The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

April 06, 2011 #4,127 Publisher-Barry Block, DPM, JD

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FL Podiatrist Dicusses Aesthetic Foot Procedures

The concept of foot "enhancement" for females dates back to ancient times, when the Chinese would bind the feet of young women. Modern women, on the other hand, actively seek elective foot procedures. Dr. Bret Ribotsky, a board-certified podiatric surgeon affiliated with Boca Raton Community Hospital, has been specializing in the growing field of "foot aesthetics" since 2004. He says that the vast majority of elective procedures are done to either: A) improve the look and/or comfort of one's feet in revealing shoes; or B) rectify the years (or decades) of damage done to one's feet by the stress of wearing high heels.

Dr. Bret Ribotsky

"There are numerous ways in which we can improve the form and function of a woman's foot that don't require surgery," Ribotsky explains. For example, women who wear heels daily might have their toes pinch together. This, in turn, could lead to bone spurs and/or loss of some of the foot's essential fat. Ribotsky's solution? "We inject the feet with a filler, such as collagen. It acts like a pillow for the balls of the feet - and improves appearance," he says. As with any "plumping" procedure, be it for the face or the feet, the effects are not permanent and usually need to be repeated. Other noninvasive services Ribotsky recommends include "Botox injections for overperspiring feet, foot 'facials' and foot resurfacing."

Source: Steve Dorman, The Palm Beach Post [4/4/11]

FL Podiatrist Receives The Jefferson Award for the Treasure Coast and Palm Beach County

Dr. Andrew D'Errico has spent the last two years making sure that World War II veterans get through their mission to Washington, D.C., and home safely. D'Errico, 45, is medical director for Honor Flight of Southeast Florida, a nonprofit group that brings War II veterans to see their WWII Memorial in Washington, D.C., free of charge.

Dr. Andrew D'Errico (Photo Deborah Silver)

The Jefferson Awards are a national recognition program started in 1972 to honor volunteer service. They are awarded to people who make their communities better places to live, but who go about their tasks without ever receiving or seeking recognition or reward. Since 1998, D'Errico has also conducted medical clinics in Romania, where friends have an orphanage. Every few years, he goes back to a clinic there.

Source: Cathy Reeder, Fort Pierce Tribune [4/4/11]

NY Podiatrist Named Chief of Podiatric Medicine & Surgery

Winthrop-University Hospital has announced the appointment of Garden City resident Philip M. Palmeri, DPM, to the position of Chief of Podiatric Medicine & Surgery in the Department of Orthopaedics at Winthrop. Dr. Palmeri will serve in this capacity concurrent with his role as a podiatrist at a private practice in Franklin Square, where for the last 26 years, he has served the needs of thousands of patients in the local area alongside of his father, Felix R. Palmeri, DPM, who began the practice in 1955.

Dr. Philip M. Palmeri

Dr. Palmeri has a long history with Winthrop, having been an attending podiatrist at the Hospital since 1984 and the Director of Podiatric Medicine & Surgery at Winthrop’s Wound Healing Center since 2008. A Diplomate of the American Board of Podiatric Surgery, Dr. Palmeri is also a Fellow of The American College of Foot & Ankle Surgeons. He also serves as a member of the Nassau County and New York State Podiatric Medical Associations.

Source: Newsday [4/4/11]

FL Podiatrist Arrested on Drug Charges

A podiatrist from St. Petersburg was arrested Monday in a drug sting for writing and filling prescriptions for hundreds of addictive painkillers and other narcotic drugs. Podiatrist Brian K. Hameroff, 43, of St. Petersburg, and dentist Kevin M. O'Callaghan, 49, of Largo face third degree felony charges in the prescription drug sting, dubbed "Operation Doctor, Doctor."

Detectives allege that the men were writing prescriptions to each other for as many as 200 pills a month for narcotic medications that include Hydrocodone, Lorazepam and Oxycodone. Detectives believe the pills were for the personal use of the physicians.

Source: Linda Hersey, Old Northeast-Downtown St. Pete Patch [4/4/11]

Query: Chronic Stasis Dermatitis Draining Lymph Fluid

I have been treating a 90 year old patient who suffers from stasis dermatitis of both lower limbs. She has undergone superficial vein ablation by a vascular surgeon and has been managed very closely by her internist. Her immediate problem is chronic stasis dermatitis of her left lower limb which drains lymph fluid on a regular basis. She has had this lymph problem on her other limb, and since it was a pinpoint leak, I managed to stop it with 75% AgNo3 and Polymem dressings. The left lower limb has been draining for the past few months, despite applications of Unna Boot dressings on a twice-a-week basis.

Chronic Stasis Dermatitis Draining Lymph Fluid

Her left leg is large superiorly and smaller inferiorly - the inferior portion has been ulcerated and reddened. She has been taking Augmentin 500 mg daily for the past month. I plan to add zinc oxide and hydrocortisone powder to the limb this week and would appreciate it if someone could recommend a more productive course of treatment. I have her on 60 mg of Lasix daily and this hasn't really made a big difference.

Frank J. DiPalma, DPM, Athens, GA

Query: EMR/EHR and Practice Management Software    

Has anyone had any experience with 1st Providers Choice or Medisoft by McKesson? How long have you used the program? How difficult was it to learn? How accessible is support?

Len Sanchez, DPM, Whittier, CA

Query: Lesser MTPJ Cheilectomy & Implant

The pre-operative diagnosis on my patient was Freiberg's infraction with secondary osteoarthritis. I performed a cheilectomy of the lesser metatarsal-phalangeal joint with the insertion of a lesser metatarsal head implant. How would this procedure be coded?

Ronald Adelman, DPM, New York, NY

Response: Currently, there is no code that accurately reflects the surgery you have described. Therefore, I believe you have two options:

CPT 28122-22 - ostectomy, partial, metatarsal; with the "-22" modifier indicating more complex procedure than CPT 28122 basically describes; or CPT 28899 - unlisted foot/toe procedure.

With each, you will need to submit an operative report with request for peer review.

Howard Zlotoff, DPM, Camp Hill, PA

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

RE: Obesity and Podiatry (Howard Dananberg, DPM)
From: Robert Bijak, DPM

I have to ask Dr. Dannenberg, since when is the truth "sad"? At the end, all you did was refer the patient out, and that was the right thing to do because you are not licensed or trained in nutrition or general medicine. What you call cynical, grounded people call reality. Don't pretend to be a physician "counseling" a patient as if you were doing the treating. Any family member or friend could have done the same thing. You're overweight, see an internist!

Sorry to inject reality in your world. You are a doctor of podiatric medicine, nothing more! What if the weight gain is due to a pituitary adenoma, Cushing's disease, CHF, ascites, hypthroidism, anasarca, etc? Do you trust your DPM to rule out disease other than overeating?! The law doesn't. If your scope of license in podiatry is too narrow, vote for a degree change.

Robert Bijak, DPM, Clarence Center, NY rbijak@aol.com

RE: Difficulty Passing National Boards Section (Name Withheld)
From: Dwight L. Bates, DPM

Spend one hour with me on Skype to learn how to pass the exam. Every podiatry student by the third year knows the facts, but podiatric terminology is so awkward, it is confusing on paper exams. I will not charge a fee for this.

Dwight L. Bates, DPM, Dallas, TX, dlbates04@yahoo.com

RE: Difficulty Passing National Boards Section (Name Withheld)
From: Jeff Minnuti, DPM

There are a couple of reasons why you are unable to pass a standardized exam. Here is the differential diagnosis: 1. Stress/anxiety 2. Not prepared 3. Mechanical failure of computer, or exam itself.

If it is anxiety, then you should take two or so days off prior to the exam and play golf or do something to take your mind off the exam.

There are many study materials to choose from. Pocket podiatry is the best reference. The Hershey course is excellent.

It is highly unlikely that there would be computer malfunction twice to the same person. I recommend a different test center for the next exam.

Jeff Minnuti, DPM, Tampa, FL, dr.mennuti@gmail.com

RE: Advertisements for Laser Treatment of Onychomycosis
From: Bryan C. Markinson, DPM

In New York, I cannot drive in my car for more than thirty minutes without hearing some podiatrist's advertising promoting fungus nail treatment with laser. They are taking the FDA's "temporary clearing of nail" indication and advertising quick, easy, painless "killing" of nail fungus. These podiatrists have no data to support these claims that very clearly are meant to have the public believe that their toenail fungus will be cured. Many ads state that the lasers are "FDA approved," but they never say "for temporary clearing of nail." Worse, some advertisements tout the "cure" as "once and for all," which to the public, means "forever."

Some laser companies who have yet to receive the "temporary clearing of nail" indication are advertising to us that "FDA approval for toenail fungus is pending." What does that mean? To me, it means pending approval for cure. This is outrageous. What is more outrageous is that our professional community is soaking up this onslaught of envelope-pushing claims in way too high numbers. They then put forth to the public the same claims, hiding behind "what the company told me."
 
If you want to play cosmetic dermatologist, you need to get out of podiatry. If you want to pretend that an infectious disease is like a forehead wrinkle, you are yielding to the claims of unlimited profitability and pulverizing your credibility as a podiatric physician and surgeon. These devices are effective in treatment of nail fungus. It is time to say how so and advertise ethically. .

Disclosure: I am an advisor to the makers of the Noveon laser.

Bryan C. Markinson, DPM, NY, NY, Bryan.Markinson@mountsinai.org

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 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

ASSOCIATE POSITION - CT - (FAIRFIELD AND NORTH HAVEN)

Join one of the largest podiatric groups in Connecticut. Well-established and progressive offices, including EMR, digital x-ray, vascular and NCV studies, Pinpointe and CO2 lasers, diagnostic ultrasound and electrical stimulation therapy. You can expect a full schedule of patients the day you start, and a very competitive salary. For more info www.greatfootcare.com. Send resume to Dr.Kassaris@yahoo.com

ASSOCIATE POSITION - MICHIGAN

Entry level DPM needed to join an established, full service, group podiatry practice in Monroe, MI. A generous salary and future partnership opportunity will be offered to the right applicant. Check out our website at www.monpod.com Send CV and cover letter to info@monpod.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 - NYC, NY

Part/time, full/time associate for busy, well established multi-doctor, multi-office NYC group. Seeking motivated, ethical, NYC licensed DPM with excellent office management and clinical skills in all phases of Podiatry. Board Qualified/Certified preferred. Salary plus incentives, pension/medical/dental. Partnership potential. E-Mail CV to urbebe78@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 these lasers on your patients. E-mail footcare@comcast.net

PRACTICE FOR SALE - HOUSTON, TEXAS

28 year old busy, progressive practice for sale with an excellent reputation and well established referral base. Well-trained, dedicated, supportive staff. Excellent cash flow $475K income after overhead. EMR, digital x-ray, diagnostic ultrasound. Free standing building also available with large outdoor sign. Also available are two transferable surgical center partnerships(with distributions). Owner retiring and willing to stay part time during transition. Cover letter/CV to softechpodiatrist@gmail.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

OFFICE TO SHARE- NYC GREAT OPPORTUNITY

6 rooms (1000 sq. feet), Gramercy Park area. Newly renovated, painted, fully equipped and wired. Good for all situations. Available for immediate occupancy. Rental terms are competitively priced based on need. Please contact 157629@gmail.com for more information.

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

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