The Voice of Podiatrists

Serving Over 9,500 Podiatrists Daily

June 29, 2007 #2,974 Editor-Barry Block, DPM, JD

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DE Podiatrist Provides Advice on Fitness Walking

As a podiatrist, Dr. Scott Newcomb knows feet. And he knows the importance of a good walking shoe on the foot. If you're getting into a walking program, Newcomb said, be sure to buy a new pair of walking shoes. They don't have to be fancy, but they should accommodate your foot. He estimates the average fitness walker can spend between $60 and $80 on a good walking shoe.

Dr. Scott Newcomb

Newcomb said people with flat feet should look for a stable, supportive shoe. Those with a high arch should seek out a cushioned shoe to protect their foot from the impact of movement. If your feet have a tendency to swell when you walk, try to get shoes made from a mesh fabric instead of leather, Newcomb suggests. It should go without saying that the shoes need to have enough room in the toes and be comfortable when you wear them. Running shoes also work for walking, Newcomb said, though you wouldn't want to go running in walking shoes.

Walking should be an enjoyable workout, said Newcomb, who also serves as president of the Delaware Podiatric Medical Association. "It really shouldn't hurt while you're doing it or afterward." But that isn't to say that you may not feel the effects of your new walking routine. Newcomb said overuse injuries like plantar fasciitis -- tendinitis is another one -- are more common in people with foot alignment problems.

Source: Kelly Bothum, The News Journal [6/26/07]

PA Podiatrist Charged With Prescription Drug Abuse

A Luzerne County (PA) doctor was charged Tuesday with fraudulently obtaining large quantities of high-powered prescription pain medication for personal use, the state attorney general's office said. Dr. Lawrence Kansky, a podiatrist with offices in Mountain Top and Hazleton, is accused of ordering more than 2,000 tablets of Hydrocodone during a six-month period of 2006.

Dr. Lawrence Kansky

Kansky had become the number six purchaser of Hydrocodone in the state, according to the attorney general's office. "It is extremely disappointing to see another medical professional charged with prescription drug abuse," said Attorney General Tom Corbett. "These cases are becoming more common and it is unfortunate that individuals such as Dr. Kansky would risk their entire career for a temporary high."

Kansky, 50, of Mountain Top, was arraigned Tuesday by Magisterial District Judge Ronald Swank in Wright Township. He was ordered to surrender his Drug Enforcement Agency registration license, and released on his own recognizance.

Source: Bob Kalinowski, Citizens Voice - Wilkes-Barre, PA [06/26/2007]

Proposals to Require Disclosure of Pharm Payments to Doctors Advance

As states begin to require that drug companies disclose their payments to doctors for lectures and other services, a pattern has emerged: psychiatrists earn more money from drug makers than doctors in any other specialty.

How this money may be influencing psychiatrists and other doctors has become one of the most contentious issues in healthcare. For instance, the more psychiatrists have earned from drug makers, the more they have prescribed a new class of powerful medicines known as atypical antipsychotics to children, for whom the drugs are especially risky and mostly unapproved.

Today, the Senate Special Committee on Aging, which is led by Senator Herb Kohl, Democrat of Wisconsin, will hold the first of a series of hearings on the issue, which could lead to legislative proposals to restrict and require disclosure of payments and gifts to doctors from drug companies nationwide. Several lawmakers on Capitol Hill have expressed interest in such legislation, including Senator Charles E. Grassley, Republican of Iowa. “A federal law requiring public disclosure of payments to doctors could be very effective if it was carefully monitored and consistently applied,” Mr. Grassley said.

Source: Gardiner Harris, New York Times [6/27/07]

Query: Case of Clear Cell Sarcoma of the Foot

A patient recently presented to our office with what appeared to be a benign tumor of the heel, possibly a lipomatous mass. To my surprise, and the patient, it was a clear cell sarcoma or malignant melanoma of soft parts. I know that these tumors are rare (about 1% of all melanomas).

Clear Cell Sarcoma of the Foot

Does anyone else have experience with this tumor in their practice, and if so, what has been the overall outcome?

Al Kline, DPM, Corpus Christi, TX

RE: Metal Insoles ( Kel Sherkin, DPM)
From: Jeffrey Kass, DPM, William Roman, DPM

I use the ones manufactured by Dr. Jills (DrJillsFootPads@aol.com) . They come in forefoot plates or full length. The actual plate I believe to be thinner than 2 mm. , but I use it for the purpose you describe and am happy with it.

Jeffrey Kass, DPM, Forest Hills, NY, Jeffckass@aol.com

You may want to try WRYMARK in St. Louis MO. They have carbon fiber plates that can replace your metal ones. The phone # for WRYMARK is (800)969-3668

William Roman, DPM, Valparaiso, IN, footdoc76@yahoo.com

RE: Alcohol Injections for Neuromas (Paul Kesselman, DPM)
From: Marc Katz, DPM

I've done plenty of alcohol injections and after the results and reading the literature I believe we are headed for another showdown. There are big issues with our current practice of using 4% alcohol. When you discuss this with pain management specialists, you see that this is not considered therapeutic.

I believe that podiatry has fallen prey to the get rich quick 200 dollar/2 minute injection. In Tampa there is a physician that will give 20+ injections! Say bye-bye to that trick. We as a profession have once again ruined it for all by abusing this treatment. That's why Medicare and all other insurances are hot on our tails. We all know that when you do neurolysis, a treatment should kill the nerve. Stop this every 10 day injection scheme for the Medicare global. If a "therapeutic" injection is given there may need to be a repeat months later not 10 days.

A well-known pain specialist in my community is using alcohol concentrations closer to 100% using a nerve stimulator to get exact nerve placement. For some, ultrasound guidance is a good guide. However, for others once again, it is a modality just to make money and ride the system once again. I talked with a colleague and he said, "this is great every patient gets ultrasound." He could be looking at a gall bladder image and find an intermetatarsal ligament?!

That same pain specialist is writing the LCD for neurolysis injections. This 10-day deal is gone and the 4% will likely go as well. Or they will just cut our fees to 50 dollars. Bottom line: Podiatry is a great profession. So let’s keep it honest and do what's right, not what pads our pockets.

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

RE: Topaz Coding Question (David Sands, DPM)
From: Wes Daniel, DPM, Ira Weiner, DPM)

One of the doctors using our ASC performs a lot of surgeries using Topaz. The ASC uses CPT-2008 for plantar fasciosis surgery. The Topaz company puts the base unit in the ASC at no charge and we pay them for the wands used. For billing we simply add an additional fee to the above code to recoup the cost of the wand. Most insurance carriers have been allowing this slightly "inflated" surgical fee without question. This approach keep us from having to use the "junk" CPT code which virtually always raises questions causing us to spend time and energy to explain.

Wes Daniel, DPM, Gainesville, GA, wdan-gpma@mindspring.com

I have been using the ArthroCare Topaz unit for some time now. There is truly no specific code for it, I do however use the appropriate repair code for whatever tendon I am repairing using the Topaz as an adjunctive unit and not billing separately. I think Dr. Sands will find the ambulatory surgical center he mentioned to be reluctant to purchase the unit since the disposable hand pieces run several hundred dollars each.

Ira Weiner, DPM, Las Vegas, NV, vegasfootdoc2005@yahoo.com

RE: Addiction to Oxycontin (Elliot Udell, DPM)
From: Name Withheld

Editor’s. Note: The author serves on the disciplinary committee of his state’s licensing board. This note can be read at: http://www.podiatrym.com/letters2.cfm?id=14650&start=1

PRACTICE FOR SALE - RIVERSIDE, CA

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Practice grossing over 250K/yr three days/wk. room to expand, large physician referral, good mix of sx., wound care, DME's, routine care. no rest homes. Medicare cert. surgery center on site. Will consider associate-to-purchase. may carry paper. Consider all offers. Office and sx. center also for sale. e-mail tentoes001@hotmail.com or call 951 7804782.

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ASSOCIATE POSITION FLORIDA - NORTHEAST REGION

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Busy, well established, full scope podiatry practice seeking highly motivated, hard-working, reliable, responsible and especially likeable to the average human, Associate. Surgical training a plus. Prefer PSR 24+. This is an Associate position with lots of potential. Team players only. Email CV to: healthparkmgr@bellsouth.net or fax CV to: 904-826-1586, Attn: Amy

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POSITION AVAILABLE - SOUTHEAST TENNESSEE/ NORTH GEORGIA

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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 – OHIO – SOUTHEASTERN

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Reputable, thriving, well-rounded practice available with EMR. Grossing over $320K over the last 3 years. Priced to sell at 150K. Owner relocating. Email inquiries and CV to podsx@yahoo.com

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WANTED: BIOMECHANICS CONSULTANT

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West Houston Medical and Kingwood Medical Centers are seeking a biomechanics consultant to help develop competency based curriculum/assessment forms, provide workshops, and lecture to their residents. The individual must be Board Certified by the ABPOPPM, be a Fellow of the American College of Foot and Ankle Orthopedics and Medicine, and must be able to come for quarterly visits to Houston, Texas. Interested candidates should fax a C-V and consulting fees to Dr. Samuel Mendicino, Residency Director, West Houston and Kingwood Medical Centers. 281-589-1618.

ASSOCIATE POSITION – SOUTHEAST MICHIGAN

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Seeking quality-oriented, patient-focused, RPR-trained associate for a fast-paced, established group practice This is a secure, long-term position. Emphasis on diabetic foot and wound care. Gain surgical experience while earning an excellent living. Partnership possibility. If you are highly motivated, ethical, and have good communication and clinical skills, forward CV to: fax (734) 466-8501 or email mbell6@msn.com

EQUIPMENT FOR SALE - WASH. DC

Name your reasonable price and pay shipping- Body chairs, X-Cell X-rays, Konica developer, SmartDop20, viewboxes, lakesidecart, Endoscopic unit with all attachments, topical hyperbaric O2 units, castle autoclave, xerox copier, fax machines, etc. call 202-841-5545 or email to JHALLUX@yahoo.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

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