The Voice of Podiatrists

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May 18, 2007 #3,939 Editor-Barry Block, DPM, JD

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Diabetic Neuropathy is Problematic: OR Podiatrist

One symptom of diabetes is nerve damage in the feet. Dr. Donald Carlson, a Hermiston, OR podiatrist, said many of his patients struggle with diabetes-caused foot problems. "The feet start to go numb - the nerves start to die off," Carlson said. Sometimes, diabetics puncture their foot and don't realize it until infection sets in.

Dr. Donald Carlson

"Someone with normal function would complain about the pain and do something about it," Carlson said. But, complicated by poor circulation, the injuries often become infected. The infections sometimes ulcerate and infect the bone, leading to amputation. Carlson urges diabetics, who make up a third of his practice, to inspect their feet often for injury and to wear specially-made extra depth shoes to aid circulation.

Source: Kathy Aney, East Oregonian

Yoho Elected Vice Chairman/Chairman-Elect of CPME

Robert Yoho, dean of the College of Podiatric Medicine and Surgery at Des Moines University, was recently elected vice chairman/chairman-elect of the Council on Podiatric Medical Education.The council is the accreditation body for podiatric colleges, residency programs, fellowships and continuing medical education.

Dr. Robert Yoho

Yoho was also recently appointed to the Vision 2015 Committee of the American Podiatric Medical Association. The committee is charged with advancing the podiatric medical profession academically, politically and legislatively.

Source: Des Moines Register (IA)[5/15/07]

GA Podiatrist Arrested For Allegedly Running Drug Operation

A Smyrna (GA) doctor is facing federal charges for allegedly running a big drug operation. Federal prosecutors say Doctor Steven Roy Hollander was part of a huge drug distribution scheme. Prosecutors said the podiatrist worked with drug traffickers. Steven Hollander reportedly bought huge quantities of prescription drugs through the mail and then shipped them to Florida, where they were sold on the street.

Authorities said the 46-year-old physician ran an illegal drug operation out of his Smyrna home on countryside place. "He would order thousands of pills at a time," said Asst. U.S. Attorney Kurt Erskine.

Kurt Erskine, Asst. U.S. Attorney said "when he was arrested Dr. Hollander was in possession of what we believe was a package full of hydrocodone, alprazolam." They claim the doctor used his license to obtain massive of drugs, including hydrocodone and other controlled substances. He reportedly shipped the narcotics from Atlanta to drug traffickers in Fort Lauderdale and Miami.

Source: Deidra Dukes, Fox News [5/16/07]

Query: Rescheduling a Procedure Post Sinusitis

I had a 15 y/o male scheduled for ORIF of a 5th metatarsal base fracture. The day before the surgery the patient developed a fever (101) and was seen by an immediate care center and placed on oral antibiotics. The Strep test was negative and he had a diagnosis of sinusitis. I cancelled the surgery. Is there standard of care as to how long one needs to wait before rescheduling the procedure? The parents are pressuring me to reschedule ASAP.

Alan Mauser DPM, Louisville, KY

RE: Monitoring Liver Function for High-Dose Vitamin A (Giulio V. Zanetti, Podiatrist)
From: R.D.Teitelbaum, DPM

When I was as a junior at NYPCM in 1975, Aquasol A was in use for the treatment of warts in strengths of up to 250,000 units per day, orally, for up to six months. I don't think we monitored liver function then and I also doubt there was any liver disease we encouraged, so to speak. Of course, to be safe, you do the testing. But the aversion I have personally noted among pharmacists concerning Vitamin A is one of the reasons one cannot buy a Vitamin A pill larger than 25,000 units. I have read about a United Nations W.H.O. program in Africa where children are given doses of Vitamin A up to 500,000 units/day for an eye condition. The question arises: What really is a toxic dose of A? When would "pseudotumor cerebri" show up?

For pediatric and/or mosaic warts I recommend 100,000 units per day for two months. I also combine this with local treatment with a formalin solution topically. I also add topical Vitamin E to the treatment because the anecdotal evidence for efficacy of this still remains, at least in my practice.

R.D.Teitelbaum, DPM, Naples, FL, mfvandange@aol.com

RE: Poor Outcomes (Sheldon Marne, DPM)
From: Multiple Respondents

Dr. Marne obviously has no idea what the recovering physician program is all about, has no knowledge of any of the issues they address, and certainly has ever been involved or had a family member involved in such a program.

The comment “one strike and you are out” would be tough for any of us to accept if it were applied to the art of foot surgery—“one post operative complication (strike)and you are out”—would put many of us on the side line.

Tip Sullivan, DPM, Jackson, MS, tsdefeet@msfootcenter.net

Dr. Marne seems to be taking a very aggressive stance toward surgeons who wind up with a poor outcome. I certainly agree that a colleague who is clearly incompetent should be reprimanded, and possibly punished in some way. But the truth of the matter is that any one of us, for reasons beyond our control, could end up with a poor surgical outcome. I personally know a podiatrist who is an attending at a local residency program, and all colleagues there consider his surgical skills to be superb. He did a relatively simple type of case on one of his private patients...he did everything right, but the patient ended up with a post-op infection. He even did everything imaginable to treat the post-op infection, but this patient still went on to develop osteomyelitis, requiring further surgery.

She went for a second opinion, and the new doctor started talking about the "horrible job" that was done. So guess what? Now he's being sued, when he really did nothing wrong. And he has no need for the "impaired practitioner program."

Unfortunately, even in the best hands, surgery has the risk of a poor outcome. And that's not even getting into a discussion about patients who don't follow post-op instructions.....perhaps a topic for another day.

B. Thomas Kempf, DPM, Sayville, NY, drftlong@optonline.net

Our obligation is to our patients, but not all complications are malpractice and not all bad outcomes are caused by impaired podiatrists. I find that dissatisfied patients are for the most part disappointed because their expectations were not met. This can be stopped by frank discussions with our patients before surgery about complications and expected outcomes. I have done second opinions and revisional surgery my whole career and have even been dragged into a law suit for rendering a second opinion. We cannot be afraid of treating patients in pain. What we must do is not be lawyers or judges of our colleagues work.

When a patient comes into my office and asks, "Is this malpractice?" my answer is that I am not a lawyer and I quickly change the subject as to what is the problem. Ninety percent of the time the patient only needs reassurance that the previous surgery is fine and things will get better. If there is a complication, I spend time discussing why the complication occurred. I always ask permission from the patient to talk to the previous surgeon. I have found that my colleagues are not drug crazed butchers out to maim my grandmother but honest practicing podiatrists trying to do their best.

David Gutierrez, DPM, Bronx, NY, DOCG2100@aol.com

ASSOCIATE WANTED – NYC

Associate wanted for practice with offices in Queens and Manhattan. Applicant should be 2-3 year trained, ABPS certified/ eligible. All aspects of Podiatry from necessary routine care to reconstructive rearfoot surgery. Growth potential, partnership potential, benefits available, access to managed care contracts. Send CV to METROFOOTAPPS@aol.com
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PRACTICE FOR SALE – OHIO – SOUTHEASTERN

Reputable, thriving, well-rounded practice available with EMR. Grossing over $320K over the last 3 years. Priced to sell. Owner relocating. Email inquiries and CV to podsx@yahoo.com

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EQUIPMENT FOR SALE: CRYOPROBE SYSTEM

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A cryoprobe system (less than one year old and rarely used) from CryoTech is available for only $12,000. This lists for $14,900. The CryoPac system comes complete with two fully sterilizable probes. This system has been used less than 15 times and can be used to treat plantar fasciitis, neuromas, and other foot pathology. E-mail serious inquires to: drsammendicino@gtef.org

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ASSOCIATE POSITION – SAN DIEGO COUNTY

Immediate opening for qualified forefoot surgeon for well-established practice in San Diego County. Opportunity to buy in as well. foothold@msn.com

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

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

PRACTICE FOR SALE : LA JOLLA CA (SAN DIEGO) Price reduced!

$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. $129K Selling due to age, health problems. www.SDFootDoctor.com DrRDWorley@yahoo.com

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ASSOCIATE POSITION- SOUTH JERSEY

Associate PT/FT wanted for progressive (EMR, Digital x-ray, Diag U/S ), ethical, full scope group practice. A motivated team player with very good surgical and routine skills. ABPS cert and 24/36 PSR preferred but will take experience into consideration. A very fair benefits /compensation package. CV and references Dalilfeet@AOL.com

ASSOCIATE POSITION- KNOXVILLE, TN

PT/FT, multiple positions to fill, surgically and non-surgically trained, immediate and in near future. State-of-the-art facilities with in office surgical suites as well as full privileges at all area hospitals. Area nationally ranked as fifth best place to live and work. davidphawk@adelphia.net

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