08/23/2013
RESPONSES / COMMENTS - (NON-CLINICAL) - PART 1A
RE: Wart Treatments (Theresa M. Hughes, DPM)
From: Michael J. "Dusty" McCourt, DPM
In regard to cantharone, I obtain mine from a compounding pharmacy in Roseburg, OR and have even heard that the local compounding pharmacy here in Eugene does it as well. I, too, have had great results and happy patients with using it.. Here are the websites:
NW compounding pharmacy: nwcmpd-rx.com/Homepage.html
Broadway: broadwayapothecary.com/
Michael J. "Dusty" McCourt, DPM, Eugene, OR, dustydock@gmail.com
08/20/2013
RESPONSES / COMMENTS - (NON-CLINICAL) - PART 1C
RE: Diagnostic Ultrasound (David Samuel, DPM)
From: Martin Wendelken, DPM,
It is totally clear to me that there are a number of podiatric physicians who do not understand the capabilities of diagnostic ultrasound. For example, 1) there are many patients who have heel pain where the plantar fascia is torn and injection is contraindicated or 2) there is a tendonopathy, where partial tears exists, or 3) there are swellings where a tumor resides. For those who feel that it is only a financial incentive, I need to state that they are misdirected. The instrument is only as effective as the capabilities of the user.
Martin Wendelken, DPM, NY, NY, drmew@optonline.net
08/20/2013
RESPONSES / COMMENTS - (NON-CLINICAL) - PART 1A
RE: Diagnostic Ultrasound (Bryan Markinson, DPM)
From: Robert Kornfeld, DPM
Bryan Markinson states a case of ultrasound abuse which has nothing at all to do with efficacy of guided injections. This simply sounds like an unethical doc. Guided injections have their place in our armamentarium. There is no shortage of journal articles supporting its use. I have found it to be extremely helpful in injection placement and efficacy (although I do not inject cortisone into ligaments, tendons, or joints). Realize that if your injection is not in the right place or the right plane, no amount of "diffusion" is going to get it there. My fellow podiatrists should also know that guided injections are becoming the gold standard in radiology, rheumatology, orthopedics, etc. It should be in podiatry as well. Why rely on hit or miss when you can clearly see where you need to be?
In the same vein, why should we do minimally invasive fluoroscopic or endoscopic procedures? Let's just put the knife in and slash around. We're bound to be right half of the time.
Robert Kornfeld, DPM, Manhasset, NY, holfoot153@aol.com
08/16/2013
RESPONSES / COMMENTS - (NON-CLINICAL) - PART 1B
RE: Diagnostic Ultrasound (Michael Forman, DPM)
From: David Secord, DPM
Here's a relevant article on this topic: "Ultrasound Guidance for Intra-articular Injections Improves Clinician Accuracy" Arthritis Rheum. 2010;62:1862-1869.
Summary
The use of ultrasound guidance has been advocated as a technically superior method for performing intra-articular injections. This study compared clinical efficacy and technical accuracy in 184 patients who underwent either ultrasound-guided intra-articular injections or blind injections.
One third of blind intra-articular injections were found to have been inaccurate. Moreover, injections performed by a trainee rheumatologist using ultrasound guidance were shown to be more accurate than those performed by more senior rheumatologists performing blind injections.
No significant difference between the two groups was noted in the clinical outcome measures used (Visual Analogue Scale, modified Health Assessment Questionnaire, and the EuroQol 5-domain questionnaire, erythrocyte sedimentation rate and C-reactive protein levels), except for an improvement in Visual Analogue Scale joint function scores in the ultrasound-guided injection group at 6 weeks.
David Secord, DPM, Corpus Christi, TX, ledocdave@hotmail.com
08/16/2013
RESPONSES / COMMENTS - (NON-CLINICAL) - PART 1A
RE: Diagnostic Ultrasound (Bryan Markinson, DPM)
From: Martin E. Wendelken, DPM, Bill Greco, DPM
The use of diagnostic ultrasound in the identification of tumors on any location of the foot should not be understated. I have identified 4 malignant soft tissue masses that appeared to be “ganglions”, some of which were injected by others thinking they were ganglions. Therefore, all soft tissue masses are examined using diagnostic ultrasound before we inject or aspirate them.
One oncologist unfortunately stated to one of the referrals that injections into tumors can complicate treatment and may cause spreading of the cells/mass (causing legal issues for one of the podiatrists). This technology can improve patient care, however, it is clearly operator-dependent. As far as guided injections, sonography can allow for exact placement of injectable medications in the area where the pathology is located as determined by the US exam. We have found, in fact, that this reduces the number of injections to achieve a satisfactory result.
Martin E. Wendelken, DPM, RN, NY, NY, drmew@optonline.net
Is the example of ten ultrasound-guided steroid injections an example of the fallibility of ultrasound or the incompetence of care, bordering on malpractice, of one individual?
Ultrasound as a practice adjunct will provide the practitioner valuable information. Is the mass cellular or fluid? Is it lobulated or a single chamber? Are there extensions of the mass beyond...
Editor's Note: Dr. Greco's extended-length letter can be read here.
08/14/2013
RESPONSES / COMMENTS - (NON-CLINICAL) - PART 1
RE: Maximalist Running Shoes are In, Minimalist Running Shoes are Out
From: Kevin A. Kirby, DPM
I just wanted to clarify a point that I made in my recent posting about the new "maximalist" running shoe, the Brooks Transcend. The Brooks Transcend was "unveiled" at the Outdoor Retail Summer Market trade show held in Salt Lake City on August 1, 2013. However, the Transcend won't be on store shelves until February 1, 2014. The maximalist running shoe, Hoka One One, has been on specialty running store shelves for three years. Sorry for any confusion this has created.
Rumors also have it that many of the major running shoe manufacturers will be introducing new "maximalist" running shoes in 2014. Much of running shoe manufacturers' ability to design thicker, more cushioned, yet relatively light running shoes seems to be due to the recent development of newer midsole materials that allow these new running shoe sole constructions to occur. It is an exciting time in the history of running shoe development that every sports podiatrist should try to stay abreast of.
Kevin A. Kirby, DPM, Sacramento, CA, kevinakirby@comcast.net
08/13/2013
RESPONSES / COMMENTS - (NON-CLINICAL) - PART 1
RE: Obtaining Reports from Uncooperative Specialists (Elliot Udell, DPM)
From: Paul Kesselman, DPM
Elliot's remarks are unfortunately becoming more and more true. In speaking with a Medicare official, I was advised to try the following:
1) After you have exhausted the usual letter-writing and requests, get your patients involved and have them sign a records release;
2) If that does not work, have the patient (if possible) go the physician's office and demand a copy of their record;
3) If that fails, threaten the practice with notification that you will be notifying the state (or municipal) board of medical practice and the state's Attorney General's Healthcare Fraud Bureau.
I have usually had to resort to #1 and #2. I've only had to resort to #3 verbally, and that was with the staff who then referred me to the doctor himself. Then the records were magically produced (unfortunately in that case the record I needed was unintelligible and of little use). Bear in mind, for the most part, most physician practices are usually pretty compliant.
Paul Kesselman, DPM, Woodside, NY, drkesselmandpm1@hotmail.com
08/09/2013
RESPONSES / COMMENTS - (NON-CLINICAL) - PART 1
RE: Hill Podiatry Chairs (Marc Katz, DPM)
From: Richard Rettig, DPM
I have had a Hill chair for about 20 years. It is a very basic chair at a reasonable price. I had my concerns originally about some ergonomic minor issues (switch placements and footrest length) that were changed by the company for my chair at my request, and I felt they should have adopted these changes for all their chairs, and stated it publicly in the past.
Recently a +500lb patient (above the chair-rated capacity) damaged the frame of my chair which, in turn, ruined a motor, too. This was well beyond any warrantee. The company picked up my chair (I am within 50 miles of their plant) and fixed it in-house and returned it, re-welding the frame and replacing the motor. They refused payment for this. I need to now publicly commend them for their service.
Richard Rettig, DPM, Philadelphia, PA, rettigdpm@gmail.com
08/08/2013
RESPONSES / COMMENTS - (NON-CLINICAL) - PART 1A
RE: Diagnostic Ultrasound (Michael Forman, DPM)
From: Marc Katz, DPM
There is no overuse of ultrasound. There is not enough use of ultrasound. I completely agree that ultrasound is invaluable for all of the applications that you mentioned and serves as a great diagnostic tool.
However, there are issues to be discussed. Many doctors that use ultrasound have no clue what they are viewing, but they use this tool to add dollars to...
Editor's note: Dr. Katz's extended-length letter can be read here.
08/02/2013
RESPONSES / COMMENTS - (NON-CLINICAL) - PART 1
RE: Source for Steel Toe Caps (Miki Hori, DPM)
From: Kevin Pearson, DPM, David Mader, DPM
Check out oshatoes.com. These are steel toe shoe covers that will fit over most shoes.
Kevin Pearson, DPM, Stockbridge, GA, pearsondpm@bellsouth.net
OSHA TOES makes slip-on safety toes for shoes and boots.
David Mader, DPM, Danbury, CT, docmader@icloud.com
08/01/2013
RESPONSES / COMMENTS - (NON-CLINICAL) - PART 1
RE: PADnet (John Romans)
From: Richard Silverstein, DPM, Steven Selby Blanken, DPM
Mr. Romans, how do you intend to build a relationship with podiatrists for years to come moving forward when close to a thousand podiatrists lost thousands of dollars on extended warranties that were never honored as recently as two months ago? Please let us know.
Richard Silverstein, DPM, Havre de Grace, MD, ersilver1@aol.com
Mr. Romans, when should we expect our monthly, overboard maintenance fees to continue PADnet use? When will we receive the letter from the "new" company stating that they don't honor previous contracts which may have included some many years of paid support/maintenance? Also, will the letter state on the "email" that if we don't respond in a set few days, we will most likely not be able to use the PADnet as we had before? Will the new PADNet company put down the previous owners like the new company that purchased your old EHR company did? How can any DPM who has done business with you in the past and spent thousands of dollars want to work with any company that you have an association with? What say you, Mr. Romans?
Steven Selby Blanken, DPM, Silver Spring,, MD, blankenpod@aol.com
07/20/2013
RESPONSES / COMMENTS - (NON-CLINICAL) - PART 1
RE: Setting the Record Straight on Debridement of Calluses in Diabetics
From: Alan Sherman, DPM
Are amputations caused by podiatrists? A position statement by controversial low-carb guru Richard Bernstein, MD has been circulating in various forms since August 2012, blaming all foot amputations in patients with diabetes on debridement of calluses. DiabetesCare, the well-respected Journal of the American Diabetes Association, this past April 2013, republished the letter.
The misinformation in this letter has been reproduced enough, and I think it’s time that it be corrected. Here is the letter. The issue is his sweeping generalization and ridiculous misquoted statistics. Bernstein calls....
Editor's note: Dr. Sherman's extended-length letter can be read here.
07/19/2013
RESPONSES / COMMENTS - (NON-CLINICAL) - PART 1
RE: Inventory Tracking System
From: Jerry Cosentino, DPM
Several months ago, I saw a post requesting information regarding inventory tracking. I searched the market for over one year and found most programs such as Quickbooks and other software companies were too sophisticated for our purposes.
During one of my conversations with a software manufacturer, they suggested I contact a company called Redbeam (Redbeam.com). We have had this system for over one year and find it fairly easy to use. However, the accuracy is only as good as the employee input. We have a hand-held scanner at the reception desk, which is used as items are dispensed. We have extended this to our office medical supplies. We still do a manual inventory check every month, to make adjustments and find where our discrepancies are coming from.
My goal is to have an inventory turnover about every 3 months, for each item. It is also nice to have your staff give you a weekly inventory values report for asset evaluation. I recommend this product.
Disclosure: I have no financial dealings or gain in making this suggestion.
Jerry Cosentino, DPM, Tampa, FL, drgcosentino@gmail.com
07/11/2013
RESPONSES / COMMENTS - (NON-CLINICAL) - PART 1A
RE: Reliable Medical Billing Company
From: Joseph Smith, DPM, Michael Forman, DPM
My billing company rules - 1st Choice Medical Billing Terry Raynor-Fritz (757 560-0202) . She has been doing podiatry for over a decade and has been teaching medical billing at Tidewater Community College for over 20 years. She handles all types of practices and handles many out-of-town clients.
Joseph Smith, DPM, VA Beach, VA, jsmith531@cox.net
I am using Doctors Central Billing in Ohio. They are easily the best billing service I have had. At this time, they are also in Indiana, Kentucky, and Florida. Write to PaulF@drsbillinginc.com
Michael Forman, DPM, Cleveland, OH, im4man@aol.com
07/08/2013
RESPONSES / COMMENTS - (NON-CLINICAL) - PART 1
RE: The Disruptive Physician
From: Steven J. Kaniadakis, DPM
Is the podiatry profession a victim of a so called "disruptive physician" syndrome? Is this a growing disease that needs to be stemmed before podiatry becomes rooted? These are hard questions needing introspective examination with patient satisfaction surveys becoming an increasingly significant part of the healthcare arena. Read an article on this topic here.
Steven J. Kaniadakis, DPM, Saint Petersburg, FL, stevenkdpm@yahoo.com
06/27/2013
RESPONSES / COMMENTS - (NON-CLINICAL) - PART 1A
RE: TRAKnet Charges (Marge Portela, DPM)
From: Irma Godoy, DPM
The new owners need to charge for services, but I am still paying a lease. My contract says “lease to buy, services included for 5 years, buy-off $1.” I was supposed to be the owner of the software in 5 years; now I own nothing and have to pay extra (almost the same amount that I’m paying for the lease), and I am being threatened that if I don’t pay, I will incur fees, and my software might have problems working. I love the software; I finally learned how to work it, but being a small business, it’s too expensive for me. What are TRAKnet's owners doing about it?
Irma Godoy, DPM, Wayne, NJ, igrt53@yahoo.com
06/26/2013
RESPONSES / COMMENTS - (NON-CLINICAL) - PART 1
RE: MLS Laser (Joe Borden, DPM)
From: Paul V. Ledesma, DPM
As a long-time user of laser therapy (in particular 4 years with MLS), I can honestly say it has out-performed other lasers that I have used when treating most conditions. In the beginning of using cold laser therapy, I had the privilege of utilizing 3 different laser companies simultaneously. Inevitably, when laser therapy didn't seem to be working with one device, the patients would typically respond to the MLS.
I advise that you look into the science more specifically before making any decisions when thinking of making a purchase. After my research, I found that the MLS system had the most advanced technology behind it compared to competitors, and the results backed it up. As for willingness of patients to pay for treatment, the answer lies in the type of patients you are trying to treat, and for what conditions. In particular, I started with the patients who had mostly run out of options for treating their pain, and who would try just about anything to make it go away.
Identify these types of patients first within your practice, and start there. Once you've seen good results, you'll have more confidence in offering it to other patients who may not be as desperate. As for the profitability, it all depends on your level of confidence with the device. If you believe in the therapy and know that it works, your patients will start asking for it.
Disclosure: I do consulting work for Cutting Edge Lasers on a periodic basis.
Paul V. Ledesma, DPM, Phoenix, AZ, paul@ledesmafootandankle.com
06/25/2013
RESPONSES / COMMENTS - (NON-CLINICAL) - PART 1B
RE: Will Podiatric Residencies Accept MDs? (Ivar Roth, DPM, MPH)
From: Allen Guehl, DPM
This is an excerpt from the Ohio medical board licensure requirements. It does not appear that in Ohio, a podiatry residency would lead to MD licensure.
Graduate medical education means: Internships and residencies accredited by the Accreditation Council for Graduate Medical Education (ACGME) or the American Osteopathic Association (AOA); a clinical fellowship conducted at an institution that has an ACGME or AOA accredited residency program in the same or a related field; Canadian internships accredited by the National Joint Committee for Approval of Pre-Registration Physicians Training Program; and Canadian residencies accredited by the Royal College of Physicians and Surgeons of Canada or the College of Family Physicians.
Allen Guehl, DPM, Dayton, OH, (International University of the Health Sciences, MD class of 2014.), drguehl@gmail.com
06/25/2013
RESPONSES / COMMENTS - (NON-CLINICAL) - PART 1A
RE: Will Podiatric Residencies Accept MDs? (Ivar Roth, DPM, MPH)
From: David Gottlieb, DPM
While it’s a nice thought for the times when there are more programs than applicants, MDs cannot be podiatry residents. One of the required prerequisites to be accepted into a CPME-approved residency program is that the applicant has graduated from a CPME-approved podiatry school/college.
A better option would be for your son to graduate medical school, then go to podiatry school for 2 years. At that time, he would be an MD/DPM and could decide which residency track and specialty he wanted [MD or DPM].
H. David Gottlieb, DPM, Baltimore, MD, hdavidgottliebdpm@gmail.com
06/19/2013
RESPONSES / COMMENTS - (NON-CLINICAL) - PART 1B
RE: Time for EBM Study on Custom Orthotics (Richard A. Simmons, DPM)
From: Robert Scott Steinberg, DPM
Dr. Simmons, please, we do not need to turn this into rocket science. For years and years, I have seen hundreds upon hundreds of patients for plantar fasciitis. A great many of them had tried, not one, but two or three different OTC devices. Because they did not help, they sought me out. I do plaster casts, in STJ neutral, with the bisection of the calcaneus marked, and an Rx for the appropriate modifications to treat the underlying biomechanical defect and deformity. And because I do not go off on half-baked biomechanical theories, my biomechanical exams are quite "standardized."
I am quite sure I have plenty of company, i.e., colleagues who practice real, hands-on (not having someone else do it) exams, and personally do the STJ neutral casts, that they do not push off on an unqualified office assistant. So, we do have plenty to show for our expertise!
Robert Scott Steinberg, DPM, Schaumburg, IL, Doc@FootSportsDoc.com
06/19/2013
RESPONSES / COMMENTS - (NON-CLINICAL) - PART 1A
RE: Time for EBM Study on Custom Orthotics (Carl Solomon, DPM)
From: Roy Lidtke, DPM
This is a big problem but it is also a big project. There have been several projects funded by APMA, PFOLA and even physical therapy, but obviously we have not seen any great change in our research portfolio on the "pro" side of the argument. It is expensive to do any substantial research. Research projects like this will not get done until someone pays for it.
As funds are limited by the government, and industry isn't stepping up, I suggest we set up a crowd source funding website and invite the "experts" to submit proposals with all of us voting on the best. Maybe then something will get done.
Roy Lidtke, DPM, Marion, IA, Roy.Lidtke@dmu.edu
06/18/2013
RESPONSES / COMMENTS - (NON-CLINICAL) - PART 1A
RE: Time for EBM Study on Custom Orthotics (Carl Solomon, DPM)
From: Kevin Kirby, DPM
Over the last seven years, I have written one paper and two book chapters which describe, in detail, the multitude of research studies which show that foot orthoses not only effectively alter the kinetics and kinematics of gait, but also show that foot orthoses are very effective at treating a number of foot and lower extremity biomechanical pathologies. Most of these research studies are published in non-podiatric scientific journals. I highly recommend Paul Scherer's recently published book which focuses on the research evidence for foot orthoses (Scherer PR (ed), Recent Advances in Orthotic Therapy: Improving Clinical Outcomes with a Pathology Specific Approach, Lower Extremity Review, USA, 2011).
Kirby KA: Foot orthoses: therapeutic efficacy, theory and research evidence for their biomechanical effect. Foot Ankle Quarterly, 18(2):49-57, 2006.
Kirby KA: "Evolution of Foot Orthoses in Sports", in Werd MB and Knight EL (eds), Athletic Footwear and Orthoses in Sports Medicine. Springer, New York, 2010.
Kirby KA: Introduction to Recent Advances in Orthotic Therapy. In Scherer PR (ed), Recent Advances in Orthotic Therapy: Improving Clinical Outcomes with a Pathology Specific Approach, Lower Extremity Review, USA, 2011.
Kevin A. Kirby, DPM, Sacramento, CA, kevinakirby@comcast.net
06/15/2013
RESPONSES / COMMENTS - (NON-CLINICAL) - PART 1
RE: Educational Commission of Foreign Medical Graduates (ECFMG) (Robert Bijak, DPM)
From: Steven J. Kaniadakis, DPM
I do not agree with the posting by Robert Bijak, DPM. Donald Trump said, 'How are we going to treat everyone in America when we don't have enough doctors now to treat every American?" As much as I regret to quote him, he drives home an interesting point. Will this mean more foreign medical graduates in America encouraged by our government? In 1978, President Carter spawned "offshore" medical schools and opening residencies to foreign grads. If podiatry thinks we do not have enough residencies now, then just wait and see how "change" in healthcare will change our profession. Think about this. Will podiatry need more American schools and residencies?
Steven J. Kaniadakis, DPM, St. Petersburg, FL stevenkdpm@yahoo.com
06/14/2013
RESPONSES / COMMENTS - (NON-CLINICAL) - PART 1
RE: A Message to the Lost 92
From: Name Withheld
I walk among you every day and I feel what you feel. I am no longer young, but a middle-aged man who graduated podiatry school 10 years ago, harvesting only an RPR year from a 3-year PSR-12 program at NYCPM back in 2004.
Back then, DPM graduates found themselves fighting over a limited number of surgical slots, with the rest (majority) of us settling for...
Editor's note: This extended-length letter can be read here.
06/07/2013
RESPONSES / COMMENTS - (NON-CLINICAL) - PART 1
RE: Compounding Pharmacies (Marc Katz, DPM)
From: Elliot Udell, DPM, Ivar E. Roth DPM, MPH
These companies should be turned into the insurance commissioners office. What a rip-off. Something is wrong here. Do any pharmacists out there have comments for us?
Ivar E. Roth DPM, MPH, Newport Beach, CA, ifabs@earthlink.net
Dr. Katz is rightfully concerned that certain compounding pharmacies have found ways to milk the healthcare system and charge close to 2K for a prescription. While this is odious, it is only the tip of the "iceberg." Many healthcare providers as well as hospitals have found "Innovative" ways of billing, which are bringing our nation's healthcare system to the brink of bankruptcy. An expose on the front page of this past Sunday's New York Times showed that some gastroenterology groups, using surgical centers they own, have billed some insurance companies up to 18 thousand dollars for a routine colonoscopy.
An expose on CNN several months ago, showed how some hospitals rack up charges, causing bills for fairly short hospital stays to be hundreds of thousands of dollars. A physician I know who was not insured, fractured his hip and received personal bills from the orthopedists and hospital for close to a quarter of a million dollars. If these near-crooked billing practices are not brought under control, it will lead to a collapse of our healthcare system, which would not make any of us happy.
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com
