August 07, 2006 #2,648 Editor-Barry Block, DPM, JD

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See Doc If OTC Fungal Medicine Doesn’t Work in 10 Days: MS Podiatrist

With months of hot weather left on the calendar, it's not too late to take better care of your feet, said Amory podiatrist Dr. Vern Christensen. Sweaty feet are a recipe for more than stink. "When you get perspiration and fungus in the feet, it is a breeding ground," Christensen said.

The itchy, dry, flaky feet of athlete's foot signals that the fungi have gotten the upper hand. Bare feet can pick up the fungi in places like dressing rooms, locker room showers and hotel rooms. Sweaty summer shoes can create a breeding ground for the common fungal affliction. Over-the-counter sprays are a good place to start, but if they don't clear the problem in seven to 10 days, people should see a doctor for a prescription treatment that covers a broader range of fungi, Christensen said. "If you let it go too long, it can become compounded by a bacterial infection," Christensen said.

Source: Michaela Gibson Morris, Northeast Mississippi Daily Journal, 8/4/2006

JAPMA to Publish NYCPM Faculty Paper on DNA Identification of Dermatophytes

The Journal of the American Podiatric Medical Association has accepted for publication a paper written by NYCPM faculty member Judith Binstock, Ph.D., Professor of Biochemistry and Molecular Biology in the College’s Division of Pre-Clinical Sciences. The paper, entitled “Molecular Biology Techniques for Identifying Dermatophytes and Their Possible Use in Diagnosing Onychomycosis in Human Toe Nail: A Review,” looks at a number of the DNA-based techniques that are presently being used to identify dermatophytes, and assesses the possible diagnostic use of those techniques.

The abstract states, “Traditional methods for diagnosing onychomycosis such as microscopy, histological staining, and cultures may not provide the clinician with documentation before initiating antifungal therapy. DNA technology now supplies the tools for increased sensitivity, speed and accuracy in the diagnostic arena by allowing for the amplification, qualification and quantitation of DNA. These techniques, already being used to identify many infectious agents, may soon be commonly applied to onychomycosis.”

Gov’t Gets $15 Return on Each Dollar Invested on Fraud Enforcement: Report

The federal government is collecting $15 for every dollar it invests in health fraud enforcement — almost twice as much bang for the buck as the government got in the late 1990s, a new report says. A big reason for the government's high yield is the False Claims Act and its whistle-blower provisions, according to the report, which was written by health care economist Jack Meyer. But the Department of Justice (DOJ) still underuses the statute, the report asserts.

"The U.S. taxpayers are getting an excellent return on their dollars invested in fighting fraud against the Medicare program," said Meyer, who prepared the July report for Taxpayers Against Fraud (TAF), a Washington, D.C., organization.

Between 1997 and 2001, the federal government collected an 8-to-1 return on investment (ROI) for money pumped into investigating and prosecuting health care fraud, according to the report, which was released this month. That grew to $15 per $1 from 2000 to 2004, with the feds spending $443.8 million to collect $6.6 billion in health fraud-related settlements and judgments. Meyer attributed the increase in the ratio to the fact that recoveries have grown much faster than enforcement costs.

Source: Report on Medicare Compliance [7/31/06]

Query: Rising Gas Prices and Employment

I'm beginning to hear rumblings from employees who say they are thinking about changing jobs because their commute is becoming too expensive. I'm interested in knowing whether anyone has experienced any problems with recruiting or retaining employees because of rising gas prices? Has anyone offered employees any kind of assistance such as a mileage allowance to compensate for the of high price of gas?

Bob Levoy, Great Neck, NY, b.levoy@att.net

RE: Malignant Melanoma (R. Denis Russell, DPM)
From: Multiple Respondents

Dr. Russell asks about the level of amputation required, and enhanced pathological analysis after he excised a 1.78mm deep melanoma from the tip of a fifth toe. This situation is addressed in the next print issue of PM News in the Dermatology Issues section. First of all, he should be commended for excising the lesion totally, which if possible, is always the best biopsy option for suspicious lesions when size allows for it. This lesion is certainly at a depth where scrupulous follow up is required as follows:

Firstly, the patient should be referred to an oncologist familiar with treating melanoma. The patient will be evaluated for any evidence of metastases. The patient also needs a total body skin examination by a dermatologist, including the scalp and genital and anal areas. At the same time, the patient should be scheduled for amputation of the digit to the level of the metatarso-phalangeal joint. Although the need for sentinel node biopsy, which provides enhanced pathological analysis, is controversial at the moment, it still is pretty much standard procedure and optimally should be done at the same time as the amputation. This must be coordinated with nuclear medicine and a general surgeon. In my institution, all of the above is completed within ten days of diagnosis.

Bryan C. Markinson, DPM, New York, NY, Profpod@aol.com

I suggest you work with a plastic surgeon on this case; node biopsies will have to be taken and a wide margin will have to be surgerized to obtain clear margins. The patient should be very grateful that you had the foresight to take a biopsy.

Robert J. Snyder, DPM, Tamarac, FL, drwound@aol.com

Not long ago we had a similar patient with a distal melanoma of the 2nd toe. We did the appropriate biopsy. My partner and I thought we would go ahead and do a digital amputation. I discussed it with a general surgeon and he strongly suggested the patient be sent to the regional melanoma clinic. In our area that happens to be at the University Of Michigan. They did the sentinel node testing and amputation of the digit. They essentially told the patient no one should do these except them of course. They did a lousy job with the amputation, but they were the experts. I would think twice before tackling melanoma on your own.

John Clarke DPM, Fremont OH, jclarke2735@sbcglobal.net

One absolutely should obtain sentinel node biopsy in the overwhelming majority of malignant melanoma cases. This is the standard of care for this pathology, especially when the tumor's vertical growth extends beyond 0.75 cm (Breslow II and higher). The most recent conferences from the American Academy of Dermatology conclusively show that the performance of sentinel node biopsy in malignant melanoma cases improves the overall 5 year survival rate, most interestingly, whether the test's outcome is + or -. Presumably, just the mere fact that the patient is monitored extremely closely, apparently improves the long term outcome.

In addition to what has already been done, I highly recommend that you immediately refer your patient to a dermatological oncologist for further follow up. They are in the best position to determine whether additional surgery, whether it be even wider excision, or possibly partial or total digit ablation, is warranted. The largest malpractice risk one incurs, in cases like this, is the failure to consult the appropriate specialist, especially if there is a significant risk of mortality.

More importantly, with all due respect to your own medical and surgical expertise, your patient's long term medical outcome in cancer pathology can only be enhanced when they are evaluated by the appropriate specialist. Kudos to you for recognizing the pathology and making the diagnosis through wide excisional biopsy. This is one potentially very deadly tumor, especially when it vertically integrates beyond 0.75 cm. that cannot be medically mismanaged.

Barry Mullen, DPM, Hackettstown, NJ, YAZY630@aol.com

RE: Doing Business With Patients (Elliot Udell, DPM)
From: Lloyd Smith, DPM

I have had many wonderful experiences dealing with patients. My accountant of nearly 30 years came from a patient contact. I have had 2 lawyers, a home decorator, an office designer, 2 home gardeners and many others I have dealt with in very positive ways.

Doing business in you community and practice will enhance your life if done wisely. Of course, that tired cliche applies to everything you do..

Lloyd Smith, DPM , Newton center, MA, lloydpod@yahoo.com

RE: Bruce Frankel, DPM

Dr. Bruce J. Frankel was truly an ambassador to podiatry. I have never encountered another practitioner who was so pro our profession. In freshman year he taught us basic operative podiatry, and offered us many of his "pearls." My wife affectionately referred to him as the "Godfather" of podiatry. I had the pleasure of working in the admissions and student affairs office with Bruce while I was a student. He was great to work for, and spoiled me rotten!! I went to several career days with Bobbi. & Bruce. What an honor this was to see this man promote a profession which he truly loved passionately!!

Going to spend a Saturday in his office was a thrill. One time he was doing a surgery in his office. Being a naive Junior student, I didn't understand when he turned to me, and said "Craig, did you bring the book?" This was right before the operation, and, in front of the patient! Bobbi played along perfectly, and said, "How can Dr. Frankel operate without the book??!!" It was the perfect way to relax the patient before the procedure!!

Bruce literally knew everyone in the profession. His office door was always open to all. In the years when residencies were scarce, he would make phone calls to ensure as many students would be placed as possible. My sympathies to Bobbi, the girls, and the beautiful grandchildren. Rest assured, Bruce is in a better place with his son Justin right now. There will never be anyone again like Bruce. He will be sorely missed, but his spirit will live on forever. Rest in peace dear friend. It was a pleasure and honor to know you!

Awilda and Craig Campbell, DPM

ASSOCIATE POSITION - GULFCOAST OF FLORIDA

Great opportunity in rapidly growing practice for a PSR- 24/36 BE/BC podiatrist with strong surgical skills. Hospital privileges available at 548-bed hospital system, new hospital is being built and multiple surgical centers. Candidate should perform rearfoot & ankle surgery, including Charcot reconstruction. Candidate needs to be ethical and motivated and must have a current Florida license. Established practitioner or new practitioner OK. Salary + percentage + benefits including insurance and 401K. Fax CV to (239) 566-8778.

POSITION AVAILABLE-RETIRED OR DISABLED PODIATRIST-DELRAY BEACH FLORIDA

Full or part time position in start up pharmaceutical company. Duties would range from answering phones to publishing scientific papers. Please contact: rhm123@gmail.com

Southeast Florida Podiatrist Needs Top Notch Candidate

South Florida podiatrist looking for an astute, personable, extremely well trained podiatrist with excellent clinical skills and acumen. My practice is busy, rapidly growing, and referral based. Looking for a full time associate to start immediately. Partnership opportunity available. I require someone who can work independently and wants to help elevate this practice to a new level. Email your resume to podiatry49@hotmail.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

ASSOCIATE POSITION- SOUTH CAROLINA

Associate position available in South Carolina south of Charlotte. Two office practice, with two podiatrists, in a growing area. Well-rounded practice with all aspects of podiatry. Opportunity for future partnership. Please send CV to cathykop@hotmail.com or fax it to 803-396-8657.

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

PRACTICE FOR SALE - BERKELEY CALIFORNIA

Well-established office in professional medical building; Biomechanics, Geriatrics and General Podiatry; Excellent growth potential for surgery; Payor base MC, PPO, and self-pay (NO HMOs); Reliable referrals from local physicians; Electronic billing in-house; Transition terms negotiable. Send letter of intent to: foot4sale@sbcglobal.net

WELL ESTABLISHED PODIATRY PRACTICE IN MT. AIRY, NC

Dr. John H. Hodges had a well-established podiatry practice in Mt. Airy, NC that is either for sale or in need of an associate/partner to come on board. Dr. Hodges unexpectedly passed away in January 2006, leaving approximately 3500 patients without a podiatrist. This is a unique opportunity to be able to work in an extremely busy practice. If interested, contact Carolyn McMackin at (336)577-2886 or cmcmackin@triad.rr.com

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

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