The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

May 25, 2009 #3,554 Publisher-Barry Block, DPM, JD

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Look At Toenails For Clues To Health: MI Podiatrist

For a quick "snapshot" of your health during the past year, bend over and take a look at your toenails. "Their shape, color, growth rate and susceptibility to pain all offer vital clues that your family doctor or a foot specialist can interpret," says Michael Schey, D.P.M., a Beaumont Hospitals podiatrist.

Dr. Michael Schey

Dr. Schey recalls seeing a patient with infected toes and peeling, cracked skin on her feet who had recently lost weight. He urged her to see her family doctor, who confirmed Dr. Schey's suspicions. The woman had diabetes.

The Beaumont foot specialist urges everyone to pay attention to their toenails, noting any changes in texture, shape and color, including unusual growth, pitting or holes in the nails and dark brown streaks beneath the nails.

Source: EMax Health [5/21/09]
 

FL Podiatrist is Finalist in Healthcare Heroes Awards

Dr. Chet Evans has been named a finalist in the 2009 Healthcare Heroes Awards presented by the Greater Miami Chamber of Commerce. Evans is the former dean of the Barry University School of Podiatric Medicine.

Dr. Chet Evans

“Dr. Evans is a remarkable leader, who has influenced the lives of thousands of students who are responsible for the health care of millions of Americans across the country. His character and values stand next to none, as he has dedicated his career to inspiring access to health care for the forgotten and the medically disenfranchised.”, said Robert McKinlay, Assistant Dean, Barry University School of Podiatric Medicine.
 

NY Podiatrist  Says Healthcare Reform Should Include Illegal Aliens  

Healthcare reforms aiming for universal coverage won't provide insurance for illegal immigrants and may not address the cost to state and local governments for providing medical care to this large group of the uninsured, the chairman of the Senate Finance Committee said Thursday. "We're not going to cover undocumented aliens, undocumented workers," Sen. Max Baucus, D-MT, said at a meeting with reporters. "That's too politically explosive."

Dr. Jamie Torres

Some immigration advocates have argued health care reform will be incomplete if it does not extend coverage to illegal immigrants. "In light of what's happening right now with the flu pandemic, it's pretty clear that, for any healthcare system to work, it has to cover everyone residing in the United States," said Dr. Jamie Torres, a New York-based podiatrist who is director of Latinos for National Health Insurance.

Source: Jim Landers, The Dallas Morning News [5/22/09]
 

U.S. Announces Effort to Combat Medicare Fraud

The Obama administration on Wednesday unveiled an anti-healthcare-fraud mission aiming to combat billions of dollars in Medicare scams from Miami to Los Angeles. The joint effort by the Justice Department and the Department of Health and Human Services will bolster Medicare-fraud strike forces in those coastal cities as well as establish new ones in Detroit and Houston, where suspicious billing schemes have spread, senior officials said.

Attorney General Eric Holder stressed that the fight against Medicare and Medicaid fraud — estimated to be at least $60 billion a year — must accompany the administration's greater ambitions to reform health care, a monumental political challenge. "By all accounts, every year we lose tens of billions of dollars in Medicare and Medicaid funds to fraud," said Holder, who outlined the new initiative with HHS Secretary Kathleen Sebelius at a news conference.

The plan announced Wednesday includes a recommendation by the Obama administration to invest $311 million in the fiscal 2010 budget to fight fraud, waste and abuse in the Medicare program, a 50 percent increase over this year. During the Bush administration, Congress committed scant new funds to combat fraud.

Source: McClatchy News Service [5/20/09]
 

It Pays to Sweat the Small Stuff

On the job, tiny details are easy to overlook. Yet they can make the difference between a “good enough” effort and the kind of outstanding results that earn you praise and promotion.

To illustrate that point, a speaker once asked his audience, “How many of you have ever been bitten by  an elephant?” Of course no hands went up. Then the speaker asked “How many of you have been bitten by a mosquito?” Every person in the audience quickly raised a hand. “See!” the speaker said. “That proves it. It’s the little things that get you.”

Source: Adapted from The Eight Competencies of Relationship Selling, Jim Cathcart via Communivation Briefings

RE: Post-Op Care for Alzheimer's Disease Patient

I have a fairly young diabetic man with early onset, very advanced Alzheimer's who had to have a 2nd toe amputation for osteomyelitis.  Post-operatively, he repeatedly pulled open the incision because he thought the sutures were dirt stuck on his skin. After repeatedly closing the incision, and finally fiberglassing on a cam walker, he healed, but he continues to self-mutilate the amputation site and cause an ulcer. (He literally pulls his skin off, even though there is nothing there.)  We have been duct taping on his sock (he is well-perfused) to keep him away from the area but he continues to get in and open a wound there. Does anyone have any suggestions on a device or technique I can have his facility use to keep his hands off the area when he is not monitored?

Daniel Cohen, DPM, Melbourne, FL
 

RE: Charcot Foot and Gout (Leonard Kuzmicki, DPM)
From: Multiple Respondents

Ct scan and MRI are certainly helpful when diagnosing Charcot neuroarthropathy. This being said, a radiological report that suggests gout is just that, a suggestion. Degenerative changes seen in an MRI/CT scan are just one piece of the diagnostic puzzle. In order to accurately diagnose Charcot vs. an alternative degenerative process, a good history and physical exam is essential.

Gerald Mauriello, Jr., DPM, MA, Philadelphia, PA, drmauriello@gmail.com

I too have seen patients like this. However, the patients I had were being treated for hyperuricemia with uricosuric agents as well as Allopurinol for years. The patients also had extreme gouty attacks of which they were aware. It is possible that the patient has Charcot foot with underlying hyperuricemia. However, I am sure that they would have remembered extremely painful gout attacks, even with severe neuropathies. What is most likely is that this particular patient was not giving you a full medical history. Even with that being said, I would treat her as any other Charcot foot patient and consult a rheumatologist as these tophi can be reduced with low-dose Colchicine treatments. AS we know, the Charcot foot cannot.

Judith Rubin, DPM, Houston, TX, jrubinfoot@aol.com

It would be logical to expect that the same patient population which develops Charcot foot would be at higher than average risk for gout. Diabetes which has progressed to neuroarthropathy could be expected to take a significant toll on the kidneys as well. And these patients are also often on blood pressure meds which are known to increase risk of gout.

But the sort of profound midfoot destruction that Dr. Kuzmicki describes is neuroarthropathy, not gout. Gout attacks are exquisitely painful. So, it is unlikely that a patient would walk on a foot during gout attacks enough to cause destruction of the navicular and cuneiforms with lateral dislocation of the metatarsals. Gout also destroys articular and peri-articular surfaces while Charcot neuroarthropathy is characterized by profound destruction which leads to foot collapse. If there is any question at all, a joint aspiration is indicated as that is necessary for a definitive diagnosis of gout. My rheumatologist wife says that it is rare, but gout can cause the extent of bone and joint destruction that Dr. Kuzmicki describes. This would most likely be accompanied by exquisite pain in the patient history.

Richard Gosnay, DPM, Danbury, CT, glabroushead@gmail.com

ASSOCIATE POSITION – NYC, NY

Wanted: Podiatrist seeking a first practice as a partner in existing upper West side NYC office. Must have NY license.  myfootodoctor2@aol.com

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

CASE CONSULTING

Dennis Shavelson, DPM is now accepting referrals of difficult cases involving biomechanics, surgical complications, non-healing wounds diagnostic and treatment dilemma’s and subtalar stenting from DPM’S. Full reporting with second opinion only, rapid return after care and assumption of care options. Medicare and Out-of-Network Only. (212) 288-3668 or drsha@lifestylepodiatry.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  

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

EQUIPMENT FOR SALE

Used Acoustic Imaging Diagnostic Ultrasound. Comes with 10 MHZ linear probe. Printer included. Unit is a console on wheels and cannot be shipped due to its weight, must be picked up.. See website www.hurtheel.net for more details. Price: $3,000 Contact Information Henry Slomowitz  E-mail hslomowitz@gmail.com Phone 973-479-6305.

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 

1-YEAR PODIATRIC SPORTS MEDICINE FELLOWSHIP

Monrovia, California. Applicant must be a licensed podiatrist and have completed a podiatric residency program. Monthly Stipend $4,000 to $5,000. Please email your curriculum vitae to victoriamanagers@gmail.com Thank you for your interest in our Program.

SEEKING PODIATRIST FOR SUNDAYS - HOWELL, NJ
 
Our practice of over 18 years is looking for a DPM to provide treatment on Sundays at our Howell office located approximately 1 mile from Lakewood , NJ. Speaking Hebrew preferred, but not required.  Please reply by emailing a CV and cover letter to: toetoe@optonline.net or by faxing to 1-888-645-0241.

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 - NORTHWEST IOWA

Great opportunity for hard-working, ethical podiatrist to join Midwest multi-physician, podiatric group with multiple locations. A well-established, successful, growing practice with strong hospital affiliations seeking FT and PT surgically trained physician. Applicant should be well-trained in all aspects of surgical care, completed a 24-36 month residency, & at least board eligible. Diverse practice offering high surgical volume, advanced wound care and good mix of general podiatry. Competitive salary, excellent benefits. Fax resume to: 712-258-9977

ASSOCIATE POSITION- HUDSON VALLEY REGION, NEW YORK

Unique opportunity for the right person! We’re looking for a personable, motivated individual who is seeking opportunity and security in a high end multi-office group practice. This is an incredible position for the right person. Please reply to Hudson Valley Foot Associates, PO Box 3300, Kingston, NY 12402-3300; or email CV and cover letter to: jobs@hvfa.com

DIAGNOSTIC ULTRASOUND FOR SALE

Mindray 6600 with Sony thermal printer. Machine comes with a 10 Mhz linear probe. Split screen allows two images on one screen. All digital machine. Comes with factory warranty for 1 year from Atlantic Medical LLC. Price when new is close to $11,000.00. Price for this machine with printer is $5,500.00. For further information see website

PM News Classified Ads Reach over 11,500 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 11,500 DPM's. Write to  bblock@podiatrym.com or call (718) 897-9700 for details. THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451 Ext 110. 

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