The Voice of Podiatrists

Serving Over 10,800 Podiatrists Daily

March 20, 2008 #3,198 Editor-Barry Block, DPM, JD

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Walk Your Way to a Healthier Lifestyle: AZ Podiatrist

"Walking is one of the best exercises you can do," said Dr. Gilbert Shapiro, a Tucson podiatrist. "Fat burns nicely on a low flame. It's a gentle way to speed up your metabolism and if you walk far enough, you can burn off some calories. It gets the job done and it's kinder to the hips, knees, ankles and feet."

Dr. Gilbert Shapiro

However, you have to be persistent, Shapiro adds. "Just like you have to have a work ethic, you have to have an exercise ethic. You have to get your butt off the couch and start moving because research shows that physical activity is the key to a healthy lifestyle."

Source: Sandra Valdez Gerdes , Tucson Citizen [3/17/08]

NYSPMA Chooses “Biggest Loser” as Spokesman or Foot Health Month

Howard Dinowitz, DPM, a Brooklyn podiatrist will serve as spokesperson for the New York State Podiatric Medical Association during April, Foot Health Awareness month. Dinowitz has taken a sizable load off his feet—218 pounds, the size of a better-than-average man, to be exact. And like a true podiatrist, he did it by taking small steps. He’s down from 388 pounds to 170 pounds in just 13 months without surgery, fad diets, or extreme exercise regimes.

Dr. Howard Dinowitz

Dr. Dinowitz used common sense, uncommon will power, and a sensible walking regime to get to his goal. “The day I got stuck in a pew at my Uncle’s funeral and couldn’t get up to say a few words on his behalf, I made up my mind,” he explains.

“Howard is a credit to himself and to our profession,” says NYSPMA President Dr. Robert Rampino. Dr. Dinowitz will represent NYSPMA during Foot Health Awareness month when podiatrists across New York State educate the public about the value of foot health in general and the importance of walking in particular.

Cutbacks May Force Docs to Stop Bone Scans

Scheduled cutbacks in Medicare physician payments may force doctors to stop offering bone density scans, despite health specialists' efforts to get osteoporosis "on the same public wavelength" as mammograms, prostate exams and other routine screenings, the South Florida Sun-Sentinel reports.

Cuts in Medicare reimbursement for dual energy x-ray absorptiometry began last year, reducing payments for a scan of the hip, pelvis and spine from $140 to $88. According to the Sun-Sentinel, based on current projections, Medicare will pay only about $50 for the same scan by 2010. According to the National Osteoporosis Foundation, most physicians and imaging centers are unable to absorb the cost and will be forced to stop offering the scans, which "could mean seniors, especially those in smaller cities, might have less access to the screenings and be less likely to get bone scans," the Sun-Sentinel reports. However, a bill in the House (HR 4206) would freeze Medicare reimbursements for bone scans and other procedures at 2006 levels for two years, according to the Sun-Sentinel.

Source: Diane C. Lade, South Florida Sun-Sentinel [3/17/08] via American Health Line

Query: Pediatric Patients with Extraordinary Foot Complications Needed
From: Mike Kulick, APMA PR Specialist

Are you an APMA member podiatrist who has recently helped better the life of a pediatric patient with a major foot disorder? The American Podiatric Medical Association (APMA) is looking for member podiatrists with unusual pediatric cases they consider significant for APMA's upcoming "Podiatrists Keep America Walking" campaign. These pediatric patients should be undergoing treatment currently or have been recently treated for a profound foot deformity or condition, such as club foot, pediatric flat foot, etc. If you think it's significant, please let us know. These patients or their parents should be willing to share their story with national and local media. If you are an APMA member and would like to participate in this exciting opportunity, please contact Mike Kulick in APMA's public relations department at (301) 581-9220 or by e-mail at mskulick@apma.org

RE: Resistant Verruca (Jodi Schoenhaus, DPM)
From: Elliot Udell, DPM, Thomas A. Graziano, DPM

I applaud Dr. Schonehaus for raising the question as to whether there is an association between the Herpevac herpes vaccination and the development of a resistant verruca. The development of the verruca and the patient having had this fairly new vaccine may be totally coincidental. The only way to know is to survey our colleagues as you are doing and ultimately publish the results. A survey of primary care doctors and OBGYN doctors who administer this vaccination routinely might also yield some definitive findings. We learned in school that we should "never say never" when it comes to medicine. In any case if it is a single encapsulated verruca, why not do a blunt dissection of the entire lesion and send it off to pathology? That way you most likely remove it entirely and dermatopathology can determine if it is indeed a wart. If it turns out to be something other than a wart, publishing it as a single case scenario in a well read journal could turn out to be a significant contribution that will put physicians on the alert for other cases.

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

The correlation is interesting. We would all agree that this condition is most common in our practices in children and in pregnancy. Both of these groups clearly are immunosuppressed or underdeveloped in the case of children if you will. Your patient with recent onset of verruca after Herpevac vaccination may just fit into that category. Her immune system is currently building up its defenses against the vaccine which might make her temporarily suppressed leading to the verruca. After thorough medical, family and social history, I would consider ordering some serology to rule out STD's on this patient and/or refer her for infectious disease consult, particularly if the condition does not resolve.

Thomas A. Graziano, DPM, Clifton, NJ, TGrazi6236@aol.com

RE: Texas Appeals Court Overturns Scope of Practice Definition
From: John Scheland, DPM, Bob Kornfeld, DPM

Nothing illustrates the challenges our profession faces better than the decision handed down by the Texas Court of Appeals in two important ways. First, the court of appeals merely interpreted the law that exists in Texas and sadly, after a little research, I have to agree with the courts findings. It is not a matter of whether or not podiatrist in Texas should be going up the leg (they should), it is a matter of Law. This raises the more important issue that we podiatrists should be more focused on; the states that have such antiquated laws. We all must make sure that the PACs are well funded so as to move legislation in the states where leg laws do not exist. It is law through legislation that will ensure matters like this cannot be repeated throughout the country. Trivial issues such as the AMA truth in advertising movement is a mere distraction from important issues such as certain state laws. The only thing that truly can stop us is the court system using the law.

The second issue is the medieval biases of people like Texas Medical Association (TMA) President William W. Hinchey, MD. Our profession is in part to blame for this as we have failed to impart to our colleagues and the public of the true scope of education and training podiatrists obtain. However, notwithstanding public education, we don't need permission from the "world is flat" mentality of Dr. Hinchey's class of 1491 to proceed to move forward with our progression toward expanding our education, clinical/surgical acumen and scope of practice. We should, however as a matter of face, publish the name of the pathology chain Dr. Hinchey works for and NOT use them. In other words, use our considerable economic power to make guys like Dr. Hinchey unemployed.

John Scheland, DPM, Clarks Summit, PA limblengthener@yahoo.com

I have been involved with podiatry my entire life. My father graduated NYCPM in 1950 and I in 1980. So I have heard about, seen and experienced most of the growing pains of this profession for the past 50+ years. There are a number of points we seem to forget in our zeal to cement a rational scope of practice for our profession. First of all, as Dr. Markinson points out, we are not M.D.'s. Second, we are a very small profession. We simply cannot withstand the financial power that they have to fight against us. The prejudice against our profession will continue as long as we have a different degree simply because if we are not "one of them", then we are "the enemy.”

What exactly are we preserving by hanging on to an antiquated degree title? History? The degrees awarded to podiatrists have changed through the years, as a matter of course, because the profession needed to be redefined as our training, experience and expertise matured. The specialty of podiatric medicine and surgery will not die with a degree change to M.D. Quite the contrary, I believe it will thrive in a way that we can only dream of at this point. It is time again to "redefine" this profession with another degree change. Time to move forward. Time to put present-day podiatric medicine and surgery "on par" with all of our other allopathic colleagues. That will never happen without the degree change.

Simply put, we will continue to exhaust time, energy and funds on a losing battle, because even if we win the scope of practice battle, we will still not be "one of them". Other roadblocks will continually be placed in our way. The scope reversal should not be seen as a defeat. Rather, it should be seen as a wake up call to this profession. Our time has come. We know who we are. Now let's communicate it to the rest of the world.

Bob Kornfeld, DPM, Lake Success, NY, Holfoot153@aol.com

RE: DFCon 08
From: Warren S. Joseph, DPM, Rene D. Perez-Silva, MD

Once again, I must congratulate Drs. Andros and Armstrong on the success of DFCON. This meeting continues to be the foremost annual diabetic foot meeting in the world. I was honored to be invited to lecture there for the 3rd year in a row. If you are, justifiably, upset at the Texas decision or angry at the boneheaded comment of the President of the TMA, I urge you to make plans to attend the next DFCON. This is the most egalitarian meeting in the nation. It does not matter if you are a DPM, MD, PhD, RN, PT…all have equal access to the podium and all opinions are equally respected. You will feel good and vindicated about our vital role in the diabetic healthcare community. This extends beyond the scientific sessions.

For example, at the Wolfgang Puck-catered lunch on Saturday I sat with a local DPM from Los Angeles, a world renowned plastic surgeon from DC, a PhD nurse wound expert, the foremost wound authority in Saudi Arabia (who happens to be a male RN), some folks from industry and even a retired Professor of English Literature from the UK. This is a must meeting for any DPM who even remotely considers themselves a “diabetic foot specialist” and no, I do not have any vested interest in the meeting.

Warren S. Joseph, DPM, Huntingdon Valley, PA, wsjoseph@comcast.net

Thanks for putting on such a fantastic conference. As an internist practicing general medicine, diabetes and diabetic foot infection are a huge part of my practice and present a very difficult problem. The breadth of the topics was truly amazing: from how to obtain a proper culture to advance modalities for treatment. Although some of the advanced modalities are beyond the scope of my practice, it is my responsibility, as the patient's advocate, to present to my patients as many treatment options as possible.

This conference offered the opportunity to become well-versed in these latest treatment options. Options were presented form a surgical, podiatric, or medical point of view, and often from an integrated focus. The information I learned will be put to use in my practice on Monday morning. That's how relevant it was. I would like to congratulate your conference Co-Chair, Dr. George Andros for his passion and his commitment to save as many diabetic limbs as possible.

Rene D. Perez-Silva, MD, Long Beach, CA, drpsis@yahoo.com

RE: Painful Nails in Patient With Raynaud's Disease
From: Harry Goldsmith, DPM

After Dr. Rosenblatt's response, "I agree with Dr. Markinson, and respectfully disagree with Dr. Poggio. It is my understanding that Dr. Poggio insists there are no 'other reasons' for continued evaluation of this condition by the podiatrist, after initial examination," I re-read the original question and Dr. Poggio's comments. Actually Dr. Poggio never insisted that "there are no 'other reasons' for continued evaluation of this condition by the podiatrist, after initial examination." His response only focused on the question Dr. Wertheimer posed (paraphrased): In a patient with known Raynaud's disease, how would one code and bill the cutting of long nails? That was it. That's all it was about.

Dr. Poggio's response was consistent with California Medicare payment scenarios for the stated systemic condition in a patient with a difficult time cutting her nails. He didn't address the need to work-up this patient with known Raynaud's disease by a podiatrist...because that was never part of the question. While the responding posts discussed differential diagnoses, the rule outs of contributing medical causes, various Raynaud's disease treatments, the weather, etc., which are all interesting, the original question (paraphrased) was, would I be paid for cutting the patient's nails? Dr. Udell asked, "...could there be something else going on with the patient other than Raynaud's phenomenon [sic]." The answer is "yes," the nails have become...long.

PS: The original Codingline response of Dr. Poggio's opens with "I will assume, for my response, that this is a Medicare patient." That wasn't included in the PM News response. Also, Dr. Markinson's disagreement "with Dr. Poggio's statement that no further evaluation and management would be necessary beyond his first visit" was not what Dr. Poggio said. He said, "...you would not - if the patient regularly presents to have her painful nails trimmed - be able to continue to bill an E/M service since there would be no basis for repeat evaluation and management when the patient is returning for a procedure, and no additional findings are obtained or management (other than trimming the painful nails) provided."

Harry Goldsmith, DPM, Cerritos, CA, hgfca@verizon.net

ASSOCIATE POSITION – OHIO

According to Podiatry Management’s most recent financial survey, some new podiatrists with a 2 or 3 year surgical residency make only $100,000 a year. All four of our young podiatrists made over $200,000 by their third year. If you are ethical and ambitious, email your resume, including a photo to: kroesch4poh@aol.com

ASSOCIATE POSITION - FT. MYERS/CAPE CORAL FL

Great opportunity for BE/BC established DPM or podiatric surgical resident with strong surgical skills. Well-established podiatric practice offering high surgical volume, advanced wound care, PT, vascular diagnostics and large diabetic population. Exceptional pay with incentives for high performers. Generous benefit package. Relaxed lifestyle, golfing, boating, fishing, close to beautiful SW FL beaches. Please send CV with references to janekelly331@msn.com

PART TIME PRACTICE W/ PROPERTY FOR SALE, BLOOMFIELD, NJ

Very busy 3 days/week. All modern equipment including digital x-ray and recently remodeled office suite. Office over 1300sf with 3 treatment rooms, large consultation room and second private office suite with full bathroom. Located in a professional building with plenty of parking on a main road. Bus stop in front. 2 blocks off Garden State Parkway. Please contact doccapo@yahoo.com

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