The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

May 24, 2012 #4,470 Publisher-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2012- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

Over-Prescribing Can Lead to Antibiotic Resistance In Diabetics: PA Podiatrist

Diabetic foot infections are an increasingly common problem, but proper care can save limbs and, ultimately, lives, suggest new guidelines released by the Infectious Diseases Society of America (IDSA).

Dr. Warren Joseph

"There is quite a bit of over-prescribing or inappropriate prescribing of antibiotics for diabetic foot wounds, which doesn't help the patient and can lead to antibiotic resistance," said Warren S. Joseph, DPM, co-author of the guidelines, and consultant for lower extremity infectious diseases at Roxborough Memorial Hospital, Philadelphia. "The guidelines note that when antibiotics are necessary, they should be discontinued when the infection is gone, even if the wound hasn't completely healed," says Joseph.

Source: Laurel White, Innovations Report [5/22/12]

Pregnancy Can Lead to Overpronation: UK Podiatrist

During pregnancy, pain may often appear elsewhere in the body, says podiatrist Rina Bimbashi. In pregnancy, the impact of the weight gain is compounded by the effect of hormones. "During pregnancy, there is an increase in three hormones — relaxin, oestrogen and progesterone — which soften the muscles and ligaments in preparation for childbirth, making them more flexible," adds Mrs. Bimbashi. 

Rina Bimbashi

The problem is that if you have mild to moderate degree of overpronation before pregnancy, the looseness of the ligaments means your feet can roll in even more. As a result, you can end up with moderate to severe overpronation (the effects of these hormones are evident in ligaments and muscles for about five months after giving birth). "Pregnancy has a huge impact upon your whole joint alignment, and your muscles and ligaments need to work much harder in order to maintain stability. I commonly see women who have good, normal foot arches which collapse during pregnancy leading to very excessive pronation."

Source: Jenny Hudson, Daily Mail [5/21/12]

MN, CA Podiatrists Report Increase in Barefoot Running Injuries

Podiatrist Dr. Paul Langer used to see one or two barefoot running injuries a month at his Twin Cities Orthopedics practice in Minneapolis. Now he treats between three and four a week. "Most just jumped in a little too enthusiastically," said Langer, an experienced runner and triathlete who trains in his barefoot running shoes part of the week. 

Drs. Paul Langer and Bob Baravarian

Dr. Bob Baravarian, chief of podiatry at the UCLA Medical Center in Santa Monica, CA said he has seen "a fair number" of heel injuries and stress fractures among first-timers who are not used to the different forces of a forefoot strike. "All of a sudden, the strain going through your foot is multiplied manifold," and problems occur when people don't ease into it, he said.

Source: Alicia Chang, Athens Banner-Herald [5/22/12]

FL, AZ Podiatrists Advocate a "Measure What You Manage" Revolution in Wound Healing

Robert Snyder, DPM, MSc, President of the Association for the Advancement of Wound Care and David G. Armstrong, DPM, MD, PhD, Professor of Surgery and Director of the University of Arizona's Southern Arizona Limb Salvage Alliance (SALSA) today led discussion on next generation diagnostics in wound care in Vienna, Austria. "The fact of the matter is that we can't manage what we can't measure," noted Dr. Armstrong. "What is particularly exciting is we are seeing the first-ever point-of-care wound diagnostics to help direct therapy." 

Drs. Robert Snyder and David Armstrong

Dr. Snyder, who serves as Professor and Director of Clinical Research at Barry University College of Podiatric Medicine, went further "What we're talking about is nothing short of a fundamental change in how we assess wounds in our patients. Our current methods are based on thousands of years of experience by clinicians - but they are subjective. We need to make this objective. That's what's happening." This session preceded the European Wound Management Association (EWMA) symposium, which begins tomorrow.

CMS to Version 5010 Laggards: Get Ready to Borrow Money

Physicians not yet up to speed on new federal standards for electronic claims should be prepared to borrow money to keep their practices afloat come July. That dire counsel comes from the Centers for Medicare and Medicaid Services (CMS). Last week, as it has before, CMS advised physicians who are still trying to comply with the new standards to either take out a line of credit or expand an existing one at a bank because of payment delays that may occur when the agency begins to enforce the standards on July 1. At stake is the ability of physicians to meet payroll and write rent checks.

The new standards are called Health Insurance Portability and Accountability Act Version 5010 standards. The successor to Version 4010 standards, they are designed to streamline electronic claims and other digital transactions between providers and third-party payers, including Medicare. Physicians, insurers, makers of billing software, and claims clearinghouses are all under the gun to convert their systems to the new standards.

Source: Robert Lowes, Medscape News [5/22/12]

Query: Down's Syndrome Complication

I just saw a 5 year old female with Down's syndrome. She has the classic pes planus/HAV of Down's, but ambulates without pain or difficulty. Her mother relates that every night her feet become very flushed and apparently painful. She rubs the feet together until they are chaffed and nearly bleed. They have tried acetaminophen, antihistamines, and OTC topicals like Biofreeze without relief. She wears good supportive sneakers and custom orthotics made by a pediatric pedorthist.

I see no reason for these symptoms from my exam. She has no other contributory medical history. Has anyone else encountered a similar case, and if so, been able to offer some relief?

Brad Shollenberger, DPM, Reading, PA

Query: Certifying Disability

I have a patient who is on permanent (disability) restrictions at his place of employment and limited to restricted sedentary work. This is never going to change in his case. His employer is good about the restrictions, but makes me fill out a new disability form quarterly.  Every two years, I have the patient come in so I can not be accused of any wrongdoing. Do I even legally need to see this patient (the paperwork always asks, which is why I see him)? He needs no current care, and has no problems other than the original one which limits him.
 
David E. Gurvis DPM, Avon, IN

Editor's comment: PM News does not provide legal advice. You should be entitled to examine him on a periodic basis to certify that he is still disabled. You should also be entitled to a fee for your time and expertise in examining this patient.

RE: Lamisil, Tamoxifen Drug-to-Drug Interaction (Craig Herman, DPM)
From: Charles M. Langman, DPM

I checked Epocrates, which I use to check interactions on all my patients, and found this interaction listed there. I highly recommend using a system such as Epocrates (which is free) to check for interactions before prescribing any medication. You can never be too cautious.

Disclaimer: I am an Epocrates Advocate, an unpaid position.

Charles M. Langman, DPM, King of Prussia, PA, footdoc66@verizon.net

RE: A2D2 Digital X-Ray Machine (Sean Rosenblum, DPM)
From: Andrew Shapiro, DPM, Harvey Danciger, DPM

I have the A2D2  for one year. I highly recommend it. The quality, ease of use, and support have been excellent.
 
Andrew Shapiro, DPM, Valley Stream, NY, DrShapBark@aol.com

I highly recommend the unit. It has interfaced with my EHR and network very well. I am able to import x-rays into treatment rooms on monitors very quickly. It's easy to learn and use and has excellent x-ray picture quality. I highly recommend FOZ Networks as the supplier and dealer. They give unsurpassed service and support. The company is very open to suggestions to improve their product, and makes changes to adapt, which you get for free. They provide a great warranty as well. The unit also retrofits to X-Cel x-ray machines, and very likely to others.
 
Harvey Danciger, DPM, Palm Desert, CA, docofeet@hotmail.com

RE: Replacement Sources for Burrs
From: G. Stephen Gill, DPM, MBA

Correction: ERN Company, maker of burrs and other debridement equipment is, in fact, still in business and on the Internet (ernburr.com)  Ph: 800.755.3852. I apologize for posting wrong information.

G. Stephen Gill, DPM, MBA, Denver, CO, georgestephengill@gmail.com

RE: Dubai Podiatrist Introduces Portable Foot Toning Device
From: Kathy Satterfield, DPM

While I am curious about the procedure and hope it will be further explained at conferences, I cannot help but wonder why it is popular in a country where women are often veiled and covered from head to apparently reduced-toe-length! There seems to be an apparent irony here.

Are Jimmy Choo shoes really a hot item in the Middle East?

Kathy Satterfield, DPM, Pomona, CA

RE: Nail Polish Can Mask Diseases: DC Podiatrist (Janet McCormick, MS)
From: Gino Scartozzi, DPM

Ms. McCormick apparently has taken a post provided by Dr. Osterman literally. I believe, after reading the initial post, it was the intent of Dr. Osterman to explain some aspects of predisposing nail disease in "layman's terms" so that the general public could comprehend the concerns and issues he raised. Ms. McCormack is absolutely correct in her citing that nails are "dead and do not breathe." She is also correct in that the nail bed is "living."

I disagree, however, that nail infections cannot occur as the result of multiple applications of nail polish which can potentially mask infections to a non-medically trained person. Increased duration of nail polish on nails can mask...

Editor's note: Dr. Scartozzi's extended-length letter can be read here.

Codingline & PM News In conjunction with AAPPM Present
The Greenbrier Coding & Practice Management Workshop - August 20-22

   (Following the 2012 APMA Annual Scientific Meeting in Washington, DC)  

The Infinity Pool at the Greenbrier

Coming to Washington D.C. for the National? Don't miss out on being treated like a President and First Family. Enjoy world class amenities including golf, tennis, spa, casino and children's programs. 

Speakers: Harry Goldsmith, John Guiliana, Barry Block, Michael Brody, Paul Kesselman, Jonathan Moore, Rem Jackson, Chad Schwarz, and other nationally-known authorities in morning-only presentations. 

RESERVE YOUR UPGRADED ROOM NOW

Click Here for information or to Register

GREAT OFFICE STAFF FOR HIRE - SOUTH JERSEY

Very experienced office staff needs jobs. Office is closing and  they are experienced   people to hire in South Jersey. E-mail for CV and or what you are looking for They know podiatry and are both certified  podiatric medical assistants. They do billing, scheduling, chairside, and much more  Footcare@comcast.net

LOCUM TENENS - TEXAS STATEWIDE

It is that time of year, and you want to go on vacation, but can't or won't leave your practice, I can help. Please contact me at:  netexasl@gmail.com  I will forward a CV

EQUIPMENT FOR SALE

Retiring from practice. Equipment For sale. Mini x-ray. One year old Ultrasound with MS arterial/venous X-ray plates. Great condition Ritter chairs. Drills, surgical tools. So much. Just ask, I probably have itFootcare@comcast.net

EQUIPMENT FOR SALE: EPAT

(Extracorporeal Pulse Activation Treatment) for sale. D-Actor 200. This machine is still new. Purchased in late 2011.( new machines>30K). It is the conservative alternative to surgery. Treats Plantar Fasciitis, Heel spurs, Achilles Tendonitis, Joint pain. Great Buy. $19,995. Please call 713-541-3199 for more information. or email contactus@houstonfootankle.com

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. Also availability E 22nd between 2nd and 3rd and E 70th off 3rd. Turn-key operation - no investment needed 516 476-1815 PODO2345@AOL.COM

PRACTICE FOR SALE — BROOKLYN, NY

This practice has been in the same location for 31 years, seeing 80-100 pts/week, working 4.5 days/week. Grossing $350K and netting close to 70%. All surgery referred out. Low rent, option to buy the building in future. Asking $225K, doctor willing to finance. Call 800-983-4194, or email:contactus@podiatrypracticeconsultants.com

PRACTICE FOR SALE - BALTIMORE, MARYLAND

Established 40+ year old well-rounded practice of both surgical and non-surgical care with special emphasis on sports medicine. Medicare and BS/private insurance base, no Medical assistance. Needs to transition to a confident well trained individual. Purchase can include building. Contact:podiatrypracticesale@gmail.com

Very busy, two location group practice seeking a full-time, self motivated and hard working podiatry associate. Competitive salary and benefits are offered. Please email CV to: footcare4all@aol.com

ASSOCIATE POSITION - NORTHWEST IOWA

A well-established, midwest multi-physician practice with strong hospital affiliations seeking FT podiatrist. Applicant should be well trained surgical physician, completed a 24-36 month residency, & board eligible. Practice offers high surgical volume, advanced wound care and good mix of general podiatry. Competitive salary, excellent benefits. Fax resume: 712-258-9977

ASSOCIATE POSITION - NYC

Full and part-time opportunity available in 40 year old practice in downtown Brooklyn. State-of-the-art office with EMR and digital x-rays. Must be experienced, highly motivated with good clinical skills. Competitive salary. Possible buy-in opportunity available. please email resume to dpm10019@yahoo.com

ASSOCIATE POSITION - MANHATTAN

Podiatrist needed for busy state-of-the-art offices in Manhattan. Offices are located near Penn and Grand Central Station. 10+ years experience only and an out-of-network doctor for most insurances. Please forward your information and CV to: roni@myfcny.com

ASSOCIATE POSITIONS - MULTIPLE STATES

Podiatrist Needed in Arkansas, Kansas, Missouri, Nebraska, Iowa, Minnesota, North Dakota, South Dakota, Texas, Colorado, Wisconsin, and Oklahoma. Expanding multi-state medical practice seeking podiatrists to service long-term care community residing in nursing homes and assisted living facilities. We offer an established patient base, scheduling, equipment allowance and cover travel expenses. Provide generous compensation, bonus opportunities, disability, health insurance benefits, malpractice coverage and flexible scheduling. Looking for a podiatrist with excellent skills, able to provide expert and compassionate care to patients. Email CV to: careers@aggeus.org or call 773-770-0140 x300/x305.www.aggeus.org

ASSOCIATE POSITION - OH

Join a well-established modern practice in Dayton, Ohio. Excellent reputation and referral base. Base salary $120,000, benefits and bonus structure. EMR, diagnostic ultrasound, Padnet vascular studies, CO2 lasers, all aspects of DME. We seek a surgeon that is well-trained and personable to join our group of 4 podiatric surgeons. Would like to have this individual buy in to the practice eventually. Please send CV and to Ohiodoctors@aol.com

ASSOCIATE POSITION - CALIFORNIA

Office and hospital-based podiatry group in Bakersfield, CA seeks highly-trained surgical associate to join us. Prefer surgeon with trauma and Charcot reconstructive experience. Staff privileges with 5 local hospitals. Offering health insurance, CME allowance and competitive salary. Must be PSR 24/36 trained, ethical and thoughtful when treating patients. Please forward CV to: aghams2@aol.com

ASSOCIATE POSITION - BEAUTIFUL LONG ISLAND

Business-oriented, mature Board eligible/certified podiatrist who is not just looking for a job, but a secure future. Buy-out of practice will be available. Practice does in excess of $500K. 2 hospitals available. No nursing homes, no Medicaid. Competitive package. Please fax CV to 631-581-0857.

ASSOCIATE POSITION - NEW JERSEY

Immediate opening for a full-time podiatrist in a rapidly expanding multi-office practice in central New Jersey. Well established referral base with full admitting hospital privileges. Availability to become part owner of a multi-room, multi-specialty ASC. Excellent opportunity for the right doctor with potential to achieve $200K in the first year. Wonderful working conditions. Applicant must have at least PSR-24 surgical training. Valid NJ license and Medicare number is required. Applicant should also be familiar and competent in biomechanics, trauma, ESWT, PRP, wound care, and ultrasound diagnostics. Participating insurance #'s a plus. Please fax resume to:(609) 259-6637.

ASSOCIATE POSITION - ILLINOIS

Full and Part-time opportunity to provide conservative, ethical podiatric care to residents in long-term care throughout Illinois . Full time position includes health, disability, 401, auto/travel expenses. Ideal Full-time candidate would be willing to travel 2-3 days per month, or be located in central or downstate IL. We have a 30 year history of providing exceptional care and service, with appropriate reimbursement. Please email queries or resumes to: gh@podiatryplus.net.

ASSOCIATE POSITION - CALIFORNIA

We are hiring podiatrists for part-time positions in California: San Francisco, San Diego, San Jose. Duties: Diagnosis and treatment of Onycomycosis using Pinpointe laser in our facilities (training at the clinic); flexible schedule. Qualifications: Valid DPM California license; active medical liability insurance. email CV to: ofer@lasernailtherapy.com

ASSOCIATE POSITION - WORCESTER MASSACHUSETTS

Podiatry practice in Worcester Massachusetts is looking for an associate podiatrist. Busy 2-person practice. High surgical numbers. No nursing homes. Call to hear free recorded message for more information. Call 641.715.3800 Access Code 32299 and message 4 to learn about the practice. Visit our website www.centralmasspodiatry.com

ASSOCIATE POSITION - KANSAS CITY, MISSOURI

Kansas City may be the perfect move for you and your family. I am looking for an entrepreneurial minded associate who wants to grow and then own part of an already successful practice. If you are the right candidate for this associate position, you will enjoy a competitive compensation package and you will be working with a doctor who is as committed to your success as he is to his own. Go to:www.YourFutureInPodiatry.com for full details.

ASSOCIATE POSITION - FLORIDA

Looking to hire an associate who is caring, friendly, and holds a patient in the highest regard. I am a single practitioner with a large podiatry practice in Tampa, FL. Will provide an outstanding salary with additional incentives, excellent healthcare benefits, retirement and cell phone. Please email resume toHeliodiety@aol.com or fax to 813-854-6105.

PM News Classified Ads Reach over 13,500 DPM's and Students

Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 13,500 DPM's. Write to bblock@podiatrym.com or call (718) 897-9700 for details. Weekly ad rates start as low as $115 for a 50-word ad. THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451.

• To Post a message, send it to:    bblock@podiatrym.com
• Notes should be original and may not be submitted to other publications or listservs without our express written permission.
• Notes must be in the following form:
  RE: (Topic)
  From: (your name, DPM)
  Body of letter. Be concise. Limit to 250 words or less). Use Spellchecker
  Your name, DPM City/State
• Subscribers are reminded that they have an ethical obligation to disclose any potential conflicts of interest when commenting on any product, procedure, or service.