The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

April 13, 2010 #3,830 Publisher-Barry Block, DPM, JD

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We've just mailed the April/May 2010 issue of Podiatry Management. This month's cover story examines the issue, "Best Practices: Seven Steps Can Help Your Practice Become More Efficient." This 252-page issue includes our annual Who's Who Buyer's Guide.  In addition, you'll  find our usual assortment of features, including our columns, and a CPME-approved CME.

April/May 2010 Podiatry Management

CA Podiatrist Demonstrates Laser Doppler for PAD Diagnosis

Lee C. Rogers, DPM was a guest on The Doctors on Friday, April 9, 2010. The Doctors is a national talk show featuring four doctors, co-hosts of different specialties, who tackle the most troubling conditions facing patients. Dr. Rogers spoke about PAD in diabetes and demonstrated the Sensilase by Vasamed.

Dr. Lee Rogers on The Doctors

“The Sensilase system uses a laser Doppler under a blood pressure cuff that can tell you what the pressure is in the tiny capillaries in the skin. We can also see changes in the blood volumes in the arteries with every beat of the heart,” said Dr. Rogers. “This is a non-invasive skin perfusion test that can more accurately diagnose PAD, especially in those with diabetes.”

NYCPM Alumni Reunite at Pre-Centennial Event

Alumni representatives from the last half century recently returned to the New York College of Podiatric Medicine (NYCPM) for a pre-centennial reception. The college plans to celebrate its 100th anniversary with a gala dinner to be held on May 18, 2011 at the Grand Hyatt Hotel.

(L-R) Dr. Vito Rizzo, Louis Levine, CEO; Drs. Barry Block, Larry Santi, and Mark Feldman

Attendees at this year’s reception were treated to cocktails and dinner, and provided with guided tours of the recently upgraded facilities by enthusiastic podiatric students.

Lecture Halls Packed Again at 9th Annual APWCA Conference

If you’re looking for evidence that podiatry is approaching parity with other allopathic specialties, you need look no further than last week’s National Clinical Conference of the American Professional Wound Care Association (APWCA) in Philadelphia. The world-renowned faculty of wound care experts packed the voluminous ballroom. Most pre-conference workshops were sold out and many exhibitors were turned away for lack of space.

(L-R) Steven Kravitz, DPM (executive director), Robert Gunther, DPM, and David Brotman, MD (president); In the photo, Dr. Gunther receives an award as retiring president.

This meeting, which has grown every year, is the brainchild of podiatrists Steven Kravitz, DPM (APWCA founder and executive director), Robert Gunther, DPM (APWCA president), and Larry Schuster, DPM (Synergy editor). Throughout this interdisciplinary meeting, podiatrists interacted with physicians, nurses, and other wound care team stakeholders. Next year, APWCA plans an even bigger meeting (April 7-10, 2011) to celebrate its 10th anniversary, and has set its sights on a membership goal of 10,000.      

Reverse Feedback

The most common and least effective feedback technique involves leading with the negative: “You messed up when you …”

Improve the way you give feedback by emphasizing the positive instead: “You could be more effective if you …” That comment focuses not on the observed negative behavior but on the desired behavior. Recipients of that type of feedback will be better disposed to listen and learn what you want them to do.

Source: Adapted from The Golden Rules for Managers: 119 Incredible Lessons for Leadership Success, Frank McNair, Sourcebooks Inc. via Communication Briefings

Query: Consent For Office Procedures

What are most podiatrists doing for office procedures? Do they have patients sign a general consent for treatment as part of the new patient paperwork, or do they have patients sign a specific procedure consent prior to wart, biopsy procedures, etc.?

Nicole Hancock, DPM, Denton, TX

RE: Taste Disturbance from Lamisil (Al Musella, DPM)
From: Multiple Respondents

Some 8 or 9 years ago, I had a patient who experienced what Dr. Musella has described. My patient was a male in his early 70's. In this case, it was more of a loss of taste than an alteration of it (ageusia vs. dysgeusia). The patient became quite depressed over his loss of joy associated with food. When we derive no pleasure from food, we eat less. He experienced a profound weight loss. I referred him to a neurologist at the University of Pennsylvania who deals exclusively with disorders of taste. He agreed that Lamisil was the cause. There was no treatment and I am sad to say that the condition did not reverse. This was devastating for the patient and his wife. To this day, I include this incident in my discussion of possible risks and side-effects of oral Lamisil.
 
Will Parker, DPM, Myrtle Beach, SC,

I had two patients who did get a metallic taste with Lamisil therapy. Both eventually cleared, but it took several months with one lasting almost 1 year. I did not do any treatment for this patient.

Ken Jacoby, DPM, Elgin, IL, Gkjaco@aol.com

One time only, I had a patient who lost the ability to taste food for several months from the original name brand Lamisil. It did resolve in less than a year's time. However, since both drugs are now unavailable in name brand, we have experienced a sharp increase in side-effects and dramatic decrease in efficacy of both generic terbinafine and generic itraconazole. All things being equal, if I had to choose one, I prescribe the itraconazole, which seems to be slightly more efficacious than the terbinafine. 

Corey Fox, DPM, Massapequa, NY, drwdstk@aol.com

RE: Stiff Joint, Post-op Bunion Surgery (Mathew M. John, DPM)
From: Barry Mullen, DPM, David Secord, DPM

While it is possible that Dr. John has experienced excellent long-term results without complications walking his patients following distal 1st metatarsal and hallux osteotomies without protective fracture boots or post-op surgical shoes, this cannot be the norm and violates post-op weight-bearing osteotomy standard of care. Early mobilization does not equate to early unprotected ambulation. The Swiss acknowledged this fact in their original AO protocol. Rigid internal compression fixation of weight-bearing fractures, in all forms, is not guaranteed to withstand those forces. As such, Dr. John's early unprotected weight-bearing protocol not only can't be condoned, its associated complications would be difficult to defend in a court of law should a poor outcome result from a compromised osteotomy. My colleagues would be well advised to stick with the classic Swiss AO protocol.

The etiology of stiff 1st MTP's following distal 1st metatarsal osteotomy is too multi-factorial to cover in this format. However, one constant in its prevention is the absolute necessity for early 1st MTP mobilization. Those surgeons who eschew the Swiss' original AO protocol increase the risk of experiencing that complication. If, for whatever reason, your patient won't self-perform passive 1st MTP ROM exercises immediately after 1st ray surgery, then your responsibility as the surgeon is to get the patient to someone who will (P.T.).

Barry Mullen, DPM, Hackettstown, NJ, yazy630@aol.com

Editor’s Note: Dr. Secord’s extended-length letter can be read here.

RE: MASS Theory (Tyler Brahm, DPM)
From: Multiple Respondents

A chiropractor called today and left a message on my answering machine. She wants to know what I think about Sole Supports and Dr. Glaser's orthotics. She attended one of his seminars and is interested in prescribing Sole Supports for her patients. Apparently, Sole Supports is heavily marketing to the chiropractic profession  as well as the podiatric medical profession. 
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

I have been reading the posts regarding the MASS theory vs. the Root theory of in-shoe orthotic fabrication. In practical terms, there is a biomechanical misalignment (imbalance) identified that needs to be improved. I told Dr. Glaser directly (at one of his lectures) that his "theory" has some validity; so does the Root theory. Somewhere in the middle "lies the truth." I think the MASS theory may be a more appropriate technique in a pediatric device where a more aggressive arch position would be tolerated.

For a mature foot, forcibly plantarflexing the first ray (during the casting process) would probably lead to a device (in most cases) that would not be "well-tolerated." Chasing perfection with orthotics is a flawed concept. Orthotics (especially with adults) are a control, not a cure. We should always maintain "analytical vigilance" with regard to our acceptance and use of new as well as established theories. We should never "drink the Kool-Aid" based on information that may not stand up to the rigors of objective scientific analysis.
 
Arnold B. Wolf, DPM, Sterling Heights, MI, omnifootcare@prodigy.net

Dr. Kirby reflects the tone of current biomechanics as a science. Scientific development is a cyclical progression from pre-science, to normal science, to crisis, to revolutionary science, to paradigm shift, to (new) pre-science, to (new) normal science, etc.  Modern biomechanics is in the (new) pre-science phase with new schools of thought addressing the same subject matter from mutually incompatible standpoints. There is competition and rivalry between schools reflected in recent PM News posts, including Dr. Kirby’s. Does Newsby’s lab make the best Kirby-skived orthotics? Is Dr. Dananberg’s sagittal plane theory dead? Did it need to get “repackaged” into “dorsiflectory stiffness of the metatarsal rays” by Dr. Kirby?

I agree with Craig Payne’s suggestion that there are valid points in all the schools of biomechanics that have survived to this point with a following, and that all deserve examination and scrutiny. At some point, a consensus will be reached by a majority of our scientific practitioners and a new normal science will evolve from the current paradigms as Rootian Theory did in the '70’s.

The “certain individuals” that Dr. Kirby eludes to in his post probably share one thing in common: we do not feel that his take on biomechanics is leading us to a (new) normal science on its own.

Dennis Shavelson, DPM, NY, NY, drsha@foothelpers.com

RE: Orthotics for Ice Skates (Joel Morse, DPM)
From: Arnold Ross, DPM, Nancy A. Kaplan, DPM

The best orthotics for ice skates are poly or graphite orthotics closely contoured to the patient's neutral-casted foot.  These orthotics need to be balanced to the frontal plane deformity and then fit to the skates. Leg-length discrepancy needs to be corrected as well. The main difference in these orthotics is fitting the skates, which are narrow.    

Arnold Ross, DPM, Los Angeles, CA, asross1@juno.com

I am anxiously waiting for the article to appear authored by Dr. Weil on orthotics for ice skaters. I have a patient who has a problem with tailor bunion pressure plantar to the 5th metatarsal. She is a serious adolescent athlete in the field and stated to me that all the skaters need the sensory feedback from wearing skates without anything but a thin stocking or nothing at all as a barrier between the skates and their feet. I suggested felt padding inserted into the skate or applied to her skin but she was very reluctant to try this.

As an aside, she sought advice to alleviate the odor that emits from these favorite skates as a result of wearing them constantly with so little material to absorb any perspiration. 

Nancy A. Kaplan, DPM, Springfield, NJ, drnoonee@hotmail.com

RE: Aren't We Worth More?
From: Bret M. Ribotsky, DPM

Are people really paying police and fireman more than podiatric physicians? Today, UPS drivers are making 75K a year without 8 years of college and now 3 years of residency. There is a push about recruiting new people to podiatry schools. What will be the future for these graduates?

In February of 2004 I wrote in this forum about teachers' vs. DPM's salary and received a lot of "jabs" from many I respect. But the fact remains, teachers have received raises each year and doctors have not. 
 
We all need to take action NOW and "stop the Insanity." Learn how to run a business. Opportunities are easily available. We have a great profession at the cusp of capitalizing on this new healthcare system if you are smart and make changes now.  
 
Bret M. Ribotsky, DPM, Boca Raton, FL, ribotsky@yahoo.com

RE: Accountability of Expert Witnesses  (Adam Cirlincione, DPM)
From: Michael M. Rosenblatt, DPM, Adam Cirlincione, DPM

Adam Cirlincione, DPM, of Glen Cove, NY reports that there are several DPM experts who take plaintiffs' positions, at least in the NY area. According to Dr. Cirlincione, these names appear “over and over” on various cases where most plaintiffs lose their cases.

If you are a defendant and ask your own counsel if you should initiate some kind of action against these “repetitive experts,” your counsel will almost always advise against it. This represents a “cognitive dissonance” between doctors and lawyers. Doctors and lawyers cross paths, but each have their own professional interests. These conflict, even if they are hired to defend you.

Defense attorneys can and do “cross the line” to go to the other side. This elasticity is part of their economic view. They are disinclined to see “experts” either sued or censured, because they may need them in some case in the future. The entire business model of the malpractice industry DEPENDS on plaintiffs' experts, even if incompetent.

If you wish to take action, whether legal or by association censure, don’t expect help from attorneys. You will have to do it yourself, in concert with your various professional associations. Attorneys who defend you are as much a part of the system as those repetitive plaintiffs’ experts. In general, nearly all attorneys wish to perpetuate the present system, whether they disclose this to you or not.

Michael M. Rosenblatt, DPM, San Jose, CA, Rosey1@prodigy.net

Editor’s note: Dr. Cirlincione’s extended-length letter can be read here.

RE: PM News Celebrates 16th Anniversary
From: Hal Ornstein, DPM

Congrats to Barry Block and his team for 16 years and 3,828 issues of PM News. This is delivered with his heart and soul. What an incredible impact on our wonderful profession this has made with the ability to improve our clinical, management, and personal skills. Knowledge is power (the good kind) and I am happy that PM News continues to be a driving force for this profession on many levels!

Hal Ornstein, DPM, Howell, NJ, toetoe@optonline.net

ASSOCIATE POSITION – MICHIGAN (10x)

Well established practice in Southeast Michigan suburbs seeking full time associate. Must be ethical, personable and professional. This is a solid opportunity for a PSR-36 graduate or experienced practitioner. Must be able to diagnose and treat everything from general podiatry to reconstruction of severe deformities of the foot and ankle. The practice is currently maintained by two board certified surgeons. This practice is residency affiliated. Please forward current location and availability with C. V. to HKANEDPM@gmail.com

CANADIAN PODIATRISTS COME BACK HOME!

An Edmonton, Alberta group of DPM’s requires an additional Podiatrist. Interest in biomechanics essential. Given Canadian visa restrictions, this position is open only to Canadian Citizens or permanent residents. Very attractive compensation package. Fax C.V. or letter of interest to: (780) 483-5796.

ASSOCIATE POSITION FULL-TIME - SUBURBS OF CHICAGO

PSR 36 - month-trained podiatrist needed for busy suburban Chicago practice. Full benefit package included. If interested, please email your curriculum vitae to foot1st@yahoo.com

PRACTICE FOR SALE: TENNESSEE

Established 30-year full-scope podiatry practice. Excellent hospital and surgery center privileges with investment opportunities. Fully equipped 2200 sq.ft. office across from hospital. High volume of new patients, DME, and local referral base. Great community for a family and the outdoorsman. Reply to tnfootdr@gmail.com

ASSOCIATE POSITION - TEXAS

Dynamic, growing practice in Dallas/Fort Worth area, seeking surgically trained, Board Certified/Board Qualified Podiatrist. Excellent salary and benefits compensation package, for the right candidate, with partnership/buyout opportunity. Contact/Send resume to: jmh6122@yahoo.com Texas Podiatry License Required.

ASSOCIATE POSITION - SOUTHWESTERN PA

Suburban Pittsburgh. To work in an established practice and also a new office scheduled to open in August 2010. Future partnership buy-in possibilities. Rearfoot credentials needed to expand the established practice, and to maximize the potential in the new practice. Competitive salary, benefits. 724-337-4433.

ASSOCIATE POSITION - SW FLORIDA, BEACHES

Well-established podiatry practice with excellent mix office/surgery seeking full-time associate PSR 12-36. Excellent salary & benefits for the right hardworking, personable candidate. Email resume to capecoralpodiatry@live.com or fax to 239-573-9201

PRACTICE FOR SALE - MAINE

20+ year full scope turn-key practice in the same medical building, podiatrist-friendly hospitals nearby, appreciative and cooperative patients, excellent expansion potential. Retiring seller will stay for transition. mainefootdoc@yahoo.com

PRACTICE & BUILDING FOR SALE - MIDDLE TENNESSEE

Two locations each with 3 exam rooms, x-ray room, large waiting room, and ample parking. Excellent locations and growth potential. All equipment and furniture included. Website and marketing material included. Seller happy to assist with transition. Priced to sell with financing available 250k. Call 931-446-5724.

PRACTICES FOR SALE – BOSTON SUBURBS

Two established part-time practices. 2009 Gross 150K. Turn-key opportunity with low overhead. Diverse payer mix & loyal patient base. Currently open 2 days a week, but can expand to increase revenues. Personnel to remain, seller will assist transition. Asking 65K for both offices. Contact david@transitionconsultants.com (800) 416-2055.

ASSOCIATE POSITION – NEW YORK

Podiatrist Needed Immediately - RFC only. $45/hr working for the state prison system. Clean and safe. Easy money to help pay the bills. Several shifts available. If interested, E-Mail hansfeet@aol.com.

ASSOCIATE POSITION – CALIFORNIA

Looking for a motivated Podiatrist to join a rapidly growing practice in Los Angeles. Excellent compensation. Please reply to coasttocoastpodiatry@yahoo.com

PRACTICE FOR SALE IN HOFFMAN ESTATES, IL NEXT TO SCHAUMBURG

Established 16 year old practice, great Payer mix, no HMO. Fully equipped, updated 1253 ft2, Class A space. Excellent Suburban location just west of Chicago. Great Start-up opportunity - Tremendous expansion potential! Email to: ILDPMpractice@aol.com for more information.

ADVANCED RESEARCH AND SURGICAL FELLOWSHIP

Boston University Medical Center has two unique fellowship positions Become an expert in Limb Preservation, Tissue Repair and Regeneration. Be part of this unique Fellowship at a major teaching facility. During this time, he/she would be expected to become a knowledge expert who will contribute significantly to research, surgical procedures, teaching, and innovations in limb preservation and tissue repair. Requirements: Completion of a two or three year surgical residency; Candidate must possess a commitment to an academic career in podiatric medicine and surgery. Annual Salary: Year 1 $61,000, Year 2 $66,000. Submit a CV and letter of interest to: erin.springhetti@bmc.org

ASSOCIATE POSITION – CALIFORNIA

Looking for a motivated podiatrist to join a rapidly growing practice in Los Angeles. Will hire immediately. Excellent compensation. Please fax CV to: 310-652-3669.

FULL-TIME PODIATRY OPPORTUNITY - BOSTON, MA

HealthDrive is seeking a caring podiatrist to join our group practice. We currently have a FT non-surgical opportunity available in the Boston, MA area. We offer a competitive salary, Paid malpractice Insurance, health and dental Insurance, long & short term disability, flexible schedule (No weekends), established patient base, equipment, supplies and complete office support provided. If interested in this opportunity, please call Maria Kelleher (toll free) at 877-724-4410 or email caring@healthdrive.com

PM News Classified Ads Reach over 12,000 DPM's and Students

Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 12,000 DPM's. Write to bblock@podiatrym.com or call (718) 897-9700 for details. THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451

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