The Voice of Podiatrists

Serving Over 10,800 Podiatrists Daily

May 02, 2008 #3,235 Editor-Barry Block, DPM, JD

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Diabetic Patients Need to Inspect Feet Daily: WA Podiatrist

Nearly 350,000 people in the state of Washington have been diagnosed with diabetes, according to the WA State Department of Health, and almost 150,000 more are undiagnosed. “In most hospitals, over 90 percent of admissions are diabetic patients,” said Dr. Thomas Burghardt, a podiatrist at Foot & Ankle Surgical Associates in Centralia, WA.

Dr. Thomas Burghardt

Burghardt says there are three main concerns for diabetic patients: the immune system can be depressed, the disease can affect the blood supply to the feet, and a condition called peripheral neuropathy can develop, in which patients can lose sensation. In turn, that can make them more susceptible to injury.

“Our main job is to break that chain,” said Burghardt. He said patients can develop sores or ulcers on their feet that can lead to infection or even to amputation. That’s why it’s important for patients to inspect their feet every day. “Look at the top, bottom and toes,” Burghardt said. “Check for any redness, dryness or cracking, check between the toes and check the toenails.” For those who can’t bend enough to see their feet, Burghardt recommends they set up a mirror so they can see all parts of the foot, including the bottom.

Source: Kathy Hall, The Chronicle [4/29/08]

IL Podiatrist Walks to Combat Obesity

Podiatrists from the Illinois Podiatric Medical Association are joining New Balance Chicago stores to encourage Illinoisans to get out and walk by providing free pedometers to any Illinois resident who visits a participating podiatrist. It's part of the Keep Illinois Walking campaign. Ken Jacoby of the Elgin Foot and Ankle Clinic said his office received 50 pedometers in late April. The office will provide free pedometers while supplies last.

Dr. Ken Jacoby

According to Jacoby, walking can combat obesity, diabetes and other weight-related diseases that have a direct impact on one's overall health as well as foot health. To that end, the IPMA debuted its first television show, Feet Forward on Chicago Cable Access Network Television on April 23. CAN-TV covers everything from local issues to the Chicago arts scene. The network reaches 1 million households in the Chicago area.

Jacoby encourages everyone to walk 10,000 steps per day -- every 2,000 steps equals one mile.

Source: Charity Bonner, The Courier News [4/30/08]

DE Podiatrist Receives One Year Probation for Tax Evasion

A New Castle podiatrist was placed on a year's probation Tuesday after pleading guilty in Superior Court to failing to file a Delaware personal income tax return. State Director of Revenue Patrick T. Carter said Dr. Rodney T. Grobes, 43, pleaded guilty before New Castle County Superior Court Judge Charles H. Toliver IV to the misdemeanor offense for failing to file his Delaware taxes in 2004. Grobes was indicted in March on two counts of failing to file a Delaware personal income tax return.

The state Division of Revenue's criminal investigation unit determined that during the years 2004 and 2005, Grobes owned and operated a New Castle-based podiatry practice and received taxable income from this business, but he failed to file an income tax return or pay income taxes to the state. In addition to being given probation, Grobes was ordered to pay $18,101 in restitution to the state Division of Revenue, along with the cost of prosecution.

Source: The News Journal [4/30/08]

Query: Isogard Blades

I have been unable to find Isogard blades. It appears that Koby is no longer in business and their phone has been disconnected. Does anybody know if there is a supplier out there who will still furnish the Isogard blades used in the Koby surgical instrumentation sets for plantar fasciotomies, etc.

David S. Tarr, DPM, Lowell, MA

Editor’s comment: Koby is now part of Osteomed. Try their site.

RE: The Value of Photodocumentation
From: Kenneth Meisler, DPM

I have been using a digital camera for years in my office. I have frequently e-mailed photos to other physicians for second opinions. Attached is an example of a patient where a digital photo came in handy. A patient presented on 4/11/08 with an acute onset of severe pain in the forefoot with mild erythema. The skin was intact. The differential diagnosis included cellulitis and gout. A digital photo was taken to document that the patient's condition did not warrant hospital admission or I&D at that time. It was a Friday and she was sent for blood work CBC, uric acid, arthritis profile. She was given a prescription for Omnicef 300mg BID and Indocin 50mg TID because we were unsure of the diagnosis.

4/11/08

She was instructed to remain at home and use warm compresses. She was instructed to return on Monday 4/14/08. When the patient returned 3 days later, there was a superficial abscess with what appeared to be a deeper component. Debridement revealed purulent drainage and the area of erythema had increased dramatically. The patient was also in significantly more pain. All of the bloods performed 3 days earlier were WNL. The patient was admitted and an I&D was performed. The culture revealed heavy growth of MRSA.

4/14/08

As they say "a photo is worth a thousand words." I feel it shows that the patient did not warrant admission or I&D at the time of the first visit, a good photo supports your notes. Too many doctors are not using digital photos on a regular basis. I use PICASA to sort my photos, it makes it very easy. I sort them by patient chart number.

Kenneth Meisler, DPM, NY, NY, kenemeisler@aol.com

RE: Health Club Memberships for Employees (Bob Levoy)
From: Jon Hultman, DPM, MBA, Brooke Weaver

I have always been an advocate of offering a health club membership as an employee benefit. I think this is especially important in podiatric practices where our treatment goals are to keep people active, walking, and healthy. As a side benefit, employees have more energy, are more productive, and they really appreciate the after tax benefit. I think this benefit has worked well in my hands because staff knows that exercise is an important part of my life, and they recognize that I feel their health is an important concern of mine. As is said in business, if we want staff to follow our lead, we need to “walk the talk.”

Jon Hultman, DPM, MBA, Los Angeles, CA, jhultmaned@podiatrists.org

We have tried this on two separate occasions. In the beginning, everyone was all for it and went to the gym even joined some classes, but in both cases after a few months everyone dropped out. The first time we offered this benefit, it was totally company paid and we had only 5 employees at the time, but even at $30 a month per person with no one going it was a waste of money. The second time we had over 20 employees and the company paid half and the employee paid half through a payroll deduction. While we had better success with this option, after 6 months there was no one using the health club and was once again this was a waste of money.

The health club has come back to us with a third option which was the company would pay $200 per person for anyone wanting a membership and the employee would have to pay the rest to the health club, with the health club automatically deducting the monthly fee from the employees checking account. To date I have yet to have one employee take me up on that offer.

Most health clubs have a corporate program which will get employees a better deal than if they went in as an individual. It is always an option to have an agreement with the health club, but make it financially the employees responsibility.

Brooke Weaver, Central Kansas Podiatry Associates,Brooke@ksfootdoc.com

RE: ACFAS Members Vote to Reject APMA Membership Requirement
From: Multiple Respondents

When the Board of ACFAS decided that they could make decisions that the membership of the College should make, they lost my vote of confidence. Then, as Dr. Gurvis states, they decided on a membership vote to change it back. The honorable thing for the Board to have done would have been to say "hey, we made a mistake, let's start over, let the membership vote, and we will follow their mandate." But, that’s not what happened, and I am not sure if anybody knows which way this is going.

I recently had the occasion to have new business cards and letterhead printed, and I intentionally removed the FACFAS from both items, in anticipation of the outcome of this fiasco. My dues are also payable, but I have decided to wait to pay these until this is settled. I will gladly pay the late fee when I hear that the Board has corrected their mistake and done the right thing.

If the APMA decides to start their own "college", let me know and I'll be glad to assist in the formation.

Robert A. Boudreau, DPM, Tyler, TX, rbftdoc@aol.com

I am having a terrible difficulty understanding the current situation that ACFAS has hoisted upon its membership. Maybe someone can clear this up for me.

Number one, I do not understand how the ACFAS board can mandate a change to the bylaws, such as they did, and then ask the membership to come up with a 2/3rds majority to override their change? I have never seen this done in any other organization before. A proposed bylaw change should be offered from the board and then if it is not ratified by 2/3rd’s of the majority, it does not go into operation. Not the other way around.

I think that the ACFAS board greatly overreached their powers in this situation. If this is allowed within the bylaws, and someone can show that to me, I will immediately apologize. I have no personal axe to grind, but due process does not seem to have been followed in this matter, and as a member and fellow of ACFAS, that greatly disappoints me.

Bruce E. Williams, DPM, Merrillville, IN, bwilliams@airbaud.net

Editor’s Note: An extended-length letter by Rob Katz, DPM, MBA appears at: http://www.podiatrym.com/letters2.cfm?id=19277&start=1

RE: Office Assistant Paging System (Will Parker, DPM)
FROM: Bob Hatcher, DPM, Eric J. Lullove, DPM

I strongly recommend the Expeditor Systems light system. I've had it for 15 years and don't think I could get along without it. Nurses can be reached through either lights or sound.

Bob Hatcher, DPM, Raleigh, NC, Bob.RFC@intrex.net

I have started to implement two-way radios throughout the office. My office manager, me and the medical assistants carry small Motorola TalkAbout Radios with earpieces/microphones, so that I am not leaving the rooms while treating patients, and I can ask for anything that I might need.

Eric J. Lullove, DPM, Boca Raton, FL, ericsops@yahoo.com

ASSOCIATE POSITION - VIRGINIA IS FOR LOVERS

Immediate full-time associate position available. Unlimited income potential. Busy, diverse, 40+yr Hampton Roads practice. Must be compassionate; energetic; and motivated; PSR24/36. Looking for long-term arrangement. Please send letter and CV to podiatrycenter@gmail.com or fax to 757-397-5889 or click here

ASSOCIATE WANTED – NEW YORK IMMEDIATE OPENING

Busy multi-dimensional practice; 70 miles north of New York City . Currently four (4)-doctor practice. looking to expand – all phases of podiatric medicine. contact: (845) 454-8308 EXT: 106

PRACTICE FOR SALE – WESTERN WASHINGTON

Magnificent natural scenery in unique area of Washington state. Seller owns condo with ASC built for podiatry practice. The layout was designed to provide maximum efficiency for patient, doctor, and staff. Located within sight of hospital and medical community. Over 25 years established podiatric medical practice with potential to grow beyond $400K gross. 386 597-5766

PRACTICE FOR SALE - CORAL GABLES, MIAMI AREA (FLORIDA)

Beautiful location in the heart of Miracle Mile. Excellent opportunity for a starting practitioner. Most insurances accepted. Good mixture of surgical and general podiatry. Fully equipped with low overhead. Located in a professional building, with referrals from other doctors in the same building. Contact zoesar@aol.com or call 786-877-5149.

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 POSITION - TEXAS

Check out San Antonio, Wonderful place to live. Full or part-time podiatrist with current Texas license. Better pay. Unique mobile podiatry practice and mobile wound care clinics, in addition to office locations. Check out our website Fine working conditions with excellent support staff. E-mail Response to footcenter1@sbcglobal.net or fax to 210-495-6484.

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 Visit our website

ASSOCIATE POSITION - CONNECTICUT

Nice community outside of New Haven. Well-established, busy practice seeking part-time or full-time associate. Excellent opportunity for a highly motivated and ethical professional. Must have good patient skills. PSR-12 or higher with excellent skills required. Send resume and cover letter to fax # 203-439-7916.

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

ASSOCIATE POSITION – NW INDIANA (1 HR FROM CHICAGO)

Great opportunity for financial and personal success. Start at $150K plus incentive compensation, good benefits, and ownership potential. Must be highly motivated, have a great bedside manner and excellent surgical skills (forefoot and rearfoot). E-mail resume to friendlyfootcare@comcast.net or fax resume to (219)662-7290. Learn about us here

ASSOCIATE POSITION – FLORIDA

Emerald Coast on the North Shore of the Gulf of Mexico, a well-established group practice with multi-offices, seeking an associate with opportunity for partnership for a PSR-24/36 Doctor well-trained in foot/ankle/diabetic problems/wound care/surgical and medical podiatric care, covering 3 area hospitals, NO nursing homes, Please fax a letter of interest, CV, and references to 850-862-5470, e-mail ecpodiatry@aol.com

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