The Voice of Podiatrists

Serving Over 9,800 Podiatrists Daily

September 05, 2007 #3.032 Editor-Barry Block, DPM, JD

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MA Podiatrist Claims 83 Percent Success With Nerve Decompression Surgery

“Chronic pain is big," said Tewksbury, MA podiatrist and neuropathic surgeon Peter Bregman. "It's like a dark little world and people get caught in a cycle and never get out."

Dr. Peter Bregman (Photo: Jon Hill)

Bregman is one of two surgeons in Massachusetts offering a relatively new alternative, nerve decompression surgery. Bregman slices open the tissue compacting swollen nerves to relieve constriction. He likens the procedure -- pioneered by plastic surgeon A. Lee Dellon -- to a kinked or compressed garden hose with water in it that's made straight and allowed to channel water again.

Fluid or fat can compress nerves. And because nerves can't heal themselves, Bregman said, people with unaddressed neuropathy risk permanent muscle loss or even amputation. More than 200 people have sought treatment from Bregman, and most -- 83 percent, he said -- found relief. The outpatient procedure, done under general anesthesia, takes about an hour and involves three incisions -- outside the knee, below the ankle and on the top of the foot. Recovery takes six to 12 weeks.

Source: Christine Phelan, The Lowell Sun [9/3/07]

Worn Our Athletic Shoes Can Lead to Injuries: GA Podiatrist

Athletes aren't the only ones getting a workout during a run, so are their shoes. Podiatrist, Dr. Perry Julien says by the time you see excessive wear on your shoe, you've worn the shoes one or two hundred miles too long. That's why it's important to keep track of the mileage on your sneakers, they're only meant to be used up to 500 miles.

Dr. Perry Julien

Dr. Julien says letting a shoe go past its lifespan can lead to injuries. That's what happened to Julie Beverly. Running 20 miles a week has taken a toll on her old shoes and her body. She says her shoes turned in and were making her ankles hurt.

Source: Bay 9 News (FL) [9/4/07]

HHS Must Release Medicare Physician Claims Data: Court

Physician claims: The U.S. District Court for the District of Columbia has ruled that HHS must release Medicare physician claims data for Illinois, Maryland, Virginia, Washington state and Washington, D.C., a decision that could help the public evaluate the performance of the program and the physicians, the Wall Street Journal reports. In the case, Consumers' CHECKBOOK/Center for the Study of Services filed a lawsuit to obtain access to the data. HHS argued that the release of the data would violate the privacy of physicians. However, the court rejected that argument because Medicare claims account for only a portion of the incomes of physicians.

According to the court, the release of the data would "help the public make more informed Medicare decisions" and provide "more information of how government funds are spent." The group plans to post the data, which HHS must release by Sept. 21, online for public use. Researchers could analyze the data to determine the number of times physicians perform certain procedures and to compare the mortality rates among patients of certain physicians, and health plans could use the data to improve their analyses of physician quality. The group has requested similar data for the other 46 states. An HHS spokesperson said that the department has begun to review the decision and has not decided whether to appeal.

Source: Wall Street Journal Via American Health Line [9/4/07]

Query: Digital X-Ray Equipment

I am considering conversion to digital x-ray. Do I need a single dedicated computer for this? I am an old fashioned guy and still measure angles on WB x-rays. How does one easily do that with digital x-ray? What is a ball park figure for the hardware and software needed to go digital. Will the technology be outdated in a month or two like many other “new” things?

Tip Sullivan, DPM, Jackson, MS

Query: Dispensing a Walker

As a DME supplier (not in a competitive bidding region), can I dispense walkers, just like dispensing diabetic shoes and wound care supplies?

Jengyu Lai, DPM, Rochester, MN

Response: I do not recall us ever receiving such a denial for any of our clients though I cannot remember seeing that exact situation. A review of the 855S application, page 7, shows 28 different "Types of Supplier" so it is possible that the supplier could have some limitations.

Safest bet is to first call the National Supplier Clearinghouse (NSC), and ask them. Take names, dates and times, of course, and make a record of their response. NSC phone number is 866-238-9652.

If there is still any doubt, sell or rent one, and see what happens before doing a second one. If you bill it electronically, you will have your answer within 14 days, or less.

Rich Papperman, CHBME, Cape May Court House, NJ

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RE: Uncontrolled Gout (Kazu Suzuki, DPM)
From: Barry Mullen, DPM, Elliot Udell, DPM

Dr. Suzuki makes an excellent initial point about the importance of diagnostic confirmation of gout through synovial fluid analysis, especially in the clinical setting where an acute attack is prolonged. Perhaps this isn't gout. Assuming that it is gout, allopurinol may not always be the drug of choice, as in Dr. Slowik's 2nd cited example of the patient on dialysis. Here, gout attacks have likely been initiated from uric acid retention from malfunctioning kidneys. In those cases, long term uricosuric control is best achieved with probenecid which facilitates uric acid's renal clearance. If birefringent monosodium urate crystals have been recovered from this patient's synovial fluid analysis confirming gout, the serum uric acid is elevated, then a 24 hour urine uric acid clearance test can help determine if this patient is an under excretor or over producer.

Additionally, the patient should be evaluated for extensive dietary counseling for initiation of low purine diet while her existing medications carefully reviewed for their potential uric acid elevating side effects. In addition, gout is typically more prevalent in the summer in warm climates where dehydration elevates all solutes including uric acid. Patient's personal history should be checked for beverage consumption that causes diuresis and her daily water consumption. Lastly, the injection of intra-articular crystalline steroids is contra-indicated for gout.

Barry Mullen, DPM, Hackettstown, NJ, yazy630@aol.com

Dr. Suzuki very ably describes his treatment of gout using allopurinol. Is the use of allopurinol which is used to treat systemic hyperuricemia within the scope of practice of podiatry? To date, I have been sending my patients with hyperuricemia or gouty tophi to internists, family practitioners and rheumatologists when patients have needed allopurinol and I have restricted my treatment to management of acute gout.

I would love to be able to include allopurinol as part of my armamentarium. Proponents of our use of this drug see no difference between prescribing allopurinol for localized gout with concurrent hyperuricemia and the use of systemic antibiotics to treat an infection that is localized to the foot. Others who are against our use of it, say that it is akin to a podiatrist giving a diabetic patients prescriptions of insulin or other glucose-lowering agents which would clearly be out of scope. What is legally correct?

Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

Editor’s comment: PM News does not provide legal advice. Scope of practice is generally determined by training and experience. Podiatrists prescribe antibiotics, which have systemic effects because we are taught how to in school. We then prescribe to clinic patients, in hospital residencies, and later in practice. In light of Vision 2015’s goal of defining podiatrists as physicians, there is no reason why our schools can’t teach students how to write for allopurinol for patients with gout.

RE: Conflict of Interest for Experts
From: Richard Boone, Esq.

With all due respect, association or college rules which establish a blanket prohibition against testifying against a fellow podiatrist in a legal proceeding are very bad rules. They cannot and will not achieve the goal of limiting frivolous litigation. Further, they give the appearance of institutionalizing an anti-patient bias which will be detrimental to your profession in the long run. For many years the so-called "conspiracy of silence" in the medical community (whereby, it was alleged, physicians combined together to deny injured patients their day in court by withholding needed expert evidence) has been one of the plaintiff bar association's favorite whipping boys. I'm not sure it is a good idea to give them documentary proof that it really exists in the form of these resolutions and rules.

The need to keep these postings concise prohibits me from listing the myriad ways in which "gag" rules such as that apparently enacted by the NYSPMA can come back to haunt the group or entity that enacted them. It suffices to say that freedom of speech is so deeply engrained in the fabric of our national identity that, historically, society usually finds a way to penalize those who try to inhibit it.

Please don't misunderstand what I'm saying here. Anyone who knowingly gives false testimony against a fellow professional for money should be dealt with severely. Association officials who try to use their official positions for their personal profit, through court testimony or otherwise, are legally and morally reprehensible. But blanket rules such as the ones being discussed here are not, in my considered opinion, the correct way to deal with these offenders. There are other, and more effective, ways to deal with those individuals.

Richard W. Boone, Sr, Health Care Attorney, Fairfax, VA, RWBoone@aol.com

Editor's comment: We'd be curious to hear what Mr. Boone would tell alumni who now refuse to donate to their alma maters because of faculty members who testified against them. We'd also like to know what he'd tell APMA members who drop out of the association because an elected leader testified against them.

As to freedom of speech, there's certainly no shortage of qualified podiatrists available who can honestly testify for plaintiffs. Those who elect to teach at our colleges or run for office in our associations assume a responsibility to this profession which should preclude them from testifying against those whom they represent.

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

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

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 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

CRYOPROBE SALE: ADDITIONAL PRICE REDUCTION!*

A cryoprobe system (less than one year old and rarely used) from CryoTech is available for only $9750.00 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

SATELLITE PODIATRY OFFICE FOR RENT - TUCSON, ARIZONA

Modern x-ray with automatic processor. Professional atmosphere. office is shared space in a chiropractic office with separate front desk. Excellent start-up opportunity for a new doctor Front desk staff, copy machine, fax are also available. Contact Dr. Parks at 520-544-2445 or parksovc@aol.com

INDEPENDENT CONTRACTOR WANTED - KANSAS CITY, MO

Immediate opening for podiatrist as independent contractor. Flexible schedule. All phases of podiatry. Knowledgeable and dedicated support staff. Must be compassionate and personable physician with good podiatric skills. Wonderful place to live and work. Please email CV and letter of interest to: Dr.Fine@FineFootCareCenter.com

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