July 05, 2006 #2,622 Editor-Barry Block, DPM, JD

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Middle-Aged Need to Stretch: Canadian Podiatrist

Steven D. Stark, a sports medicine-oriented podiatrist in British Columbia, and author of the new book, "The Stark Reality of Stretching," predicts dire consequences for middle-aged people if they don't do some flexibility training.

If you don't stretch at 50, he said, "you will be crippled by damage to joints and the spine. People don't shrink -- they compensate and round at the spine. It's a predictable and preventable thing.

"We didn't notice it 300 years ago; you died at 19. Now we're running around on an artificial surface your [body] is not prepared for and living until you're 80. It doesn't work so well." The problems, he said, will increase for the rest of your life.

Source: Pohla Smith, Pittsburgh Post-Gazette [6/29/06]

CMS Posts Review of Wound Management Literature

The Centers for Medicare and Medicaid Services (CMS) have recently posted
A monograph titled “Usual Care in the Management of Chronic Wounds: A Review of the Recent Literature” published by the Agency for Healthcare Research and Quality.
Included in this informative text are a :

– review of clinical practice guidelines’ recommendations
– review of surgical textbooks’ recommendations
– review of usual care in randomized controlled trials
– selected review of randomized controlled trials according to the FDA draft guidance document

You can view this document at:

http://www.cms.hhs.gov/determinationprocess/downloads/id37TA.pdf

Source: CMS [6/30/06]

Evidence-based Protocol for Diabetic Foot Ulcers

Brem H, Sheehan P, Rosenberg HJ, Schneider JS, Boulton AJ.

The following protocol was developed for patients with diabetic foot ulcers:

(1) establishment of good communication among the patient, the wound healing team, and the primary medical doctor
(2) comprehensive, protocol-driven care of the entire patient, including hemoglobin A1c, microalbuminuria, and cholesterol as well as early treatment of retinopathy, nephropathy, and cardiac disease
(3) weekly objective measurement of the wound with digital photography, planimetry, and documentation of the wound-healing process using the Wound Electronic Medical Record, if available
(4) objective evaluation of blood flow in the lower extremities (e.g., non-invasive flow studies)
(5) debridement of hyperkeratotic, infected, and nonviable tissue
(6) use of systemic antibiotics for deep infection, drainage, and cellulitis
(7) off-loading
(8) maintenance of a moist wound bed
(9) use of growth factor and/or cellular therapy if the wound is not healing after 3 weeks with this protocol
(10) consideration of the use of vacuum-assisted therapy in complex wounds.

Source: Plast Reconstr Surg. 2006 Jun;117(7 Suppl):193S-209

Don't' Miss the 9th Annual International Conference on Foot Biomechanics and Orthotic Therapy

This conference provides lectures and workshops featuring internationally renowned clinicians and researchers. The Prescription Foot Orthotic Laboratory Association (PFOLA) uses the proceeds from this meeting to provide educational grants for clinical outcomes studies using custom prescription foot orthoses. Mark your calendar! December 1–3, 2006 Chicago, IL For details, go to www.pfola.org or call Myrna at 415-928-6141

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For a list of all meetings go to: www.podiatrym.com/meetings.pdf

Query: Cryoplasty for Fasciitis, Neuromas, Etc.

I know cryoplasty for chronic plantar fasciitis and neuromas is being advertised in several publications. Can anyone give me feedback on how well it has been working and any worries of serious side-effects? What other conditions it can be used for?

Greg Mowen, DPM, Ventnor, NJ, gregmowen@comcast.net

Query: Disposal of X-Rays

I have purchased a podiatric practice that has been in existence for many years and as a result there are many old files and x-rays. What is the process for disposing of old x-rays of patients NOT seen in the past 7 years? Do the names have to be removed (cut off) from the x-rays or may they just be emptied into the usual garbage bins? Is there a HIPAA regulation that applies to x-rays over 7 years old or are they to be treated under the new HIPAA guidelines.
.
Charles F. Ross, DPM, Springfield, MA, cross12@nycap.rr.com

Editor’s comment: PM News does not provide legal advice. The HIPAA start date was April 14, 2003, so records created before that date do not fall under HIPAA. The important regulations to consider are those governing your state (Massachusetts). Readers should always remember that HIPAA sets the minimum requirements, while state statutes, if stricter, almost always apply.

Records should never be disposed in garbage bins. They should be shredded. You can either purchase a high volume shredder or bring in a commercial company to do this for you.

RE: CRPS (Peter Riznyk, DPM)
From: Howard A. Stone, DPM

If you have even the slightest suspicion that a patient has CRPS, an immediate referral to an anesthesiologist who specializes in chronic pain should always be your first treatment option. A sympathetic block will give a definitive diagnosis as well as begin to reverse the malfunction within the sympathetic nervous system. The key signs to watch for are a cold extremity, burning pain, sweating, and edema.

Other modalities can be added with a sympathetic block including Neurontin/Lyrica and anti-depression medications. The pain specialist should be the primary physician making the decisions regarding these difficult cases.

Howard A. Stone, DPM, Glenview, IL, justus313@comcast.net

RE: Residency Program Funding (H. David Gottlieb, DPM)
From: Barry Mullen, DPM

Dr. Gottlieb's disturbing residency revelation represents another ominous sign why merely "physician" designation, in name only, is meaningless without gaining true, liquid equality and entitlement amongst our "medical" peers. Our graduating podiatric medical students must have the ability to further their education through residency training. That not only impacts the ability of our profession to fight the fight in gaining long-term "medical equality," it is critical to the long-term financial survival of our profession and its practitioners.

Each podiatric "veteran" should harbor a certain sense of moral and professional obligation to ensure that this occurs. Even if you don't view the issue this way, let's talk turkey then. Ladies and gentlemen...project what your own practice equity will be worth at retirement if the number of qualified podiatrists remaining in your profession diminishes through residency attrition. Add the impact of slowly deteriorating financial trends affecting podiatry as a result of the existent economic reality of medical inequality previously raised and you'll arrive at a disturbing conclusion...that podiatric medicine won't stand a chance of remaining an attractive professional option for graduating college students if the trend(s) is allowed to continue. Will you be able to sell your practice in 10, 15, 20 years? If so, what will its true net worth become if these trends continue?

The signs are here. APMA needs to reflect on these issues, take a good "medical history," make a differential diagnosis pertinent to the chief complaints brought forth by many of your distinguished colleagues, and come up with an effective treatment plan...NOW! The impetus must come from our APMA leadership. Some very prominent colleagues, who are in the trenches every day, have stepped forth and laid out some of the issues currently impacting podiatry...Future financial implications and projections can't remain favorable under current circumstances.

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

RE: MD/DO Degree
From: Multiple Respondents

What I am now reading regarding our designation change from D.P.M. is the same as when we fought to change our degree from D.S.C.. Fortunately, those of us who fought for the change, won the battle.

Times have changed, medicine has changed, our practitioners and graduates MUST have parity with the doctor of medicine or doctor of osteopathy. I have been writing this for years. Thanks to my friends Drs. Barry Block and Tilden Sokoloff, we will continue the fight until organized podiatric medicine realizes that we deserve to be doctors of medicine!

Earl L. Cherniak, D.P.M., D.Sc.(Hon)
Editor, The Hospital and Healthcare Podiatrist
Los Angeles, CA, mailto:drearlcherniak@aol.com

Editor’s note: This topic is now temporarily closed.

PRACTICE FOR SALE - CENTRAL FLORIDA

Well established surgical podiatry practice for sale. Located in a state-of-the art out patient surgical center.Grossed $1,038,000 in 2005. Low down payment. Price negotiable. Contact Camille Todd/Transworld 321 217-3625 or camille@tworld.com

ASSOCIATE POSITION- NEW ENGLAND

Terrific Opportunity Now Available in growing New England practice. Well established and respected practice with new, large office space, latest technology, very helpful staff, loyal patients and solid referral base. Close proximity to hospitals with modern surgical suites. Opportunity for shared ownership. Prefer 24 month PSR with clinical practice experience or an experienced doctor looking to improve their situation. E-mail CV and particulars to NEAFC3@aol.com

PRACTICE FOR SALE - WALLA WALLA, WASHINGTON

32 year old established podiatry practice for sale immediately. 2 treatment rooms, 1 surgical suite, x-ray room, sterilization equipment, and private office area. Located at busy intersection, only 2 blocks from major hospital. $50,000 or Best Offer. Please call 509-525-2863 or email darcycharlesDPM@charter.net , if you are interested.

EQUIPMENT FOR SALE - ESWT - BEST OFFER CONSIDERED NOW!!!!

If you are using or thinking of using ESWT, I have a new machine that has only been used twice. There is no Orbasone in the country priced like this one. Will provide training and installation. Take a look at http://www.orbasone.com Call 1-856-229-2939.

RESIDENCY POSITION – VIRGINIA

One Year Foot and Ankle/Rearfoot Surgical Fellowship with excellent salary/benefits available July 1, 2006. If you are finishing a PSR-24 and don't have a job yet, this is an excellent way to learn additional surgical and business skills. Please fax resume to 703-491-9994.

PRACTICE FOR SALE - NEW JERSEY

Well established practice with modern equipment for sale. Two main offices and two satellite offices included. One podiatrist has been able to make very comfortable living, but also great for two docs looking to start up. Willing to transition over 1 year. This is a great opportunity! contact DOCCAPO@YAHOO.COM

ASSOCIATE POSITION - PITTSBURGH, PA AREA

Excellent opportunity for a hard working, surgically trained podiatrist to join a well-established, high volume, multi/location practice in the suburbs of Pittsburgh. Must be willing to perform all aspects of podiatry. Incentive-based salary, compensation package, with potential for partnership. Must presently have Pennsylvania license. Would like to fill position asap. Fax resume to 412-831-2115.

ASSOCIATE POSITION- KANSAS CITY, MO

Excellent opportunity for a hard working, ethical podiatrist to join a vibrant, successful and growing podiatric medical and surgical practice. Dedicated, supportive staff with strong marketing and medical knowledge. Must be board eligible/certified. PSR/24. Partnership opportunity. Competitive salary, bonus structure, benefits. Wonderful place to raise a family. Fax CV to 816-455-8901.

PRACTICE FOR SALE - CENTRAL FLORIDA

Well established surgical podiatry practice for sale. Located in a state-of-the art out patient surgical center.Grossed $1,038,000 in 2005. Low down payment. Price negotiable. Contact Camille Todd/Transworld 321 217-3625 or camille@tworld.com

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