July 28, 2006 #2,641 Editor-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2006- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

PM just posted the 24th Annual Podiatry Management Survey at www.podiatrym.com. We have improved and simplified this year’s survey, which should take about 10 minutes to complete. Part of the survey is your chance to vote for the 2007 PM Podiatry Hall of Fame inductee. This year we’ve added a new category for non-podiatrists.

Those completing the survey will also be eligible for valuable weekly prizes, including our grand prize of a one-week Caribbean cruise for two aboard a Windjammer (Value $2,000). This week’s prize is a one-week classified ad in PM News (Value $75). Enter by simply sending question 45 to bblock@podiatrym.com with your name and address. All entries are eligible for the grand prize.

Tips For Toenail Season: RI Podiatrist

Podiatrists say they, too, have noticed an increased popularity among female and male patients to beef up toenails. "Women are especially showing more of an interest in painting toenails," said podiatrist Dr. Charles "Chuck" M. Cavicchio, who's based in Lincoln, R.I. "People like to make their toes nice, especially during what I call 'toenail polish season.'"

He noted that when you are in your 30s and 40s, you are more likely to have "nail deformity" because of sports activities or an injury or an infection or just from age. Runners often damage big-toe nails or have them fall off, he said. A fungus infection may require Cavicchio to cut a nail extremely short; or an acute injury can cause a nail to grow back deformed.

How safe are artificial toenails? Cavicchio said that they are safe but there is a risk of developing a fungus infection if you are not careful. "I'm a big fan of prevention," he said. "I suggest over-the-counter anti-fungal creams or liquids and maintenance."

Cavicchio said that if you decide to use artificial nails over your regular nails, only leave them on for seven to 10 days. For his patients who have had a nail removed permanently, they can glue an artificial nail onto the toe bed. But he or she should then remove it after a day. Then, when you remove the artificial product from the toe bed, clean the area well with soap and water. Regular users of these products should inspect nails regularly for signs of a fungus.

Source: Faye B. Zuckerman, The Providence Journal, [7/25/06]

Study Shows Only One Quarter of Older Americans Wearing Appropriate Shoes

In one of the largest studies to date in this population, it appears as though three out of four older Americans are walking in incorrectly sized shoes. These are the findings reported in the Veterans Shoe Size Selection Study (VAS4), a study published in this month’s Journal of the American Podiatric Medical Association.

Researchers from VA Medical Centers in Tucson and North Chicago partnered with Scholl’s Center for Lower Extremity Ambulatory Research (CLEAR) at Rosalind Franklin University of Medicine and Science to conduct a study carefully examining the size of the shoe to the size of the foot in 440 persons averaging 67 years old.

“We were surprised by these findings,” noted David G. Armstrong, Professor of Surgery at Scholl and Director of CLEAR. “They are similar to previous smaller studies, but the rates of foot-shoe mismatches are even worse, especially for persons at high risk for foot problems.”

The study also evaluated subsets of patients with diabetes, nerve problems, and wounds. Of this population, more than 9 in 10 had a shoe size that was more than one half size too large or small. Armstrong reports that “persons with diabetes often don’t have the gift of pain, and they can wear a hole in their foot just as easily as they’d wear a hole in a sock.”

The researchers recommend that persons fitting a high-risk group seek out the advice of a professional when purchasing new shoes. Armstrong concludes: “This is simple preventive maintenance that will help keep people walking and healthy throughout their lifetime.”

Query: Polyneuropathy

I was looking for some suggestions on a 57 year old male with polyneuropathy in his hands and feet likely caused by treatment for hepatitis C with interferon and IV Ig many years ago. He has a 30 pack year history of smoking, has HTN, takes Lamectal, Diltiazam, Cozaar, and Clonazepam. He has tried several vitamin regimens; including B-6 and B-12, E, C, alpha lipoic acid; Rx's including Lyrica, Cymbalta, Neurontin, Cobalamin injections, and Metanx over a course of 6-9 months.

He has peripheral nonpitting edema in his feet and distal 1/3 of his extremities, his labs are currently normal including liver function. The feeling of lead feet and numbness is driving him crazy. Nothing has helped. He does not exhibit classic painful neuropathy as seen often in patients with diabetes. Has anyone had any success with a similar case with different treatments?

Glenn Weinfeld, DPM, Cortlandt Manor, NY, glennweinfeld@msn.com

RE: Bruce Frankel, DPM

I was shocked and saddened to read about the untimely passing of Bruce. He was a terrific mentor and a true icon in this profession I visited his office often and learned much from him - from surgical techniques to charm, something he really excelled in. His smile was most illuminating.

What I most admired about Bruce was that he really did "what was right" and cared about the patients. My heartfelt sympathy to his family. We shall miss him.

Sloan Gordon, DPM, Houston, TX

RE: Barry's Unique 3 + 4 Program
From: Bob McKinlay, MPS

The Barry University School of Podiatric Medicine's 3 + 4 program is unique to podiatric medicine, as it recruits students directly from high school, instead of college like other 3 + 4 programs as alluded by Mr. Greene of NYCPM in his July 26 letter.

This way young high school students learn about podiatric medicine as a career before entering college. The earlier we are able to impart knowledge to our youth about our profession, the better chance we have of competing for their enrollment with allopathic and osteopathic schools.

Barry University has also received federal funding for a project entitled, "Kids Into Health Careers." Here Barry University podiatric faculty and students teach elementary age children about careers in healthcare, especially podiatric medicine.

Bob McKinlay, MPS, Assistant Dean, Program Development
Barry University School of Graduate Medical Sciences

RE: Medical Fees Should Be Tied to the CPI
From: Paul Kesselman, DPM

According to the American Orthotic and Prosthetic Association (AOPA):
“After three years of living under a Medicare reimbursement freeze,
Orthotic and Prosthetic providers are scheduled for an increase to take effect
January 1, 2007. Under federal statute, Medicare payment updates for O&P services are determined by the annual update to the Consumer Price Index for All Urban Consumers (CPI-U). In data released on July 19 by the Bureau of Labor Statistics, the CPI-U increased by 4.3% from June of 2005 to June of 2006. Unless Congress elects to make changes, the O&P community can expect to see a corresponding increase. AOPA has worked tirelessly with key lawmakers in defending this payment update.”

In light of the above, I do not believe that physicians’ payments are formulated exactly in this same fashion. The question I would have for the lawmakers are: Do physicians have similar if not higher expenses than those of the O&P professional? Do physicians not have expenses which increase with the CPU? Why are we forced to live with the philosophy that no pay decrease is a pay increase? Does my landlord or my malpractice carrier say hey doc you didn’t get a pay raise so we won't charge a higher rent or premium??

Something is most definitely wrong!!

Paul Kesselman, DPM, Woodside, NY, pkesselman@pol.net

RE: Dragon Dictate
From: Simon Young, DPM

I too have used Dragon Dictate since the dark ages (Version 2 professional) and now version 8.1. Dragon provides very professional-looking charts, which are very comprehensive. Dragon still makes mistakes, but is a very good way to electronically dictate your charts. Also, I can keep years of charts on a DVD or CD and transport to different offices.

Dragon is somewhat time-consuming, 3-5 minutes per continuation note or 5-10 minutes for a new patient depending on how comprehensive or thorough you are and how many mistakes it makes. I estimate accuracy is about 85-90%, but this 10-15% is somewhat a royal pain in the "arch." Nevertheless, charts are clear, and look extremely professional. To dictate to a service: You need to dictate the chart, hold the chart, wait for dictation to return, and file into chart, and do billing. I think this is more time-consuming.

Simon Young, DPM, New York, NY, simonyoung@juno.com

ASSOCIATE POSITION- COLLEGE STATION, TX

Full time associate position for a surgically trained podiatrist to join an established growing practice in College Station, Texas. This is a great opportunity for a motivated individual to join the leading podiatry group in a family oriented growing community with a wholesome, small town atmosphere. Good package with opportunity for buy-in within two years. Please send CV to billglaze@brazosvalleyfootcare.com

ASSOCIATE POSITION- KANSAS CITY, MO

Excellent opportunity for a hard working, ethical podiatrist to join a vibrant, successful and growing podiatric medical and surgical practice. Dedicated, supportive staff with strong marketing and medical knowledge. Must be board eligible/certified. PSR/24. Partnership opportunity. Competitive salary, bonus structure, benefits. Wonderful place to raise a family. Fax CV to 816-455-8901

HOUSE CALL PRACTICE OPPORTUNITY- CHICAGO / NORTHWEST INDIANA

Chicago-Home Physicians specializes in house calls to the elderly homebound. Full and part-time positions available in Chicago/Northwest IN. Competitive Compensation, including malpractice. Contact Scott Schneider. Phone-773-292-4800. Fax-773-486-3548. E-mail sschneider@homephysicians.com www.homephysicians.com

ASSOCIATE POSITION - NEW ENGLAND

Terrific Opportunity Now Available in growing New England practice. Well established and respected practice with new, large office space, latest technology, very helpful staff, loyal patients and solid referral base. Close proximity to hospitals with modern surgical suites. Opportunity for shared ownership. Prefer 24 month PSR with clinical practice experience or an experienced doctor looking to improve their situation. E-mail CV and particulars to NEAFC3@aol.com

HOUSE CALL PRACTICE FOR SALE – SOUTHERN CALIFORNIA

House Call practice for sale which includes approx. 400 patients and continued referrals. Perfect for solo practitioner. Extremely easy and profitable practice to run. Yearly gross of over $200K. Current DPM is retiring. Financials will also be provided. Please contact ccipinc@ccipinc.net

ASSOCIATE-PARTNER WANTED MICHIGAN-DETROIT AREA WESTERN SUBURBS

Great opportunity-must be hard working, reliable, responsible and good with patients & staff surgical training a plus-partnership after 1 yr. Michigan license required. Fax resume to 248-478-1370 Starting salary $200,000. plus benefits plus percentage. Serious inquiries only

FOR SALE MICHIGAN-DETROIT AREA

Michigan practice Detroit western suburbs for sale. 3 offices, great locations approx 1.5m gross, Buy outright or overtime. Call 561-213-9400 after 7:00 p.m. Serious inquiries only

WEEKLY SPECIAL - One week of ads (6x) for only $75

PM Classified Ads Reach over 8,000 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 8,000 DPM's. Write bblock@podiatrym.com for details. Note: For commercial or display ads contact David Kagan at (800) 284-5451 dekagan@aol.com

• To Post a message, send it to:    bblock@podiatrym.com
• Notes should be original and may not be submitted to other publications or listservs without our express written permission.
• Notes must be in the following form:
  RE: (Topic)
  From: (your name, DPM)
  Body of letter. Be concise. Limit to 250 words or less). Use Spellchecker
  Your name, DPM City/State
• Subscribers are reminded that they have an ethical obligation to disclose any potential conflicts of interest when commenting on any product, procedure, or service.