The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

May 26, 2011 #4,170 Publisher-Barry Block, DPM, JD

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NY Podiatrist Re-Attaches Severed Toes of 5-Year Old

A five year old child is recovering after a freak accident severed some of his toes. "His foot got caught in the track of a sliding glass door, which severed the fourth and fifth digits of the left foot, with the exception of the skin, which was holding the toes, says Dr. Frank Lattarulo, a podiatric surgeon at Phelps Memorial Hospital, who re-attached the toes. 

Dr. Frank Lattarulo

While the surgery was a success, the child is now getting follow-up treatment in the largest hyperbaric chamber in the Northeast. "At this point, you try to have a five year old not grow up with eight toes instead of ten," says Lattarulo.

Source: News-12 TV (Westchester, NY)

NY Podiatrist Collects Over 3,600 Shoes for Those in Need

When it comes to shoes, Dr. Mary Carlson has outdone Imelda Marcos, but in a way that benefits women who want to get back into the Long Island workforce. Carlson has collected about 3,600 pairs. But unlike Marcos, who kept all the shoes for herself, Carlson, a podiatrist in Williston Park, has given them all away to organizations serving women who want to get back into the business world but can’t afford outfits, and to other groups serving the poor.

Dr. Mary Carlson (Photo: Daniel Goodrich)

She first went to a fair in Williston Park, asking for donations of shoes. “I got an overwhelming response,” Carlson said. “People came to the fair with boxes” of shoes. Dress for Success, an organization that helps outfit poor women who want to return to the workforce, and the Interfaith Nutrition Network are among the organizations that receive shoes from Carlson.

Source: Josh Stewart, Newsday [5/24/11]

Alleged Unnecessary Surgery (New Jersey)

Facts: On Nov. 17, 2006, plaintiff Gerald Dorsey underwent surgery on his right foot, performed by defendant. The surgery sought to address complaints of right foot pain and decreased range of motion. Following the surgery and an appropriate recuperation period, Dorsey claimed continued foot pain and discomfort that he expected would have been alleviated by the surgery. He presented to another podiatrist who eventually performed two additional “corrective” surgeries. Dorsey sued defendant for medical malpractice.

Plaintiff's counsel alleged that the initial surgery Dorsey underwent was improper and unnecessary under the circumstances and a deviation from the standard of care. Dorsey alleged that defendant deviated from podiatric standards of care by advising the plaintiff to undergo an inappropriate surgical procedure and did not provide him with sufficient information to make an informed consent to the surgery. The initial procedure that defendant performed was called an arthoereisis (implant), and the plaintiff's expert stated that...

Result: Defendant's verdict ($0)

Plaintiff's expert witness: Lawrence G. Lazar, DPM, Washington, DC
Defendant's expert witness: Harold D. Schoenhaus, DMD; Podiatry; Philadelphia, PA

Editor's note: The full-length version of this reporter can be read here.

Take the ‘No Expletive’ Oath

As hard as it might be to believe, with curse words flying around seemingly everywhere you go, the word expletive refers not to so-called four letter words, but to a type of sentence.

An expletive is a sentence that begins with There, Here or It, followed by a be verb. Expletives can be useful on occasion, but if you find yourself overusing them, look for more creative ways to express yourself. Search your documents for constructions like “There is” and replace them with more active and engaging phrases.

Source: Adapted from “Writing (Communications),” LifeTips, via Communication Briefings

Query: Axial (Sesamoid) View Devices

Can someone suggest where to purchase axial view devices?

Jay Goldstein, DPM, Portland, OR

RE: Niacin, Cherry Juice and Acute Gout (Tom Silver, DPM)
From: Robert Creighton, DPM

Some studies have suggested that niacin may reduce the renal tubular excretion of uric acid. The RDA recommendation for niacin is 20 mg, however, many over 65 years of age are not meeting this recommendation via diet alone. In addition, niacin is often used to assist in the management of dyslipidemia at much higher doses. It has been shown to improve HDL levels.

Regarding the anecdotal information about cherries and gout: The polyphenol content of cherries and other fruits have been shown to have anti-inflammatory effects---the flavonoids in particular. The catechins in green tea have also been shown to inhibit xanthine oxidase.

I have recently posted on this site regarding encouraging our patients to view their "diet as medicine." The physiologic influence of niacin supplementation and various polyphenols are practical examples of this concept.

Robert Creighton, DPM, St. Petersburg, FL, rcreightonjr@hotmail.com

RE: Cracked Arm of Smart Toe Implant (Jay Hassenfratz, DPM)
From: Stephen Kominsky, DPM

My suggestion would be to splint the toe to an adjacent toe and keep the patient in a stiff-soled surgical shoe. The broken implant arm appears to be intra-medullary and proximal to the arthrodesis site. It is unlikely that the post-op symptoms as experienced by this patient are related to the broken implant. More likely, they are due to excessive motion at the fusion site (which is probably the reason for the broken implant). Typically, when this implant fractures, it is due to excessive motion and not a fault of the device.

Stephen Kominsky, DPM, Washington, DC, sjkom120@aol.com

RE: Idiosyncratic Reaction to a Foot Injection (Elliot Udell, DPM)
From: Robert Bijak, DPM

Although 0.25 cc of dexamethasone is a small dose, a facial redness is not an uncommon steroid-induced manifestation of flushing. But, being it is such a low dose, I am curious if the patient is overweight or has any Cushinoid appearances. This low dose may be causing an adrenal spill-over, vasodilatory effect of an otherwise borderline hyperadrenalism. A plasma cortisol or 5 hydroxy sterol blood and urine test after the injectable dose has cleared may be of benefit.

Cushing's syndrome can be caused by anything from a pituitary adenoma to a de nova adrenal tumor. You may have inadvertently (and fortunately) detected an early endocrine abnormality. A referral to an endocrinologist or a clinical pathologist would be interesting, but perhaps a little premature at this point.

Robert Bijak, DPM, Clarence Center, NY rbijak@aol.com

RE: SC Medicaid Elimination of Podiatry Services
From: George Pattis, DPM

Just a heads up to those providers in parts of the country who have not yet seen 100% Medicaid elimination of podiatry services in your state. Since Feb 1, 2011, there is no Medicaid podiatry coverage in SC. It is the strangest feeling working at a multi-specialty clinic to have a  patient present as a walk-in with a complaint of a typical podiatric chief complaint and be unable to see a podiatrist, and end up having to be seen by the primary care NP, PA, or MD. With some things in life, you just shake your head and think to yourself that makes no sense.

George Pattis, DPM, Greenville, SC, georgepattis@aol.com

RE: EHR Certification Charges (Andrew Levy, DPM)
From: Richard A. Simmons, DPM

The concern is that MD Logic is just now going through certification and will roll out a new program that will cost more money. I was a Medinotes-e user and enjoyed it, but did not want to pay the extra fees associated with their changed and certified version. My solution was simple: I still create my notes in Medinotes, then copy/paste them into Practice Fusion, which is free. I suggest that anyone who has an existing program that works might try the same. This allows you the ease of creating your note as usual.

My concern, which I think is reflected by others, was to create a quick, correct and seamless note during the patient encounter. I found that simple to do using existing software. If your office copy/pastes notes from Microsoft Word or another Word Processing Program you can very easily incorporate that into Practice Fusion. The advantage to me is that I can always create a note for my patient, even if the internet is down and I have a stored, signed copy of that note in my office network and in Practice Fusion.

Disclaimer: I have no financial interest in Practice Fusion.

Richard A. Simmons, DPM Rockledge, FL (RASDPM32955@gmail.com)

RE: Podiatrists' Responsibility When Taking Patients' Blood Pressures (Brian Kashan, DPM)
From: Charles Morelli DPM

Dr. Kashan and others have said that in order to meet meaningful use, we do not have to take a patient's blood pressure; nor do we have to actually measure their height and weight in our office in order to calculate their BMI. What we DO have to do in order to meet meaningful use, is simply record those values. That is done by asking patients what their BP is, and then recording what they tell you. If they say their BP is normal, then to meet meaningful use, you simply record 120/80. If they tell you their height is "x" and their weight is "y", then you record those as well, and your software will calculate their BMI.

You do not have to physically take those measurements. If they tell you they have an allergy to penicillin, you record that too. What you do not have to do is actually perform a scratch or patch test in your office to determine their allergy.

I take BPs on almost all of my patients, and I suggest we all do. It's just good medicine. Taking BPs can be life-saving. Young healthy patients who present with heel pain, a wart, or splinter will just be asked what their BP is, and invariably it will be normal (and you record that). But to meet meaningful use, all you have to do is write down what a patient tells you.

Charles Morelli DPM, Mamaroneck, NY, podiodoc@gmail.com

1-YEAR PODIATRIC SPORTS MEDICINE FELLOWSHIP - MONROVIA, CALIFORNIA

Applicants must have completed a podiatric residency program and must have or be eligible for a California license. Annual stipend: $48,000 and $60,000. If interested, please e-mail your resume with cover letter to the Program's management company at victoriamanagers@gmail.com

PRACTICE FOR SALE - NORTHERN NJ

Well established, part-time practice is for sale in Northern NJ. Digital X-rays, EMR, located in a medical condo building. Surgery 35%, Routine 30%, Average Gross is 130K on 2 half days per week. Practice is expandable to full time with increasing hours and marketing. Real estate available for purchase. Financing available. Please call 800-983-4194, or email contactus@podiatrypracticeconsultants.com

PRACTICE FOR SALE - BROOKLYN, NY

A large, busy practice is for sale in Brooklyn, NY. This practice has been in the same location for over 50 years. Average 150 pts/week, average gross 730K, most surgery is currently being referred out. Financing available. Please call 800-983-4194, or email contactus@podiatrypracticeconsultants.com

PRACTICE FOR SALE - SOUTH CAROLINA

$800,000+ gross, single location practice needs well trained, energetic podiatrist. Confidential inquiries carpodpract@gmail.com

PRACTICE FOR SALE - HOUSTON, TEXAS

28 year old busy, progressive practice for sale with an excellent reputation and well established referral base. Well trained, dedicated, supportive staff. Excellent cash flow $475K income after overhead. EMR, digital x-ray, diagnostic ultrasound. Free standing building also available with large outdoor sign. Owner retiring and willing to stay part time during transition. softechpodiatrist@gmail.com

PRACTICE FOR SALE - MISSION VIEJO, CA

Relocating to Tulsa. Great opportunity to buy my office. Located on Mission Regional Hospital Campus. Gross income 2010 was $340,000. Approximately 1300 sq ft with 3 treatment rooms, digital x-ray and fully computerized. Only 3 years old. Will consider all offers. 949-702-1052. David Stoller, DPM (Family Footcare) david@missionviejofootcare.com

PRACTICE FOR SALE - MARYLAND, DC SUBURBS

Great opportunity. Well established and equipped practice for sale. Office includes state licensed Ambulatory Surgical Center. Present owner is retiring but will stay on as needed for smooth transition. Average gross over past 3 years is $575 K. dpmpracticeforsale@yahoo.com

ASSOCIATE POSITION - CENTRAL NORTH CAROLINA

Well-established, busy podiatric practice is seeking highly motivated, well-trained and personable associate for full-time position. Competitive Salary and Benefits, Buy-in Opportunity. Interested persons must be actively pursuing or have NC license. Send resume and letter of intent to gpagpa530@yahoo.com

ASSOCIATE POSITION - SOUTHERN CALIFORNIA

Southern California practice looking for highly motivated podiatrist for very busy, two location practice. Excellent salary and benefits offered. Please email resume to mrsmcmackin@aol.com

ASSOCIATE POSITIONS - NW INDIANA, CHICAGO AREA

2 Full-Time positions open - One for Northwest Indiana and one for the Chicagoland area. Must have 2-year surgical residency. Must be motivated and a self-starter. State License required. If interested email: f-massuda@footexperts.com

ASSOCIATE POSITION – NEW YORK

Great opportunity to share “state-of-the-art” offices and equipment in mid-town Manhattan and White Plains with Board Certified podiatrist. Out-of-network or participating providers welcome. Please call 212-704-4310 for additional information and fax your CV to 212-704-4311

ASSOCIATE POSITION – IOWA CITY AREA

Modern practice seeking a well-trained (PSR 24/36) associate. Excellent opportunity for an energetic, hardworking individual with strong surgical and medical skills. Solid referral network and 13 years of growth. Come live in the Iowa City area and enjoy the quality of life and stability of a Big Ten University community. Competitive salary and benefit package available. If interested, fax CV to 319-354-1014 or e-mail to dave@341foot.com

ASSOCIATE POSITION - SW FLORIDA

Huge opportunity. Are you an outstanding person? Would you like the freedom to utilize your talents to the max? Opportunity awaits right candidate. Excellent mix of office/surgery motivated/experienced staff. Full Time Associate PSR 12-36. Great Salary/Benefits, Bonus Package, Unlimited Potential, Buy-In Opportunity. Email resume to podiatry22@yahoo.com

ASSOCIATE POSITION – NEW YORK

Well-established, multi-doctor podiatry practice with offices in Putnam and Westchester counties. Compensation based on productivity. Excellent opportunity for recent residency graduate to build skills and learn practice management. Full-time preferred but right part-time candidate will be considered. Email cover letter and CV to: Podiatry2011@gmail.com

ASSOCIATE POSITIONS - TEXAS

Texas licensed podiatrists needed in San Antonio and Austin. Great paying positions for full or part-time. Well established, unique mobile podiatry practice servicing senior living facilities. Business office locations in both cities with excellent support staff for your assistance and scheduling. Check us out before looking elsewhere. Find us at www.footmobile.com Reply with cover letter and CV to doctor.cohen@yahoo.com with a cc: to lisa.schulze@yahoo.com or call us at 210-495-6477.

ASSOCIATE POSITION - MARYLAND

Looking For The Best. Busy practice. F/T associate possibly leading to partnership. Seeking sharp, honest and hard-working associate who is extremely personable. Board Certified or eligible. Exceptional surgical skills and training needed, but is just as important to diagnose accurately. Excellent salary and benefits. Email CV to Marylandfootcare@live.com

ASSOCIATE POSITION - SOUTHERN MI (NOT DETROIT AREA)

Leading to partnership for rapidly growing 3-physician group practice. Must be residency trained and willing to learn and follow our very successful business model. Salary plus incentive. If you're unhappy with where you're at now this may be the answer! If, interested send CV to: paulapmac@me.com

ASSOCIATE POSITION- NEVADA

Well established 22-year practice in Las Vegas/Henderson, Nevada seeking full-time associate. General podiatric care with moderate amount of surgery to be done in local hospital or surgery center. Competitive salary and benefits. Modern office in new area. Please respond by email to lvfootandankle@gmail.com

ASSOCIATE POSITION - WA (KIRKLAND, SEATTLE, EVERETT, AND REDMOND)

Join one of the fastest growing podiatry practices in Washington state. Must be motivated to grow practice. Competitive salary and benefits. For more information go to seattlefootdoctor.com. Send resume to seattlefootdoctor@yahoo.com

ASSOCIATE - POSITION - SOUTHEAST GEORGIA & SOUTH CAROLINA

Seeking recent residency graduate to join practice. Must be PSR-24/36 trained. Multiple locations. Full range of services with new facility. E-mail to melissafoot@pol.net

ASSOCIATE POSITION - NEW YORK CITY & QUEENS

One of the fastest growing podiatry practices in New York City and Queens seeks a podiatrist who participates with HealthFirst, Fidelis, and other Medicaid plans. Preferably a Spanish speaking podiatrist. Contact me at Podocare@aol.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. Turn-key operation - no investment needed 516 476-1815 PODO2345@AOL.COM

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