The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

September 29, 2009 #3,661 Publisher-Barry Block, DPM, JD

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Toe & Flow Teamwork Approach Can Prevent Amputations: Podiatrists

Every 30 seconds, across the globe, an individual loses a limb due to poor diabetes management. In the U.S., diabetes affects nearly 24 million people. When poorly controlled, diabetes results in nerve damage and poor circulation to the legs and feet. When this occurs, patients lose the ability to sense foot pain injury, and, when left untreated, this leads to foot ulcers, reduced mobility, and amputation.

Dr. John S. Steinberg

Preventive care makes the difference. Leading podiatric experts, Dr. John S. Steinberg of Georgetown University Hospital’s Department of Surgery, and Dr. David G. Armstrong, director of the Southern Arizona Limb Salvage Alliance (SALSA), are pioneers of the “toe and flow" approach, which they say is more effective than repeated endovascular stent procedures. They urge a team approach to diabetic foot care and argue that current health reimbursement incentives work against delivery of evidence-based guidelines and cost-effective care.

Source: Earth Times [9/25/09]

PA Podiatrist Receives Kidney from His Patient

Doctors save patients every day. Rarely, is it the other way around. But Dr. Jay Schnitzer owes his life to his patient Kim Myers, who noticed that the podiatrist had a bulky bandage on. She asked the then 300 pound diabetic doctor, “what is that?”, and he told her he was on dialysis.

Dr. Jay Schnitzer

Surprisingly, Myers offered to donate her kidney to the ailing doctor. But the story became very complicated because when her kidney was tested, it was found that it was incompatible with Schnitzers. Ultimately though, a solution was found – the Paired Kidney Donor Network - which allowed Myers to donate her kidney to a complete stranger in order to obtain a matching kidney for Schnitzer.

This week Schnitzer plans to return to seeing patients. “I am thrilled. It’s like my life is back. Kim is truly my sister,” he said. 

Source: Bucks County Courier Times [9/6/09]

Canadian Podiatrist Finds a Green Way to Commute

For almost 15 years, podiatrist Marshall Baer has been commuting by bike to his downtown Victoria office. Two years ago, Baer, who is “pushing 50” and has “exertion asthma,” decided he needed a bit of help on the 30-kilometre round-trip commute, without resorting to his car.

Dr. Marshall Baer

An electric bike looks much like a regular bike, but with a battery on the front triangle of the frame and a motor usually between the pedals or in the rear hub. The electric motor works in tandem with the pedals, but cuts out if the bike’s speed exceeds the legal 24 km/h limit. The plus for Baer is that he does not need to pedal as hard as he would on a regular bike. Nor is operating the $1,500 electric bike as hard on his wallet as his Mercedes.

“It’s like pennies compared to dollars,” he says, contrasting the cost of plugging his bike into the wall between rides with the gas his car burns on commutes. Most electric bikes are good for 20 to 30 kilometres between charges. Baer’s commute by electric bike takes almost twice as long as it does by car, but the bonus is the fresh air and natural beauty of the ride along Victoria’s bike trails, largely reclaimed from old rail lines. “It’s a great stress-reliever,” says Baer.

Source: Canada.com [9/27/09]

Georgetown Diabetic Limb Salvage Shatters Attendance Record

The third annual Georgetown University Hospital Conference on Diabetic Limb Salvage, A Group Approach, brought a record 1,200 physicians and other medical specialists to Washington, DC, September 24-26, 2009, to learn about new ways to save limbs at risk of amputation due to complications of diabetes.

Drs. John Steinberg (L) and Christopher Attinger (R) moderate session at Georgetown Diabetic Limb Salvage Conference

The conference, presented by Georgetown University Hospital/MedStar Health, expanded this year with a below-the-knee vascular symposium and an administrative session on how hospitals can start their own wound and limb salvage center. The conference featured seven live surgical cases, lectures by more than 60 internationally-known diabetic salvage experts, and interactive workshops and symposia.

The Georgetown DLS Conference itself exemplifies the team approach, as the conference co-chairs – Drs. Richard Neville, John Steinberg, and Christopher Attinger – are respectively a vascular surgeon, podiatrist, and plastic surgeon.  The conference is multidisciplinary and delegates are from a variety of medical specialties. Next year’s conference is set for October 14-16, 2010, again at the JW Marriott Pennsylvania Avenue in Washington, DC.

Look Out for Red Flags From Unhappy Employees

Watch for warning signs in conversation and in the hallways. You will know that a bad situation is developing when you see these red flags:

•  A normally friendly employee avoids making eye contact.
•  A reliable worker begins missing or pushing deadlines.
•  Absenteeism and tardiness increase.
•  Employees fall silent when you enter the room.

An observant leader will have little trouble noticing such signs. When you do, don’t wait. Take a positive approach to employee complaints. Keep your team members working well together. It's common to think “If I ignore it, it will go away.” However, that is usually not the case. You should intervene at an early stage. You will find it easier to address and resolve the brewing conflict before it has time to fester and spread to others.

Source: Adapted from Communication Briefings [October 2009}

Query: Employee Tracking

Does anyone know of a way to monitor work of an employee on the computer. I have two billers that work remotely from home. One of them seems to clock a lot of hours, but the work is not getting done.

Mark Stempler, DPM, Staten Island, NY

RE: Intractable Plantar Keratoma Sub 2nd Metatarsal  (Gary Gugliada, DPM)
From: Multiple Respondents

In all likelihood, given the presence of an HAV deformity, the patient has a degree of metatarsus primus elevatus. This is an important consideration and needs to be addressed along with your 2nd metatarsal/digit repair. The patient won't be interested in the fact that they have "a normal metatarsal parabola" if the IPK does not resolve because you didn't address the 2nd metatarsal. The parabola may appear to be normal on a  AP radiograph, but functionally the 2nd ray is bearing most of the weight-bearing load. I would repair the hallux valgus deformity to remove the influence of the great toe on the 2nd toe, and address the elevatus with first metatarsal osteotomy, perform a osteotomy of the 2nd metatarsal to shorten it slightly (not so much that you end up with a transfer lesion) and an interphalangeal arthrodesis of the 2nd toe.
 
Thomas A. Graziano, DPM, MD, Clifton, NJ, TGrazi6236@aol.com

Consider a hammertoe repair with sequential reduction to the second toe. If it is semi-rigid, perform a PIPJ arthrodesis. Consider a Weil osteotomy of the second metatarsal as well. Sometimes, if the Weil osteotomy becomes unnecessary, you can often just plane down a hypertrophic condyle to the plantar surface of the metatarsal with a saw to help get rid of  the IPK. Do an axial sesamoid x-ray with that same lesion marker to see if a hypertrophic condyle or plantarflexed metatarsal can be seen.  This view is very useful in planning for these type cases. Fixing the toe will decrease the retrograde bucking forces on the joint and allow the plantarflexed metatarsal to come up as well.
 
Chris Browning, DPM, Nederland, TX, chrisbrowning@att.net

If the toe & MPJ are flexible, and if the circulation is adequate, and you think the lesion is due to retrograde pressure, then percutaneous tenotomies and capsulotomies of the extensor and flexor longus would seem like a good option. I think that will reduce the pressure and still leave you the option of more open arthroplasty / arthrodesis work, if need be.

Using a wire marker around the point of interest on an x-ray still lets you identify where you want to focus attention, but it does not block out possibly important structures.

Andrew I. Levy, DPM, Jupiter, FL, rcpilot48@gmail.com

Editor’s Note: An extended-length letter by Dr. Mullen can be read at: http://www.podiatrym.com/letters2.cfm?id=29181&start=1

RE: Obama’s Healthcare Plan
From: Arden Smith, DPM

Different aspects of the discussion about healthcare reform speak to different people at different levels. Some of the issues that concern me are:

1-The cost of my own health insurance. My own Oxford family plan with medium high co-pays and deductibles for different services runs me just under two thousand dollars a month, almost twenty four thousand dollars a year. It has been going up in the neighborhood of about 15% a year over the last few years and I have been  "insuring down." Being in a small business with a group of one, my options are limited.

2-I have patients who are middle class, have "done all the right things", played by all the rules, and have seen their life savings wiped out by a catastrophic illness and "non-covered", "investigational" chemotherapy drugs.

3-I have also seen the same thing happen to the same socio-economic group of patients [savings wiped out] when long-term custodial care, or skilled nursing care was needed. [long term care insurance is not always an option and there is a five year "look back"].

4-I hear talk in the doctor's lounge, the OR, and socially, of doctors in just about every specialty, complaining that they are working just to keep their offices open, to pay their bills and to pay their staff. Organized medicine has been relatively silent regarding the issue of escalating overhead expenses.

I would be interested to hear some of my colleagues’ views and experiences.

Arden Smith, DPM, Great Neck, NY, digitiquinti@aol.com

ASSOCIATE POSITION - SOUTHERN CALIFORNIA

Looking for board certified/board eligible ABPS associate to join a multi doctor practice with 2 offices. May lead to eventual buy-in and purchase. Must have minimum 2-year residency and comfortable with rearfoot procedures and diabetic care, ER call. Must be dependable, honest, ethical individual. Send cover letter and CV to familyfootcenter@earthlink.net

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 a full-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to fmassuda@footexperts.com

OFFICE SPACE/ MRI RENTAL – NYC, LI

Turn-key space available, daily, monthly; East 60th off Park Ave, East 22nd St. off 3rd Ave, Hicksville and/or Plainview Long Island. JACHO-certified operating rooms available, as well as all surgical equipment and anesthesia. Extremity MRI Rental. Stark compliant. All exams read by board certified radiologist. Call for details. 516 476-1815

LOCUM TENENS/ASSOCIATE—PHOENIX

Busy multi-location practice in South East Valley seeks immediate well-trained personable individual. Part time Locum position may lead to permanent part-time, full-time, and buy- in potential if desired. Please send letter of interest and C.V. to AzToesRus@aol.com

ASSOCIATE POSITION – LOS ANGELES

Well established Los Angeles-based practice seeking a surgically trained, highly motivated, well-trained podiatrist. We have a very busy multi-office practice with state of the art podiatric equipment. Must be dependable, honest, and an ethical individual. This position is available immediately. Send resume and your email address to desierec@kimfoot.com

ASSOCIATE POSITION - MICHIGAN

Seeking quality-oriented, patient-focused RPR or Surgically-trained associate for a fast-paced, established group practice in Southeast Michigan. Emphasis on diabetic foot and wound care. Gain surgical experience while earning an excellent living. Our outstanding staff allows you to concentrate on optimal patient care without the responsibilities of practice management. If you are highly motivated, ethical, have a current Michigan License and have good communication and clinical skills, please forward your C.V. cfsdr@yahoo.com

ASSOCIATE POSITION - WASHINGTON, DC

Interested in working in Washington D.C.? Our group is looking to add a highly motivated, hard working, well trained podiatrist to our practice. Must have surgical training. We have a very busy multi-office practice. We practice state of the art podiatry with EMR and digital radiography. Associate to partner on a fast track for the right person. E-mail CV and cover letter to Washingtonpod@aol.com

ASSOCIATE POSITION (SURGICAL) – CONNECTICUT

Connecticut Surgical Group is seeking a Board-Certified podiatrist to add to our Surgical Podiatry division based in Central Connecticut. This podiatrist will provide all aspects of Podiatric care with a focus on wound and surgical care to a well-established patient base. We require PSR-36 training and board certification or eligibility, excellent surgical and wound care skills, a strong focus on providing compassionate care to our patients, and the ability to work as part of a team in a group practice setting. To apply please visit our website . EOE

ASSOCIATE POSITIONS - INDIANA/OHIO

PrimeSource Healthcare is a leading provider of mobile, on-site healthcare services at long-term and skilled nursing facilities. Our exceptional growth has created an immediate need for traveling, independent contractors of podiatry services in Indiana/Ohio. Earn between $175k and $225k per year. E-mail CV to kwright@pshcs.com. Visit us at pshcs.com.

ASSOCIATE POSITION - FREDERICK, MD

Well-established and growing 2 office state-of-the-art practice located in medical/professional buildings. EMR, Digital X-ray, Ultrasound, DME provider, etc. Competitive Base Salary plus bonus, malpractice, health insurance, etc. PSR 24 minimum/Board Qualified or Certified with ability and desire to take ER call. If interested, forward CV to DOCSBNB@aol.com

EQUIPMENT FOR SALE- ARTOSCAN EXTEMITY MRI

In excellent cosmetic and working condition. Originally an A model, upgraded to a model D. Looking to sell the MRI because additional space is needed in the office. Price to sell. Picture can be seen at by clicking here  Contact baileymeans@yahoo.com for any inquiries

EQUIPMENT FOR SALE - ORTHOTIC FABRICATION SYSTEM

Amfit Orthotic Insole Fabrication System with Footfax SL Contact digitizer- For Sale Machine, Laptop, rolling bag, small inventory of shoes, insoles, all cords, parts and hardware Asking $8k. OBO! Please contact Jeff at Jhunt@psbank.net for further information, pictures.

PRACTICE FOR SALE - FLORIDA—CENTRAL/SOUTH

Turn-key operation grossing $570,000 annually based on one full-time doctor. Great opportunity for growing the top-line. Surgery is only 14% of the professional man-hours; it can significantly increase income. Medicare makes up 64% of revenues. Seller will assist with transition. Call 863-688-1725, ask for Chas.

EQUIPMENT FOR SALE - AMFIT ORTHOTIC MANUFACTURING MACHINE

Includes digitizer, fabricating mill, new updates have been added and enough supplies to pay for the machine in the long run. At $200 per pair = about $28,000. Selling FOR $25,000, O.B.O, F.O.B. americanfoot@email.com or 405-733-2783.

NEEDED CHICAGO -- NW IND & BALTIMORE/WASHINGTON, DC PODIATRISTS

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists in Chicago, Northwest Indiana, and Baltimore, MD. 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

PM News Classified Ads Reach over 11,500 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 11,500 DPM's. Write to bblock@podiatrym.com or call (718) 897-9700 for details. 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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