The Voice of Podiatrists

Serving Over 13,000 Podiatrists Daily

September 27, 2011 #4,264 Publisher-Barry Block, DPM, JD

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UK Podiatrist Offers Tips for High Heel Hangover

We’ve all been there — you’ve spent the previous day tottering around in towering heels and you wake up with aching calves and feet that feel as if they’ve gone five rounds with boxer Mike Tyson. We call it the high-heel hangover. Flat shoes may have been big news this summer, but autumn is seeing a return to towering heels. But don’t fret just yet — Harley Street podiatrist, Mr. Stephen Strain, has some top tips on how to sidestep that painful morning after a night out in your Louboutins.

UK Podiatrist Stephen Strain

Stretching out your legs and feet the morning after lengthens the muscles and gets the blood flowing again, says Strain. Yoga is great for this. Downward-facing dog (when your hands are on the floor a small distance in front of your feet and your bottom is stretched up to the ceiling, forming a triangle shape with the floor), is a particularly effective position. Strain also says a hot bath helps ease tired muscles. Try adding Epsom salts, which are loaded with natural minerals including magnesium and sulphate.

Source: Indai Sturgis, Daily Mail [9/25/11]

HRSA: Doc Database Removal a 'Temporary Action'

The government agency that removed from public view a national database that chronicles physicians' malpractice fines and sanctions declined to provide a time frame for restoring public access to the database.

The U.S. Health Resources and Services Administration's National Practitioner Data Bank didn't list physicians' names, but agency officials removed the database's Public Use File in response to concern that reporters and other members of the public could use other data sources in combination with their information to confirm the identity of doctors.

Source: Ashok Selvam, Modern Physician [9/22/11]

MGMA: Medical Practices Cut Spending 2.2% Last Year

Medical groups cut spending by 2.2% in 2010, despite the fact that general operating costs have risen by more than 52.6% since 2001, according to the Medical Group Management Association.

The MGMA's Cost Survey for Multispecialty Practices: 2011 Report based on 2010 Data drew information from 44,000 providers and 1,994 groups. Total medical revenue in multispecialty practices not owned by hospitals or integrated delivery systems has risen 45.9% since 2001 and 8.5% since 2009, likely because practice managers are scrutinizing their operating expenses more closely, according to the association.

Source: Ashok Selvam, Modern Physician [9/20/11]

Clinical Informatics to be Certified Subspecialty

For the first time, physicians will have the opportunity to become board-certified in the subspecialty of clinical informatics, the American Medical Informatics Association announced.

The American Board of Preventive Medicine will administer a clinical informatics examination for physicians seeking certification in the subspecialty, which the American Board of Medical Specialties recently voted to recognize. Physicians who have primary specialty certification through the ABMS will have the opportunity to sit for the exam.

Source: Joseph Conn, Modern Healthcare [9/23/11]

Alleged Failute to Diagnose and Treat a Diabetic Ulcer

Summary of Facts: Douglas Bullock, a diabetic with peripheral neuropathy, sought care for a right foot infection from the defendant podiatrist in April 2003. Defendant treated Bullock for a severe callus on the plantar aspect of the 5th metatarsal head. The podiatrist provided ongoing treatment from June 2004 through October 2007.  Bullock sought care in January 2007 from a different podiatrist. He was admitted into the Tucson Medical Center October 27, 2007 with a diabetic ulcer requiring amputation of the right fifth metarsal and toe.

Douglas Bullock and his wife Jill Bullock filed a complaint in the Pima County Arizona against defendant. The plaintiffs alleged the defendant fell below the standard of care, failed to properly diagnose and treat Douglas' diabetic ulcer and caused Douglas to suffer permanent and severe harm, injury, disfigurement and humiliation in addition to medical expenses and lost wages.

Defendant denied negligence. The defendant asserted affirmative defenses of intervening/superseding cause and contributory negligence.

Result: A jury convened before Judge Christopher P. Staring returned a unanimous verdict for defendant ($0).

Plaintiffs' experts: John A. Ciccone, DPM, El Cajon Foot Clinic, El Cajon, CA; Mordechai Twena, MD, vascular surgeon, Tucson, AZ.
Defendant's expert: Lewis H. Freed, DPM, East Valley Foot and Ankle, Mesa, AZ.

Source: West's Jury Verdicts - Arizona Reports

Editor's Note: PM News is proud to present excerpts from Meet the Masters.

Bret Ribotsky: How can a podiatrist get a better knowledge of sports medicine?    

Dr. Karen Langone

Karen Langone: Fellowships are a great way. Right now, the programs that we have require a year-long commitment. We don’t have anything that’s set up on a shorter term, but that is an interesting perspective to think about - setting up programs where people could go for that intense one-week or two-week experience.

I think that there are great opportunities just networking within the American Academy of Podiatric Sports Medicine and with ACFAOM. I also suggest reading everything that one possibly can get their hands on and attending as many of the seminars that you can. I think that is really the best way to learn.

Meet the Masters is broadcast each Tuesday Night at 9 PM (EST). Meet the Masters is on vacation this week. You can register for future events by clicking here

Recover After a Terrible Speech

Rather than becoming deflated after botching a speech, recognize and fix your mistakes to become a stronger speaker next time around. Start by analyzing your technique. Objectively review a recording of your failed speech, or ask a trusted colleague who heard your presentation to give honest feedback.

Scrutinize body language, vocal tone, and energy level. Identify words that needed more emphasis and ideas that needed more explanation. In addition to noting what you did wrong, note what you did well. Build on your effective techniques and find a way to use any bad habits to your advantage. Example: If you utter too many filler words, “ums” and “uhs,” practice pausing and being silent instead. That will make you appear thoughtful.

Source: Adapted from “How to Recover From a Disastrous Speech,” George Dixon, Presentation Magazine via Communication Briefings

RE: Support DPM Candidates for Congress (Marc Garfield, DPM)
From: Michael Rothman, DPM

"I marvel that society would pay a surgeon a large sum of money to remove a person’s leg ...but nothing to save it."  George Bernard Shaw

Thanks, Dr. Garfield for the warning. I will not support anyone if I disagree politically with WHO they quote but not necessarily the quote itself. Why would we, as podiatrists, want to save a limb if we are not getting paid to do so. And WHY would we want society to pay for it either way. How Socialistic is that?

And to think I took government-backed loans and grants to attend podiatry school. How could I have been so naive? And now Medicare is planning on funding podiatric residencies. Let private corporations and especially the drug and medical device companies fund those programs.

Michael Rothman, DPM, Skokie, IL, michael_rothman@comcast.net

RE: Sclerosis of Neuroma (Harry Goldsmith, DPM)
From: Derick Ball, DPM

I find Dr. Goldsmith's distinction between sclerosis and destruction of a nerve specious at best. Serial 4% injections to the neuroma certainly render the nerve non-functional regardless of the histological description post-injection. If this isn't de facto destruction, what is? This is not a nerve block but a concerted effort to render the nerve quiescent. I have utilized this treatment regimen dozens of times over the past several years and can report similar results as Dr. Dockery: i.e. 75 % improvement/resolution without surgery.

Secondly, the use of this protocol as promulgated by Dr. Dockery has certainly obviated the need for surgical excision in many cases, saving CMS the cost of admission, pathology, surgeon, and anesthesiology. So where is the rub here? Additionally, Dr. Goldsmith seems to recommend/require the use of 40% ETOH for this condition. I caution my colleagues to avoid this concentration as literature suggests it will likely cause adjacent tissue destruction. The 4% advocated and used extensively throughout our profession has proven itself capable of the aforementioned relief of symptoms (and echoed by Dr. Goldsmith himself).

I cannot but think that Dr. Goldsmith's resistance to the use of this code is that it pays well. Perhaps it makes up for those codes that do not. We are continually instructed to use the most descriptive and accurate codes. Serial 4% ETOH injections are intended as destructive and are so. If contrary literature can be cited, then please do so.

Derick Ball, DPM, Hawthorne, CA, drdb@cox.net

Dr. Goldsmith responds:

“We are continually instructed to use the most descriptive and accurate codes. Serial 4% ETOH injections are intended as destructive and are so. If contrary literature can be cited, then please do so.”

Dr. Ball, nothing in your response validates your point that a 4% alcohol solution is destructive. Obtaining a therapeutic effect demonstrated by either elimination of the nerve symptoms or diminishing of those symptoms does not evidence destruction of peripheral nerve by neurolytic agent. You are not, in my opinion, using “the most descriptive and accurate codes.”

The 40% or 30% alcohol solution for peripheral nerves quote from me comes from alcohol package inserts. I was making a distinction between the effects of a weak alcohol solution and a significantly higher one. For clinical applications, I recommend you read “Treatment of Intermetatarsal Morton's Neuroma with Alcohol Injection under US Guide: 10-Month Follow-Up” by Fanucci E et al (2004). They used 30% alcohol under ultrasonic guidance into the nerve.

I am not advocating one way or another that doctors begin injecting higher concentrations of alcohol solution. That’s a clinical judgment left to individual doctors. I would, however, like to presume anyone performing alcohol solution injections to treat/destroy a peripheral nerve would be intellectually curious enough to review the related and current literature on the subject, and, from a clinical standpoint, determine how they want to treat their patients.

I was attempting to make a distinction between the terms “sclerosing” and “destructive.” I stand by my position that a weak alcohol solution injected near (not into) a peripheral nerve (e.g., a common plantar digital nerve) may produce a positive therapeutic effect, but it does not necessarily destroy the nerve. 

“I cannot but think that Dr. Goldsmith's resistance to the use of this code is that it pays well. Perhaps it makes up for those codes that do not.”
  
Actually, the opposite is the case. CPT 64450 – peripheral nerve block, therapeutic – which I feel is the appropriate code for injecting a 4-6% alcohol solution close to a peripheral nerve has a Medicare value of 3.01 non-facility RVUs. CPT 64632 - destruction by neurolytic agent; plantar common digital nerve – has a Medicare value of 2.5 non-facility RVUs.
 
Harry Goldsmith, DPM, Cerritos, CA, admin.codingline@verizon.net

RE: Outrageous Shoe of the Day

Now every woman can pretend to be Lady Gaga

Designed by Kobi Levi

Source: Submitted by Dr. Stuart Steinberg

EQUIPMENT FOR SALE - CLASS FOUR LASER

I have a class four pain laser for sale. Used for plantar fasciitis, Achilles tendonitis, neuroma, arthritic conditions and even fungus toe nails This laser is portable, re-chargable and can be move from room to room or office to office. This isn't the cold laser that you see. It is a 10 watt laser. We have used this laser on NFL sports players. For those that understand a good laser. E-mail David Zuckerman, DPM for Details and pricing. footcare@comcast.net

PRACTICE FOR SALE - NORTH DALLAS, TX

Great opportunity; 26 year old solo practice, reasonably priced. General practice consisting of hospital surgery, office surgery, orthotics, children, adults, geriatrics. Turn-key office located in medical building inside Loop 635. Will consider owner finance with down-payment.dallasfootdr@yahoo.com

ASSOCIATE POSITION - DAYTON, OH

Join a Well-established modern practice in Dayton, Ohio. Excellent reputation and referral base. Base salary $120,000, benefits and bonus structure. EMR, diagnostic ultrasound, Padnet vascular studies, CO2 lasers, all aspects of DME. We seek a surgeon that is well-trained and personable to join our group of 4 podiatric surgeons. Would like to have this individual buy in to the practice eventually. Please send CV and current photo to Ohiodoctors@aol.com

ASSOCIATE POSITION - MANHATTAN

Well-established successful Park Avenue podiatry practice is recruiting an In-Network, skilled and well-trained DPM with a minimum of 3 years of experience. Must be experienced in rear and forefoot reconstruction. Must be self-motivated and great with patients. Practice facilities and technologies include: in-office Physical Therapy, digital x-ray, diagnostic ultrasound, and Electronic MedicalRecords. MRI, and Private Operating Room. Please E-mail CV to sjohnson@parkavemed.com 

ASSOCIATE POSITION  - FLORIDA/N.W. FLORIDA- TALLAHASSEE AREA
 
Home of Florida State University. Great university town!  Well established full scope solo physician with busy practice. Looking for a full time associate leading to partnership in a short time. Great general practice with 2 locations. Staff privileges with 2 local hospitals and 2 surgery centers. Offering competitive salary, health insurance. Will need forefoot and rearfoot surgical competency. Friendly office with fun staff that’s easy to work with. Call/Text – 850-510-4371.

ASSOCIATE POSITION - EAST TENNESSEE

30 year old practice with 5 offices in greater Knoxville area seeking ethical, personable, hardworking, team player. Extremely competitive base salary with bonus incentives and benefits. Knoxville is consistently ranked in top 5 places in U.S. Post-residency experience a plus. Please send resume to ddavidphawk@yahoo.com

ASSOCIATE POSITION - PORTLAND, OREGON

Busy office with good steady referral sources looking to expand. Areas of expertise wanted: wound care, surgery of all aspects, knowledge of running an office. Please come with good personality and hard work ethics. New main and satellite offices. mail: office.pfac@gmail.com

ASSOCIATE POSITION - UPSTATE NEW YORK

Outstanding Opportunity. Our medical surgical group is recruiting a well-trained licensed podiatric physician. Located in Beautiful upstate NY. Full hospital privileges, as well as working with two residency programs. Must be highly motivated and great with patients. Opportunity for growth. Competitive salary and benefit package. Please send CV to associateinfoot@yahoo.com

ASSOCIATE POSITION – IOWA CITY AREA

FULL-TIME ASSOCIATE POSITION – NORTHEASTERN PENNSYLVANIA (LEHIGH VALLEY)

Well-established, rapidly growing practice with multiple offices. Motivated, ethical and personable with well-trained PSR-24/36. Modern office’s with complete EMR, digital radiography, diagnostic ultrasound, and laser. Competitive salary/benefits package with partnership opportunity. If interested please fe-mail your CV, letter of intent and references to: Pafootdocs@gmail.com

EQUIPMENT FOR SALE - ULTRASOUND, CRYO-PAC, FLOUROSCAN

Ultrasound w/printer, Cryo-Pac w/two probes, Flouroscan w/printer. There may be other surgical equipment as well. Please contact Jolene as young_jolene@yahoo.com

SPACE AVAILABLE - NYC & LI

SUB LEASING TIME on MRI (NYC)

.31 tesla extremity MRI in state-of-the-art midtown Manhattan office location. Lease time on magnet in compliance with the Stark laws. This magnet is the only one that will be accepted by Medicare and all other insurance as of 2012. Why not bill out for your own MRI's??? Email today dri@myfcny.com

PM News Classified Ads Reach over 13,000 DPM's and Students

Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 12,500 DPM's. Write to bblock@podiatrym.com or call (718) 897-9700 for details. Weekly ad rates start as low as $109 for a 50-word ad THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451.

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