The Voice of Podiatrists

Serving Over 9,500 Podiatrists Daily

May 25, 2007 #2,945 Editor-Barry Block, DPM, JD

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IA Podiatrist Uses New, Improved Ankle Replacement Implant

The Des Moines woman shattered her right ankle in a 1990 accident. Surgeons performed numerous operations to try to repair it. They prescribed brace after brace. By last year, the pain was unbearable. Rupe's next move appeared to be fusion surgery, in which doctors permanently immobilize the ankle.

Dr. Vincent Mandracchia

Her podiatrist, Dr. Vincent Mandracchia, offered another option: A new, metal and plastic ankle replacement. The device could relieve Rupe's suffering while still allowing her to move her foot, the podiatrist said. Mandracchia, who is chief medical officer at Broadlawns Medical Center, said he had never implanted one of the devices. But he had been trained by the manufacturer, a subsidiary of Johnson & Johnson, and he believed he could perform this operation.

X-ray showing ankle implant

Mandracchia said the device should last at least a decade. Either the implant or the portion of the foot where it's installed could wear down over the years, he said. In that case, Rupe could wind up having her ankle fused. Mandracchia said the surgery is relatively safe. Risks include infection, which always is a potential problem during surgeries. Also, the podiatrist said, scar tissue can reduce the range of motion in the joint. The full charge for the operation is about $45,000. Insurance companies, which negotiate discounts, would pay about $25,000.

The operation is not for everyone, Mandracchia said. "This is not a panacea," he said. The surgery generally isn't done on people weighing more than 250 pounds because the weight could break or dislodge the device. It also isn't recommended for people with poor blood circulation in their feet.

Source: Tony Leys, Des Moines Register [5/23/07]

ME Podiatrist Elected Chief of Medical Staff

Penobscot Valley Hospital has a new medical staff leader. Todd O’Brien, DPM has been elected President of the PVH Medical Staff at the Lincoln facility.

Dr. Todd O'Brien

Dr. O’Brien has practiced podiatric medicine and surgery in Lincoln since 1997. He has served on numerous hospital committees including one that focused on quality improvements including "fall prevention." In addition to his hospital involvement, Dr. O’Brien is President of the Maine Foot and Ankle Society and founder of West Enfield-based O’Brien Medical, LLC.

Penobscot Valley Hospital is a 25-bed critical-access hospital located in Lincoln, Maine. Its medical staff members take turns in leadership, and Dr. O’Brien was chosen to take over for Dr. John Shannon, who rotated out of the chief’s position this spring.

Source: Magic City Morning Star [5/23/07]

CA Podiatrist Disciplined for Multiple Acts of Misconduct

Dr. Richard H. Graves, a Los Alamitos podiatrist has admitted to failing to adequately treat a 49-year-old man with foot problems. He was cited in a 2004 criminal indictment for allowing unlicensed employees to treat patients and fraudulently billing Medi-Cal for nearly $600,000. Graves pleaded guilty in September to one felony count of making false statements, was fined $200,000 and placed on two years' probation.

According to the Board of Podiatric Medicine of California, Dr. Garves has agreed to the following disciplinary sanctions: Revocation of license (stayed), seven (7) years probation, eighty (80) hours of community service, restitution in the amount of $200,000, completion of the following courses; clinical training program, medical recordkeeping course, ethics course, as well as monitoring of his practice/billing, and cooperation in the Board’s ongoing investigation.

Source: California Board of Podiatric Medicine

Query: Surgery on Dialysis Patients

I have a male patient, 60 years old, on dialysis, who has symptomatic bunions. He would love to have them removed. He also has occasional gouty attacks for which peri-articular steroid injections are the preferred treatment because he cannot tolerate oral NSAIDs. He recovers very quickly from his gouty episodes. Between the dialysis and gout, I have no intention of operating on this patient, but I would like to get some opinions on doing elective foot surgery, in general, on dialysis patients.

Robert Teitelbaum, DPM, Naples, FL

RE: Cold Laser Therapy for Morton’s Neuroma (James M. Petko, DPM)
From: Maria Kasper, DPM

Cold laser therapy is a relatively new modality that can be very effective in treating many conditions of the foot and ankle as well as other parts of the body. I have been using cold laser therapy in practice for over two years with some pretty amazing results---including pain relief from Morton' neuroma. The catch is that you have to make sure that the cold laser that is being used is of the proper power to be able to penetrate into the area of pathology to have a positive effect. In short, cold laser therapy takes laser light that penetrates into the cells of the body, the cells then take this light energy and convert it to chemical energy by a series of biochemical reactions. The end results is healing within the tissues, decreased inflammation, pain relief, and improved function of nerve tissue to name just a few. Treatments are usually 3x/week for 3 weeks depending on the condition---patients with neuromas usually will not take this long to get complete relief.

I would have your patient check with the chiropractor to see what type of cold laser he is using and what the power is on the laser. The laser that I use in practice is a 40,000mW laser---much higher than most. Unfortunately, most of the lasers on the market are only 60-90mW and some are as low as 5mW---which is about the same power as a common laser pointer, and obviously will not be very effective.

Cold laser therapy is a very exciting new field with many different applications in podiatry--plantar fasciitis, diabetic wound healing, neuropathies and inflammatory conditions such as tendonitis, to name just a few. I would hate to see people get discouraged by seeing unimpressive results because an inappropriate laser with power that was too low was used. I have an article on cold laser therapy in the March 2007 issue of Podiatry Management.

Maria Kasper, DPM, Pittsburgh, PA, drmariakasper@yahoo.com.

RE: Digital Camera For Office
From: From: Michael Corcoran, Richard Boone

A second here for the Canon SD800IS. Aside from the features mentioned by Dr. Purdy, the 800IS was chosen by the NYT's tech columnist, Dave Pogue, as his favorite compact digital camera, particularly for its Image stabilization (IS), which, Pogue claims, saved "about 90% of the low-light photos that would otherwise have been ruined by blur." Link to review: http://pogue.blogs.nytimes.com/2007/05/03/pogues-picks/

Michael Corcoran, Student, SCPM 2009

I personally use a Nikon D2Xs with a 105 mm Micro Nikkor VR lens and an 8 GB micro drive mounted in a CF card. That gives me a 16-bit, 12 MP file which I then download into a 4 TB RAID 0 standalone hard drive using Image Ingester Pro, import into Adobe Lightroom and do any final processing in Photoshop CS3. For prints, I use any one of several different raster processors, Quadtone RIP works well, and output the image to an Epson R3800 for 16X20 prints.

Richard W. Boone, Sr., Fairfax, VA, RWBoone@aol.com

ASSOCIATE POSITION – MISSOURI

One of our longterm associates needs to relocate due to family reasons. Step immediately into full schedule. Partnership available after 2 years and board certification. Missouridpm@yahoo.com

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

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

ASSOCIATE POSITION - PHOENIX ARIZONA

Seeking preferably an experienced podiatrist versed in all aspects of podiatry with current AZ License. Practice is well established over 25 years, successful and large volume in the Phoenix metro area. Position available immediately. Email CV and inquiries to : pprac4sl@cox.net

ASSOCIATE POSITION – CALIFORNIA

Permanent associate position for very busy Southern California, two office practice. We offer a competitive salary, bonus plan, and fully paid benefits. Good surgical training is a must, and experience is a plus. Please fax CV to (909) 796-3709, or call (909) 227-5393.

ASSOCIATE WANTED - IMMEDIATE OPENING- NEW YORK

Hudson Valley (NY) for multi-location well rounded podiatric practice including high volume orthotics and reconstructive surgery. Looking for well trained (PSR- 24/36), personable, energetic practitioner to expand practice. Outstanding opportunity to work into partnership. Competitive starting salary, bonus incentives, benefits, and pension. Please submit: CV, letter of intent and references to: footassociate@yahoo.com

ASSOCIATE WANTED – PHILADEPHIA AREA

Opportunity in a high volume office-based practice in suburban Philadelphia.full-time office, close proximity to hospitals for surgery, consults and in-house care. Candidate must be well-trained in all facets of podiatry.PSR24/36 board certified/eligible required. Email CV and contact info to:mrgpod@hotmail.com or fax CV to 610-688-5175.

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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

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

EQUIPMENT FOR SALE – SURGICAL SYSTEM / TOURNIQUET SYSTEM

1) Osada Pedo-30w-electric surgical system with drill handpiece and oscillating saw handpiece. Includes several blades, and sterilizable handpiece rests (2) $2100 plus shipping (9 lbs,6.6 ozs). 2) DELFI Medical P.T.S. tourniquet system. Does not include tourniquet $1500, plus shipping (4 lbs,4 ozs). Both in excellent condition. TEMDPM@CS.com or 814-237-3338.

FOR SALE - EQUIPMENT

Boyd chairs, mini x-ray floor unit, Konica developer, ultrasound,Ellman surgitron, Imex 9000, Ille whirlpool, viewboxes, SmartDop, topical oxygen units, office furniture, etc. cast saw, lakeside carts, parafin wax bath, hand instruments. Contact jhallux@yahoo.com or fax (703) 264-7745 for full list.

PRACTICE FOR SALE WASHINGTON, DC

Hospital based 25 y/o practice, Billing 400k/yr/gross 285+. Four tx rooms fully equipped. X-ray, US, THBO, vascular testing. Loyal patient base, Wound care, diabetes, all aspects of surgery. Hospital priviledges. Seller very motivated to move fast. Relocating - $125k (OBO). Contact jhallux@yahoo.com or fax: (703)264-7745.

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

ASSOCIATE POSITION - EASTERN NORTH CAROLINA

Multi-physician Podiatric practice looking for PSR-24/36 trained Podiatrist to join our progressive, diverse practice. High surgical volume with teaching opportunities. Competitive compensation package with definitive plan leading to partnership. Must have North Carolina license. Position available late 2007. E-mail CV and/or letter of interest to ncdpmsearch@earthlink.net

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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