The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

April 15, 2011 #4,135 Publisher-Barry Block, DPM, JD

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NY Podiatrist Discusses Toning Shoes

Toning shoes promise customers that they can walk their way to firmer thighs, tighter butts and improved posture. But do they really work? Dr. Michael Wodka, a podiatrist with offices in Middletown and the anchor of Health Matters on WTBQ radio, maintains that he has been wearing his MBT shoes for years. He points out that the shoes are worn without an orthotic. "That can be a savings to the consumer who has depended upon orthotics to help with a host of foot problems and pain," he says. The shoes come packaged complete with a video on how to properly wear them.

Dr. Michael Wodka

Wodka says wearing the shoes takes a little getting used to. "At first, you feel like you're leaning back." That feeling of falling backward understandably causes the wearer to work hard to stay upright. "The spine is also better off because the shoes alleviate the pounding impact from the pavement or hard ground," he adds.

Source: Gloria Smith Zawaski, Times Herald-Record [4/13/11]

PA Podiatrist Receives APWCA's Outstanding Achievement Award

Guido LaPorta, DPM, FAPWCA was recently honored with the Outstanding Education Achievement Award presented during the American Professional Wound Care Association's (APWCA) National Clinical Conference in Philadelphia, PA.

(L-R) Dr. Guido LaPorta Receives Outstanding Achievement Award from Dr. Steven Kravitz, APWCA Executive Director

The Outstanding Achievement Award has been given to only four recipients over the past ten years. Also receiving the award this year  was Sharon Baranoski, MSN, DAPWCA. 

Obama 'Framework' Would Lower Healthcare Spending by $480 Billion Over 12 Years

President Barack Obama offered a deficit reduction “framework” Wednesday that would reduce projected healthcare spending by $480 billion as part of an effort to achieve $4 trillion in deficit reductions over the next 12 years.

Obama's plan would create first-time Medicare spending caps—based on per beneficiary growth in spending relative to per capita growth of GDP—enforced by the controversial Independent Payment Advisory Board or by the secretary of HHS. That 15-member body—created by the 2010 healthcare law—has drawn concerns from healthcare providers over its power to cut provider payments without Congressional approval to achieve billions of dollars in Medicare spending reductions

Source: Rich Daly, Modern Healthcare [4/13/11]

Sharpen Productivity

You will realize a productivity boost when you start maintaining a “don’t do” list along with your to-do list. Add items like these:

• Too-large goals. You may be working toward a five-year goal, for example. Take it off your to-do list—after you break out one or two actionable steps that you can start working on now.
• Inappropriate uses of your time. What are your time-wasting workplace vices? Consider things like personal phone calls, unnecessary meetings, workplace gossip and online distractions.

Source: Adapted from “Creating a ‘Don’t Do’ List,” Bob Peters, Life@Work Journal via Communication Briefings

Query: Peromax and Neurodyn Braces

Has anyone used the Peromax and Neurodyn braces. How do they compare to AFO braces?

JE Schiller, DPM, Cleveland, OH

RE: Uric Acid Crystals, Post-op
From: Charles Morelli, DPM

This is trauma-induced hyperuricemia, and the best way to treat this is to be your patient’s doctor and treat him as you would any patient with gout. If it's acute, treat the acute manifestation (steroid injections, analgesics, anti-inflammatories, colchicines, etc). If it’s chronic, either do that yourself too, or refer the patient back to his internist, whichever you are more comfortable doing. The goal of treatment in acute gout attacks is to end the "flare up" and convert the patient's condition to the chronic state. Going on a low purine diet can help prevent recurring attacks.

Charles Morelli, DPM, Mamaroneck, NY, podiodoc@gmail.com

RE: Uric Acid Crystals, Post-op
From: Elliot Udell, DPM

Perform blood work on the patient and determine the uric acid levels. The recommendation is to bring those levels down to or below 6 ml/dl. If the crystals are all in the joints as described, the blood levels may have to be reduced even more. If the patient is an overproducer of uric acid, one drug of choice is allopurinol, 100 mg per day, but this can raise coumadin or theophyllin levels. A newer pharmaceutical is Uloric. It has a better safety profile, but is expensive. You can give between 40 and 80 mgs per day.

Initially, either drug can cause other gouty inflammatory attacks. If the patient's kidneys are under-secreting urate, probenecid is the drug of choice, however, if the person is excreting less than 800 mg/dl...

Editor's note: Dr. Udell's extended-length letter can be read here.

RE: Mosaic Wart Treatment (Stephen Merena, DPM)
From: Brian Kiel, DPM, Robert Kornfeld, DPM

I have used the following with reasonable success over the years: Tagamet 400mg/3 qd and Lazerformaldehyde applied once daily. I have seen lesions resolve in weeks and sometimes in months. I see the patients every six weeks for evaluation and debridement.

Brian Kiel, DPM, Memphis, TN, Footdok4@gmail.com

The overlooked issue here is why is this patient suffering with chronic viral infection? This is clearly an immune system problem and needs to be addressed as such in order to cure this patient AND eliminate the dynamics that will lead to other health issues down the road. Epigenetic influences on the immune system need to be identified and corrected. Once this is accomplished, these warts can be eradicated with a natural medicine protocol that enhances viral discharge, creates a more vital immune system, and kills the warts already present in the skin. This can be accomplished without side-effects, without burning or irritating the skin, and without surgical approaches.

For so much of what we treat, we need to look "outside" the foot for mechanisms and causes. Then, we treat the foot and we see amazing healing occurs, both podiatric and systemic. You can keep trying to patch the leak in the ceiling, but it is much more effective to see why the roof is allowing the water to enter the house.

Robert Kornfeld, DPM, Manhasset, NY, Holfoot153@aol.com

RE: Laboratory Confirmation of Dermatophyte Infections
From: Bryan C. Markinson, DPM

In recent postings (which were outgrowths from my original post on unethical advertising by podiatrists for laser treatment of onychomycosis), several podiatrists advocate clinical diagnosis only before beginning treatment of any kind for onychomycosis. One poster even stated that if it looks and smells like onychomycosis, healthcare dollars should not be wasted on laboratory confirmation. It has been estimated that clinical diagnosis of dermatophyte infection of the nails is around 80 - 85% accurate. Some might say ONLY 80 - 85%. It is probably true.

The literature has shown that up to 67% of empiric diagnosis of tinea pedis may be INCORRECT. However, here is one CERTAINTY….in the past three years, I have reviewed/been deposed as an expert in two cases regarding mycotic nail treatment where a question of sub-standard practice centered on failure to get positive laboratory confirmation of infection prior to treatment. Whatever you may argue, there is no question that when science comes up against the reality, even the most unskilled plaintiff’s attorney will destroy the credibility easily of anyone stating that clinical diagnosis alone is acceptable before initiating treatment. Having said that, my own current opinion, (which has changed over the years) is that failure to get laboratory confirmation of onychomycosis before treatment cannot be defended in any way.

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

RE: Orthotic for Golfer With Met Adductus Foot
From: Barry Mullen, DPM

In addition to what has already been mentioned, just ensure that the selected golf shoe has an accentuated curved last (versus a straight last) to accommodate the overall architecture of the forefoot.

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

RE: HIPAA and Doctor Reviews on Websites (Carl Solomon, DPM)
From:  Raymond F. Posa, MBA, Carl Solomon, DPM

Dr. Solomon brings up an interesting situation that is shared by other professionals, like attorneys. An attorney can bring a sound legal case and yet still lose based upon the ruling of the judge. The client can then rant and rave on line but the attorney can’t respond due to attorney client privilege.

Similarly, you as a doctor cannot respond in any meaningful way without specifying details of the case which would violate HIPAA. From a practical point, it really will not help you to get into the mud and argue with this person. The best solution: have your happy clients post their positive experiences on the same site and just drown out the single outlier.

Raymond F. Posa, MBA, Farmingdale, NJ, rposa@themantagroup.com

It wasn't 24 hours after sending my post to PMNews that I saw a spot on a local TV newscast detailing doctors' concerns over this very issue, and having patients sign "non-disclosure" contracts before treating them. (Here's the link: wfaa.com/news/health/Doctors-asking-patients-119609244.html). I'm not saying this is necessarily the proper approach, but it does illustrate that it's an emerging concern.

Carl Solomon, DPM, Dallas, TX, cdsol@swbell.net

RE: Routinely Taking Patients' Blood Pressures in a Podiatric Setting (Elliot Udell, DPM)
From: Charles Morelli, DPM, Michael M. Rosenblatt, DPM

Dr. Udell said that he "instituted this in our office solely to satisfy "meaningful use." You DO NOT have to take a patient’s blood pressure to satisfy meaningful use. What you need to do is simply record their blood pressure to satisfy meaningful use. All you have to do to "satisfy MU" is simply ask the patient what their BP is and record it. If they say it is normal, then all you have to do is record that. You do not have to actually take their BP.
 
Please don’t misunderstand what I am trying to say here. I too take BP’s in my office, but not for the reason of satisfying meaningful use. There are many reasons why taking a BP in your office makes sense. I just want to be clear that you do NOT have to actually take patients' BP for meaningful use.

Charles Morelli, DPM, Mamaroneck, NY, podiodoc@gmail.com

Dr. Udell takes BP's in his office routinely. He discovered a situation where the patient had neglected to take his anti-hypertensives for over a week, obviously a dangerous issue. I had a similar case. A long-time female patient of mine presented for her "usual" RFC visit. She complained of a "nagging pain in her left shoulder that made it impossible for her to sleep." She described it as "arthritis pain."

I took her BP and found it dangerously elevated. It then occurred to me that she was most likely having a heart attack. I had her call her doctor from the office and she met him at the ER. Within 12 hours, she had a quadruple bypass surgery. Her husband called me in tears a few days later. He said the internist told him: "That podiatrist saved her life."

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

GROWING PRACTICE FOR SALE- PHOENIX ARIZONA

Part of the largest multi-specialty group in Phoenix comprised of approximately 30 referral sources. Selling 50% share in practice grossing 600K. Gross is based on part-time practice but easily expandable to full-time if desired. Active, healthy client population, excellent surgical base, very minimal palliative care. PSR-36 required. Inquire at drlaurel@cox.net

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

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

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

ASSOCIATE POSITION – NEW JERSEY

Associate wanted full-time, for practice in East Orange NJ PSR 24-36 trained. Must be motivated to grow practice, especially build wound care and surgical services. Buy-in possible after the 1st year. send CV to Drfoot44@gmail.com

Cornerstone Health Care, one of the largest physician owned and managed multispecialty groups in the Southeast, seeks podiatric physician for office located in the Piedmont Triad of North Carolina. The physician must be licensed in NC, have three years of training, and board qualification in forefoot and rearfoot surgery. Cornerstone has over 290 providers in 75 locations. Physicians benefit from centralized billing, purchasing, and human resources, while maintaining autonomy over office practices. A state-of-the-art EMR system provides instant access to all Cornerstone patient records. Send CV to page.redpath@cornerstonehealthcare.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 - NEW YORK CITY & QUEENS

One of the fastest growing podiatry practices in New York City and Queens seeks a podiatrist who participates with HealthFirst, Fidelis, and other Medicaid plans. Preferably a Spanish speaking podiatrist. Contact me at Podocare@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

PODIATRY SUPPLIES--CHEAP!

Closing office. Gloves, pads, CAM walkers, casting splints, Powersteps, dressings, Covelets, Elastikon, Zonas, Coban, etc, etc. E-mail for complete list/description. Why pay full price? Huge discount if you take entire inventory. E-mail for complete list/description to goodfeet@hbci.com or call 507-429-7957.

PM News Classified Ads Reach over 12,500 DPM's and Students

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