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February 12, 2008 #3,165 Editor-Barry Block, DPM, JD

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Don’t Take Socks For Granted: CA Podiatrist

"It's a common misconception that socks are not important," says Dr. Douglas Richie, a podiatrist in Seal Beach, CA. "They are the most intimate layer of material against your skin," Richie says. 'When people get calluses and blisters they first blame the shoe, when they should be looking at the sock.' Fibers generally fall into two categories: Absorbent, such as cotton and wool, and water repellent, such as polyester and acrylic.

Dr. Douglas Richie

Technology comes at a price. Many brands of premium sport socks will run as much as $10 or more a pair. Richie believes that they're worth it, especially for growing feet: "Children put out high volumes of moisture even when they're not running," he said. "Any active person needs to look at socks as an essential piece of equipment," he said.

Source: Janet Cromley, Los Angeles Times [2/9/08]

CA Podiatrist Part of Clinical Trial of Excellerate Gel

A local podiatrist is looking to a new therapeutic protein gel to aid the healing and prevent amputation. “The application is once, maybe even twice,” explains Dr. Dean Vayser, a Diabetic Limb Salvage Specialist at Scripps Clinic in La Jolla. “And that's it, so patients don't need to apply it every day, or every week.” It works by stimulating blood vessels and new tissue formation.

Dr. Dean Vayser

Diabetes is the leading cause of non-traumatic lower-extremity amputations in the United States. But Dr. Vayser says he reminds patients prevention is the best medicine. “They have to check their feet, they have to control their sugar, they’ve got to control their diabetes.” He tells them to wear appropriate footwear, and follow up with their doctors.

Source: Brooke Beare, Fox News [2/09/08]

Bush Budget Cuts Hospital Funding But is Silent on Medicare Doctor Pay

President Bush's fiscal 2009 health budget, with steep Medicare spending cuts as a main highlight, sets the stage for a tough fight with Congress in the months ahead.

The proposal, part of a wider $3.1 trillion plan, is just the first step in this year's health care budget debate. Healthcare organizations and congressional Democrats have found a lot not to like. Bush proposes reducing Medicare and Medicaid spending anticipated under current law by $196 billion over five years, with hospitals as the main target. The plan would do nothing to prevent Medicare physician payment cuts.

If nothing is done, physician reimbursement will fall 10.6% from today's levels beginning July 1 through the rest of 2008, and an additional 5% in 2009.

Source: Doug Trapp, AMNews [2/18/08]

Query: Pruritic Rash

My patient is a 29 y/o caucasian female with a one-year history of a pruritic unilateral right foot rash (see photo below). No prior history of rash. No rash on remainder of body. Rash waxes and wanes in intensity.

Pruritic Rash Right Foot

Prior treatment consisted of two months use of clotrimazole 1% cream and then one month with betamethasone dipropionate 0.05% cream, with no improvement. Medications: Ortho Tri-Cyclen x7 years. Would there necessarily have been improvement with clotrimazole cream if tinea pedis was the culprit? Any suggestions?

Chris Seuferling, DPM, Portland, OR

RE: Recurring Metatarsal Fractures in Healthy Adult (Jeffrey Bean, DPM)
From: Howard J. Bonenberger, DPM, Simon Young, DPM

If blood work is unremarkable then consider a bone biopsy near the fracture site not to look for infection but for further insight into the cellular, biochemical and structural characteristics of the bone. A specialty lab (or that of a major medical center) may be in order to look at the specimen. An endocrinologist may be able to guide you regarding this.

As for the patient with MS which was diagnosed after a series of multiple, presumably non-traumatic fractures. I would consider that prior to the MS diagnosis she may have had altered sensation and mechanics for quite a while which, due to the insidious onset she may not have realized. She may have in fact developed a neuropathic foot leading to the fractures.

Howard J. Bonenberger, DPM, Nashua, NH, howardbon@aol.com

Check between the ears. Consider psychiatric causes, possibly Munchenhausen syndrome by proxy.

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

RE: Large-Sized Orthotic Sandals (John Hester, DPM)
From: Robert S. Schwartz, C. Ped.

Eneslow fabricates orthotic sandals on our premises. We also carry and can order ready-made orthotic sandals larger than men’s size 15. More importantly, Eneslow customizes ready-made sandals (shoes, boots, sneakers, etc.) to include any and all orthotic modifications needed. The patient can purchase a ready-made pair of sandals and we will remake them to fulfill their custom orthotic needs. For more details go to (www.eneslow.com), and see Comfort For The Sole and Eneslow Pedorthic Shoe Modification Price List.

Robert S. Schwartz, C. Ped., New York, N. Y., rss@eneslow.com

RE: Universal Healthcare (PM Jan 08 Column by Harry Goldsmith, DPM)
From: Richard Loninger, DPM

Editor’s note: Dr. Goldsmith’s article appears at: http://www.podiatrym.com/pmarticle.cfm?id=114

Dr. Loniger’s extended-length letter can be read at:
http://www.podiatrym.com/letters2.cfm?id=17865&start=1

RE: Peer Review
From: Paul Kesselman, DPM

I received many suggestions to my recent posting requesting objective methodology for performing peer review. I wanted to share the two of the best responses with the readers of PM News.

1) Perform a Digital Chart Audit. More information on this can be found at: http://hierarchieschartaudit.homestead.com/

This website provides an objective, easy to repeat methodology for performing peer review. The site is easy to read. Contacting them is easy and their site manager, Dr. Michael Rosenblatt, is more than willing to answer many more questions.

2) The New York State Podiatric Medical Association (NYSPMA) has a Peer Review Program manual which provides rules and procedures for conducting a peer review hearing.

Paul Kesselman, DPM, Woodside NY, pkesselman@pol.net

ASSOCIATE WANTED -BOCA RATON-DELRAY BEACH AREA

Great opportunity-must be hard-working, reliable, Responsible and good with patients & staff-surgical Training a plus-partnership after 1yr. Florida License required fax resume to 561-865-2225.

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 (NORTHERN)

Excellent opportunity to join a multi-office practice. In search of a well-trained, hard-working, ethical podiatrist to take this well established full scope practice to the next level. Competitive salary and benefits package. Looking for a long-term relationship with potential for partnership. Reply to: footdocva@cox.net

OFFICE TO SUBLET – SUFFOLK COUNTY, NY

Podiatrist needed in busy medical office building, sublet space Tuesdays, Thursdays and Saturdays. 1,000 square feet. Electric, garbage, taxes, all inclusive fully furnished, absolutely beautiful three treatment rooms, complete waiting room and consultation room. Asking $1,200, call (631) 981-1334 or Fax: (631) 981-6766. Building has internist, psychologist and chiropractor.

EQUIPMENT FOR SALE - BIDIRECTIONAL DOPPLER

KOVEN SMART-DOP 45 Performs arterial & venous studies on its LCD screen or on a computer (software included). Unit & accessories in excellent condition. Unit is 1 year old and has been used about 3 times. Asking $2,800. New unit is $5,000. Doppler specifications: http://www.koven.com/products/SD45.pdf Email nefootandankle@optonline.net

PRACTICE FOR SALE – PHILADELPHIA, PA

Six year-old well established practice averaging 300K over the past three years. Suitable for surgical podiatrist. Large referral base and surgical care. I am looking to relocate. I will stay during transitional period. Excellent Philadelphia location. Practice is still growing, allowing instant and increasing income. Hospital and Surgical Center privileges. Equipment included. Fax 215-665-9242 for details.

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 – 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

PODIATRISTS NEEDED - CHICAGO --NORTHWEST INDIANA

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists. We are located in Chicago and Northwest Indiana. Full and part time positions are available. Competitive Compensation including malpractice. Contact Scott Schneider. Phone-773-342-4201 FAX 773-486-3548-E-Mail sschneider@homephysicians.com -- www.homephysicians.com

ASSOCIATE WANTED – NEW YORK IMMEDIATE OPENING

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

MEDICAL SPACE FOR RENT OR SALE - NEW YORK CITY

305 Second Avenue (17-18th Sts), 3 Treatment rooms, Private office, Lab, Separate Receptionist/Business area, waiting room, bathroom w/ stall shower Deluxe/Landmark/Prime Building and Location, 24/7 security. Multi-specialty condominiums originally designed specifically for podiatry has also been upgraded for dentistry. For further details contact Laura Dobrusin, Ny2azld@aol.com or jdobr@arizonamed.com 480-951-2480 602-980-8457.

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