The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

August 13, 2009 #3,621 Publisher-Barry Block, DPM, JD

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MN Podiatrist Discusses MIST Therapy for Diabetic Wounds

A significant challenge with non-healing wounds is that they often have deep wound beds where bacteria colonize and produce flourishing infections, says Dr. Steven Kavros, a respected podiatric surgeon and researcher at the famed Mayo Clinic in Rochester, Minnesota. The bacteria develop into a biofilm, which he describes as looking like a cookie. In fact, the bacteria create a sugar-laden form over the wound that obstructs the application of antibiotics and treatment.   

Dr. Steven Kavros

MIST Therapy, which was approved by the FDA in October 2004, was developed by a Minnesota company named Celleration. Treatments are done 5 centimeters from the wound. Typically, wounds are treated three times a week, and each treatment is about four minutes long.

In one study done by Dr. Kavros and his co-investigators, size-of-wound reduction in patients using the system was achieved 72 percent of the time, versus a 46 percent reduction in the patients using normal wound therapy. Total wound closure for patients using the system was 70 percent, compared to 21 percent for the patients receiving normal care.

Source: Dennis McGrath, Diabetes Health [8/10/09]

26 Spanish Podologists Hone Their Skills in NYCPM’s Bako Anatomy Lab

The New York College of Podiatric Medicine (NYCPM) recently hosted twenty-six podologists from Spain in cooperation with the Universidad Complutense de Madrid, providing them the opportunity to attend two challenging week-long courses on anatomical dissection and surgical skills taught in the College’s new Bako Anatomy Lab.

Louis L. Levine (R), and Dr. Michael J. Trepal present a certificate to Professor Ricardo Becerro de Bengoa Vallejo, DPM, PhD (L)

Michael J. Trepal, DPM, Vice President for Academic Affairs and Dean at NYCPM, directs this semi-annual program of visiting students from Spain, now in its eighteenth year, on behalf of the College.  Professors Ricardo Becerro de Bengoa Vallejo, DPM, PhD., a graduate of NYCPM, and Marta Losa Iglesias, RN, PhD., work closely with Dr. Trepal to direct the program. Both of these course directors accompanied the students on their visit. The work with the Spanish students involved lower extremity cadaver dissection, as well as videotaped demonstrations.

Retired MI Podiatrist Feared Murdered

A popular podiatrist dies under suspicious circumstances, and police believe he may have been murdered. The family tells a sad story of his final moments. Dr. Gary Ceresnie was 54 years old and a recently retired podiatrist who had practiced in Brighton. Illness forced Dr. Ceresnie to retire late last year. He died Sunday night.

Dr. Gary Ceresnie

He was on Michigan Avenue west of downtown Detroit when he approached a business owner. Ceresnie had experienced some kind of trauma and was bleeding.

Detroit homicide detectives are trying to piece together the case, and forensic test results are pending. Police are unsure why Dr. Ceresnie was in the area and they haven't ruled out the possibility that he might have been brought there.

Source: Bill Gallagher, Fox 2 News [8/11/09]

Carry Conversational Load With Ease

How good are you at casual conversation? The following tactics will show you how to master the art:

• Don’t tell all that you know. Tell it all and you risk tiring your listeners. If they are interested, they will ask you for more details.
• Spice it up. Use body language to gain and hold listeners’ interest.
• Keep an even keel. Don’t raise your voice to gain attention. Many listeners will unconsciously move away.
• Seek feedback. Ask a close friend if your voice seems shrill, harsh, too soft or too loud. Awareness of those vocal faults lets you correct them.
• Skip the slang. Listeners may not understand or appreciate slang and clichés.Worse, using them conveys the impression that your vocabulary is limited.

Source: Adapted from “Handling Communication Problems,”W.H.Weiss via Communication Breifings

Query: Tarsal Tunnel Syndrome?

My patient is a 42 year old female with pain on the medial proximal aspect of the foot. There is a positive Tinel’s sign over the tarsal tunnel. MRI, x-rays, ultrasonograms are either equivocal or negative. Three injections have reduced the symptoms for only a few days when the discomfort comes back. I tried to inject the sinus tarsi, but this had no effect. Orthotics have reduced the pain such that the patient can go about her business most, but not all, the day in pain but comfortable enough to carry on. This patient is ready to be off of her feet by the end of the day. There is no pain when non-weight-bearing. I have been reluctant to do EMG due to the above negative symptoms and because the real “clue” to the diagnosis—I believe—lies in the fact that a positive heel with her orthotics has helped (though not cured) the problem. Is it tarsal tunnel syndrome or have I missed the boat?

Jim Fisher, DPM, Eureka, CA
 

Query: Care Credit
 
Does anyone have experiences they would like to share utilizing Care Credit (GE Money Bank) as a payment service in private practice? 
 
Bruce Pinker, DPM, Pomona, NY
 

RE: Surgical Options for Hallux IPJ Pain (Richard Frost, DPM)
From: Jeffrey Kass, DPM

My vote is for the hallux IP Fusion. As you state in your posting, the pain is medial and not lateral (even though the fracture fragment is lateral). You have the hallux interphalangeus and you have the hammered hallux, both of which will be fixed with a fusion. If you take out the fracture fragment, you might still be left with pain, as the pain is medial and not lateral. You are also still left with the hallux interphalangeus and hammer toe deformities.

Incidentally, I would try infiltrating the region with steroid prior to the surgery to see if any pain is eliminated. This obviously will not correct the interphlangeus or the hammer toe, and not allow your fracture fragment to heal.
 
Jeffrey Kass, DPM, Forest Hills, NY, Jeffckass@aol.com
 

RE: Tingling and Burning of Toes Under Bedcovers (Bob Hatcher, DPM)
From: Dan Waldman, DPM

Perhaps change her bed sheets and/or get a new mattress. Does it happen in other beds (hotels, etc.)?

Dan Waldman, DPM, Asheville, NC, DPMcareer@aol.com
 

RE: Delighting Patients (Bob Levoy)
From: Jim Steinberg, DPM, Jeffrey Kass, DPM

When I first started in practice in the mid 70`s, I had a receptionist who had an outstanding personality. She would greet everyone as they entered my reception room with a big "GOOD MORNING (or afternoon) with a big genuine smile on her face. I know what you are going to say, don`t say good morning to patients as you might get an answer back such as "what`s good about it?" But, it did work and I stuck with it, not interfering with how she initially greeted patients.

Jim Steinberg, DPM, Tampa, FL, footmedicine@yahoo.com

Call patients on their birthday to wish them a happy birthday. Elderly patients are often forgotten, and this makes them feel great.
 
Jeffrey Kass, DPM, Forest Hills, NY, jeffckass@aol.com

Editor’s note: Bob Levoy will award a copy of his recent book, "222 Secrets of Hiring, Managing and Retaining Great Employees in Healthcare Practices" (Value = $59.95) to the PM News subscriber with the best response to "How do you delight patients?" 

RE: Meet the Masters is a Success
From: Ira M. Baum, DPM

Last night’s teleconference with Dr. Barry Block was very enjoyable and informative. I think one of the most interesting features of Dr. Ribotsky’s concept is who is listening, and who participates.  Even though there is a featured speaker, to have other experts such as Dr. Morgan and Dr. Guiliana participate in a round table discussion was more than I expected. 

After the fact, I listened to Dr. Weil’s teleconference, but I hope he and other featured guests will continue to participate in the programs, as will other experts in our field, whether known or unknown.  I look forward to future conferences.
 
Ira M. Baum, DPM, Miami, FL ibaum@bellsouth.net

RE: Yellow Pages Parity (Frank DiPalma, DPM)
From:  Pete Harvey, DPM

In Texas, it has been my experience that the continual problem with Yellow Pages discriminating against podiatrists is an AT&T issue. All other Yellow Pages have no problem listing Podiatrist, D.P.M. in the Physician and Surgeon section of the Pages. The listing used to be after the Plumbing section. The problem was solved for a few years and then AT&T reversed its decision, and podiatry listings now are placed after the MD listing when it should be alphabetical as DPM, DO, MD, etc.

The correct listing is not a problem for other directories in the state such as Great Western. I suspect this is true all over the country. I have been told for years that orthopedists have kept a position on the Board of Directors of AT&T. It seems that this might be a good issue for APMA to tackle as a cause célèbre.

Pete Harvey, DPM, Wichita Falls, TX, pmh@wffeet.com

PRACTICE FOR SALE - FLORIDA—CENTRAL/SOUTH

ASSOCIATE POSITION - FREDERICK, MD

Well-established and growing 2 office state-of-the-art practice located in medical/professional buildings. EMR, Digital X-ray, Ultrasound, DME provider, etc. Competitive Base Salary plus bonus, malpractice, health insurance, etc. PSR 24 minimum/Board Qualified or Certified with ability and desire to take ER call. If interested, forward CV to DOCSBNB@aol.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 - ILLINOIS

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 - 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

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 - MARYLAND

Harford County, Bel Air, est. 1991, seeking PSR24/36, strong ethics, friendly demeanor. Associate or partnership opportunity for the right applicant. We provide onsite ambulatory surgical center, patient base, strong referral resources, billing, scheduling, and many technologies. Visit our website. e-mail your CV to drhoward@hlsfootcare.com.

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

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