The Voice of Podiatrists

Serving Over 9,500 Podiatrists Daily

July 02, 2007 #2,976 Editor-Barry Block, DPM, JD

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Globetrotting PA Podiatrist Fights Diabetic Foot Ulcers by Changing Lifestyles

Dr. Neil Donohue was recently interviewed on Channel 5 in Belize. Here is an excerpt from the broadcast:

“All we are doing is going to create a totally positive atmosphere for people with diabetes to take responsibility for their disease. I mean I still have people at home in the U.S. that come to me and say ‘oh my diabetes is my doctor’s problem.’ Well, it’s not your doctor’s problem.” Donohue says the program involves a participatory approach in getting not only families but whole communities to change their lifestyle. Donohue says he knows it will be a challenge but all parties have agreed to be a part of the process.

“We are trying to do something very difficult. We’re trying to change people’s behavior. We’re trying to change ways people have lived all their lives. If they are overweight, we need to think about them wanting to have a healthier lifestyle.”

“We are not only educating patients with diabetes, but we are going to be engaging their whole community around their families, and their friends. Even at home, ways can be reinforced at home to begin to live a healthier lifestyle. And getting into that health center or clinic on a regular basis to have their diabetes looked after, to get their foot examination, to get proper shoes, proper insoles and proper ulcer care. So it’s an integrated process; it’s one where all we are doing is going to create a totally positive atmosphere for people with diabetes to take responsibility.”

Source: Channel5Belize.com [6/27/07]

NY Podiatrist Has Swell Advice For Potentially Serious Foot Problem

Dr. Andrew Shapiro, a Long Island-based podiatrist who is a trustee and spokesperson for the New York State Podiatric Medical Association--the largest statewide component of the American Podiatric Medical Association (APMA)--advises that swollen feet and ankles may indicate the presence of vascular disease and other problems including arthritis, infections, and nutritional deficiencies and should be examined sooner than later.

Dr. Andrew Shapiro

Vascular disease refers to problems specific to the arteries and blood vessels, he explains. “When you consider how hard the blood vessels in the lower extremities must work to pump blood back up to the heart, it’s not surprising that they experience difficulties accomplishing this amazing job,” says Shapiro.

According to Dr. Shapiro, swollen feet should be immediately evaluated by a professional to rule out the more serious possible causes. “A podiatrist will pay particular attention to the nerves and the blood vessels supplying these nerves,” he says. Unfortunately, swollen feet rarely disappear unless the cause of the problem is addressed. “That’s why it’s important to see a foot specialist as soon as the problem occurs,” Dr. Shapiro adds.

VA Podiatrist Ordered to Serve an Additional Year in Prison

Dr. Marc Blatstein, a Fredericksburg, VA podiatrist, must return to prison for an additional year as part of a new sentence handed down Tuesday in federal court in Richmond. U.S. District Court Judge Richard L. Williams told Blatstein to surrender to federal authorities by July 24 to begin another prison term. Blatstein was released from federal prison in March after serving an original sentence of one year and one day."Obviously, we're disappointed," David G. Barger, Blatstein's Fairfax attorney, said yesterday.

Dr. Marc Blatstein

Barger said Blatstein served his initial term in a federal prison and halfway house in Pensacola, Fla. He has been living in Florida since his release, Barger said. Blatstein's new sentence is the latest twist in a series of legal maneuvers that began with his conviction for mail fraud in 2006.

Blatstein pleaded guilty to operating a billing scam at his podiatry office in Central Park. He billed for a surgery center he did not have. The fraud lasted three years and resulted in overpayments by insurance companies of $272,704. In 2006, Williams sentenced Blatstein to the year-and-a-day term, despite an agreement between Barger and federal prosecutors that he would serve two years.

Source: Jim Hall, The Free-Lance Star [6/29/07]

Query: Using a Higher Concentration of Alcohol For Neuromas

I, too, do a fair number of alcohol injections with positive outcomes. I average 5 - 8 serial injections spaced 7 - 10 days based on pt tolerance. I use ultrasound guidance occasionally, not routinely. I read the post regarding the European study using 20% alcohol. I would love to use a higher concentration because I feel it would be more effective and less costly. It truly feels it is a better option for the patient prior to performing a neurectomy. My question is, is anyone using a higher concentration or would I be performing something considered "experimental."

Amy Schunemeyer-Purdy, DPM, New Iberia, LA

RE: CLARIFICATION (Addiction to Oxycontin)
From: Barry H. Block, DPM, JD

The note posted and discussed on this topic was submitted by a podiatrist whose name is being withheld to protect his identity. This individual is not any of the individuals, including Dr. Udell or others who responded to this query. This podiatrist has subsequently voluntarily entered an addiction treatment program, and wishes to express his appreciation for the large amount of support he has received.

RE: Clear Cell Sarcoma (Al Kline, DPM, Donald Jay Arenson, DPM)
From: Bryan C. Markinson, DPM

Clear cell sarcoma, sometimes refered to as melanoma of soft parts, is most correctly termed clear cell sarcoma of tendons and aponeuroses. Franz Enzinger, MD, a pathologist who did his work at the Armed Force Institute of Pathology, has the original description of this tumor to his credit, as well as fibrous hamartoma of infancy, myofibromatosis, epithelioid sarcoma, extraskeletal Ewing sarcoma, angiomatoid fibrous histiocytoma, fibroma of tendon sheath, ossifying fibromyxoid tumor, among others. These are all "Enzinger's tumors." Enzinger co-wrote the first definitive text on the pathology of soft tissue sarcomas.

This rare tumor with a poor prognosis is sometimes very dificult to differentiate from metastatic spread of skin melanoma. It requires enhanced pathologic genetic analysis to make the distinction. Therefore, many such tumors have been diagnosed as metastatic melanoma. Of course, the distinction is important from the point of view of prognostic and treatment parameters. If you do a little reasearch on this tumor, you will find no shortage of foot cases in the world-wide literature.

Thanks to Drs. Kline and Arenson for helping to raise the level of awareness and highlight caution in dealing with ALL soft tissue masses.

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

RE: Alcohol Injections for Neuromas (Marc Katz, DPM, Michael J. Schneider, DPM)
From: David Secord, DPM, Barry Mullen, DPM

I believe that the point being made by Dr. Katz is being missed here. There is no such thing as being ‘sort of dead’ or ‘sort of pregnant.’ You either are or aren’t. In the exact same vein, you either sclerosed or didn’t sclerose a tissue—nerve in this instance. If what you are doing is actually sclerosing in its application, there is no need to do any more applications—unless it isn’t sclerosing (as in 4% absolute alcohol) or is driven by profit. That, I believe, is the point being made by Dr. Katz. So, for those using the CPT 64640 code and being paid for something that isn’t sclerosing by nature—and by strength—and continue doing it because it pays well, the word greed may be applicable.

David Secord, DPM, Corpus Christi, TX, David5603@pol.net

Editor’s note: The letter from Barry Mullen, DPM appears at: http://www.podiatrym.com/letters2.cfm?id=14670&start=1

PRACTICE FOR SALE -FORT LEE, NEW JERSEY AND MANHATTAN

Nice mix of commercial insurance, Medicare, cash, routine care, surgery. Experience the NY metro life with shopping, dining, professional sports, culture at your doorstep. AMERICAN DOCTOR SALES 614-918-3000 or email us at sell_my_practice@yahoo.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

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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