The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

July 29, 2011 #4,219 Publisher-Barry Block, DPM, JD

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PM Podiatry Hall of Fame Another Sellout

All 300 tickets to Thursday's PM Hall of Fame Luncheon have been bought. Those arriving without tickets can have their names placed on a waiting list at the APMA registration desk in the event of late cancellations. Attendees for this PM/ APMA Educational Fund are requested to arrive between 11:30 AM and Noon, as the program will start promptly at 12:00 PM. PM wishes to thank all those who have donated tickets to students. 

NY Podiatrist Wonders Why Women Continue to Wear High Heels

After The Daily Caller reported last week that Ms. Bachmann, a Republican congresswoman from Minnesota, had identified high-heel shoes as a source of her migraines, her son Lucas, a medical resident at the University of Connecticut, confirmed to The New York Times that his mother had noticed a “correlation” between days she wears heels and days she experiences headaches. 

Dr. Joanna Youner

Dr. Johanna S. Youner, a podiatrist in Midtown, said her patients’ high heels led to broken feet, bunions, hammertoes, and inflamed nerves — but no headaches. Dr. Youner wondered why anyone would continue to wear heels if it seemed to precipitate such pain. “Heels can make you feel empowered,” she said. “But it’s another issue if it’s detrimental to your health.”

Source:  Matt Flegenheimer, NY Times [7/25/11]

OH Podiatrist Joins MedCentral Health System

Dr. Jessica Rose Brent has joined the MedCentral Health System medical staff and the Advanced Foot and Ankle podiatry office of Dr. H. Joseph Kurtzman and Dr. Christopher George She has been working part time with Kurtzman for several months.

Dr. Jessica Rose Brent

She earned a bachelor's degree in biomedical and sports science at Hiram College and doctor of podiatric medicine degree at Ohio College of Podiatric Medicine in Cleveland in 2006. She was an instructor for Toledo's Mercy St. Vincent's Hospital podiatry residency program, where she completed a residency in podiatric medicine and surgery in 2009. She was chief resident there in 2008 and 2009.

Top 10 Sectors That Will Benefit from Health Insurance Exchanges

Industry research firm IBISWorld has forecast the top 10 sectors that will benefit from the creation of state health insurance exchanges under the new rules released this week by the U.S. Department of Health and Human Services. With nearly 12 million people expected to buy insurance on the exchanges in 2014 and as many as 28 million by 2019, according to Congressional Budget Office estimates, the 10 sectors expected to benefit most are: 

Top 10 Sectors that will Benefit from Health Insurance Exchanges

Source: Healthcare Finance News [7/12/11] via Andrew Shapiro, DPM

If You're an Introvert, Reach Out to Others

Reach out to other people by explaining if you are an introvert. Otherwise people may misinterpret your silence in unflattering ways. When they understand your style, they will draw you out.

Source: Adapted from “Are You an Introverted Boss?” Douglas Conant, The Conversation via Communication Briefings

Query: Hip De-rotation Device

My patient is a mid-50's male, post CVA who says his leg "rolls out" (externally rotates) in bed while he is asleep. It takes several hours of daily walking, etc. for the leg/foot to return to a more normal position. He wants to know if there is any device to hold the leg during sleep that will prevent this.

Larry Aronberg, DPM, Lake Worth, FL

RE: Accessing Patients' Medication History (John Chisholm, DPM)
From: Daniel Chaskin, DPM

If a pharmacist and a doctor of podiatry are responsible for the same patient, there can be oral communication between both of you. One suggestion is to request that the patient bring in all the original Rx prescription bottles for you to copy or to sign a release of records for you to send to the pharmacist.

Daniel Chaskin, DPM, Ridgewood, NY, podiatrist1@optonline.net

RE: Chronic NSAID Use Doubles CV Deaths in Elderly (Robert Kornfeld, DPM)
From: Eliot Udell, DPM

Dr. Kornfeld referred to the paper titled "Harmful Effects of NSAIDs among Patients with Hypertension and Coronary Artery Disease" by Bavry AA, Khaliq, et al. It associated an increased mortality in chronic users of NSAIDs and elderly patients with hypertension and coronary artery disease. There are problems with this paper. It is a post hoc study on the paper titled: "International Verapamil-Trandolapril Study".  It asked  people who had the above co-morbidities if they were taking NSAIDs. The shortcoming of this study is that it did not differentiate between different NSAIDs. In the study that lead Merck pharmaceuticals to withdraw Vioxx from the market, the drug was compared to naproxen which was shown to be the safest NSAID from a cardiovascular perspective. Aspirin, the original NSAID is used to prevent certain cardiovascular episodes.
 
Another problem with the paper is that  it studied a cohort of the population of people with hypertension and cardiovascular disease. We have known for years that NSAIDs are sodium retaining and can increase blood pressure. We also have known since the 1990's that Cox II inhibition can lead to vasoconstriction, platelet aggregation an  thrombosis, hence disposing a patient to cardiovascular disease.

Dr. Kornfeld is correct. We should not be prescribing NSAIDs for patients long-term, but we should not broadly condemn all NSAIDs as causing cardiovascular problems based on an incomplete study cited.

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

RE: DO Designation for Podiatrists
From: Paul Kruper, DPM

I continue to be confused by some DPM doctors who profess we should be granted a DO designation when our education is deemed to be equivalent. We are not osteopathic physicians. We do not practice osteopathy and do not receive 500 hours of training in osteopathic manipulative medicine similar to osteopathic med students. I am sure the osteopathic associations do not support granting the DO to podiatrists any more than the APMA thinks the DO should get a DPM designation. This concept seems silly. We are DPM specialists who should receive an allopathic scope DPM license when our education is deemed to be equivalent.

Paul Kruper, DPM, Kingsburg, CA, prkruper@yahoo.com

Editor's comment: 1) In three of our schools, students sit side-by-side with osteopathic students. 2) Podiatrists can take a 3-year residency at Nova Southeast College of Osteopathic Medicine, which results in a DPM, DO with licensure in both. 3) DOs are considered R-1 physicians under Medicare and Medicaid. A podiatrist with an MD or DO would still be a podiatrist, with a scope of practice limited only by education, training, and experience.

RE: Chronic NSAID Use Doubles CV Deaths in Elderly (David Zuckerman, DPM)
From: Tip Sullivan, DPM

I read with interest Dr. Zuckerman's point about using a class-4 therapeutic laser in lieu of NSAIDs. I don't use this technique but wanted to learn more about it so I Googled it. I wonder why most everything on it was from the vets and the chiropractors? Could it be because they can afford to use this treatment modality because they can charge their patients for it?  And actually get paid? Cash even? I would love to try it out but how could one get reimbursed? My contracts don't allow us to ask patients to pay, and I have never heard of a company in my area of the country covering this modality. Things like this make me feel like we are victims of the system, but more importantly that our patients are ultimately victims and don't even know it!

Tip Sullivan, DPM, Jackson, MS, tsdefeet@msfootcenter.net

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