The Voice of Podiatrists

Serving Over 10,900 Podiatrists Daily

June 02, 2008 #3,261 Editor-Barry Block, DPM, JD

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Baby Boomers Need to Consider Alternative Activities: TX Podiatrist

Doctors who specialize in disorders of the skeletal system and associated muscles, joints and ligaments are being kept busy these days, as increasing numbers of baby boomer athletes and exercise enthusiasts hit middle age and beyond. "We are seeing a number of overuse or 'wear and tear' injuries in the foot, ankle, knees, hip, shoulders and elbows, in baby boomers," Dr. Jeffrey A. Ross, a podiatrist from Baylor College of Medicine, Houston, told Reuters Health.

Dr. Jeffrey A. Ross

"Baby boomers suffer injuries over a period of time and a lot has to do with biomechanics, poor flexibility, wear and tear, and pounding on hard surfaces that come with sports like running, tennis, step aerobics and basketball," Ross added. As people age, Ross believes it's worth considering alternative activities that put less stress on joints. "It is really important that people continue to be physically active, but they need to think logically about how to remain active as they age," he said.

As people age, Ross believes it's worth considering alternative activities that put less stress on joints. "It is really important that people continue to be physically active, but they need to think logically about how to remain active as they age," he said.

Source: Megan Rauscher, Reuters Health [5/30/08]

AAPPM Pledges $25,000 to OCPM in Honor of Dr. Bernhardt C. Egerter

On Friday, May 23, 2008, at the Ohio College of Podiatric Medicine’s (OCPM) Post-Commencement Reception, The American Academy of Podiatric Medicine (AAPPM) pledged $25,000 to name the President’s Office in honor of OCPM and AAPPM past president, Dr. Bernhardt C. Egerter. Dr. Egerter was president of OCPM from 1952-1966 and was one of the founders and charter president of AAPPM.

Pictured left to right are Larry Block, DPM, OCPM ‘65, who named the OCPM Fitness Center for $50,000, Steven Berlin, DPM, OCPM ‘66, who named the Auditorium for $250,000, Hal Ornstein , DPM, OCPM ‘87 chairman of AAPPM, along with Vincent Hetherington, DPM, OCPM dean of academic affairs.

FL Passes Bill to Boost Private Health Coverage for Uninsured

Florida lawmakers early last month adopted a bill that aims to increase access to affordable health coverage by allowing insurers to offer plans not subject to state benefit mandates.

Under the legislation, private health insurers would contract with the state through a new program called Cover Florida to offer coverage options to anyone who has been uninsured for at least six months. Eligibility would be faster for people who have lost their jobs. The bill would require the state to approve at least one statewide plan.

In addition, the measure would allow insurers and other companies to offer more flexible insurance options and other products geared toward businesses with 50 or fewer employees through a new initiative called Health Choices. These products also would be exempt from insurance mandates. About 3.8 million Floridians lack health coverage.

Source: Doug Trapp, AMNews [6/2/08]

How To Keep Cool Under Fire

When someone reacts hotly to your words, take the three-A approach to keep the situation from escalating:

• Acknowledge that you heard the person’s comments by pausing, nodding or verbally responding—but without blaming or labeling. Your goal: to buy time for you both to cool off.

• Ask for more information. Seek common ground based on the other person’s underlying concerns or needs.

• Add your own perspective. Ask “May I give you my take on the situation?”
That puts the other person in the position of granting you permission to state your view.

Source: Adapted from “Keeping Cool While Under Fire” by Kare Anderson

Query: Laser Smoke Evacuator Filter

I have a Microvac laser plume vacuum from 1985. I have finally run out of filters and cannot find anything on-line. It takes filter part LFS-103 originally from Sackhouse Assoc, in CA. Any help locating these would be greatly appreciated. If not, what other system works for CO2 laser plume?

Michael Saginaw, DPM, Dallas, TX

RE: Hypergranulation (Chris Seuferling, DPM)
From: Multiple Respondents

Be sure that no infection remains in the bone, which after 2 surgeries, a traumatic fracture, and post-op infection is potentially compromised and ripe for osteomyelitis or avascular necrosis. A period of IV antibiotics is likely indicated. As far as the wound, if it is truly clear of infection, consider the negative pressure wound therapy with the Wound VAC. It may help with the edema as well.

Pat Caputo, DPM, Holmdel, NJ, pat_caputo@alumni.rutgers.edu

The foot appears quite edematous. As with all wounds, I would control edema to aid in healing or closure. I would recommend some compression therapy for 1-3 weeks and then attempt delayed primary closure. With the large wound and hypergranulation, I would expect heavy drainage from this wound. I would apply stockinette, cast padding and Coban @25% compression, with an interdigital sling for edema control, or try Unna boots daily, but I find the edema would be best controlled in the forefoot with the Coban and interdigital sling.

Also, at this stage you, could try applying silver nitrate to the hypergranulation in conjunction with the compression. This would help control the heavy drainage that I would expect to be present.

Allen Sater, DPM, Jupiter, FL, Bunionpain@aol.com

I had a similar case where primary closure of a bunionectomy dehisced. My patient dehisced due to an allergic reaction to the Tincture of Benzoin I applied for Steri-strip adhesion. I used a Wound VAC, and the site completely closed in about a month. This is assuming your patient is otherwise healthy and a non-smoker.

Evan F. Meltzer, DPM, Jackson, MS, Evan.Meltzer@va.gov

RE: Gouty Ulcer (Frank Graham, DPM)
From: Multiple Respondents

I have seen these before, although uncommon (see picture of a second toe). These patients are generally malingerers, fear doctors or they have LOPS and cannot feel attacks. Note other locations of tophi. X-rays (or MRI) should help you define the depth and extent of tophaceous invasion to the digit and then as much of the tophus must be removed as you can by expression or debridement. That will allow closure. If tophus continues to be deposited, however, the wound will re-occur. Send the debrided material to the lab for confirmation.

Gouty Tophus 2nd Toe

Monitor uric acid and have an internist actively treat (especially with allopurinol, if not being used). Have a 24-hour urine catch taken, that if abnormal, would help define whether the patient is an overproducer or under-excreter of uric acid. Try to make dietary adjustments. This will hopefully reduce tophaceous deposition. These sometimes get secondarily infected, at which point the drainage (exudate) appears Pepto Bismol-colored due to the mix of blood and tophus. .

Dennis Shavelson DPM,,NY, NY, drsha@lifestylepodiatry.com

All respondents have made excellent points, serial debridements, colchicine, diagnose cause of gout, evaluate circulation DM control status. Three years ago I co-wrote an article discussing gout and its treatment. In it I also reviewed a surgical procedure for an appropriate patient, a diabetic with gout and osteomyelitis, and also another patient with superficial gouty ulcers of the knee. Two case studies were discussed using serial debridement on one set of wounds, and surgery on another. I refer you to the article in SYNERGY, the Official Newsletter of APWCA summer/fall issue. Go to APWCA.org and go to news tab, then Newsletter/Synergy tab, where you will find the summer/fall 2005 issue. As the other respondents stated, there is no “cookbook” method that works on all patients; each patient must be individually evaluated and treated appropriately.

Larry Schuster, DPM, Parsippany, NJ, lschus@comcast.net

I have to disagree with Dr. Boxer, and point out his inaccuracies. While allopurinol is a "systemic" drug, so is probenecid. In addition, so is penicillin, Neurontin, Plavix, Pletal, Cymbalta, and numerous other medications we regularly use within our scope of practice.

Since I'm often the admitting and attending physician for my patients at the hospital and perform their H&P for admission, it's my responsibility to write all their medications. I would categorically state that prescribing and using allopurinol is within the scope and practice of a prudent podiatrist practicing today (when s/he is familiar with the usage, mechanism and dosage).

I'm unsure what makes Mike think probenecid, which systemically inhibits the renal tubular resorption of urates shouldn't be used by a DPM, whereas probenecid, another systemic drug, should. I also use colchicine (a mitotic inhibitor), which is used for acute gout in patients with GI problems to avoid the NSAIDs.

Sloan Gordon, DPM, Houston, TX, sgordondoc@sbcglobal.net

RE: Dealing With a Claim of Racism (Name Withheld)
From: Clarence M. Stewart, DPM

You should call your colleague because actually you don't know if what she is telling is the truth. I have found out that believing what a patient tells you is the truth, can get you into major trouble. Also, how do you know that she is not exhibiting racism, or envious of an African-American physician?

Clarence M. Stewart, DPM, Raleigh, NC, IIICMS@aol.com

RE: MD Logic (Josh Prero, DPM)
From: Paul Yungst, DPM, Harry E. Confer, DPM

I have been using MD Logic for the past 4 years and find it very helpful, but the program lacks adequate surgical procedures for in-office surgical procedures and the entries are not carefully organized and set up. My biggest problem with the company is that they are not interested in helping you in an audit of your notes. That's why I purchased the program - to defend my treatment documentation in case of an audit. Plus, I have asked for a program manual for the last program update numerous times, which was promised, but never delivered. There is poor program backup.

Harry E. Confer, DPM, West Covina, CA, DRHEC@aol.com

I have been involved with MD Logic since its inception in 1996, first as a client and then as author of the podiatric knowledge base. I have seen the company grow from a clinical software product to a fully integrated EMR, which is currently used in my 4-doctor 2-office podiatry practice. Accuracy of documentation, speed and ease of use are three goals, which MD Logic has clearly achieved.

There are numerous features within the electronic charting system, best described and demonstrated by an MD Logic sales rep, such as tabs for intraoffice staff memos, surgery scheduling, and prescription summary - all accessible while creating a note or while previewing an existing note. Lab reports and inter-office correspondences are easily accessed with the click of a button.

The podiatry knowledge base comes pre-loaded with all the templates necessary to complete clinical office notes, operative reports, wound care documentation, DME documentation, X-ray and diagnostic ultrasound documentation, worker compensation reporting with impairment ratings, and letters of medical necessity. Editing of existing templates and the addition of new templates can be performed on the fly during the creation of a note. Referral letters, prescriptions and office documents are generated automatically. There have been numerous software updates throughout the years and these are completed in the evening with no downtime. The software is extremely stable and support has been readily available when necessary. In short, I highly recommend the MD Logic EMR.

Paul Yungst, DPM, Sarasota, FL, PGFY@aol.com

RE: Daniel Joseph McCarthy, Jr., D.P.M., Ph.D

Kudos to a doctor who loved podiatry! Dr. McCarthy was a brilliant scientist and raised the standard of podiatry in the eyes of the medical education world. He was a good friend to me since I was a student. His knowledge of dermatology was outstanding! He was a phenomenal teacher. He will be missed. His friendship and professionalism will be missed.

Francine G. Schiraldi-Deck, DPM, MS, MD(hon), Williamsport, PA

BIOMECHANICS FELLOWSHIP – NEW YORK

Neoteric Biomechanics (patent pending) Nine-Month Fellowship: At The Foot Typing Center® in New York City. Practice, Research, Publish and Credentialize Yourself In This New Paradigm. $36,000 Stipend. New York License Required.Fax Interest to: 212 288 3034 or apply to Dr. Shavelson @ drsha@lifestylepodiatry.com.

PRACTICE FOR SALE - VENTURA, CALIFORNIA

Selling satellite office, fully furnished and equipped. Existing patients and room for more growth. Inquire at tkhk@sbcglobal.net

ASSOCIATE POSITION – CHATTANOOGA, TN

Associate needed for established practice. ABPS qualified or certified candidate preferred. Patient mix, hospital privileges readily available, excellent benefits and salary with production-based bonus. Please e-mail cover letter and CV to asocfoot@bellsouth.net or fax to (423) 855-1558.

PRACTICE FOR SALE – BROOKLYN, NY

Busy multi-faceted 20 year old practice for sale. Large office with 3-4 fully-equipped treatment rooms, modern and updated. Located in Walgreens shopping center, subway on corner. Free parking lot. Turnkey operation. Make money first day. Call Jon @917-364-8057 or email: jonnytee@aol.com for more details.

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

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

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