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January 28, 2008 #3,151 Editor-Barry Block, DPM, JD

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FL Podiatrist Uses Cryosurgery to Treat Chronic Foot Pain

For those with chronic foot and/or heel pain, Dr. Brent Rubin has a suggestion: Give it the deep freeze. Rubin, a podiatrist, isn't advocating that pain sufferers immerse their feet in a bucket of ice cubes. Rather, it's cryosurgery - an ancient concept that uses super-cold temperatures to treat inflamed or diseased tissue.

Dr. Brent Rubin

"It literally freezes the nerve," Rubin said of the procedure, which he has performed on about 150 patients. "It doesn't kill it permanently. The nerve will regenerate anywhere from six months to a year later." And, it usually heals itself in the process, thereby eliminating the source of the pain, he said. The procedure is minimally invasive and can be performed in a doctor's office in less than 30 minutes.

It's also virtually painless, with the only pain usually coming from the initial injection of local anesthesia, Rubin said. The procedure usually costs around $500 and is covered by Medicare and most insurance plans, Rubin said. Potential side-effects are rare and usually mild, and can include infection of the incision site; bruising and swelling; fluid buildup and the formation of scar tissue, he said.

Source: Duane Marsteller, Bradenton Herald [1/26/08]

Santi Named NYCPM Alumnus of the Month

Lawrence Santi, DPM, a 1979 graduate, has been named the Alumnus of the month by the The New York College of Podiatric Medicine (NYCPM). Dr. Santi’s list of Accomplishments includes: residency director and Chairman of Wound Care at the New York Community Hospital in Brooklyn, and Conference Director of the New York Clinical Conference.

Dr. Lawrence Santi

Dr. Santi is former president of the New York State Podiatric Medical Association (NYSPMA) and presently serves on the APMA Coding Committee and has served as an NYSPMA delegate to the APMA House of delegates for many years.

Source: Kelly Powers, Student Alumni Report [January 2008]

NYSPMA Clinical Conference “Brings Down The House”

It was standing room only at this weekend’s New York State Podiatric Medical Association’s (NYSPMA) Clinical Conference, aptly named “Bringing Down the House.” Both the lecture halls and exhibit halls (with a record 280 exhibitors) were packed. On Friday, one attendee jokingly commented, “now I know what it feels like to be in Times Square on New Year’s Eve.”

(From L-R) NYSPMA President Dr. Robert Rampino, NYSPMA Executive Director Len Thaler, and APMA PAC Chairman Dr. Thomas Godfryd

The celebration continued into Saturday night with two simultaneous gala events. At the leadership dinner, APMA PAC Chairman Thomas Godfryd, DPM announced that NYSPMSA led the nation in contributions. Dennis Trenner, DPM of Oroville, CA was picked as the APMA PAC raffle winner of a free trip to APMA’s Scientific Meeting in Hawaii this Summer. In another venue, conference attendees partied at the Golden Ticket event which featured music, food, dancers, and celebrity impersonators, as well as a raffle for valuable prizes.

Dr. David Gutierrez

The only bittersweet moment at the Conference was the posthumous recognition of Dr. David Gutierrez, who was awarded the Excellence in Service award. An active member of the NYSPMA and a beloved member of its Bronx division, Dr. Gutierrez passed away at the age of 48 last fall. The award for Special Achievement went to Susan Wilk, Executive Director of the Diabetes Resource Coalition of Long Island in recognition of the outstanding programs her organization has developed about foot health for people with diabetes and the importance of podiatric intervention and care.

RE: Hypoallergenic Nail Polish/Remover (Larry Dorman, DPM)
From: Adam Cirlincione, DPM

Most commonly a dermatitis or true allergy to nail polish is a result of the formaldehyde within the polish. Perhaps Dr. Dorman's patient can be tested for this. The majority of polish on the market contains formaldehyde. (and some other ingredients that have received bad press- like DBP and toluene). Try a polish without the formaldehyde (Dr.s REMEDY - created by podiatrists www.remedynails.com). There is a push by the safecosmetics.org to remove some of the typical ingredients found in most nail polish because there is question regarding their safety.

Adam Cirlincione DPM, AdWill Labs, pittpod@aol.com

RE: 20% Sclerosing Alcohol injections for Neuromas (Dan Methuselah, DPM)
From: Jeffrey Kass, DPM

I'd like to chime in on the alcohol injection discussion with 2 points. 1) I agree with the previous comments on if prior injections failed, as well as a surgery, make sure you are looking at a neuroma. I recall a lecture given by Dr. Dellon where some mistaken neuroma pain is actually tarsal tunnel syndrome.

2) I had one of my residents at a hospital I'm on staff pull all the articles we could find on alcohol injections for review. Dr. Dockery advocates giving the injections proximal to the neuroma, Studies by radiologists technique varied, they under ultrasound will inject the neuroma. The needle is inserted into the neuroma tissue and then delivered. I believe they were using higher dosages but were getting it right into the nerve tissue as opposed to injecting a region. This difference in technique I find of particular interest.I am not stating one is better than the other nor do I believe any comparison study exists.

I have had success using Dr. Dockery's described method. One advantage of the "direct neuroma injection" is the fact the neuroma is visualized and measured in size and a noticeable difference in size was seem. In the particular case that started this discussion I am not sure how this would be done. if the neuroma was excised I would think while the pain would be there the neuroma would not. During the surgery was the stump tucked into muscle belly? This is another point Dr. Dellon stresses when doing neuroma surgery and possible reasons for its failure.

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

RE: When an Unhappy Post-op Patient Appears in Your Office (Peter Bregman, DPM)
From: David Secord, DPM, Kathleen Toepp Neuhoff, DPM

I’ve dealt with this on 3 or 4 occasions I can remember and have learned that there is always 3 sides to every story: the surgeon’s side, the patient’s side and the truth lying somewhere in-between. Knowing this and the fact that some of my surgical results are in other offices with similar fabrications being related, I attempt to make an attempt to assure the patient, contact the original surgeon and explain the situation and get the patient back to the first doctor for follow-up. If the patient is adamant that the first surgeon is not going to be involved in further care, I’ll attempt to salvage the situation as best I can without indictment of anyone. In one of the 3 or 4 occasions I’ve dealt with this situation, a return to the operating room was needed. Although the patient was happy with my results, she threatened to sue to the other guy and when I refused to become involved, there was some anger expressed at first. The patient remained in my care and had several relatives and friends come to me as well. No one was sued and the everyone was generally happy.

Just knowing that there MUST be someone from my hands in someone else's office with a similar complaint has tenored my response, especially if it looks like a disaster. I don't see it as refusing to accuse another doctor and 'covering up', just trying to act as a peace maker and hope that the same courtesy is shown to me when the time comes.

David Secord, DPM, Corpus Christi, TX, David5603@pol.net

This scenario happens in my office from time to time. I ALWAYS advise the patient that I will be calling their surgeon. If possible, I make the call while the patient is in my office. If the patient declines to allow me to contact their surgeon, I decline to render any kind of an opinion or provide any care. Most of the time, there is a significant difference between the story told by the patient and that told by the physician. Sometimes, the patient is attempting to obtain a derogatory report as a preface to a malpractice suit, but usually the problem is that the patient is worried and the physician has not communicated well with the patient.

Usually, after consulting with the physician, I am able to reassure the patient and return the patient to their surgeon. If the patient does not want to return and the patient seems sincere, I provide care, but am always careful to avoid any negative comments. If the patient appears to be looking towards a malpractice claim, or it is clear from the discussion with the surgeon that the patient is non-adherent or problematical, I advise them that I am not willing to provide any care for them.

Of course, I follow the same protocol if the surgeon is a DPM or MD/DO.

Kathleen Toepp Neuhoff, DPM, South Bend, IN, VETPOD@aol.com

RE: Reimbursement for Topaz Procedure (Ira Weiner, DPM)
From: Allen Mark Jacobs, DPM

Dr. Weiner states that Topaz has been used in "over 45,000 " cases with effectiveness. Where is the data? Many of us are frankly tired of these unsupported claims.

Far too many lectures at far too many CME meetings are industry-supported commercials which dominate the "academic" content of these meetings.

It is about time that “UNRESTRICTED MEDICAL GRANT” means unrestricted.

Allen Mark Jacobs, DPM, St. Louis, MO, allenthepod@sbcglobal.net

EXCELLENT OPPORTUNITY IN SOUTHERN CALIFORNIA

Established 25 year well-rounded biomechanical and surgical practice seeking energetic, enthusiastic, personable and proficiently trained foot and ankle surgeon poised to take practice to the next level. Associate position with ultimate partnership. Excellent position for an individual interested in all aspects of podiatric medicine with emphasis on reconstructive foot and ankle surgery. No HMO patients. Email CV to dr4feet@sbcglobal.net

SEEKING ASSOCIATE WITH POTENTIAL TO FULL PARTNER

Busy multi-physician podiatric group with 2 locations seeking BQ/BC surgically trained doctor. Applicant should be well-trained in all aspects of surgical and conservative care. Seeking ethical, hard working and outgoing physician to join our 4-physician group. Excellent quality of life in suburban Houston, near NASA and the Gulf of Mexico. Email CV and cover letter to Dr. M. Rockett at Mrockettman@comcast.net.

Busy multi-dimensional practice; 70 miles north of New York City . Currently five (5)-doctor practice. looking to expand – all phases of podiatric medicine. contact: (845) 454-8308 EXT: 106

ASSOCIATE POSITION- CONNECTICUT

Established Practice looking for PSR 24/36 trained surgeon. Must have experience and be responsible for all surgical cases for the practice. EMR and digital x-ray in new 6-treatment room office. Hospital privileges available. Connecticut has a new ankle law for the Properly-trained DPM. Competitive salary, benefits, and bonus. Great area to raise a family. Fax resume to 860 243-5790

ASSOCIATE POSITION - VIRGINIA (SOUTHERN)

Immediate full-time and part-time associate position available. Unlimited income potential. Busy, diverse, 40+ yr Hampton Roads practice. Must be compassionate; energetic; and motivated; PSR24/36. Looking for long-term arrangement. Please send letter and CV to dcarrone@cox.net fax to 757-397-5889

Excellent opportunity for ethical & personable hard-working individuals to join a busy multi-office two physician practice. Looking for one podiatrist with interest in conservative care, including sports medicine and one podiatrist trained in rearfoot surgery. Rearfoot surgeon must be board eligible and working toward board certification. Competitive salaries, 401-K, health insurance, paid vacation and more. Please forward CV with references to nrussell@neondsl.com

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