The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

August 05, 2009 #3,614 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’ve just posted the August 2009 CME titled:

By Robert G. Smith DPM, MSc, RPh

You can Earn 30 CPME-Approved CME Contact Hours Online

 Earn 15 Contact Hours for only $139

Orthotic Device Can Often Help Prevent Bunions: MI Podiatrist

High heels and pointed-toe shoes create a number of foot conditions in women that aren’t as common in men, because of the difference in footwear.

Dr. James Hirt

Bunions are an excellent example of a condition that affects more women than men, “five to one,” according to Dr. James Hirt of Fenton Foot Care. He estimates that about 10 percent of his patients suffer from bunions.

“Preventative care is the most important aspect of successful bunion treatment,” said Dr. Hirt. “Catch the problem early, wear proper shoes and, if necessary, get into a good orthotic device that redistributes one’s weight on the foot.”

Source: Sally Rummel, Tri-County Times, [8/3/09]

BUSPM to Celebrate 25th Anniversary

Barry University’s School of Podiatric Medicine will celebrate its 25th anniversary in 2010 and, to celebrate, will host a casual and fun “Barefoot Ball” Jan. 10, 2010. The Florida-themed gala will take place at the Caribe Royal Resort in Orlando, FL during the Florida Podiatric Medical Association’s (FPMA) annual Science and Management Symposium. 
 

Barry University School of Podiatric Medicine

Funds raised from the anniversary celebration will benefit the Dr. Marvin and Ruth Steinberg Memorial Scholarship at Barry University. The scholarship supports podiatric medical students with the cost of their education. "There will be a lot of surprises in store for our alumni,” said Dr. John Nelson, interim dean for the School of Podiatric Medicine.

Dr. John Nelson

The School of Podiatric Medicine has made notable progress since its modest beginning in 1985; there were 18 students in the first class, no clinics, and only one hospital affiliation. Today, the school has nearly 200 podiatric medical students with over 250 hospital based clerkships. The school boasts a 36-month podiatric medical and surgical residency training program and more than 1,100 graduates.

Go Ahead And Print Extras; Thermal Paper Is Cheap

Always hit the print button twice with any diagnostic ultrasound images you capture. Give a copy to the patient to show around their office or to put on the refrigerator door at home. You will get the positive attention of your patient’s family, friends, and co-workers.

Make sure your practice name is in the "facility" space and always notate the view (cross section or longitudinal) and diagnosis with measurements, where applicable.

In addition, you can send a copy to the patient's PCP with your ultrasound report and/or office notes. The PCP will realize your practice is on the diagnostic cutting edge and I promise they will be impressed.

Source: D. Charles Greiner, DPM, Vice-President, AAPPM. For information about  the American Academy of Podiatric Practice Management, visit www.aappm.org

Dr. Comfort Launches Certified Fitter Education Program

“This new course is going to be a great educational opportunity for any podiatrist, podiatry assistant, or staff,” said Rick Kanter, Dr. Comfort’s President and Founder. “We have a good instructor and are excited to give podiatrists and their staffs the chance to brush up on fitting skills and teach staff proper techniques. Our goal here is to give as many people as possible the opportunity to further their education and learn about diabetic footwear, so we’re going to be offering the course all around the country for a reasonable price. We’re hoping for great attendance in the coming months.”

Rick Kanter

Five courses have already been scheduled, and Dr. Comfort plans to add many more in the Fall. August 23 in Atlanta, GA, August 24 in Nashville, TN, August 25 in Memphis, TN, Sept. 14-15 in Mequon, WI, Oct. 8 in Orlando, FL

The course will be taught by Brian Lane, C.Ped., Dr. Comfort’s Director of Education. Lane joined Dr. Comfort in February 2009 after serving as the Director of Pedorthics for a large podiatry practice in Atlanta. Brian also has years of experience as a public school teacher and is a veteran of the National Guard.

Query: Primary Vs. Secondary Repair of Tendons

Would someone explain the difference in primary and secondary tendon repair as it pertains to coding (for example, a peroneal tendon repair that is not an acute injury)?

Jon Strickler, DPM, Cleveland, TN

Response: This matter was discussed on Codingline in 2006, and published in the December 2006 issue of CodinglinePRINT. At that time, the concensus of the experts was that:

PRIMARY Repair: Any repair of an acute injury completed within 24 hours of the injury;

DELAYED PRIMARY Repair: A repair performed later than 24 hours after, but less than 2 weeks after the acute injury;

SECONDARY Repair: Any repair performed greater than 2 weeks subsequent to the injury.

Rick Horsman, DPM, Olympia, WA

Codingline subscription information can be found at:
http://www.codingline.com/subscribe.htm

Phenol During Pregnancy or Nursing (David Wolf, DPM)
From: Stanton C. Southward, DPM, Dra. Marta Losa Iglesias, PhD

I advise deferring elective procedures involving anesthetics and chemicals until after delivery and after the infant is weaned. I know of no literature on this subject, but I believe common sense should prevail.

Stanton C. Southward, DPM, Colorado Springs, CO, sbsouthie@comcast.net

For further information about this topic see:Losa Iglesias ME, Veiga de Cabo J, Tejedor Traspaderne J, Aguilar Franco J, Bernaola Alonso M, Becerro de Bengoa Vallejo R.Safety of phenol vapor inhalation during performance of chemical matrixectomy to treat ingrown toenails. Dermatol Surg. 2008 Nov;34(11):1515-9. 

Conclusion: The performance of chemical matrixectomies is safe for healthcare personnel when they are exposed to the vapor of phenol solutions of up to 95% concentration for up to 21 minutes. The degree of safety would be greater with lower phenol concentrations and shorter exposure times.

Dra. Marta Losa Iglesias, PhD (Spain) marta_losa_iglesias@hotmail.com

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

My condolences to Michael Rosenblatt, DPM on the loss of his friend. I agree with his concern over stopping anticoagulation therapy. I work in a vascular department where the majority of our patients are on Coumadin.
 
Irrespective of the scope of surgery to be performed, or the scope of our podiatric license, it is common courtesy to contact the physician who placed the patient on any systemic medication. This is particularly true for medications such as Coumadin, hypertensive medications, cholesterol-reducing medications, etc. Patients often don’t know the reason why they are on many of these  and often only offer a very generic rationale (e.g., cardiac condition,  previous leg blood clots, etc.).

My standard of practice is to contact the specialist who initiated the treatment and discuss the case with him/her. In the case of Coumadin, that medical specialist is more than just responsible for anti-coagulating the patient, but for managing the patient’s systemic condition which warrants anti-coagulation. This is a common practice of dentistry and orthopedics to name only a few. Podiatrists should be proud of their specialty and eagerly refer and defer to those specialists who manage these conditions every day.

Podiatrists (as all other specialists) have a difficult enough time keeping up with our own specialty. One should be expected to defer to other specialists to provide the care they do every day. It should not matter whether one is planning to perform an ankle fusion, placing the patient in cast for fractures, or performing minor nail surgery. One should be deferring to the PCP, cardiologist, etc. and allow them to plan the discontinuation, initiation and/or resumption of Coumadin for our mutual patients.

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

At our hospital, if a surgery is planned, typically the patient is switched from Coumadin to heparin. The foot surgery is done when the INR hits around 1.7-1.9. We will "hold the heparin on call to the OR." For an emergent surgery, Vitamin K or FFP may sometimes be needed. Heparin is resumed immediately after the surgery. Coumadin is resumed and monitored to therapeutic levels prior to discharge. This is actually more complex than I am stating as other medical factors come into play, so we do involve the entire medical team to discuss the health of the patient, goals of the surgeries, medical treatments, etc.
 
In the clinical setting, I routinely check the INR. I will do the surgery if the INR is still therapeutic, but closer to 2. I am also much more careful about debriding ulcers when my INR is 3 or greater. This has paid off as I discovered a patient whose wife was accidentally poisoning him with a stronger dose of Coumadin from a old bottle. His INR was 10.
 
Diane Branks, DPM, Baldwin Park, CA, barrydiane@hotmail.com

Editor’s note: An extended-length note by Dr. Mullen appears at:
http://www.podiatrym.com/letters2.cfm?id=27891&start=1

RE:  2009 APMA Scientific Meeting
From:  Robert Chelin, DPM

First of all, I would personally like to thank the APMA for the wonderful Achievement Award that I was presented. I have attended the Annual Scientific meeting for the last 10 years and this ranks up there with Philadelphia and Boston, which were the biggest meetings ever. From the opening address by Mike Huckabee to the closing evening celebration, it all ran smoothly with no glitches. The scientific program was top notch and even the weather participated. Events like this do not just happen. It takes the hard work of many individuals who must work together like a fine tuned engine. The APMA Annual Meeting Committee and APMA staff did such a wonderful job in making this event a success. It is these behind the scenes individuals who deserve a lot of credit. We must all thank you

On behalf of my Canadian colleagues, I would like to thank the APMA for taking this bold move in coming to Canada. Your Canadian brothers and sisters  on the north side of the border are the largest contingency of DPM's in the world who do not reside on American soil and most are APMA members. We have all graduated from your schools and most of us continue to support your alumni. Podiatry in North America is the gold standard and we are all very fortunate. Together, we can make a difference to raise the bar of podiatry, globally

Robert Chelin, DPM, President, International Federation of Podiatrists (FIP),                       ft-biz@rogers.com

RE: American People Don’t Want Rationed Healthcare: DE Podiatrist
From: David Mullens, DPM, JD

Why would anyone think for-profit insurance companies don’t “ration” health care? Put the name of your favorite for-profit insurance company into the Google search bar and add the word “lawsuit” after the name of the company. Now hit the ‘search’ command and scroll through the (literally) hundreds of thousands of hits describing the disgusting, rationing-for-profit conduct of that company.  To make sure you understand how industry-wide this behavior is, put the names of the other large insurance companies – one at a time – into the Google search bar and repeat the same search. Every one of the for-profit companies has been sued over and over again for fraudulent denial of benefits (rationing) motivated by insurance company (corporate) profits.

Do you really want your health care coverage rationed by for-profit corporations who have mile-long rap sheets with prior convictions for fraudulent denial of benefits? 

David Mullens, DPM, JD, Palo Alto, CA, dmullens@mullenslawoffice.com

ASSOCIATE POSITION - NEW JERSEY

Established successful practice in Central New Jersey seeking PT/FT Associate. PSR 24/36. Please forward CV to rpg145@gmail.com or fax 908 753-0100.

ASSOCIATE POSITION - ILLINOIS

Excellent opportunity for qualified candidates in Northern Illinois/Western suburbs of Chicago. Growing two office practice searching for an associate to grow into a partnership. Full-time position, PM&S-36 board certified or qualified physician in forefoot and rear foot surgery. Multiple hospital and surgery center affiliations. e-mail DrTina@DrTinaOnline.com

ASSOCIATE POSITION – CHICAGO

South Side Chicago practice seeks podiatrist. Practice focuses on general podiatry, surgery, biomechanics, and diabetic foot care. Candidate should be surgically trained, certified/ working toward certification by ABPS. Surgery in office and hospital with residents. Base salary w/bonus incentives, paid malpractice insurance, benefits. Contact. ChicagoDoctor2009@yahoo..com or 773-632-7042

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.

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

• 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.