The Voice of Podiatrists

September 15, 2006 #2, 690 Editor-Barry Block, DPM, JD

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OH Podiatrist Corrects Club Feet of African Children

It's a medical mission that's changing the lives of children from third world countries. Karim Ouedraogo is a two year old from Africa who was born with a birth defect that caused him to have two club feet. He's visiting Lima, OH and staying with a host family while his feet are corrected and Wednesday was the big day, his surgery.

Lima Memorial podiatrist Dr. Darryl Haycock has helped numerous children like Karim in conjunction with Children's Medical Missions West. Haycock says Karim has a long way to go until his feet are completely corrected and today was just another step.

Dr. Darryl Haycock

Karim will have to wear frames on his tiny feet that keep pins inside the bones of his feet. Once the frames are removed Karim will undergo therapy and then return home with a brace that he will wear for several years. And then Karim will have a chance at walking and even running without problems. A chance he wouldn't have had without American technology.

Source: WLIO-TV (Lima, OH) [9/13/06]

Podiatrists Discuss Foot Care For Diabetics

If Charcot foot is caught early, wearing a cast and keeping weight off the limb can prevent severe injury, said Dr. Jim Christina, director of scientific affairs for the American Podiatric Medical Association. But the condition is "very commonly mistaken for an infection or cellulitis," he said.

Dr. Jim Christina

"Often, we're presented with foot and ankle problems we shouldn't be presented with because patients come to us so late and with significant deformities," said Dr. Stephen Conti, director of foot and ankle surgery at Allegheny General Hospital.

He said patients with neuropathy should wear protective shoes -- generally covered by Medicare -- and should consider any unusual sore or warm, swollen foot as a potentially serious problem requiring immediate evaluation from a medical professional familiar with diabetic foot and ankle problems.

Source: Joe Fahy, Pittsburgh Post-Gazette [9/13/06]

COX-2 Inhibitors and NSAIDs Have Cardiotoxic Effects

Further information on the cardiotoxicity of cyclooxygenase-2 (COX-2) inhibitors and regular nonsteroidal anti-inflammatory drugs (NSAIDs) has come from 2 systematic reviews published in the September 12 Early Release issue of JAMA.

In an editorial accompanying the 2 JAMA articles, David J. Graham, MD, from the Food and Drug Administration (FDA) in Silver Spring, Maryland, welcomes the 2 reviews, which he says "provide clarity on a topic that has been dominated more by disinformation than reason."

Another article by Solomon and colleagues focusing specifically on the cardiotoxicity of celecoxib, published in the September 5 issue of Circulation, suggests that cardiac adverse effects are also an issue with celecoxib and follow a dose-response relationship. And, coinciding with these publications, the FDA has issued an alert notifying consumers and healthcare professionals that taking ibuprofen for pain relief may interfere with the benefits of aspirin taken for heart disease and advising that these two drugs should be taken at different times to avoid such an interaction.

Source: Sue Hughes, Medscape Medical News [9/13/06]

Query: Lamisil for 12 Year Old

I have a 12 y/o female patient with severe (and documented) onychomycosis of both great toenails. Toes 2 thru 5 are healthy. Both hallux nails are not salvageable. There are no issues of pain. She is otherwise healthy. The parents are very concerned about the condition spreading to her lesser toes. They are pushing for oral Lamisil as seen on TV. I quoted the PDR to them "the safety and efficacy of Lamisil in pediatric patients has not been established." They were unmoved. Are any of my colleagues using oral Lamisil in pediatric patients? Pro or con feedback would be appreciated.

James M. Petko, DPM, Falls Church, VA, footdoc@erols.com

RE: Scope of Practice Legislation (Richard W. Boone, Sr)
From: Tim Vogler, DPM, Gerald Peterson, DPM

Mr. Boone’s perspective regarding a national scope of practice is appreciated (as are all of his comments as a healthcare attorney experienced with podiatry) however naïve. Having been intimately involved in the legislative process to change a state scope of practice act (North Carolina 1995 t include ankle, etc) I feel qualified to speak regarding this matter.

A national scope of practice is unlikely under our present constitution as it would require national legislation preempting states’ right to self govern. Therefore, a “uniform national scope of practice” would require adoption by all 50 state legislatures. Every time a scope of practice act is opened in the legislature there is the inherent “risk” of coming away with less than what you started with. Currently, the AOFAS has an ongoing objective to re-define every scope of practice act in the US and to “limit” the practice of podiatry nationwide and I’m sure the AOFAS would welcome podiatry “opening the door” to each state’s podiatry scope of practice statute. One hard fought battle has already been waged in Florida regarding this issue.

I must disagree with the concept of a national scope of practice concept. Instead, I fully support the concept of a degree change and physician licensure status. I began podiatric medical school in 1985 at the University of Osteopathic Medicine and Health Sciences, and have been part of the rapid evolution of our profession to where it is today. Podiatrists/podiatric surgeons today need the bonds of a limited license and scope of practice lifted in order to continue to evolve and provide an even higher level of care for our patients and to gain the full respect of our medical colleagues which we deserve.

Tim Vogler, DPM, Treasurer, North Carolina Foot and Ankle Society, Timothy.Vogler@cornerstonehealthcare.com

We indeed have a Universal National Scope of Practice. Having served on the Scope of Practice Committee for the Project 2000, I can assure you we have a National definition of the Scope of Practice. I would suggest you contact APMA for the specific verbiage. I can sure you it was developed after extensive and heated debate by both the members of the sub-committee and the full committee before it was accepted.

Gerald Peterson, DPM, Member, Project 2000 Committee, Blkjck@ifixft.com

The other day, I was leaving a nursing home patient's room and I heard a nursing assistant comment on the nail care that I had just provided. I snickered to myself when I heard: "Oh, how nice. You had a pedophile this morning."

Richard Wolff, DPM Oregon/Ohio

PRACTICE FOR SALE – SOUTH FLORIDA

Miami-Dade and SW Ft. Lauderdale, well established surgical practice for sale. This one has everything. Surgery, Orthopedics, Pediatrics, Trauma, ER, General Podiatry. Participates in all local and national managed care plans. $850,000 but will discount depending on amount up front. Mature, serious inquires with business experience preferred. Email response to podfootdocs@aol.com

FOR SALE - ORTHOTIC LAB EQUIPMENT

Supreme Dual Vacuum Press from Gateway with Gast Vacuum Pump, silencer and filter. full description of features upon request. Originally $1200, Like New $ 750 drmorse@northpod.com

ASSOCIATE POSITON - SOUTHEAST TENNESSEE/ NORTH GEORGIA

Immediate position available or will wait for the right individual. Unique practice opportunity in growing multi-physician/multi-office practice. Well established/cutting edge within the medical community. Close proximity to hospitals as well as opportunity to become involved with a free standing podiatric surgical center. Must be BQ/BC. Minimum PSR/24. Competitive salary, bonus structure and benefits. E-mail CV to afcjen@hotmail.com

EQUIPMENT WANTED - X-RAY Machine

I am looking for a used x-ray unit, preferably no older than 15 years. EXCEL units or units of this type are appropriate for my needs. If you have a unit, with or without the stand, please e'mail a picture and relevant information to me at drkarendpm@aol.com I can also be reached at 619-892-3549. Shipping would be to Southern CA.

ASSOCIATE POSITION – NEW ENGLAND

Opportunity in growing New England practice. Well established and respected practice with large office and surgicenter, latest technology, great staff, loyal patients and solid referral base. Close proximity to hospitals, full scope practice. Opportunity for partnership. Prefer 24 month PSR with clinical practice experience or an experienced doctor looking to improve their situation. E-mail CV and contact info to: Footdoc-office@usa.net

ASSOCIATE WANTED - SOUTH FLORIDA

Miami-Dade and SW Ft. Lauderdale, well established surgical practice needs part-time podiatrists to assist in surgical cases and patient volume. Email response to podfootdocs@aol.com

PRACTICE FOR SALE/ASSOCIATE/PARTNERSHIP - WASHINGTON, DC

A 26 year old practice for sale in hospital's attached medical building. Fully equipped. All aspects of podiatric medicine;surgery. Large diabetic practice with wound care clinic. Large referral base with loyal patients. Charcot, forefoot, rearfoot, orthopedics. Residency required for privileges. Moving but will stay for transition. Associateship until purchase. Will finance sale with adequate down-payment. Serious inquires only. Contact scottr0666@yahoo.com

SEEKING ASSOCIATE POSITION IN TEXAS, DFW AREA

PSR-24 trained podiatrist seeking a FT associate position with possibility of future partnership. Trained in all aspects of podiatric medicine including forefoot and rearfoot surgery, and diabetic limb salvage. Email: fixfeet@hotmail.com

ASSOCIATE POSITION-INDEPENDENT CONTRACTOR – FLORIDA

Florida License / Medicare and Medicaid numbers in effect and active. High income potential for hard working, ethical and honest DPM great for semi-retired. Transportation a must. FAX CV or Resume to 1-727-785-4697.

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

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

PRACTICE FOR SALE – SOUTHERN INDIANA

Established, respected solo podiatry practice immediately available in scenic southern Indiana. Fully equipped attractive building conveniently located on an active corner with great staff, loyal patients and excellent referral base. Includes relationships with local assisted living and nursing homes. Practice and building available for $200,000. Serious inquiries preferred e-mail to: dhall@cmbuck.com

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

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