The Voice of Podiatrists

Serving Over 9,000 Podiatrists Daily

January 27, 2007 #2,795 Editor-Barry Block, DPM, JD

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GA Podiatrist is Expert on Ancient Israeli Coins

Savannah's Jewish Educational Alliance will host "Coins of Ancient Israel: Hanukkah to Bar Kochba," presented by Dr. Fred Spector on Feb. 11 as part of the Collector Series.

Dr. Fred Spector

Spector is a podiatric surgeon and a collector of ancient Israeli coins. His collection includes rare Masada coins, Roman coins and coins devoted to Bar Kochba, the last prince of Israel.

Source: Hilton Head Island Packet (SC) [1/25/07]

PA Podiatrist Faces Drug Charges

Attorney General Tom Corbett today announced that agents from the Attorney General's Bureau of Narcotics Investigation have charged a Cumberland County doctor with allegedly writing prescriptions for a patient in order to obtain the drugs for his own use. Corbett identified the defendant as Dr. Mark David Reiley, 51, of New Cumberland. Reiley closed his Dauphin County practice in 2002, the attorney general said.

Reiley, who is a podiatrist, is charged with one count of practicing outside the normal course of doctor-patient relationship, which carries a maximum penalty of 15 years in prison and a $250,000 fine.

According to the criminal complaint, between May 2, 2004, and March 20, 2005, Reiley wrote at least 73 morphine prescriptions to a patient, who in return allegedly gave a significant quantity of pills back to the doctor for his personal use.

Source: The Carlisle Sentinel [1/25/07]

Obama Calls For Universal Coverage, Kucinich for Single Payer System

The momentum for major healthcare reform continued to build as Sen. Barack Obama (D-IL) called on federal lawmakers to make affordable, universal healthcare coverage a reality by 2012. Obama, who has announced his plans to pursue the Democratic nomination for president in 2008, said “by the end of the first term of the next president, we should have universal care in this country.” Speaking at the Families USA conference in Washington, Obama said parts of President Bush’s proposal to revise the tax code and redirect federal funds to states to improve access to private health insurance “are interesting,” but he said the proposal doesn’t go far enough. “We have to act bold,” Obama said.

Meanwhile, another candidate for the Democratic presidential nomination, Rep. Dennis Kucinich (D-OH), introduced legislation to create a national single-payer healthcare system and said his bill has the backing of 100 members of Congress. Under the proposal, all Americans would be eligible for a national health insurance card good for all healthcare services at any facility in the country. The system would be funded by a variety of sources, including Medicare and Medicaid funds, a modest payroll tax on employers, and additional taxes on “the richest Americans,” Kucinich said. –

Source: Matthew DoBias and Jennifer Lubell, Modern Healthcare [1/25/07]

Malaysia Women Said to Secrete Gemstones From Toes

Recent visitors to the Southeast Asian nation of Malaysia have read serious newspaper articles about miracle healers. Now, there is a woman who apparently secretes gem-stones out of her big toes. The wondrous toes of 23-year-old Siti Suhana Saadon, a rubber-tapper's daughter, have become a media sensation, drawing serious commentary from health officials and medical experts.

Welfare authorities have even offered to pay for tests to be carried out on the poor villager and her collection of clear round stones, the New Straits Times said on Thursday. "I would like to see her. Her condition is very unusual," the mainstream daily quoted a senior academic as saying.

Source: Mark Bendeich, Reuters via Richard Rettig, DPM [1/25/07]

Query: Running Shoe for Size 12-1/2 AAA

I have a patient who is a female runner who has a shoe size of 12-1/2 AAA. Would you believe that she has difficulty finding running shoes that fit well? Because of this, she has foot pain when running. Does anyone have any suggestions regarding a running shoe that might fit this lady?

Doug Milch, DPM, Ashville, NC

Query: Comparing EMR’s

Is there a compiled list of EMR's comparing their respective pros, cons, and price? Or is there a published list or recommondation of top EMR's for podiatry?

John Sharp, DPM, Lone Tree, CO

Editor’s comment: Here are some sites you might find useful:
http://www.healthtechnologyreview.com/
http://www.emr-electronicmedicalrecords.com/price_comparisons.asp

Query: CPT 17110 for 2007

I just treated 3 warts, do I bill CPT 17110 (destruction of benign lesions, any method) 3 units, or just 1 unit.

Ilene Terrell, DPM, Fredericksburg, VA

Response: The 2007 code descriptor for CPT 17110 states, "1-14 lesions," not "per lesion." Therefore, you would bill this procedure ONCE for treating up to 14 lesions. Whether you destroy 1, 7, or 14 lesions, you would only bill a single CPT 17110.

If you destroy 15, 18, 25, or 1000 benign lesions (warts), you would only bill a single CPT 17111 (CPT 17110 no longer applies when CPT 17111 takes over).

Tony Poggio, DPM, Alameda, CA

Codingline subscription information can be found at
http://www.codingline.com/subscribe.htm

RE: Kick Boxing Injury (Chuck Ross, DPM)
From: Ira Weiner, DPM, Cosimo A. Ricciardi, DPM

I have had a significant amount of experience with boxers as well as kick boxers and mixed martial artists, both in treating them as patients as well as working with them in the rings as a second.

The problem that you will have with orthotics is the rules with regards to the athletic commissions. No objects particularly an orthotic can be used as this could present an unfair advantage in kickboxing and Mixed martial arts. This does not hold true in conventional boxing. Be advised that each state is somewhat different with regards to their rules, but taping with a small pad should be allowed before a fight so long as the taping is applied under the direct supervision of the commissioners prior to the fight. I have taped ankles and feet of fighters before a fight under supervision here in Nevada with no problems.

Also, any injectables prior to a fight would be not allowed as well including any form of steroid or local anesthetic. The rules are pretty specific with regards to this.

Ira Weiner, DPM, Las Vegas, NV, vegasfootdoc2005@yahoo.com

Dr. Ross describes a common finding in the martial arts, mixed martial arts, kickboxing, etc. as far as shoe gear goes, there have been great strides over the past 2 years. Adidas (recommended) makes the best and most supportive shoe. You can direct your patient to a martial arts supply site http://www.awma.com has a good supply for both training and competition. As for orthoses, I would presume that your patient cross trains with running as well. I have found that a 1/8 inch polypropylene with a runners fore foot wedge and accommodation from the 3rd to 4th met head may help in both activities.

Cosimo A. Ricciardi, DPM, Ft Walton Beach, FL, basewedge@yahoo.com

RE: Cryotherapy S/P Hammertoe Surgery (Allen Jacobs, DPM)
From: Multiple Respondents

I recently reviewed medical records at the request of the machine manufacturer, regarding a lawsuit pertaining to a cryotherapy (ice water) unit. The patient was a healthy female who had been instructed to use the machine 24/7, both from the treating podiatrist and the nursing staff at the hospital. She subsequently sustained gangrene secondary to frostbite from extended usage. The machine did not have an auto-off, and ran basically 24/7.

My philosophy is that while these are high-tech gadgets, a simple ice pack applied 30 minutes four times daily does just as much good, w/o the liabilities; however if you would like for your patient to use it, specifically limit the amount of time that the unit is utilized (and make sure you document that conversation well).

Robert A. Boudreau, DPM, Tyler, TX, RBFTDOC@aol.com

While there is no applicable standard of care that would allow the use of a cryotherapy unit for continuous overnight use, the use of the cryotherapy system is designed to only be used for 20-30 minutes every two hours for post-operative edema control.

Disregarding the fact that this patient is diabetic, smoker and hypertensive, the non-specific ABI elevation would still have warranted a more thorough vascular workup with PPG and toe-brachial/toe-pressure indicies to determine this patient's ability to withstand surgery, and more importantly, post-operative healing. The additional history of African-American and 59 years of age even more so presume that a more thorough vascular evaluation is warranted.

Elevation of the extremity with the therapy system for 3-4 days post-operatively is certainly appropriate. Eight days post-operative seems excessive, even for a bunionectomy and hammertoe.

Eric J. Lullove, DPM, Boca Raton, FL, ericsops@yahoo.com

Considering the patient's medical history of diabetes, tobacco use, hypertension, hypercholesterolemia and a slightly increased ABI ( which may represent calcified blood vessels), I'm not sure it would be prudent to perform digital surgery on this patient, let alone use cryotherapy on this patient post-operatively.

Additionally, with the limited information available such as whether or not the patient has palpable pulses or the results of the vascular studies other than the ABI's, and other factors such as the patient's glucose control, compliance, neurological status, etc., it is difficult to make an accurate assessment of the entire scenario.

But, given the information available, I would say it's safe to say that the use of the cryo unit would NOT be prudent, especially having the patient sleeping with the unit. The possible compromised circulation and the use of continued cryotherapy could ultimately be a recipe for disaster.

David S. Wander, DPM, Philadelphia, PA, padpm@comcast.net

Cryotherapy might be dangerous since patient is a smoker -- smoking has been shown to significantly diminish peripheral perfusion, as well as, diminishing healing. A dyslipidemia could also contribute to peripheral vascular disease. Patient is a diabetic -- how many years?, is there a diabetic neuropathy. Elevated ABI is generally unreliable especially in the presence of potential Monkenbergs calcific sclerosis and PVR wave forms are important to evaluate, as well as, toe vascular evaluation.

Allowing patient to utilize cryotherapy units overnight especially in the presence of neuropathy, in my opinion, is dangerous.

Simon Young, NY, NY, simonyoung@juno.com

Unsupervised use of a cryotherapy unit in a diabetic with elevated A.B.I.'s (indicative of vascular calcifications which make them not compressible) and who has other risk factors for perferal arterial disease (smoker, hypertensive, elevated cholesterol) would be risky and potentially foolish. There is no mention of the presence or absence of neuropathy or retinopathy, so the patient potentially could have inadequate arterial inflow, loss of protective sensation and poor vision.

Ira Deming, DPM, Bethesda, MD, IMDDPM@aol.com

I feel it is too risky. From what Dr. Jacobs has described, I would not use it and I certainly not allow her to sleep with it. You have to ask yourself, "is this treatment necessary?" and "is there a potential downside in using this treatment on this patient?" Again, it’s not worth the risk.

Neil A Burrell, DPM, nburrell@gt.rr.com

RE: Hereditary Neuropathy With Liability To Pressure Palsies
(Bryan C. Markinson, DPM)
From: Peter J Bregman, DPM

I would say why delay in referring to someone who can perform the decompression? Even if the neuropathy is present if there is still a compression then it needs to be decompressed. This is the same scenario in diabetics as well. We treat the compression, not the diabetes. You do not want any more axons dying while the person spends weeks or months with neurologist.

Peter J Bregman, DPM, foot.guru@verizon.net

PRACTICE FOR SALE -NORTHERN CALIFORNIA

Great opportunity to own a well-established turn-key podiatry practice located in modern medical office building in East Bay; Electronic billing, good payor base, no HMO contracts; biomechanics, general podiatry with great potential for surgery. Please send CV and letter of interest to: norcalpod@hotmail.com

PEDALIGN SCANNER, COMPUTER, MONITOR, AND KIOSK FOR SALE

Considerable savings on 1 year old system. Lease may be assumed. Contact Jeffrie Leibovitz, D.P.M. Office 317-545-0505 ftbenpod@sbcgloabal.net

ASSOCIATE POSITION--PHOENIX SUBURB

Attractive opportunity for enthusiastic, proficient, and personable associate. Well-established modern practice with multiple newer spacious offices, technology and equipment. Solid referral base, close to hospitals, knowledgeable certified staff. 22% MCR. Practice and surgical center partnership potential opportunity. Prefer 24-36+ PSR. Send CV: AZpodassociate@aol.com

ASSOCIATE POSITION -WASHINGTON - SEATTLE AREA

Two-location practice looking for long-term commitment leading to partnership. Medicare certified surgicenter each location. Must be highly motivated, ethical & have good patient skills. Competitive salary & benefits package available. Excellent opportunity for the right candidate. Send CV to fax 425-775-9078, e-mail to nwfootandankle@yahoo.com or call 425-775-1505.

POSITION AVAILABLE - SOUTHEAST TENNESSEE/ NORTH GEORGIA

Immediate position available or will wait for the right individual. Unique practice opportunity in growing multi-physician/multi-office practice. Well established/cutting edge within the medical community. Close proximity to hospitals as well as opportunity to become involved with a free standing podiatric surgical center. Must be BQ/BC. Minimum PSR/24. Competitive salary, bonus structure and benefits. E-mail CV to afcjen@hotmail.com

ASSOCIATE POSITION - CENTRAL CALIFORNIA

Central California multi-location practice looking for PSR-36 associate leading to partnership. PSR-36 trained podiatrist with great opportunity for reconstructive surgical practice. Practice has Medicare-approved surgery center. Must have excellent interpersonal skills. Excellent salary and incentive. Respond to: westsidefoot@yahoo.com

ASSOCIATE POSITION – MISSISSIPPI

Well established, busy, 3-doctor practice seeks PSR 12 or 24 trained podiatrist for associate position to fill vacancy of retiring member. East central location is a great area to raise a family and is a prime location for accessibility to several major cities. Competitive salary, benefits, and incentives. Partnership possible in 2 years to right individual. June - July start date. Applicant must be ethical, personable, and motivated. Please E-mail CV and letter of intent to shanegan@bellsouth.net

ASSOCIATE WANTED FOR SOUTH MIAMI AREA

Large group, busy, multi-office, partner potential. Motivated applicants only. Mail resumes and letters of intent to 999 N. Krome Avenue, Homestead , FL 33030. July start time OK, sooner preferable. E-mail lianadpm2@aol.com

ASSOCIATE WANTED - NORTH CAROLINA, CHARLOTTE AREA

Incredible opportunity to join a busy, well-established group practice. Looking for a self-motivated, hard-working individual seeking to become a partner. Hospital and surgery center privileges. Salary plus percentage, 401k and real estate opportunities. Send CV to universityoffice@ bellsouth.net

EXCELLENT ASSOCIATE OPPORTUNITY – SOUTHERN CALIFORNIA

Established 25 year well-rounded biomechanical and surgical practice seeking energetic, enthusiastic, personable and proficiently-trained PSR-24 or PSR-36 foot and ankle surgeon for associate with ultimate partnership opportunity in LA area. Excellent position for an individual interested in all aspects of podiatric medicine with emphasis on reconstructive foot and ankle surgery. Only 8% Medicare with No HMO. Email CV to dr4feet@sbcglobal.net

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