The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

July 09, 2012 #4,509 Publisher-Barry Block, DPM, JD

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MS/TN Podiatrist Discusses Dangers of Pedicures

Podiatrist Dr. Carla Martin of Desoto Foot Care and Pedi-Spa, says that she has treated patients after problem pedicures. “The thing is, with those you can get down so far that you can’t tell the difference between the good skin and the bad skin, and that’s when the problem comes in if they go too deep.”

Dr. Carla Martin

That’s when you run the risk of infection, but Dr. Martin says the same potential exists from unsterilized tools, foot baths, and basins. She recently opened a nail salon that’s attached to her practice, mainly marketed to patients. Dr. Martin says they use hospital-grade cleaning solutions and devices. “Everything here is autoclaved, which 100% kills everything.”

Source: Zaneta Lowe, WREG-TV [7/5/12]

Proper Footwear Can Help Prevent Knee Pain: IL Podiatrist

Choosing footwear involves more than picking the right color and size, according to everydayhealth.com. Why? Because footwear can affect knee health. To minimize knee pain, shop for footwear with the following tips in mind. Look for well-cushioned footwear. This will help prevent shock to the knees. Check the sole.

Dr. Elizabeth Kurtz

Firm midsoles help reduce overpronation, a type of gait common in people with low arches. “Overpronation causes the lower leg and knee to rotate inward each time the foot hits the ground,” says Elizabeth Kurtz, DPM, a podiatrist in Chicago and spokesperson for the American Podiatric Medical Association. This inward rotation can cause knee strain and pain. (If your old shoes have excessive wear on the inner sides or if the heels tilt inward, this is a sign that you overpronate.)

Source: The Daily Ardmoreite [7/5/12]

Chinese Orthopedic Surgeon Visits MD Podiatrist to Learn Subtalar Arthroeresis Procedure

(L-R) Drs. Jian Zhong Zhang and Burton Katzen

Orthopedic surgeon Jian Zhong Zhang, MD, clinical professor and director of the Foot and Ankle Center in Beijing, China, recently visited Maryland podiatrist Dr. Burton Katzen to observe and learn the technique of the subtalar arthroeresis procedure, a method to correct flexible flatfoot deformity.

MA Governor Backs Easing of Industry Gift Ban

Massachusetts Gov. Deval Patrick said in a letter this week that he will support amendments to the state's law banning drug and medical-device companies from giving gifts to healthcare providers. Legislation banning gifts to providers was passed in 2008. The Massachusetts Public Health Council later issued related regulations in March 2009.

The changes would allow manufacturers to pay for “modest meals and refreshments” during educational presentations for healthcare providers. In the July 3 letter to two national leaders of the American Medical Student Association's “PharmFree” campaign, Patrick said companies will now be required to make quarterly reports detailing presentations where meals and refreshments were served, and the total cost for manufacturers.

Source: Jaimy Lee, Modern Healthcare [7/6/12]

Assert Yourself

Make people take your requests seriously by eliminating these weak, apologetic phrases from your vocabulary:

• “I know you’re busy …”
• “I don’t know if you’ll consider …”
• “I don’t know if this is possible …”
• “I hate to do this …”
• “I don’t know if there’s room for this in the budget …”
• “I’m sorry if the timing is bad …”

Source: Adapted from “How Not to Ask,” Mika Brzezinski, Stepcase Lifehack via Communication Briefings

Query: Hypersensitivity Reaction to Kenalog

My patient, A 67 y/o healthy male c/o sub IPJ pain of his hallux, had an unusual hypersensitivity reaction to a local injection of Kenalog.  After not responding to rest, padding, accommodative orthotics, I injected .25 cc of Kenalog 40, sub IPJ. Initially, there was modest improvement, but two months later, his complaints grew to severe sensitivity to the area, making all footgear difficult to wear, except for Crocs.  Ambulation is now limited. He has had consults with neurology and vascular, both rendering all normal findings. The only abnormal finding is a slight case of telangiectasia at the sight of injection. I recently started him on a topical compounded cream for neuralgia, but it is too soon to evaluate. Any insights would be appreciated.
 
Rob Tyrrell, DPM,  Cherry Hill, NJ

RE: Amazing Charts (Gary A. Lieber, DPM)
From: Joshua Kaye, DPM

I have been using Amazing Charts since the last quarter of 2011. As is the case with any EMR software, it has limitations, but the cost and annual support is one of the lowest in the industry. It has a feature called the “Meaningful Use Wizard” that allows you to monitor your charting in a manner to achieve meaningful use (MU).

I qualified for MU within four months of using the software and received the first year incentive funds from Medicare six weeks later. Their Guardian Angel support allows fast “chat” access or, if I need more detailed help, I set up an appointment with them, and we speak on the phone and connect to my computer via...

Editor's note: Dr. Kaye's extended-length letter can be read here.

RE: Nurse Practitioners Modernization Act ?(Robert Bijak, DPM)
From: Bret Ribotsky, DPM

Between the nurse practitioners and the dental therapists working independently – it should be crystal clear to all physicians that the future of first-level care in this country is going to be provided by “non-doctors.” If DPMs were given an MD overnight, this problem would not change; internal medicine and family practitioners are facing this problem head on.

It’s time for real strategic thinking for our personal survival, and that of our profession to start now. As ACOs and large hospital practices become “at-risk” and capitated, many of the tasks that most DPMs currently perform will be assigned to less compensated providers. Physical therapists have take a great interest in biomechanics and the off-loading wound care patients. Wound care nurses, and even medical assistants are doing palliative foot care. The mandate for outstanding healthcare is gone, and is not rewarded when it is provided. Evidence-based medicine is all you hear, along with cost-containment. BUZZZZZZZZ! The alarm is going off. Action is needed.

Please join me for a 90-minute lecture on Sunday morning at the APMA National, as together we work through many of the obstacles and critical thinking needed to chart our success into the future of our healthcare system. Then attend the Greenbrier Coding and Practice Management Workshop in nearby West Virginia. Success is possible with a well-structured plan for the next 5 years.

Bret Ribotsky, DPM, Boca Raton, FL, ribotsky@gmail.com

RE: Different Pulses for Different Nurses
From: Paul Busman, DPM, RN

Last month, my wife had the first of two total knee replacement surgeries. After 3 days in the hospital, she was sent to a local rehab center for further physical therapy and O.T. On her second night there, she had an older nurse sent by a temp agency. The nurse started to take my wife's vital signs by putting a pulse oximeter on one finger. She then proceeded to take a radial pulse.

My wife, who is a nurse practitioner and is very familiar with such things asked her why she was doing that. "Oh, I'm taking your pulse, dear." My wife pointed to the pulse rate prominently displayed on the pulse oximeter machine and the nurse replied, "Oh no, that's your HEART rate!"

Paul Busman, DPM, RN, Clifton Park, NY

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