The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

March 10, 2009 #3,489 Publisher-Barry Block, DPM, JD

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NY Podiatrist Discusses Onychomycosis

"It's everywhere and that is where your shoes are usually dark and your feet sweat and it stays moist and it just lives in your shoes,” said podiatrist Dr. Jennifer Hutton." According to Hutton, foot fungus starts out very subtle. "Fungus starts out very mild and at the point where you almost can't detect it," Hutton said.

Dr. Jennifer Hutton

For women who wear toenail polish, it is easily overlooked."Certain types of fungus can put pigments out so you can start seeing black, sometimes you will see orange, sometimes it is brown, sometimes yellow," Hutton said. Dr. Hutton says give nails a break, and go polish free as often as possible. Fungus commonly begins by entering outside of the nail and then goes underneath the surface. And it's often caused by trauma.

Treatment for mild cases includes topicals, which often don't work, and oral medications for more severe cases. But some oral medications have risks; “They all break down in your liver. So we always have to monitor liver function before patients start, make sure patients aren’t taking medication that also interact through the liver that could potentially put them at risk of liver failure," said Hutton.

Source: Marcie Fraser,  News 10 Now (NY) [3/8/09]
 

IA Podiatrists Share Amputation Prevention Techniques with Surgeons from India

Podiatric surgeons at the Amputation Prevention Center at Broadlawns Medical Center recently welcomed two surgeons from India to visit Broadlawns. Dr. Ajit Kumar Varma from Cochin, India and Dr. Rajesh Kesavan from Chennai, India came to Des Moines to study new techniques to prevent amputations in those with diabetes in India.

Drs. Lee Rogers (L) and Nicholas Bevilacqua (R) with Dr. Rajesh Kesavan

Varma and Kesavan each spent a week at Broadlawns Medical Center observing methods used to heal foot ulcers and reconstruct feet destroyed by diabetes. More than 40 million people in India are estimated to have diabetes—the most people with diabetes in any one country

“While typical healthcare in India is very modern, few specialists concentrate in preventing limb losses,” explained Lee C. Rogers, DPM, director of the Amputation Prevention Center at Broadlawns.

PA Podiatrist Coordinates Blood Drive for Burn Victim

It was a November afternoon when her husband, Evan Goldglantz, intent on installing a new kitchen in their Gloucester City twin, ripped up the old floor and decided to burn some debris in the backyard. A wind kicked up and a nearby gas can ignited and exploded onto Evan. Neighbors called 911, but the young husband and father had suffered third-degree burns over 92 percent of his body. Since the Nov. 17 accident, Evan, 28, has been in the burn unit at Crozer-Chester Medical Center in Upland, PA. There, despite what has been a grim prognosis, he has hung on through surgery after surgery, through infections, through a coma, through unbelievable pain.

Evan and Danielle Goldglantz

Family friends such as Dr. Shelly Chinkes are riding the roller coaster of Evan's ups and downs, as well. Chinkes, trained as a podiatrist, has become the spokesman for the family and the medical liaison, coordinating the direction of blood donations to Evan. Doctors had estimated 50 to 100 units of blood would be needed to get him through his surgeries. Already, well over 100 units have been used.

"This family draws from the strength of hope. You see how they are managing and it puts everything in perspective," said Chinkes of Pine Hill. To cope, Danielle Goldglantz is selling two of the family's three cars. Chinkes said, "It's heart-wrenching, but I've never witnessed so many people coming together. There is such a connection and closeness of people putting their own lives aside."

Source: Barbara S. Rothschild,  Courier-Post [3/8/09]

Tips for Online Networking

If you are considering joining the world of online social networking, beware. Subtle faux pas can affect your online reputation and derail your professional and personal relationships. Use these tips to manage your profile on a social networking site like Facebook or LinkedIn:

• Post an appropriate profile picture. You don’t need to post a professional headshot. However, do keep in mind that your goal is to build your network and not to alienate any potential contacts. So choose a neutral photo that shows your friendly side without veering too far into casual or personal territory.
• Manage your biography. Most sites allow you to post information about your interests, both personal and professional. Keep it brief, but feel free to personalize your profile by revealing a bit about yourself, within limits. For the most part, you should follow the rules of polite society and avoid talking about religion, politics, and sex.
• Limit links. By all means, post content that highlights your personal interests and areas of professional expertise. Examples: links to the trade publication you contribute to or the charity your organization formally supports. Offering a glimpse of your personal interests can strengthen your business relationships and reveal connections with professional contacts.

Source: Adapted from “Facebook Etiquette: Five Do’s and Don’ts,” by C.G. Lynch via Communication Briefings
 

Query: Procardia Topical

Has anyone used Procardia topical to increase perfusion to wounds?  If you have tried Procardia, I would be very interested to hear about your experience and how you dose/apply.
 
Wm. Barry Turner, RN, DPM, Royston, GA
 

RE: Bunion Deformity with Severe Contracted Digital Deformities (Jim Giannakaros, DPM)
From: Michael Rallatos, DPM, Richard Young, C Ped

We had a very similar looking foot for a lady with rheumatoid arthritis in the office a few months ago. My partner and I performed the following procedures:
 
1) MPJ fusion of the 1st MPJ
2) Partial met head resection, 2nd and 3rd
3) IPJ fusion toes 2,3, and 4th
5) Arthroplasty 5th toe.
 
We had an excellent result post-operatively and the patient is very pleased. The pre-op and post-op results were very dramatic. 
 
Michael Rallatos, DPM, Kenilworth, NJ, mrallatos@hotmail.com

Another option would be to send this lady to a competent certified pedorthist. Custom accommodating inserts to off-load higher pressure areas, properly fit shoes or custom-molded shoes to accommodate her deformities, and possible rocker soles to speed up transfer to load forces off the met heads, while not providing any kind of cosmetic fix, might possibly provide her with enough release from pain and discomfort as to make her life more tolerable.
 
Richard Young, C Ped, Fayetteville, GA, c_ped@bellsouth.net
 

RE: Intra-op Use of Kenalog 40 (Ivar Roth, DPM)
From: Nicholas Taweel, DPM, PT, James Hetfield, DPM
 
I looked at the package insert for Kenalog-40 and Kenalog-10. As stated previously, Kenolog-40 is indicated for Intramuscular or intraarticular use only. However, the Kenalog-10 inserts states that it is NOT suitable for intramuscular use and IS indicated for intraarticular and intralesional use only. 

The only difference between the two formulations is the concentration of triamcinolone. All other ingredients are the same. Since most clinicians dilute the Kenalog with local, it is logical to assume that Kenalog-40 is safe for intralesional use if diluted down to 10 mg/ml, thereby turning it into Kenalog-10. In my opinion, it is the amount of mg's used that is the issue. However, if someone is going to be sued over the package insert info, the amount of dilution is really the issue.

Nicholas Taweel, DPM, PT, Philadelphia, PA, dpmpt@hotmail.com dpmpt@hotmail.com

So, I read the package insert. (fda.gov/MedWatch/safety/2006 /Nov_PIs/Kenalog-40Inj_PI.pdf). Nowhere does it say that intra-op Kenalog has a correlation with infection. It talks about drug-induced adrenal insufficiency. It also says "Patients who are on corticosteroids are more susceptible to infections than are healthy individuals. There may be decreased resistance and inability to localize infection when corticosteroids are used...These infections may be mild to severe. With increasing doses of corticosteroids, the rate of occurrence of infectious complications increases."

I read carefully “MAY”- also this is referring to people taking corticosteroids for some time. Bottom line is FDA package inserts DO NOT define standard of care (unless it states a direct contraindication).

James Hetfield, DPM, linezolid99@yahoo.com
 

RE: What to do in the Face of the Projected Medicare Cuts? (Jeffrey Kass, DPM)
From: Multiple Respondents

I agree with Dr. Kass and remember ~ 1 year ago saying the same thing when we staved off the last reduction and noted that the system in place was not fixed--that this is "the Band-aid" approach and we will face the same threat year after year. The prior administrations have acknowledged the flawed formula, but the new administration needs to provide a fix, which should have been in the bloated bailout plan. The Obama Administration has called for a sit-down and is "open to all opinions” regarding healthcare in this country. Now is the time for APMA, AMA and all other groups that can lobby to voice their opinion on correcting a very flawed and outdated formula tied into GDP, and who knows what else, to  factor in how we get reimbursed.
 
Michael A. DeVito, DPM, Oak Lawn IL, devitodr2@sbcglobal.net

The issue of the economy as it will affect all facets of medicine is either being ignored or dangerously underplayed by leaders of the medical professional community. No one seems to think that the American economy which gave up over 630,000 more jobs last week alone, will never affect doctors. Are we ostriches with our heads in the sand or behaving like sun bathers on a beach refusing to take shelter even though the news reports that a tsunami is headed our way?

We need to be much more proactive in a unified manner in handling a future dirge of patients, who will find themselves without a job, eventually without health insurance and an inability to afford private medical care. We are not talking about "deadbeats' who are too cheap to pay a doctor but the potential of millions of fine people who the ailing economy will leave without jobs, homes, and without health insurance. Our profession has to address this issue both from a practice management as well as from a moral perspective. 
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

You can be assured that the leaders of the APMA are on top of this, as is probably every other medical society. Now more than ever, our profession needs to come together to fight these drastic cuts. How can each of you "do your part" to help the profession and yourselves? You need to open your wallets, blow out the dust and moths, and write a check to the APMA PAC now! No more whining, no more complaining, just write the @#$% check! Got it? Good! Can you see I am serious about this?

Neal Frankel, DPM, Chicago, IL, DRNRF@aol.com
 

ASSOCIATE POSITION – HOUSTON, TX

Associate needed for 30 Year Houston practice. 2 offices, each located in growing medical center. Heavy surgical/office practice with minimal RFC. Tremendous opportunity for personable self starter. English & Spanish would be a big asset.PM&S-24 and PM&S-36 graduate welcome. Texas license required. Reply to ssssmosk@aol.com

PRACTICE FOR SALE - CENTRAL FL

Practice sale, in beautiful, high quality of life, growing area; 2000 sf bldg. fully equipped/ designed for podiatry; excellent location, features & exposure; near hospital, wound and HBO center. Great opportunity for expansion; good insurance climate. 352-357-7499 / E-mail: windnwave@earthlink.net

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

PRACTICE FOR SALE or ASSOCIATE WANTED – SOUTHEAST OHIO 

Well-established, two-office practice in Southeast Ohio for sale. Seller currently works 3.5 days per week. Gross >$300K, Net ~$140K.  Excellent locations and growth potential. All equipment and furniture included. Seller is willing to help with transition, Ohio Licensure. Contact seller at bjadpm@hotmail.com for more information.

ASSOCIATE POSITION- CALIFORNIA

Associate needed for coverage in the office, nursing homes and facilities in Orange County Southern California. Surgical as well as C&C. Will help to get on staff at St. Jude Medical Center. Please contact Dr. Lee for more information at (714) 333-5837 or by e-mail to chinuklee@yahoo.com

ASSOCIATE POSITIONS – CALIFORNIA

Three podiatrists needed for busy North Hollywood office. Full-time Monday-Friday 8am-2:30pm.  No weekends and no call. Pay negotiable. New podiatrists are encouraged to apply. Please email resume and salary request to Coasttocoastpodiatry@yahoo.com

ASSOCIATE POSITION – NAPLES, FL

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. 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

PRACTICE FOR SALE-SOUTHEAST MICHIGAN-BRIGHTON
 
Outstanding opportunity. Eleven year established. Excellent location in mid to high income growth area. Must sell due to illness. Turn-key, all equipment and furniture included. Beautiful 1,350 sf build-out. Great visibility and parking. Priced low to sell immediately. Call (248) 565-5266. Docpod@aol.com 

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

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

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

 
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