The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

July 13, 2011 #4,205 Publisher-Barry Block, DPM, JD

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Laser Effective for Onychomycosis But Not a Cure: DC Podiatrist

Toenail fungus causes nails to become thick, yellow, and brittle in a way that looks pretty ugly and can be painful. Sufferers can spend years and hundreds of dollars trying to clear the infection with drugs, topical treatments, and home remedies, sometimes to no avail. It tends to be a cosmetic issue for the younger set and a pain issue for older folks. “The problem is huge. It is bigger than you can imagine,” says Washington podiatrist Dr. Stephen J. Kominsky. “I would say 70 percent of the patients who come into my office have fungal infections on their toenails.”

Dr. Stephen J. Kominsky

There may be hope. Podiatrists have begun using a laser treatment that combats the infection — or wastes their patients’ money because it doesn’t work, depending on whom you ask. Kominsky has treated 400 to 500 patients with the PinPointe laser. Compared with oral medication, he says, “the odds of success are better with the laser; plus, there are no side-effects.” “I never use the term ‘cured’ with toenail fungus,” Kominsky says. “With a cure, people think there’s no chance for a recurrence. In this case, there is a chance.”

Source: Rachel Saslow, The Washington Post [7/11/11]

OCPM Students Man Booth at the Tour de Cure

Ohio College of Podiatric Medicine students, Rebecca McGaha and Vinai Prakash, attended the recent "Tour de Cure" event that was held at the Blossom Music Center by the American Diabetes Association. 

OCPM Students Vinai Prakash and Rebecca McGaha

OCPM was given a free booth at the event to promote the college and try to reach out to diabetic patients in town. Rebecca and Vinai also distributed some recruitment flyers for the college's ongoing NIH study.

Source: Footsteps [June 2100]

APMA to Hold 5K Run/Walk at Annual Meeting

APMA will again be holding a Team APMA 5K Run/Walk at The APMA Annual Scientific Meeting in Boston. This year's event is sponsored by acsis, Bako Podiatric Pathology Labs, and New Balance.

APMA Team 5K Run/Walk

This year’s event takes place Saturday, July 30, at 6 a.m. at beautiful Castle Island Park. Transportation to and from the park will be provided. Buses will depart at 5:15 a.m. from the Sheraton Boston Hotel. Click here  to view a video and for more information!

NJ Podiatrist Learns About Thoroughbred Racehorse Ownership

By profession, Dr. John Ridenour is a podiatrist. On Saturday afternoon, he did have feet on his mind, but of the hooves kind; specifically, the thoroughbred racehorse kind. “On my bucket list is to be an owner (of a thoroughbred) one day,” said Ridenour, 59, who lives in Ocean and practices in Red Bank. “And I know a few owners. They seem to enjoy it.”

Dr. John Ridenour

So, there he was attending a free seminar, “Thoroughbred Ownership 101: Get in the Game,” at Monmouth Park. Ridenour talked about the horse-racing bug. “My parents introduced me to it in the ‘70s,” Ridenour said. “The excitement, the possibilities to win money, and I like the challenge of handicapping.”
 
Source: Joseph Sapia, Asbury Park Press [7/9/11]

VA Podiatrist Competes in Bocce Tournament

Kielbasi, beer, and bocce ball.That's how it all began, 35 years ago. Six buddies converged for that popular triumvirate of reasons, as well as the simple pleasure of kicking back together. When one of them died suddenly in 1982, the event got an official name: the Ron Owczaryk Memorial Bocce Ball Tournament.

Dr. Matt Testani

It has been held every summer since, in what they call the Bocce Dome, which doubles as the backyard of founder Don Andrejko's Johnson City home. Podiatrist Dr. Matt Testani, 38, makes his way here from Centreville, VA, so he doesn't miss the event. "We used to sit on the roof and watch when we were growing up," he said. "Now we're playing."

Source: Valerie Zehl, Press Connects.com, [7/9/11]

Query: Post-op Complication
 
A 50 y/o healthy female had an Austin bunionectomy with pin fixation of the 2nd toe performed by another surgeon. The patient had a post-op dislocation of the 1st metatarsal head, which required another surgery to relocate it. The 1st metatarsal was shortened significantly. She had a significant 2nd toe contracture afterwards, and this was treated with a failed Weil osteotomy of the 2nd metatarsal, and a failed dorsal V-Y skin flap. 

Overlapping 2nd Toe S/P Austin Bunionectony

Here is the latest x-ray and picture. I have an idea what needs to be done, but would love to hear from others who have treated this type of post-op problem. Her pain is at the IPJ of the great toe, and the 3rd MPJ and 2nd MPJ.

David Weiss, DPM, Richmond, VA

Query: Attesting with Practice Fusion

I have been using Practice Fusion EHR software for several months. I am at a point where I feel ready to undertake the "attestation" process. What has been the experience of those who have attempted to attest with this softwere?

Joseph Marzzacco, DPM, JD, Carbondale, PA

Query: Help with Coding Tendon Tear

What is the procedure code for treatment/repair of a tear of the flexor digitorum tendon?

John Fanelly, DPM, Philadelphia, PA

Response: Flexor digitorum longus repair has two coding choices:

1) CPT 28200 - repair, tendon, flexor, foot; primary or secondary, without free graft, each tendon.

2) CPT 28202 - repair, tendon, flexor, foot; secondary with free graft, each tendon (includes obtaining graft)

David J. Freedman, DPM, CPC, Silver Spring, MD

Codingline subscription information can be found here
APMA Members: Click here for your free Codingline Silver subscription

RE: Silastic Implant Complication
From: Roody Samimi, DPM

It is likely to be a Charcot reaction, or an implant reaction, or a seeded osteomyelitis. A bone biopsy for culture and path is warranted. If intra-p you see no signs of infection, consider debridement of all non-viable bone, placement of antibiotic spacer or leave it open until micro/path comes back in another week or so with a drain, if needed, and conversion to fusion as hopefully the last stage operation, if you decide to do it staged.

Roody Samimi, DPM, Flushing, NY, roody.samimi@gmail.com

RE: NaHCO3 with Local Anesthetic (Ivar Roth, DPM, MPH)
From: Larry Kollenberg, DPM, Pharm D

The addition of NaHCO3 with local anesthetics has been around for more than 20 years. The problem with this is the stability of the solution. One reference (ncbi.nlm.nih.gov/pubmed/2562097) from 1989 shows that small molecule precipitation is a significant concern with some anesthetics like mepivicaine. In a more recent study (springerlink.com/content/43616778m7243675/), the authors discuss the pH and pCO2 associated with the dissociation of the mixture in epidurals and its effects.

In our hospital, we commonly do allow for the alkalinization of lidocaine only. We mostly do this for administration of an antibiotic Ceftriaxone in our dilution for pediatric patients for IM injection. Dr. Falke commented about a 1:10 dilution, and that is very close to the mathematical calculation we use for our buffering in peds and NICU. The bottom line is that if you choose to do this, you must do two things. 1) Inspect your solution after about 10 minutes for precipitation. We do not commonly see it, but it has occurred for unknown reasons. 2) Use your mixture during that day. Lidocaine will be stable at room temperature for that day only, as temperature can affect how the patient perceives the "stinging" or "burning" sensation if it is too cold.

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

RE: How Would Your Life be Different if You Had an MD Degree (Art Korbel, DPM, MD)
From: Matthew B. Richins, DPM

I am often in the minority when this debate comes up, but I would wager that I am really in the silent majority. I love podiatry. Why would I want to trade my DPM for an MD? DPM means knowledge and a medical niche that 99% of MDs cannot fill. Instead of trying to change the degree to say we are something we are not, let us proclaim with a proud voice who we are and why the medical world is a better place with us in it!

Matthew B. Richins, DPM, Joplin, MO, mnmrichins@yahoo.com

Editor's Note: This topic will be discussed on  tonight's Meet the Masters. You can register for this event by clicking here

ASSOCIATE POSITION - SOUTHERN CALIFORNIA

Busy multi-office practice in L.A./Inland Empire areas in need of full-time or part-time associate for a well paid position. NO Nursing homes! Must have CA license. Medicare and DME numbers are helpful. Please send CV and contact information to scpodgroup@yahoo.com

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 - CANADA

Beautiful Victoria, B.C. Canada on the ocean, fast growing area. Associate for multi-office full scope practice. Reply to dr.cole@shaw.ca

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.

PRACTICE FOR SALE - NANAIMO, BRITISH COLUMBIA, CANADA

Have you ever dreamed of owning a practice where... you can see 0-50 patients daily .. .average 100 new patients monthly have zero accounts receivable ... gross $480 M per year .... live in a beautiful community with skiing, hiking, fishing and boating on your doorstep. This could be yours! If interested contact pistone@telus.net or 250-754-4192.

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.

EQUIPMENT FOR SALE - CLASS FOUR LASER

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 

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