairs a number of committees for the APMA, including the Education and Development Committees. In 2008, Phoenix Magazine included her among their listing of “Top Docs” and for the third time she was recognized as one of the most influential podiatrists in America by Podiatry Management Magazine.

First established in 1990, the Alumnus of the Year Award is bestowed upon Scholl alumni who have distinguished themselves in the profession and exemplified consistent commitment and dedication to the Dr. William M. Scholl College of Podiatric Medicine and the Scholl College Alumni Association. Dr. Stone will be honored at the 26th Annual Scholl Scholarship Benefit and Alumni Reunion on Saturday, April 4, 2009 in conjunction with the Midwest Podiatry Conference at the Hyatt Regency in Chicago.

CA Mandates Language Interpreter Services for Commercial Health Plans

On Jan. 1, California became the first state in the nation to implement a mandatory interpreter law for commercial health plan members, according to DMHC. Patients who have primary languages other than English can now ask their health plans to provide interpreters when they make appointments at doctors' offices, clinics or hospitals.

More than 80 health plans were required to gain approval of their language assistance programs, detailing which languages are spoken by their members, how language assistance services will be provided and what staff training is needed, said DMHC. So far, the department said, it has received only five calls from patients who wanted help getting interpreters, the Ventura County Star reports.

Source: Health Plan Week [2/2/09]

Query: Weil Osteotomy Complication

I frequently do the Weil osteotomy for dorsomedial subluxation of the 2nd MPJ and typically have good results. Reduction at the time of surgery was excellent (the collateral ligaments were released; the plantar plate was freed up with a McGlamry spoon); this is 6 weeks post-op.

Complication of Weil Osteotomy

This improved the toe, but the overall result is still poor. I suspect it failed in this case because the 1st metatarsal is very short. I am uncertain if further shortening of the 2nd metatarsal should be considered. I don't want to overload the 3rd MPJ. Has anyone else had this problem? Any suggestions would be appreciated.

Calvin Britton, DPM, Little Rock, AR

RE: Topaz Procedure (Gary Gugliada, DPM)
From: Robert P. Thiele, DPM, Steven Goldstein, DPM

I have no experience with using Topaz for this condition but you have some other minimally invasive options: Cryosurgery, radiofrequency ablation, or ETOH injections. If you have no luck with these, then try surgical resection of the stump neuroma with implantation into muscle belly/bone.

Robert P. Thiele, DPM, Denville, NJ, drthiele@comcast.net

Using radiofrequency devices like Topaz can actually cause neuromas, so I do not recommend it for this problem. Cryosurgery works extremely well on stump neuromas. I have performed hundreds.

Steven Goldstein, DPM, Royal Palm Beach, FL, stevefootdr1@cs.com

RE: B12 Injections
From: Multiple Respondents

With pathology as complex as neuropathy, injections of Vit. B12 as a treatment protocol seems to be an over-simplification of the condition. That is not to say that in some patients it would not be of benefit. However, in this day and age of advanced diagnostic testing, many patients with the same diagnosis may have different mechanisms at work that awaken a gene of degeneration. It is our responsibility as physicians to not only make a diagnosis, but to uncover causes of that diagnosis in that particular patient. Only then does a treatment protocol address that patient's unique therapeutic needs. The neuropathy patient, like all patients with degenerative diseases, needs to have a complete assessment of epigenomic triggers that may awaken these genes of degeneration. The path of medicine in the future will lead us to a more comprehensive assessment of each individual patient. When our treatment protocols become patient specific rather than condition specific, we will see a rise in positive outcomes and a decrease in morbidity associated with these conditions.

Bob Kornfeld, DPM, Lake Success, NY, Holfoot153@aol.com

I have used B12 injections for 20 years for treating the burning pain associated with DPN. I was told by an older neurologist that for many, it helped with their pain. I have found this to be true in my own practice. I do not see any reason to order plasma B12 levels, as most are normal. I can’t tell you if it’s the "placebo" effect or not..but I can tell you that 50% of those I use it on, get sufficient relief to sleep at night, and live more comfortably without the side-effects associated with other drugs used to treat DPN. I usually find that 1 cc. per month is not sufficient, and usually use 2 cc. a month, or 1 cc. every 2 weeks. I have also noticed in the past several years, neurologists in my area are using this regimen quite often. As the old neurologist said, "you aren’t going to hurt them by giving them B12"

David H. Long, DPM, Paris, TN, ParisDPM@aol.com

B-12 injections for neuromatous and "neurogenic" complaints such as peripheral neuropathy were developed and researched by Dr. Marvin Steinberg in the 60's-70's. Two points to mention are that B-12 is buffered and preserved with 1.5% (or more) benzyl alcohol, giving it a "sclerosing alcohol effect", making Dr. Steinberg the father of modern sclerosing injections. In addition, he believed that there might be a need for B-12 locally in terms of tissue perfusion of B-12 and therefore the blood testing that Dr. Udell suggests may be a red herring.

It is often stated on this site that in order for new diagnostic and treatment regimens to be appreciated and long-lived, they must be published. The side-effect is the ability for insurance companies to declare that any study is self-funded, too small, not longitudinal enough, etc. and call it "experimental" in order to deny payment .

Dennis Shavelson, DPM, NYC, drsha@lifestylepodiatry.com

RE: Ballet Shoe for Cavus Foot (Seth Rubenstein, DPM)
From: Robert Scott Steinberg, DPM

Dr. Rubenstein said that the patient’s problems began 10 months ago. That would be during Nutcracker season! Was there ever a culture to verify infection? What adhesives did the cobbler use? Make sure this isn't some sort of contact dermatitis.

If she is in a Russian or Russian-style shoe, and her forefoot is square, there is a huge mismatch. Russian style shoes are narrow, purposely so, with a smaller flat area than other pointe shoes. In these shoes, many women have to fold their toes on each other.
English-made shoes (Freeds), as well as Gaynor Miden's (US), have larger toe boxes and are usually stronger than Russian shoes. If her narrow heel lifts out of the shoe when the shoe goes 'up', this adds to the stress. It would be horrible if a shoe came off during a performance, so most women cram their feet into pointe shoes that are too small. This is also for ego to show a small foot.

It sounds like this woman has spent too much time 'up' on pointe. Her tights could also be a problem. Besides shoes that fit, she needs a rest, but resting ballerinas can gain weight. Get her off pointe and resting. Think cross-training. Your patient and her mother will not like to hear most of this.

Robert Scott Steinberg, DPM, Schaumburg, IL, doc@footsportsdoc.com

RE: EMR and Obama (Richard A. Simmons, DPM)
From: Lloyd S. Smith, DPM

I have been working with an electronic medical record for about 6 months. It is linked to a database that includes health records on about 2 million people. It is instantly available and I have terminals in every room. It is the most compelling change in my practice behavior since I began to practice over 30 years ago. I now see health histories on patients that I could never gather in an interview, an intake form, or any other format. Most patients love and appreciate my access to their complete history and the access to their records. Those that don't should be seen elsewhere. Is it intrusive? I guess so. Is it helpful in providing care to my patients? Absolutely. Would you want to operate on someone whose medical history is hidden? Would you want your physician or surgeon to fail to appreciate your complete medical record? I wouldn't.

Lloyd S. Smith, DPM, Newton, MA, lloydpod@yahoo.com

RE: ProAssurance Receives Regulatory Approvals for PICA Group
From: Multiple Respondents

1. I think it's important to note that PICA is not going to become 'dissolved' under the proposed demutualization. It simply will become a wholly-owned subsidiary of ProAssurance, and will continue to function with its current staff. From page 9 of the Proposal: "With respect to your Policy, you will speak with the same people at the same phone numbers and our underwriting and claims operations will not change."

2. The dividend credit for my most recent policy renewal was $597. The cash compensation I am being offered under the proposed demutualization is over $13,000. That's over 20 YEARS worth of dividends. Frankly, I don't see how this can be considered 'insignificant', or 'a few dollars', in context.

3. I, too, am concerned about the potential for increasing premiums. Having said that, if the premiums are raised in a way that makes PICA uncompetitive in the marketplace, we all have the opportunity to obtain malpractice coverage with another company. I would like to see an 'escape clause' in the proposal for current policyholders to waive their cash compensation in lieu of a tail policy (or tail policy credit).

Finally, I think it's interesting that the podiatry profession, on one hand, constantly seeks to achieve parity with our MD/DO colleagues, but at the same time, we want 'our own' malpractice company. To me, this seems a bit hypocritical. My vote is undecided at the moment, and I look forward to reading further comments on this important issue.

Robert Wunderlich, DPM, San Antonio, TX, rwunder@gmail.com

I was at the recent SAM conference in Orlando. I found the explanation for selling out to ProAssurance less than adequate. I received the material from PICA recently. It really feels like I'm being bribed. If you take the money, it will all be better. If you don't, beware.

It seems that PICA was fine, so why change the structure. This sounds like some political game to me. Who really benefits when several years have passed?

Marc Katz, DPM, Tampa, FL, dr_mkatz@yahoo.com

Editor’s note: An extended-length note by Dr. Gershman appears at: http://www.podiatrym.com/letters2.cfm?id=24388&start=1

ASSOCIATE POSITION - VIRGINIA IS FOR LOVERS

ASSOCIATE POSITION - CENTRAL FLORIDA AREA

Exceptional opportunity for qualified candidates. Associate position available in a rapid growing, well-established multi-office practice. Well trained (PSR-24 or more). Compensation includes excellent salary plus incentives and benefits. Please e-Mail CV, letters of reference to CF_resume@hotmail.com

PRACTICE FOR SALE - CENTRAL FL

practice sale at bargain, in beautiful growing area; 2000 sf building fully equipped/ designed for podiatry; excellent location, exposure; near hospital& wound center. Great opportunity for expansion; good insurance climate. 352-357-7499 / E-mail windnwave@earthlink.net

POST GRADUATE PODIATRIC RESEARCH FELLOWSHIP

Boston University Medical Center and Boston University School of Medicine. This unique fellowship at a major teaching facility is a two-year opportunity, during which he/she would be expected to become a knowledge expert who will contribute significantly to research, teaching, and innovations in limb preservation and tissue repair. Requirements: Completion of a two or three year surgical residency; Massachusetts license-eligible, ABPS Board Qualification-eligible. Candidate must possess a commitment to an academic career in podiatric medicine and surgery. Annual Salary: Year 1 $61,000, Year 2 $66,000. Submit a CV and letter of interest to: Dr. Vickie Driver vickie.driver@bmc.org

ASSOCIATE POSITION -SOUTHERN NEW JERSEY

I’m looking for podiatrist who wants additional practice hours. Perfect for combining your own practice with an additional income. Must be on Aetna Insurance, Horizon Blue Shield, Medicare, and most commercial carriers. I am looking for someone who has a desire to learn how a very successful practice is run, so that I will be able to have time away from my practice. Payscale to be discussed. Could lead to partnership or sale. E-mail contact information, CV, and why you would be perfect for this opportunity. Contact foot.care@verizon.net

POSITION WANTED In NY or NJ AREA

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