The Voice of Podiatrists

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August 04, 2008 #3,314 Editor-Barry Block, DPM, JD

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Flip-flops Linked to Skin Cancer: UK Podiatric Surgeon

Specialists say that wearing open-toed footwear can increase the chance of getting lesions as the skin becomes exposed to intense sunlight, a key cause of skin tumors, or melanomas. Cancer that affects the feet is known as "acral melanoma" and typically occurs on the sole of the foot, between the toes or under the toenails. Research shows that only half of patients with foot melanomas survive compared with four out of five people who develop cancer elsewhere on their legs.

Anthony Kontos, Podiatric Surgeon

Anthony Kontos, head of the clinic at the Hospital of St John and St Elizabeth, said patients often mistook skin cancer on the feet for bruising. The podiatric surgeon said: "With the increasing popularity of open-toed sandals and flip-flops, feet often have a sudden blast of intense sunlight. "Our feet are enclosed in shoes most of the year and then we pack our sandals for a holiday in very hot temperatures. This means feet are particularly susceptible to sunburn.

"People are generally aware of checking other parts of their body for suspicious moles but they're unlikely to examine their feet" he added. Exposure to sun in childhood is the biggest risk factor for melanomas. Initial discomfort is hard to spot and is often diagnosed at a late stage which by then has spread to other parts of the body.

Source: Urmee Khan, London Daily Telegraph [8/1/08]

Take Steps to Save Fuel: NYSPMA

“When you’re using your feet, you’re using your head to beat fuel prices” says Dr. Roy DeFrancis, president of the New York State Podiatric Medical Association. “Walking to work, shop and relax doesn’t tax your wallet, can take off unwanted pounds and can help you stay in shape,” he says.

Dr. Roy DeFrancis

The Association is urging New Yorkers to take steps to beat the rising fuel costs…as well as the rising cases of obesity and diabetes in New York State. For about the same price as an SUV fill-up, you can buy the right pair of shoes. The ideal walking shoe should be stable from side to side, well-cushioned, and should enable you to walk smoothly. Don't cut corners on your shoe budget; buying shoes is the only real expenditure necessary , so treat your feet well.

Dead Doctors' IDs Used to Bilk Medicare

Some physicians worry that their professional identities will be stolen and Medicare fraud perpetrated in their names for as long as they live. A new report shows that this possibility doesn't necessarily end after a doctor has died.

Medicare paid at least $60 million and as much as $92 million since 2000 for fraudulent durable medical equipment claims that were filed using deceased physicians' identification numbers, a Senate investigation found. Of these nearly half-million claims, an estimated 16% were from doctors who had died 10 or more years before the service date listed.

The Social Security Administration has recently agreed to provide Medicare with monthly updates of deaths. CMS will match this information with the NPI system and deactivate the IDs and enrollment information for physicians who have died.

Source: David Glendinning, AMNews [8/4/08]

When Tension Boils Over

Call a timeout when tension boils over and makes productive conversation impossible. Say something like: “Let’s take a break. We’re just going around in circles. Why don’t we meet back here in half an hour.”

When you reopen the discussion, start by offering an apology. Apologize for not understanding what the other person was saying, for getting hot under the collar, for making accusations or anything you can think of that contributed to the conversation’s derailment. Your apology signals your regret for the tension – and gives the other person a face-saving way to admit regret too.

Source: Adapted from “How to Overcome Team Tension” by Pace Productivity

Query: Linear Toenail Hyperpigmentation Streaks

My patient is a 41 y/o healthy Hispanic female patient with a previous history of onychomycosis treated 5 years ago with oral Lamisil x 4 months with partial fungal clearing of some of the nails but with persistent residual full-length linear brownish hyperpigmented streaks noted on most of the other nails. Two nails are completely clear; the left hallux and 3rd toenail left. The mycosis has returned to some of the other nails. The pigmentation appears to be in the nail plate only, not in the nail bed-at least distally. The pigmentation does not extend into the eponychial skin. Her fingernails are all normal.

Her toes are contracted with obvious chronic pressure on the nails with weight-bearing. She used to wear tight high-heeled shoes but not now. My plan: repeat oral Lamisil, avulse the affected nails and apply topical steroid cream to the root as the new nails grow in, eliminate toenail pressure with proper shoes/orthotics/ surgery as needed. Does anybody have any other ideas/experience with this condition?

Mario Rizzo, DPM, San Francisco, CA, mwrizzodpm@yahoo.com

RE: Excision of Foreign Body
From: David S. Wolf, DPM

History: This 45 Y.O. RN, stepped on shag carpet in her home and felt pain in her forefoot. I took her to OR and removed this foreign object in less than one minute (thanks to Xiscan).

Foreign Object in Foot

I nicknamed her the "blade runner."

David S. Wolf, DPM, Houston, TX, RebDovid@aol.com

RE: Athena Billing Service (Aimee Judy, PMAC)
From: Michael J. Schneider, DPM

We have been using Athena for about two years. I would advise that you have at least one "practice manager" type employee who will work with them. That being said, we are very satisfied. Our accounts receivable have gone from 90-120+ days with Lytech type programs to 30-40 days with Athena. Anyone who would like to discuss Athena may contact me personally. I have no financial interest in Athena.

Michael J. Schneider, DPM, Vail, CO, mjs10vail@aol.com

RE: The Importance of Clean Dressings

After 28 years in practice, I thought I had seen/heard it all with regard to my patients. Many months ago I treated a woman with a diabetic ulcer. After debridement and application of appropriate medication, I covered it with a clean, dry sterile dressing. I informed the patient to keep the dressings "clean and dry." One week later she returned with a clean bandage but a dirty ulcer. I asked her why her wound was dirty and she replied that "you asked me to keep the dressings clean and dry so I took them off and placed them on my dresser and went about doing my business and put the dressings on later." I had to step out of the room to avoid either laughing or shaking my head in disbelief.

Steven Snider, DPM, San Antonio, TX

ASSOCIATE POSITION OPPORTUNITY IN MULTI SPECIALITY GROUP PRACTICE - ILLINOIS

Christie Clinic is a large Multi-Specialty Group practice located in Champaign, Illinois. We are seeking a PSR-36 ABPS Board Certified or Board Eligible podiatrist to join a well established Podiatry department. Must be competent in all phases of podiatric care, Surgical and Conservative. This position will involve rotating through multiple office locations with surgical privileges available at two medical centers and two outpatient surgery centers. Very competitive salary, bonus plan, vacation, and health/mp insurances. Forward CV to wpierce@chrisiteclinic.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

UNIQUE OPPORTUNITY FOR THE RIGHT PERSON! - NEW YORK

We’re in search of a motivated, well-trained DPM who is great with patients. Our well-established multi-doctor, multi-office practice is located in the Hudson Valley region of New York State. All DPM´s in our group are board-certified and there is a residency program affiliated with our practice. Please reply to HVFA, PO Box 3300, Kingston, NY 12402-3300; or via email to bud@hvfa.com

ASSOCIATE POSITION - SOUTHERN CALIFORNIA

Multi-office group seeks associate in Southern California for general podiatry in office setting. NO nursing homes! Spanish speaking a plus. Full or part-time. Excellent compensation with potential for partnership. E-mail scpodgroup@yahoo.com for more details.

ASSOCIATE POSITION – CALIFORNIA

Coast to Coast Mobile Podiatry Group Seeks Podiatrist with Nursing Home contracts! Join our group and let us handle the back-breaking task of billing and managing your patients. This will equal great compensation for you. Please email us back at coasttocoastpodiatry@yahoo.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

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

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