The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

January 12, 2010 #3,751 Publisher-Barry Block, DPM, JD

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NH Podiatrist Discusses Onychomycosis

Do you suffer from painful, thickened, discolored and often hard-to-cut toe nails? If so, you are not alone. "Contrary to what many individuals believe, onychomycosis is not caused by a lack of cleanliness or easily transmitted from one person to another. The fungus that causes the nail changes of onychomycosis is all around us. We are exposed to it every day and everywhere we go, not just at the gym or in the shower," says podiatrist James Dolan.

Dr. James Dolan

"I believe the most common cause of a fungal infection is an injury to the nail. This could be anything from stubbing your toe to dropping a heavy object on the toe, to wearing shoes that are too tight. Runners are susceptible to this problem because of repetitive trauma to the toenails. Fungus is on our skin all the time and an injury that loosens the nail allows the organism to get under the nail and then grow. Another less common cause of onychomycosis is leaving toenail polish on for too long. The fungus gets trapped between the nail and the polish. I have seen individuals notice changes in their toenails after removing polish that has been on for many weeks," says Dolan.

Source: Seacoast Online [1/10/10]

New Buildings Open at WesternU

A tangible sense of excitement filled the new Health Education Center (HEC) as students returned from winter break to begin classes this week. The 180,000-square-foot center, part of WesternU’s $100 million campus expansion project, features two 356-seat lecture halls, small group learning rooms for the Interprofessional Education curriculum, teaching laboratories in dental medicine and optometry, research laboratories, commons areas, conference rooms, and faculty offices.

Dr. Lawrence Harkless

HEC houses the College of Osteopathic Medicine of the Pacific, the College of Dental Medicine, the College of Optometry and the College of Podiatric Medicine.  The new buildings place WesternU on the cutting edge of academia, said College of Podiatric Medicine Founding Dean Lawrence Harkless, DPM. “The fact that students are able to be instructed and to participate in this environment speaks volumes,” he said. “This will create a culture of interprofessional education.”

UK Podiatrist Performs Implant Surgery for Flatfeet

A UK-based podiatrist has trained to perform a surgical procedure designed to correct the problem of flat feet. Referred to as hyperpronation, this is a condition which means that sufferers have a low arch in the soles of their feet or none at all. While some patients never experience any pain or trouble, others can find that it places a strain on the connecting ligaments and muscles.

Emma Supple, UK Podiatrist

Emma Supple wrote in the Daily Mail that after hearing about a new technique being used by an American surgeon, Dr. Mike Graham, which involves the insertion of a titanium stent into the foot to hold the bones in the correct position - she travelled to the U.S. to learn how to do the operation herself. "I'm now performing the surgery on patients, as are other surgeons in the UK, and we're working to have stent surgery introduced into the NHS," said Supple.

Source: James Puckle, Mediplacements.com [1/6/10]

NY Podiatrist  Chairs Local Merchants' Association

Dr. Vincent Evangelista has been Chairperson for the 101st Avenue Merchants’ Association since it was reorganized. Having had a podiatry practice in Queens since 1990, he realized the need for greater communication between the businesses in the area. That’s when he, as well as his neighboring business owners, decided to revive an old idea. “We got together and discussed that we’d like to improve the viability of our businesses as well as the overall community, and that the best way to do this was to form an association,” said Evangelista.

Dr. Vincent Evangelista

Although the Association had existed many years before, Evangelista says that it fell apart because no one kept up with it. Its goal is to create an environment in which business owners will cooperate with each other based on mutual respect and the embracing of community pride. “We’re going to be bigger than the Beatles!” he joked. He also lends his voice to Community Board 9, and sponsors a team in the Ozone-Howard Little League.

Source: Michael Fiacco, Queens Courier [1/6/10]

Query: DEXA Scans

Does anyone have any experience with DEXA bone density scans in-office for the calcaneus? Any recommendations on machines would be appreciated. 

David Ellenbogen, DPM, NY, NY

Query: Laser Repair

I have a Hi-Tech C02 laser that needs service. The laser was purchased in 1988 from Gyne-Tech Instrument Corp. Burbank CA. They are no longer in business and have no forwarding number/address. Does anyone have recommendations on who can service this laser?

Douglas Robinson, DPM, Campbell, CA

RE: Restless Leg Syndrome (Thomas Tran, DPM)
From: Multiple Respondents

I have had success with Qualaquin 324 mg tablet about one hour before bedtime. It is not cheap, but seems to help my patients.
 
Rich Hofacker, DPM, Akron, OH, Cavsdoc26@att.net

Requip is a medication out there to treat restless leg syndrome. I don't prescribe it myself, but may make a recommendation to the internist or patient. I have recently heard at a lecture that patients were using Metanx, which I would have no hesitation to prescribe.

Jeffrey Kass, DPM Forest Hills, NY, jeffckass@aol.com

"Shaky feet" is usually NOT an intrinsic foot problem, but more likely a systemic problem such as Parkinson's, RLS, iron deficiency, a drug side-effect, magnesium or folate deficiency, peripheral neuropathy, or multiple other conditions. Older patients are often victims of poly-pharmacy and have been prescribed multiple drugs by multiple providers.

In an 80 year old, one would need to take a thorough history to determine the cause of the shaking. A thorough look at the medication history is warranted as well. A neurology consult or internal medicine consult is recommended. 

There are several drugs on the market, including Requip, dopamaine agonist, iron supplements, gabapentin, and opiods which can be used to treat "restless leg syndrome." The problem is that most have major side-effects so I would be reluctant to use them in an 80 year old. Simple blood tests, including ferritin, serum iron, magnesium, B-12, and thyroid profile are helpful, but while waiting for your consult, put the patient on Centrum Silver multivitamin, which could help with underlying deficiency, and is relatively benign.

Chris Browning, DPM, RN, Nederland, TX, chrisbrowning@att.net

RE: AAPS (Stanton C. Southward, DPM)
From: Ed Davis, DPM

I have been a member of the AAPS for over 15 years. The AAPS was formed to represent physicians in private practice and promote private practice. The AMA represents physicians employed in a variety of venues, from group model HMOs, insurance companies, government, etc. AAPS was notable for filing suit back in the early 1990's to open up the "back room" negotiations of those formulating the Clinton health care reform plan to the public.
 
Most podiatrists are in private practice so I believe that an ad hoc organization formed for the promotion of private practice in healthcare is a good place to be. AAPS was open to podiatrists since its inception, unlike the AMA. I maintain membership in the APMA and ACFAS and believe that belonging to the AAPS in no manner conflicts with support of our own organizations. Please read the information on this link to see if AAPS sounds appealing: aapsonline.org/
 
Ed Davis, DPM, San Antonio, TX, ed@sanantoniodoc.net

RE: My New Career as an Orthotist (Paul Bishop, DPM)
From:  Paul Kruper, DPM, Daniel Chaskin DPM

We will never be in line with medical doctors as long as we have a limited practice license. The limit license implies limited knowledge, limited training. All the certifying boards and residencies in the world will not change that perception. I work in a primary care clinic with MDs, DOs, PAs, FNPs; and they all are perceived to have more general medical education than me. It doesn't matter that it is not true. The perception remains, which is why podiatrists have limited job opportunities, limited hospital privileges, etc.

We will never move out of the limited box we are perceived to be in until we get a full scope license. We need to move in the same education direction as was done by the DOs. Until then we will have more pods becoming orthotists to be able to get a job and put food on the table. The tragedy is not that he became an orthotist. He is doing fine. The tragedy is that the ranks of podiatry have been weakened by the loss of a good practitioner.

Paul Kruper, DPM, Kingsburg, CA, prkruper@yahoo.com

“NO ONE but podiatrists have the knowledge and training to deal with the unique problems of the diabetic foot.” – Larry Cohen, DPM

I disagree with the above. I feel that podiatry residency training if performed more than 10 years ago is probably outdated and does not at all deal with a podiatrist's current competence in dealing with the diabetic foot. The only informal education that may possibly contribute to a podiatrist's current knowledge of the diabetic foot is the continuing education courses taken by podiatrists.

The question I wish to pass onto readers is: are the continuing education courses given by our podiatry colleges and organizations more comprehensive than those given by speakers who are  medical doctors? Also, are podiatric journals that far superior to medical journals published by medical doctors regarding diabetic foot care?  As far as I see it, the one difference is a legal difference whereby a podiatrist may have a limited scope of practice. I feel it is not the degree that is important, but instead the current competence that a practitioner has regarding the care of the diabetic foot.

Daniel Chaskin, DPM, Ridgewood, NY, podiatrist1@optonline.net

RE: NJPMS Sues Insurer to Block New X-Ray Policy
From: Mark E Weaver, DPM, George F. Jacobson, DPM

We all know the real motivation behind NJ Blue Shield's new policy to force podiatrists to outsource x-rays. What about other specialties who x-ray, e.g., dentists, PCPs, orthos, etc.? A $50 office visit to refer a patient out is more expensive than a $30 x-ray, and they will still have to pay for the x-ray. And a good percentage of the time, the radiologist recommends an additional radio-graphic test to CYA (cover theirs). Now, I'm obligated to consider that test to CMA (cover mine)!
 
What about needle placement and lesion markers? Weight-bearing x-rays are a killer at some radiologists' locations. What if you feel you need another radiographic angle to view?  If you truly do need another angle, oops there goes another office visit.
 
I think Blue Shield needs a little education. Then, the insurance commission needs some education that this is just a ploy to make it so difficult for patients that they do not seek help. It is certainly not in anybody's best interest to do this!
 
Mark E Weaver, DPM, Ft. Myers, FL, tcopn@att.net

New Jersey's policy change will cause a delay in diagnosis and treatment of fractures and multiple other conditions treated in our offices. Our immediate diagnosis and treatment, not only provides the best immediate complete care, but is also the most cost-effective. 

My x-ray machine is licensed and inspected by the State of Florida. My tech is also licensed by the State and has to complete CE to renew her license every two years. No one else looks solely at foot films as we do. When the healthcare plans get their first lawsuit for delay of medical care, they may be sorry they opened up this can of worms.
 
George F. Jacobson, DPM, Hollywood, FL, FL1SUN@MSN.COM

RE: Covered, Then Non-Covered Orthotics (Jeffrey Kass, DPM)
From:  Richard A. Simmons, DPM

Let me offer some clarification. I assume that everyone who bills L3000 or L3030 bills them as individual units, which would mean that a pair would be billed as L3000-RT and L3000-LT. That said, the purpose for recommending a healthcare attorney is for him or her to read the carrier's specific language that defines L3000 and L3030. The CPT description for these is very simple and neither has terminology about forefoot or rearfoot posting. 

After consulting with your healthcare attorney, it may be agreed that the carrier covers L3000/L3030, but that the forefoot and rearfoot posts are non-covered items, and therefore the financial responsibility of the patient. Show the patient what L3000/3030 looks like and then show a device that attempts to hold the subtalar joint in a neutral position during the stance phase of gait. At this point in the discussion with the patient, salesmanship comes into play. Other examples of this: some insurance companies offer coverage for bi-focal glasses, but not Varilux(R) lenses; some insurance companies offer coverage for up to 4-channel hearing aids, but the 6, 8 and 16 channel devices will cost extra. The insurance company is not interested in your patient becoming a world-class athlete, but your patient may wish to pay extra to improve his or her athletic abilities.

Individual podiatrists deal one-on-one with the insurance carrier when a contract is signed. This explains why it is important to have the contracts reviewed by a healthcare attorney.

Richard A. Simmons, DPM, Rockledge, FL, RASDPM32822@aol.com

ASSOCIATE POSITION - BROOKLYN, NY 
 
Full or part-time position available for a busy well-established podiatry practice in downtown Brooklyn. All phase of podiatry. Modern office with EMR, Ultrasound, digital x-rays with a great support staff. Must be highly motivated, ethical, with good communication and clinical skills. please email resume to tkd@gishpuppy.com

ASSOCIATE POSITION – ILLINOIS

Quality Podiatry Group provides quality services to residents at long term care facilities. We are currently offering full-time or part-time positions for motivated ethical podiatrists. Immediate openings are available. If interested, fax curriculum vitae to 847-674-2113 or e-mail to feetwork@aol.com

ASSOCIATE POSITION - MASSACHUSETTS

PSR-24 trained podiatrist for busy multi location practice, high volume and high-tech. Seeking energetic individual for high volume of patients with multiple needs. Orthopedic, sports medicine, wound care, pediatric orthopedics and surgery skills required. Looking for immediate hire for the right candidate with possibilities for partnership. Contact Debbie Roberts debbierobertsm4@hotmail.com

ASSOCIATE POSITION – NORTH AND CENTRAL FLORIDA

Quality Podiatry Group of Florida provides quality services to residents at long term care facilities. We are currently offering full-time or part-time positions for motivated ethical podiatrists. Immediate openings are available. If interested, fax curriculum vitae to 847-674-2113 or e-mail to feetwork@aol.com

ASSOCIATE POSITION – TEXAS

Dynamic, growing practice in Dallas/Fort Worth area, seeking surgically trained, Board Certified/Board Qualified Podiatrist. Excellent salary and benefits compensation package, for the right candidate, with partnership/buyout opportunity. Contact/Send resume to: jmh6122@yahoo.com

ASSOCIATE POSITION IN WESTERN NORTH CAROLINA 
 
Well diversified growing podiatry practice with good mix of office, surgery center and hospital procedures seeking a full-time associate.  Must have NC license or taking state exam this year. Candidates should have excellent bedside manner equal to their medical skills. E-mail a cover letter and CV to DPMCAREER@AOL.COM

PRACTICE FOR SALE - ALABAMA, GULF COAST

Established 26 year old practice for sale. Owner desires to sell and relocate. Practice operated 25 hours per week. Mixture of surgery and general podiatry. MD referrals. Surgery center and hospitals in close proximity. Highly profitable. Priced to sell. Seller will lease office to buyer. Call Mike Crosby at 1-888-776-2430 or email at mcrosby@providerresources.com

ASSOCIATE POSITION – CINCINNATI, OHIO

This is your once in a lifetime opportunity to join one of the most successful practices in the United States. We do not have a seniority system. If you are motivated and have completed a PSR 24-36 residency, your income is limited only by your enthusiasm and desire to achieve. Email resume to khart@cincinnatifootcare.com

PRACTICE FOR SALE - TENNESSEE

Well established practice for sale. Full scope medical and surgical practice including DME. Exceptional practice with a high volume of new patients. Excellent hospital and surgical center privileges with investment opportunity. Great area for a family and the outdoorsman. 731-446-7285/E-mail nraines@charter.net

ASSOCIATE POSITION - MINEOLA, NEW YORK

Full-time associate position with future partnership potential available with busy multi-office practices on Long Island. Must be proficient in all phases of podiatry with emphasis on surgery, biomechanics and RFC. Minimum standards include either a three-year PSR, or board qualified/certified status with ABPS. Existing hospital privileges with a NY based facility helpful. Interested doctors are encouraged to e-mail their CV to mets724@gmail.com

PRACTICE FOR SALE - FLORIDA—CENTRAL/SOUTH

Turn-key operation grossing $570,000 annually based on one full-time doctor. Great opportunity for growing the top-line. Surgery is only 14% of the professional man-hours; it can significantly increase income. Medicare makes up 64% of revenues. Seller will assist with transition. Call 863-688-1725, ask for Chas.

PRACTICE FOR SALE - CENTRAL FL

Practice and medical building for sale, in beautiful, high quality of life, growing area, Central Fl.; 2000 sf bldg. fully equipped/ designed for podiatry; excellent location, features & exposure; near hospital, wound and HBO center. Great opportunity for expansion & investment; good insurance climate. 352-223-2713 / E-mail: windnwave@earthlink.net

ASSOCIATE POSITION FULL-TIME - SUBURBS OF CHICAGO

PSR 36 - month-trained podiatrist needed for busy suburban Chicago practice. Full benefit package included. If interested, please email your curriculum vitae to foot1st@yahoo.com

ASSOCIATE POSITION - CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for a full-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to f-massuda@footexperts.com

PRACTICE FOR SALE - MAINE

20+ year, full scope, turn-key practice. Retiring seller will assist in transition. Excellent expansion potential, superb place to raise a family. mainefootdoc@yahoo.com

DREAM PRACTICE OPPORTUNITY - OKLAHOMA

Use forefoot, rearfoot, wound skills in ideal small city with nearby lake. No buy-in costs. No limit on income. EMR. Act fast. OK State License deadline is 1-30-10 and test is comprehensive. Personality preferred over ego. Email julietburk@gmail.com or call 918-931-1425 for details.

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