The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

July 19, 2008 #3,302 Editor-Barry Block, DPM, JD

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Cheapie Sandals Don’t Provide Protection to Feet: CA Podiatrist

Americans spent $7.4 billion on sandals in the past year, down from $8.1 billion in 2007. It ranks third behind dress shoes and athletic wear, according to the NPD group, which tracks consumer spending. Tracy Basso, a Davis, CA podiatrist and past president of the California Podiatric Medical Association, says he has treated flip-flop wearers for pain conditions such as plantar fasciitis -- inflammation of the tissue along the bottom of the foot that connects the heel bone to the toes.

Dr. Tracy Basso

"I especially see it with pronated feet -- semi-flat feet," says Basso. "The arch is falling, the foot rolls in. That's a patient that would have problems with flip-flops and needs support. But unless you have predisposing foot problems, I don't have strong reservations about sandals," Basso says. "But to the degree that a family has within their budget to buy a better or more supportive sandal, I'd do it. But they tend to be expensive."

High-end brands, such as Teva, Merrell and Bite, can cost $36 to $104. The advantages of those flip-flops, says Basso, is that you can safely wear them for prolonged periods. "The support is there, just like an athletic shoe," he says. "Those cheapie sandals don't protect in any meaningful way. Might as well go barefoot."

Source: Sam McManis, Scripps Howard News Service [7/16/08]

NCFAS Installs New Officers

The North Carolina Foot and Ankle Society installed Timothy Vogler, DPM, High Point, as president during the group’s recent summer meeting in Wrightsville Beach. He succeeds Robb Mothershed, DPM, of Winston-Salem.

Dr. Timothy Vogler

Other officers installed were Vice President Kirk Woelffer, DPM, Raleigh; Treasurer James Judge, DPM, Wake Forest; and Secretary Bruce Fawcett, DPM, Raleigh.

The North Carolina Foot and Ankle Society is comprised of a majority of licensed podiatrists in North Carolina. The society maintains a headquarters office in Raleigh.

NJ Podiatrist Receives a Personal Blessing from the Dalai Lama

Dr. Hal Ornstein was given the very unique opportunity to meet with the Dalai Lama yesterday in Philadelphia. When not practicing as a podiatrist, Ornstein devotes considerable time, effort, and money to support a variety of community causes. “I have always professed that the best service is service to the community and humanity” said Ornstein.

Dr. Hal Ornstein receiving personal blessing from the Dalai Lama

The Dalai Lama spoke to a crowd of several thousand at the Kimmel Center, but Dr. Ornstein, along with nine others, met him personally in a private room where they were given a personal blessing. Afterwards Ornstein said, “It was unbelievable to speak to his Holiness, an individual that represents so much of what I cherish and love in my life.”

Energize Your Business Card

Add your photo. Adding your own image makes you memorable and makes others feel connected to you. Your photo creates instant recall for people who receive your card., especially at a network event, health fair, or seminar where they might collect 50 or more cards in one day.

Source: Adapted from 10 Business Card Blunders That Hurt Business by Laurie Hayes

Query: To Biopsy or Not?

My patient is an 80 year old male of Italian heritage. This lesion is of years duration with no texture change, no heat, no pain, no edema.

Should this lesion be biopsied?

It is perhaps slowly enlarging. It seems of low risk because of very long duration without problem, but I wonder if I should biopsy it. The patient says a recent dermatologist exam raised no alarms.

Larry Aronberg, DPM, Lake Worth, FL

Query: Coding for Ligation of a Blood Vessel

I had a patient come into the wound center for a leg flap-type laceration treated with Steri-Strips in the ER the day before. He was actively bleeding from a small pulsating artery on his lower leg, soaking through multiple ABD pads over night. He has been on Coumadin. After numerous attempts at compression and application of Surgicel, he continued to bleed so the vessel was tied off in the clinic with suture. The laceration could not be repaired due to necrosis of the overlying flap.

How would the ligation of the bleeding vessel be coded? I couldn't find a code for ligation of a small vessel. Certainly there must be more to coding this event than an office visit.

Daniel Cohen, DPM, Melbourne, FL

Response: The codes in the vascular section of the CPT for ligation of large vessels, include one for the vessels in the extremities (CPT 37618 - ligation, major artery [e.g., post-traumatic, rupture]; extremity), but, in the case you present, those codes would not apply.

I would therefore use the unlisted vascular procedure code, CPT 37799, and submit both an op report and a letter of explanation. The letter should recommend reimbursement based on some other code of equal value (or a percentage value of a code like CPT 37618). Unfortunately, with an unlisted code, the payer will need to hand review it to price it.

Tony Poggio, DPM, Alameda, CA

Codingline subscription information can be found here

RE: Post-op Pitting Edema (Brian Quinn, DPM)
From: Multiple Respondents

R/O DVT ASAP!

Nicholas Taweel, DPM, PT, Philadelphia, PA, drtaweel@hotmail.com

I have seen this type of scenario when I was practicing. I always felt that this should be treated aggressively. If left untreated, the patient will have a difficult time returning to normal footgear. I recommend placing the patient in an Unna boot and surgical shoe. I also gave the patient a prescription for 20 mgs. of Lasix and advised them about having it with a glass of orange juice or eating a banana if they preferred. You will be quite amazed at how much edema is resolved within a week. After this, place the patient in an elastic ankle support like the kind you would use for an ankle sprain (use a closed back device). Let them continue with that for one month.

Steven H. Goldstein, DPM, Royal Palm Beach, FL, stevefootdr1@cs.com

Dr. Quinn can try to refer the patient to a lymphedema clinic (independent office or hospital outpatient) where they perform complex decongestive therapy including manual lymphatic drainage for post-op surgical lymphedema. She might have had a reaction not only to the surgery, but possibly the anesthesia, which can be a normal response. It is a covered physical therapy indication post-surgical and your patient will love you for recognizing that he/she needs the therapy. She may also benefit from a Bio-Compression Pneumatic Lymphedema Pump system. (biocompression.com)

Eric J. Lullove, DPM, Boca Raton, FL, info@happyhealthyfeet.com

RE: Chronic Dryness and Cracking in Heels (Rick Burnell, DPM)
From: Dan Klein, DPM, Elliot Udell, DPM

I have seen this condition in many women and some men. The problem usually stems from the patient having a weight issue and wearing open backed shoes and sandals. This is commonly referred to as "ridge callus" with fissuring. Thyroid conditions can also play a role. Years ago a product called Whitfield’s ointment was available. I used to combine full strength Whitfields with Vioform HC Cream. Applied to the heels under plastic wrap at night and wash off in the morning. You will see a dramatic result. You may have to find a compounding pharmacist to help you formulate Whitfield’s full strength. Let the patient know about the wearing of open backed shoes as a contributing factor. Another product which is helpful is the use of "Heel Balm", made by Flexitol. It has 25% UREA and it is OTC. .

Dan Klein, DPM, Fort Smith, AR, toefixer@aol.com

It might be helpful if when any of us asks for clinical advice and particular medication or set of medications have been tried and failed, that the actual names of the products be stated. Just stating the patient used moisturizers and anti-fungals is akin to saying, "the patient had an infection and antibiotics were used, help me." If all of the prescribing data is given, doctors who read the query won't give information on potential medications that have already been tried without success. Based on the pictures, but without knowing if you already tried these medications, I would recommend three products. One is Calicylic cream and Sorbidon Hydrate made by Gordon labs and a new product called Hydro 40 foam, that I am getting great results with. The latter is a prescription and the former two products can be purchased and dispensed to the patient in your office. Both of the companies will supply you with samples if you want to test the products before putting the patient through any additional expense.

Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: APMA Wins Medicare Victory (Ross Taubman, DPM)
From Paul Kesselman, DPM

The passage of HR 6331 was directly a result of hard work by a core group of medical associations {AMA, AOA (Optometry and Osteopathy), APTA and many subspecialty associations} and lay health care advocacy associations including AARP. The most burdensome restrictions related to the prescribing and dispensing of durable medical equipment (including facility accreditation) were…

Editor’s Note: To read more go to http://www.podiatrym.com/letters2.cfm?id=20798&start=1

Please note that Dr. Taubman's recent note on this topic should have read "The AMA has contributed only $300,000 more than the APMAPAC in this election cycle."

EQUIPMENT FOR SALE

1) 'Vintage' working x-ray machine, by X-Ray Manufacturing Corporation. Passed recent inspection and takes fine X-rays. It's on wheels, though too heavy to move from room to room. Also included is an auto-developer. Buyer responsible for pick-up in Baldwin, NY, as well as removal of developer (if desired). Excellent for new practitioner or satellite office. Price: $600 2) PDM motorized chair/table in excellent condition. Tan/gold color. Price: $600 Price of both together: $1,000 phone: 516 223 4026, email aikiman44@aol.com

ASSOCIATE POSITION WITH OPPORTUNITY FOR PARTNERSHIP

Group practice located on NY-PA border with excellent growth in the area’s industrial, retail, and college campuses. Surgical privileges in medical centers in NY and PA. This position will involve rotating through multiple office locations, and wound care centers. Local insurance reimbursement involves mostly private pay PPO models. We are looking for an ABPS Board Qualified podiatrist to join our team. Candidates would need to obtain licenses in NY and PA, and become ABPS certified to maintain hospital privileges. Base salary starting at $85,000 plus bonus plan incentive, vacation, and health/mp insurances. Forward CV to prefprovider@hotmail.com

ASSOCIATE POSITION – GEORGIA

Atlanta area need a full-time or part-time associate for a 25 years old well-established practice ,well rounded surgery and routine, please email your CV to superrang@bellsouth.net

CASE CONSULTING

Dennis Shavelson, DPM is now accepting referrals of difficult cases involving biomechanics, surgical complications, non-healing wounds diagnostic and treatment dilemma’s and subtalar stenting from DPM’S. Full reporting with second opinion only, rapid return after care and assumption of care options. Medicare and Out-of-Network Only. (212) 288-3668 or drsha@lifestylepodiatry.com

PODIATRISTS NEEDED - CHICAGO --NORTHWEST INDIANA

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists. We are located in Chicago and Northwest Indiana. Full and part time positions are available. Competitive Compensation including malpractice. Contact Scott Schneider. Phone-773-342-4201 FAX 773-486-3548-E-Mail sschneider@homephysicians.com Visit our website

Central Valley/Southern CA. Salary excellent with all paid benefits/incentives including malpractice/401k and profit sharing. Surgery Center and hospital based with no HMOs/no rest homes. Bilingual in English and Spanish. Offering a permanent position/partnership in a multi-million dollar hi-tech practice. E-mail CV to: Tonya@wetreatyourfeet.com

PODIATRIST POSITION – SOUTHERN CA

Medical group in Southern CA seeking a residency trained DPM. Practice includes general podiatry, biomechanics, wound care, surgery, diabetic feet, trauma. Part-time position available may lead to full-time. Excellent salary/benefits. Position available in mid July 2008. Please reply to E-mail: slowed2@yahoo.com; 4476 Tweedy Blvd, South Gate, CA 90280.

ASSOCIATE POSITION - NEW JERSEY

Established practice in Ocean County seeks hardworking, ethical, energetic and well-trained (PSR 24/36) individual. Must be willing to do all aspects of podiatry! Base salary $100,000 to start plus benefits package. Hospital & surgical center privileges. E-mail CV to NJFeet@aol.com

PRACTICE FOR SALE WA STATE: BELLINGHAM - WITH ASC

Located by hospital and medical community. Owner will carry part of financing. Potential for increased revenue abounds. This is a value that should not to be overlooked. Bellingham is rated in national magazines as one of the most desirable places to live or retire. 386 597-5766.

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