The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

July 11, 2011 #4,203 Publisher-Barry Block, DPM, JD

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Type-111 Collagen Heals Diabetic Wounds Faster: MN Podiatrist

Charcot foot is a condition where bones are weakened, collapsed, and then split through the skin. Mayo Clinic Doctor Steven Kavros says if a wound won't heal, amputation can be the next step. Now, by using one of the purest forms of collagen, he's seeing faster healing. "Type-111 collagen is a special type of collagen that heals very quickly." It's present in human fetuses but disappears after birth. This new material, called primatrix, is made from fetal cow tissue.

Dr. Steven Kavros

"This Primatrix is front-loaded with type-111 collagen, so it can stimulate not only wound healing, but wound healing in an organized fashion," said Kavros. It's activated in saline, then placed on the wound. Blood vessels integrate into it. It dissolves into the skin. "What we are finding is that the wounds healed exponentially faster compared with the standard of care."

Source: WCTV-6 [07/09/2011]

Minimalist Shoes Not for Everyone: MD Podiatrist

Last week, the U.S. Army sent out a memo with this order: Effective immediately, only those shoes that accommodate all five toes in one compartment are authorized to be worn. But are minimalist shoes actually bad for all people when they run, walk, or do other sports? According to Dr. James Christina, Director of Scientific Affairs for the APMA, "It's not something that's going to be good for everybody. There's going to be certain people who will do very well with the minimalist-type shoe who don't need a lot of support for their foot and will find it very comfortable." 

Dr. James Christina

"The interesting thing is you don't see a lot of competitive runners running either barefoot or in a minimalist shoe," says Christina.

Source: Michele Norris, NPR [7/6/11]

PICA Sponsors Plenary Program at APMA National

Larry Van Horn, Associate Professor of Economics and Management and Executive Director of Health Affairs at Vanderbilt University's Owen Graduate School of Management, where he oversees the Health Care MBA and Master of Management in Health Care programs, will be speaking at 9 am on Saturday, July 30, on the subject of healthcare reform and its effects on the podiatric profession. 

Larry Van Horn

Dr. Van Horn has spoken on the topic twice this year, at both The Midwest and The Western, but has kept the presentation fresh as the issue changes almost daily. APMA members who are PICA policyholders get an additional 5% risk management credit if they attend this PICA risk management program.

Query: Silastic Implant Complication

I performed a total joint replacement with silastic neutral stems in the 1st MPJ, left foot on a 69 year old well-controlled diabetic female patient in March 2011. Post-op recovery was uneventful until after six weeks when she suddenly developed intractable pain at the site of surgery. An MRI with contrast to rule out abscess or osteomyelitis showed no abscess. X-rays were unremarkable and showed very good implant position.

She was then referred for PT and dispensed a TENS unit for continuous home care. At 12 weeks, she still had pain, although it reduced a bit. X-rays then showed remarkable erosion in the 1st metatarsal and the implant was displaced. She has no symptoms of infection. Is this a case of diabetic osteolysis? If so, what would you recommend next? Is fusion with bone graft and plate a viable option? 

Name Withheld, Los Angeles, CA

RE: NaHCO3 with Local Anesthetic (Ivar Roth, DPM, MPH)
From: Jerry Falke, DPM

There have been numerous studies regarding buffering lidocaine, and all have consistently concluded a substantial decrease in burning at the injection site (i.e., greater than 50% improvement in tolerability).  We did that for many years in our practice, mixing 10% NaHCO3 0.9% solution with lidocaine; i.e., remove 1 cc of lidocaine from a 10 cc. bottle and replace it with 1 cc. of 0.9% bicarb. 
 
Lidocaine requires an acid medium for stable shelf-life, and it is that acidity that is thought to be the cause of injection discomfort. So be keenly aware that this will shorten the shelf-life of your mixture. Statistically, the lidocaine will retain approximately 90% strength at 2 weeks, if kept refrigerated, compared to about 60% in one week stored at room temperature. 
 
We mixed our syringes in the morning and rarely used the ‘left-overs’ even the following day, mainly because we were uncertain of the shelf-life at that time. Google “buffering lidocaine” for some of the aforementioned studies.
 
Caution: This will NOT work with Carbocaine, as it will precipitate from solution almost immediately.
 
Jerry Falke, DPM, retired, Hagerstown, MD, falkeg@hotmail.com

RE: Heparin-Induced Thrombocytopenia
From: Larry Kollenberg, DPM

I appreciate Dr. Udell’s comments regarding heparin-induced thrombocytopenia (HIT). The literature reports the incidence of HIT as 0.5to 5%. Thrombocytopenia is actually reported with many medications. The real comment or question involves what risks are there for the medical treatment of our patients on a day-to-day basis? In the case of immobilization, what are the risks of DVT? Consider the risk of that patient. Isn't it a standard of patient care to prevent complications? What do the guidelines recommend? What is the step-by-step evaluation that every patient with immobilization should undergo? UFH and LMWH are just two of the pieces to that puzzle. As a physician, you should be aware of the benefits and risks of all forms of treatment that you prescribe.

Larry Kollenberg, DPM Pharm D, Baltimore, MD, lkollenberg@hotmail.com

RE: Credit Card Processing for Physicians (Ronald Werter, DPM)
From: Pam Hoffman, DPM
 
There is a difference in credit card processing for doctors. Retriever, who I use for credit cards in my office, is very big with dentists. Your dentist probably uses them. My dentist gave me their number. I was being charged by another credit card company (North American) $20/ month for being HIPAA non-compliant. Retriever costs less and is compliant for us doctors who take credit cards. It is different if you are not a store.
 
Disclosure: I have no invested interest with this company.
 
Pam Hoffman, DPM, Katonah, NY, katonahpodiatry@yahoo.com

RE: How Would Your Life be Different if You Had an MD Degree?
From: Jon Purdy, DPM

I don’t think the operative question pertaining to a degree change is about personal accomplishment and honoring of letters. In my mind, the degree change would accomplish three main goals. The first would be to end our struggle for unlimited scope of practice. The second would be to free our small podiatric community from the financial burdens of fighting our personal and global medical battles on “the Hill.” The third would be to free up the individual practitioner from having to jump through the hoops of hospital confusion as to what we are, where we fit in, and what we can and cannot do within the medical community.

In the grand scheme of things, the change would be a significant undertaking, but if we wanted to achieve this goal, we could. I believe the biggest problem is fighting the “powers” in podiatry that see their financial interests and status threatened. One of the side-effects from this change of degree would be more peace in the daily administrative practice of podiatry. Although born out of ignorance, the community more readily accepts doctors who have an MD behind their names.

Jon Purdy, DPM, New Iberia, LA, Podiatrist@mindspring.com

RE: Source for Dehydrated Alcohol (Olga Luespchen, DPM)
From: Carl Ganio, DPM

My compounding pharmacist usually mixes my 5% ethyl alcohol solution in a multi-dose vial, so I have consistent concentration and it is mixed under a hood. He has also had trouble getting the ampules, due to quality control problems at the source. The ampules may have been recalled, and who knows when they will be available again. I did locate ethyl alcohol through Lee Pharmacy, Inc. in Fort Smith, AR. 1-800-209-9940. They will send it to you, not in an ampule, but as a multidose vial. I took this to my compounding pharmacist, who again under the hood, mixed it to my desired concentration in a multidose vial.

Unfortunately, Lee Pharmacy can only provide the straight ethyl alcohol, (they could compound it for you... but they would have to submit samples to the FDA and apply for a new NDC number, and that process is time- consuming and costly.) So, order the ethyl alcohol from them, and have your friendly local compounding pharmacist mix it for you.

Disclaimer: I have no financial interest in Lee Pharmacy.

Carl Ganio, DPM, Vero Beach, FL, drcarlganio@veropodiatry.biz
 

RE: Repair of Spring Ligament CPT Code(Howard Zlotoff, DPM)
From: Amol Saxena, DPM
 
I have had situations where the spring ligament is torn as an isolated injury and long-term from posterior tibial dysfunction. The correct CPT is 28555, as anchors are typically placed to imbricate the ligament and T-N capsule. I am not certain that this is typically perfomed with various posterior tibial tendon/FDL transfers, so if the repair was performed as above, I believe you should code and bill as noted. This would be analogous to repairing the deltoid ligament and coding as needed with certain posterior tibial dysfunction situations.
 
Amol Saxena, DPM, Palo Alto, CA, heysax@aol.com

RE: OCPM Students Have First-Ever Orthotics Rotation
From: Jeanne M. Arnold, DPM

Perhaps it is the first-ever outside orthotics rotation. When I was attending OCPM (1979-1983), we rotated through the in-house orthotics lab where we learned how to make orthotics from scratch. I remember taking negative casts, making the positives with all the intrinsic corrections, and then manufacturing the prescribed orthotics from rubber butter or rohadur. It was a very valuable experience, and I would be dissappointed to find that it is not still part of the boimechanics curriculum at OCPM. I've found over the years that when it comes to biomechanics, hands-on experience is the best teacher. 

Jeanne M. Arnold, DPM, Coeur d'Alene, ID, jarnolddpm3@frontier.com

PRACTICE FOR SALE - MISSOURI

Well established, but still growing. Grossed over $300,000 last year. Located in a thriving medical community. Good payer mix. All aspects of podiatry needed in the area. Do not let this opportunity to own your own practice pass you by. Contact footdoc2002@yahoo.com for more information.

I have a class four pain laser for sale. Used for plantar fasciitis, Achilles tendonitis, neuroma, arthritic conditions and even fungus toe nails This laser is portable, re-chargable and can be move from room to room or office to office. This isn't the cold laser that you see. It is a 10 watt laser. We have used this laser on NFL sports players. For those that understand a good laser. E-mail David Zuckerman, DPM for Details and pricing. footcare@comcast.net 

ASSOCIATE OPPORTUNITY – SOUTHERN NEW JERSEY

Searching for the “perfect” associate for our busy and rapidly growing practice; EMR, ultrasound, vascular studies, and DME. We have advanced surgical and admitting privileging at multiple teaching hospitals. You must bring strong medical and surgical skills to a practice that is sincere about teaching you success in private practice. Hardworking and personable doctors only! Partnership track. If we sound like your “perfect” practice, email CV, letter of recommendation, personal introduction of yourself, why you are passionate about podiatry (like us) and want to live in Southern New Jersey to doctor@sjfootdrs.com

ASSOCIATE POSITION - NEW YORK CITY & QUEENS

High Income Potential. One of the fastest growing podiatry practices in New York City and Queens seeks a hard-working podiatrist who participates with HealthFirst, Fidelis, Metroplus, and other Medicaid plans. Preferably a Spanish-speaking podiatrist. Contact me at Podocare@aol.com

ASSOCIATE POSITION - SAN DIEGO

Well-established practice is seeking an associate with the opportunity for a future partnership position. Great location and medical environment. Must have a California license and an interest in the full range of podiatric services. Please email resume and cover letter to ethuen@hotmail.com

ASSOCIATE POSITION – NEW YORK
 
Busy, well-established for 35 years, multi-site practice in upstate New York looking for licensed podiatrist who is ready for a thriving practice. Must be highly motivated, personable and great with patients. Competitive salary and benefit package. Send CV or letter of interest to associateinfoot@yahoo.com

ASSOCIATE POSITION - TEXAS

San Antonio, Texas. Prefer an experienced practitioner in all phases of podiatry; will consider PSR36 trained resident, with good people skills. This opportunity will lead to full partnership for the right person. Good starting salary and benefits in modern office in Northeast Medical Center. Fax CV to 210-495-6484 or email footcenter1@sbcglobal.net

ASSOCIATE POSITIONS - NW INDIANA

2 Full-Time positions open - One for Northwest Indiana. Must have 2-year surgical residency. Must be motivated and a self-starter. State License required. If interested email: f-massuda@footexperts.com

ASSOCIATE POSITION/PART TIME - ORANGE COUNTY CALIFORNIA

Experienced podiatrist - 2-3 days/week, two office locations in beautiful south Orange County California. Exceptional opportunity for seasoned semi-retired practitioner. Fax or e-mail Resume and LOI to 949-488-0868/ Info@feetfixer.com.

ASSOCIATE POSITION – IOWA CITY AREA

Modern practice seeking a well-trained (PSR 24/36) associate. Excellent opportunity for an energetic, hardworking individual with strong surgical and medical skills. Solid referral network and 13 years of growth. Come live in the Iowa City area and enjoy the quality of life and stability of a Big Ten University community. Competitive salary and benefit package available. If interested, fax CV to 319-354-1014 or e-mail to dave@341foot.com

ASSOCIATE POSITION - CENTRAL NEW JERSEY

Seeking associate for busy, growing practice located in Toms River, Ocean County. Looking for PSR 24/36, board eligible doctor. Basic podiatry a must. Practice has a up-to-date EMR and practice management program. Digital x-rays, ultrasound, laser, vascular studies. Excellent opportunity for highly motivated and ethical DPM. Send CV to toesec@aol.com

ASSOCIATE POSITION - NORTHWEST FLORIDA BEACHES

Excellent opportunity for an energetic, compassionate, hardworking individual with superior surgical and medical proficiency. Recent graduate or experienced practitioner. Excellent salary, benefits and partner-buy in offered, full admit privileges and surgical scope. Fax CV to Ecpodiatry@aol.com

SPACE AVAILABLE- NYC & LI

Office to sublet and share - East 60th Manhattan, and Plainview Long Island. access to an MRI, Joint Commission certified operating rooms, digital x-ray, diagnostic ultrasound, and access to a multi-specialty ambulatory surgical center. Also availability E 22nd between 2nd and 3rd and E 70th off 3rd. Turn-key operation - no investment needed 516 476-1815 PODO2345@AOL.COM

TURN-KEY PODIATRIC OFFICE - CALIFORNIA

Fully equipped modern suite with built-ins at Mission Regional Medical Center, Mission Viejo CA. Four treatment rooms, New Midmark chairs, x-ray/processor, phone system & much more. $45,000/assume lease. Call Jackie, 949-493-8020.

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