The Voice of Podiatrists

November 07, 2006 #2,734 Editor-Barry Block, DPM, JD

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Prominent Podiatrists Discuss Treatments for Onychomycosis

As toenail fungi grow, the nails become thicker and may smell foul. Topical prescription solutions such as Loprox, Loceryl, Keralac, and Penlac may help, said Dr. Peter Paicos Jr., immediate past president of the Massachusetts Podiatric Medical Society and associate medical director of the wound healing center at Winchester Hospital. There are also some nonprescription topical solutions available, including Mycocide NS.

Dr.Peter Paicos, Jr.

If topical treatments don't work, you can try oral medications such as Lamisil or Sporanox, which are usually taken daily for 12 weeks. But the oral medications can in rare cases cause liver damage , so you should get a liver function test before starting these medications and during the course of treatment, said Dr. Joseph Caporusso , a McAllen, Texas, podiatrist and trustee of the American Podiatric Medical Association.

Dr. Joseph Caporusso

In really stubborn cases, the permanent solution is to remove the infected nail and nail root surgically.

Source: Judy Forman, The Boston Globe [11/6/06]

TUSPM Professor Provides Cold Weather Foot Advice

Prolonged exposure to harsh winter conditions can cause damage to the skin and underlying tissues, or frostbite. "Warm towels and water should be used to warm the affected area at the first sign of numbness. The person should then see a doctor, who can determine if there's any tissue damage," said James B. McGuire, D.P.M., assistant professor and chair of podiatric medicine at TUSPM.

Dr .James B. McGuire

"Dressing properly is the best defense against the problems that severe weather causes," said McGuire. "But it is important to remember that proper footgear is just as important as a warm coat, hat and gloves."

Because extreme cold and wet clothes put exposed areas such as the feet and toes in jeopardy, well-insulated shoes and boots are a must, McGuire stressed. And socks made from acrylic keep feet dry by slicking away perspiration from inside shoes and boots.

Source: Medical News Today (United Kingdom) [11/6/06]

OH Podiatric Resident Marries Olympic Gold Medal Gymnast

Dominique Moceanu, who won a gold medal at the 1996 summer Olympics as part of the U.S. women's gymnastics team dubbed the Magnificent Seven, wed longtime beau Michael Canales in her hometown of Houston on Saturday afternoon.

Dr. Michael Canales and Dominique Moceanu

Moceanu, 25, and Canales, 29, a former nationally ranked collegiate gymnast who is now a resident in podiatric surgery in Cleveland, started dating in 2001. They first met in 1994 at the Junior National Championships when she was a precocious 12-year-old star. They became a couple after meeting again years later, and Canales served as her coach as she trained last year for a planned return to competition.

Source: Michael Haederle, People, [11/5/06]

U.S. Unlikely To Consider Single-Payer Until 2020

The U.S. healthcare system "continues to weaken" as the number of uninsured U.S. residents increases, health care costs rise and companies reduce or eliminate workers' health benefits, but "chances are slim" that the U.S. will adopt a "far less expensive 'single-payer' health system ... anytime soon," the Christian Science Monitor reports. Polls have found that at least 60% of U.S. citizens support government funding of the nation's $2 trillion health care system, according the Monitor.

However, many U.S. residents "are cynical about government, distrusting its ability to provide a competent healthcare system" and "prefer a market-based system with a high degree of individual choice," the Monitor reports. In addition, "self-interested groups" with "political clout" -- such as pharmaceutical companies and health insurers, which "fear more government regulation, more interference" -- "don't want the government to restrain prices for [prescription] drugs or other medical services, as systems in other industrial countries do," according to the Monitor. There also "is no strong leadership in Congress or the White House for radical change in the healthcare system," and "those who are satisfied with the system are unlikely to urge reforms to help the less fortunate," the Monitor reports.

Source: Christian Science Monitor via American Health Line [11/6/06]

RE: Hepatitis and Mycotic Nails

I have a patient with mycotic nails and a history of hepatitis. before starting any oral treatment I performed a baseline liver function panel. The total billirubin was elevated at 3.01mg/dL normal (0.2-1.5) and the direct level was elevated at 0.45mg/dL with normal ( 0.0-0.3). My question is this does anyone know of any treatments/medications to lower the billirubin in a 43 y/o male? Obviously I did not start him on Lamisil.

Steven H. Goldstein, DPM, Livingston, NJ

RE: Free PDR?

Does anyone know where one can get a free yearly hardcover PDR? Years ago you could contribute to the APMA Student Scholarship Fund and get a PDR.

Sherwood A. Weisman, DPM, DeBary, FL

Editor’s Comment: The PDR program, formerly sponsored by Medicis, has been replaced with the APMA CD ROM Coding Manual. As a result of this change, the APMA Educational Foundation Student Scholarship Endowment has received over $130,000 from the sale of the Coding CDs, far more than the proceeds from the sale of the PDR.s.

RE: Indocin (Michael Felicetta, DPM)
From: Rich Rettig, DPM

I see no reason for its use in the treatment of gout anyway. Indocin was one of the very first NSAID's. It worked well for gout, at a time when the only other drug commonly used for acute gout was colchicine, and that was highly problematic, as was butazolidin alka. So it became ingrained in physician's minds that specifically Indocin was the drug of choice for acute gout. But since then, there have been many other NSAID's that have come out. I believe that they all are virtually equally effective for gout, and the newer generation NSAID's, like Relafen for instance, are much safer to the GI system. Clinoril and Naprosyn did specifically get an FDA approval for gout, I believe.

So even if it is true that indomethacin is not available, there should be no reason for concern. Better medications, in my opinion, have long been available.

Rich Rettig, DPM, Philadelphia, PA, rettigdpm@verizon.com

RE: ESWT and Neuroma (Elliot Udell, DPM)
From: Peter Bregman, DPM

Lowell Weil Sr and Jr have both done extensive treatment with ESWT for neuromas…I would refer you to them. As for me since most insurances do not pay for ESWT, I use endoscopic decompression or external neurolysis with 90% success and almost all patients prefer this technique.

Peter Bregman, DPM, Wilmington, MA, footguru@comcast.net

PRACTICE FOR SALE - TEXAS

Podiatry practice for sale in fast growing suburb of Dallas, TX. Part-time practice, can be made Full-time. General podiatry practice, routine care, orthotics, surgery, etc. Hospital privileges available. Excellent opportunity, don't pass it by. Please respond to: CDinbigD@aol.com.

ASSOCIATE POSITION - NEW ENGLAND

Terrific Opportunity Now Available in growing New England practice. Well established and respected practice with new, large office space, latest technology, very helpful staff, loyal patients and solid referral base. Close proximity to hospitals with modern surgical suites. Opportunity for shared ownership. Prefer 24 month PSR with clinical practice experience or an experienced doctor looking to improve their situation. E-mail CV and particulars to NEAFC3@aol.com

HOUSE CALL PRACTICE OPPORTUNITY- CHICAGO / NORTHWEST INDIANA

Chicago-Home Physicians specializes in house calls to the elderly homebound. Full and part-time positions available in Chicago/Northwest IN. Competitive Compensation, including malpractice. Contact Scott Schneider. Phone-773-292-4800. Fax-773-486-3548. E-mail sschneider@homephysicians.com www.homephysicians.com

PSR-24 RESIDENCY POSITION SOUTHEASTERN MI

Available for recent graduates or former PPMR/RPR or PSR-12 residents. this is a major teaching affiliate of Michigan State University college of Osteopathic Medicine and serves 17 residency and fellowship programs. Active podiatric clinics in wound care, limb salvage, foot and ankle surgery, medicine and orthopedics. competitive salary and benefit package. meded@pohmedical.org

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