The Voice of Podiatrists

Serving Over 9,500 Podiatrists Daily

June 13, 2007 #2,960 Editor-Barry Block, DPM, JD

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CA Podiatrist Killed in Motorcycle Accident

A 67-year-old South Bay podiatrist died Sunday after losing control of his motorcycle when he swerved to avoid a quail and collided with a telephone pole on Bailey Road in South San Jose, according to San Jose Police spokesman Enrique Garcia.

Aaron Ditlow, of San Jose, was pronounced dead at the scene, according to the Santa Clara County coroner's office. On a morning ride with his adult son, Ditlow was traveling westbound on Bailey Avenue when he attempted to avoid a quail, Garcia said. "It's just sad," Garcia said. "It was a father and son going out for a nice weekend bike ride."

Bianca Allen, a secretary at Ditlow's private practice in Sunnyvale, said the doctor was "just a delight to have around. His personality was very outgoing, very uplifting and he always made everyone smile. He was very giving, and very loving. Just a wonderful person."

Source: Mark Gomez, Mercury News [6/12/07]

Podiatry "Front and Center" at Society for Vascular Surgery Meeting

Feet, and the circulation that keeps them going, were front and center at this year’s Society for Vascular Surgery (SVS) symposium in Baltimore, MD. With that, came the significant input of podiatry. For only the second time, podiatrists participated in a dedicated symposium on the lower extremity.

Dr. Nicholas Bevilacqua

Dr. Warren Joseph, editor of the Journal of the American Podiatric Medical Association, and Dr. Nicholas Bevilacqua, outgoing Fellow in Scholl’s Center for Lower Extremity Ambulatory Research (CLEAR) at Rosalind Franklin University of Medicine and Science, joined such luminaries as Harvard Vascular Surgeon Frank Pomposelli, Georgetown Plastic Surgeon Christopher Attinger, University of Arizona Vascular Surgeon Joseph Mills, and Boston University Vascular Surgeon Gary Gibbons, along with session chair George Andros of Los Angeles.

“I think that what Drs. Joseph and Armstrong did in the first such session was groundbreaking," said Dr. Bevilacqua. "Now it is simply expected that we participate.” The meeting, attended by vascular surgeons from around the world, was chaired by SVS president C. Craig Kent, MD.

NY Podiatrists Offer Foot Safety Tips For Boaters

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Three Long Island podiatrists—Captain (Dr.) Frank Spinosa, Dr. Robin Ross, and Dr. Vito Rizzo--avid boaters who are prominent members of the New York Podiatric Medical Association—have volunteered their time to create some tips that will keep your feet topside and ship shape this summer.

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Dr. Frank Spinosa

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According to Dr. Spinosa, “the bad news is that feet are particularly sensitive to sunburns and sun damage and can become a hotbed for skin cancer. That’s why boaters should beware of going barefoot.”

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Dr. Robin Ross

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Dr. Robin Ross cautions that not just any shoe will do when you’re on board. “This is not the place for high heels and spaghetti straps that cut into the foot,” she says. “You’ll want to take those off, and that’s when the trouble begins.” Dr. Ross advises that “stylish-looking shoes like flip flops may have slippery soles and don’t provide enough protection from the sun. “Even boat moccasins may not provide enough support to keep the foot upright on the water this summer,” she says.

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Dr. Vito Rizzo

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Dr. Vito Rizzo maintains that his medical services are often called for on board his own boat and on others as well. He says foot injuries happen on slippery boat decks, in rocky water or on glass-infested shores. They can range from broken toes and lacerations (cuts) to foot and ankle sprains, sun burn and sometimes even heel and arch pain from shoes with no support.

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Source: The Boating Channel www.boatingchannel.com

Query: ESWT for Posterior Tibial Tendinitis
From: Marc Goldberg, DPM

I have heard of many of us doing ESWT for Achilles tendinitis and some for neuromas, but has anyone tried it for posterior tibial tendinitis. Many conservative therapies have been tried for two years (2 MRI's show inflammation only) with no relief, and the patient does not want surgery.

Marc Goldberg, DPM, Olney, MD

Query: Wound Care Product Reimbursement

I attended a seminar on wound VAC, and had a discussion with a doc who runs a wound care center. He informed me that most wound care centers are affiliated with hospitals, and thus are able to be reimbursed for the products they use and dispense for wound care, as the hospital is paid line by line. Conversely, individual practitioners are paid for E/M codes, debridement codes, etc, but most of the materials they use and/or dispense are costs that are absorbed and not reimbursed.

Several articles have come out regarding the care of wounds. Of all the gamet of wound care products available (silver products, alginates, hydrocolloids, cleansing agents, debriding agents, etc), what products are able to be billed, and which of these codes is actually getting paid? Example, I have read several articles mentioning the use of Dermacyn Solution (http://www.dermacynus.com/), a cleansing agent for wounds, yet no payer I've encountered covers this particular solution. Is there something I'm missing?

Steven Block, DPM, Owensboro, KY

Response: Wound care products may be reimbursed under Medicare from your regional DMERC. Jurisdiction B, AdminiStar (www.administar.com), covers Kentucky. This is where you would send your DMERC claims. The carrier who writes the coverage policies for DMERC A and B is Tricenturion (www.tricenturion.com).

All the surgical dressings you noted under specific circumstances may be covered when dispensed by a physician to a patient for self-home use. Wound care cleansing solutions, however, are not covered, nor would gauze be covered if used to cleanse a wound.

I would urge you to carefully review Tricenturion's Local Carrier Decision (LCD)for surgical dressings. This may be found on Tricenturion's website.

Third party non-Medicare, Medicaid or Medicare Advantage plans all have different coverage policies for surgical dressings. I would urge you to contact them for more specific coverage/reimbursement policies.

Previous issues of Podiatry Management (June/July 2005,2006) as well as the current issue provide articles which review surgical dressing reimbursement.

Paul Kesselman, DPM, Woodside, NY

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RE: Alec Levin, DPM

There was a recent notice in the APMA News of the death of Dr. Alec Levin of Washington DC. We have lost so much of our history. Dr. Levin was a member of the APMA's Executive Committee that became the APMA Board of Trustees. His contributions to podiatric medicine were significant. He helped the Profession gain much through Congressional activity during the 1950's and early 1960's. He was a force in helping the profession gain US Army Direct Commission status. We all owe much to his dedication and quite manner. Dr. Levin was one of the individuals what helped change the Association to the American Podiatry Association in 1957. We owe much to Dr. Levin's knowledge, integrity, and continuing support for the Profession. Dr. Levin was a true gentlemen of the old school.

Arthur E. Helfand, DPM, Narberth, PA

RE: Treatment for Intra-epidermal Pustular Dermatitis (John Chisholm, DPM)
From: J. Ressler, DPM, Barry Mullen, DPM

I have had some very good success using Temovate ointment or cream. The patient is instructed to apply it BID for two weeks. The ointment seems to be a little more effective.

J. Ressler, DPM, Lauderhill, FL, RedWingCrzy@aol.com

I believe what was depicted on the slide, in conjunction with the path report findings and history of failed topical antifungals and corticosteroids, is a classic example of what we called pustular psoriasis in podiatry school. I recommend reviewing the patient's chief complaint history to learn exactly which corticosteriods were previously used. There are excellent references for this disorder in Andrew's Skin Disorders. Also, check to see if any other form of autoimmune disease concurrently exists in this patient. Was an HLA-B 27 done?

Generally, severe cases of psoriasis, like pustular psoriasis, like this case, with its significant erythematous base, indicative of acute inflammatory skin disease, need very high potency topical steroid creams (to dry the lesions and reduce the skin inflammation). If all topical steroids fail, some forms of psoriasis respond to a combination of coal tar and UV light (Goekerman) which is an old but effective treatment combination. In the most recalcitrant cases, often, one needs to resort to the use of systemic mytotic inhibitors, such as Methotrexate. Since this is a rather high risk medication with potentially extremely nasty side effects, like aplastic anemia, someone well experienced with this medication and its side-effects should assume the patient's care. Dermatologists and rheumatologists (because of their general experience consistently treating autoimmune disorders and Methotrexate usage for various other rheumatic diseases) would be my first consulting choices.

Barry Mullen, DPM, Hackettstown, NJ, YAZY630@aol.com

ASSOCIATE POSITION - MIAMI BEACH, FL

Seeking well trained PMS 36 / PSR 24+ for Full-Time associate position. Leading to partnership for the person. practice is 50% hospital based. Must have strong Sx skills, including Limb Salvage & Trauma. Competitive Salary & benefits Package. Fax 305-652-6672 or Call 305-785-2559 Email: doctorsole@aol.com

ASSOCIATE POSITION – SOUTHEAST MICHIGAN

Very busy home care and office practice looking for associate/s for full time position. offering great benefit packages, very competitive salaries. excellent opportunity for right individual PM&S 24/36 preferred. partnership possibility significant for right person. please call 248-303-3736 or fax CV to (248)996-1023 poda1@aol.com

PRACTICE FOR SALE - CENTRAL FLORIDA

Practice, all phases, including wound care and hyperbaric, with excellent building and location in central Florida, in 21st fastest growing county in U.S. Outstanding place to live and work; low penetration by managed care. Excellent exposure, and parking at 2000 sq. ft building near hospital and on busy highway. Great price and opportunity to grow large practice. windnwave@earthlink.net

ASSOCIATE POSITION SANTA FE, NEW MEXICO

We are looking for a highly trained, personable, ethical, and caring podiatrist, to work in a two doctor, three office practice, of thirty years. Send CV to sfpodiatry@ aol.com

PRACTICE FOR SALE: SAN DIEGO, CA (LAJOLLA) PRICE REDUCED!

Gross $289K in '06. Asking $120K. Possible finance. 5 y/o practice, affluent community with excellent schools. Selling due to age and health. Wish to consummate sale by summer's end. www.SDFootDoctor.com DrRDWorley@yahoo.com for stats and other info.

PRACTICE FOR SALE - NORTHERN CALIFORNIA

This podiatric practice is located near downtown Berkeley. The practice has been established in Berkeley for 15 years and focuses mainly on biomechanics and conservative care, but would do well with a practitioner who wants to expand the surgical component. The terms of the transition are negotiable. Serious offers only inquiry at : foot4sale@sbcglobal.net

ASSOCIATE WANTED – NYC

Associate wanted for established growing practice with offices in Queens and Manhattan. Applicant should be 2-3 year trained, ABPS certified/ qualified. All aspects of podiatry from necessary routine care to reconstructive rearfoot surgery. Unique opportunity to work with a 40+ physician primary care practice affiliated w/ NYU. Growth/ partnership potential, benefits. Please send CV to METROFOOTAPPS@aol.com

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PGY-2 POSITION AVAILABLE - ILLINOIS

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PGY-2 position available in a large PM&S-36 for an applicant who has successfully completed: -PGY-1 type program including all the basic core rotations RPR/ PPMR/ PSR-12/ PSR-24 -Passed the national Boards 1-2-3 -Must be hard working and personable -Must attain Illinois license. Please contact drzappa@zappafootclinic.com phone 312-243-3769.

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ASSOCIATE WANTED – NEW YORK IMMEDIATE OPENING

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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

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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

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PRACTICE FOR SALE----NEW YORK, ORANGE COUNTY

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Busy part-time practice for sale. Easily expandable to full time. Contact carol924@aol.com

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OFFICE TO SHARE AND RENT PLAINVIEW LONG ISLAND (SOUTH OYSTER BAY RD.)

3 treatment rooms, JACHO certified operating room, MRI extremity unit and x ray equipment on premises, turn-key operation -no investment- call 516- 4761815 or email podo2345@aol.com

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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

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