The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

March 26, 2011 #4,118 Publisher-Barry Block, DPM, JD

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Bako Pathology Services Establishes $25,000 Endowment

The APMA Educational Foundation has announced that, in a generous show of dedication to the profession and our podiatric medical students, APMA corporate partner Bako Pathology Services has established a named endowment in the amount of $25,000. 

Dr. Bradley Bakotic

The Bako Pathology Services endowment will benefit podiatric students attending one of the nine colleges of podiatric medicine. Dr. Brad Bakotic will be honored at the PM Podiatric Hall of Fame Luncheon held at the APMA Scientific Conference in Boston. All proceeds from that event will do directly to the APMA Educational Foundation.

Source: APMA News Brief [3/24/11]

Healthy Feet are Part of Staying Fit: NYSPMA President

April is National Foot Health Awareness Month and the more than 1,200 podiatrists of the New York State Podiatric Medical Association (NYSPMA) are educating parents and children about the importance of having healthy feet. The NYSPMA is emphasizing the connection between pediatric foot health and childhood obesity, so that kids can stay active, pain-free, and combat this growing health concern.

Dr. Robin Ross

An APMA study found that 72 percent of Americans claim they do not exercise because they are prevented from participating by foot pain. “The importance of proper foot health and footwear is essential to fighting the epidemic of childhood obesity,” Dr. Robin Ross, president of the NYSPMA states, “and healthy feet are a key part of staying fit.” The NYSPMA is drawing inspiration from the national “Let’s Move!” campaign initiated by First Lady, Michelle Obama. The goal of “Let’s Move!” is to end childhood obesity within a generation, so children born today will reach adulthood at a healthy weight.

FL Podiatrist to Host Horse TV Show

The American Quarter Horse Association is teaming with The Weather Channel’s Dr. Anna Marie Chwastiak to provide equine content on America’s Horse TV. A lover of all animals, Dr. Anna Marie is a medical correspondent for The Weather Channel and the host of “Your Life” with Dr. Anna Marie.

Dr. Anna Marie Chwastiak

Dr. Anna Marie received her doctorate of podiatric medicine from Temple University School of Podiatric Medicine in Philadelphia. She completed her surgical training at the Community Medical Center in Scranton, Pennsylvania. She is the proud owner of two American Quarter Horses: RR Zans Shaker, a red dun mare, and Poco Quarter Note, a bay gelding.

Source: The American Quarter Horse Journal [3/21/11]

Hazards Seen in Medical Overuse

A study published in the Archives of Internal Medicine two years ago concluded that as many as 29,000 cancers a year could be caused by the radiation from diagnostic imaging, and as many as 15,000 people actually die from cancers caused by it. “Our minds have been marinated to believe more is better,” said Rosemary Gibson, an author of books on medical overuse and a section editor with the journal that published the study. "In many contexts, the mantra is volume, volume, volume. That certainly can drive overuse,” she said, highlighting a 2008 statement from the National Priorities Partnership that named four prime areas of medical overuse: medications such as antibiotics, C-sections, laboratory testing and diagnostic procedures.

The conventional wisdom had been that financial incentives and fear of malpractice drive medical overuse, but Gibson said a more detailed review finds other causes as well, including fear of uncertainty, misplaced enthusiasm by physicians, peer pressure among doctors and patients' expectations. “Overuse has an impact on our health and well-being,” Gibson said. “We're reaching a point of critical mass where we realize this truly is a public health hazard.”

Source:Joe Carlson, Modern Healthcare [3/24/11]

Query: Debridement of a Blister

The patient has a blister (consistent with the blistering that is seen with Raynaud's or thermal injury). The blister was debrided with tissue nippers. Is there a code appropriate for "debridement of blistered area"?

Laurie Bodo, Lake Orion, MI 

Response: I guess each blister is unique but, by definition, it is a fluid-filled pocket within the skin. Treatment of blisters involve incision and drainage (CPT 10140 or CPT 10160 [for bulla]). Any debridement following the I&D - at the time or within the 10-day Medicare global period - would be included. If the doctor debrided a post I&D blister site (beyond the 10-day Medicare follow-up period), then there are several coding choices, depending on the clinical presentation:

CPT 11000 - debridement of extensive eczematous or infected skin; up to 10% of body surface - If extensive eczematous or infected skin is present or CPT 17999 - unlisted procedure, skin, mucous membrane and subcutaneous tissue.

The medical record documentation needs to be very clear on what was present and performed. This is a good time to take digital photos of the presentation. Personally, if it is a matter of minimally "cleaning" up a post-blister I&D or ruptured site, I just include it in the re-evaluation office visit.

Tony Poggio, DPM, Alameda, CA

Codingline subscription information can be found here APMA Members: Click here for your free Codingline Silver subscription

RE: Obesity and Foot Pain (Scott Shields, DPM)
From: Charles Morelli, DPM, Juliet Burk, DPM
 
I have never, never EVER had a patient get offended or insulted when I suggest that his/her 350 pound frame is contributing to a condition. When a person gets offended, it is usually because of "how" something was said and in what context. I don't mean to imply that you are being insensitive, but if an obese patient gets offended and cannot understand this simple concept, then it is you who will be beating his head against a wall. 

You should not ignore this topic. None of us should. With sensitivity and compassion, you can refer your patient to your local bariatric center, or nutritionist/endocrinologist.  Or, if you feel comfortable doing so, and have determined that the weight gain is due to a possible psychological disturbance (depression, abuse etc.), then suggest they consider speaking with a therapist or psychiatrist.  Most people don't have the testicular fortitude to discuss this with their patients, and every time I have done this, patients have been appreciative. Remember...it is always "how" you say something. 
 
Charles Morelli, DPM  Mamaroneck, NY, Podiodoc@gmail.com

I read Dr. Shields' query in PM News and commiserated. Living in the same state, with the highest rate of barbecue and heart disease, we see similar patients. I would like to share with you an experience that happened to me today. One year ago, I saw a 21 year old man for a diabetic foot exam. He weighed 423 pounds. His blood pressure and heart rate were elevated, his limbs were edematous, and he was already having brawny discoloration to his skin. He was 21!! I looked at him and had a moment when I thought, “This poor young man is killing himself!” I put down my tools and had a heart to heart with him. I told him that...

Editor's note: Dr. Burk's extended-length letter can be read here.

RE: Podiatrists Advised to Receive a TDAP Vaccination
From: Elliot Udell, DPM
 
I attended a lecture given by Paul Lee, MD who is an infectious disease specialist at Winthrop University Hospital. He reported on a February 23, 2011 recommendation by the  Advisory Committee on Immunization Practices (ACIP). This is part of the Centers for Disease Control. Their recommendation is that all healthcare professionals, without delay, have a vaccination called TDAP which stands for Tetanus Dyphtheria and Pertussis. The latter disease, is commonly known as whooping cough and there is an epidemic of it in this country. It is rampant in California and physicians practicing in New York who were also attending the lecture are already indicating that they are seeing patients stricken with pertussis. According to the recommendation, if you have had a recent tetanus  and dyphtheria vaccination, you will still need the TDAP to protect you from catching pertussis as well as spreading it to your patients. It does not matter how recently you received the prior vaccination.
 
At this point in time, this is a strong recommendation by the committee. In a few months, it will become official when the actual paper is published in the CDC's Morbidity and Mortality Weekly Report. This vaccine is available from primary care physicians. Eventually hospitals will be providing it to all staff members. It seems advisable that all of us get a heads up and get the vaccine now since the disease is already out there and spreading. 

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

RE: Dizziness from Urea Cream? (David Weiss, DPM)
From: Jeffrey Kass, DPM

I wonder if the dizziness associated with the urea cream may be from the patient bending down to apply it to the feet? I may be reaching (no pun intended) but I thought I'd throw it out there, i.e., orthostatic hypertension.

Jeffrey Kass, DPM, Forest Hills, NY Jeffckass@aol.com

RE: Test for Raynaud's (Bryan Markinson, DPM)
From: Elliot Udell, DPM
 
Dr. Markinson indicates that he treats many of his patients with nifedipine or Cardizem during the winter months for symptoms associated with Raynaud's phenomomen. These are in the class of drugs called calcium channel blockers and were originally used to treat hypertension. Nifedipine acts as a peripheral  vasodilator.  Cardizem (diltazem) also dilates peripheral arteries but asserts greater activity on the  the heart. It slows the AV node. In our practice, we place many of our Raynaud's patients on Nifedipine XL or isradipine which is a similar calcium channel blocker. If a patient has a history of cardiac pathology, the patient's physician or cardiologist must be consulted prior to giving the patient a prescription.

These drugs which were once deemed innocuous are contra-indicated in the presence of certain types of cardiac pathology, and many cardiologists and internists have not allowed me to prescribe any form of calcium channel blockers for patients presenting with specific types of cardiac pathology. Hence, while these drugs are miracle cures for many people, they are not for everyone, and medical clearance before prescribing them is often necessary.
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: Pain in the Hallux Interphalangeus Joint (David L. Nielson, DPM)
From: Gino Scartozzi, DPM

With all due respect to Dr. Nielson, I am NOT in agreement that the first metatarsal-phalangeal joint arthrodesis presented by Dr. Sheff's radiographs has arthrodesed in an "under-dorsiflexed" position. I am, however, in agreement with his explanation that "under-dorsiflexion" of an arthrodesis of the first metatarsal-phalangeal joint can cause interphalangeal joint pain, but would manifest radiographically in a different manner. However, can arthrodesis of the first metatarsal- phalangeal joint in an overly "dorsiflexed" position cause interphalangeal joint pain? Most definitely!

Let me explain why I believe that the first metatarsal-phalangeal joint is, in this case, "over-dorsiflexed" and creating...
 
Editor's note: Dr. Scartozzi's extended-length letter can be read here.

RE: Homeopathy is a Safe Way to Complement Treatment Choices: IL Podiatrist
From: Jeanne M. Arnold, DPM

Homeopathy, like many alternative treatments, is not well understood but does work and is very safe. Many more people have had adverse reactions and even died from 'scientific' FDA-approved treatments than from a homeopathic remedy. Personally, I have used homeopathy for many years. For all of you who say it is a scam that doesn't work, try this. Does your dog panic during thunderstorms or when he goes to the vet? There is a homeopathic remedy called 'rescue remedy'. It's available at most health food stores (and many animal supply stores).  It's for calming during stressful situations. A dropperful under the tongue will quickly settle a distraught animal. I think this shows the efficacy of homeopathy. 

Animals, unlike humans, have no pre-conceived notions of whether a treatment will or will not work. They have no idea what or why you're giving them anything. It has always amazed me how well this works, and how many traditionally-trained veterinarians recommend this product. This is just one of many examples I could give you. Is homeopathy the answer for all maladies? No, but it is an effective and safe adjunct to many traditional treatments.

Jeanne M. Arnold, DPM, Coeur d'Alene, ID, jarnolddpm3@frontier.com

Editor's note: This topic has been temporily closed. No new letters will be published.

ASSOCIATE POSITION - MARYLAND

Associate position for  podiatry office on Maryland’s Eastern Shore. Certified ambulatory surgery center on-site. Please fax letter and CV to 410-749-6807.

ASSOCIATE POSITION - EAST TEXAS, DELAWARE

Looking for podiatrist to see patients in Nursing Home Facilities in East Texas and Delaware. AVAILABLE IMMEDIATELY.  Please contact me at doconcall@aol.com.

POSITION AVAILABLE – NEW YORK
 
Well-established, multi-doctor podiatry practice with offices in Putnam and Westchester counties. Compensation based on productivity. Excellent opportunity for recent residency graduate to build skills and learn practice management. Full-time preferred but right part-time candidate will be considered. Email cover letter and CV to: Podiatry2011@gmail.com

ASSOCIATE POSITION - TEXAS

Are you looking for a busy, well-rounded practice experience?" Group practice in DFW area looking for a 3-year surgically-trained associate with a sports medicine background. Needs to be as comfortable making orthotics as fixing a complex flat foot. Email CV to crane@faant.com

ASSOCIATE POSITION - NYC, NY

ASSOCIATE POSITIONS – MARYLAND

Are you motivated, personable and enjoy working with the elderly? We are offering full or part-time positions in Maryland. Our group, Podiatry Management Services, provides care to the elderly in Nursing Homes, Assisted Living, Senior Homes, Adult Daycare and other similar facilities. Please e-mail your c.v. to drhprosen@verizon.net or fax to 410-486-2049 or call Dr. Herbert Rosen at 410-580-0255.

ASSOCIATE POSITIONS - TEXAS

Podiatrists needed in San Antonio or Austin. Great paying positions for full or part-time physicians. Established, unique mobile podiatry practice servicing senior living facilities. Office locations in both cities with excellent support staff for your assistance and scheduling. Check us out before looking elsewhere. See us at www.footmobile.com.  Reply with cover letter and CV to doctor.cohen@yahoo.com with a cc: to lisa.schulze@yahoo.com or call us at 210-495-6477 or 210-545-3338.

POSITION AVAILABLE – PHOENIX, ARIZONA

Full-time or part-time position available for an associate to join a modern, well established practice. Needed is a motivated, hard-working, well-rounded, surgically-trained podiatrist to complement our office. Excellent income potential with possible partnership opportunity available. Arizona license required. Email CV to Foot.doctor@hushmail.com.
 

ASSOCIATE OPPORTUNITY - FREDERICKSBURG, VA

Progressive, busy practice seeks personable, ethical, confident associate interested in future partnership. Lucrative opportunity for self-starter with strong work ethic. State-of-the-art office in rapidly growing community with two new hospitals and new surgery center. Practice has excellent reputation with well established referral base. Cover letter/CV to: fredfeet@verizon.net

ASSOCIATE POSITIONS - NW INDIANA, CHICAGO AREA

2 Full-Time positions open - One for Northwest Indiana and one for the Chicagoland area. Must have 2-year surgical residency. Must be motivated and a self-starter. State License required. If interested email: f-massuda@footexperts.com

EQUIPMENT FOR SALE - DOPPLER, SURGICAL INSTRUMENTS

Koven Technology Smartdop 45 hand-held bi-directional vascular ultrasound Doppler with real-time waveform LCD - like new in carry case. all attachments for ABI and Digital PPG & PVR. AC charger and computer cords included. Also available are surgical hand instruments, rasps, Weitlanders, stats, needle holders, retractors, and more. Email. Podassociate@aol.com

EQUIPMENT FOR SALE -  SONOACE ULTRASOUND

2007 Sonoace, Pico color ultrasound image, Medison, MY202C MAI, 7.5 mhz small head, hl59edn, 40 mm, 4 modes - 2d, Doppler, 3-D, and multi-image. $9,800 or best offer. Just finished servicing by Universal, includes Sony black and white printer. Charles W. Kelley III, DPM cwkell@aol.com

EQUIPMENT FOR SALE - COOL TOUCH LASER
 
Cool Breeze Cool Touch CT3 plus laser used for ugly, unsightly, toe nail infections. Less than six months old. Great price won't last long. Considering a laser? We also have the Q- Clear Q- switch laser too. This laser is perfect for you. Also a used Lumix 2 laser, best price today   Dr. Zuckerman is in the Fort Lauderdale area and will demo this lasers on your patients. E-mail footcare@comcast.net

PRACTICE FOR SALE - WASHINGTON STATE - SUBURBAN SEATTLE

16 year established part time practice. Includes Midmark 417 (4 position keypad), Excel X-ray, processor, Ritter M9, instruments, bandaids, etc. 1 Day/week $50K gross. Professional Business appraisal at $48K. Asking $35K. Shared office with 2 FP's. Easily expandable. Reply: practiceforsale18@yahoo.com

PRACTICE FOR SALE - MARYLAND, DC SUBURBS

Great opportunity. Well established and equipped practice for sale. Office includes state licensed Ambulatory Surgical Center. Present owner is retiring but will stay on as needed for smooth transition. Average gross over past 3 years is $575 K. dpmpracticeforsale@yahoo.com

SPACE AVAILABLE- NYC & LI

Office to sublet and share - East 60th Manhattan, and Plainview long island. access to an MRI, Joint Commission certified operating rooms, digital x-ray, diagnostic ultrasound, and access to a multi-specialty ambulatory surgical center. Turn-key operation - no investment needed 516 476-1815 PODO2345@AOL.COM

PM News Classified Ads Reach over 12,500 DPM's and Students

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