The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

July 12, 2010 #3,907 Publisher-Barry Block, DPM, JD

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Diabetic Patient Credits OH Podiatrist for Saving Her Foot

In January, Linda Fernatt looked at her foot and discovered it had changed color. She was horrified to think that she might lose her foot. "I believe great medical care and divine intervention saved my foot." Imaging studies revealed two small wires embedded in Fernatt’s heel. She had not felt the pain due to a lack of sensation in her foot (neuropathy), a common problem for patients with type-2 diabetes. Tina Demou, DPM, a podiatrist and medical director at the Community Health Partners Wound Center, removed the wires and prescribed outpatient visits to the Community Health Partners Wound Center.

Dr. Tina Demou

"I thank God for taking me to the right place and for sending me Dr. Demou and the kind staff at the Wound Center. While this was a difficult wound to treat, it was their diligence and attention to detail that helped me keep my foot. I cannot say enough about the quality of care and the genuine love I felt at the Wound Center."

Source: The Morning Journal [7/8/10}

Quality Shoes Should be Part of Back-to-School Supply List: APMA President

"Notebooks, pens, and new clothes aren't the only fresh supplies children need when heading back to school. Quality shoes that provide the support growing feet need are among the most important purchases on any back-to-school shopping list," says Dr. Kathleen Stone, president of the American Podiatric Medical Association (APMA).

Dr. Kathleen Stone

"Healthy feet and comfortable shoes play important roles in children's overall health," Stone says. "Parents should monitor their children's foot health and seek the advice of a podiatrist if they notice a problem. Podiatrists are specially trained to diagnose and treat ailments of the foot and ankles in people of all ages."

Source: ARA [7/8/10]

FL Podiatrist is Chapter Author for New McGlamry Text

Hilaree Milliron, DPM is a contributing author for the upcoming 4th Edition of McGlamry’s Comprehensive Textbook of Foot and Ankle Surgery.  Milliron is in the third year of a residency program at the University of Florida and Shands Jacksonville Medical Center.

Dr. Hilaree Milliron

The chapter is entitled "Surgical Management of Bone Tumors." This landmark textbook, (as the three previous editions) is being produced by the Podiatry Institute and published by Lippincott Williams and Wilkins. The expected release date for this textbook in early 2011.

FL Podiatrist Survives 1st Cut on Big Brother

On the first night of the CBS reality series, Big Brother, Dr. Andrew Gordon, a Miami Beach podiatrist lied to houseguests, telling them that he’s a day trader who lost his job and currently works as a shoe salesman. A clever plan for the single father, who has already declared that he will not ease up on his faith for his game and will continue to observe Shabbat in the house.

Dr. Andrew Godron dressed as a Hot Dog on Big Brother

Andrew watched passively (in a hot dog costume, no less) as a houseguest slipped off a zip line hot dog into a pit of gravel, injuring her foot. Andrew could have earned brownie points for even acting concerned, but thought it best to play it cool so that the other contestants wouldn’t learn his occupational secret. Dr. Gordon volunteered to be the mascot, thus earning him an exemption from house eviction. But is Dr. Gordon actually a sabateur? Tune in Sunday night to find out.

Julie Miller, Movieline [7/9/10]

Query: Bath or Shower for Diabetics?

My wife (who has been a labor and delivery nurse for 30 years) and I were having a "heated discussion" last night about diabetic foot care. Her position was that diabetics should be advised to take sitting baths rather than standing showers because common sense tells us that one’s feet are easier to take care of in the sitting position vs. standing in the shower. My point was that it didn't matter as long as a diabetic had a habitual "time" to perform needed routine care.

I found an article which says that hot tubs can lower glucose (Diabetes Health, Aug, 2008). Of course, there are all of the concerns about water temp and neuropathy - but I found that to be the case with both baths and showers. I could not find a hard recommendation regarding baths vs. showers for diabetics. Is there any research that shows higher or lower complication rates for diabetics who take showers vs. baths?
 
Tip Sullivan, DPM, Jackson, MS

RE: Endochondroma (James W. Clark, DPM)
From: Multiple Respondents

It appears you actually have an "osteochondroma", not an enchondroma. Osteochondromas are quite common at the distal phalanx of toes, and surgical excision is not complicated with the exception that it is a child who likely will require sedation, vs. straight local if this were an adult. The most concerning potential complication specific to this condition is 1) recurrence and 2) post-op nail dystophy.
 
I see lots of children, and this benign bone tumor is common in children, I have had the opportunity to excise many of these. I have had only one recurrence (which by the way was within 8 weeks of doing the surgery) On the re-do surgery, I removed the distal 1/2 of the distal phalanx, where as I usually remove only the cartilagenous cap with a very small rongeur or fine bone cutter, and then saucerize the bone where the growth comes from. Usually a distal "fish mouth" incision can spare removing the toenail, however, depending on the location (this is actually a metaphyseal growth), the nail sometimes requires removal for exposure.
 
Keith Gurnick, DPM, Los Angeles, CA, keithgrnk@aol.com

We had a similar case off the hallucal distal phalanx in a 14 y.o. girl -- it had a cartilage cap which appeared as if a proximal phalanx head was growing out of it. We rongeured it, and took more bone after intra-op imaging to ensure that we had all abnormal parts, and then used cautery at the base of the bone tumor.  We then flapped the skin into the nail, as ours was directly subungual and required distal medial nail trimming for access.

Roody Samimi, DPM, Sacramento, CA, roody.samimi@gmail.com

The actual diagnosis would be an osteochondroma. Dr. Clark is correct in that these lesions do have a high recurrence rate, especially in an actively growing child. Treatment is straight-forward in exposure through a distal fishmouth approach, with care to prevent damage to the nail bed, as well as preservation of the attachment of the long flexor at this level. It may be necessary to isolate and reattach this structure. Less common would be damage to the epiphysis, and is easily avoided while employing atraumatic technique.

I recommend being aggressive with your resection, as well as use of light Bovie cauterization at the remaining stump of the phalanx. Closure can be easily achieved with simple suture or your choice of skin glue. Cosmetic results are excellent, with little risk to neurovascular structures with this approach.

Alec Hochstein, DPM, Great Neck, NY, ahochstein@aol.com

RE: Hypopigmentation Following Injection (Joan E Schiller, DPM)
From: Subodh K Choudhary, DPM

The hypopigmented lesion will likely get back to the normal color over a period of time. It may take up to a year. You could avoid such side-effects by injecting in deeper tissue. As to the cause, it is likely that as you withdrew the needle, some steroid was deposited subcutaneously.

Subodh K Choudhary, DPM, Greenville, SC, ppodiatry@gmail.com

RE: Digital Scanners for Orthotics (Kenneth Meisler, DPM)
From: Lloyd Nesbitt, DPM

Dr. Ken Meisler is on the right track with his reference to the use of a 3-D NWB laser scanner. For those who are gun-shy about switching to this new technology, I say go for it -- without hesitation! Having used the scanner on about 1,500 patients in the last 18 months, I can say that I absolutely love it. In the past, I had liked to consider myself to be a biomechanical purist (CCPM grad from '75)-- so for my first 50 scanned patients, I took plaster casts as well, for comparison.

The results with the scanner were just as good if not better than with plaster. You can still see FF valgus, for example, and post accordingly. Appreciate that you still capture the STJ. Eliminating plaster slabs, sink traps, and all the preparation and clean-up time has been one of the best moves in my practice. In fact, I have had less orthotic adjustments or "re-do's" as a result. As a DPM, your clinical knowledge and experience will not fail you when you use this modality.

Lloyd Nesbitt, DPM, Toronto, Canada, foothealth@lloydnesbitt.com

RE: Internet-Based Software Systems (Tip Sullivan, DPM)
From: Multiple Respondents

I have been using Wisdom for years. Cerner's track-record on support has been abysmal over the years. I did a webinar with them recently on their new PowerWorks EMR, and it is much more complicated and not nearly as user-friendly as others I have seen. Also, on a recent survey, only 8% of current PowerWorks users would buy the same system again! What does that tell you?
 
Neil B. Levin, DPM, Sycamore, IL, drfeet1@aol.com

The one glaring statement is the 5-year contract. This seems lengthy. What if things do not work well in this business model? Also, can you download and print patient charts and do your own back-ups to another location besides their own back-ups?  Think Iron Mountain remote back-up service. The question with all these services becomes what happens when they have a failure? What kinds of back-ups do they provide? How many duplicate servers do they have? Will they sign a HIPAA Business Agreement? What kind of encryption do they use?

Using Internet services for EMR companies is going to become the norm in a few years. Wisdom has been around for a long time and is not a new company, just a long-standing company that is adding a new feature. I encourage a test period to make sure that this is what you want to do, and that it actually works well with your Internet speed, connections, etc.

Larry Kosova, DPM, Chicago, IL, lkosova@yahoo.com

I recommend, without hesitation, OfficeAlly (officeally.com).  We have used them for four years for our billing, at no charge. They get paid by the insurance companies to act as a clearinghouse and get paid about 3 cents per claim. They process millions of claims monthly.  About two years ago, to promote more business, they made EHRs available with e-prescribing, lab results, and include Medicare billing for about $80 per month for everything. They serve major IPAs and HMOs. It’s all Internet-based with plenty of safeguards, back-ups, and the ability to back-up your own files at your own site anytime you wish. 

We have been paperless for nine months now, with great results. There is some work required to set up your offices and enter your macros, coding numbers, etc.; then it’s all a breeze. It is a month-to-month deal, with no long-term contract, and a one month free trial. The no-frills package costs only $29.95 per month with no e-prescription. Any month that Medicare claims are over 50% of your billing, they charge a flat rate of $19.99 because they don’t get paid by Medicare to process claims. I have no financial interest in this company, but they do serve 6,000 doctors at this time and I want them to remain strong. In addition, if you get EHR in place by October 2010, you could qualify for the stimulus money of $18,000 in 2011. 

Martin R. Taubman, DPM, MBA, San Diego, CA, mtaubman@san.rr.com

RE: OPEIU and Podiatry (Gregory T. Amarantos, DPM)
From: Michael Wodka, DPM

I am writing this letter in response to Greg Amarantos’s comments that appeared in this forum yesterday. It is difficult to address a broad comment, such as Greg made, in any short manner. Annually, the OPEIU issues, to a meeting of executive directors of Guild states, an accounting chart that displays the aggregate income from and expense paid on behalf of the Guild. From each member’s annual per capita payments, the OEPIU pays a portion to the AFL- CIO, the State Fed AFL-CIO, the OPEIU Defense Fund and OPEIU member benefits.
 
The remainder of the dues goes to the general fund of the OPEIU. From that fund, the OPEIU hires the lobbyists for national and state issues, pays its dues to podiatry-related national health interest groups and makes grants to...

Editor’s note: Dr. Wodka’s extended-length letter can be read here.

RE: Podiatry’s Limited License (Russell F. Trahan, DPM, Bryan Markinson, DPM)
From: Robert Bijak, DPM, Ira Baum, DPM

Dr. Trahan says he's weary of his colleagues calling a podiatric medical license limited. He misses the point. The states, not his colleagues, limit the license; and anyone not delusional, knows that means you have a limited license period. To say you're unlimited in your limited sphere toys with Einsteinium relativity, whereby reality is contingent on the position of the observer. A jailed prisoner is unlimited in his cell. Is he unlimited? Regretfully, most of the world does not observe our license as unlimited, especially state boards and lawyers. So, Dr. Trahan, enjoy your view, but to the rest of the world, you are just a podiatrist.

Robert Bijak, DPM, Clarence Center, NY, rbijak@aol.com

Dr. Trahan and Dr. Markinson's responses lead back to the same old question about podiatry. Dr. Trahan's statement that our license should not be considered limited. and Dr. Markinson's statement that we can't compare training and income, citing DPN's, appears to use market need with income.

I agree with both, but taking away the human characteristic of some people being more motivated and aggressive than others, podiatry is isolated by third-party payors as a specialty with less value than others and reimbursements levels reflect that attitude. I don't think PR and self-promotion or self-belief that our license is not limited will do anything to remedy the problem of low reimbursements and relatively low incomes. The subject of parity has been beaten to a pulp on PM. 

There probably is only one way to resolve it, and that would be compelling insurance companies to pay for a service equally regardless of the specialty providing the service. But that would involve costly litigation with a questionable outcome. The other way is for the profession to evolve, as I believe it should, into an allopathic/osteopathic specialty. No promises of riches, every man for himself, but let's be honest, podiatrists deserve (based on education and training) to be paid fairly for the services provided.
 
Ira Baum, DPM, Miami, FL, ibaumdpm@bellsouth.net

RE: Discharging a Neo-Nazi Patient (Jeffrey Kass, DPM, Robert Bijak, DPM)
From: Richard Jaffe, DPM

I have been following this discussion and the reaction to my comment regarding the question of treating a neo-Nazi.

Israel is a liberal democracy based on the rule of law. Displays of swastikas and Nazi symbols are against the law here. The same is true of another liberal democracy, Germany. These two countries understand the extent of evil which this nefarious movement represents and the depth of suffering which it has caused. I believe that defense of the Nazi movement is reprehensible. Nazism is not a political or moral stand. Defending it encourages a license to commit genocide. Those who adhere to it have chosen to put themselves outside of acceptable society and hence should be deprived of...

Editor’s note: Dr. Jaffe’s extended-length letter can be read here.

RE: Runners Need To Take it Easy After Blisters: DC Podiatrist
From: Steve Pribut, DPM

A tiny bit of hyperbole by Dr. Pribut, but at least his original quote was a welcome change from the deluge of "Local Podiatrist Hates Flip-Flops" articles that seem to be the public's only image of podiatry of late. I got the joke, Steve.

Paul Busman, DPM,RN, Clifton Park, NY, paul@busmanwhistles.com

MANHATTAN MEDICAL SPACE AVAILABLE

Multispecialty Medical Building with 24/7 doorman. Prime Luxury Building and Location, Gramercy, Stuyvesant, Peter Cooper Area. 305 Second Avenue (17th-18th). Prior tenants past 23 years; podiatrist, dentist (plumbing/electric intact), internist. Ideal for podiatry, co-share with dentist, MD, etc. (flexible lease terms). E-Mail; jbdrun@aol.com Phone; 480-951-2480.

ASSOCIATE POSITION - SOUTHEAST GEORGIA

Beautiful weather year round & near the Coast. Opportunity for Early Buy-in. Seeking associate or new residency graduate to join practice. Must be PSR-24/36 trained. Multiple locations. Full range of services with new facilities. E-mail cover letter & CV to melissafoot@pol.net

PRACTICE FOR SALE - MINNESOTA

Practice Grossing over $500K yearly. Good mix of surgery, orthotics, DME, diabetic care, general podiatry. Commute < 5 miles to work. Friendly Midwest lakes area with arts, good schools, affordable living, restaurants, shopping. Option to purchase building. Will consider associate to buy-in/ buy-out. Midwestpractice@gmail.com

POSITION AVAILABLE - SOUTHERN CALIFORNIA 
 
Very well established, multiple location group practice has immediate opening for associate doctor. Attractive compensation and benefit package offered. E-mail resume to mrsmcmackin@aol.com

PODIATRISTS NEEDED NATIONWIDE

Podiatry referral company has thousands of diabetic patients nationwide in need of immediate service. We are looking for podiatry practices interested in joining our network to receive referrals. Email coasttocoastpodiatry@yahoo.com

ASSOCIATE POSITION - VIRGINIA IS FOR LOVERS

ASSOCIATE POSITION - FREDERICK, MARYLAND

Fredericks premier group practice is located only 45 minutes from both DC and Baltimore. Immediate opening for a minimum PSR 36 Podiatrist for full time position. We have it all: EMR, digital x-ray, ultrasound, ASC, etc. Excellent salary with bonus structure and benefits. Please email resume to docsbnb@aol.com

PODIATRIST NEEDED - BROOKLYN, NY

Position available for 2-3 days busy office in large medical group. HIP credentialed. email resume to hallux62@aol.com

PART-TIME PODIATRIST NEEDED - LOS ANGELES, CALIFORNIA

Busy Podiatrist looking for assistance with patients located in facilities, home, office etc. Flexible hours, independence, and great compensation. If interested email CV to homefootcare@hotmail.com or call Terri at 323-353-8103.

TN PRACTICE FOR SALE (SOUTH OF NASHVILLE)

Active, established practice with new equipment (digital x-ray, ultrasound, computer network, etc.). Great referral network with an excellent scope of practice. Turn-key operation with seamless transition. Grossed over $350K last year. Call 931-446-5724 or e-mail mchad500@gmail.com

PM News Classified Ads Reach over 12,000 DPM's and Students

Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 12,000 DPM's. Write to bblock@podiatrym.com or call (718) 897-9700 for details. THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451

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