The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

February 23, 2012 #4,392 Publisher-Barry Block, DPM, JD

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MI Podiatrist Uses Dermagraft to Help Heal Diabetic Ulcers

Every year in the United States, more than 65,000 people lose a limb because of diabetes due to a cut that doesn't heal. Eighty-eight year old Garrett Adema knows all too well how devastating a wound that won't heal can be. “I had it on the other foot,” says Adema, “I had the same type of sore on the big toe and they removed the big toe.” It’s a scenario Dr. Marisha Stawiski sees time and time again in her patients with diabetes. “If you can't heal the wound, if it becomes deeper or gets infected, it's catastrophic to your limb.” 

Dr. Marisha Stawiski

Stawiski recommended Dermagraft, a skin substitute made from human cells that are taken from newborn foreskin tissue. Those cells are called fibroblasts. “Fibroblasts are cells that we all have in our skin that produce really high levels of healing factors that are important to stimulating the cascade of healing,” Stawiski told FOX 17.

Source: Fox 17 News [2/16/12]

P.A.D. Can Indicate Widespread Arterial Disease: MPMA

Be good to your heart all year, but especially in February, which is designated American Heart Month.  "This is the perfect time to take action on preventative care for one's heart," said Dr. Jodie Sengstock, president of the Michigan Podiatric Medical Association. 

Dr. Jody Sengstock

"The MPMA recommends that many individuals have a very simple, yet telling, test done to confirm proper circulation and avoid potential complications."

Source: The Macomb Daily [2/21/12]

Alleged Failure to Diagnose Charcot Foot (VA)

Facts: Cynthia Cline claimed that she received care for problems with her right foot from defendant, a podiatrist who practiced in Virginia. She claimed that defendant treated her from Oct. 15, 2001, to Feb. 4, 2004. Cline claimed that defendant failed to properly diagnose an acute Charcot joint of the right foot and ankle, engaged in improper usage of medication for the foot problems, and failed to refer her for problems that were out of his area of expertise.

She claimed that defendant's failure to comply with the standard of care resulted in the amputation of her right foot, contributing to renal failure. Cline sued defendant on Jan. 27, 2006, in the U.S. District Court for the Western District of Virginia, Roanoke Division. A motion to transfer venue to the court's Abingdon Division was granted March 22, 2006.

Result: Defense verdict ($0)

Plaintiff's Expert: Michael Downey, DPM, Philadelphia, PA
Defense's Expert:  Jeffrey Coster, DPM, Alexandria, VA

Source: Mealey's Jury Verdicts & Settlements 2012

Query: Do Runners Need Orthotics?

Dr. Nick Campitelli, a member of the medical advisory board for the Vibram Fivefinger shoes suggests that, instead of podiatrists using foot orthoses to treat running injuries, they should instead be instructing runners on proper running form, including using forefoot-striking running technique: Campitelli said, "In my practice, when runners bring up the question of what type of shoe they should be wearing, I explain that they first need to 'learn how to run.' Then footgear and orthotics become irrelevant."
 
I am interested in this rather unusual way to treat running injuries. How many podiatrists think that shoe selection and the presence or absence of proper foot orthoses are "irrelevant" in running injuries as does Dr. Campitelli?  Certainly the scientific literature is very clear that foot orthoses not only change the kinetics and kinematics of running gait, but are also quite effective at treating many running injuries, a fact that Dr. Campitelli has conveniently omitted from his blog. How many podiatrists tell runners to change their gait from a heel-striking gait to a forefoot striking pattern when treating running injuries and think running shoe selection and foot orthoses are "irrelevant," as does Dr. Campitelli?
 
Kevin A. Kirby, DPM, Sacramento, CA

Query: Switching to Comcast for Phones and Internet

Currently, I use AT&T for all my office phones, including Internet. Has anyone switched to Comcast, and if so, how happy were you with the switch? Comcast has offered me a deal for at least half of what I'm paying AT&T.

Barrett E Sachs DPM, Plantation, FL

RE: Hallux Rotation S/P Bunionectomy (Scott Hughes, DPM)
From: Stanley Beekman, DPM

I derotate a metatarsal head in the frontal plane for an everted metatarsal as seen in HAV with a tibial sesmoid lesion. The procedure I use is a Roux with a plantar shelf, but any “L” shaped osteotomy can be modified to accomplish the same goals. After making the transverse plane osteotomy from the metaphysis distally into the metatarsal head, a second osteotomy is performed commencing superior to the initial osteotomy and progressing plantarly laterally so that a wedge is resected. The amount of correction is determined by the wedge that is resected. Since it is a blind osteotomy, a good feel for the width of the metatarsal is required. The rest of the “L” then needs to be made to allow for movement of the metatarsal head.

Stanley Beekman, DPM, Cleveland, OH, sbkmn1@gmail.com

RE: Achilles Tendon Pathologies Caused by Crestor (Norm Wortzman, DPM)
From: Elliot Udell, DPM
 
Crestor is in a class of drugs known as statins, which are used to treat hyperlipidemia and to reduce cardiovascular incidents. One of the potential side-effects of this class of drugs is muscle pain. The pain can range the gamut from being mild, making it painful to ambulate, to that of a serious life-threatening muscle disorder called rhabdomyolysis.
 
The symptoms described may or may not be caused by Crestor. Many people develop Achilles tendon pain who have never taken any statin. The only way to find out if there is a link between Crestor and the patient's symptoms is to work with the patient's physician and have the patient temporarily discontinue the medication. If the symptoms abate, reintroduce the medication and see if the symptoms return. In such cases, many physicians will have the patient take the medication on alternate evenings. In any case, since Crestor can be a life-saving medication, all efforts should be made to enable the patient to continue with it or switch to a different statin and hope that the pain does not return. 
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: Overburdened by Paperwork
From: Joseph Borreggine, DPM

We rarely ever receive this type of response from a new patient, but it is worth noting because of all the paperwork that patients need to give a doctor to have a complete medical record, comply with HIPAA, and obtain the necessary assignment of benefits and explanation of office payment policies. Whatever happened to the good ole' days of practicing medicine? The government has too much regulation that we pass onto the patient, and hence this type of response...I wonder how much more frequent this will become?

"This is my notice that I would like to cancel my appointment. I am sending it via email so that it can be received before the 24-hour time frame is encountered. I only received the (overwhelming) packet in yesterday's (Friday's) afternoon mail and did not have the time to contact you by telephone during your office hours then. I will not be rescheduling this appointment. The tone and volume of the mailed packet did not convince me that I want your office to be my care provider."

Joseph Borreggine, DPM, Charleston, IL, footfixr@consolidated.net

RE: Podiatry and FQHC Health Centers
From: Edmond F. Mertzenich, DPM

Having worked full-time for an FQHC since 2004, I have found the work fulfilling and interesting. The need for podiatric care is significant. I can assure the podiatric community that we are the foot care experts. Working in close proximity with other providers is fun. I frequently see cases that one would only see in textbooks. This includes assorted diabetic complications, infectious disease, neurological issues, and musculoskeltal problems, to name a few. Almost all my work is primary care.

It is a good feeling to have other primary care providers ask me to consult on their cases. It can be frustrating when there is a low compliance rate from patients. As for funding, I believe it would be a mistake to look at Medicaid as the only funding source for podiatric care in the FQHC environment. Many patients are on some form of disability and have Medicare. Those without insurance are given a discount and have to pay a fee to obtain services (and this also applies to other providers). There is the occasional private insurance. 

That being said, I think the place to change this funding discrepancy is to get our legislators to support and pass the change to Title XIX funding; to not allow podiatry to be an optional form of care. Without this change, many people will not have access to expert foot care.

Edmond F. Mertzenich, DPM, MBA, Rockford, IL, doctoreddpm@frontier.com

RE: Podiatric Physicians Practice Podiatric Medicine: RIP Podiatry (Leonard Levy, DPM)
From Fred Huss, DPM

I'm not sure I understand this debate.
I go to the urologist for my prostate exam.
I go to the ophthalmologist for my eye exam.
I go to the optometrist for glasses.
I go to the dentist for my teeth.
I go to the psychiatrist or the psychologist for meds or talk therapy.
I've been to a gastroenterologist for my colonoscopy.

When I was admitted for CABG....

Editor's note: Dr. Huss' extended-length letter can be read here.

RE: TX Podiatrist Awarded Patent For Flat Foot Implant (Narmo L. Ortiz, Jr., DPM)
From: Bret Ribotsky, DPM

Dr Ortiz's quest for information on just how to obtain a patent is available directly from many podiatric inventors on Meet the Masters (www.PodiatricSuccess.com). You can listen or download interviews with many patent holders which includes discussions on what steps to take. Drs. Jensen, Graham, and Spalding are just a few that have been on the show in 2012. My interview with Gary Lepow from 2011 is also available. As I have been saying for years, "The masters have the answers and success leaves clues."

Bret Ribotsky, DPM, Boca Raton, FL, ribotsky@yahoo.com

ASSOCIATE POSITION - NORTHEAST GA

Well-established 18 year practice in Northeast Georgia seeking full-time associate leading to partnership. General podiatric care with moderate amount of surgery to be done in local hospital or surgery center. Competitive salary and benefits. Please respond by email to: Fivetoes1946@aol.com

ASSOCIATE POSITIONS - MULTIPLE STATES

Podiatrist Needed in Missouri, Nebraska, Iowa, Minnesota, North Dakota, South Dakota, Ohio, Texas, Colorado, Oregon, Washington, Arizona, Massachusetts, Rhode Island, Wisconsin, Indiana, Oklahoma, Connecticut and Vermont. Expanding multi-state medical practice seeking podiatrists to service long-term care community residing in nursing homes and assisted living facilities. We offer an established patient base, scheduling, equipment allowance and cover travel expenses. Provide generous compensation, bonus opportunities, disability, health insurance benefits, malpractice coverage and flexible scheduling. Looking for a Podiatrist with excellent skills, able to provide expert and compassionate care to patients. Email CV to: careers@aggeus.org or call 773-770-0140 x300/x305.www.aggeus.org

ASSOCIATE POSITION - MARYLAND

Looking for 3rd associate. Must be personable, well trained and highly motivated. Great locations in Southern Maryland, including an Ambulatory Surgical Center. We currently have EHR, digital radiography, dispensing center and PADNet. Looking for immediate hire! Please send CV to:myfeetfeet@aol.com

PART-TIME PODIATRIST NEEDED - LOS ANGELES, CALIFORNIA

Busy podiatrist looking for assistance with patients located in facilities, homes, office, etc. Flexible hours, independence, and great compensation. If interested email CV to or call Terri at  323-353-8103   homefootcare@hotmail.com

ASSOCIATE POSITION - CENTRAL NEW JERSEY 

Associate Wanted for Central NJ offices. Looking for highly motivated self starter to build/expand practice locations. Great part-time opportunity for the right candidate. Email your CV with references to  ejema@aol.com 

ASSOCIATE POSITIONS - TEXAS

TEXAS licensed podiatrists needed in San Antonio and Austin. Great paying positions for full or part-time. Well-established, unique mobile podiatry practice servicing senior living facilities. Business office location with excellent support staff for your assistance and scheduling. Check us out before looking elsewhere. Find us at www.footmobile.com. Reply with cover letter and CV to doctor.cohen@yahoo.com with a cc: to lisa.schulze@yahoo.com or call us at 210-495-6477.

ASSOCIATE POSITION - SOUTHERN CALIFORNIA

Full-Time Associate needed for busy multi-office locations in LA, Orange, San Bernardino and Riverside counties. SIX FIGURE SALARY PLUS BENEFITS!! Knowledge of Spanish is helpful. Good mix of office patients, house calls, some surgery, etc. NO NURSING HOMES!! Needed in July, 2012 or sooner. If interested, please send contact information and CV to scpodgroup@yahoo.com

ASSOCIATE POSITION - UPSTATE NEW YORK

Outstanding Opportunity. Our medical surgical group is recruiting a well-trained licensed podiatric physician. Located in Beautiful upstate NY. Full hospital privileges, as well as working with two residency programs. Must be highly motivated and great with patients. Opportunity for growth. Competitive salary and benefit package. Please send CV to associateinfoot@yahoo.com

SOUTHEAST GEORGIA- SAVANNAH & SURROUNDING AREAS

Beautiful weather year round & near the Coast. Opportunity for Early Buy-in. Seeking podiatrist looking to build a career & long-term relationship. Either established practicing physician or new residency graduate. Must be PSR-24/36 trained. Multiple locations. Full range of services with new facilities. E-mail cover letter & CV to melissafoot@pol.net

ASSOCIATE POSITION - EAST CENTRAL NEW JERSEY

Well established practice needs a career-minded podiatrist for associate position leading to Fast Track Partnership. Competitive salary/benefits. Busy practice. Great location. Board Certification a plus. Part-time or full-time. Immediate availability, but will wait for best candidate. GardenStateDPM@aol.com

ASSOCIATE POSITION - KANSAS CITY, MISSOURI

I'm not just looking for an associate. I am looking for a doctor who wants to build a highly successful career with a doctor who is as committed to their success as he is to his own. Go towww.YourFutureInPodiatry.com to find out about this opportunity.

ASSOCIATE POSITION - SOUTHERN KENTUCKY

Available in beautiful southern Kentucky in progressive, multi-office practice with 6 providers. Excellent base salary, malpractice, full benefit package with 2-year track to partnership. Looking for someone that wants to grow with our practice, work hard and develop relationships with local hospitals and surrounding communities. Strong communication skills, bedside manner and willingness to learn a must. Narrow window for interviews: email CV and letter of interest before March 1: footdocky@gmail.com

ASSOCIATE POSITION - CENTRAL NJ

Looking for a three-year surgically-trained associate who has entrepreneurial spirit. Partnership guaranteed within three years for the right person. Must be very outgoing and personable. Great opportunity for a person who is confident and a go getter. drwfoot@verizon.net

PRACTICE FOR SALE - BALTIMORE, MARYLAND

Established 40+ year old well-rounded practice of both surgical and non-surgical care with special emphasis on sports medicine. Medicare and BS/private insurance base, no Medical assistance. Needs to transition to a confident well trained individual. Purchase can include building. Contact: podiatrypracticesale@gmail.com

EQUIPMENT FOR SALE

Koven Doppler, Synthes Titanium Mini Frag screw set, Zimmer & Hall Micro 100 set (all 5 heads including wire driver), Two full major surgical instrument sets, miscellaneous surgical tools including osteotome set (curved & straight). All German stainless steel. Best offer. Retired due to illness. Call 586-675-4311 or 440-285-2827. Dr. Gary Docks.

EQUIPMENT FOR SALE

Cosman Radiofrequency Generator for Sale! Model RFG-1B Like New Condition. Comes with Manual, 17 Dispersive Electrodes, 2 CSK-R 10 Kits, 2 CSK-R 5 Kits, 11 CC RF Cannula 10cm/10mm/22G, 4 CC RF Cannula 10cm/5mm/22G, 1 - 5cm RF Cannula/22G (4mm Sharp Curved Tip), & 2 Replacement Fuses. Asking $10,500 OBO Please Contact: nffpbosk@gmail.com

EQUIPMENT FOR SALE

Koven Smartdop 45 hand-held Doppler w/training CD, operator's manual and reference guide. PC compatible (used less than 20 hours). Cryostar cryosurgery- tabletop unit with (2) Hand-PC (4) probes (2 dull, 2 sharp) for Morton's neuroma, plantar fasciitis, and fibromas. Comes with rolling carrying case, training CD & instruction manual. Also CryoPen, CryoProbe case, several N2O cartridges (for warts, etc.). Diabetic inserts, all different sizes. Please email me at young_jolene@yahoo.com

EQUIPMENT FOR SALE - COOL BREEZE COOT TOUCH VARIA

Cool Breeze Coot Touch Varia. Very low use. You won't find a laser at this price. $39,500. Has about 19 hours of use of it. E-mail for photos, and ask any questions. Will go fast. David Zuckerman DPM 856-229-2939 footcare@comcast.net

SPACE AVAILABLE - NYC & LI

Office to sublet and share - East 60th Manhattan, and Plainview, Long Island. access to an MRI, Joint Commission certified operating rooms, digital x-ray, diagnostic ultrasound, and access to a multi-specialty ambulatory surgical center. Also availability E 22nd between 2nd and 3rd and E 70th off 3rd. Turn-key operation - no investment needed 516 476-1815 PODO2345@AOL.COM

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