The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

June 29, 2009 #3,583 Publisher-Barry Block, DPM, JD

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TUSPM Podiatrist Discusses Fungal Infections

Dry, itchy feet likely mean you have a fungal skin infection (a.k.a. athlete's foot). Yellow, thick toenails indicate the fungus has invaded your nails.

Dr. Tracey Vlahovic

How you get them: Heavy winter socks and rain boots create a dark, humid environment, which facilitates fungal growth. You can also pick up the fungus at the gym or during a salon pedicure if the instruments or footbath weren't sterilized properly, says Tracey Vlahovic, D.P.M., a podiatrist at Temple University in Philadelphia.

How to get rid of them: Once a fungal infection spreads to the nails, it's much more difficult to get rid of, so start treatment right away. Vlahovic recommends using an OTC antifungal cream such as Lamisil. If you have a nail infection, see your podiatrist, who will likely prescribe an oral version of Lamisil. But know that it can take up to a year before your toenails look normal again. In the meantime, nail polish can safely mask the condition.

Source: Redbook

DC Podiatrist Supports Public Healthcare Option

After playing nice for months, insurance companies, healthcare providers, and pharmaceuticals are suiting up for battle. Dr. Steven Pribut, a Washington podiatrist, was on the elliptical at the gym when he heard former Republican speaker Newt Gingrich on one of the cable networks denounce a public option. Pribut says he poked around on the Internet to learn more about Gingrich's expertise on the topic. He discovered that Gingrich was the founder of a health-reform organization that has as its members more than 20 large corporations, including GlaxoSmithKline and UnitedHealthcare. Pribut was moved to post an item on his blog, suggesting that those making pronouncements should disclose their conflicts. (In the spirit of disclosure, I should say here that I get orthotics from Dr. Pribut.)

Dr. Stephen Pribut

Pribut supports a public option as a way to set a minimal standard and put pressure on the insurance industry to conform to that standard without deception. Right now, competition too often means looking for ways to exclude people. Pribut calls insurers "holding companies—they hold patients' money and withhold payments they should be making." But he's not calling for their elimination; he thinks there's much they can do to make their services more attractive and add value for many people.

Source: Eleanor Clift, Newsweek [6/26/09]
 

U.S. Senators Closer to $1 Trillion Healthcare Bill

U.S. senators on Thursday moved closer to agreement on a $1 trillion U.S. healthcare overhaul that would extend medical coverage to nearly everyone. Senate Finance Committee Chairman Max Baucus and other panel members said that reducing the cost was a significant step toward getting a final package that could gain at least some Republican support.

Baucus said panel members have narrowed talks to options that bring the price tag to about $1 trillion over 10 years, down from an earlier estimate of $1.6 trillion. "We have options that would enable us to write a $1 trillion bill, fully paid for," Baucus told reporters after a closed-door meeting with panel members. "We're getting a lot closer to an agreement," Baucus said.

Source: Donna Smith, Reuters [6/25/09]

The Importance of Properly Answering the Phones

In the course of our busy days, we sometimes forget it is the small details in our practice that make all of the difference. A great example of this is the way your front office answers the phones. It is in that moment that the patient, or prospective patient, on the other end of the phone makes a decision on whether or not they are comfortable with your practice. Success for this “impact moment” depends on your preparation, observation and correction. Prepare your front office by having the verbiage for answering the phones written and placed in the office manual. 

In addition, explain to your entire team the importance of answering the phones correctly and how it can positively or negatively affect the practice. Observe your front office periodically to make sure the phones are being answered correctly and the tone is always positive.  To obtain some outside feedback, have a “mystery shopper” call into the practice to schedule a mock appointment.

Chad Schwarz, Practice Administrator, Howell, NJ. For information on the American Academy of Podiatric Practice Administration click here.

Query: Peeling Skin

This is an active 15 year old whose feet peel on a regular basis. She denies itching or excessive sweating. She is involved in competitive cheerleading. 

Peeling Skin, Not responsive to Anti-fungals

Her parents have tried anti-fungal creams with no relief. Any input would be appreciated.
 
Patrick J. Nunan, DPM, West Chester, OH

Query: Viewing F-Scans on an Apple PC

I am curious if anyone is running F-Scan on an Apple computer, either using boot camp, parallels or VM ware? What I am trying to figure out before I purchase an Apple is if I can view my F-scan recordings. I’m not as interested in if the cuffs will be functional. I will use my PC to do the recordings, then download the files onto the new Apple computer, which I can take home to view the F-scan movies.
 
Ayne Furman, DPM, Alexandria, VA

RE: Melanoma in Situ (Bret Ribotsky, DPM)
From: Multiple Respondents

The most appropriate biopsy for any pigmented lesion that is very suspicious (more than just subtle) for melanoma is complete excision if small enough. I believe Dr. Ribotsky's example fits the bill for very suspicious. If too large to accomplish primary closure, then incisional or punch biopsy is best. If the diagnosis is ultimately melanoma in situ, then if completely excised with just clear margins, you are done. If you have done a punch or incisional biopsy, you will then have to completely excise the remainder of the lesion, and make certain that no part of the remaining lesion is invasive. If not, then no further surgery is required.

If after the complete excision, the pathology indicates invasion, then another excision of the surgical site with one centimeter margins for each millimeter of depth should suffice. This is why very suspicious lesions should be excised if possible on the first surgery. For subtle lesions, shave excisions are popular, but regardless of the method you chose, you must make sure that all tissue submitted after the "complete excision" has been examined for invasion.

Bryan C. Markinson, DPM, NY, NY, Bryan.Markinson@mountsinai.org

Great job with the biopsy and diagnosis. But now it is time to punt this case to a surgical oncologist/dermatologist specializing in melanoma treatment. 

Robert P. Thiele, DPM, Denville, NJ, drthiele@comcast.net

I would refer to a Mohs trained dermatologist to remove this. They will look at every cut surface and perform a frozen section to make sure there are clean margins and the tumor is completely excised.

Robert Bondi, DPM, Kansas City, MO, Robert.Bondi@foot-docs.com 

RE: Neuropathy From Chemotherapy (Jim Benedict, DPM)
From: Jack Ressler, DPM, Steven H. Goldstein, DPM

I have been prescribing Metanx for about three years and have had some good results. If you prescribe it to a patient and they feel it isn't working (minimum of one month), have them discontinue taking them. In several circumstances, the patients will call the office and will want to be put back on it. What they realize is that they were getting some relief and when they stopped the Rx, the symptoms returned. I find the renewal rate for these patients is high. The beauty of Metanx is that it can be taken with most medication, with the exception of people taking medication for Parkinson's disease.
 
Jack Ressler, DPM, Lauderhill, FL, RedWingCrzy@aol.com

This is a subject that is near and dear to my heart as my own mother has severe neuropathy from undergoing chemotherapy for colon cancer. She was given oxoleplaten which has a high incidence of producing neuropathy. Although her oncologist told her it would dissipate with time, it has actually gotten much worse over the past 4 years to the point of becoming disabling. The symptoms were confirmed by EMG and NCV studies. That being said, we have tried everything possible, from drugs to different therapies, without much success. The point to take away here is that one should use whatever is offered to try to reduce the symptoms as quickly as possible. She had many side-effects from Cymbalta, Neurontin, and Lyrica. We tried Metanx, High potency B complex vitamins, alphalipoic acid, all with very little help. I am puzzled as to why her neuropathy has gotten progressively worse. I always tell her not to give up as we will find something to help.
 
Steven H. Goldstein, DPM, Royal Palm Beach, FL, stevefootdr1@yahoo.com

RE: Answering Service (Anas Khoury, DPM)
From: Martin V. Sloan, DPM, Neil A Burrell, DPM

I've used answering services in the past and found them to be inefficient and unnecessarily expensive. Most physicians in my community, me included, have answering machines that say "you have reached the office of Dr. ________. If this is a medical emergency, please proceed to the nearest hospital emergency room immediately." ER physicians and support staff are well-trained in treating emergency conditions. If they need me, they know how to reach me.

Martin V. Sloan, DPM, Abilene, TX, mvs321@suddenlink.net

We use an answering service that does an excellent job. They screen calls such as appoints and pain meds refills. Most doctors in our area do not refill pain meds when the office is closed. This is stated in our welcome to our office brochure. If the floor at the hospital or ER needs us, they go through our answering service. We are proud of our "costumer service" and a big part of that is having a live person to talk to when a patient has a problem, 24/7. It is well worth the $250.00 a month. 

Neil A Burrell, DPM, Beaumont, TX, nburrell@gt.rr.com

RE: Time Clock/ Management Software (Stuart W Kushel, DPM)
From: Micheal Schey, DPM, Patrick J Evoy, DPM

We have been using Count Me In, LLC software with biometric punch in/out for over 5 years.  It has been a great time-saver, an excellent employee management tool, and has provided documentation for employee disputes. Fingerprint punch in/out has removed all concerns of “buddy punchs”, and there is no dispute about the "time." It also provides protection for employees by providing proof of their attendance. The support of the company with updates has been outstanding. We have 5 offices and could not have made a better investment.

Micheal Schey, DPM, Warren, MI, mscheydpm@aol.com

We like the SB100 from icontime.com purchased from Costco a few years ago.

Patrick J Evoy, DPM, Bend, OR , pat@cascadefoot.com
 

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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

Who wants to continue making good money in a down economy, and who would like to live in Florida on the coast? I have been working for over 45 years and have had enough. My business grosses over $940,000 dollars a year and my net is over $250,000. I see approximately 40 patients a day in a coastal Florida town and am sitting on a little gem. Office is 2000 sq. ft. Hospital very close with surgical center. Large scope of practice in Florida. Contact me if you are ready to step up. $585,000 dollars. Contact me at: hagen5644@yahoo.com

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

PRACTICE FOR SALE - ALABAMA, GULF COAST

Established 26 year old practice. Owner desires to sell and relocate. Operated 25 hours per week. Mixture of surgery and general podiatry. MD referrals. Surgery center and hospitals in close proximity. Highly profitable. Priced to sell.  Will lease office to buyer. Call Mike Crosby at 888-776-2430 or email mcrosby@providerresources.com

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

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