The Voice of Podiatrists

Serving Over 9,500 Podiatrists Daily

May 19, 2007 #2,940 Editor-Barry Block, DPM, JD

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Jones Fractures Often Overlooked: VA Podiatrist

Raymond opened a door to step outside his North Carolina home and his left foot slipped on the floor and shot forward. The pain was immediate and intense. He phoned the foot and ankle surgeon he sees for diabetes care and made an appointment. Several hours later, Raymond found himself in the Suffolk, VA examining room of Matthew Dairman, DPM, FACFAS. Dairman diagnosed a fifth metatarsal fracture

Dr. Matthew Dairman

Many people break the same foot bone as Raymond but don't realize they're injured. Not all fifth metatarsal fractures are as sudden and painful as his experience. The American College of Foot and Ankle Surgeons (ACFAS) says people who feel pain on the outside of their foot should seek prompt treatment. Walking on or failing to treat a fractured fifth metatarsal can lead to complications including bone deformities, failure to heal, arthritis and chronic pain.

PA Podiatrist Wins Primary for County Commissioner

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Republican voters tossed out two incumbent county commissioners on Tuesday and opted instead to hand their endorsements to two political newcomers.

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Dr. Timothy Brooks

Obama Promises Universal Health Insurance

Presidential candidate Sen. Barack Obama (D-lL.) on Monday at an event in Trenton, NJ, said that the U.S. would have universal health insurance by the end of his first term as president, Gannett/Asbury Park Press reports.

Sen. Barack Obama

At the event, sponsored by AFL-CIO, Obama said to an audience of about 400 union members, "This is an issue whose time has come," adding, "It actually came a long time ago, but Washington doesn't seem to know it." He said he would fund his universal health insurance proposal with $75 billion in savings from increased use of preventive care, improved care for individuals with chronic diseases and the implementation of technologies to reduce paperwork.

Source: Gannett/Asbury Park Press via American Health Line [5/16/07]

Query: Therapeutic Shoe Fraud

A patient I have been treating for ten years came into the office for a regular visit and I noticed he was wearing therapeutic shoes with the inserts. I questioned him about them since I know he has never had a problem with diabetes and his circulation is excellent. He went on to boast about how he got the shoes for "free" from a place in Florida through the mail. All that was needed was a signature from his doctor. I then asked him what was the form that needed a signature asking for. He wasn't sure, since his daughter did it for him.

Evidently, he received a pair of therapeutic shoes with six inserts intended for patients with diabetes and "at least 1 of the 6 qualifying conditions" to qualify for them. The inserts were not molded to his foot, nor were his feet measured by anyone other than his daughter if that. this patient was excited that he got the shoes for "free" but saw his EOB showing that Medicare paid "over $220.00. Should I question him further about this company in Florida, call his daughter and question her, or just take it on the chin and let it go knowing that this type of fraud is everywhere?

Timothy Sorensen, DPM, Cape May Court House, NJ

Editor’s Comment: PM News does not provide legal advice. This appears to be outright fraud because the rules and regulations governing diabetic therapeutic shoes require face-to-face interaction. Pursuing this matter requires obtaining addition information about this company and then forwarding it to the OIG for investigation with the name of the patient redacted. If monies are recovered, you may be entitled to a compensation under the qui tam laws. Be aware that before you provide any PHI, you must do this in accordance with HIPAA and state regulations, which generally allow you to provide such information to a government agency.

Query: Darco Tennis Shoe

I remember seeing a Darco lace-up type of tennis shoe designed for long-term use. Does anyone recall a resource for this or an alternative for long-term use?

Pat Evoy, DPM, Bend, OR

RE: Monitoring Liver Function for High-Dose Vitamin A (R. D. Teitelbaum, DPM)
From: Larry Kollenberg RPh, DPM

Dr. Teitelbaum is mistaken. In 1975, at the NY College of Podiatric Medicine, we were using vitamin A for treatment of warts, but the dosages used were 25,000 units a day for children, not 250,000 units a day and it was prescribed for up to one month only. Adults were given 50,000 units a day also to be taken for only one month since it is one of the stored vitamins. Those are safe doses well below toxic levels and liver function studies are not needed. 250,000 units a day for six months is a rather massive dose. The RDA for adults is 5,000 units a day and 2,500 units a day for children.

Mike Boxer, DPM, Woodmere, NY, MCBDPM@aol.com

According to Poisondex, the leading source of information for poison control centers,
toxicity can begin to occur in children at doses of 25,000 units and Adults at 50,0000 units.
Dr. teitelbaum is correct about doses from the 70's and 80's. Aquasol was removed from the market.

It is interesting that 3 oz of beef liver has over 25,000 units of vitamin A. There is an excellent NIH review of vitamin A at http://ods.od.nih.gov/factsheets/vitamina.asp This review goes into many dietary aspects of vitamin A and about caratenoids The biggest problem with rx of high doses vitamin A is the accumulation of the vitamin in the liver.

If you use high dose vitamin A therapy for your wart patients then consider giving their livers a break to allow some of the extra stored to be released. A good rule of thumb for wart patients that I used in practice was 50,000 unit daily x 30 days on 30 days off in kids and 100,000 units 30 days on and 30 days off in adults

Larry Kollenberg RPh, DPM, Jacksonville FL, lkollenberg@hotmail.com

RE: Poor Outcomes (Sheldon Marne, DPM)
From: Shay Fish, DPM, Arthur Gudeon, DPM

I understand what Dr. Marne's concern is about proper patient care, but it sounds like he brings a lot of baggage to the table. I agree that our primary duty is to the patient, but that requires neutrality in approach. One simply does not know the facts when a patient presents with pain and implicates another doctor, and the scenario becomes more dubious with each additional prior treating doctor.

Concerns about doctor incompetence should be directed to the respective state board for investigation (Texas requires that we post a notice for our patients to do just that); not by individuals preoccupied about the competence of others. The world is imperfect and "one strike you're out" policies would be subject to the same errs, thereby compounding the problem. Dr. Marne's concerns are best addressed when the patient is fully informed and committed to their decision(s).

Shay Fish, DPM, San Antonio, TX, fishdpm@aol.com

Perhaps Dr. Marne should review his own history of many years of podiatric practice in various states and reflect on the old adage, "...people who live in glass houses shouldn't throw stones."

Arthur Gudeon, DPM, Rego Park, NY, afootdoc@ix.netcom.com

Editor’s comment: Dr. Marrne was previously in practice with plaintiff’s expert witness David Widom, DPM. For more on Dr. Marne’s history as a plaintiff’s expert witness, see:

http://www.judicial.state.sc.us/opinions/HTMLfiles/COA/3134.htm

ASSOCIATE POSITION - SUBURBAN PHILADELPHIA

Associate leading quickly to Ownership Wonderful opportunity to join Kaiser trained podiatrist in a well established, ethical, full scope podiatric practice. Competitive compensation Most be BE/BC Send CV and references to: reversoman@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

ASSOCIATE WANTED – NYC

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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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