The Voice of Podiatrists

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October 01, 2007 #3,053 Editor-Barry Block, DPM, JD

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IL Podiatrist Uses Neurolytic Injections for Neuromas

A common foot ailment can be treated over the lunch hour as well. A neuroma is a swollen nerve in the ball of the foot that can cause burning, cramping, numbness or pain while standing and walking.

Dr. Howard Stone

Surgery requiring weeks of recovery traditionally has been used to remove the neuroma. A new treatment called neurolytic injections can reduce or eliminate the neuroma in many cases without surgery, according to Dr. Howard Stone, a podiatrist with the North Shore Podiatry Group in Glenview, IL.

The doctor injects a small amount of an alcohol/local anesthetic solution around the nerve to chemically dissolve the neuroma. Anywhere from three to nine injections are given at two-week intervals. "It's a wonderful, non-surgical treatment for a common foot problem," Stone said.

Source: Terri Yablonsky, Chicago Tribune [9/30/07]

NJ Podiatrist Charged With Selling Drugs

A foot doctor and his wife were arrested Thursday in Randolph and charged with illegally selling pain killers, capping an 11-month investigation, police said.

Mark B. Spal, 54, and his wife, Susan Spal, 55, were arrested at his office on Springhill Road office. Authorities say the doctor, who is also a pharmacist, issued 31 prescriptions for drugs including Xanax and Oxycodone in exchange for cash, or in some cases in-kind services. Spal is charged with illegal distribution of drugs. His bail was set at $50,000. His wife was charged with conspiracy to distribute drugs. Her bail was set at $25,000.

Source: Joe Ryan, Newark Star Ledger [9/28/07]

Query: Mixed Fungal Infections

In addition to the expected cultures positive for T. rubrum and T. mentagrophytes, we are getting a lot of mixed infections that do not cleanly fit into the rather limited indications for Lamisil. A recent culture came back with Cryptococcus albidus, Penicillium species, and Aspergillus niger, from what clinically appeared to be onychomycosis. I understand the reality of this; however, is that I am not sure which, if any, oral antifungal is appropriate for these mixed infections. Over the years, I have had much greater success and fewer safety concerns with Lamisil than Sporanox. These new culture results, however, are making me rethink the use of Sporanox. Ideas?

Greg Caringi, DPM, Lansdale, PA

RE: Request for Unwarranted Disability Certification (Doug Dickson, DPM)
From: Jon Purdy, DPM

Over my years of practice, I noticed that patients with work related complaints would ask one of two questions: 1)How long do I HAVE to stay out of work? 2)How long CAN I stay out of work? That little linguistic difference tells you a lot about what type of patient you're dealing with.

Paul Busman DPM,RN , Cohoes, NY, brewerpaul@aol.com

This presented scenario could be a patient with a suit, applying for disability, or just trying to get out of something. When I have a patient like this, of which there seem to be many, I take two things into consideration. One is that a patient’s subjective pain is just that, subjective, and I can’t deny them their opinion. The second is what I feel the patient’s restrictions should be. For the patient I feel is malingering with no supportive clinical findings, I have no problem filling out a form that says I feel there will be no detrimental effect for that person to perform any task, and they are only limited by their subjective complaints.

I use techniques like distraction while examining to see if I can find inconsistencies in their related exam pain. I may send them for a bone scan or MRI to document pathology or the lack there of. I can also send them to PT for functional evaluation which is really a corroborative documentation. Ultimately, if there are no clinical findings to support the patient’s complaints, I simply tell them that there is nothing more I can do for them and they will need to find another doctor.

I have found the disability papers provide opportunity for you to put down your lack of findings. That’s what I do and I let the patient, their lawyer, other doctors, and the disability office figure it out. They can have all of my notes they want. Whenever a patient has called wondering why I have not bent to their will, I simply state that I cannot get them out of work or disable them, I can only put down my findings and assessment of their limitations. The rest is up to the powers that be. I almost always have an understanding patient on the other end of the phone.

Jon Purdy, DPM, New Iberia, LA, Podiatrist@mindspring.com

RE: Arthroereisis vs. Arthrodesis (Cheryl Christensen, Mark Schilansky, DPM)
From: Robert Scott Steinberg, DPM

The real issue here is why insurance companies are classifying so many procedures as "experimental" and we (the APMA & state components) aren't screaming bloody murder. We, not the insurance company medical directors, are the experts. If the FDA approves a device or medication, how can the insurance company claim their opinion supersedes the FDA.

And please, don't write me and tell me that the insurance companies are doing the same thing to orthopods. They deserve it ---- OK, just kidding, but why are we so good at rolling over and playing dead?

Robert Scott Steinberg, DPM, Schaumburg, IL, Doc@FootSportsDoc.com

ASSOCIATE POSITION – VIRGINIA

Must have Virginia license. Requires 24 to 36 month Residency. Permanent position with potential buy in. Includes all phases of Practice excluding nursing homes. Competitive Salary and Benefit package. Please send Resume including salary requirements and availability date to needpodjob@yahoo.com

ASSOCIATE POSITION – CENTRAL FLORIDA, ORLANDO AREA

Exceptional opportunity for qualified candidates. Associate position available in a rapid growing, well established multi-office practice. Applicant must be bilingual in English and Spanish, well trained (PSR-24 or more). Compensation includes excellent salary plus incentives and benefits. Please e-Mail CV, letters of reference to CF_resume@hotmail.com

PODIATRIST WANTED – RIVERHEAD, NY

Podiatrist needed in Riverhead, NY for an Article 28 Diagnostic and Treatment Facility with unlimited growth potential. Multidisciplinary site with much cross referral. Great opportunity. Call 631-981-1333. lakechiropllc@optonline.net

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 -- www.homephysicians.com

ASSOCIATE POSITIONS – MARYLAND

Are you motivated, personable and enjoy working with the elderly? We are offering full or part-time positions in Maryland. Our group, Podiatry Management Services, provides care to the elderly in Nursing Homes, Assisted Living, Senior Homes, Adult Daycare and other similar facilities. Please e-mail your c.v. to drhprosen@comcast.net or fax to 410-486-2049 or call Dr. Herbert Rosen at 410-580-0255

ASSOCIATE POSITION – MANHATTAN / QUEENS

Associate wanted for busy and growing Manhattan/Queens office. Full-time, PSR-24 minimum, straight 30% income with possibility of partnership in 1-3 offices. Call 917 880-6639 or e-mail hansfeet@aol.com

ASSOCIATE POSITION – CINCINNATI, OH

This is your once in a lifetime opportunity to join one of the largest, most successful practices in the United States. Start immediately with a six-figure income. If you are motivated, and knowledgeable in practice management, your income is unlimited. Please fax resume to: 513-577-7261

ASSOCIATE WANTED – NEW YORK IMMEDIATE OPENING

Busy multi-dimensional practice; 70 miles north of New York City. Currently five (5)-doctor practice. looking to expand – all phases of podiatric medicine. contact: (845) 454-8308 EXT: 106

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