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February 04, 2008 #3,158 Editor-Barry Block, DPM, JD

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Marigold Therapy Show Promise For Warts: TUSPM Podiatrist

A common flower that helps wipe out garden insects has also shown promise in eradicating stubborn warts, according to preliminary research presented by podiatrist Tracey Vlahovic at the American Academy of Dermatology’s Annual Meeting on Feb. 1. Vlahovic is assistant professor at Temple University School of Podiatric Medicine.

Dr. Tracey Vlahovic

Marigold Therapy, a line of creams, ointments, tinctures and oils developed and patented by chiropodist M. Taufiq Khan, contain extracts of several types of the marigold plant. Marigold has been used for nearly 30 years in the United Kingdom to treat a variety of foot issues, including bunions, tendonitis, plantar faciitis, fungal infections and verrucae, commonly known as plantar warts.

Vlahovic, who has a professional interest in phytotherapy — the use of plants for medicinal purposes — offers Marigold Therapy to her patients, and specifically investigated its use in three of her patients who had HIV as an alternative treatment for the small skin lesions called verrucae. She found that the treatments either cleared or greatly reduced the number and size of the warts in four to six sessions, after other treatments had failed to do so.

Source: Renee Cree, Temple University [2/1/08]

Query Post-op Complication

A 55 year old presented with painful HAV and an over-riding second digit of her left foot. There was pain at the medial aspect of the 1st metatarsal head, as well as the plantar aspect of the 2nd metatarsal. An IPK was present at the plantar aspect of the 2nd met. The 1-st met was slightly elevated pre-operatively. X-rays revealed pes-planus with an increased IM angle over 15 deg and subluxed second MPJ. Clinically there was a hypermobility of the 1st ray.

After nearly a yr of conservative care, a Lapidus procedure, tenotomy/capsulotomy of second MPJ, arthrodesis 2nd with K-wire for fixation was performed. Clinically a satisfactory alignment was achieved. The IM was reduced to less than 10. The 2nd MPJ was congruent. Post-op, the 2nd digit was vascularly compromised. Loosening of the dressing, partial retraction of the pin followed by complete removal a day later was done. The patient developed darkening of the toe. The vascular status subsequently improved but the patient had a great deal of pain not responding to any treatments. The pain was excruciating on palpation of the 2nd digit. Following excision of the plantar nerve of the 2nd intermet area (without relief), she agreed to resection of the 2nd digit. This offered a temporary relief.

Now 4 months post op her pain is the same. she feels a pulling sensation better when walking and worst when sleeping. MRI revealed possible presence of neuroma at 2nd inter-met area and fracture of 3rd met. The patient was placed in a BK cast. Subsequent CT scan was negative for any fracture. The patient has been placed on Neurontin and Cymbalta and has been referred to a pain clinic. She has been given TENS unit, night splints, ultrasound therapy (without relief). Bone scan and clinical findings do not confirm presence of any CRSP. Any suggestions?

Name Withheld (CA)

Query: Charging for Copies of Patient Records

How much can we charge a patient for requesting records? Is it 75 cents per page? Is there a place I can find this statute to copy it and show it to patients who think we are in error for charging them?

Peter Bregman, DPM, Tewksbury, MA

Editor’s Comment: PM News does not provide legal advice. The amount one can charge for records varies from state to state. The $.75 applies to New York. In MA, the charge is $.25 a page (243 CMR 2.07(13)(c) The following website provides information for most states: http://www.lamblawoffice.com/medical-records-copying-charges.html

Query: Coding Bone Resections

The patient had resections performed at the 1st and 2nd metatarsal-phalangeal joint (metatarsal head and base of the proximal phalanx) done many months prior to this surgery by another podiatrist. The patient currently has osteomyelitis of the left 1st and 2nd metatarsal shaft - she did not have an ulcer.

I went in and resected the distal part of the shaft of the 1st and 2nd metatarsals of the left foot. I did not amputate the proximal phalanx. I need advice on what CPT codes to use and any corresponding modifiers.

Mark Gasparini, DPM, Massapequa, NY

Response: I would suggest using CPT 11044 for the bone debridement. It does a have a 10 day Medicare global so that if you are dealing with osteomyelitis, you may be able to perform and get paid for any necessary E/M follow-up services after the global.

Tony Poggio, DPM, Alameda, CA

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RE: Safety of Silicon Injections Debated (Barry Mullen, DPM)
From: David Secord, DPM

I’m not sure why, but over the years, I’ve been fascinated with the ability of urban legends to take on a life of their own and become self-sustaining. I’ve tried to kill off at least one medical urban legend (Valliex’s sign), with some success, but enjoy seeing others come to the surface every now and again. Usually, these things tend to have a trial attorney involved somewhere along the line and often leads to someone going bankrupt while a law firm becomes richer.

Dow Chemical and the silicon breast implant debacle is a good example. Based upon absolutely no science what so ever, billions of dollars were doled out and Dow went bankrupt. Years later, multiple metanalysis studies showed no association with the silicone implants and any disease state. Who does Dow contact to get their money back? I don’t know if injected silicon is effective or not, but concerns about cancer or other such nonsense are not supported by science (unless you’re a liability tort case attorney).

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

RE: Hiring a Foreign Podiatrist as a Medical Assistant (Bret Ribotsky, DPM)
From: Jengyu Lai, DPM

In my experience, H-1B is probably the most difficult visa to obtain. My understanding is that there are two types of H-1B: standard and advanced-degree. The advanced degree has to be obtained in US. Most H-1B applications come from computer and biotech companies, such as Microsoft and 3M. In the past few years, the allowed number of regular H-1B was exhausted in the first day of application and the advanced-degree in 4 weeks. I applied for green card while still in podiatry school and have always advised my friends to apply for a green card instead of H-1B.

Jengyu Lai, DPM, Rochester, MN, jylai99@yahoo.com

RE: Reimbursement and Quality of Care
From: Ira M. Baum, DPM

Editor’s note: This extended-length note appears at: http://www.podiatrym.com/letters2.cfm?id=17748&start=1

ASSOCIATE POSITION- KANSAS CITY, MO

Excellent opportunity for a hard working, ethical podiatrist to join a vibrant, successful and growing podiatric medical and surgical practice. Dedicated, supportive staff with strong marketing and medical knowledge. Must be board eligible/certified. PSR/24. Partnership opportunity. Competitive salary, bonus structure, benefits. Wonderful place to raise a family. Fax CV to 816-455-8901

ASSOCIATE POSITION – VIRGINIA

Must have Virginia license. Requires 24 to 36 month Residency. Permanent position with potential buy in. Includes all phases of Practice excluding nursing homes. Competitive Salary and Benefit package. Please send Resume including salary requirements and availability date to needpodjob@yahoo.com

EQUIPMENT FOR SALE – PODIATRY CHAIRS, ETC.

SELLING quality clean, sturdy well padded exam chairs priced at $500 each, waiting room chairs $100 each, and large desks with rolling chairs at $200 each pair. Email: dr.wright@bigfoot.com or call 609 267 7707

ASSOCIATE POSITION – NAPLES, FLORIDA

Great opportunity for PSR- 24/36 BE/BC podiatrist with strong surgical skills to join multi-office practice. Hospital privileges available at 648 bed hospital system, 200 bed hospital system and multiple surgical centers. Candidate should have the skills and desire to perform rearfoot surgery including Charcot reconstruction and ankle surgery. Florida has a great scope of practice law and we rotate for ER call at all 4 hospitals. Candidate needs to be ethical and motivated. Established practitioner or new practitioner OK. Base salary, percentage, benefits including 401K. Fax CV to (239)566-8778 or Email CV to Drgordon@gulfcoastfootcare.com

ASSOCIATE POSITION - CENTRAL VIRGINIA

Immediate opening. Two office practice, EMR, digital x-rays, sonography. Full scope of foot and ankle care. Candidate needs to be mature, hardworking, and personable. ABPS certified/eligible. Base salary, percentage, and benefits. Submit letter of introduction, CV, and photo to practice administrator at mtrevor41@yahoo.com

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

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

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.

PODIATRISTS NEEDED - CHICAGO --NORTHWEST INDIANA

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