The Voice of Podiatrists

Serving Over 9,000 Podiatrists Daily

February 26, 2007 #2,819 Editor-Barry Block, DPM, JD

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CT Podiatrists Provide Advice on Nail Pedicures and Polishes

Bridgeport Podiatrist Dr. Tina Chieco said some podiatrists even offer medical pedicures, which only include cutting or filing and cleaning the nails. Although it isn't as glitzy as the pedicures done in nail salons, Chieco said, it is safer and done by licensed professionals."We have been trained to work with feet," she said. "We know where and how much to cut the nail. The only difference is that we don't do massages or fancy little nail designs; just the basics." Medical pedicures are usually offered to people with diabetes, according to Chieco. "It's hard for diabetics because they want to look and feel good,

Dr. Tina Chieco

Chieco also is concerned about the damage to nails from dark nail polish. "The dark colors seep into the nail, essentially staining it and leaving it discolored," she said. "The more you use it, the more it strips away at the protective layer of your nail leaving you vulnerable to infection."Chieco said she recommends using nothing darker than a coral shade.

Dr. Sanjay Patel

Hamden Podiatrist Dr. Sanjay Patel said all colors contain harmful chemicals damaging to nails. "Not a lot of women know this, but nail polish is very damaging, especially when you change the polish frequently," he said. "Women tend to get overzealous with nail polish, and it just thins away at the nail."

Source: Lissette Rodriguez, Easton Courier [2/23/07]

Rollins College Basketball Star to Attend OCPM

One of these days there will be time for reflection. Time to appreciate the 20-win seasons, the big wins, the clutch performances that have marked her career at Rollins. For the time being, though, Larissa McDonough is too busy adding to her scrapbook of memories to start reviewing them. The latest chapter for the Father Lopez product came Wednesday night, when she scored 17 points and handed out three assists to lead her Tars (21-5) past nationally ranked Florida Tech in overtime. It was the final home game for a senior veteran coach Glenn Wilkes Jr. describes as one of the five best -- and the most versatile -- ever to wear a Rollins uniform.

Larissa McDonough

"When she's out there on the court, everything's OK -- we're gonna be all right," said Wilkes, who is in his 21st season at Rollins. "And that's pretty much the way it's been the four years she's been here. "We know we're always gonna be in the game. We know we always have somebody who can hit a big shot when we need it. She's had a very calming effect on our team because everybody knows how good she is." That knowledge will persist long after the 6-foot-1 McDonough has moved on to the Ohio College of Podiatric Medicine.

Source: Steve Master, Daytona News- Journal [2/23/07]

Poll Finds Support For Prescription Privacy, But Few Have Signed on to AMA Program

About 54% of physicians support a ban on the collection of any personal drug-prescribing information, saying tougher restrictions should apply to their privacy with patients, according to a new national poll. Despite those concerns, only about 4% of doctors have taken advantage of the American Medical Association’s Prescription Data Restriction Program, which effectively prohibits the release of prescribing information to drug salespeople.

The Internet survey, which includes six specialties, also found that only about 29% of the physicians plan to use the AMA’s data-restriction program to keep their prescribing policies off-limits. About 44% of those surveyed said they will wait and decide later whether to join the data-restriction program. At the same time, the survey found, an overwhelming majority of these doctors—about 85%—said they would be willing to provide information on prescribing practices to the drug industry through market-research questionnaires. A spokesman for TNS said doctors are concerned about the accuracy of information from secondary sources, including pharmacies, but are much more comfortable when the information on their prescribing habits is “self-reported.”

The AMA said about 6,000 of its 244,000 members have signed up for the data-restriction program since it was launched in July 2006.

Source: Michael Romano, Modern Healthcare [2/23/07]

FAH Announces Universal Health Insurance Proposal

As expected, the Federation of American Hospitals on Thursday announced a proposal that would require all U.S. residents to obtain health insurance, Reuters/Los Angeles Times reports. Under the proposal, which FAH hopes will become part of federal legislation after the 2008 presidential election, residents would have to enroll in health plans offered by employers, purchase individual health insurance or obtain coverage through public programs. The proposal would expand eligibility for Medicaid and SCHIP

In addition, the proposal would provide subsidies, based on income, to help cover the cost of health insurance and allow those who purchase individual coverage to deduct the cost from their income taxes.

Source: Reuters/Los Angeles Times via American Health Line [2/23/07]

Query: MicroVas e-stim Machine

I am looking for feedback on the Microvas e-stim machine manufactured by the NeuroVasix Company.

Scott Knutson, DPM, Albert Lea, MN

RE: Perioperative Anlagesia (Eugene Batelli, DPM)
From: Multiple Respondents

The rationale behind my pain regimen is that surgical trauma causes a ‘pain cascade’ in the body that includes a local inflammatory response and a systemic and central nervous system response. I began using it after talking to a pain management specialist. The reason for the short term use of Lyrica is to help limit the central nervous system component of the post-op pain cascade- not to treat post op pain. He had also recommended dextromethorphan cough syrup, which I don’t use. Of all the different components, I find the Toradol most effective.

I forgot to add in my original post that I give 4 or 8 mg of dex IV intra-op as well.

Scott Hughes, DPM Monroe, MI, soulking_1@comcast.net

Dr. Batelli writes that he treats some of this diabetic patients with high doses of Lyrica and goes up to 150 mg. three times a day. On one hand, I am happy to hear that some doctors are venturing to give high doses of pregabalin to patients with recalcitrant diabetic neuropathic pain. On the other hand, I tell doctors who attend my lectures on the treatment of DM neuropathy that the package insert on Lyrica which is available online at Lyrica.com states on page 38 (online PDF document) the following: "In view of dose dependant adverse effects, treatment with doses above 300 mg. a day is not recommended."

What is confusing is that in other parts of the same handout, it says that the treatment for post herpetic neuralgia is as high as 600 mg a day and much earlier in the handout it makes of point of saying that in test groups where patients took over 900 mg. a day the types of adverse reactions did not differ than with patients taking the recommended dosages.

From a medical legal perspective, if a doctor gives a diabetic patient above 300 mg. a day and he or she has a bad untoward reaction, could that patient hold the doctor liable because the pamphlet composed by the company warns the prescriber not to go above 300 mg. a day for diabetic patients?

Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

I'd like to comment on the suggestion of using corticosteroids (Celestone or DepoMedrol), in or near the surgical site. Every now and then somebody expresses the concern about possible masking of infection, delayed wound healing, weakening of collagen...who knows? Nonetheless, the practice seems generally accepted to some degree or another.

I don't know of any studies that have looked at this, but wonder why we often use a dose in a localized area, that parallels what one would use for the entire body. A whole cc of Celestone...or 40 mg of DepoMedrol! If you break it down and think about it in terms of mg of drug per Kg of tissue, that's a monumental amount, given the very small mass of tissue in the foot that has to be affected. I have absolutely no scientific basis for doing it this way, but whenever I use corticosteroids in a surgical site, I dilute it down to about 1/2 of a tenth of a cc with saline or into the local anesthetic and it still seems to be effective. But I wonder...without a control, who knows whether it really makes a difference?

So why doesn't somebody do the following study. Take a whole bunch of patients undergoing bilateral foot surgery under local anesthesia. One foot gets local with no corticosteroid. The other foot gets local plus 1 cc of corticosteroid either full-strength or diluted 1/2, 1/4, 1/8, 1/16...etc. The investigators are blinded to which foot gets what. Then determine how far out the dilution gets before the corticosteroid no longer makes a difference. Also see if any delayed healing or masking of infection and if that correlates to the concentration. Of course there would be other considerations like whether to use soluble vs. repository type of steroids, but at least the use of these would be more rational.

Carl Solomon, DPM, Dallas TX, cdsol@BaylorHealth.edu

PRACTICE FOR SALE -NORTHERN CALIFORNIA

Great opportunity to own a well-established turn-key podiatry practice located in modern medical office building in East Bay; Electronic billing, good payor base, no HMO contracts; biomechanics, general podiatry with great potential for surgery. Please send CV and letter of interest to: norcalpod@hotmail.com

ASSOCIATE POSITION – WASHINGTON, DC

Associateship leading to full purchase or immediate sale. 25 Year old practice located in a hosp. w/ full surg privileges. Large number of diabetic patients and referrals. Fully equipped with x-ray, topical hyperbaric oxy units, 4 tx rooms and more. $400K on only 3 days a week. Will finance with generous terms and stay to introduce. Owner leaving area. Contact R. Benjamin, DPM jhallux@yahoo.com or 202-841-5545

PRACTICE FOR SALE MICHIGAN-DETROIT AREA

Michigan practice Detroit western suburbs for sale. 3 offices, great locations & high gross, buy outright or over time. Call 561-213-9400 after 7:00 p.m.

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 – PORTLAND, OREGON

Immediate opening in beautiful Portland, OR. Busy, well-established private practice is seeking a dynamic, motivated, surgically-trained podiatrist. High volume of primary care referrals. Work with a well-trained support staff in one of the most efficient offices in the area. Surgically-oriented practice. Competitive compensation package including malpractice and benefits. Call (503) 652-1121. Ask for Dr. John Mozena or email jlmozena@aol.com

SEEKING RESIDENT FOR PSR-24 POSITION: BALTIMORE, MD

Mercy Medical Center -Position for a highly motivated individual with completed non-surgical residency or one desiring additional surgical training in well-established Podiatric Residency Program. Busy metropolitan hospital with high surgical numbers and inpatient care. Resident is integral member of multidisciplinary team. Begins mid June 2007. Includes competitive salary/benefits. Send inquiries to rsher18@yahoo.com

ASSOCIATE POSITION – NY & CONNECTICUT

Opportunity to be a part of a prestigious and well-established large Orthopaedic and Rehabilitation practice, with locations in Stamford, CT and West Harrison, NY. Looking for a Podiatrist to join an already busy practice with opportunity to build. We have state-of-the-art offices with MRI, digital x-ray, paperless charts, physical and occupational therapy. Applicants should be Board Certified or Board Eligible. Competitive salary and benefits. For further information on the practice, log onto WWW.NYCONNORTHO.COM Interested candidates should forward their C.V. to: Cliff Katz, Executive Director ckatz@nyconnortho.com

SOUTH CENTRAL PENNSYLVANIA-PM&S 36 ASSOCIATE WANTED

Large, busy podiatry group looking for associate interested in future partnership. Practice facilities and technologies include: Surgical Center, Physical Therapy Department, six appointment locations, EMR, MRI and Digital X-ray. Full compensation and benefit package offered. Mail CV to Martin Foot and Ankle, 1203 S. Queen St. York, PA 17403 or email business administrator, johnreitzel@comcast.net.

POSITION AVAILABLE - SOUTHEAST TENNESSEE/ NORTH GEORGIA

Immediate position available or will wait for the right individual. Unique practice opportunity in growing multi-physician/multi-office practice. Well established/cutting edge within the medical community. Close proximity to hospitals as well as opportunity to become involved with a free standing podiatric surgical center. Must be BQ/BC. Minimum PSR/24. Competitive salary, bonus structure and benefits. E-mail CV to afcjen@hotmail.com

ASSOCIATE POSITION - EAST/CENTRAL TEXAS

Practice in East Central Texas has an opportunity for an associate to join as an associate leading to partnership. Hospital supported practice which has two doctors seeking a third for new office. Practice is leading provider in market and offers an outstanding compensation and benefit package. This position is targeted to be an equity partner within two to three years. easttxdpm@comcast.net

ASSOCIATE POSITION - SANTA FE, NM

Established, 30 year practice with multiple office locations looking for a PSR 24/36 trained, hardworking, personable, ethical, highly motivated individual for associate position with immediate partnership available. E-mail CV and reference letters to sfpodiatry@aol.com

ASSOCIATE WANTED FOR SOUTH MIAMI AREA

Large group, busy, multi-office, partner potential. Motivated applicants only. Mail resumes and letters of intent to 999 N. Krome Avenue, Homestead , FL 33030. July start time OK, sooner preferable. E-mail lianadpm2@aol.com

ASSOCIATE WANTED - NORTH CAROLINA , CHARLOTTE AREA

Incredible opportunity to join a busy, well-established group practice. Looking for a self-motivated, hard-working individual seeking to become a partner. Hospital and surgery center privileges. Salary plus percentage, 401k and real estate opportunities. Send CV to universityoffice@ bellsouth.net

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