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August 14, 2008 #3,322 Editor-Barry Block, DPM, JD

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PA Podiatrist Dies after Completing Triathalon

A man who friends said “lived to run” died in Quakertown on Sunday after participating in a triathlon at Lake Nockamixon. Dr. Michael Conte, a podiatrist from Orwigsburg, Schuylkill County, died from what appeared to be a heart attack shortly after the race Sunday afternoon.

Dr. Michael Conte

On Monday, Dr. Joseph Campbell , podiatrist and Bucks County coroner, said Conte died of natural causes. No autopsy was planned. Held at Nockamixon State Park with about 1,200 athletes participating, the Steelman Triathlon included three segments: running, biking, and swimming. The race Conte entered began with a 1,600-yard swim in the lake, then a 25.6-mile bike course and finished with a 6.2-mile run.

Conte was 57, and was a serious runner who had participated in similar events before. According to his closest friend, Karen Dallago, a nurse he had worked with for 22 years, Conte spent a lot of time running and was in great health. “He lived to run,” Dallago said. “When there was a nice day, he'd be out running. He was getting older and he knew that and accepted that, so he didn't push the limits.”

Source: Lindsay Redding, The Intelligencer [8/12/08]

Wearing Proper Size Running Shoes Important For Nail Health: DC Podiatrist

The fact that running shoes have a tendency to run small may mean the right size is as much as a whole size larger than what you'd opt for in a dress shoe.

Dr. Howard Osterman

That somehow tends to be easier for men to swallow. "For some women, it's hard to get over wearing a size 10," says Howard Osterman, a podiatrist with offices in the Washington area. They manage, however, when he tells them the alternative is possibly bloody toenails.

"The caveat, though, is that getting a shoe that's too large - can also make you lose your toenails," he adds.

Source: Vicky Hallett, Washington Post [8/12/08]

CMS Bans Use of Stamped Signatures

CMS has now stated unambiguously that all providers and suppliers must stop using physician signature stamps. In an MLN Matters article (SE0829) released July 29, CMS states, "Stamped signatures are not acceptable on any medical record." "Medicare will [only] accept hand written, electronic signatures or facsimiles of original written or electronic signatures," says the article. This includes progress notes, orders and treatment plans. The reason for this crackdown is CMS's longstanding concern over abuse of signature stamps. "CMS has identified problems of non-compliance with existing statutes, regulations, rules and other systemic problems relating to standards of practice for a valid physician's signature on medical orders and related medical documents," the article states.

Cheryl Rice, corporate director of corporate responsibility for Catholic Healthcare Partners in Cincinnati, says hospitals will have to convey to employed physicians that signature stamps are banned. Hospitals also should get the word out to community physicians because hospital payment may hinge on their compliance with the new CMS policy if their reports are part of a medical review.

Joint Commission surveyors are checking whether hospital medical record entries are dated, timed, and signed as instructed by the Conditions of Participation. "Since the Joint Commission is checking for authentication, hospitals need to be diligent in making sure their internal documentation is stamp free," Rice says.

Source: Report on Medicare Compliance [8/11/08]

A Revealing Question for Job Candidates

Ask a candidate you're interviewing this question: "If I met your former boss at a barbeque and asked to hear just one sentence about you, what would that one sentence be?"

Chances are good that you'll get an accurate picture of that person.

Source: Gail Glasser, Office of the Attorney General, Sante fe, NM

Query: Skin Reaction to Fire Ants

This patient came to see me last week. He states that he was bitten by fire ants (lovely little creatures that we have here in the South) 2 years ago and he has had a slow progression of the skin reaction ever since. He has been given various steroid creams (he could not remember the names of them) and it continues to spread.

Skin Reaction to Fire Ants

Has anyone ever seen this kind of reaction with fire ant bites and can someone suggest a treatment?

Rick Burnell, DPM, Camden, SC

Query: Disposal of X-Rays

Does anyone know the proper way to dispose of x-rays when you destroy the chart after 7 years?

Marc Klein, DPM, Boca Raton, FL

RE: P&A During Pregnancy (Joel Greenwald, DPM)
From: Brian Kashan, DPM, Brian Kashan, DPM

The question about phenolization during pregnancy has to consider that phenol is definitely a toxic substance. Whether it is absorbed at a high enough level, and whether it crosses the placental barrier is the question.

That said, why would anyone risk doing anything that may cause harm to the fetus at all? This is an ingrown toenail, not an acute MI or appendicitis! Just do an avulsion, which will provide the patient with relief of their condition, and if they develop another ingrown nail after the pregnancy, worry about phenolizing it then. In 27 years, I have NEVER had a pregnant patient question my rationale for not doing the P&A.

Brian Kashan, DPM, Baltimore, MD, drbkas@worldnet.att.net

It would seem to me that any amount of phenol absorbed systemically during the short time that a P&A takes would be minimal at most. If you're worried about it, though, you might consider switching to sodium hydroxide and vinegar for your permanent nail removals.

Paul Busman RN,DPM, Clifton Park, NY, brewerpaul@aol.com

RE: Chiropractic Adjustment before Casting for Orthotics? (Jeff Root)
From: Howard J. Dananberg, DPM, Elliot Udell, DPM

Jeff Root questioned the outcome of manipulation prior to orthotic impression casting and queried whether it would change the plantar contours of the foot. My experience has found that the foot contours do change, most particularly the forefoot to rearfoot relationships. Forefoot supinatus can be almost immediately resolved via manipulation, and thus the entire posting strategy altered. When coupled with the technique for manipulating ankle equinus, the changes are so profound, I find it hard to imagine trying to solve complex biomechanical issues without using manipulation.

Last week, I saw a 23 yo Down's Syndrome male for the first time. He was in high top boots and UCBL orthotics. He could barely walk down the hallway and his feet were almost 45 degrees abducted! On exam, the forefoot was very sloppy and hypermobile, but there was a negative 4 degrees of ankle joint dorsiflexion with the knee extended. He had a large keratotic lesion sub medial/inferior navicular where it abutted the UCBL. After manipulating his equinus and basically grinding his UCBL to a standard orthotic design with a 1st ray c/o, he was able to stand and walk w/out pain. His abducted position decreased to near normal as well. His smile was ear to ear....and I think explains the value of manipulation procedure when combined with foot orthotic therapy.

Howard J. Dananberg, DPM, Bedford, NH, howiedbpg@aol.com

RE: Gas: The New Workplace Perk (Bob Levoy)
From: Multiple Respondents

I give one full-time employee a $120 gas card per month. This is because of the considerable distance she has to travel and that she is the office manager. Everyone else gets a $25 gas card. This has increased staff moral considerably. It shows them that I appreciate their difficulties and I am on their side.

Michael Forman, DPM, Cleveland, OH, IM4MAN@aol.com

We have not reimbursed our staff for gas but a few weeks back to show our appreciation for their great efforts each and every day we gave them all a one hundred dollar gas card with a thank you note. They loved it! I always say, it's not our customer who is #1, it's our staff.

Hal Ornstein, DPM, Howell, NJ, hornstein@aappm.org

We don’t provide a gas allowance but we do have one valuable, hard-working employee in our business office who lives 45 miles away with two very young children. We set her up on gotomypc.com. She telecommutes 3 days a week and comes to the office 2 days a week. She works whatever odd hours of the day she chooses and her hours have decreased while her output has increased. Since she is doing our insurance most of the time it does not matter where she is. If she calls patients from her home we cover her phone bill for those calls if they are long distance. It has been win-win.

Alan Kalker, DPM, Middleton, WI, ajkalker@facstaff.wisc.edu

RE: Projections of Supply and Demand for Podiatric Physicians
From: Bruce Smit, DPM, Bryan C. Markinson, DPM

Editor’s note: These extended-length letters appear at: http://www.podiatrym.com/letters2.cfm?id=21299&start=1

Name Withheld (8-12-08) makes an excellent point that many are unwilling to admit. I practice...

Bruce Smit, DPM, Frankfort, IL, footbiz@sbcglobal.net

As a podiatry student 30 years ago, we were told that there were enough podiatrists, but they were poorly distributed around the country. As I...

Bryan C. Markinson, DPM, NY, NY, Bryan.Markinson@mountsinai.org

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