The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

August 04, 2009 #3,613 Publisher-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2009- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

We encourage you to participate in this important survey at www.podiatrym.com/survey Completing this anonymous survey provides us with valuable data, which we will publish in the February 2010 issue of PM. It also makes you eligible to win thousands of dollars of valuable prizes. Enter by sending Question #43 (no answer necessary) to bblock@podiatrym.com along with your name and address.

The Podiatric Practice Manual

This week's prize is a copy of The Podiatric Practice Manual by Joseph Borreggine, DPM (Value $99)..

This is also your opportunity to vote for the next DPM and Non-DPM inductees into the PM Podiatry Hall of Fame.

Supportive Shoes Help Prevent Plantar Fasciitis: IA Podiatrist

Plantar fasciitis is among the most common of foot ailments — but it is also a very treatable one. The baby boomer generation is particularly vulnerable to its pain simply by virtue of the number of boomers. The majority of cases fall into the over-40 crowd.  “There is no question it is the most common situation I see in my office,” said Dr. Steven Brau, podiatrist with Mercy Medical Center-North Iowa.

Dr. Steven Brau

“As we get older our feet tend to flatten out” which will also result in more stretching and tears, Brau said. Getting up in the morning can be the most painful. There are ways to minimize the potential for the painful condition, he said. Do not go barefoot, he said, and avoid wearing flip flops. A good, supportive pair of shoes will help protect the arch.

Source: Deb Nicklay, Globe Gazette [8/2/09]

New Powder Can Heal Diabetic Foot Sores: TUSPM Study

Foot complications, such as open wounds, can be difficult to treat or heal. However, a study has revealed that a new dressing powder, which acts exactly like a layer of skin, is cutting down healing time and reducing the quantum of pain ensuing from serious foot ulcers. “This new powder comes together, in an amazing flexible film that mimics the wound’s surface and helps it to retain moisture and protect the wound, but still allows the right amount of air flow needed for the wound to close,” said study co-author Tracey Vlahovic, Temple University School of Podiatric Medicine (TUSPM).

Dr. Tracey Vlahovic

The study focused on atypical wounds with irregular shapes and causes. The wounds were treated with the powder dressing once a week for four to eight weeks. The study ultimately showed that the powder dressing provided a painless, efficient, and protective treatment that assisted in closing the wound. The powder also helped in preparing the wound for further interventions that are sometimes needed, including options like skin grafts. These results were presented at the APMA’s 97th Annual Scientific Meeting in Toronto July 30-Aug 2.

Source: Thaindian News [8/3/09]

AAPSM Elects New Officers and Directors

On July 31, 2009, the American Academy of Podiatric Sports Medicine (AAPSM), at their annual meeting, elected and installed the following new officers for 2009-2010:

(L-R) Drs. Rob Conenello, Matthew Werd, Bruce Williams, Karen Langone, David Davidson, James Yakel and Executive Director Rita Yates (not shown Paul Langer, Director)

President - David Davidson, DPM - Amherst, NY
President Elect - Karen Langone, DPM - Southampton, NY
Vice President - James Yakel, DPM - Brighton, CO
Secretary/Treasurer - Rob Conenello, DPM - Orangeburg, NY
Director - Paul Langer, DPM - Minneapolis, MN
Immediate Past President - Bruce Williams, DPM - Merrillville, IN
Executive Director - Rita Yates- Walkersville, MD

American People Don’t Want Rationed Healthcare: DE Podiatrist

A raucous standing-room-only crowd of more than 400 cheered, jeered, and booed Health and Human Services Secretary Kathleen Sebelius and U.S. Sen. Arlen Specter. "I'm happy to see democracy is at work," Sebelius said, no detectable irony in her voice.  As each side battled for volume ("I think the boos were louder. That's my opinion," said one in the crowd, Diana Reimer of Lansdale), Sebelius and Specter managed, barely, to impose a tenuous civility on the hour-long meeting titled "Health Insurance Reform -- What's in it for You?"

Dr. Jason Bell

Among the naysayers who stepped up to the microphone was podiatric surgeon Jason Bell from Newark, DE, who said, "The American people don't want rationed health care." Applause followed his remarks.

Source: Jane M. Von Bergen, The Philadelphia Inquirer [8/3/09]

How to Ask for Testimonials

Testimonials are a key component of any good marketing program and getting them isn’t as hard as you think. In fact, the toughest step in the process is the first: asking.

To help, consider asking these three questions in an e-mail or questionnaire after a patient’s visit. These questions are general, you should adapt them to the specifics of your practice.

1. What factors led you to decide to choose us for your foot care needs?

2. Could you explain how our service has helped to improve your health?

3. If you were to recommend us to a friend or family member, how would you describe the benefits of our services?

Jon McDowell, Newsletters Ink PLUS. For information about  the American Academy of Podiatric Practice Management, visit www.aappm.org

Query: Phenol During Pregnancy or Nursing

I have been advised that you should not use phenol with pregnant  women or nursing mothers. We have used empirically it for years without incident. Is there any literature to substantiate this contraindication?

David Wolf, DPM, Houston, TX
 

RE: Coumadin Therapy and Foot & Ankle Surgery (Michael M. Rosenblatt, DPM)
From: Multiple Respondents

Dr. Rosenblatt brings up a very important point that can and does adversely affect many patients on Coumadin living in this country. Even though as Dr. Rosenblatt explains, we as podiatrists, may not be licensed to regulate a person's Coumadin levels, surgeons from other specialties can and do lower their patients' Coumadin levels prior to surgery. I suspect many podiatric surgeons do as well in localities where it is allowed. Here is where communication between the surgeon and the patient's primary care doctor is absolutely essential.

I had an elderly patient on Coumadin who went for an elective ophthalmic procedure. The surgeon took him off Coumadin prior to the surgery, but since he was not his primary care doctor and there was no ongoing line of communication between the two doctors, the patient was never placed back on Coumadin and ultimately suffered a completely debilitating stroke. What this incident, as well as what Dr. Rosenblatt is describing shows, is the absolute need for there to be a primary care doctor who is well informed and involved in the process. This is true whenever a mutual patient, especially one who has significant medical problems, is undergoing any surgery. It is inexcusable for important medical information to fall between the cracks, leading to an untoward medical result. 
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

I have a slightly different perspective from that of Dr. Rosenblatt.  In addition, his report is anecdotal and one should consider all facets of drug therapy when performing foot & ankle surgery. If the patient is on Coumadin, e.g. for atrial fibrillation, their INR will be between 2-3, which means longer bleeding/clotting time. The best approach to this is to pick up the phone and call the prescriber of the Coumadin and discuss what the surgery will entail, and decide what is the best course of treatment, i.e. stopping the Coumadin or substituting Lovenox, a more controllable anti-coagulant. This is the same issue we face regularly with patients on Plavix.

These drugs are anti-coagulants, and depending on the procedure, can have some effect in post-operative healing, hematoma formation, and bleeding.  In addition, often anesthesiologists have an "opinion" regarding anti-coagulation from their perspective, which is potential hematoma at IV site and bleeding post-intubation. This is a complicated issue and just saying "no" does not resolve it.

My suggestion is: 1. consult with the prescriber of the Coumadin, and see how significant the anti-coagulation therapy is for the patient.  2. If the patient is on Coumadin post-DVT, obviously you want them anti-coagulated with Lovenox pre-operatively. 3. The same issues arise in the office, for removal of a toenail or other procedure, e.g. biopsy. In most cases, for office procedures, we are not concerned with Coumadin or Plavix, but inpatient and ASC surgery is a different story.  You don't want to leave Coumadin on board and risk significant bleeding post-operatively.  There are ways to manage these patients, but it's a cooperative effort.

Sloan Gordon, DPM, Houston, TX, sgordondoc@sbcglobal.net

Editor's Note: Dr. Sullivans' extended-length note appears at: http://www.podiatrym.com/letters2.cfm?id=27858&start=1
 

RE: National Healthcare and Podiatry
From: Michael Lawrence, DPM

A couple of years or so back, our esteemed colleague, Harry Goldsmith, DPM, wrote an article in this forum relating to Medicare being a model for a national healthcare delivery system. As you might surmise or recall, this created a stir of controversy. I believe we need to visit this once again and would encourage all of you to go to ourhealthreform.com, the website of Mark Green, MD. I think you will find his thinking stimulating and he is most receptive of constructive input.

I certainly never thought that a traditional Medicare-plus-a-supplement patient would be my best patients from an insurance standpoint - no gatekeepers, no rationing, no pre-authorization, patients have choice. I encourage all to take a look at the options with an open mind and have some say in the changes that are ahead of us, both as providers and consumers.

Michael Lawrence, DPM, Chattanooga, TN, ftdoc@joimail.com

RE: Dragon Naturally Ver. 10 (Larry Kosova, DPM)
From: Burton J. Katzen, DPM

Following up on some of the responses I have received, another time-saving aspect of Dragon is that you can save entire phrases or notes. For example, "Patient denies all past and present food and drug allergies" could be saved as "allergy history." Or, if you usually start a post-op visit with "Patient returns to office today for post-operative visit. A sterile dressing change was performed and all incisions were dry and intact _____,etc.", that could be saved as "Post-op one."

Also, in response to Dr. Kosova, when you "add" words or phrases, the program then allows you to "train" the word, which only takes the amount of time it takes to say the word and click "stop" with your cursor. Almost all the medications I have been using are coming out fine, now after only one week (with four days off to attend the national). It’s the best $200.00 I ever spent. As far as the microphone, I agree that the microphone that comes with the package is not great, and I did not want to put on the attached earphones every time I dictated. The $36.00 Best Buy mike works fine.

Eventually, I would like to use the digital recorder, because going into my office, sitting down, and dictating after every patient is really slowing me down, as opposed to dictating on the run (I have told waiting patients that I was just trying to prepare them for their future national health care), but as of now, I would not feel confident not checking the dictation after every patient. 
 
Burton J. Katzen, DPM, Temple Hills, MD, DrburtonK@aol.com

ASSOCIATE POSITION - SOUTHERN CALIFORNIA

Excellent Opportunity, Full-Time or Part-Time, in busy and expanding podiatry practice. Offices located in Los Angeles and San Bernardino Counties. Fantastic Compensation. No Nursing Homes! Looking for at least one DPM now and one in July 2010. Spanish is helpful. Please send an e-mail to scpods@yahoo.com

ASSOCIATE POSITION - WASHINGTON — WEST PUGET SOUND

Well-established, two-doctor practice in all phases of treatment looking to replace associate who is leaving the area. Looking for energetic, affable, surgically-trained DPM to take over associate position leading to partnership. Satellite office and adjacent multi-disciplinary ASC available for use and possible partnership. Silverdale rated 92nd in best 100 locations in Money/CNN 2009 poll. See link . Contact and résumé at pwa@kitsappodiatry.com

PRACTICE FOR SALE - ALABAMA, GULF COAST 
 
Established 26 year old practice. Owner desires to sell and relocate. Operated 25 hours per week. Mixture of surgery and general podiatry. MD referrals. Surgery center and hospitals in close proximity. Highly profitable. Priced to sell. Will lease office to buyer. Call Mike Crosby at 888-776-2430 or email mcrosby@providerresources.com

ASSOCIATE POSITION - BOSTON, MA 
 
Associate wanted, Full-time or part-time, for busy long time, well established, and well-rounded practice. Good mix of general podiatry and surgery. Office will generate approximately 100+ surgical cases per year. Must have surgical background, ABPS Qualified minimum needed to obtain hospital privileges. Associate position is open for partnership or purchase. Contact robert.nunberg@comcast.net 

ASSOCIATE POSITION - CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for a full-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to fmassuda@footexperts.com

FOR SALE: MICROVASC UNIT

Excellent Condition, Never Used, New 14K, BEST OFFER. All-Pro 2010 X-Ray processor, used, great condition, Includes cassettes BEST OFFER
NYCPodiatry@gmail.com

ASSOCIATE POSITIONS - CALIFORNIA

Podiatrist needed for busy North Hollywood office. Part-time Monday-Friday 8am-2:30pm. No weekends and no call. Pay negotiable. New podiatrists are encouraged to apply. Please email resume and salary request to Coasttocoastpodiatry@yahoo.com

PRACTICE FOR SALE - FLORIDA—CENTRAL/SOUTH

Turn-key operation grossing $570,000 annually based on one full-time doctor. Great opportunity for growing the top-line. Surgery is only 14% of the professional man-hours; it can significantly increase income. Medicare makes up 64% of revenues. Seller will assist with transition. Call 863-688-1725, ask for Chas.

ASSOCIATE POSITION - FLORIDA

Busy practice in East Central Florida in search of full-time podiatrist to perform routine foot care in office and nursing home. Competitive salary and full benefits available. Reply to jrdpm@bellsouth.net

LOCUM TENENS – TEXAS

Looking for locum tenens to work about 3 weeks for me while I am out for an operation. Need Texas license and obviously need malpractice.  Tentative dates are: Last week in August 09 - first two weeks of September. Need to be able to see variety of post-op patients, and otherwise, general podiatric practice and common office procedure (nail, etc.) skills. Salary/terms negotiable. If interested, please call, 409-466-7401 and mention this ad.

PRACTICE OPPORTUNITY - CINCINNATI, OH
 
Well-established practice located in medical/professional building minutes from hospital. Many referrals, three satellite clinics and two assisted living facilities to keep you busy. Associate leaving due to family emergency-need to either find an associate or sell ASAP. Contact bjadpm@hotmail.com for more details.

NEEDED CHICAGO -- NW IND & BALTIMORE/WASHINGTON, DC PODIATRISTS 

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists in Chicago, Northwest Indiana, and Baltimore, MD. 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

ASSOCIATE POSITION – ILLINOIS 
 
Quality Podiatry Group provides quality services to residents at long term care facilities. We are currently offering full-time or part-time positions for motivated ethical podiatrists. Immediate openings available. If interested, fax curriculum vitae to 312 225-9366 or e-mail feetwork@aol.com

ASSOCIATE POSITION – PACIFIC NORTHWEST

Russian-speaking podiatrist needed. Looking for well-rounded, recently out of residency, podiatrist. Would you like to raise your family in our beautiful Pacific Northwest? We are well-established and fast growing multi-office practice with all aspects of podiatry. Attractive compensation, malpractice and medical insurance provided. Call 206-661-9644.

PM News Classified Ads Reach over 11,500 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 11,500 DPM's. Write to  bblock@podiatrym.com or call (718) 897-9700 for details. THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451 Ext 110

• 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.