The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

April 18, 2011 #4,137 Publisher-Barry Block, DPM, JD

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TX Podiatrist Discusses Pregnancy and Foot Health

Pregnancy is seen by most as a time of anticipation and joy, but it can take a toll on a woman’s body. Even the feet can be affected. Researchers report that more than half of all pregnant women have foot complaints. According to Adriana Karpati, DPM, a podiatrist in Grapevine, TX one of the most commonly encountered foot problems in pregnancy is plantar fasciitis (heel pain). As the woman nears the last trimester, production of a hormone, called relaxin, causes the ligaments to loosen in preparation for movement of the baby through the birth canal. This process also loosens the ligaments in the foot. 

Dr. Adriana Karpati

Karpati says pregnant women may also develop ingrown toenails. This is usually caused when the swollen feet are stuffed inside shoes that are too tight. She says pregnant women are used to getting bigger maternity clothes to match their growing girth. However, many patients don’t think about changing their shoe size. The foot can get flatter and wider, growing in length by an extra half inch.

Source: WSOCTV.com [4/15/11]

White House Issues Online Privacy Strategy

President Barack Obama today released the National Strategy for Trusted Identities in Cyberspace, a 45-page outline  of how the government will work with the private sector to develop what's described as an electronic "identity ecosystem" to protect privacy and curb online fraud.

"The Internet has transformed how we communicate and do business, opening up markets and connecting our society as never before," Obama said in a news release accompanying the release of the plan. "But it has also led to new challenges, like online fraud and identity theft, that harm consumers and cost billions of dollars each year. By making online transactions more trustworthy and better protecting privacy, we will prevent costly crime, we will give businesses and consumers new confidence, and we will foster growth and untold innovation."

Source: Joseph Conn, Health IT Strategist [4/14/11]

Project Confidence Through Posture

No matter how you are feeling inside, you should concentrate on projecting self-confidence at work. After all, others will hesitate to place confidence and trust in you if you don’t seem to believe in yourself. The following postures will make you seem both confident and competent:

•  Back straight. Stand upright with your back straight.
•  Shoulders square on your spine.Do not round your shoulders.
•  Head erect. Balance your head evenly above your shoulders and neck.
•  Chin parallel to the ground. A raised chin can convey arrogance; a downward-oriented chin conveys hesitation or dejection.
•  Eyes forward. Focus on where you are going, instead of looking down.
•  Weight even. If you are standing, distribute your weight evenly on both legs, without leaning to one side or the other. If you are sitting, do not slouch.

Source: Adapted from What Your Body Says (And How to Master the Message), Sharon Sayler, John Wiley & Sons Inc. via Communication Briefings

Query: Allergic Reaction to CaSO4 Beads

Given all of the obvious variables, has anyone ever seen a suspected allergic reaction to the sulfur component of the Wright Medical calcium sulphate antibiotic-impregnated beads? Should you use them in patients who are allergic to p/o sulphates?

Tip Sullivan, DPM, Jackson, MS

RE: PMLexus Exam Prep

I have 25 years of experience as a podiatrist and plan to take the PMLexus exam for licensure in other states. I would appreciate any recommendations for prep courses to get ready either online or at an actual seminar. I’m trying to get the most bang for my buck.

James Petko, DPM, Falls Church, VA

RE: Uric Acid Crystals, Post-op
From: Michael M. Rosenblatt, DPM

This complication should be treated in concert with immediate referral to an internist/nephrologist; because there is also a possibility that kidney damage could result from this situation. The podiatrist could start by ordering a series of laboratory tests, including creatinine clearance, BUN and, of course, uric acid.

Gout is a systemic disease with systemic risks and complications. The patient must stop drinking any form of alcohol. Alcohol use post-op may be the precipitating factor in this complication. When you question a patient about alcohol, one doesn't say: "Do you drink?"  The correct question is: "About how many drinks of alcohol do you take daily, and in what form?"

While I have no objection to podiatrists prescribing medications to treat gout, this issue must be over-seen by an internist. The internist will decide if it is necessary to do further tests of kidney function. In a sense, the patient was "lucky" that this complication occurred...as it represents a doorway to future treatment of a serious systemic disease. The referral will also help protect the podiatrist against possible charges of treatment outside the DPM license, as well as potential lawsuits.

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

RE: Mosaic Wart Treatment (Stephen Merena, DPM)
From: Alan L. Bass, DPM

Shortly after reading Dr. Mullens’ article published in JAPMA back in 1995, I decided to begin using cimetidine to treat verruca in my pediatric population. While I have no specific data to back up my statement, I would say that I have had greater than 90% success rate over the past 15 years. I think that once this treatment is explained to the parents in an honest, up-front way, they are more than happy to try it, and are happy that their child is not be subjected to sometimes painful treatments. The greatest part about it is all the referrals from the pediatricians and the parents themselves!

Alan L. Bass, DPM, Manalapan, NJ, abassdpm@optonline.net

RE: Laboratory Confirmation of Dermatophyte Infections (Mark E. Spier, DPM)
From: Bryan C. Markinson, DPM

Dr. Spier cites a definitive publication by Drs. Baran, Hay, Haneke, and Tosti that only highlights that which we agree on, namely that there is some unreliability of laboratory testing in mycology. These noted authors, except for Dr. Hay, are my co-board members on the Council for Nail Disorders. I can assure you that citing them (including Hay) on this subject and using it to advocate for treatment WITHOUT laboratory confirmation would not be supported by any one of them, indeed it would be absolutely frowned upon, whether the treatment is a bottle of tea-tree oil, systemic, or a laser. Indeed, a presentation at our annual meeting this year by Dr. Bonnie Elewski absolutely supported confirmatory diagnosis before treatment, without exception.

Dr. Spier further puts forth that PCR testing is...

Editor's comment: Dr. Markinson's extended-length letter can be read here.

RE: HIPAA and Doctor Reviews on Websites (Richard Boone, Esq.)
From: Larry LaRussa

I constantly see this type of posting from medical professionals and I do not feel the situation is that difficult to handle. The same reason that you dislike the patient on-line reviewing capabilities is the same reason the problem is easy to solve. They are not restricted from doing posts about your podiatric services, but neither are you. Simply write several reviews of yourself, (these don’t have to be overly positive, just neutral) and post it on the website. The reason I say "several" is because you want to make sure the negative post is on the second or third page of reviews. That way, it will be read by a very minimal number of people.

It is not even that time-consuming, because if another post should arise, just have your staff copy/paste your previous reviews to make sure the negative review is not on the first page. Other than that, just shake it off because Richard Boone is absolutely correct in his previous post.
 
Larry LaRussa (TUSPM’ 13) Rochester, NY, tuc33628@temple.edu

RE: Evaluating All-Purpose Lasers (John Moglia, DPM)
From: John Strisower

If you are interested in a tool that is legally-marketed for the most different possible uses, it is a regulatory question that can be answered by looking at the FDA clearance letters for each device. These laundry lists say nothing about how they can be used for these applications and certainly don't state whether or not they work in practice. If you are interested in treating specific indications or performing certain procedures, ask your colleagues what works and examine the body of clinical experience available for each device.

Generally, multi-purpose tools excel at nothing. Consider asking for the best multi-use automobile. Wouldn't your first question in answering that be since all cars can be used for almost any purpose, what is most important? If you are interested in carrying sheets of plywood or lumber, a pickup truck may be the best tool while a sports car might be poor. If you are trying to comfortably carry a large group on a long trip, that is best performed by a large SUV. For a sunny summer cruise on the coast with just your spouse, an exoticar works best.

If you want something that you "can" use on anything, almost any laser can be acquired. Results will likely be poor for most applications, and patient experience will be unacceptable. A better question is: What are your primary intended uses? Then select from the devices that are best in class with proven track records for those procedures.

John Strisower, CEO, Pinpointe, Inc., john@patholase.com

RE: Evaluating All-Purpose Lasers (John Moglia, DPM)
From: Joel Morse, DPM

At the 2011 Cherry Blossom Dermatology Seminar, we have three lectures on the topic of lasers for skin and nail problems. These will be in-depth and varied. There will also be exhibitors from top laser companies including: Cutera, Clearly Beautiful Nails/Lightage (Q-Switch), Cooltouch, and Fotona. If you have laser questions - this is the venue to come and learn. This seminar will have the most number of laser exhibitors at a podiatric seminar to date.

Joel Morse, DPM, Washington, DC, Foxhallfoot@aol.com

RE: Routinely Taking Patients' Blood Pressures in a Podiatric Setting (Elliot Udell, DPM)
From: John Scheland, DPM

Routinely taking blood pressures and all vitals should be an integral part of all doctors’ offices, especially a podiatrist's office. Whenever patients enter my office, they may be coming for a surgical consultation, or are already post-op. What better way to glean a patient's general health than a history and vitals? Next, podiatrists see many patients with chonic wounds. Vitals, with an emphasis on temperature, are essential in the initial assessment of these patients.

I recently heard a comment from another podiatrist who mainly does  routine care and felt no need to take vitals. Are you kidding? Routine nail patients, overall, are the sickest patients entering my office; almost all are diabetic, or worse, renal diabetics or have PVD with multiple co-morbidites, not the least of which is coronary artery disease. While I don't use it all the time, a glucose meter is also an essential tool to anyone seeing diabetics patients and can be invaluable in assessing diabetics with potential infections or who do not feel well.

In the midst of all this talk of parity, I am wondering why this is even a conversation. What benefit would it be to NOT take vitals? It is an easy bullet point for an E&M level, expected in any other doctor's office, provides important patient information that can play a vital role in clinical decision-making, and is a source of referral creation that will integrate a podiatric practice more fully into the medical community. Those who don't take vitals really should consider adding it to their patient check-in.

John Scheland, DPM, Clarks Summit, PA, limblengthener@yahoo.com

RE: Mrs. Malaprops Visits My Office

These are actually comments recently made to me by patients:

“I was in the hospital with slime flu and I was under canteen.”
“I have roter cups in my shoulder, but I don’t want surgery.”
“I need a chromosome shot.”
“Is the swelling in my leg due to all the gas I've been having?”
“I have immaculate degeneration in my eyes.” 

J Schiller, DPM, Euclid, OH

PODIATRIST NEEDED - NY/QUEENS/LI

Must be min. PSR-3 with excellent training. Experienced in billing, selling non-covered services, products, Patient medical and surgical exp. with good rapport/comm. skills necessary. Unique position working in offices, clinics, hospital with orthopedist, podiatrist, P. therapists. P/T, F/T available. Growth, income potential and partnership opportunity excellent. A chance to use all your skills; foot, ankle and more. Please respond with cover letter and CV to hansfeet@aol.com

ASSOCIATE POSITION - SOUTH CAROLINA 

Upstate, two-office practice seeking PSR-24/36 trained associate. Full-time position with partnership opportunity. Must be ethical, highly-motivated with strong surgical and medical skills. Please send CV to palpodiatry@att.net

PART TIME PODIATRIST NEEDED- LOS ANGELES, CALIFORNIA

Busy podiatrist looking for assistance with treating home-bound patients. Flexible hours, independence, and great compensation. If interested, email CV to homefootcare@hotmail.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

ASSOCIATE POSITION - NORTH CAROLINA

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

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

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

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

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

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