The Voice of Podiatrists

Serving Over 10,800 Podiatrists Daily

April 08, 2008 #3,214 Editor-Barry Block, DPM, JD

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ACFAS Agrees to Table Its Policy Change on Membership

The following eflects a joint statement released by APMA and ACFAS:

At the APMA House of Delegates meeting this week, ACFAS and APMA agreed that all ACFAS members should vote to determine whether ACFAS should change its bylaws to require APMA membership as a prerequisite for sustaining ACFAS membership. Measuring ACFAS member sentiment on dual membership is important to both organizations.

Any ACFAS member who has not yet voted is encouraged to do so. The deadline for receipt of ballots (by e-mail, fax, or e-ballot) is 12 noon, Central time on Friday, April 18, 2008.

The Board of Directors of ACFAS has agreed to table its policy change on membership pending the tabulation and analysis of the vote. During this time, the two organizations will continue their current ongoing dialogue.

APMA Election Results

The following is a list of elected APMA Officers and Trustees:

President-Elect - Ron Jensen, DPM

Dr. Ronald Jensen

Vice-President - Kathleen Stone, DPM
Treasurer - Michael King, DPM
Board of Trustees - Joe Caporusso, DPM
Board of Trustees - Phill Ward, DPM
Board of Trustees - David Edwards, DPM*

* 2-year Term. Dr. Edwards defeated Jeff DeSantis, DPM 69-68 in the closest election in APMA history.

Speaker of the 2009 House - Mark Schilansky, DPM

Query: Extremity MRI

I remember seeing advertised for a while an MRI machine specifically for the lower extremity. I cannot seem to find any reference to it anywhere. Could someone point me in the right direction?

Jonathan Rosenblum, DPM, Jerusalem, Israel

Query: Absence From Practice

I have a colleague who must leave town for 2 years while his spouse does M.D. residency out of state. They plan to return after she completes her residency.). I’m looking for Ideas regarding his small but successful solo practice. He plans to return approximately once per month during the two years. Is locum tenens feasible? Should he sell his practice or hire associate to run the practice in his absence?

Gary Trent, DPM, Chicago, IL

RE: Injectible Cortisone Dosage (John Moglia, DPM
From: Robert K Hall, DPM, Bob Kornfeld, DPM

We typically use 0.5ml of Depo-Medrol 40mg/ml (i.e. 20 mg.) plus 1.0cc 1% lidocaine plain. While "cortisone flare" occurs about 5% of the time for us, we advise ALL pts. of this possible & transient side-effect of "injecting crystals, under pressure in an already inflamed area".

Perhaps try 1% plain, with a rapid onset, which may help break the pain cycle faster, rather than the longer onset/duration Marcaine. Occasionally, in recalcitrant cases, we make a "cocktail/shotgun" of 0.5 cc each of DepoMedrol 40 mg/ml, Dexamethasone phosphate, 1% plain & 0.25 or 0.5 Marcaine to cover all bases.

Robert K Hall, DPM, Ft Lauderdale, FL, robertkhalldpm@bellsouth.net

Dr. Moglia has experienced issues with steroids, as have many others, because of the nature of cortisone and the purpose of inflammation. It is my opinion that a dose of 40 mg. of insoluble steroid is far above what is actually needed to assist in patient comfort. Do not forget that the actual reason the area is inflamed is because there has been repetitive stress and tissue injury. The immune system pathway of inflammation is then recruited to detoxify those highly metabolically active tissues and repair the cellular damage. When this pathways fails in its attempts to fix the problem, a chronic inflammatory pathway is enabled which protects the tissues under stress and prevents the tissue damage from spiraling out of control. This is when the patient seeks medical intervention.

Now along comes cortisone. In high doses, such as 40 mg. of an insoluble steroid, there is a binding to tissues of the medication. These cortisone molecules are then read as an invasion of toxins. To overcome the high concentration of the drug, the immune system will enliven a profound acute inflammation to detoxify the cortisone (i.e. acute inflammation superimposed on chronic inflammation). Hence, the patient suffers an exacerbation of symptoms. Not what we want to create at all. While readers of this forum already know where I stand on natural medicines,

I absolutely still use cortisone injections when deemed prudent. But you must choose your patients wisely. There are predictable reasons why some patients will not respond well to cortisone, which I cannot go into here. However, it is my opinion that when the functional and metabolic causes of the pathology are being addressed, a dose of 1 - 2 mg of a soluble steroid is more than enough cortisone to net the result you are striving for.

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

Symptomatic Treatment of Peripheral Neuropathy (Steven Goldstein, DPM)
From: Jeffrey Kass, DPM, Richard Mann, DPM

I echo the sentiments of Dr. Goldstein regarding medicinal treatments of neuropathy. On Jan 31st of 2008, The FDA sent notices of 11 medications with an increased risk of suicide after as little as one week. These were medications used for treatment of epilepsy. Two on the list were Neurontin and Lyrica. I would be cautious in their usage. Like Dr. Goldstein, I have had excellent success with Metanx, and I would agree that not every medicine or supplement will work for everyone.

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

I can understand Dr. Sullivan's interest in Sinemet for the treatment of peripheral neuropathy. Any degree of amelioration with respect to the numbness, burning, tingling and shooting pains associated with peripheral neuropathy is a highly desirable clinical outcome. I find these patients to be among the most difficult to treat and the most desperate for effective treatments. I would share with him the following: in the past two years I have dispensed Neuremedy to over 500 of my neuropathic patients. Approximately 35% of these patients have had some level of improvement in their symptoms including, at times, partial return of sensation. This rate of success has been duplicated in many other podiatric practices.

The treatment of peripheral neuropathy with the active ingredient in Neuremedy, benfotiamine, a lipid-soluble, thiamine analogue, has been well studied in the scientific literature. It has been safely, extensively and successfully used in Japan since 1962 and in Europe since 1978 on people suffering from peripheral neuropathy. There have been no significant adverse effects reported from its use.

I respectfully submit that it would seem reasonable and prudent to consider this safe and proven agent as a first option in managing patients suffering from peripheral neuropathy. I would also urge caution in using an agent with as many potential adverse effects as Sinemet for an off-label indication.

Richard Mann, DPM, President and CEO, Realm Labs, Distributors of Neuremedy, rhm123@gmail.com

RE: AMA’s Scope of Practice Report
From: Michael M. Rosenblatt, DPM

The recent "enlightened" stance by AMA, in its willingness to "share" input from APMA is not as surprising as it may seem. "In 1975 the U.S. Supreme Court ruled in the case of Goldfarb vs. The Virginia State Bar, that learned professions are not exempt from antitrust suits. In 1982, the Court ruled that the FTC can enforce antitrust laws against medical societies. These two suits paved the way in 1976 for five chiropractors to file an anti-trust suit against the AMA and several other heath care agencies and societies in Federal District Court (known as the Wilkes Case)."

It is tragic and shortsighted for AMA to try to limit podiatry on primarily economic grounds, "shielded" by so-called defects in our training. All physicians have "defects" in training. At the present time, a large percentage of American physicians are being recruited from overseas. It is very difficult to actually "gauge" the quality of their training, and patients rely only on the fact that their MD is "licensed." That's hardly a guarantee!

I credit APMA for their full frontal attack on this "AMA paper." Every podiatrist should reach heavily into their pockets NOW to fund your APMA, who is looking out for YOU!

Michael M. Rosenblatt, DPM, San Jose, CA,rosey1@prodigy.net

PRACTICE FOR SALE - BUFFALO'S KENSINGTON SECTION

Established satellite practice. In urban metropolitan area on a busy commercial street corner - commercial building with an attached retail store that allows easy advertising of the podiatric medical practice. Gross $170K+ at 2 ½ day per week. Great potential for growth. 260 402-7490

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 WANTED – NEW YORK IMMEDIATE OPENING

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

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

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

ASSOCIATE POSITION – CONNECTICUT

Connecticut Surgical Group, one of the largest multi-specialty surgical group practices in New England, is seeking a Podiatrist to add to our three-physician Podiatry division based in Hartford. Provide all aspects of Podiatric care with a focus on wound and surgical care to a well-established patient base. PSR-36 training and board certification or eligibility and excellent surgical and wound care skills required. We offer competitive salary and productivity bonus, partnership opportunities, excellent benefits, and reasonable overhead. Apply online at https://home.eease.com/recruit/?id=21426 or via our website or fax your CV to 860-524-2653. No phone calls. EOE.

PODIATRISTS NEEDED - CHICAGO --NORTHWEST INDIANA

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists. We are located in Chicago and Northwest Indiana. Full and part time positions are available. Competitive Compensation including malpractice. Contact Scott Schneider. Phone-773-342-4201 FAX 773-486-3548-E-Mail sschneider@homephysicians.com -- www.homephysicians.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

Great opportunity: our busy multi-physician, podiatric group practice, with multiple locations, strong hospital affiliations and faculty positions with PM&S-36 residency program, is seeking a full-time RRA BQ/BC, PM&S-36 surgically trained doctor. Applicant should be well trained in all aspects of surgical and conservative care. Candidate should be ethical, hard working and outgoing physician to join our practice. Commensurate pay with incentives and benefit package. Definitive plan leading to partnership tract. Contact: Daniel Hellman, M.D. @ 414.831.0512 or by e.mail @ hellmandr@gmail.com

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.

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

Excellent opportunity for a hard working, ethical podiatrist to join a vibrant, successful and growing podiatric medical and surgical practice. Dedicated, supportive staff with strong marketing and medical knowledge. Must be board eligible/certified. PSR/24. Partnership opportunity. Competitive salary, bonus structure, benefits. Wonderful place to raise a family. Fax CV to 816-455-8901.

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