The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

March 08, 2010 #3,798 Publisher-Barry Block, DPM, JD

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Laser Holds Hope for Treating Onychomycosis: TX Podiatrist

Podiatrist Dr. Gabriel Maislos says chronic toenail fungal infections have been tough to treat. "Historically, we had topicals that were 8 percent effective. Then you had the pill, which was Lamisil, but as you know, it can have an adverse effect on your liver, and it's only 70 percent effective. Now we have the laser, which is 87 percent effective," Dr. Maislos said.

Dr. Gabriel Maislos

The doctor follows a grid-like pattern, passing an infrared laser over the toenail to kill the pathogens causing the infection, leaving the nail and surrounding tissue intact. "We're able to kill the fungus at the source,” Dr. Maislos said. In a clinical trial testing one brand of laser, the infection was eliminated in 50 percent of toenails tested after four treatments. Six months later, 76 percent of patients had clear nail growth. The laser is not FDA-approved for toenails, but the device was cleared for dentists to use, so some doctors are using it off-label. Another brand of laser is still in clinical trials.

Source: Maureen McFadden, WNDU [3/3/10]

French-Speaking Temple Resident Bridges Gap Between Haitian Patients and Doctors

Sebastien Demoiny, a fourth-year podiatric surgery resident at the School of Podiatric Medicine and Temple University Hospital, accompanied a relief team to provide wound care and surgical care to displaced residents of Haiti. Demoiny and his team set up a clinic in their hotel in the southern Haiti port town of Jacmel the very first day, treating almost 350 people. Over the course of the week that they were there, the team saw more than 1,000 patients.

Dr. Sebastien Demoiny in Haiti (Photo: William Haun)

Demoiny said, as a podiatrist, he at first felt a little unsure of how his skills might be helpful. But his medical specialty came in handy on a number of cases. In addition, Demoiny is fluent in French, which helped bridge the communication barrier between patients and doctors. “I got all the wounds, abscesses, and extremity problems, but I also treated a lot of patients with asthma, diarrhea, malaria and stomach aches,” he said. “There had been so much dust since the earthquake that people were having a lot of respiratory issues and irritated eyes.”

Armstrong and Mulder Keynote at Symposium in Jeddah

Under the stewardship of Saudi Arabia's Prince Mishaal Bin Majed Bin Abdul Aziz, David G. Armstrong and Gerit Mulder, Professors of Surgery at University of Arizona and UC San Diego, respectively, were keynote lecturers at a high-powered gathering of clinicians at the International Surgical Diabetic Foot Symposium in Jeddah, this week. "Fully one quarter of adults in Saudi Arabia have diabetes", noted Armstrong, who was the guest of honor at the opening ceremonies of the event.

Dr. Sami Badawood (Health Minister) and HRH Prince Mishaal Bin Majed Bin Abdulaziz (Governor) present award to David G. Armstrong at the opening ceremonies of the International Diabetic Foot Surgery Conference in Jeddah, Saudi Arabia.

The meeting, which attracted physicians and surgeons from throughout the region, was focused as much on policy as on surgical procedures. Armstrong continued, "I think that the goal is to bring further awareness to this issue. The fact that Prince Mishaal and leaders from the Health Ministry of the Kingdom are here supporting this is a superb first step. It acknowledges all the good work that has been done by the clinicians in Saudi Arabia."

Professionalism and E-Mail

Maintain professionalism while you communicate online, by telling yourself, “I may be alone at my computer right now, but the words I write can create first impressions for thousands of people whom I may never meet.”

Source:  Adapted from Heart & Soul Internet Job Search, Chuck Cochran and Donna Peerce, Davies-Black Publishing via Communication Briefings

RE: Pre-Fab Gait Plate (Jeffrey Kass, DPM)
From: J. David Skliar, DPM

Dr. Kass’s search for a pre-fabricated gait plate for an excessive toe-out problem is denying the understanding of what a gait plate can do and, more importantly, what it cannot do. Gait plates were originally designed and fabricated from a flat steel plate in the 1950’s by the late Dr. Richard Schuster. In later years, rigid plastics like Rohadur were substituted. They have no functional effect on the foot except to…

Editor’s note: Dr. J. David Skliar’s extended-length letter can be read here.

RE: Foot and Ankle CME Opportunities for Physical Therapists (Eric Hart, DPM)
From: Amol Saxena, DPM

If you are attending the Midwest Podiatry Conference, two PTs will teach the Kinesio/Darco Body Armor Taping course on Saturday Mar 13 @ 2 PM, and will later help with the lecture "Rehabilitation of the Athlete" that day. I hope to incorporate more rehab lectures in future meetings, as it is clearly needed and there are few EBM protocols.

Amol Saxena, DPM, Palo Alto, CA, heysax@aol.com

RE: Council for Nail Disorders
From: Bryan C. Markinson, DPM

For the sixth year in a row, I am writing from the 14th Annual Scientific Session of the Council for Nail Disorders, one day before the start of the American Academy of Dermatology meeting in Miami Beach. Today, 62 physicians, 60 dermatologists, and 2 podiatrists from all over the globe convened for what was universally described as the best nail disorder meeting ever. This organization is totally “open-door” to DPMs. The subject matter presented and discussed amongst these world-renowned experts was so extensive that the only limitation was the time of day. I presented several cases of subungual amelanotic nodular melanoma.

I encourage all DPM's to read the writings of Eckart Haneke, Antonella Tosti, Richard Scher, C. Ralph Daniel, Bertrand Richert, Robert Baran, Nilton Di Chiacchio, Nathaniel Jellinek, and Philip Fleckman, and then come and meet them in person at next year's meeting in New Orleans on February 3rd, 2011. Go to nailcouncil.org for additional information on membership in this made-for-podiatrists organization, where every question is valued as an opportunity for extending knowledge. At the meeting of the board of trustees of the Council, of which I am a member, it was decided to organize a poster/paper award, where dermatologists and podiatrists from the residency level on will be invited to submit work in the area of nail pathology/diseases.

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

RE: The Future of DME in Podiatry?
From: Narmo L. Ortiz, Jr., DPM

In late February, I received a letter from the VP of Contracting & Provider Services for CIGNA Great-West Healthcare, covering the Florida & PR/USVI regions with an update on home health, home infusion and durable medical equipment services in FL. Basically, it stated that home health and infusions services, as well as DME on medical supplies, orthotics and prosthetic products and services were going to be provided by two independent contractors in the service areas covering about sixteen counties in West, Mid-central, and SW Florida.

In the county where I practice (Lee), the major "non-profit" health system, which accounts for about 90% of the total healthcare services provided, has also re-directed their DME products and services to their own independent contractor for all employees under their health insurance plan. 

Are these the signs of things to come from ALL insurance companies and possibly even Medicare? If we, as a profession, lose the ability to dispense DME to our patients, a lot of practices will lose about 30% to 40% of their income. We will also lose the ability to make our own choice of which products are the best for our patients with specific pathologies.
 
Narmo L. Ortiz, Jr., DPM, Cape Coral, FL, narmoortizdpm@gmail.com

RE: Concerns from a Podiatric Physician (Joseph S. Borreggine, DPM)
From: Multiple Respondents

I don't know why I was personally upset at Dr. Borreggine's letter, but my heart went out to him. He seems savvy, well trained, skilled, and connected to his community, yet his practice is waning.

I suggest he conduct an amateur, but thorough, statistical analysis of his practice using Excel which is an excellent tool for this purpose. He should create a data base of new patients seen in the past 6-12 months who have not returned or followed up with treatment. He should include things like age, neighborhood, referral source, diagnosis, treatment recommendations, insurance, etc. He should then do a similar analysis for patients who are loyal and have returned. Do separate analyses for each office. Sort the data various ways and see what trends emerge.

Joel Lang, DPM (retired), Cheverly, MD, langfinancial@verizon.net

All Dr. Borreggine, or for that matter, any podiatrist, needs is a chance, but no one wants to give it to us. Any of us who want to change our poor podiatric plight just need the opportunity to be sponsored to take the USMLE I and II exam. US medical schools don't care. Foreign medical schools are a possibility, but require a major change in geography. Take just one podiatry school, convert it, and accept only graduate podiatrists without MCATS, grade checks, etc. and give them the chance. Many foreign schools do not require MCAT's at all. Just having even a provisional acceptance as a W.H.O. medical school automatically qualifies the students to take the USMLE and/or ECFMG. 

Having the MD degree would give you opportunities in clinics, hospitals, insurance companies, etc. You can take all the podiatric subspecialties you want.  You can sell all the shoes and medicaments you can.  You can take all the practice management you can stand, but  nothing will propel you ahead like having the MD. Write to the schools, the APMA, and  the Council on Podiatric Medical Education. Demand that we are given a chance to save podiatry as an MD specialty, NOW.

Robert Bijak, DPM, Clarence Center, NY,  rbijak@aol.com

Editor's note: Dr, Chuck Ross' extended-length letter can be read here.

RE: The Loss of Robert Piccora, DPM
From: Vincent Gramuglia, DPM

I am sorry to see Bob Piccora leave us and my prayers are with his wife Myrna and his children Nicholas and Christine.
 
He left his mark on everyone he came in contact with, especially those of us from St Barnabas Hospital in the Bronx. In no other residency program could you scrub 6 foot cases a day, tell jokes, and then eat dinner on Arthur Avenue with the other residents, the students, and the residency director (Bob Piccora). After this, we would go back to the hospital and scrub cases with ortho, vascular, neuro and general surgery. He was a great ambassador who cultivated these interdisciplinary relationships through his magnetic personality. None of us were ever in a hurry to leave.
 
In 1987, he hired me to work in his office after my residency for a year, and I was fortunate to learn many more things. Most of them were "non-podiatric";  like how to drink double espressos...or the fact that if I really concentrated, I could eat 4 slices of pepperoni pizza!...or how to hit 3 golf balls in the water and still write down a 5 on the scorecard.
 
The greatest thing I learned, though, was how to talk to people and make them feel like they were your best friend for that moment in time. To me, that was his greatest gift, and I'm happy to have known him, albeit for much too short a time. Rest in peace my friend. We will miss you.
 
Vincent Gramuglia, DPM, Bronx, NY

RE: $1,475,000 Settlement for MD's Failure to Diagnose Charcot Foot
From: Elliot Udell, DPM
 
When the topic of Charcot foot has come up in the past, there has been controversy over what can or should be done to slow down the process. Some of us have tried some of the off-label uses of pharmaceuticals that are used to treat osteoporosis. Others have used bone stimulators off-label, with some degree of success. I have had success with one patient using both approaches. Of course, if there is extreme distortion of the foot, surgical management is always an option, but that too has its risks, especially since these patients generally have co-morbidities.

One of my patients with lots of illnesses sought out an orthopedic surgeon to operate on his Charcot foot, even though both I and a noted wound care (MD) specialist advised against it. He did not survive the surgery. In light of the fact that there are no silver bullet treatments that work all of the time for this condition, did failure to make the diagnosis warrant a million and half dollar settlement?
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

FULL-TIME PODIATRY OPPORTUNITY -  BOSTON, MA

HealthDrive is seeking a caring podiatrist to join our group practice. We currently have a FT non-surgical opportunity available in the Boston, MA area. We offer a competitive salary, Paid malpractice Insurance, health and dental Insurance, long & short term disability, flexible schedule (No weekends), established patient base, equipment, supplies and complete office support provided. If interested in this opportunity, please call Maria Kelleher (toll free) at 877-724-4410 or email caring@healthdrive.com
  
OFFICE SPACE TO SHARE - NYC

Wanted- Licensed podiatrist to share space in a State-Of-The-Art medical office in the midtown area. Please call Dr. Robert Singer (212) 921-5775 or e-mail dr.roberth.singer62@netzero.net

ASSOCIATE POSITION - TAMPA BAY

Associate needed for a dynamic multi-doctor practice in the Tampa Bay area. Preference given to a PSR 24+ training and must have a Florida license. Well-established practice, high-tech with EMR and digital x-rays, with specialties in sports medicine, surgery and wound care. No nursing homes or HMOs. Excellent hospital privileges available. Choose an area of practice concentration that you are passionate about and enjoy a lifestyle for yourself and your family second to none. Kindly forward C.V. to e-mail drcosentino@tampabay.rr.com

ASSOCIATE POSITION - DAYTONA BEACH, FLORIDA

Associate position with buy-in potential. Daytona Beach, Florida Great opportunity for PSR 24-36.trained physician to join state-of-the-art practice. Please forward resume to pfk4@yahoo.com

ASSOCIATE POSITION-INLAND EMPIRE, SOUTHERN CALIFORNIA

Associate needed full or part-time for multi office practice. Must be ABPS BC/BQ. Hard working, ethical individual who is looking to a possible partnership opportunity. Looking for current licensed or resident completing program this spring. Email CV to bkatzman2@earthlink.net or call Martha 909 984-5614.

ASSOCIATE POSITION - TEXAS

Dynamic, growing practice in Dallas/Fort Worth area, seeking surgically trained, Board Certified/Board Qualified Podiatrist. Excellent salary and benefits compensation package, for the right candidate, with partnership/buyout opportunity. Contact/Send resume to: jmh6122@yahoo.com

PRACTICE FOR SALE: TENNESSEE

Established 30-year full-scope podiatry practice. Excellent hospital and surgery center privileges with investment opportunities. Fully equipped 2200 sq.ft. office across from hospital. High volume of new patients, DME, and local referral base. Great community for a family and the outdoorsman. Reply to tnfootdr@gmail.com

ASSOCIATE POSITION - NORTHERN VIRGINIA/DC SUBURB

Excellent associate practice opportunity leading to partnership for PSR 24-36 foot and ankle surgically-trained physician. Currently 4-doctor/2 office practice in fast-growing area, expanding to 5 doctors. Hard working, personable, highly-motivated individuals needed. Great opportunity with excellent salary and benefits. No nursing homes. Top hospitals. Fax CV with references to 703-491-9994

ASSOCIATE POSITION - MICHIGAN - (OAKLAND COUNTY)

outstanding opportunity for associate in well established practice, general & surgical podiatry forefoot, rearfoot & ankle (full or part-time). Well-trained, responsible, motivated with good communication skills, ABPS qualified or better. Send CV & letter of interest to: PodiatristWanted@AOL.COM

ASSOCIATE POSITION - TEXAS

Wonderful opportunity! Successful multi-office, multi-professional practice seeks well-trained new and established podiatric physicians with expertise in sports medicine, podopediatrics, rearfoot/ankle surgery, or hospital podiatry. A must to be outgoing, motivated, and personable with a dedicated hard-working ethical desire to become a winner. Send resume, current photo and letter of interest to sierrajip@gmail.com

PRACTICE FOR SALE - UPPER WEST SIDE NY

Great starter practice or satellite office in NY. Looking for new podiatrist who needs to start on his/her own, enthusiastic and flexible hours. Serious inquires only. Office has been used as satellite office, but can easily be expanded to a primary office if your schedule permits. Call 201-491-2173

POST-GRADUATE PODIATRIC RESEARCH FELLOWSHIP

Boston University Medical Center and Boston University School of Medicine. This unique fellowship at a major teaching facility is a two-year opportunity, during which he/she would be expected to become a knowledge expert who will contribute significantly to research, teaching, and innovations in limb preservation and tissue repair. Requirements: Completion of a two or three year surgical residency; Massachusetts license-eligible, ABPS Board Qualification-eligible. Candidate must possess a commitment to an academic career in podiatric medicine and surgery. Annual Salary: Year-1 $61,000, Year-2 $66,000. Submit a CV and letter of interest to: erin.springhetti@bmc.org

PRACTICE 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.

PRACTICE FOR SALE – CONNECTICUT

Outstanding practice for sale in northern Fairfield county, CT. Shared space with other medical professionals. Very low overhead. Grossing almost $300K on 30 hours per week. Referrals from three different primary care physician offices. If interested e-mail CTPodiatry@gmail.com

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