The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

February 23, 2009 #3,476 Publisher-Barry Block, DPM, JD

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WI Podiatrist Among First to Use PinPointe FootLaser

Dr. Chris Milkie, a board certified podiatrist, is one of just 49 foot doctors in the U.S. using the FDA-cleared PinPointe FootLaser for the treatment of toenail fungus infections, an ugly and sometimes painful disease affecting over 35 million people in the United States.

Dr. Chris Milkie

Dr. Milkie said, "Up until the release of this patented technology in September, there have been no good options for people suffering from onychomycosis. Topical treatments don't work and the oral antifungal medications must be taken 3 months with a risk of liver toxicity. This new treatment is a painless, 30-minute procedure performed right in my office - that has an 88% cure rate." PathoLase, the developer of this new technology, expects over 1,000 podiatrist to be using their laser system within the next few years.

Dr. Chris Milkie is board certified by the American Board of Podiatric Surgery and is the chairman of the Podiatry Department at Wheaton Franciscan Healthcare - St. Joseph Hospital. He has been in private practice since 1991 and has offices in Wauwatosa and Fox Point.

Source: Wisbusiness [2/20/09]

Students Line up for Australian Podiatry School

Students are lining up for a four-year full-time-only podiatry course at La Trobe's Bundoora campus. According to associate lecturer and first year coordinator Daniel Bonanno, would-be podiatrists are often drawn to the profession after personal contact with a podiatrist, possibly following a sports injury. Podiatrists see everyone from young children and elite athletes to the elderly. La Trobe students get a chance to see the full range of patients at the university's podiatry clinic, which is apparently the biggest in the southern hemisphere.

Podiatrist Danni Paterson at Royal Newcastle Hospital (Photo: Darren Pateman)

On graduating, podiatry students can apply for registration and are able to work across Australia and even in Britain. The fact that the qualification is recognised in Britain means students can, and often do, go to work there for a few years. For those working in Australia, starting salaries for podiatrists are about $50,000 a year - and, says Mr. Bonanno, there's no shortage of jobs.

Source: The Age, Melbourne, Australia [2/22/09]
 

States Consider Requiring Hospitals to Screen for MRSA

The rate of patients entering the hospital with methicillin-resistant Staphylococcus aureus increased eightfold between 1999 and 2006. Politicians in statehouses around the country say hospitals need to take a more active approach to stopping MRSA's spread.

Since 2007, four states -- California, Illinois, New Jersey and Pennsylvania -- have enacted laws requiring hospitals to screen high-risk patients for MRSA infection or colonization and follow precautions to prevent other patients from becoming infected. Eight states considered similar legislation last year, and as of late January, new bills had been filed in Washington and Kentucky.

Source: Kevin B. O'Reilly, AMNews, [2/16/09]

Project Body Language Confidence

Patients constantly read your body language, whether or not you are aware of their doing so. So, make a constant effort to project an image that exudes confidence and puts them at ease. Three tips:

• Maintain handshakes for one second longer than you normally would. That conveys your self-confidence.
• Hold your head level instead of letting it relax into a tilt toward one shoulder. You will seem more levelheaded.
• Stand straight and tall. Doing so makes you appear more energetic.

Source: Adapted from How to Think Like a CEO, by D.A. Benton, Via Communiction Briefings

Query: Is Podiatry a Profession or a Medical Specialty?

This coming weekend, the Vision 2015 Summit will be held in Bethesda, Maryland. Although Podiatry Management is not a designated stakeholder at this meeting of podiatry’s leaders, we wanted to put our “two cents” in on the development of an APMA Resolution which we helped write. We invite PM News readers to read our upcoming April editorial at: http://www.podiatrym.com/pmarticle.cfm?id=122

We invite readers to respond to this editorial and/or to write to Frank Spinosa, DPM (FASpinosa@apma.org), Chair of the Vision 2015 Committee.

Barry H. Block, DPM, JD, Forest Hills, NY bblock@podiatrym.com 
 

RE: Chloro-preps and Infections (Eugene A. Batelli, DPM)
From: Multiple Respondents

I'm an OR nurse at a small community hospital in upstate NY and we use ChloraPrep extensively.  Most of the general and orthopedic surgeons like it, and there seems to be less contact dermatitis than with povidine solutions. One back surgeon went back to Betadine because he felt he was having a higher post-op infection rate with the chlorhexidine, and some of the older surgeons have been slower to accept it, but they're the exceptions. Also, you can't use ChloraPrep on open wounds or mucous membranes. If you really feel the need for a pre-paint scrub, there are chlorhexidine scrub brushes that you could use prior to the ChloraPrep.

One advantage of the ChloraPrep is that it supposedly remains bacteriostatic for 48 hours post-surgery, which is a benefit you don't get with povidine iodine, especially since you wash that off at the end of a procedure.

Paul Busman DPM, RN, Clifton Park, NY, brewerpaul@aol.com

I agree that the Betadine scrub/paint combo is more effective in controlling infection than the once and done Chloro-prep. My reason has nothing to do with the anti-microbial activity and more to do with the technique. The studies that Dr. Batelli refers to are open heart surgeries. Prepping a foot is somewhat more involved for two reasons. First, my guess is that a foot harbors more local flora to begin with, and therefore needs a more aggressive pre-surgical scrub, no matter which anti-bacterial material used. This is similar to the concept that pulse-lavage with or without antibiotics is effective as long as the lavage is done well. Compare the incidence of paronychia and interdigital bacterial tinea vs. chest folliculitis. I have seen some nasty stuff interdigitally, and those web spaces and peri-ungual areas are natural breeding grounds for bacteria.

Second, technician error in prep with the “once and done” technique can be higher due to the irregularity, contour and curvature of the heel, toes and webs. If an area is missed, germs are not killed or removed and the surgical field is at risk for higher rate of infection.  If you don’t want to go back to the Betadine scrub/paint, then I recommend a detailed soap and water scrub and rinse, and then the Chloro-prep. 
 
Pat Caputo, DPM, Holmdel , NJ, pat_caputo@alumni.rutgers.edu

I have not had much experience with Chloroprep, but I have used Duraprep in the OR over the past few years without any problems when compared to the regular ortho prep.

Ken Jacoby, DPM Elgin, IL, Gkjaco@aol.com
 

RE: Instrument for Incurvated Toenails (Vincent L. Travisano, DPM)
From: Dave Nielson, DPM

VHO Osthold brace (vho-osthold.de/en/vhoinfo.php) is a system sold in Europe.

VHO Osthold brace

Rather than pushing the skin edges away, it pulls the nail away from the skin.

Dave Nielson, DPM, Roanoke, VA, Pampantla@hotmail.com
 

RE: Mucoid Cyst
From: Bryan C. Markinson, DPM

I agree with those who stated that arthroplasty is essential for cure. These cysts cause pressure on the overlying skin and cause effacement and atrophy of the epidermis, often making the overlying skin unsuitable for simple closure. The Shrudde flap (already mentioned) is an excellent way to cover the defect. I have another tip - Before starting the procedure, inject a tiny (and I mean tiny) drop of methylene blue into the cyst. You will be amazed at how it details the dimensions of the lesion and leads you right to its origin. Caution: if you inject more than a literal drop, it will be unmanageable and stain the entire surgical site, which defeats the purpose in the first place. Try it, you'll like it.

Bryan C. Markinson, DPM, NY, NY, Bryan.Markinson@mountsinai.org
 

RE: Nail Dust Extractor (Robert Charnam, DPM)
From: Multiple Respondents

I recently purchased three nail dust extractor systems from a company called J-VAC, which is headed up by Jack Ressler DPM. They work with a Dremel and some of the Micro drills on the market.  My staff has been using the J-VAC for several days and has given me very positive feedback. The treatment rooms stay cleaner and  we even have had some patients compliment us. The unit sells for $119 and requires you to purchase an inexpensive Hoover canister vacuum (S 1361) to complete the system. So far, I have been very impressed with this product. This company also gives back to our profession by donating $5 to APMA PAC for each unit sold. Their email address is jvacsystem@gmail.com

Mike McCormick, DPM, Venice, FL. venicefootclinic@comcast.net
 
I use a Fein vacuum with a HEPA filter. It has a "switched outlet" that I plug my Dremel into. This is nice, as when I turn the Dremel on, the vacuum automatically turns on. Fein vacuums are relatively quiet, but it is still difficult to carry on a conversation over them. I hold the hose in my left hand and the Dremel in my right. You can buy the Fein with HEPA filter as a package, which saves about $50. I think I paid about $400 for mine over the Internet.
 
Gary Bjarnason, DPM, Roanoke Rapids, NC, pedalpod@embarqmail.com

Larry Sasso of  Med-Pro sells a fine German unit using water spray that's very effective. Tel # 800/633-7761.

Richard Belli, DPM, Woodside, NY, drrichardbelli@yahoo.com

RE: Heel Spurs Don’t Cause Pain (Robert Steinberg, DPM)
From: Multiple Respondents

Editor’s Note: Since this topic has been closed, notes from Drs. Silvers, Purdy, and Wander can be read at: http://www.podiatrym.com/letters2.cfm?id=24732&start=1

RE: Stay Clear of Hungry Polar Bears!

Polar Bear Bite

Editor's Note: This was submitted by Charles R. Oehrlein, DPM

OFFICE SPACE/ MRI RENTAL – NYC, LI  

Turn-key space available, daily, monthly; East 60th off Park Ave, East 22nd St. off 3rd Ave, and Plainview Long Island. JACHO-certified operating rooms available, as well as all surgical equipment and anesthesia. Extremity MRI Rental. Stark compliant. All exams read by board certified radiologist. Call for details. 516 476-1815

IMMEDIATE OPENING – MIAMI, FL 
 
Part-time and Full-time position available now. Massive growth potential present in an expanding group practice. June graduates are welcome to apply. Send CV and LOI to qvan@aol.com

NEEDED CHICAGO -- NW IND & BALTIMORE/WASHINGTON, DC PODIATRISTS

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists in Chicago, Northwest Indiana, and Baltimore, MD. 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 Visit our website

ASSOCIATE POSITION -SOUTHERN NEW JERSEY 

I’m looking for podiatrist who wants additional practice hours. Perfect for combining your own practice with an additional income. Must be on Aetna Insurance, Horizon Blue Shield, Medicare, and most commercial carriers. I am looking for someone who has a desire to learn how a very successful practice is run, so that I will be able to have time away from my practice. Payscale to be discussed. Could lead to partnership or sale. E-mail contact information, CV, and why you would be perfect for this opportunity. Contact foot.care@verizon.net

CASE CONSULTING

Dennis Shavelson, DPM is now accepting referrals of difficult cases involving biomechanics, surgical complications, non-healing wounds diagnostic and treatment dilemma’s and subtalar stenting from DPM’S. Full reporting with second opinion only, rapid return after care and assumption of care options. Medicare and Out-of-Network Only. (212) 288-3668 or drsha@lifestylepodiatry.com

GREAT OPPORTUNITY- ATLANTA, GEORGIA

Forget getting paid by percentage or a salary, be your own boss. Great opportunity to have your own office with patients without major financial burden. Well-established practice/ office, fully equipped, five treatment rooms, x-ray room, lab, kitchen, doctor’s office, large street sign on a main road, office location and doctor's name is well-known in the community, lease or lease to buy. The doctor is cutting back on this location to become semi-retired. E-mail superrang@bellsouth.net

PRACTICE FOR SALE – ANDERSON, INDIANA

Well established office in Anderson Indiana for sale. Seller currently works 3 half-days per week and gross over $200K. Excellent locations and growth potential. Very podiatry-friendly community. All equipment and furniture included. Seller is willing to help with transition. Contact seller at mddpm@sbcglobal.net for more information.

PODIATRY ASSOCIATE WANTED – NJ

Northern NJ. Bergen County Must be well-trained. No nursing homes or house calls. Modern well-equipped office. Digital x-ray and ultrasound. Excellent pay and opportunity. Must have NJ license. Call 973-472-4700.

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

ASSOCIATE POSITION NORTHERN CALIFORNIA

Need associate in busy office in two locations. Hospital privileges
available. Emphasis on wound care. All aspects of Podiatric Medicine and Surgery. Associate position to lead to partnership and buyout. Please contact jimf@humboldt1.com

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.

  
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