The Voice of Podiatrists

Serving Over 9,500 Podiatrists Daily

August 28, 2007 #3,025 Editor-Barry Block, DPM, JD

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Congratulations to Deborah L. Cook, DPM of , Mentor, OH, our weekly survey contest winner, who has won an ACME MADE Designer Slim Computer Bag (Value $149).

Bones and Cartilage

This week's prize is a copy of Bones and Cartliage by Brian K Hall (Value$104) . To enter the contest, complete the survey at www.podiatrym.com and send us question #45, along with your name and address. Be sure to vote in the survey for the 2008 inductees in the PM Podiatry Hall of Fame. All entries are eligible for the grand prize of a one-week Windjammer Caribbean Cruise.

CA Podiatrist Creates New Nail Fungus Treatment Based on Super Blue

Dr. Tim Nguyen is a podiatrist in Oxnard. Dr. Paul Rehder has dermatology offices in Oxnard and Camarillo. The two have teamed up to test and market a nail fungus treatment created by Nguyen. "A lot of doctors don't believe anything works on fungus," Nguyen said. "There are so many over-the-counter medications, and none of them work. Nobody believes there's any topical that works on fungus."

Dr. Tim Nguyen Photo by Juan Carlo Mendoza

Nguyen was an electrical engineering student before his native South Vietnam fell into communism and he moved to the United States. He majored in biology and chemistry at UC San Diego but ran into a roadblock when he went to enroll in medical school — his English wasn't good enough at the time. So, Nguyen worked as a research associate at UCSD while he worked on his doctorate. He later went into podiatry. "I never stopped looking for an opportunity to improve and continue my research," he said. A part of the research he read tickled the back of his brain. He found that the stuff found in Super Glue created a strong bond with the keratin in nails. He started thinking that the Super Glue material could help to bond anti-fungal agents to nails.

The doctors say they are waiting for the publication of a 154-patient study that shows it works. After three months, 100 percent of patients with mild cases of nail fungus and 35 percent with severe cases were fungus free. More than 80 percent of all cases showed improvement in nail thickness and color.

Source: Allison Bruce, Ventura County Star [8/26/07]

PA Podiatrist/Coroner Rules On Delayed Cause of Death

Can a bullet kill someone 40 years after it’s fired from a gun? That’s the big legal question after Bucks County’s coroner ruled that a bullet fired in 1966 killed a former Philadelphia police officer on Sunday. Joseph Campbell’s ruling this week has thrown Philadelphia prosecutors into uncharted legal waters, area lawyers said. The city’s district attorney is considering pressing murder charges. And the DA could successfully convince a judge to put the shooter on trial, several lawyers said. But some attorneys said a conviction is far from a slam dunk.

Dr. Joseph Campbell

In November 1966, 23-year-old police officer Walter T. Barclay was responding to a burglary in North Philadelphia when he crossed paths with William J. Barnes. The 30-year-old armed with a handgun shot Barclay several times, shattering his spine and leaving him a paraplegic. Barnes, now 71, served out his 10- to 20-year sentence in state prison for attempted homicide. And, he’s been in and out of prison ever since for other crimes. Barclay, on the other hand, suffered “horribly” after the shooting, according to his sister, Rosalyn Harrison. “You have no idea what a hard time he had,” she said. In his later years, Barclay spent time in a rehabilitation center in Buckingham before he was taken to St. Mary Medical Center in Middletown, where he died Sunday.

Campbell said there was a clear connection between Barclay’s gunshot wound and his death. The coroner said the shooting led to Barclay’s paralysis, which led to a urinary tract infection. That infection turned into the system-wide infection that killed him at the age of 64, Campbell said.

Source: Ben Finley, Bucks County Courier Times [8/24/07]

APMA has lost contact with a number of Life Members.

If you have any information on the DPMs listed below, please contact Beth Shaub, Director of APMA Membership Services, at 1-800-ASK-APMA x270 or by e-mail at bshaub@apma.org

NAME PODIATRIC COLLEGE & YEAR OF GRADUATION

Benjamin Feldman Temple, 1950
Sidney Friedman Scholl, 1933
Henry Simon Ohio, 1933

Query: CAD/CAM Milling Fabrication Systems

I’d appreciate any comments from those having experience with CAD/CAM Milling Fabrication Systems for orthotics?

Anas Khoury, DPM, Passaic, NJ

RE: Delayed P & A (Jeffrey Kass, DPM)
From: Multiple Respondents

The protocol I use is when there is a paronychia or abscess formation or hypertrophic ungualabia, I will perform the I & D and/or partial nail avulsion initially and then bring the patient back for the matrisectomy 2-4 weeks after. (I also prefer 10% sodium hydroxide to phenol because of fewer post-op complications). I have few complications or severe burn reactions with this protocol. I also use Cortisporin otic or opthalmic solution post-op to relieve the burn, which is typically healed within a week post-op. I have performed literally thousands of this procedure over the last 30 years in this fashion.

Fred Birnbaum, DPM, Bensalem, PA, themick8@comcast.net

If an infection is present when avulsing an offending border of a nail, it is best to wait until the infection is cleared before doing a matrix procedure to avoid the possible spread of the infection. The matrix lies over the base of the phalanx and one would not want to inoculate the periosteum.

Ron Worley, DPM, San Diego, CA, drrdworley@yahoo.com

Editor’s note: An extended length note by Dr. Mullen appears at:
http://www.podiatrym.com/letters2.cfm?id=15402&start=1

RE: ESWT As “Investigational”
From: Multiple Respondents

I am friends with one of the original investigators and investor of ESWT and the business plan was, from the very beginning, for this to be our "Lasik" procedure, a cash cow that patients would be glad to fork out big time fees for a high tech, relatively easy in and out and effective treatment option. I am pretty certain the insurance people were aware of this as well. The eye folks have never wanted their work to be covered as it would be greatly reduced from what they can get CASH, often times with some easy financing to expand the patient pool. Perhaps like Dr. Katz says, therein lies the answer. Don't rely on third-party insurance as much, and profit more.

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

Regarding Dr. Taubman’s post, I was an early user of ESWT. I, and most of my colleagues, were never ”opportunistic”. I initially charged an amount for ESWT similar to what we charged for an open fasciotomy or EPF, even though we only received a ridiculous $350 for the open procedure. I now charge much less. I always receive payment up front since so many insurance companies will not pay for the procedure. The fee collected by the shockwave company is usually reduced to about $3000. If we perform an open fasciotomy, the hospital and anesthesiologist charges greatly exceed this amount. The lesson here, is that we have a wonderful non-surgical treatment that works the majority of the time, has virtually no risks, and that allows the patient to return to work within 48 hours.

Howard A. Stone, DPM, Glenview, IL, justus313@comcast.net

I was heartened to see over utilization of a procedure due to high reimbursement invoked by Dr. Taubman as a reason that ESWT (extracorporeal shock wave treatment) is covered less and less often by insurance companies. The parallels between the financial history of endoscopic plantar fasciotomy and ESWT are uncanny and as they went down the same road, they were bound to end up at the same dead-end of reimbursement. When I rotated through the Harris county program here in Texas as a 4th year student in December of 1995, I encountered just how ugly the opportunistic amongst us can be. At the beginning of the month, I did the chart and clearance H+P on a patient having a right lower extremity endoscopic plantar fasciotomy procedure. At the end of the month, I saw the same guy in front of me for another clearance H+P. I asked him why he was back, and he stated that he was having the left heel done.

As part of the past medical history, I inquired as to how long his left heel had hurt him and what had been done conservatively. His response was that “my left heel has never hurt, but the doctor assured me that it eventually would, just like the right heel did and so I may as well get it out of the way as I have some vacation time with the Christmas holiday”. A ‘prophylactic’ endoscopic plantar fasciotomy! Why? Because the procedure used to pay around three grand at the time for about 10 minutes work, that’s why. I clearly wrote in the patient’s chart that there was no indication for surgery as there was no chief complaint and refused to scrub the case with the two individuals doing the procedure. I can only hope they are out of practice by now, but this capricious overuse of the endoscopic plantar fasciotomy lead to the drastically lowered reimbursement for the procedure, just as the ESWT is seeing now—or just as likely, not covered as a treatment at all.

David Secord, DPM, Corpus Christi, TX, David5603@pol.net

I was also an early user of ESWT, first with the Ossatron in the outpatient surgery centers, and currently with the EPOS unit, performed in the office under local anesthesia. I was originally informed that I “should be” charging over a thousand per foot. I personally settled on $500.00 for one foot, and $750.00 for bilateral treatments. It seemed fair and it is cash only. I do bill the insurance company, and if paid (rare) I do the contractual calculations and refund the patient what I need to….and I gripe. Certain things are just as well off, or better, being cash only.

My patients have had breasts enlarged, reduced, noses fixed, laser on their eyes to see better, liposuction…all cash. If they grips to me that “My insurance pays everything” I patiently explain that, “NO, they don’t.” My patients pay for the service the day it is rendered. If they show up without cash, check or charge card, I cancel the procedure.

We all need to begin to realize that cash talks. Patient’s, most of them, can and will pay to be better, and avoid surgery. My question regarding ESWT is not if it works or not, but why are we so embarrassed to tell someone it is not covered, it is a good modality, and they should pay for it. I, for one, am not one bit embarrassed to ask for payment.

David E. Gurvis, DPM, Avon, IN, deg1@comcast.net

Editor’s notes: An extended length note by Dr. Weil, Sr. appears at:
http://www.podiatrym.com/letters2.cfm?id=15401&start=1

This topic is now closed.

Privileges at Certified Surgical Facility With MRI- NY & LI

Certified operating rooms which qualify under the new NY Patient Protection Law (which will require accreditation for in-office procedures) are available in Manhattan East 60th Street and Plainview, LI. Rent or Lease Extremity MRI. Turn-key operation no investment needed. Call 516 433-4447 for information or e-mail podo2345@aol.com

PODIATRISTS NEEDED - CHICAGO --NORTHWEST INDIANA

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists. We are located in Chicago and Northwest Indiana. Full and part time positions are available. Competitive Compensation including malpractice. Contact Scott Schneider. Phone-773-292-4800. Fax 773-342-4201 -E-Mail sschneider@homephysicians.com -- www.homephysicians.com

CRYOPROBE SALE: PRICE REDUCTION!

A cryoprobe system (less than one year old and rarely used) from CryoTech is available for only $10,500 or best offer. This lists for $14,900.00 new. The CryoPac system comes complete with two fully sterilizable Probes. This system has been used less than 15 times and can be used to treat plantar fascitis, neuromas, and other foot pathology. Please email inquires or your offer to: drsammendicino@gtef.org

ASSOCIATE POSITION SANTA FE, NEW MEXICO

Immediate opening for PSR 24/36 individual in three office practice. We are looking for an ethical, hard working, well trained Podiatrist. Partnership available. Please Fax CV to sfpodiatry@aol.com

ASSOCIATE POSITION – LOUISVILLE, KY

Immediate opening for multi-office podiatric practice specializing in general podiatry, high volume orthotics, surgery, and advanced wound care. Looking for a motivated, surgically trained podiatrist. Partnership opportunity. Competitive starting salary, benefits, and pension. Please submit: CV, letter of intent and references to: jbroyles23@yahoo.com

ASSOCIATE POSITION – CENTRAL VIRGINIA

Two office practice, fully automated, strong referral base, hospital and surgery center privileges. Full scope of foot and ankle care. ABPS –certified/eligible. Competitive salary/percentage structure and benefits. Email letter of intent and curriculum vitae to jdisabato@virginiafootandankle.net

ASSOCIATE WANTED – NEW YORK IMMEDIATE OPENING

Busy multi-dimensional practice; 70 miles north of New York City. Currently five (5)-doctor practice. looking to expand – all phases of podiatric medicine. contact: (845) 454-8308 EXT: 106

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