The Voice of Podiatrists

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May 30, 2008 #3,259 Editor-Barry Block, DPM, JD

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Transitioning to Outdoor Sports? "Start Slow": Advice from TUSPM Podiatrist

Even if you're a devout gym-goer, it can be hard to resist the lure of a fresh-air jog or bike ride once summer arrives. But forging ahead with an outdoor workout routine without giving much thought to the details can have health consequences ranging from an annoying allergy attack to a serious incidence of heat exhaustion.

Dr. Howard Palamarchuk

"To me, it's like starting over," says Dr. Howard Palamarchuk, a Temple University podiatrist who frequently cares for runners' feet. "You may have been maintaining an aerobic base during the winter, but when you go outdoors you should consider it starting new training."

When you make the transition from exercising indoors to outdoors, Palamarchuk says it's important to start slow. Working out on an indoor bike, whether it's a recumbent or a spinner, is a far cry from riding in the open air, where you're dealing with elements like heat and wind.

Source: Allison Van Dusen, Forbes [5/27/08]

NY Podiatrist's Poodle Sits With Patients, Visits Nursing Homes

Jaden is the "therapy dog" at the New Century Podiatry office by Dr. James P. Pelletier. The 6-year-old miniature poodle has been working at the office for about two years. A sign on the door to the exam rooms advises patients: "A spoiled rotten poodle works here." Behind the door is where Jaden follows Dr. Pelletier from patient to patient.

Jaden with Dr. James P. Pelletier (Photo: Colleen White)

When Dr. Pelletier works on patients' feet, Jaden takes his lap position and patiently waits for the procedure to conclude as patients pet him. Sometimes the dog is lulled to sleep. "It's unbelievable how many patients make their appointments around him," said Yolanda M. Pelletier, wife of Dr. Pelletier and New Century's office manager. "They say, 'I'll be back if Jaden is going to be here.'"

"It makes his job so much easier," said Mrs. Pelletier. "They're holding the dog, and he can work on their feet and they're so calm. With young children, it's the same. They are holding the dog, petting him, and they are distracted." "We just find so many uses for the animal-human bond," she said.

Source: Chris Brock, Watertown Daily News [5/28/08]

Medicare Spending Not Linked to Satisfaction, Study Finds

Variations in regional Medicare spending do not affect beneficiaries' perceptions of the care they receive, according to a study released Tuesday in the Journal of the American Medical Association, Bloomberg/Tennessean reports. Medicare spending differences -- which range from an average of nearly $12,000 a year for a beneficiary in Miami to $5,700 for one in Minneapolis -- are not linked to beneficiary satisfaction, the study found.

"This is kind of the puzzle of health spending," Jonathan Skinner, co-author of the study and a Dartmouth College economist, said. Skinner added, "In areas that spend a lot of money and provide intensive care, there's no consistent evidence that patients benefit. Nor do patients in low-cost areas feel deprived" (Bloomberg/Tennessean).

Source: Bloomberg/Tennessean via American Health Line [5/28/08]

Use Your Eyes to Make a Powerful First Impression

Try this simple tip to help you project a good impression: Notice the color of a patient’s eyes as you shake hands.

Why it works: You’ll gain strong eye contact in a way that shows you’re interested in what the patient has to say.

Source: Adapted from Roger Dawson, Secrets of Power Persuasion

Query: Gouty Tophaceous Ulcer

This 47 year old diabetic type-2 obese male presented with a painful gouty ulcer at the 1st MPJ. I gave him a PT block with Marcaine, which relieved the pain.

Gouty Tophaceous Ulcer

I started him on allopurinol. I’m looking for some recommendations on the best way to close the wound.

Frank Graham, DPM, NY, NY

RE: MI Podiatrist Advocates Cryotherapy For Heel Pain, MA Orthopod Disagrees
From: Marc Katz, DPM, G. Javier Cavazos, DPM

I would like to know if every procedure that George Theodore performs has been tested with a randomized, double-blind, placebo-controlled study. He may not think the procedure works because he has likely not performed any or a significant number. How interesting is the fact that he's pushing ESWT and is author of a study on shock-wave therapy that was funded by a manufacturer of the equipment involved. Something stinks here.

We cannot advance new technology and immediately have major studies. We are getting consistent excellent results and would be happy to teach Dr. Theodore the appropriate method of performing cryo so that he too may have good outcomes.

I noticed that Dr. Cavazos' study, which is significantly larger than that of Dr. Fallat, was omitted. "Another podiatrist, Javier Cavazos of McAllen, Texas, reports in an abstract accepted for presentation at the APMA's July annual meeting that 76% of 168 subjects who had cryosurgery had little or no pain two years later, while 24% had at least a little bit of pain. Overall, pain was reduced from an average of 7.57 on the scale of 10 to 1.10."

Dr. Cavazos, Dr. Rampertab, and I have all gone far beyond the methods of Dr. Fallat and we actually do know how cryo works for heel pain. We hope to come up with standards for the procedure to attain consistent outcomes. We have developed our own cryosurgical techniques for heels that are completely unrelated to Dr. Fallat's procedure. There is a lot more to the procedure than just finding painful points and freezing them.

We are happy to share our knowledge without strings attached and without special recognition. We truly want to advance cryosurgical technology, so that soon it will be the procedure of choice for foot pain. That's where this technology is headed. We hope to be working on studies in the future.

Marc Katz, DPM, Tampa, FL, dr_mkatz@yahoo.com

Although Dr. Fallat is the pioneer in cyrotherapy, Dr. Fallat was not the only podiatrist mentioned in the Wall Street Journal article. His data was not the most compelling evidence supporting cryotherapy for plantar fascitiis. In reviewing his article, Dr. Fallat reports a 54 percent complete resolution after one year follow-up compared to a 76 percent complete resolution reported by Dr. Cavazos' abstract and pending publication for 174 patients after 2-year follow-up.

Furthermore, much of the skepticism surrounding cryosurgery is because of many poorly-written anecdotal case study articles in commercial publications such as yours. The lack of peer-reviewed articles on this topic is the main obstacle for the acceptance of cryosurgery. My personally-funded research group is currently working on comparative prospective studies.

Dr. Fallat deserves a lot of credit for his vision in cryotherapy, but I, along with Dr. Rampertsdt, Dr. Katz, and Dr. Khan have taken this procedure to new levels and are working diligently in trying to educate our public and peers in the medical community in an acceptable empirical fashion. I have an article reporting a 92 percent success rate in 2,700 cases during the last 5 years, which is available for reproduction, if requested.

G. Javier Cavazos, DPM, McAllen, TX, javnancjon@aol.com

RE: Dox Podiatry (Josh Prero, DPM)
From: Brian Doerr, DPM

.

I have been using DOX podiatry for 2 years now and I'm very satisfied with the program. It is extremely easy to use and to navigate. The biggest negative that I can say is that the front-office component still needs some work. The best part of the program is that they know it's not perfect and they are constantly upgrading the program.

Brian Doerr, DPM, Ft Myers , FL, DocDoerr@aol.com

ASSOCIATE POSITION - SAN ANTONIO, TEXAS

Seeking three-year trained resident for associateship, hopefully leading to partnership. Competent in all phases of podiatry particularly reconstructive rearfoot surgery. Outstanding opportunity for the right individual. Reply to Richard Pollak at 210-692-0279, or fax resume to 210-692-0028 or e-mail drpllk@hotmail.com

IMMEDIATE OPENING - MINNEAPOLIS, MN

Associate leading to partner in well-established practice. Seeking personable, skillful, and attentive podiatrist. No nursing homes, evenings or weekends. Competitive compensation package including health insurance, malpractice, short term disability, 401(k), generous vacation, paid holidays, and excellent salary plus bonus! E-mail cover letter and CV to jbremer@associatedpodiatrists.com or fax to (612) 866-5875 attn: Jennifer Bremer

INTERNET FOOT THEMED CANDY BUSINESS FOR SALE

Well-known foot-themed chocolate and candy company with over 6,000 customers. Unique products with trademarked names for seasonal (Mistle Toes, Valentoes, etc.) as well as everyday (A Foot of Feet, Twinkle Toes, etc.). Excellent opportunity to generate income from home with an established business. Serious inquiries to Mwolpa@ToeFood.com

PRACTICE FOR SALE - FLORIDA

Well-known practice in Coral Gables,FL for over 20 years. Excellent location on Coral Way with heavy traffic, great visibility and plenty of parking. Busy, fully equipped, full-time office with established patients. Grossing over 300K with tremendous growth potential. Office is currently open and ready to take over immediately. For additional information contact QVAN@aol.com or 305-975-5516.

ASSOCIATE POSITION – LEHIGH VALLEY, PA

Large medical/surgical practice centered in Lehigh Valley, PA looking for exceptionally trained podiatrist. Excellent opportunity for income as well as potential partnership. E-mail resume to jkaufman@lvfoot.com

ASSOCIATE POSITION – NW INDIANA (1 HR FROM CHICAGO)

Great opportunity for financial and personal success. Start at $150K plus incentive compensation, good benefits, and ownership potential. Must be highly motivated, have a great bedside manner and excellent surgical skills (forefoot and rearfoot). E-mail resume to friendlyfootcare@comcast.net or fax resume to (219)662-7290. Learn about us here

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

EQUIPMENT FOR SALE

Relocating satellite office and selling redundant equipment, all less than 2 years old. Koven Smartdop45 - $2995 Scan X Digital X-ray - $17995.00 SIUI CTS 5500 Diagnostic Ultrasound and cart with printer - $4695 Chattanooga Therapeutic Ultrasound - $495. Please call Priscilla at 281.313.0090 if interested.

ASSOCIATE POSITION - PITTSBURGH, PA

Excellent opportunity to join busy and established practice for 27 years. Must be graduate of PSR 24+/36 Residency. Terms negotiable. 30-40 hours per week. $100,000+ guaranteed. Please fax resume to (412) 563-0740.

PODIATRISTS NEEDED - CHICAGO --NORTHWEST INDIANA

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists. We are located in Chicago and Northwest Indiana. 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

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