The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

September 18, 2008 #3,351 Editor-Barry Block, DPM, JD

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Athletes at High Risk for Foot & Ankle Injuries: NY Podiatrist

According to the American Podiatric Medical Association (APMA), both professional and amateur athletes are at an extremely high risk for injuring their lower limbs during play. Whether performing hairpin turns on artificial turf or taking part in a powerful, high-speed collision with other players, foot and ankle injury risks for athletes run rampant - and participating in a favorite sport should always involve playing it safe.

Dr. David Davidson

"Stress fractures and ligament injuries are all, unfortunately, quite common in popular fall sports such as football," said Dr. David Davidson, APMA member and podiatric medical consultant for the Buffalo Bills of the NFL. "From maintaining proper conditioning to wearing sport-specific footwear, athletes can function at peak performance much more often when constantly maintaining high levels of foot care safety."

Source: XTRA (CA) [9/16/08]

Yoga Can Help Reduce Falls in Elderly: TUSPM Study

According to the Centers for Disease Control and Prevention, falls are the leading cause of injury death for people ages 65 and older. Researchers from the School of Podiatric Medicine at Temple University in Philadelphia examined the gait and postural stability of 24 elderly females who were enrolled in an Lyengar yoga program specifically designed for people over age 65.

Dr. Jinsup Song

Jinsup Song, D.P.M., Ph.D., director of the Gait Study Center at Temple University School of Podiatric Medicine, said, "People are gaining more confidence as they stand and walk at the end of the yoga intervention. People are more aware of their body posture. It [yoga] opens up a whole range of treatment options we didn't think we had before."

Researchers say this preliminary study will pave the way for a larger study on how yoga may affect the function of the foot to improve balance and stability, and prevent falls.

Source: ABC-7 News (Denver) [9/13/08]

Stark Introduces EHR Adoption Bill

House Ways and Means Health Subcommittee Chair Pete Stark (D-CA.) on Monday introduced a bill (HR 6898) that would use Medicare payments to encourage healthcare providers to adopt health information technology systems, CQ Today reports. The bill would offer payment incentives to physicians who are early adopters of health IT, such as electronic health records, and impose penalties on providers that delay implementation or fail to switch to the technology (Armstrong, CQ Today, 9/15). The bill would codify within HHS the position of health IT coordinator, a position created by executive order by President Bush in 2004. It also would create a federal advisory committee -- consisting of government and private sector health experts -- that would be charged with creating by 2011 a final version of standards governing interoperability, security,and capitalizing on the clinical use of health IT.

In addition, the bill would provide financial aid through a matching grant program to encourage not-for-profit groups and health care providers in rural, low-income and underserved regions to adopt health IT (Noyes, CongressDaily, 9/16). The bill also would direct that open-source technology be developed and made available to health care providers at "a nominal cost." In addition, the bill would establish new privacy protections that ban the sale of patient health data and require pre-authorization before any data is used for marketing purposes. Fines of up to $1.5 million would be charged incrementally for privacy violations.

Source: Above-cited sources via American Health Line [9/16/08

Success Strategies

Two strategies will help you perform better at work:

• Start on a positive note. On your way to work, mentally tell yourself: "I am feeling great today. Good things are going to happen." Clarify your goals for the day and clear away the clutter from your desk and from your brain.
• End strong. Do your best throughout the day and then look at what you have accomplished. Tell yourself: "What a successful day. I am proud of myself." Your enthusiastic mood will be contagious, and everyone around you will benefit from your positive energy.

Source: Adapted from Working Smarter by Amanda Horswill

Query: MRSA and Planned Onychoplasty

I have a young healthy 24 year old male with recurrent paronychia, treated with an I&D procedure x2. A culture reveals MRSA. He was treated with local care and oral Bactrim. He needs an onychoplasty. What is the standard of care relative to the infection? How long does he have to be infection-free before an onychoplasty can be performed? Should he be on antibiotics, and if so, for how long?

Alan Mauser, DPM, Louisville, KY

Query: Hyperbaric Oxygen Chambers

I was curious if any other DPM's own their own hyperbaric oxygen chambers? I currently work at a wound center, but I cannot get them to purchase the HBO chambers. The closest one is over an hour away. I was wondering if this is something that could be done privately? Any thoughts, suggestions or insights would be greatly appreciated.

Joe Gonzalez, DPM, East Lansing, MI

RE: Risks of Prescribing Opiates For Chronic Pain
From: Larry Kollenberg, RPh, DPM, Elliot Udell, DPM

The profession of podiatric medicine and surgery has a privilege like all physicians of prescribing medications. Those medications are, by law, to be written within the "scope of practice" of that practitioner. Your license is a limited license to practice medicine. The question for you to ask yourself about any Rx, is am I writing that particular Rx within the scope of my practice? If a patient has chronic pain in the lower extremity, and you feel that it is in your purview then technically, you are within your scope of practice.

Are you trained in chronic pain management? Do you have a narcotic contract with that patient? Today, physicians are board certified in pain management. Why not refer the chronic pain patient to the pain management specialist? Are you familiar with the potential drug interactions and complications of chronic pain management? Do you monitor your patient appropriately for those drugs? What effect will drug X have on the CYP 3A4 system in the liver? Perhaps it may affect the C2D systems of metabolism. How much Tylenol is in that drug? Does your patient have other factors that may be affecting the metabolism of the drug? Beyond the Rx, what are you doing for medical management of that patient's pain? If your medical record shows that you are managing your patient within scope of practice and providing appropriate medical care (based upon chart review) for the drug in question, then write the Rx.

What do you think your local supermarket, CVS, Walgreens, etc pharmacist is going to do with an Rx from you for large quantity opiates? Will they just fill it “no questions asked?” Like you, the pharmacist has worked for many years to gain a license.

Larry Kollenberg, RPh, DPM, Jacksonville, FL, lkollenberg@hotmail.com

The issue of prescribing opiates for chronic pain, in terms of legal investigations, is complex. We live in an era where "big brother" watches what prescriptions we write and the government looks with a virtual magnifying glass at doctors whose data sheets indicate they are prescribing opiates for chronic pain. A close friend of mine who is a hematologist prescribed opiates for a patient who presented at his NYC hospital. The patient was suffering with severe pain secondary to sickle cell anemia. The medical literature at that time was divided on whether these drugs should be used for pain associated with sickle cell anemia and the investigators who pressed charges against him felt that he should not. The hematologist won the case, but spent many sleepless nights over it and it cost him a chunk of his life savings defending himself.

On the other hand, I know MDs who are pure pain management specialists who write for opiates every day with seeming immunity from investigation and prosecution. So where does this leave us? I would recommend not prescribing opiates for chronic pain. If word gets out that you do, drug addicts from all over will find their way to your door and very quickly. There are other ways to treat chronic foot pain that are more effective and less addicting. This is my professional opinion, but I would defend those who exercise their professional right to prescribe opiates.

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

RE: Restrictive Covenant (Ivar Roth, DPM)
From: Michael M. Rosenblatt, DPM

I agree with Dr. Ivar Roth, who rhetorically asks: "I would like to hear the reasons why an employed doctor thinks they should NOT pay a buyout if they terminate employment and practice locally." Ironically this is one of the very issues I bring up in an article on associateships soon to be published in Podiatry Management.

A properly executed non-compete agreement between associate employee and employer is a contract that you sign as an employee of that practice. You have not been forced to sign it, but do so of your free will. A contract usually has attributes in it that affect your potential future behavior and opportunities. Therefore, it is essential that you clearly understand them and seek appropriate legal advice through an attorney prior to your signature.

Newly graduated residents can't usually afford attorney bills, especially on top of their school loans. I would suggest that they contact local attorneys who have a working relationship with your own podiatric association. These professionals will tend to charge you fairly because they want a continuing relationship with you over your practice years. Many will accept a payment plan.

I have found most of these attorneys to be fine people who have contributed many hours, often at a lower pay rate to help the podiatry profession. Best of all, they are familiar with the geographical and podiatric practice issues close to you.

Michael M. Rosenblatt, DPM, San Jose, CA, rosey1@prodigy.net

RE: Chiropractors and Orthotics (Bob Kornfeld, DPM)
From: Paul Kesselman, DPM

The public is inundated with daily advertisements by chiropractors, pedorthists, orthotists and many others who claim they can provide foot orthotic services to the public at a fraction of the costs offered by podiatrists. One well-known chain of shoe stores has shown no shyness in offering damaging comments about the podiatric profession, while simultaneously selling their own wares to an unsuspecting public. Staying above the fray, ... (continued)

Editor's note: This extended-length letter can be read at:http://www.podiatrym.com/letters2.cfm?id=21998&start=1

PRACTICE FOR SALE - CORAL GABLES FLORIDA

Well-known practice for over 20 years. Excellent location on Coral Way with heavy traffic, great visibility and plenty of parking. Busy, fully-equipped, full- time office with established patients. Grossing over 300K with tremendous growth potential. Office is currently open and ready to take over immediately. For additional info contact QVAN@aol.com or 305-975-5516.

ASSOCIATE POSITION - NORTHERN VIRGINIA/DC SUBURB

Excellent associate practice opportunity leading to partnership for PSR 24-36 foot and ankle surgically-trained physician. Currently 4-doctor/2 office practice in fast-growing area, expanding to 5 doctors. Hard working, personable, highly-motivated individuals needed. Great opportunity with excellent salary and benefits. No nursing homes.Top hospitals. Fax CV with references to 703-491-9994

IMMEDIATE POSITION AVAILABLE TN/GA

PRACTICE FOR SALE - OREGON, WILLAMETTE VALLEY

Established practice in beautiful Willamette Valley of Oregon. Provider practices fulltime and has a well-established patient base with a strong patient flow. Practice is well-positioned for new growth and development. Doctor will transition after sale providing introductions to local referrals and healthcare facilities. Surgery privileges at local hospital and surgery center. Oregonpractice@comcast.net

PRACTICE FOR SALE - MAINE, SOUTHERN

Well-established practice located in Southern Maine seeking an associate. This is the only podiatric provider in the community. All services are office and hospital-based. No nursing homes. Senior doctor desires to bring an associate in to become partner. Strong patient base with very small amount of palliative care. southernmainepractice@comcast.net

ASSOCIATE POSITION – VIRGINIA

PARTNER WANTED - COLORADO

State-of-the-art practice with EMR and digital x-rays, in our physician-owned Medical Office Building and Surgical Hospital. Focus on Sports Medicine, pediatric and adult flatfoot, bunion surgery, and homeopathic care. Great opportunity for self starter. Please send CV and letter of introduction to: greg@stilwellfeet.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 full-time podiatrist in a multi practice location in the Chicagoland and Northwest Indiana area. Must have two years of surgical residency. Please e-mail resume to d-kitchens@footexperts.com

PRACTICE FOR SALE – CALIFORNIA

Practice is available immediately for sale in sunny Capitola, CA. The office space is available for lease or month-to-month. The practice has a loyal patient base which is mostly home visits and skilled nursing facilities in Santa Cruz county. The practice can be moved to another location or merged with an existing practice. Asking price $35,000.00. dtarsky@gmail.com

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