The Voice of Podiatrists

Serving Over 10,900 Podiatrists Daily

June 09, 2008 #3,267 Editor-Barry Block, DPM, JD

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Cryotherapy 80-90% Effective for Heel Pain: TX Podiatrist

Clara Craine is a cosmetologist; problem is she's been living with terrible foot pain for almost a year. Clara Craine says, "And it progressed and just got worse and worse. "She tried every treatment her doctor recommended. Clara Craine says, "Pain pills, cortisone injections, homeopathic injections, heat, ice, everything." But nothing worked. So she went to Dallas podiatrist doctor Jonathan Kletz.

Dr. Jonathan Kletz

Dr. Jonathan Kletz says, "Heel pain is very common; it's very, very painful. In some patients, they have difficulty just doing their normal activities." Dr. Kletz offers a new procedure called cryotherapy.

Dr. Kletz says, "I take a probe that's connected to a nitrous oxide tank and this probe creates a minus 7 degrees temperature, basically forming an ice ball within the foot." That destroys the outer layer of the damaged nerve, so a new nerve can regenerate. It only takes about seven minutes. Dr. Kletz says, "There are no stitches, patients are getting it wet the next day and there's very little after care associated with it. Dr. Kletz says cryotherapy is about 80-90 percent effective. And it's covered by insurance.

Retired WI Podiatrist Volunteers at Clinic

In tight economic times, putting food on the table and gas in the car are top priorities for many people. With prices for both food and fuel soaring, many are forced to make a cut they don't want to in terms of their health.

Dr. Edward Hommel

Dr. Edward Hommel, a retired podiatrist who volunteers his time at Middleton's Benevolent Specialist Clinic, said that many people will opt to go without health insurance to save costs. "Money is short and they drop their (health) insurance," he said.

Source: WIS-TV [6/5/08]

Offer Good Reasons, Not Excuses

The phrase “a good excuse” falsely implies a difference between good and bad excuses. All excuses are bad—and therefore unacceptable. By contrast, a reason is a legitimate, truthful account of a situation, including the part that you yourself played. The next time you must explain a shortcoming or failure, ask yourself these questions to determine if you are about to offer a reason—or simply an excuse:

• What is your intent? Are you aiming to release yourself from blame? Or do you seek to provide an account of the situation and your actions?

• Are you willing to accept the consequences of your actions? Are you able to describe the steps you plan to take to improve the situation?

• Do your words honestly acknowledge your own responsibility? Have you described what you could have done differently?

Source: Adapted from “Explain Yourself!” by Joy Fisher-Sykes

Query: Chronic Pain After Multiple Neuroma Surgeries

My patient is 54 y/o female with neuroma pain bilateral. I infiltrated twice into each foot with no relief. She opted for surgery and a left 3rd IS neuroma was removed without incident. She was again infiltrated at 10 days post-op for continued nerve pain. The incision was well-healed at this time. Two days later, she presented to the office with a dehisced wound. She was treated with Cipro and eventually the wound healed, but she continued to have pain. Two separate MRI's reveal edema and fibroma, respectively.

She opted for a second surgery and the left 3rd IS was again explored and a soft tissue mass removed. The pathology report reveals necrotizing granulomatous inflammation reminiscent of a rheumatoid nodule and residual post-traumatic neuroma. The patient's wound continues non-healed 3 month S/P 2nd surgery. The forefoot is swollen and painful under mets 2,3,4. As are the 2nd and 3rd toes. She is now on Levaquin and awaiting a repeat MRI result. Any suggestions for next course of treatment?

Jorge Nasr, DPM, Miami FL

RE: Kudos For Practice Management Tip of the Day
From: Bret Ribotsky, DPM

What a wonderful complete metamorphous and rebirth that has been going on within PM News over the past few weeks. Dr. Block reintroduced the 1st pillar of what he started years ago with bringing to the forefront the "M" in PM News. Since Podiatry Management started many years ago, it has grown to so much more. I feel that the daily email is the circulation that keeps all of us alive with information. Seeing the management tip of the day is a refreshing highlight that has become addicting. Dr. Block, "YOU ROCK !"

Bret Ribotsky, DPM, Boca Raton, FL, Ribotsky@doctorbret.com

RE: Conflicts of Interest (Richard Boone, Esq)
From: Louis L. Levine

I am responding to an unfounded and apparently unresearched assertion made by Richard W. Boone, Sr., a healthcare attorney in Fairfax, VA, in his letter published in the May 26 issue of PM News. Mr. Boone asserts, “It has always amazed me that medical professionals can go through their entire careers without ever receiving a minute's worth of formal instruction on ethics. Podiatry is by no means alone in this, of course. Ethical training for medical students is non-existent. It is my understanding that not one of the 432 graduating podiatry students this year will have received a single minute of instruction in ethics.”

Contrary to what Mr. Boone writes, the New York College of Podiatric Medicine (NYCPM) has had a mandatory course in medical ethics and the art of doctoring for more than 15 years. This 30-hour course is taught principally by two professors: Rabbi Ephraim Sturm, who has served as chaplain at a number of New York City hospitals, and was also longtime Executive Director of the National Council of Young Israel, and Hiram Chirel, D.P.M., former Executive Director of the New York State Podiatric Medical Association. Several other professors in the Department of Community Health at NYCPM also teach segments of this medical ethics course.

The first 15-hour session of the course covers such topics as biomedical ethics and ethical theories, morality and ethics, the principles of autonomy, competence, the meaning and justification of informed consent, full disclosure, non-malfeasance, the use of limited resources, the principles of justice, veracity, privacy, confidentiality and fidelity, and relevant aspects of the philosophies of such thinkers as Hume, Mills and Bentham.

The second 15-hour session covers such topics as the economics of ethics in podiatric medical practice, third-party billing, fraud, abuse, staff responsibility and liability, the sale of practices, partnership, public corporations, HMOs’ liability, medical oaths, the Hippocratic Oath, the Geneva Convention, the Nuremberg Code, the Declaration of Helsinki, podiatric codes, the codes of podiatric medical associations, and particular ethical problems in podiatric medicine.

If Mr. Boone based the statements expressed in his letter on the highly-publicized cases of malpractice or fraudulent billing found in all areas of medicine, perhaps the only conclusion we can validly draw is that ethics can be taught, and hopefully learned, but there is no way that we at the medical schools can ensure that doctors actually behave ethically as a result.

Louis L. Levine, President & CEO
New York College of Podiatric Medicine

ASSOCIATE POSITION - WILMINGTON, DE

Busy 25-year old state-of-the-art Four-Dr. Practice, -Three offices/ Two Hospitals - PSR 24/36 preferred - Need energetic/motivated DPM proficient in EMR/Computers - Fax CV with cover letter to Brandywine Podiatry, Attn: Dr. Christopher Savage -Fax # 1-302-658-7646

X-RAY PROCESSOR FOR SALE

Konica qx-70 automatic processor in perfect working condition. Has been maintained professionally on a monthly basis. Office is going digital priced for quick sale. Must be picked up - Long Island, NY. Send inquires to soledr@aol.com

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

PART-TIME ASSOCIATE POSITION - INLAND EMPIRE, CA

Ethical hard working physician for long term care practice. Send CV with salary requirements to dtoedoc@earthlink.net

PRACTICE FOR SALE - VENTURA, CALIFORNIA

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

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