The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

September 21, 2010 #3,963 Publisher-Barry Block, DPM, JD

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NYCPM Welcomes Class Of 2014 With Annual White Coat Ceremony

On September 14, the New York College of Podiatric Medicine (NYCPM) welcomed the 110 students in the Class of 2014 at the College’s annual White Coat Ceremony, in which the future Doctors of Podiatric Medicine symbolically don their white coats and together recite the Hippocratic Oath. Following remarks by Stanley R. Kalish, DPM, Medical Director of the Atlanta Foot and Leg Clinic and the Clayton Outpatient Surgical Center, and Adjunct Professor of Surgical Sciences at NYCPM, Steven J. Walerstein, MD, Executive Vice-President for Medical Affairs and Medical Director, Nassau University Medical Center, delivered the keynote address to the assembled College community and guests. Two members of the NYCPM Board of Trustees, Bob S. Biller, DPM, and Rock G. Positano, DPM, M.Sc., MPH, also offered words of welcome to the new students.

NYCPM CEO Louis Levine presents award to Dr. Stanley Kalish

IA Podiatrist Elected Vice Chair of Board of Podiatry

Denise Mandi, DPM, Section Chief of Foot and Ankle Surgery at Broadlawns Medical Center, was elected Vice Chair of the Iowa Board of Podiatry on July 9, 2010, by the members of the board.   Dr. Mandi was originally appointed to the board by Governor Culver in 2007 and began her second term this year.

Dr. Denise Mandi

Mandi joined Broadlawns Medical Center in 2004 after receiving her medical degree from Des Moines University. She is certified by the American Board of Lower Extremity Surgery. Mandi is the only Central Iowa surgeon who is certified to perform total ankle joint replacement surgery utilizing all available artificial ankle implants with the AgilityTM, InBoneTM, and TornierTM options. 

TX Podiatrist is Co-editor of New Diabetic Textbook

A new diabetic foot textbook has just been released by Informa Healthcare. The editors of the text are Lawrence Lavery, DPM, University of Texas Southwestern Medical Center, Dallas Texas, Edgar Peters, University Medical Center Ultrecht, the Netherlands, and Ruth Rush Texas A&M College of Medicine, Temple, Texas. The text was edited by a podiatrist, infectious disease specialist, and a vascular surgeon. The contributors reflect the international interest and multi-specialty expertise required to take care of diabetic foot care.

Dr. Lawrence Lavery

“The text is unique in that it identifies the evidence and recommendations for diagnosis and treatment in the text based on levels of medical evidence,” according to Edgar Peters, MD, PhD, an infectious diseases specialist. We tried to help the reader identify areas in diabetic foot care that are based on expert opinion, case series, consistent cohort studies, and randomized clinical trials.

NC Father and Daughter Podiatrists Join Health Center

Park Ridge Health has announced that Russell J. Barone, DPM, Pamela Barone Stover, DPM, and Hendersonville Podiatry are now a service of Park Ridge Health. Dr. Russell J. Barone attended Siena College in Loudonville, NY, where he received a Bachelor of Science. He earned his Doctor of Podiatric Medicine degree from New York School of Podiatric Medicine, and completed his training at Blue Ridge Podiatry Associates. 

Drs. Pamela Barone Stover and Russell Barone

Dr. Pamela Barone Stover earned her Bachelor of Arts degree from the University of North Carolina at Chapel Hill. She earned her Doctor of Podiatric Medicine degree from Barry University in Miami Shores, FL, and completed a 36-month medical and surgical residency at the Veterans Affairs Medical Center in Dayton, OH.

Source: WHKP, Hendersonville, NC [9/15/10]

Query: Non-Union of the Cuboid

My patient is a 51 y/o F, 5'7", 230 Lbs. In late 2008, she suffered an inversion injury of the left subtalar joint. X-rays were negative for any abnormality. She was placed on routine conservative treatment, but  did not get better. On 5/25/2010 and 7/25/2010 MRI scans were obtained, which showed a fracture of the cuboid. On 8/4/2010, I placed her in a wheelchair and on bone stimulation. X-rays remained unremarkable, with no clinical improvement.

Cuboid Fracture on MRI

Query: How Long to Keep Paperwork with EMR

Do we need to keep original patient intake paperwork, including signatures on HIPAA forms for seven years if we are scanning the documents and keeping electronic medical records?

Kyle J. Kinmon, MS, DPM, Boca Raton, FL 
 
Editor's Comment: PM News does not provide legal advice. In general, there is no requirement as to how long to keep most paperwork which has been scanned into an EMR system. This has saved hospitals and doctors offices money in storage charges. It is important that all EMR records be backed up, preferably off-site to protect them from physical damage, such as floods or fires, as well as computer-related problems such as viruses or bad hard drives.

RE: LFTs for Lamisil (Doug Mason, DPM)
From: Brent Rubin, George Jacobson, DPM

After utilizing Lamisil on over 500 patients, I do obtain initial LFT's  but do not obtain any further lab work. I also do not do daily dosing, and I would consider pulse-dosing of 250 mg a day for one week, discontinue for three weeks, and repeat for a total of four weeks. The patient may need further pulses if no improvement at six months. The advantage is less medication, cutting down the risk of side-effects and frequent monitoring. 

Brent Rubin, DPM, brentlrubin@hotmail.com

I do not like taking chances with other people's livers. I have my own standards. As long as I meet or are greater than the community standard, I can sleep at night. We have some dermatologists who give oral antifungals out like candy in my community, yet the family doctors are cautious. 

I chart my discussion about onychomycosis (topical vs. oral vs. matrixectomy vs. new laser). They get a liver panel before an Rx is given. The patient signs that they understand the risks inherent in taking the medicine. They sign a copy of the PDR complications and risks with a notation that they agree to repeat the liver function tests at six weeks. I do not give them the full Rx. They generally are happy that I am cautious. I tell them that I'd hate to see them in a year with great looking nails but poor liver function.

I have seen one patient who sued her doctor and the drug company for irreversible liver damage. I end my dictation with the following macro "In lay and non-technical terms the dangers inherent and potentially involved with taking Lamisil were discussed with the patient and they understand the importance of liver function tests and agree to follow-up testing at six weeks or sooner should the need arise."  
 
George Jacobson, DPM, Hollywood, FL, fl1sun@msn.com

RE: LFTs for Lamisil (Doug Mason, DPM)
From: Bryan C. Markinson, DPM

Dr. Mason's question of "what does evidence-based medicine show?" regarding monitoring for liver toxicity in patients on Lamisil, shows how crippling all the babble about levels of evidence can be. Of course, I understand the need and try to apply treatments supported by the best evidence, but specifically in the case of Lamisil, in spite of the best evidence of its safety, many MDs and DPMs are and have always been afraid to use it. If you study the world literature, and the anecdotal experience of tens of millions of cases, Lamisil is not only effective, but extremely safe by all parameters. In spite of this, several years ago, I was made aware by Novartis that in some locations in New York, there were podiatrists who wrote prescriptions for Penlac 800 to 1 over Lamisil! What level of evidence were these doctors using?

In direct response to Dr. Mason, the malpractice bar has set the parameters required when prescribing Lamisil. Firstly, if you do not have a positive culture for dermatophytes, and/or a positive PAS stain, don't prescribe Lamisil. Order a CBC, BUN and creatinine, and a liver profile before the patient takes the first pill. The FDA years ago stated that monitoring during therapy is not required. Have the patient report any symptoms they may develop during therapy.

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

RE: Foot Surgery by CA Podiatrist Saves HS Baseball Career (Charles Reilly, DPM)
From: Kevin Lam, DPM

I agree with the editor of PM News on this one. "We can all promote the profession by being featured in the media." What about the foot and ankle orthopedist who gets in the news about minimally invasive ankle arthritis care/relief, aka ankle arthroscopy with synovectomy to the rest of us in the know. The media wants a story, a headline that people want to read. Why are we so critical of our own profession when the media chooses to do a story about one of our colleagues containing more than talk about nails or shoes?  Kudos for the story about the os tibiales externum. Most GPs and the public do not know that DPM's do these procedures at all.  

The media source chooses the title of the story to grab attention, not the subject person. Stop beating up on ourselves. We should get our profession out there on the news. I remember not too long ago there was a thread about podiatrists not being the "go to" profession for surgeries of the foot and ankle, but when a story like this comes up, we are up in arms. If we can’t promote our own profession, the foot and ankle MD's will do it for us. Perhaps, it is a jealously thing. To promote the profession is to educate the public, not blind them by "we all do the same thing," mentality. Many times, I have heard that my triple arthrodesis patients have to go to a foot and ankle orthopod for that procedure for that is an orthopedic procedure. Should we be doing self-promotion - I think so. 
 
Kevin Lam, DPM, Naples, FL, klamdpm@hotmail.com

RE: Foot Surgery by CA Podiatrist Saves HS Baseball Career (Charles Reilly, DPM)
From: Michael M. Rosenblatt, DPM

Dr. Charles Reilly complained that the (favorable) articles published about particular podiatrists in the news media are "self serving." In all fairness, I believe Dr. Reilly misunderstands where these articles come from, and the fact that they (most often) are not actually written by the podiatrist they refer to...or even with their consent. They are what is called in the news business: "Copy."

In news media and on TV we see reports about MDs and dentists who do all manner of evil, from cheating on their taxes to outright murder. Not too long ago, an MD medical student was alleged to be the infamous "Craigslist" murderer. This goes on. Like most of you, I am always grateful that these are not DPMs. Instead, I am privileged to read (most often) that a local podiatrist did a really wonderful thing, either professionally, or non. And we also take notice when a podiatrist turns out to be extremely talented in a non-medical field.

I am delighted to see those wonderful reports, which remind me that I am proud to be a podiatrist. Like the editor, I say, "Keep them coming."

Michael M. Rosenblatt, DPM, San Jose, CA, Rosey1@prodigy.net

RE: Foot Surgery by CA Podiatrist Saves HS Baseball Career (Charles Reilly, DPM)
From: Lee Rogers, DPM, Bruce Blank, DPM

I applaud Dr. Block and PM News for their hard work to keep us informed of what our colleagues are doing and the press that the profession of podiatry receives, through its members. I know it's hard work to comb through all the Internet tags daily and modify the stories for publication in PM News. What may seem like a routine procedure to a podiatrist, could be quite life-changing to a patient and news-worthy to a reporter. Keep up the good work.

Lee C. Rogers, DPM, Los Angeles, CA, lee.c.rogers@gmail.com

Concerning Dr. Reilly's comments, I think that Dr. Block's response answered his concern well. Additionally, I'd like to comment that  there are still many in the medical community and many in the community at large who don't have any understanding about the qualifications and training and expertise of doctors of podiatric medicine. The most recent example I came across on Friday was a radiology report where there was a question about the diagnosis of apophysitis vs fracture of a 5th metatarsal base in a child. The radiologist's impression mentioned that, "if there is still concern, an orthopedic referral would be in order."

I think that, when DPMs are in the news demonstrating our importance and place in the treatment of foot and ankle ailments, it's always a benefit to our profession and to our patients. And, yes, even an os tibiale externum can be ignored by the medical and surgical community until the patient sees a podiatric physician and surgeon who can treat the problem appropriately. We've all run into similar situations.

Now, I'm contemplating how to educate the radiologist who read the film about "Today's Podiatrist."

Bruce G. Blank, DPM, Martins Ferry, OH, bruceblan@aol.com

ASSOCIATE POSITION - WEST COAST, FLORIDA

Outstanding opportunity for PSR-36 graduate to join successful group podiatry practice in Summer 2011. Seeking a sociable, articulate graduate who is confident in rearfoot and ankle reconstructive cases but also enjoys all phases of podiatry. Long-term opportunity for the right candidate with generous pay and benefits. Reply to jwicks@cortezfootandankle.com

ASSOCIATE WANTED - DELRAY BEACH FLORIDA AVAILABLE IMMEDIATELY

Rapidly growing well established practice seeking part-time leading to full-time. PSR 12-36. Great opportunity for highly motivated, personable individual. Please reply by emailing a CV to nursebsf@aol or fax (561) 498-9068.

ASSOCIATE POSITION - TEXAS 
 
IMMEDIATE OPENING for motivated podiatrist with good people skills.  Associateship leading to PARTNERSHIP for the right applicant. Northside San Antonio Texas practice. Attractive office and beginning income. Current TEXAS license a must. CV and letter of interest to sadpmoffice@gmail.com

ASSOCIATE POSITION - FREDERICK, MARYLAND

Well-established group practice is located only 45 minutes from both DC and Baltimore. Immediate opening for a minimum PSR 36 Podiatrist for full time position. We have it all: EMR, digital x-ray, ultrasound, ASC, etc. Excellent salary with bonus structure and benefits. Please email resume to docsbnb@aol.com

ASSOCIATE POSITION - MASSACHUSETTS

Well established, multi-office, group practice, North of Boston, seeking a well-trained (PSR 24/36) Associate to start July, 2011. This is an excellent opportunity for an energetic, hardworking individual with strong surgical and medical skills, desiring a fast-track opportunity for partnership. Our practice is well rounded in all aspects of forefoot/rearfoot reconstructive surgery, pediatrics, sports medicine and general care. Competitive salary and benefit package available. Send a cover letter, CV, and two letters of reference to: drfleishman@nefootankle.com. Visit our website at www.nefootankle.com for more information about our practice.

ASSOCIATE POSITION - BLOOMFIELD, NEW JERSEY

Part-time office, part of larger practice looking for associate with well-rounded podiatric skills. Board qualified a must. Ground position leading to partnership. Please email CV to doccapo@yahoo.com

PART-TIME, LICENSED PODIATRIST - WEST BLOOMFIELD, MICHIGAN 
Immediate opening for treating patients in a nursing facility setting.  If interested, please e-mail drteetime@aol.com

IMMEDIATELY AVAILABLE- ASSOCIATE POSITION -CT (FAIRFIELD AND NORTH HAVEN)

Great opportunity. Join one of the largest podiatric groups in Connecticut. Well-established and progressive offices. Electronic medical records, digital x-ray, diagnostic ultrasound, Padnet vascular studies, nerve conduction studies, pinpoint and CO2 lasers, electrical stimulation and ultrasound therapies. Seeking a well-trained, personable, and highly motivated individual. Please send resume and current photo to dr.kassaris@yahoo.com

ASSOCIATE POSITION(S) - SOUTHERN CALIFORNIA

Podiatrist(s) wanted for long-term care facilities. Please email reply with CV to ZbubblesZ@aol.com

ASSOCIATE POSITIONS – MULTIPLE LOCATIONS 
 
Looking for podiatrists to join group to work in nursing facilities in: Texas (Ft. Worth, Dallas, Houston) and Delaware. Please respond to: doconcall02@aol.com

PRACTICE FOR SALE - MARYLAND, DC SUBURB

Great opportunity. Retiring after 38 years in practice at the same location. Practice is fully equipped with digital x-ray, diagnostic ultrasound, computer network, orthotic scanner and state licensed ambulatory surgical center that is fully equipped. Owner will stay on as needed for easy transition. dpmpracticeforsale@yahoo.com

PRACTICE FOR SALE – MASSACHUSETTS

Solo Practice Grossing over $700K yearly 4 days a week. Mostly surgical with heavy emphasis on peripheral nerve patients and pediatrics. General bread and butter podiatry as well. No Medicaid very little Medicare. Very modern office. 30 minutes north of Boston. Modern new equipment (digital x-ray, ultrasound, computer network, etc.). Great referral network. Website included. Option to buy the condo 3500sq ft. Have PICA practice evaluation to show you. Call 978-944-7789 for details.

AMBULATORY SURGICAL CENTER PRIVILEGES AVAILABLE - NJ

Privileges available in a new 2 ORs. New certified multi-specialty ambulatory surgical center in Fairlawn, NJ - 8 minutes to the George Washington bridge. Specializing in podiatric surgery. Center will pick up and return patient home. Syndication is available. Center will accommodate doctors in Manhattan, Queens, Brooklyn, Bronx, Staten Island, and long Island. Will assist in getting NJ License. Call for information (516)476-1815 e-mail podo2345@aol.com. To view center, go to FAIRLAWNASC.SHUTTERFLY.COM

MEDICAL SPACE AVAILABLE- MANHATTAN

Multispecialty Medical Building with 24/7 doorman. Prime Luxury Building and Location, Gramercy, Stuyvesant, Peter Cooper Area. 305 Second Avenue (17th-18th). Prior tenants past 23 years; podiatrist, dentist (plumbing/electric intact), internist. Ideal for podiatry, co-share with dentist, MD, etc. (flexible lease terms). E-Mail; jbdrun@aol.com

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