The Voice of Podiatrists

Serving Over 9,500 Podiatrists Daily

May 30, 2007 #2,948 Editor-Barry Block, DPM, JD

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CT Podiatrists Find Many Benefits From Use of Digital X-Ray Machine

When a 350-pound cement block crashed onto a 40-year-old woman's foot last year, three sets of conventional x-rays indicated no breaks or fractures. As the pain persisted over the following week, so did the woman, who insisted to doctors that something was wrong. Finally, she met with local podiatrists, Dr. James DeJesus and Dr. David Mader, who were able to detect a small fracture just above the first metatarsal on the her right foot through the use of computerized digital x-ray technology.

Dr. James DeJesus

The fracture likely would have gone undetected prior to medical advances in the technology era. But now, with a few clicks of a mouse, doctors can locate miniscule fractures and hard-to-notice diseases within a few minutes. Mader said he can enlarge a digital x-ray so the patient can easily see the problem, and can colorize differences in bone density to give a better view of a problem. "The biggest benefit I see is that I can manipulate the image on the screen, which allows us to magnify the image and see it a lot closer than we previously could," he said.

Dr. David Mader

Mader can also make notes on the images, and show patients the exact procedure doctors would use during surgery, or what a screw would look like in a foot if it were needed. He said doctors can also make a copy of the X-ray in their offices and immediately e-mail images to a patient's primary care physician. Mader said his office has seen savings in time, money and space.

"We have no repeat X-rays resulting from darkroom errors," he said. "In fact, we don't need a darkroom anymore, since we have no more chemicals to purchase or dispose of. And we don't need film anymore either. ...The technology is priceless, and it's definitely the wave of the future." He expects the traditional X-ray machine will become a thing of the past as more and more doctors turn to digital scanning devices.

Source: Paul Singley, Republican-American [5/28/07]

Temple Podiatrist Offers Foot & Ankle Injury Advice

As the weather gets warmer, many take up running or hiking, but Temple University podiatrist Dr. Howard Palamarchuk advises not to ignore foot and ankle pain. Palamarchuk also says that to avoid foot injury:

Dr. Howard Palamarchuk

• Easy does it. Be aware that beginning or average runners take nearly twice as long to finish the same course and also tend to weigh more than experienced runners, leading to more stress on feet and ankles.
• Don't forget stretching and using strength training to prevent injury. The legs, feet and ankles bear up to 1 million pounds of pressure during one hour of strenuous activity and are most vulnerable to injury.
• If an injury should occur, "PRICE" the injury; that is, treat the affected area with protection, rest, ice, compressive wraps and elevation.
• Any ankle or foot injury with pain and swelling beyond 24 hours should be checked out by a physician.

Source: UPI Apples For Health [5/27/07]

Medicare Pay-For-Reporting: How to Get Your 1.5%

On July 1 2007, Medicare will take a big step toward becoming a more active health care purchaser, by launching its first program-wide quality reporting initiative for physicians. Doctors who join the effort will be eligible for a 1.5% bonus on all of their Medicare reimbursements for the last six months of this year.

First, physicians must consult the CMS-approved list of 74 quality measures to decide how many to report and determine how many of their Medicare patients fit into those categories. To be eligible for the bonus, doctors must report on at least three measures and apply each one to at least 80% of the patients who fit that category.

Physicians who see a significant number of diabetic patients, for example, might decide to keep special tabs on whether these patients maintain their blood pressure control -- one of the CMS quality measures. To meet this requirement, a doctor would have to share with the government the individual blood pressure ranges of at least 8 out of 10 under-control diabetic patients during one or more of their follow-up office visits in the last half of the year.

Doctors participating in the Medicare quality reporting initiative will include special quality codes on their regular claims for patient visits in which one or more of their selected quality measures applied. On paper claims, quality codes are recorded in section 24. On electronic claims they are recorded in the SV-1 "professional service" segment of the 2400 "service line" loop.

Source: David Glendinning, AMNews [6/4/07]

Query: Possible Parasite in Foot

Recently a man was referred to my office with a possible parasite in his foot. He has what appears to be a mobile sub-q parasite. I have tried Doxycycline for two weeks and have even tried to superficially excise it. I know something is there since it appears to move, but Doxycycline has proved to be ineffective.

He has a history of a recent vacation in the tropics. I have sent him for an MRI to look for fluid collections in his foot. I really don't feel I should open up the bottom of his foot in an attempt to find something that may not be there. Any advice would be appreciated

Ira Weiner, DPM, Las Vegas, NV

RE: Post Arthroscope Abscess (Will Godfrey, DPM)
From: Howard L. Lazar, D.P.M.

Such lesions, in my experience, occur post-operatively, and result from deep dehiscence. The literature indicates it is the result of tissue necrosis around sutures, resulting from the expansive pressure in the post-op site exceeding the ability of the tissues to maintain closure, sutured or not. Although I've not encountered it under any other conditions, it is reasonable to presume that it could occur in any deep laceration.

Each of my three cases was post-op, each was subjected to appropriate work-up, and each was found free of detectible microorganisms. The first lesion was treated with an advancing umbilical tape drain passed through a fenestrated, cohesive compression dressing. The lesion closed in ten days with no observable sequellae. This was a periarticular lesion at the 1st MPJ.

The two later, separate cases were plantar lesions. One was associated with a prior dorsal incision at the 3rd intermetatarsal site. The other was plantar to the navicluar, associated with a medial incision. Each was aspirated using a syringe-mounted 14 gauge needle. Each was flushed with Keflex-loaded saline, and closed with vertical mattress sutures of 0-0-0 nylon to occlude the dead space. Sutures were removed at 10 - 14 days. There was no drainage from either lesion. All three of these cases healed without incident.

Howard Lazar, DPM, Bloomfield Hills, MI, howardlazar@comcast.net

RE: High Definition Diuretic

Last week a routine care patient of mine was giving me the update on her medication history. She informed me that she is now taking a water pill called "HDTV."

Marc Greenberg, DPM, Dayton, OH

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

ASSOCIATE PODIATRIC SURGEON – TEXAS

We are looking for an exceptionally trained podiatric surgeon to work in the Houston, Texas area. Candidates seeking this opportunity need to be dynamic, people friendly, and have current licensure in Texas . Future licensure in Arizona will be required. Exceptional opportunity, with attractive benefits, and excellent starting salary. The successful candidate will find a rare opportunity to integrate into a specialized lower extremity practice with emphasis on peripheral nerve surgery, endoscopic and arthroscopic surgery, and other special surgery of the foot and ankle. Please submit a cover letter with current curriculum vitae via email to: Slb99@pdq.net Stephen L. Barrett, D.P.M., MBA

ASSOCIATE POSITION – SOUTHERN KENTUCKY

Southern Kentucky's largest and most respected foot and ankle group is looking for an associate to start in July 07. An amazing opportunity to grow with an established four provider practice on beautiful Lake Cumberland, Kentucky. Very competitive salary/bonus with a buy in opportunity will be offered. Established satellite offices will make for immediate patient base ready to be nourished and grown by a friendly, well-trained associate. Excellent benefit package. Lexington, KK is 1.5 hours North while Nashville, Tennessee is 2.5 hours South. Please fax CV to 606-679-4626.

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 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

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 – 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

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.

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.

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