The Voice of Podiatrists

Serving Over 9,000 Podiatrists Daily

March 16, 2007 #2,835 Editor-Barry Block, DPM, JD

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Air Bags Linked To More Foot, Ankle Trauma: AL Podiatrist

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Members of the American College of Foot and Ankle Surgeons (ACFAS) say they’ve noticed a significant increase in traumatic foot and ankle injuries among patients who survived auto accidents. The reason? Air bags. In 1998, the federal government started requiring dual front air bags in passenger cars. Since then, several research studies have documented a corresponding increase in lower extremity injuries. According to a federal report, drivers in air-bag equipped cars suffer more than 17,600 lower extremity injuries every year. One-third of those are to the foot and ankle.

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Dr. James L. Thomas

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"We see trauma we never saw before," says ACFAS President James L. Thomas, DPM, FACFAS, a foot and ankle trauma surgeon at the University of Alabama, Birmingham Hospital. "A decade ago, these patients would have died from head trauma or other upper body injuries. Now, thanks to seat belts and air bags, they survive."

"Many patients who suffer foot and ankle trauma in an auto crash – with or without air bags – face a long road to recovery," says Thomas. "But the good news is, many patients do recover and lead a normal active lifestyle."

Watch Your Feet Position on Ellipical Trainer: Richie

If your feet burn after 20 minutes on an ellipical traner, your problem has to do with nerve pain, says Dr. Doug Richie, a Seal Beach-based podiatrist and past president of the American Academy of Podiatric Sports Medicine. "It's from the concerted, unchanging pressure on the ball or the heel of the foot. There's no changing or shifting of pressure as with walking or running."

Dr. Doug Richie

Most who use ellipticals or stair climbers use the balls of the feet to move the pedals. Those pinched nerves, he says, "don't do well when they have constant pressure applied on the same spot minute after minute," and often react by creating that burning sensation you feel.

The remedy is simple; Richie suggests being more conscious of the position of your feet when you're on the machine. Make sure to keep your heels down to distribute the stress over the entire foot, not just the ball. Arch supports in your shoes might help as well. "It helps dissipate pressure to a wider area, especially the arch that isn't sharing and bearing the weight," Richie says.

Source: Los Angeles Times [3/14/07]

Simple Breath Test to Detect Diabetes and Monitor Blood Sugars

At present, Type 1 diabetes or juvenile diabetes is detected by directly drawing a small amount of blood and assessing the amount of glucose it contains. But it may be possible to sense diabetes on the breath, according to Armstrong Mbi, a graduate student at Mississippi State University.

Mbi and his advisor Chuji Wang have developed a new technique to detect acetone, one of the chemicals whose presence in the lungs rises when blood-sugar levels are high. The team injected acetone-laden water vapour into a small chamber with mirrors. They then sent an infrared laser sensitive to the acetone into the hollow. By detecting the amount of time it took the light to completely dissolve as it went back and forth between the mirrors, they were able to perceive amounts of acetone to concentrations of 0.45 parts per million by volume (ppmv). Mbi says that initial tests show that typical diabetics have acetone levels greater than 1.4 ppmv. Based on the new test, they could tell if the person is diabetic or not.

The new technique sounds helpful to Matt Petersen, director of information resources for the American Diabetes Association in Alexandria, Virginia. Current tests are highly accurate but require blood samples. "Non-invasive techniques are always better. If the technique could be extended to test daily blood-sugar levels, then it would be "extremely interesting," Nature quoted Peterson, as saying.

Source: Diabetes in Control [3/14/07]

White House Rejects Health Panel’s Key Ideas

The White House late Tuesday rejected key recommendations from the Citizens’ Health Care Working Group, a congressionally mandated, nonpartisan group that held town hall-type discussions across the country, as well as an Internet survey, to gauge the healthcare wants and needs of a broad slice of Americans.

In written comments to Congress and to the group, administration officials said that “the working group chose an approach based on mandates and government intervention rather than an approach emphasizing consumer choice and options. In reviewing the working group’s report, we have major concerns with some of the recommendations.”

The final report, submitted to President Bush on Sept. 29, 2006, contained one overarching recommendation—healthcare coverage for all—and five other actions for achieving it. Those recommendations included: protection against catastrophic healthcare costs; the fostering of integrated community health networks; the establishment of a public-private commission to define America’s core health benefits and services; promotion of quality improvement initiatives; and a full-on restructuring of the way end-of-life services are financed and provided.

While administration officials said that they agree in principle with many of the group’s ideas, they nevertheless disagreed on how to achieve them.

Source: Matthew DoBias, Modern Healthcare [3/14/07]

Query: Castellani Colorless Paint

I have been utilizing Castellani colorless solution topically for many years as an in-office chair side topical agent. Recently, my supplier discontinued a very economical 16 ounce in favor of a more expensive 1 ounce bottle. Does anybody know of a replacement supplier for this item?

Neil H Hecht, DPM, Sherman Oaks, CA

RE: Sedating Patients For Routine Care (David E. Gurvis, DPM)
From: Multiple Respondents

I used to see a lot of patients like this, and there was one time that I recall having to take a patient to the OR for sedation for routine nail care. Sometimes you can ask the nursing staff when patients are given their regular medication and schedule your visit around that time. Sometimes it is also helpful to schedule patients in the later evening when they are nearly ready for bed, as they are usually calmer.

Ira Weiner, DPM, Las Vegas, NV, vegasfootdoc2005@yahoo.com

I have taken a patient to the operating room because of this problem. She was an elderly nursing home patient and absolutely did not want anyone touching her feet. She became combative when this was tried, even with sedation. Her nails looked like the classic picture of rams horns, curving around the tips of her toes and cutting into the toes. Because of her dementia, we needed the permission of her family, who agreed readily.

She was given general anesthesia for a few minutes, and did well. I justified my trip to the OR with the thought that this was not routine care.

Randolph C. Fish, DPM, Tacoma, WA, rcfish1@juno.com

I’m sure the family physician would be happy to work with you to medicate the patient. I had a similar situation, called the family doctor, and found they had to deal with the same uncooperative behavior when they treated the patient as well. They were more than happy to assist with medicating the patient. The care facility was initially requesting general anesthesia for nail care, but this seemed pretty extreme and was not advised given the patient’s other health issues. Things worked out fine for my patient with a healthy dose of Valium.

Sylvia Trotter, DPM, Riverton, WY, jefsyl@wyoming.com

I provide podiatry services for a state mental facility. There are residents there that are just normally combative, cutting nails is hard enough let alone trying to do calluses. When one of these residents is on my list to be seen, the staff makes sure they are given a pre-med of either Ativan, Choral Hydrate, or sometimes Xanax about a half hour before treatment. They receive the same for dental care also. The biggest problem is that they seem to get accustomed to certain doses and so it needs to be bumped up to achieve the same effect. I have an individual that normally receives 4-5mg of Ativan and it barely seems to phase him.

Duane Dumm DPM, Ebensburg, PA, podtwo@netzero.net

RE: Who Owns Patients?
From: David Secord, DPM

At one time, I was in a practice that saw patients in nursing homes two days a week. One facility informed us that they were switching to a different podiatrist provider who would do what we would not: provide care to everyone in the facility. At this facility, about a third didn't qualify due to medical condition, age, having completely normal nails, etc. Because we wouldn't treat the patients who didn't qualify for free, we were dumped. In what other profession would the provider of a service be asked to do a certain amount for free to keep a contract? I've always wondered what sort of shady billing practices might have been done by the new providers to make the cost/benefit ratio acceptable to them?

David Secord, DPM, Corpus Christi, TX, Secord@medscape.com

PRACTICE FOR SALE - BUFFALO, NY

Part Time Practice with full growth potential. Mi of conservative, biomechanics and diabetic foot care. Great surgical potential. Gross 180K. Willing to stay through transition. Call 716-836-8123.

2 ASSOCIATE POSITIONS AVAILABLE IN WYOMING

We need 2 associates to work in our Wyoming offices. We are a growing multi office (podiatry only) group. We are the largest podiatry provider in the region. 100K+ potential. Percentage salary, malpractice and medical paid, CME allowance yearly. Great outdoor locations and activities. Email CV and for more information. craig@enotesoftware.com

ASSOCIATE POSITION – CENTRAL NEW JERSEY

Associate Wanted....For well established Central Jersey practice, diversified in all aspects of podiatric medicine and surgery. I am looking for a highly motivated, conscientious, individual with strong work ethics. My practice may offer great potential for the right person. Minimum PSR 24. Please reply to Jerseypod@gmail.com

ASSOCIATE POSITION- MINEOLA, NY

Excellent opportunity in fast-paced well-established podiatry practice for full time associate, all phases of podiatry including surgery, biomechanics, orthotics and routine foot care. Begins July 2007. Includes competitive salary and benefits. Please send CV and letter of interest to: cfcsteve@optonline.net

PRACTICE FOR SALE SAN DIEGO, CALIFORNIA

5 y/o LaJolla Ca (San Diego) office collecting $289.5K with mostly soft tissue office procedures, biomechanics, general care, and no HMOs. Affluent community with great schools. Major opportunity for growth. Selling due to age and health. Call 858-405-4780 before 8PM PDT. Serious only, please.

ASSOCIATE POSITION AVAILABLE - OCEAN COUNTY, NEW JERSEY

Immediate position avaliable. Desiring a hardworking, ethical, motivated and well trained individual. Minimum PSR 24. State of the art practice offering EMR, digital xrays, ultrasounds. Must be willing to do all aspects of podiatry. Competitive salary and benefits package. E-mail CV to NJFEET@aol.com

WELL ESTABLISHED PODIATRY PRACTICE IN MT. AIRY, NC

Dr. John H. Hodges had a well established practice in Mt. Airy, NC that is either for sale or in need of an associate/partner to take over patient care. Dr. Hodges unexpectedly passed away, leaving approximately 3,500 patients. This is a unique opportunity to be able to begin work in a busy podiatric practice. If interested, contact Carolyn McMackin at (336)577-2886 or cmcmackin@triad.rr.com

ASSOCIATE POSITION- KANSAS CITY, MO

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

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.

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 – SOUTHERN CALIFORNIA

Seeking a position in a warm, friendly, and productive environment? Well, look no further! A well established podiatry facility in Burbank, California has an immediate position available for a podiatrist. He/She must be motivated, reliable, and dedicated. Depending on performance, partnership is possible. If interested, email your resume to drnickoghosyan@yahoo.com

ASSOCIATE POSITION SAN ANTONIO OR AUSTIN, TEXAS

Wonderful place to live. Great climate and much culture. Full or part-time podiatrist with current Texas license. Better pay. Unique mobile podiatry practice and mobile wound care clinics, in addition to office locations Check out our website at www.footmobile.com Fine working conditions with excellent support staff E-mail to footcenter1@sbcglobal.net or fax to 210-495-6484.

Well-established, busy, diversified, multioffice/multidoctor practice seeking associate with opportunity for partnership. Must be highly motivated and ethical with strong interpersonal and patient skills. Excellent opportunity for PSR 24 or higher trained DPM to complement a full-scope podiatric medical and surgical practice. Competitive salary and benefits package. Please send CV and references to saglag2@aol.com or fax to (703) 368-5103.

ASSOCIATE PODIATRIC SURGEON POSITION - TEXAS

We are looking for an exceptionally trained podiatric surgeon to work in the Houston, Texas area. Candidates seeking this opportunity need to be dynamic, people friendly, and have current licensure in Texas. Future licensure in Arizona will be required. Exceptional opportunity, with attractive benefits, and excellent starting salary. The successful candidate will find a rare opportunity to integrate into a specialized lower extremity practice with emphasis on peripheral nerve surgery, endoscopic and arthroscopic surgery, and other special surgery of the foot and ankle. Please submit a cover letter with current curriculum vitae via email to: Slb99@pdq.net Stephen L. Barrett, D.P.M., MBA

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