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April 01, 2008 #3,208 Editor-Barry Block, DPM, JD

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GA Podiatrist Overcomes Poverty to Become Successful Practitioner

His mother struggled to make the ends meet and at times they had to go without, but modest beginnings didn't get in the way of his goal of having a successful career as a doctor. "We had the things that we needed," Dr. Rondrick Williamson said, "but a lot of the 'wants' we weren't able to have. But we had a really close-knit family, and I guess that's what brought us through."

Dr. Rondrick Williamson (Photo: Woody Marshall)

Williamson, 35, became a doctor of podiatry and owns Podiatric Medical Associates in Macon. He treats anything that relates to the foot or ankle. Williamson understood at an early age that education was the ticket to his future. He studied hard and made good grades. He was fortunate to have a good role model. "It really makes you appreciate the fruits of your labor once you have had an opportunity to go through something like that," he said. "You had to struggle a little bit as opposed to having something handed to you. ... Working hard for something makes the reward on the other end much, much sweeter. ... I can look back on it now and see it was just a process I had to go through."

When he went to Ohio College of Podiatric Medicine, he "had to really buckle down," Williamson said. He didn't get involved in much that didn't further his education and kept his eye on the prize at the end. "Even now I tell students, it's delayed gratification," as there is always time to do other things after getting a good education, he said. He graduated with honors from every school he attended, he said. When Williamson moved his office there in 2006, he had four employees and now has eight. "My favorite part of my job is the satisfaction I get from making someone feel better," he said. "Making people's lives better regarding their foot care. It makes me want to get up in the morning."

Source: Linda S. Morris, Macon Telegraph [3/31/08]

Medical Grade JELL-O® Superior to Honey for Wound Healing: Georgetown Study

A randomized, double-blind investigative study conducted by Drs. John Steinberg and April Furst at the Georgetown University Limb Center has concluded that JELL-O® is superior to honey in healing diabetic ulcers. Subjects with chronic non-healing ulcers were randomly selected for this study. One half of the patients had honey applied to their wounds and the other half had JELL-O® applied. Clinically, significant improvements in healing could be measured in 45 of 49 patients who received JELL-O® versus only 38 of 49 patients receiving honey treatments (p < .0001).

Dr. John S. Steinberg

While this study has created quite a stir, Steinberg cautioned that although this unique therapy shows great promise, it is not fool-proof and that more research is needed. According to Steinberg, the discovery of the efficacy was a result of an accident. “One of our patients reported spilling their JELL-O® dessert on an ulcer, which had previously been non-responsive to traditional therapy. Surprisingly, the wound began to gel.”

Medical Grade JELLO ®

Interestingly enough, Steinberg found that the result also varied according to which flavor was used. The best results were achieved with grape flavor and the poorest results with lemon-flavored JELL-O®.

For a demonstration of Dr. Steinberg’s application technique, click here.

For further information, contact Bill Cosby

Source: April Fools News [4/1/08]

CA Podiatrist Removes Suspected Alien Implants From People

A leading scientific researcher into UFO phenomena is to present findings at a UFO conference in New Zealand that indicate humans have received implants made of substances not found on earth. The American researcher and surgeon, Dr. Roger Leir, is to attend the September conference in Rotorua where he will share how his surgical team in California has performed 13 surgeries in which they removed objects suspected of being alien implants from people.

Dr. Roger Leir

These objects have been scientifically investigated by some of the most prestigious laboratories in the world, said Dr. Leir, a podiatric surgeon of 40 years and author of the best-selling book Aliens and the Scalpel. Dr. Leir said subsequent lab findings have baffled highly qualified scientists because the implants show anomalies in regard to their biological and metallurgical structures. The objects defy earthly scientific explanations and show isotopic ratios not of this world.

The Aliens and the Scalpel

Dr. Leir said it was strange how his team could not find any entry wounds and the molecular structure of subject’s skin and other tissues were not damaged. It’s possible the implants, which have magnetic properties, act as monitoring systems through being attached to people's nervous systems. "I'm of the opinion that implants provide evidence that the abduction phenomenon is a reality," said Dr. Leir.

Source: Scoop Independent Regional News

Query: Chronic Sub 2nd Met Head Ulcer
From: Judd Davis, DPM

I have a patient with idiopathic neuropathy with a recurrent non-healing ulcer sub 2nd metatarsal head. It was healed briefly after total contact casting but came back quickly despite an off-weighting shoe. He does not have equinus. The 2nd metatarsal is slightly elongated when compared to the remaining parabola. He does not wish to have a Weil osteotomy due to the prolonged healing time.

Metallic Marker Under Ulcer

I'm considering an isolated 2nd metatarsal head excision and am wondering what others have experienced as far as rate of transfer lesions with new ulcers sub 1st/3rd? Any other recommendations would be appreciated.

Judd Davis, DPM, Colorado Springs, CO

RE: Patient with Decreased Sub-Q tissue from Repeated Steroid Injections (Robert Chelin, DPM)
From: Carl Ganio, DPM, Paul Stepanczuk, DPM

I became interested in fillers last year at the request of a patient who was not able to consider surgery for painful IPK. She had failed conservative treatment with orthotics, etc. I contacted many of the companies that produce the fillers (Sculptra, etc) , and either received no callback, or return messages that they were not marketing podiatrists directly... or their panels were closed, or you had to work with a plastic surgeon, and order the product through them. As Dr. Chelin noted, one other product is ReDexis. I contacted their manufacturer in Toronto, and order directly through them. I have used the ReDexis Ultra in several patients now, including the painful IPK listed above. The results are very promising, with immediate relief of pain and immediate appreciation for the extra cushioning it provides. Here are pre & post injection ultrasounds for your review.

ReDexis Ultra Pre Inj sub 1st

ReDexis Ultra Post Inj sub 1st

I have several more patients scheduled for injections. At this time, the product is in the FDA pipeline, so you have to be prepared to use it off-label, and without FDA approval. However, there are many hyaluronic acid derivatives on the market (Supartz, etc) that are approved, so it is unlikely that this will not pass right through. Visit their website for additional information. Or contact them directly.

Carl Ganio, DPM, Vero Beach, FL, drcarlganio@bellsouth.net

This sounds like a patient referred to my office about a year ago. I cannot recall all the details, but previous multiple alcohol injections had been given for "neuromas" elsewhere. Shoe padding had already been tried, but was not successful. I eventually advised pan met head resection as that was about the only way I saw to have her weight-bearing on some reasonable plantar tissue.

Paul Stepanczuk, DPM, Munster, IN, pstepanczuk@juno.com

RE: April Updates on Drugs and Biologicals
From Paul Kesselman DPM, Woodside NY

For those billing Medicare and third-party payers for injectable drugs and biologicals (e.g., human skin equivalents or xenografts, etc.), please view the CMS website for the April 2008 update in order to update your fee schedules.

Note that some private carriers pay a % higher than Medicare's fee schedule.

Medicare's updated fees are updated quarterly and may be found click here.

Paul Kesselman, DPM, Woodlside, NY, PKesselman@pol.net

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

In late December, we responded to the APMA-ACFAS rift by asking your readers whether we, as podiatric physicians, could professionally afford this impending schism. Since that time, it appears as though the hearts of both sides have hardened. This most uncivil civil war is unfortunate, as it seems completely unnecessary. We have let hubris override humility. This is dangerous for anyone—especially for our professional family.

Two weeks ago, we held our annual DFCon meeting in Los Angeles. There, medical and surgical specialties from 50 countries spent the better part a weekend touting the centrality of podiatric physicians and surgeons as part of an interdisciplinary team dedicated to the management of chronic disease. We’re not talking about the importance of palliative care, but rather to the advancement in aggressive surgical intervention coupled with the aggressive non-surgical preventative follow-up that has made us unique and indispensable to the patients we serve. To leave that symposium and return to the vitriol and divisiveness of this discussion leaves us shaking our head.

Can we adapt to changing times by splitting into factions? Rather than creating this confederacy of hubris battling a union of humility, can’t we just stop for a moment and take care of this problem as a family? Can we afford to place dollar and cent issues over the well being of our patients? Have we become so blinded that we can’t stop and see the value of who we are and what we do for our patients? For those of us who love this profession so very dearly, we’d make a plea: Let’s concentrate on growing our family rather than tearing it apart.

David G. Armstrong, DPM, PhD, Professor of Surgery and Associate Dean

Terence B. Albright, DPM, Dean, Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science, Chicago.

Unfortunately, this sad state of affairs that exists within our profession is the extension of the long tortuous battle between the perceived haves and have-nots. Those who are certified by ABPS and are Fellows of the College, and those who are not. It has taken on the flavor of an economic issue, but make no mistake, power, and holding sway over the more "elite" of our profession is at the core of this battle. If money is the root of all evil certainly power is its stem or trunk.

I do not agree with all the paths that APMA has chosen. I feel that they could and should be more responsive and pro-active to issues in the smaller states. I think that oftentimes our Delegate meetings are more about politics and personal aspirations than of true substance. This however, does not overshadow the fact that the vast majority of APMA's elected and employed leadership are among the most devoted and passionate members of any professional organization.

Every podiatrist must realize that the APMA is the tree of life of our profession. Allowing its major branch to be cut away from us will kill the branch and perhaps destroy the tree. We should not cavalierly dismiss the opinions of a pioneering leader like Dr. Kanat. He, like many of our middle-aged and older practitioners remember the not-so-good-old days of second-class citizenship and fighting for privileges. Good, bad, or indifferent, APMA has put us on the map. It has helped educate our children, pay our mortgages, and put food on our table.

APMA is the parent and ACFAS (is acting like the spoiled and ungrateful) child. There would have been no ACFAS without APMA, and I fear neither will prosper without the financial commitment and mutual respect for one another.

Steven R. Rudman, DPM, Exeter, NH, ruddoc@aol.com

Editor’s note: Extended-length letters from Drs. Hubbard and Lepow appear at: http://www.podiatrym.com/letters2.cfm?id=18732&start=1

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