The Voice of Podiatrists

Serving Over 9,500 Podiatrists Daily

April 18, 2007 #2,914 Editor-Barry Block, DPM, JD

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Midwestern Student Wins APMWA Student Writing Competition

Tanya Carl, a third year podiatric student at Midwestern University, College of Health Sciences and a second year student in the masters in bioethics program, has been named the winner of the 21st Annual American Podiatric Medical Writers Association Student Writing Competition. Her paper was entitled, " Informed Consent and Medical Ethics." Carl will receive a one thousand dollar honorarium from a special endowment by Dr. and Mrs. Steven Berlin to the APMA Educational Foundation.

Tanya Carl

The Award for Honorable Mention went to, Meghan Arnold, a second year podiatry student at the Scholl College of Podiatric Medicine for her paper entitled " Teamwork: Podiatrists as Members of Healthcare Teams."

First Ever Study Predicts Outcome for Limb-Threatening Infections in Diabetes

Researchers from the University of Washington , Rosalind Franklin University of Medicine and Science, Merck Laboratories, and Mount Sinai School of Medicine have released a study suggesting that specific laboratory and clinical tests can predict outcome of antibiotic therapy for infections in persons with diabetes. “This study is unique in a couple of ways,” said Dr. David G. Armstrong, Professor of Surgery at Scholl’s Center for Lower Extremity Ambulatory Research (CLEAR) at Rosalind Franklin University

Dr. David G. Armstrong

“It comes from the largest-ever clinical trial of antibiotics for this type of infection, and it used very specific, day-to-day measures that can be done in any hospital, worldwide.”

Among other findings, the study revealed that a bad outcome rose nearly five-fold for wounds that were either assessed as being deep, or those that were associated with a very high white blood cell count. Dr. Armstrong concluded that “Data from this study will now help us continue to move forward to better care for those patients who are most in need.” The study was published in this month’s International Wound Journal.

This Week Health Information Website Launches

Revolution Health Group -- a new healthcare information company for consumers founded by former America Online CEO Stephen Case -- this week plans to launch its Web site, the New York Times reports. The no-charge Web site will feature 1,500 medical conditions that can be sorted by illness or treatment, as well as a directory of physicians that will include short reviews written by patients. Users will be able to create their own pages to store information and, if they choose, share it with others, Case said.

Users also will be able to maintain electronic health records on the website. Revolution Health eventually will sell services such as helping patients resolve disputes with health insurers, according to Case. Case acknowledged that the market leader, WebMD, "does a good job," but added, "There is a big opportunity to create the most trusted brand in health." Case said that he hoped to achieve brand awareness for the company within five years (Freudenheim, New York Times, 4/16).

Source: New York Times via American Health Line [4/16/07]

Query: Bone Infarct in Sickle Cell Patient

I recently saw a 37 year old sickle cell patient with a chief complaint of a painful bunion of several months duration. The area was not red, swollen, or hot. Circulation and neurologic were normal. X-rays revealed severe necrosis of the distal 1/3 of the 1st metatarsal with an area of cortical breakthrough of the 1st met head. MRI was done, and the radiologist and I agreed that the area represented a bone infarcts. Any recommendations for treatment without causing a severe functional and cosmetic defect in this otherwise healthy person would be appreciated.

Burton Katzen, DPM, Temple Hills, MD

Query: “Peppering” the Plantar Fascia

In cases of plantar heel pain syndrome that do not respond to multiple conservative treatments, it occasionally happens that someone is not willing or able to undergo an open surgical procedure, an endoscopic fasciotomy, or shock wave therapy.

In these instances, I sometimes anesthetize the foot, use a large bore needle to repeatedly stab the medial plantar fascial insertion, then dorsi-flex the foot, and apply an Unna boot for a week. I have had good luck with this technique [and was pleased to read a description of it in the Journal of the American Podiatric Medical Association last year by a group of Australian podiatrists]. What would be the correct CPT code for this procedure?

Kevin McDonald, DPM, Kannapolis, NC

Response: There is no CPT code for this procedure. You should, therefore, bill the procedure as an unlisted foot procedure (CPT 28899). You may very well find that the procedure is denied reimbursement ("experimental" "investigational"). I would make sure that the patient is aware of this - especially since the patient's insurer may not pay you (and, if you perform it in a surgical center, not pay the facility and anesthesiologist fees).

It would be wise to attempt to pre-authorize the procedure. You will need to provide documentation that is very clear on what you are planning to do, and be sure to include any copies or citations of published articles supporting the procedure. You should have the patient sign a notice that they very well might be responsible.

Tony Poggio, DPM, Alameda, CA

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RE: Limbrel (Dan Methuselah DPM)
From: Lawrence Kollenberg, R.Ph, DPM, Jeffrey Kass, DPM

I have used it in my practice, but only in a limited manner as it is relatively new. The one thing I have noticed so far is that few insurance companies have covered it. Most likely this because it is a "dietary supplement." This is a similar problem with Metanx, The prescription vitamins B6, B12, and L-Methlylfolate.

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

LimbrelTM (Flavocoxoid) is a medication marketed by Primus Pharmaceuticals. It is unique in its prescription classification as a medical food. Flavocoxoid is a proprietary blend of bioflavonoids, which is indicated in the long-term treatment of osteoarthritis (OA).

The recommended starting dosage is 250mg bid. Food may affect the absorption of the medication. Some dyspepsia was reported when taken on an empty stomach, but the difference was not statistically significant when compared to placebo. If there is not sufficient improvement in your patient after a two week trial of this medication at this dosage, then you could increase the dose to 500mg bid. The manufacturer’s website states that some clinicians report removing their patients from NSAID’s and putting these patients on 500mg bid dosing.

The drawback that I see is in consideration of most studies, we are hit with numbers of patients in the thousands of clinical comparatives. From reviewing what I could find on these studies, there are only a few hundred patients that were studied. Again most of the literature that is currently available does not show significant numbers of elderly patients in them. Yet since this is all from foods we commonly eat, logic states that it would be reasonable to pursue use of this new novel medical food treatment for OA.

In summary, after reviewing the literature of Flavocoxoid LimbrelTM I do feel that there is a significant potential use for Limbrel in the day-to-day management of podiatric patients.

Lawrence O. Kollenberg R.Ph, DPM, Jacksonville, FL, lkollenberg@hotmail.com

Editor’s note: For the full text of this shortened letter, see: http://www.podiatrym.com/letters2.cfm?id=13683&start=1

RE: Polydactyly in Newborn (Marc Greenberg, DPM)
From: Art Korbel DPM, MD

Many years ago I had a case of polydactylyism, bi laterally in a newborn. The mother was very anxious to have her daughter's feet "corrected" as soon as possible but after examining the child I told her to wait until the newborn was at least six months old. At six months, I did the procedure under plain local lidocaine and had no problems. I closed sub-cuticularly with Steri-strips for as minimal a scar as possible. This was a case of not only a sixth digit, but a sixth metatarsal as well on each foot. As Dr. Greenberg has said, each case is a bit different, so use your own good judgment.
Art Korbel DPM, MD, Coral Springs, FL, Classicboats4425@aol.com

Editor’s note: This topic is now closed.

RE: Closure of Macerated Incisions (Robert D. Teitelbaum, DPM)
From: Frank Lattarulo, DPM

My recommendation would be careful debridements with removal of all superficial fibrinous exudate without going to deep and start Iodosorb gel daily. Of course, a well made post op shoe is necessary as well. An otherwise healthy patient, with good vascularity is assumed here?

Frank Lattarulo, DPM, New York, NY, Doclatt@aol.com

Editor’s note: This topic is now closed.

ASSOCIATE POSITION - MANHATTAN

Park Avenue and East 7o’s. Excellent opportunity to work with renowned podiatrist/surgeon in beautiful, upscale practice. Seeking candidate with 2-3 year residency program, strong surgical skills. Assist with case documentation Opportunity to buy in. Please send CV and references to iblevinelautin@aol.com

POSITION AVAILABLE - SOUTHEAST TENNESSEE/ NORTH GEORGIA

Immediate position available or will wait for the right individual. Unique practice opportunity in growing multi-physician/multi-office practice. Well established/cutting edge within the medical community. Close proximity to hospitals as well as opportunity to become involved with a free standing podiatric surgical center. Must be BQ/BC. Minimum PSR/24. Competitive salary, bonus structure and benefits. E-mail CV to afcjen@hotmail.com

STOLEN LAPTOP AT MIDWEST CONFERENCE

A new HP Laptop Computer was stolen from Booth 623 at the Midwest Conference. The laptop is shiny blue, with a large screen. When running, it displays a picture of Monument Valley. The power cord was left at the booth. If you've seen this computer, please email ken@qnotes.com or call (954) 680-5776.

FELLOWSHIP IN PRACTICE MANAGEMENT, PODIATRIC MEDICINE & SURGERY. SOUTHERN CALIFORNIA

Must be board certified in a board approved by the Council of Podiatric Medical education Must be an APMA member. Salary 60K,to 75K with incentives. Fax resume to 562-997-9717

PRACTICE FOR SALE – CENTRAL FLORIDA

Well established surgical podiatry practice in Central Florida . Gross 2006 $744,136. Very attractive lease in an outpatient surgery center. Very low down payment. Contact Camille Todd/ Transworld Business 321 217 2625

PRACTICE FOR SALE: LA JOLLA CA (SAN DIEGO)

$287K '06. No HMOs, bone surgery, or insurance panels, so opportunity abounds! Affluent community. General practice, biomechanics, DME. Possible finance Serious/principals only. Cell:858-405-4780, 10-8 PDT. No Sunday calls, please. $149K Selling due to age, health problems. www.SDFootDoctor.com DrRDWorley@yahoo.com

ASSOCIATE WANTED - BOCA RATON-DELRAY BEACH AREA

Full time for growing practice-surgical training a plus-hard working a real plus-opportunity of a lifetime-partnership after 1 yr. Need Florida license. Fax resume to 561-865-2225

PRACTICE FOR SALE - WASHINGTON, DC

Priced to sell, 100% financing available. Owner leaving area. Hospital based 27 yr old practice with large surgical and diabetic population. Four fully equipped rooms. x-ray, topical hyperbaic oxygen units. Hospital privileges - full scope. 600+ new/yr. Will lease to you until final sale. Contact Dr Benjamin at jhallux@yahoo.com or (202) 841-5545 (cell).

ASSOCIATE WANTED – NEW YORK IMMEDIATE OPENING

Busy multi-dimensional practice; 70 miles north of New York City. Currently five (5)-doctor practice. looking to expand – all phases of podiatric medicine. contact: (845) 454-8308 EXT: 106

PRACTICE FOR SALE – PORTLAND, OREGON

Practice for sale with two locations and collecting over $500K. Great schools and parks, outdoor recreation galore, check out www.gorge.net. Both locations on all insurance plans. Staff willing to stay. Doctor willing to stay for smooth transition. 614-918-3000, American Doctor Sales, www.americandoctorsales.com

PRACTICE FOR SALE- FLORIDA

A 13 y.o. well established podiatry practice in Tavares, FL ( Lake County ) the 23rd fastest growing county in the nation. This is an opportunity not to be missed. All aspects of podiatry with hospital privileges available. PRICED TO SELL! If interested, contact Susan at (352) 406-2513 or at acrysue@gmail.com

WELL ESTABLISHED PODIATRY PRACTICE IN MT. AIRY, NC

Dr. John H. Hodges had a well established practice in Mt. Airy, NC that is either for sale or in need of an associate/partner to take over patient care. Dr. Hodges unexpectedly passed away, leaving approximately 3,500 patients. This is a unique opportunity to be able to begin work in a busy podiatric practice. If interested, contact Carolyn McMackin at (336)577-2886 or cmcmackin@triad.rr.com

ASSOCIATE POSITION- KANSAS CITY, MO

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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