The Voice of Podiatrists

Serving Over 10,800 Podiatrists Daily

March 31, 2008 #3,207 Editor-Barry Block, DPM, JD

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Medicinal Honey Both Effective and Inexpensive For Wounds: TUSPM Professor

Medicinal honey is doing wonders for some wound and burn victims. A new product is being used to significantly speed up the healing process. It’s called MediHoney, and yes it contains real honey. According to Jim McGuire of the Temple School of Podiatric Medicine “It has several antioxidants and natural anti-infectives that are resistant to bacterial growth.”

Dr. Jim McGuire

The Medihoney patch is placed directly on the wound and covered with a dressing. Dr. McGuire says that Medihoney actually acts as a barrier, and reduces bacterial growth, allowing wounds to heal faster.

Medihoney

“This is a product that allows us to expand our treatment armamentarium,” says McGuire. Medihoney is also a lot less expensive than other wound care products.

Source: Kerri-Lee Halket, FoxPilly.com [2/21/08]

NJ Podiatrist is a Practice Wizard

It's appropriate that podiatrist Dr. Hal Ornstein's favorite movie is "The Wizard of Oz." After all, it does focus quite a bit on Dorothy's feet, her ruby slippers and the clicking of her heels.

Dr. Hal Ornstein Hams it Up

The practice (yellow brick road and all) embodies other key elements found in the movie. While the Scarecrow desires a brain, the Cowardly Lion longs for courage and the Tin Man yearns for a heart, the physicians and staff at Affiliated Foot & Ankle Center, LLP utilize their vast knowledge, courageously face any challenge presented to them and do it all with the understanding, compassion and, more importantly, the heart that is rarely found in today's medical world.

The Oz memorabilia-filled office "makes people feel great," according to Dr. Ornstein. A self-proclaimed people person whose daily goal is "making a difference anytime that I can," Dr. Ornstein has held many esteemed positions in the community and has been recognized countless number of times for his services.

Source: Donna Frances Madej, The Jackson Times [3/28/08]

Clinton Details 10% Premium Cap in Health Plan

Senator Hillary Rodham Clinton said in an interview on Wednesday that if elected president, she would push for a universal healthcare plan that would limit what Americans pay for health insurance to no more than 10 percent of their income, a significant reduction for some families.

The average cost of a family policy bought by an individual in 2006 and 2007 was $5,799, or 10 percent of the median family income of $58,526, according to America’s Health Insurance Plans, a trade group. Some policies cost up to $9,201, or 16 percent of median income.

The average out-of-pocket cost for workers who buy family policies through their employers is lower, $3,281, or 6 percent of median income, according to the Kaiser Family Foundation, a health research group.

Source: Kevin Sack, New York Times, [3/28/08]

Query: When to Perform Reverse Austin

What is the consensus on when to perform a reverse Austin bunionectomy with screw fixation, for a post-op hallux varus, that did not respond to attempted soft tissue release?

Ian Klein, DPM, St. Petersburg, FL

RE: Patient with Decreased Sub-Q Tissue from Repeated Steroid Injections (Neal Frankel, DPM)
From: Peter J. Bregman, DPM, Robert Chelin, DPM

You can try using GraftJacket by Wright. They now have a protocol and video for its use. I am sure some of the other products may work in a similar fashion but I think it may be worth a try.

Peter J. Bregman, DPM, Tewksbury, MA, Footdoc@PAINFREEFEET.COM

I have been using injectible fillers for years, replacing what nature has taken away. Over the years, the fillers have become more resilient and durable. In our practice, we use the hyaluronic acid fillers that contain the proteins that promote the reconstitution of collagen. Restylene has been around for some time but Dr. Frankel may consider either Sculptra or Redexis. I have been using Redexis in the bottom of the foot for about 14-18 months

Robert Chelin, DPM, Toronto, Canada, ft-biz@rogers.com

RE: Forteo Use in a Partially-Fused Lapidus (Peter J. Bregman, DPM)
From: Nat Chotechuang, DPM, DPM

Dr. Bregman postulated that the Mini-Rail in addition to OsStaples may cause non-union and asked why I would use both. Dr. Bregman, I installed the Mini-Rail first and applied adequate compression. Next, I installed the OsStaples as secondary fixation, as a "back-up" in the event I would need to remove the external fixation prematurely for whatever reason.

The arms and spine of the OsStaple also apply compression and have room for additional motion, and therefore would not interfere with the Mini-Rail. It is common (per the Orthofix instrument representative) to use secondary fixation with the Mini-Rail, but screw is the most common device.

Nat Chotechuang, DPM, Bend, OR, natchot@hotmail.com

RE: Onychomycosis and Weeds? (Dan Klein, DPM, Elliot Udell, DPM)
From: Dennis Shavelson, DPM

Can we just make up things that "sound right" and then validate them because they make sense of an issue? The Menta's are saprophytes! They live on dead tissue unless the patient is severely immunocompromised. In either case, this means that they need weak or non-vital tissue in order to gain hold of a host!

Weeds are very strong and hearty and will grow on almost anything, even stone! I think that to analogize the two is a mistake. Scientifically, repetitive microtraumatic contact of shoes upon distal nail plates causes distal subungual onychodystrophy and onycholysis. These weakened tissues (foremost the great toe, secondly the fifth toe and finally the long second toe of a Morton;s Foot then allow free living fungus to seed the distal nail plate and then cascade.

I agree with aggressive and frequent debridement, but strongly suggest a higher and longer toe box that avoids microtrauma or an orthotic capable of eliminating function hallux extensus or a surgical procedure that eliminates functional hallux limitus for a chance at a permanent cure, not weed killer.

Dennis Shavelson, DPM, New York, NY, DrSha@lifestylepodiatry.com

RE: APMA Special Status Membership (Simon Young, DPM)
From: Bob Rampino, DPM

I have been active in NYSPMA leadership for more than a decade. We are extremely proud of the way we compassionately handle these difficult and delicate hardship cases and still maintain fiscal responsibility to all our members. Our main priority is always to help every individual podiatrist so that they can maintain their membership. We are also very proud to say that New York is the largest component membership in the APMA.

If you are aware of any non-members male or female who wish to join the Association but are having difficulty financially please encourage them to call Len Thaler and speak to him one on one. Believe me when I say financial information and names are never disclosed to anyone on the board, including the President. We are in difficult times and the leadership at NYSPMA understands the difficulty all our members are having with expenses. We cannot represent this profession appropriately without your personal and financial support, and realize that we volunteer our personal time to represent this great profession.

As I said to Simon Young, DPM on the phone, we both were present when we voted on the guidelines for special status. The bylaws and administrative procedures concerning this issue passed with a two-thirds majority vote at the annual House of Delegates where all the division representatives were present. These guidelines demand strict confidentiality, so no one should be afraid to approach Our Executive Director, Len Thaler. He can be reached at 212-996-4400.

Bob Rampino, DPM, NYSPMA President, rdrdpm@yahoo.com

RE: Value of APMA Membership
From: Michael M. Rosenblatt, DPM

I am one of those podiatrists who believe so much in APMA that I have provided for it in my Charitable Remainder trust, and a portion of my estate will go to APMA.

I cannot over-estimate the great help and PERSONAL benefits provided to me by APMA in my times of need. Don't support APMA for them. Do it for yourself. APMA IS podiatry.

Michael M. Rosenblatt, DPM, San Jose, CA, ROSEY1@prodigy.net

RE: ACFAS / APMA Membership Vote (Irvin Kanat, DPM)
From: Multiple Respondents

All ACFAS members recently received a postcard from the ACFAS board stating, "A bylaws amendment concerning ACFAS membership requirements will be sent to you in the coming weeks. By voting to support your Board of Directors, you are voting to preserve your ability to choose professional memberships as permitted in the current bylaws." While I was prepared to accept whatever the majority of ACFAS membership decided on this issue, I am unwilling to accept the outcome of a vote that is being manipulated ahead of time by providing members with somewhat misleading information and then placing a requirement for a two thirds membership vote in order to override an action that required only simple board majority to implement.

In my opinion, for the postcard to be accurate, it should have read, "By voting to support your Board of Directors, you are voting for ACFAS to become an organization that is no longer affiliated with APMA. This action will place ACFAS in violation of APMA bylaws, leaving APMA with no choice but to replace ACFAS with a new surgical organization." In this way, the ACFAS membership will know exactly what they are voting for and what the eventual outcome of that vote will be.

Jon A. Hultman, DPM, MBA, Los Angeles, CA, jonhultman@verizon.net

Last week I received a fax from ACFAS that proclaimed in a banner headline, "You Listen to Your Patients. We Listen to You." Considering that ACFAS has decided, before polling their full membership before making their decision, to eliminate the requirement that ACFAS membership also requires APMA membership, this fax banner of "We Listen to You", seems a little disingenuous.

The discussion of whether ACFAS should require their members to also be APMA members comes down to just one important point that each of us should consider as podiatrists who are all working together to make podiatric medicine a better profession, not only for us, but also for our patients. That point is the APMA is the only organization that we have that protects the interests of all podiatrists of our great nation. There is no question that anything we can do as a profession to make the APMA a more unified and stronger voice for all of us and our patients, should be done. The APMA needs a larger percentage of the nation's podiatrists to be members, not a smaller percentage, in order to fight for our rights to be recognized as physicians and surgeons of the foot and ankle.

The recent decision by ACFAS will definitely decrease membership in the APMA and, as a result, will weaken the strength of this great national organization. This is exactly what our political enemies want to see happen. I am certain that the members of the medical community that feel that podiatrists shouldn't be allowed to be given full rights as physicians and surgeons of the foot and ankle, are just loving the decision by ACFAS to weaken the APMA so that they can continue to restrict our ability to practice the full scope of podiatric medicine and surgery.

Kevin A. Kirby, DPM, Sacramento, CA, kevinakirby@comcast.net

I believe it was about time I jumped into the discussion raised by ACFAS's proposal to allow non-APMA members remain as Associates and Fellows of the College. I thought this matter was put to rest in Philadelphia years ago. This issue was not brought up by "rank and file" ACFAS Fellows (like me) but by ACFAS "leadership." I applaud the leadership's decision to democratically allow its members to vote on the proposal, but frankly, this discussion should never have been raised.

I do not believe that ACFAS should be treated any differently than any other APMA Affiliate. As an educational institution the College should be more interested in clinical interests of its members than politics. The topic of a vote for the College in the APMA's House of Delegates is an interesting one which we may want to revisit. However, I would insist that thought be given to extending the delegate position to all APMA Affiliates, perhaps even giving the APMSA an additional vote. It would seem that the state components have the power to bring the delegate issue to a conclusion.

At this point in time, with regulators and legislators so interested in the delivery of healthcare, it is imperative that podiatric medicine and surgery speak with one voice. We've made so many strides forward in the recent past. Our successes have only come about by working as one united family of foot and ankle healthcare experts. I ask all fellow ACFAS members to join me in continuing to promote our united profession by voting opposed to the proposal.

J. D. (Jerry) Ferritto, Jr., DPM, Grove City, OH,

Editor’s note: An extended-length letter from Dr. Mullen appears at: http://www.podiatrym.com/letters2.cfm?id=18714&start=1

ASSOCIATE POSITION - NORTHERN VIRGINIA

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 individual 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.

CASE CONSULTING

Dennis Shavelson, DPM is now accepting referrals of difficult cases involving biomechanics, surgical complications, non-healing wounds diagnostic and treatment dilemma’s and subtalar stenting from DPM’S. Full reporting with second opinion only, rapid return after care and assumption of care options. Medicare and Out-of-Network Only. (212) 288-3668 or drsha@lifestylepodiatry.com

ASSOCIATE POSITION - FLORIDA PANHANDLE

We are looking for a hardworking, ethical physician to join our busy practice. We are well-established and looking to expand. Must be a PS24+ with interest in all aspects of podiatric medicine and surgery. Partnership available. Fax resume to (850) 478-5227, call (850) 477-9015 or email PenFootAnk@aol.com

ASSOCIATE POSITION - NEW YORK STATE

ASSOCIATE Wanted To Be fast tracked into PARTNERSHIP. 6 doctor group with one partner anxious to retire. DON'T MISS THIS OPPORTUNITY. Check out our website, then e-mail me to arrange a visit mhudes@footcaregroup.com

PRACTICE FOR SALE - LAWRENCE, KANSAS

Great place to live and raise a family (college town). 250+ K yearly gross with good potential for growth. Good mix of general podiatry, sports medicine, and surgery. Hospital privileges available. 4 treatment/procedure rooms and well-equipped. Fully computerized. Partnership in a 4-office medical building. Partnership is for sale. Inquires to foothlr@sunflower.com 785-841-4225.

ASSOCIATE POSITION – CENTRAL NEW JERSEY

Multi-office practice located in Ocean and Monmouth counties. Lokking for a well-trained PSR 24-36 individual. Must be personable and ethical. Excellent opportunity to join a well-established diverse practice. Please fax resume to (732) 255-9364.

SEEKING RESIDENT FOR PSR-24 - BALTIMORE, MD (MERCY MC)

Position for a highly motivated individual with completed non-surgical residency or one desiring additional surgical training in well-established Podiatric Residency Program. Busy metropolitan hospital with high surgical numbers and inpatient care. Resident is integral member of multidisciplinary team. Begins mid June 2008. Includes competitive salary/benefits. Send inquiries to rsher18@yahoo.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

EXPANDING IN SOUTH-WEST FLORIDA

Seeking an associate for a well-established, busy, multiple-office practice. All aspects of podiatric medicine and surgery. Must have completed a 24-36 month residency and at least board eligible in forefoot surgery, preferably in forefoot and rearfoot surgery. Competitive salary with excellent benefit package. If interested, please fax CV to 941-639-0026 or e-mail it to Awilliam33@aol.com

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@comcast.net or fax to 410-486-2049 or call Dr. Herbert Rosen at 410-580-0255

FULL-TIME ASSOCIATE WANTED - CHATTANOOGA,TN

Well established, well-respected surgical/medical practice seeking full time associate. Send CV/ inquiries to: chattfootdoc@yahoo.com

ASSOCIATE POSITION - CHANDLER/GILBERT/PHOENIX, AZ

Multi-location office and soon to start a wound care office in a local hospital. Seeking a well-trained graduate of a PSR 24+/36 Residency. This is a practice with a nice mix of 35% surgery/trauma, 20% diabetic/wounds, 25% biomechanics, 20% pediatric. ER Call for 2 hospitals. Opportunity for partnership at 2 surgery centers. Very modern office with EMR, U/S, Digital X-Ray, Vascular Testing /Nerve Testing Machines and our own ESWT. Excellent referral base, and a well-trained certified staff. Board eligible/certified a plus. Competitive salary, bonus structure, benefits. Please e-mail CV and references to main@footanklespecialtycenters.com

PRACTICE FOR SALE - AUSTIN TEXAS

Live and work in the best place in Texas. 14-year established practice which includes beautifully finished office condo. Own a practice AND real estate. Nicest office in town. Located between 2 major hospitals and in the most heavily populated part of town. Major employers including Dell and IBM. Office can support 2 podiatrists easily. Serious inquiries only. mrobsondpm@aol.com 512 585 0242

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