The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

June 25, 2009 #3,580 Publisher-Barry Block, DPM, JD

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NJ Podiatrist Discusses Bare Foot Injuries

Dr. Charles Birk, a podiatrist associated with Cape Regional Medical Center in Cape May Court House, sees about 450 cases of bare feet injuries a year. The vast majority of them happen during the summer. The most obvious bare foot injuries are cuts and bruises related to seashells, bits of glass, and any other small, sharp objects on the beach. It's bad enough suffering a cut, but if the wound is big enough to let sand in, that can make the pain even worse.

While a cut foot can be painful, usually the worst result is a couple of stitches and a few days out of the water. But the real risk group is people with diabetes."If diabetics cut the foot, they're going to be more challenged by the infection," Birk said. Birk said most people are fine if they remove any pieces of anything that's damaged their foot and cleanse and bandage the wound as soon as possible. If it doesn't stop bleeding after about 10 minutes with pressure applied, it may be time for a visit to the emergency room.

Source: Ben Leach, The Press of Atlantic City [6/22/09]

PA Podiatrist Supports Medicare Independence at Home Act

The Independence at Home Act, an amendment to the Social Security Act, was introduced to Congress last month. The bill “would seek to provide certain high cost Medicare beneficiaries suffering from multiple chronic conditions with access to coordinated, primary care medical services in lower cost treatment settings, such as their residences.”

Dr. John Koschak (Photo S. John Wilkin)

Dr. John Koschak is a podiatrist from Kingston who agrees with the premise of this bill. Koschak built his practice on house calls for his patients. Sixty to seventy percent of his patients are seen in their own homes, because they cannot travel easily or do not have transportation.

The majority of his patients are elderly, suffering from infections, poor circulation and diabetes. Many of them have multiple health issues. “Some people will wait for a relative to drive them to a hospital, it might take days. With house calls, I can see a patient and head off an expensive emergency room visit and possible hospital stay, especially in the case of patients with diabetes,” he says. Koschak estimates that it would cost several hundred dollars to treat a patient with a foot wound in their own home, as opposed to $5,000-$10,000 a day for a hospital stay.

Source: Eileen Cipriani, Times Leader [6/23/09]

Check Out Bunions While Buying Onions

Sainsbury's Heaton Park store in Manchester has introduced the footcare service - the first of its kind in the country. Shoppers can add corn treatment and toenail cutting to their weekly grocery list, with prices starting at £18 ($30). "An NHS referral to see a podiatrist can take up to a year," says the store's podiatrist, Catherine Dean.

Podiatrist Catherine Dean

"By using our service, you can see one in a week. For those who work full-time, it's particularly helpful as we're open on Saturdays until 8pm." Michael O'Neill, spokesman for the Society of Chiropodists and Podiatrists, welcomes the move. "Due to increased awareness of foot-related health issues, such as diabetes, demand for podiatrists has never been greater," he says. "The NHS is often unable to keep up and appointments are scarce."

"By seeing a podiatrist as soon as you want one, you could prevent more serious health problems," adds Dean. Sainsbury's will initially provide two clinics a week. If the podiatry service proves successful, it's likely it will be rolled out, along with other healthcare services, to other stores.

Source: Angela Epstein, Daily Mail [6/20/09]

Patients Often Not Told About Abnormal Test Results

People who visit their primary care physician for routine blood tests or screenings are often not informed of the results, a new study finds.

The failure of doctors and medical facilities to follow-up and give people test results is "relatively common," the researchers wrote, even when the results are abnormal and potentially troublesome, and affects one of every 14 tests.

The study found that in 135 cases -- of 1,889 abnormal test results -- either the person was not informed of the test results or the facility had not documented having communicated with the patient about the results. The upshot: more than a 7 percent failure rate in communicating abnormal test results.

Source: Alan Mozes, HealthDay News [6/22/09]

Query: Drop Foot

I just had a 25 year old white male present to my office with the chief complaint of a "numb and sort of swollen" left foot. He went out drinking Saturday night (he has a history of drinking a little too much) and when he woke up Sunday, he couldn't walk on his left foot. He does not recall any trauma. When I touched the left great toe, he said his entire foot tingled. On gait analysis, he has a drop foot on the left. He cannot dorsiflex the left foot at the ankle joint at all. The young man has no insurance.

1. What do you think has caused this drop foot? 2. What would you do to treat this condition (remember, he has no insurance coverage)?

Richard Hofacker, DPM, Akron, OH

Query: Time Clock/ Management Software

I am interested in simple time clock software that can be loaded on a laptop to keep track of hourly employees. By simple, I mean time in-time out; it does not have to have links to payroll companies or print sophisticated reports. If anyone knows of any companies that can provide inexpensive software for small business (3 employees), please advise.

Stuart W Kushel, DPM, Princeton, NJ

RE: Neuropathy From Chemotherapy (Jim Benedict, DPM)
From: Multiple Respondents

I don't think that there is a one-fits-all answer for this. It depends on what the chemotherapy agent was. I have neuropathy from exposure to platinum, and find that glutamine works the best. It's been used for prevention, but still helps me for severe flare-ups. Papers on this are inconclusive. Lyrica helps also but is not FDA-approved for this use either. Most of the papers on glutamine refer to large doses, but I find much lower dosages helpful when needed.
 
Gregory B. Nellis, DPM, Gloversville, NY, gbndpm@yahoo.com

The problem with adding on Lyrica and Cymbalta to a patient that is already taking Neurontin and Zoloft  is that you are adding two medications which are very similar to the ones the patient is already taking.  What you may want to do is talk to the PCP about gradually increasing the Neurontin. Some of my patients are on as much as 3000 mgs. a day in divided  doses of every four to six hours. In any case, when you want to add on a medication to a patient in a facility (or for that matter any patient who is taking a great deal of medications), it is wise to apprise the primary care physician of what you are doing. That way, there is one doctor who is aware of the patient’s entire medical history. If every specialist has carte blanche to change a patient's medications, the patient would not be getting good medical care.
 
A problem with adding on Cymbalta, which is in the same class of antidepressants as Zoloft, is that this class of drugs is metabolized by the liver, and giving too much can be hepatotoxic. Lastly, these pharmaceuticals are really only effective in controlling the pain associated with neuropathy, and will have very little value in controlling numbness.  
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

I have had excellent results for chemo-induced neuropathy with Metanx. 
 
Jeffrey Kass, DPM Forest Hills, NY, jeffckass@aol.com

RE: Wound Care and Nursing Home (Ashley A. Keren, DPM)
From: Larry Cohen, DPM, Michael M. Rosenblatt, DPM

I believe that you are what you do. I agree totally with Dr. Simmons. When I was offered to consult at a 600 plus patient care center, I told them I would be happy to come in on a case-by-case basis to see patients, but not to cut toe nails on everyone. They declined my offer. They will find someone else to do the work, and I hate to say this, likely not bill the patient, but fraudulently bill Medicare for non-covered services.  The facility will never defend you if this is the case, but likely would never have hired you if you didn't bill Medicare.

Larry Cohen, DPM, Clinton, NJ,  larrydpm2002@yahoo.com

Ashley A. Keren, DPM, wrote that when he was first hired to a nursing home, he was instructed by the NH not to treat any ulcers or wounds, and to only cut nails. Apparently, another provider was hired to do this. Recently, this has been amended and the new requirement is to have a direct consult to treat an ulcer/infection or "leave it alone." Or maybe it means that even that is under question.

This presents serious professional liability questions. The podiatrist is responsible for treating patients within the scope of the license. For example, say a patient (who is a diabetic and has an ulcer) develops a serious infection, sustains an amputation and expires. At some point, the plaintiff's attorney might be hired by the family to '"review" the chart. Some nursing home patients are surprisingly agile and responsive. The family may believe that the patient was not treated properly.   This could present severe problems to the treating podiatrist. Suppose the wound-care nurse never showed up? Suppose the treatment administered by the nurse was substandard or even incompetent? What then?

This could also involve the podiatric professional practice board at some point. No nursing home is worth subjecting yourself to unreasonable practice restrictions that have unpredictable, far-reaching consequences. I would respectfully suggest that Dr. Keren bring in some of the letters of response that have been  published on this topic, and request the NH administrator read them. It's time for a little "basic" instruction...

Michael M. Rosenblatt, DPM, San Jose, CA, Rosey1@prodigy.net

RE: Another Shoe From Hell

This shoe does not have the APMA Seal of Approval.

Source: Submitted by Martin Taubman, DPM

ASSOCIATE POSITION – MARYLAND

Maryland Eastern Shore Practice has opening for associate with ownership interest. MCR approved ASC, EMR, Ultrasound, Flouro, with Hospital Privileges available. E-mail CV to: patimmons@comcast.net  

NEEDED CHICAGO -- NW IND & BALTIMORE/WASHINGTON, DC PODIATRISTS 

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

CASE CONSULTING

Dennis Shavelson, DPM is accepting referrals of difficult cases involving biomechanics, surgical complications, non-healing wounds, pigmented & derm lesions, PRP and diagnostic dilemma’s from DPM’S. Full reporting with second opinion only and rapid return after care options. Medicare and Out-of-Network Only. (212) 288-3668 or drsha@lifestylepodiatry.com

ASSOCIATE POSITION AVAILABLE-MIDTOWN MANHATTAN 
 
Looking for Full-time associate to work in well established practices in midtown Manhattan and Forest Hills. Immediate opening for PSR 24-36 surgically trained Podiatrist. Great opportunity with competitive salary along with malpractice benefits. Position includes Saturday office hours. Please send CV to slurie@papapc.net

PRACTICE FOR SALE – NEW YORK CITY

NY Manhattan, prime location. Upper East Side, 23. Y.O. practice, high visibility-traffic area next to post office, street level, All phases of Podiatry, NO surgery, retiring due to disability. call 516-759-4062 or Paulfxfeet@aol.com

PRACTICE FOR SALE - FLORIDA—CENTRAL/SOUTH

Turn-key operation grossing $570,000 annually based on one full-time doctor. Great opportunity for growing the top-line. Surgery is only 14% of the professional man-hours; it can significantly increase income. Medicare makes up 64% of revenues. Seller will assist with transition. Call 863-688-1725, ask for Chas.

SALES REPRESENTATIVES WANTED

SureFit has immediate openings for three sales representatives – one for Midwest, Mid-Atlantic and Southeast territories. Responsibilities include but are not limited to obtaining new business, executing sales strategy, initiating contact with customers, identifying their needs and selling appropriate products to meet those needs. Ideal candidate will be enthusiastic, highly motivated individual with a positive attitude who prefers a team environment. Minimum requirements include Bachelor’s degree, 3+ yrs sales experience, preferably in Podiatry and/or O&P Industries. Position requires up to 70% travel with residency in each territory. Please e-mail resume and references to: James R. Grady, Director of Sales SureFit jgrady@surefitlab.com

PRACTICE FOR SALE - WASHINGTON STATE: BELLINGHAM 

With Medicare-Approved ASC, located by hospital and in medical community. Seller will consider financing. This is an exceptional value. Bellingham is rated in national magazines as one of the most desirable places to live or retire. 386 597-5766 or 260 402-7490. 

OFFICE SPACE/ MRI RENTAL – NYC, LI   
 
Turn-key space available, daily, monthly; East 60th off Park Ave, East 22nd St. off 3rd Ave, Hicksville and/or Plainview Long Island. JACHO-certified operating rooms available, as well as all surgical equipment and anesthesia. Extremity MRI Rental. Stark compliant. All exams read by board certified radiologist. Call for details. 516 476-1815

ASSOCIATE POSITION - CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for a full-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to f-massuda@footexperts.com

EQUIPMENT FOR SALE

Amfit Orthotic Making System. Includes new computer, recently updated digitizer, and orthotic mill, and $2,500.00 in supplies (which would generate about $20,000.00 in orthotics). skip the middleman. Cost $35,000.00. Asking $23,000.00 OBO AMERICAN FOOT CLINIC 405-733-2783 OR 405-820-6887 americanfoot@email.com 

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Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 11,500 DPM's. Write to  bblock@podiatrym.com or call (718) 897-9700 for details. THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451 Ext 110.

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