The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

September 26, 2008 #3,358 Editor-Barry Block, DPM, JD

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Most Diabetic Amputations Can be Prevented: APMA President

Eight percent of the U.S. population has diabetes, but nearly six million people remain undiagnosed. According to the American Podiatric Medical Association (APMA), foot problems can help doctors discover diabetes. Diabetes can cause nerve damage in people’s feet, which can easily lead to amputation. Luckily, most diabetic amputations can be prevented through vigilant foot care.

Dr. Ross Taubman

"Diabetes can cause patients to lose sensation in their extremities, therefore a person with diabetes might not notice injuries to their feet until serious infection occurs," said Ross Taubman, D.P.M., president of APMA. "In most cases, patients can avoid amputation by working regularly with a podiatrist."

Once diagnosed, patients with diabetes can prevent amputation by creating a foot care plan. Plans should include annual checkups with a podiatrist and daily foot inspections. Diagnosed diabetics need to be especially careful about foot care and should work with a podiatrist to determine the best preventative treatments.

Source: The Toledo Journal [9/24/08]

Smith, Wu to Receive Rising Star Awards

The American Podiatric Medical Association (APMA) has announced that Robert G. Smith DPM, MSc, RPh and Stephanie C.S. Wu, DPM, MSc have been selected to received the Rising Star Award. The Rising Star Award is awarded to APMA members (with no more than ten (10) years of membership) in recognition of outstanding national accomplishments in scientific, professional, or civic endeavors. Nominees must have demonstrated outstanding service to APMA, including support for APMA PAC and/or the APMA Educational Foundation. Thesawards will be presented at the 2009 APMA House of Delegates.

Dr. Robert G. Smith

Dr. Smith completed his post-graduate training with the College of Medicine at the University of Wales, Cardiff, Wales, UK in wound care and tissue repair. He is a member of the American Professional Wound Care Association and a consultant to the National Board of Podiatric Medical Examiners. He is a contributing editor and reviewer to JAPMA in the areas of podiatric clinical pharmacology and has authored 50 refereed journal articles in the disciplines of pharmacy, podiatry, and wound care. He currently practices in Ormond Beach, FL.

Dr. Stephanie Wu

Dr. Wu is Assistant Professor of Surgery at the Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science and Director of Medical Education and Outreach Center for Lower Extremity Ambulatory Research (CLEAR). She is also Director of the National Center for Limb Preservation (NCLP) Advocate Medical Group at Lutheran General Hospital. Dr. Wu is a member of the American Academy of Podiatric Practice Management.

Lilly to Disclose Payments to Physicians

Eli Lilly announces that beginning next year it will become the first drugmaker to voluntarily disclose all payments more than $500 made to individual physicians for advice, speeches and other services. Lilly eventually will disclose payments to physicians for travel, entertainment and gifts. The disclosure will begin in the second half of 2009 and will include payments made during the first half of 2009. Lilly does not plan to disclose information on payments made before 2009.

The payments will be listed on a Web site, which will be available to the public at no cost. The information likely will include physicians' names and hometowns. Lilly in 2011 plans to begin disclosing payments made for clinical research and other provisions called for in the Physician Payments Sunshine Act, which currently is pending in Congress.

Source: Indianapolis Star via American Health Line [9/24/08]

Select the Best Domain Name

Selecting a domain name is an important marketing decision , so use the "3E: guide. Your domain name should be:

• Easy to remember. Google and Yahoo are easy and fun to remember. That's one reason people use those search engines more often than they use AltaVista.
• Easy to spell. Long domain names offer careless Web surfers more opportunity to misspell or mistype characters.
• Easy to pronounce. If it isn't easy to say, how do you expect users to tell others about it?

Source: What's the Big Fuss About Long Domain Names? by Alan Yap

Query: Onychomycosis in a 12 Year Old

I have a 12 year old child who presented with mycotic nails, first through fifth toes of both feet . According to his mother, condition this has been there most of his life. I performed nail biopsies for KOH prep as well as a blood draw for liver profile (in case we decide to place him on medications). With solitary nails, I usually do an avulsion and topicals as, the nails regrow with generally good results. In this case, I can't see doing 10 avulsions. I was wondering what others do in a case like this, assuming there are no surprises and the KOH is positive for fungal elements.

Ira Weiner, DPM, Las Vegas, NV

Query: Assistance in Developing "New Patient Bags"

We are looking to give out "new patient bags" in our practice. The idea is to provide all of our new patients with a small plastic bag with our practice information with helpful foot & ankle information/products inside. Where is it most cost-effective to order custom plastic bags? 2) What information/products are best to put into the bags?

Chad Schwarz, Howell, NJ

RE: Onychodystrophy (Dale Smith, DPM)
From: Multiple Respondents

From the picture, it appears that the toenails have yellowish discoloration with clearing proximally, but no thickening. Discoloration like this is often found after a patient has kept a dark (i.e., red) nail polish on the plate for an extended period of time. While there are many differential diagnoses for yellowing toenails, the answer may sometimes be the most simple.

Lauren Newnam, DPM, Gambrills, MD, lnewnam@hotmail.com

I see the discoloration in the hallux, however there appears to be the same discoloration in the second toenail. The third nail looks as if it has a small white area that looks like a superficial white onychomycosis. It was stated that two cultures were performed with negative results. There was no mention of a PAS stain. I do not know how far back the nail was trimmed to obtain your sample. If it was taken from the distal edge, then a proper culture specimen was not taken. A small quantity of local anesthesia may need to be given to the patient to be able to cut a piece of nail far enough back to repeat the culture, as well as the PAS stain.

Steven H. Goldstein, DPM, Royal Palm Beach, FL, stevefootdr1@cs.com

Ask your patient about her nail polish and pedicure habits. Was she wearing polish all summer long and then removed it before she came to your office? If she frequents the nail salon or polishes her own nails- first consider that many nail polishes contain formaldahyde and other ingredients, which are extremely drying to nails, leading to white peeling and flaking. Educate her about using products that aren't drying. Secondly, Acetone, a common nail polish remover is very drying. Have her switch to non-acetone nail polish remover.

Lastly, nail polish should not be left on for longer than 2 weeks at a time. The yellow that is on your patients nails can be a stain from darker opaque colors and can easily be "buffed" off. Nail polish also needs to be applied on top of a base coat, which protects the pigments from penetrating and staining the nail plate.

From what I can see on the picture, it looks like there is white healthy growth proximally, isn't thick, and is without any subungal debris. If this is caused by nail polish it should grow out normally as long as she adheres to these suggestions.

Jacqueline Sutera, DPM, NY, NY, jackiesutera@gmail.com

RE: Network vs. Non-network
From: Mark Levine, DPM

The disparity between participating and non-participating fees from commercial insurance companies has gotten to the point where it's ridiculous and in most instances it doesn't even pay to do any substantial surgery outside your office. I don't know whether this is only endemic in the NY City region, but as the commercials continue to lower the par fees, the par doctors are getting in the area of 20% or less than their non par colleagues. For example, an Austin bunion with Oxford, par $480, non-par $4,500, hammertoe with GHI, par $295, non- par $1,350. Many doctors who have more than one provider in their offices are playing games to bill these cases as non par. In the NY area, BC is now paying 65% of Medicare and Oxford and United Health Care paying 60% of Medicare.

I have a modicum of intelligence and I just can't understand how there is a such a difference. Par providers can NEVER make up the difference with volume. We'd need to do half a dozen bunions to make up what a non par doctor gets for one bunion.

It's time the commercials took care of their providers. It's easy to say they should pay us more, I know they won't, but something has to be done. Providers with experience will not continue taking these insulting fees with a a subsequent decrease in quality which will affect the whole profession. How can young providers, strapped with student loans, make a living getting these fees?

Mark Levine, DPM, Middle Village, NY, MarkLevineDPM@Verizon.net

RE: Wellness Life Systems and Diabetic Shoes (David Schlageter)
From: Paul Kesselman, DPM

The issue of the lack of concern for the patient’s overall health by mass mailing DME dealers and their greed, is best illustrated by companies, such as in this recent posting. Wellness, unfortunately, is not the only company which does business this way. Providing products to patients without checking the fit of the shoes is certainly a recipe for disaster. This is particularly true for a high-risk subset of patients who cannot reliably check the integrity of the medical products that they have received.

I have asked an ombudsman from DME MAC A for...

Editor's note: The full full version of this note can be read at:http://www.podiatrym.com/letters2.cfm?id=22166&start=1

Paul Kesselman DPM, Woodside, NY, pkesselman@pol.net

RE: Expert Witness Testimony
From: Marque A. Allen, DPM

Recently, on this forum, there has been a heart-felt passionate response from one of our colleagues who has felt the ill effects of false and misleading testimony in a medical malpractice case. As physicians, we are left to feel helpless in an attempt to overcome such statements. We, as podiatrists, are not alone in this professional misconduct. The AAOS has in recent years drafted a Standards of Practice (SOP) guidelines for expert witnesses who wish to engage in this venue.

To the credit of the AAOS, they have added actual teeth to this and now have started to hold experts who provide testimony that deviates from these SOP's responsible and are suspending orthopedists from the AAOS. This, no doubt, will affect a physician's ability to serve as an expert witness. This will also have to be disclosed on professional applications. I am aware of the ACFAS position statement on this same topic. This appears to be a step in the correct direction. To date, I am unaware of there being a registered complaint against another podiatrist to the ACFAS and/or action taken. There are also some legal avenues to pursue.

Medical Justice is an organization of doctors that will help you fight back . Complaints to the podiatric state board and APMA, as well as ACFAS should be considered. This is a great venue to share with colleagues, but individuals that have given false testimony must be held accountable to the full extent of professional and legal obligations.

Marque A. Allen, DPM, San Antonio, TX, FtAnkldoc1@aol.com

RE: Medicare Payments Could Be Reduced
From: Paul Kesselman, DPM

I found the following posting extremely humorous: "Beginning October 1, 2008 your Medicare payments could be reduced if the internal revenue service (IRS) needs to collect overdue taxes that you owe!"

With the transition from Medicare Fiscal Intermediaries to Medicare Jurisdictional carriers (e.g., Empire and GHI Medicare to NGS, and Noridian to Palmetto to name a few), many physicians have not received Medicare checks for several months. Without Medicare reimbursement, our incomes have significantly been reduced. Simultaneously, the workers for these carriers continue to get paid. I sincerely doubt there will be anything for the IRS to take, except perhaps the phone number for the Medicare carriers who are holding onto our hard-earned money.

Perhaps signing onto the physician’s open door forum being held by CMS is a good way to vent your frustrations about the carriers directly to CMS. This is on October 7, 2008 at 2 PM. Registration is free via: 1-800-837-1935 & Reference Conference ID 58370420. Call 15 minutes prior to the beginning of the conference.

Paul Kesselman DPM, Woodside, NY, pkesselman@pol.net

ASSOCIATE POSITION – ILLINOIS

ASSOCIATE POSITION - TAMPA BAY, FL

Live, play and practice in West Central Florida. Associate position available, leading to partnership, in a well-established, expanding, solo practice in the Tampa Bay area. Great pay and benefits in a dynamic medical/surgical practice. Join our caring, compassionate, educated team. E-mail cover letter, CV and references to rvalins18@aol.com

ASSOCIATE POSITION – CONNECTICUT

Full or part-time position available for a podiatrist licensed in CT. This practice encompasses wide variety of patients including Diabetic wound care and general podiatric care. Must be willing to cover all aspects of the practice including nursing homes and house calls. Please e-mail CV to RPMDPM@aol.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

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

ASSOCIATE POSITION – ORANGE COUNTY, NY

Immediate need for podiatrist to work a few Saturday mornings a month and possible weekday schedule. No call, No after-hour responsibilities, just a good experienced doctor. Work to full-time status, if desired. A great opportunity for the right person Orange County area. Easy commute from surrounding counties. Contact with resume to Phinster18@hotmail.com

TIMESHARE – MOTIVATED SELLER

Golfer's paradise in Myrtle Beach, S. Carolina! Click here for details! Great for family vacations. Fixed deeded week. Beachfront resort, RCI Exchange, $15,000/or bo. Timeshare points also available. Contact footfixr@consolidated.net or 1-800-366-8397

PODIATRIST POSITION - NORTH DAKOTA

Mid Dakota Clinic is currently recruiting a BE/BC Podiatrist to join our private multi-specialty practice in Bismarck, North Dakota. Full benefit package to include a first year salary guarantee, or the clinic's RVU system whichever is greater, as well as profit sharing. Bismarck is a growing and upscale community and along with our sister city of Mandan the population is approximately 100,000. Please send your CV or contact Jeff Neuberger at 701-530-6113, or jdneuberger@primecare.org

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-773-342-4201 FAX 773-486-3548-E-Mail sschneider@homephysicians.com Visit our website

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.

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