The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

May 04, 2009 #3,536 Publisher-Barry Block, DPM, JD

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TX Podiatrist Speaks at U.S. Air Force Diabetes Research Meeting 

Dr. Lawrence Lavery from Scott and White Hospital and Texas A&M College of Medicine was an invited speaker at the Diabetes Translation and Research Meeting held in Bethesda, Maryland April 29th. Dr. Lavery discussed "technology to identify, prevent, and treat diabetic foot wounds.” The purpose of the meeting was to provide feedback to the U.S. Air Force on its current diabetes research programs and to recommend priorities for future diabetes research.

Dr. Lawrence Lavery

Dr. Lavery said, “the meeting was a novel cross-section of representatives from the military, federal government, industry, and academic institutions that are all trying to address innovative ways to treat diabetes and related complications.” The program addressed a variety of issues including population health management, biomarker genomics to screen for diabetes, remote retinal screening and electronic diabetes games for health to name a few.

In the past, the diabetic foot was usually not part of the agenda for these types of meetings, according to Dr. Lavery. Advanced screening programs such as the PACT program in the Veterans Administration system headed By Dr. Jeffrey Robbins is one of the examples of initiatives that have had a national impact of amputation reduction and help make amputation prevention part of the agenda.

Medimetriks Pharmaceuticals Launches Two New Prescription Brands

Medimetriks Pharmaceuticals has announced that the Company launched Centany(R) (mupirocin ointment, 2%) and Uramaxin(TM) (20% Urea) Foam to its core dermatology and podiatry physician audiences.

Centany(R), previously marketed by Johnson & Johnson's Ortho Dermatologics professional division, is indicated for the topical treatment of impetigo due to Staphylococcus aureus and Streptococcus pyogenes, and will compete in a topical antibiotic market. In addition to a 94% clinical efficacy rate and a 98% eradication of staph and strep*, Centany(R) provides an enhanced safety profile over other mupirocin-based therapies.

Uramaxin(TM) Foam is 20% urea in a vehicle containing ammonium lactate. These components make up the vast majority of prescriptions written by dermatologists and podiatrists for dry skin conditions. Uramaxin(TM) Foam is an effective, low-potency keratolytic that complements Uramaxin(TM) (45% Urea) Nail Gel and Uramaxin(TM) (45% Urea) Cream, high-potency keratolytics previously launched by the Company. The foam delivery system is a format gaining wide acceptance by both physicians and patients, and Uramaxin(TM) Foam is provided in a large size to add value to patients.

Source: AHC Media [4/28/09]
 

Break Self-Destructive E-Mail Habits

E-mail is so easy to use that people forget it is also easy to misuse. Avoid the following bad communication habits:

•  Mass distribution. It’s easy to overuse the “cc” option. Make sure that every message reflects a work-related priority and that every person on your distribution list has a stake in the topic.
•  Fluff. Be aware that most recipients will not read your e-mail message; they will only scan it. Make it easy on them by putting your bottom line at the top of the message, preferably in a single clear sentence.
• • Ping-pong. When an e-mail “conversation” has bounced back and forth more than a couple of times, pick up the phone and initiate a vocal conversation. You will seem more professional and you are more likely to succeed in your communication goal.
•  Dividing the team. You may consider a message to be harmless fun. Yet not everyone will feel thatway. Steer clear of divisive jokes, chain messages and political opinions.

Source: Adapted from “Down Economy Spurs New E-Mail Etiquette,” by Kathleen Koster, Employee Benefit News Canada via Communication Briefings

Query: Pain in Dorsal Foot After IV insertion

I have a 19 year old patient who was in the ICU about 2 weeks ago due to some complication with kidney/bladder surgery. An IV was inserted into the dorsal aspect of his foot. It was used for 2 days, then it infiltrated, and was removed. He presented to my office 2 weeks later with severe pain over the area. There is a small amount of swelling,but no signs of infection. X-rays, MRI, and venous ultrasound were done in the hospital prior to discharge; none of which showed any pathology. He was also given several narcotics, topical Voltaren, and Lyrica in the hospital, which did not help.  Does anyone have any suggestions for possible causes of the pain? Can anyone suggest some treatments to relieve the pain. 
 
Steven Lemberger, DPM, Freehold, NJ

Query: Destroying Old Charts

We purchased a practice 2 years ago along with all the old charts.  They are an eyesore and taking up valuable space.  We have EMR and really have no need for them as any old patient is now a new patient and fills out all new paperwork, etc. We have heard we have to keep charts up to 7 years from date of last visit. Is this correct? It would be great to shred them all! 

Christian Smith, DPM, TN

Editor’s comment: PM News does not provide legal advice. You can destroy charts only after you have scanned them electronically. Most practice experts recommend that you maintain charts for seven (7) years. The charts of minors should be maintained until the patient is 18 years plus the statute of limitations for malpractice in your state.

RE: Nocturnal Leg Cramps (Richard Mann, DPM)
From: Multiple Respondents

I have been recommending my patients with the complaint of cramps in their legs at night to try one ounce of Gatorade with supper. I have been recommending this for at least five years. So far as I know, it is working. My rationale is that these cramps are caused by an electrolyte imbalance and Gatorade was developed to be an electrolyte replacement. I warn my diabetics to watch their response with accuchecks and so far no one has reported a significant elevation in their sugars. 
 
Wm. Barry Turner, DPM, Royston, GA, claret32853@gmail.com

I have had much success with telling patients to use a bar of soap. Open up a bar of soap, put it down by your feet under the sheets and leave it there. No direct contact is needed. It can be any soap. It sounds like voodoo. I have no logicial scientific explanation on its mechanism. But I will tell you that it has worked on patients more than it has not. I actually saved a patient over $50 per month on her medication. You can look it up on the Internet and get many testimonies on how it has helped many who suffer from restless leg or night cramps. You also get the "medical experts" saying it is trash.

All I can say is that if I can use something less than a few dollars to cure a significant inconvenience in someone's life, I will do it. It isn't about me, but about the patient. The worst case scenario is that after 2-3 weeks and it doesn't work, put the soap in the bathroom and you are no worse off.

Doug Mason, DPM, Freeport, IL, drdiver@yahoo.com

Quinine is available as Qualaquin, (quinine sulfate 324mg) and is approved only for malaria, but I see it used off-label by some of the MD’s for nocturnal leg cramps. It was shown in meta-analysis to be effective. Be aware of the warning for this drug:

Warnings

Use of Qualaquin for Treatment or Prevention of Nocturnal Leg Cramps

Qualaquin may cause unpredictable serious and life-threatening hypersensitivity reactions, QT prolongation, serious cardiac arrhythmias including torsades de pointes, and other serious adverse events requiring medical intervention and hospitalization. Fatalities have also been reported.

David Gurvis, DPM, Avon, IN, deg1@comcast.net

RE: Ingrown Nails in 3 Month Old
From: Multiple Respondents

Just because an infant cannot articulate that you are torturing them does not mean that removing their nail (or foreskin) hurts any less than it does in an adult. Many circumcisions are now done after prolonged treatment with EMLA cream.  You could at least try this before ripping the poor kids nail off.
 
Peter Smith, DPM, Stony Brook, NY, drpetersmith@optonline.net

Over the years, I have seen between 5 and 10 of these and have found the following treatment to work quite well. I put topical EMLA or lidocaine on the toe and cover it well and ask the mother to return in an hour. If the mother is nervous, I ask her to step out and let my assistant hold the infant. I tell the mother that her baby will whimper for a few seconds and will then be fine. I quickly take a curved hemostat and peel the nail right off. It comes off very easily and there is rarely any crying. The usual dressing and instructions are given. I have only had to do this twice on one infant who came in 4 months later. The mother didn't hesitate to bring him back. I don't know if it is coincidence or not but 100% of these have been male with the toenail being quite wide.
 
Deborah Wehman, DPM, RIchmond, IN, dswehman@comcast.net

Infant toenail surgery without anesthesia is cruel and archaic. Lidocaine is a category B drug in pregnancy same as cephalexin. If it is safe in pregnancy it is safe in infants. Lidocaine is used commonly now for newborn circumcisions. Maximum dosage is 1.5 - 2 mg/lb. In a 3 mo old 20 lb. infant, the maximum dosage would be 30-40 mg or 3-4 cc of a 1% solution. Usually 1-2 cc is more than enough for a great toe. Use only a 27 1/2 needle to decrease injection pain. Use a #61 blade and have the assistant hold the foot steady.

I have found the lidocaine plain anesthetizes quickly but not for a long time. The profuse vasculature in an infant seems to wash out the lidocaine quickly. Be prepared to perform the avulsion very soon after administration of local. Phenol is a useful choice since the nail regrows so quickly that a simple avulsion may only last a month before recurrence.

Please don't tell me that the avulsion is quicker than administration of local or that the infant doesn't really feel the pain. The screams from an avulsion without anesthesia are much more severe than the cry from an injection of local. Many times, I have seen the infant fall asleep during the surgery after the local is injected, especially when given a bottle or soother. 
 
Paul Kruper  DPM, Kingsburg, CA, prkruper@yahoo.com

RE: Gifts to Patients for Patient Referrals (Brian Homer, DPM)
From: Robert P. Thiele, DPM, Richard W. Boone, Sr.,

How did we get to this place in society where you can't thank someone for helping you without worrying about breaking a law?  If having class is wrong, then I don't want to be right.        

Robert P. Thiele, DPM, Denville, NJ, drthiele@comcast.net

Out of curiosity, I checked the APMA Code Of Ethics on this subject.
 
The following provisions might possibly apply:
 
BE1.22 The podiatrist shall not offer gifts as an inducement to secure patient patronage. (See interpretive guideline.) The Interpretive Guideline states: BE1.22 Promotional gifts of nominal value may be offered.
 
Perhaps the issue of whether these provisions apply to the giving of gifts for past referrals and just what an appropriate gift might be in that situation deserves some additional thought and discussion in this learned forum.  I don't know what the answer to that question might be and I would love to hear some additional discussion on the subject.
 
Richard W. Boone, Sr., Health Care Attorney, Fairfax, VA, RWBoone@aol.com

 EQUIPMENT FOR SALE- ALLPRO IMAGING 2010 XRAY DEVELOPER

This processor is only two years old. It is in good working order and has always been regularly maintained. We are in the process of changing to digital films. Will sell for $1300. New Hampshire e-mail wcgcoach@aol.com

ASSOCIATE POSITION – ILLINOIS 
 
Quality Podiatry Group provides quality services to residents at long term care facilities. We are currently offering full-time or part-time positions for motivated ethical podiatrists. Immediate openings available. If interested, fax curriculum vitae to 312 225-9366 or e-mail feetwork@aol.com

ASSOCIATE WANTED - FLORIDA

Associate needed for a dynamic multi-doctor practice in the Tampa Bay area. Partnership opportunity for the right candidate. Preference given to a PSR 24+ resident completing their education this spring/summer, and must have a Florida license. Well-established practice, high tech with EMR and digital x-rays, with specialties in sports medicine, surgery and wound care. No nursing homes or HMO's. Excellent hospital privileges available. Choose an area of practice concentration that you are passionate about and enjoy a lifestyle for yourself and your family that is second to none. E-mail: kimvelez@tampabay.rr.com

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.

OFFICE SPACE/ MRI RENTAL – NYC, LI   
 
Turn-key space available, daily, monthly; East 60th off Park Ave, East 22nd St. off 3rd Ave, and Plainview Long Island. JACHO-certified operating rooms available, as well as all surgical equipment and anesthesia. Extremity MRI Rental. Stark compliant. All exams read by board certified radiologist. Call for details. 516 476-1815

NEEDED CHICAGO -- NW IND & BALTIMORE/WASHINGTON, DC PODIATRISTS

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists in Chicago, Northwest Indiana, and Baltimore, MD. 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 AVAILABLE-MIDTOWN MANHATTAN

Looking for Full-time associate to work in well established practices in midtown Manhattan and Forest Hills. Immediate opening for PSR 24-36 surgically trained Podiatrist. Great opportunity with competitive salary along with malpractice benefits. Please send CV to slurie@papapc.net

ASSOCIATE POSITION - CENTRAL VIRGINIA

Join a solo surgeon in a two office private practice, modern facilities with EMR and digital x-ray, reconstructive and trauma surgery.  Excellent starting salary and benefits. Position leads to partnership. Submit letter of introduction and CV to jdisabato@vfasa.com

PRACTICE FOR SALE - FLORIDA—CENTRAL/SOUTH

Turn-key operation grossing $570,000 annually based on one full-time doctor. Great opportunity for growing the top-line. Surgery is only 14% of the professional man-hours; it can significantly increase income. Medicare makes up 64% of revenues. Seller will assist with transition. Call 863-688-1725, ask for Chas.

ASSOCIATE POSITION - CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for a full-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to f-massuda@footexperts.com

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