The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

October 10, 2008 #3,370 Editor-Barry Block, DPM, JD

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Honey Dressings Cheap and Easy-to-Apply: Mayo Clinic Podiatrist

Wound care is problematic for people with diabetes. A mere nick from an ill-fitting shoe or hangnail haphazardly cut can fester for months and develop into a gaping ulcer teeming with bacteria. Foot ulcers, in fact, are the most common reason people with diabetes are hospitalized, and studies show that an alarming 1 out of 5 people with an infected ulcer ends up undergoing amputation. Recently, however, researchers have started to find that an ancient and affordable remedy—a dab of a certain type of honey with potent antimicrobial properties—is a worthy weapon against an ulcer that refuses to heal.

Dr. Steven Kavros

In addition to its antimicrobial qualities, honey offers other pluses for patients. Research suggests that honey dressing may be less painful to use and cause less scarring. Certain potent types even seem to be effective against MRSA, a particularly irksome type of staph infection that's resistant to antibiotics. Plus, honey bandages are cheaper than many of the other options and easy for patients to apply, says Steven Kavros, a podiatrist and wound specialist at the Mayo Clinic.

Source: Adam Voiland, US News & World Report [10/7/08]

Illinois Podiatric Medical Association Names New Officers

The Illinois Podiatric Medical Association appointed new officers at its recently completed annual meeting. The Illinois Podiatric Medical Association is comprised of 600 podiatrist members throughout Illinois.

(L-R) David Yeager, secretary; Ada Paolucci, treasurer; Marlene Reid, vice president; Joseph Borreggine, president-elect, and Paul Brezinski, president.

The new officers for the 2008-09 year are:

• Paul Brezinski, DPM, president, Arlington Heights, IL
• Joseph Borreggine, DPM, president-elect, Charleston, IL
• Ada Paolucci, DPM, treasurer, Plainfield, IL
• Marlene Reid, DPM, vice president, Naperville, IL
• David Yaeger, DPM, secretary, Dixon, IL

Questions to Ask About Patients

Periodically, you should stop to ask yourself these questions:

• Who are our best and worst patients? Why?
• How many patients have we lost in the past six months? Why?
• How many new patients have we gained in the last six month? How did we do that?
• Who are our potential patients? How do we reach them?
• How can we improve our service to existing patients?

Sourec: Adapted from Van Mayros, writing in Computer World

Query: VA Salary

I have been offered a part time position to work at a VA medical facility performing routine foot care at bedside. What is an appropriate hourly rate that should be expected? It is for approximately 6-8 hours per week and there are no benefits involved.

Name Withheld

RE: PAD Testing
From: Diane Branks, DPM, RVT

I am very happy to see the increase in concern regarding PAD and vascular testing in PM News. I encourage all podiatrists to have proper Dopplers in their clinic and to learn how to use this as a tool in making better informed decisions regarding the vascularity of their patients. It is best to try to develop an association with a vascular lab who is a member of the Intersocietal Commission for the Accreditation of Vascular Labs (ICVAL). This means that the lab follows certain criteria in testing that produces consistent data. At my facility, these results are read by the vascular surgeon and pulled into their clinics if any abnormality is found. We performed over 5,000 studies last year. The verdict is not out yet on all the new technology that has emerged in the vascular field. I would encourage podiatrists to try to find vascular surgeons who can not only perform distal bypasses, but have interventional radiology (IR) abilities, or associations with IR who can perform the latest techniques from arthrectomies, to plasties and stenting.

Podiatrists also need to be aware of new information regarding cutting-edge vascular testing and techniques that affect our patients. Now there is information about MRA's causing nephrogenic systemic fibrosis (NSF) due to the gadolinium exposure that is visible in the legs and feet. We must be aware of the glomerular filtration rates (GFR) of our patients so we can help recognize how sick our patients truly are and call in the proper team of doctors. We need to jump on the vascular initiative of encouraging all these higher risk patients to be screened for carotid and AAA disease. If you see it in the foot, most likely there are much more severe vascular processes occurring in those other arteries which can truly affect the life of your patient and potentially can be lethal.

Diane Branks, DPM, RVT, Baldwin Park, CA, barrydiane@hotmail.com

RE: Weil Osteotomy w Cheilectomy (Stuart W. Kushel, DPM)
From: Multiple Respondents

We routinely perform a decompression/plantarflexion osteotomy of the first metatarsal in addition to cheilectomy for hallux limitus, especially in those patients with long and/or elevated first metatarsals. While we favor a modified Waterman/Green construct a Weil-type osteotomy would certainly achieve the same result but I believe would be more difficult to fixate and would be inherently less stable in this application.

James F. Nugent, DPM, Torrington, CT, 317124@msn.com

For stage 1 or 2 hallux limitus, I have been decompressing the joint utilizing an Austin osteotomy with the Kalish modification as well as the usual chielectomies. This allows me to plantar-flex and slightly shorten the 1st metatarsal. If the arthritic changes are severe, I place a GraftJacket Max Force Extreme over the 1st MT head. At around 3 weeks and 6 weeks, I inject Supartz 1 cc. into the joint. The results have been really favorable. For more severe arthritic changes, I do the same, but use an external fixation (EBI minirail works real well) to perform an arthrodiastasis as well. I really like this procedure but it’s hard to get patients in my area to get over the external fixation.

Eugene A. Batelli, DPM, Clifton, NJ, ebatelli2001@yahoo.com

The Weil osteotomy basically dorsi-flexes the metatarsal. One of the main etiologies of hallux limitus is either functional or structural dorsiflexion of the first ray. In my experience, it is very rare to see hallux limitus due only to a long first met. Usually along with a long first met you will see dorsi-flexed first ray. Based on this seemingly rational approach I would not purposely dorsi-flex the first. Making a transverse plane osteotomy parallel with the weight-bearing surface simply to shorten the 1st met seems like a reasonable idea, taking care not to dorsi-flex. I prefer the Austin/chevron osteotomy modification described by Dr. Fred Youngswick that plantar-flexes the metatarsal which would be very easy to modify to shorten.

Tip Sullivan, DPM, Jackson, MS, tsdefeet@msfootcenter.net

RE: Nail Dust Inhalation (Steve Bennett, DPM)
From: Multiple Respondents

As a resident, I spent a fair amount of time providing nail care in an office without a vacuum system. During this time, I went to an optometrist for an evaluation regarding my contact lenses. He immediately asked me if I spend time working in a bakery since my lenses were saturated with fine white dust, to a degree where all of the oxygen channels were plugged in the lenses, rendering them useless.

A few years later, I went to an ENT for sinus problems. After examining my sinuses he said, in a somewhat perplexed way, that my passages had a very odd appearance; one that is seen in individuals that work in very moldy environments such as those who are in the mold removal business. After I told him that we burr nails, he fully understood the clinical appearance of my sinuses.

Both doctors were astonished that we expose ourselves to this significant medical risk just to achieve smooth nails for our patients. Since the ENT visit, I only use a Dremel to refurbish guitars. Ironically, Lamisil is not only an option for patients with onychomycosis, but may become necessary for the doctors who treat those opting not to take it!

Nicholas Taweel, DPM, PT, Philadelphia, PA, drtaweel@hotmail.com

Having tried a variety of vacuum extractors in the past, I decided to try a liquid spray electric nail grinder. It was expensive (about $1,300) at the time so I purchased one unit only. I found it to be far superior in reducing dystrophic toenails, significantly reducing nail dust,operates quietly, and has a small handpiece that is easy to hold. Within a year, I purchased a second unit, and now have four! For those who may have been disappointed with vacuum extractors, I would recommend you consider the Micromat 3000 from Med-Pro Corp. They can be contacted at 1-800-633-7761. I've had these units for over six years, with no significant problems. I have no financial or personal interest in this company or product; I simply wanted to share a good quality drill.

David Arkin, DPM, Big Flats, NY, docarkin@stny.rr.com

For 20 years, I have been a representative of a company in Tennessee that manufactures electronic air cleaners. In my research, I have found it is the best product sold bar-none. It works by ionization and ozination of indoor air. I did quite a lot of research on whether it would take airborne nail dust out of the air in podiatrists offices. Indeed it will. The units are sold according to the sq. footage they are to accommodate. The average office is probably 2,000 sq. feet and would require a unit about the size of a small electric heater that would run 24/7. There are no filters. The air is electronically cleaned, causing absolutely no harm to humans. The units can be purchased at an average cost of about $700.

James Steinberg, DPM, Tampa, FL, footmedicine@yahoo.com

RE: Inexpensive Vascular Testing System (William Alexander, DPM)
From: Frank Lattarulo, DPM

I currently use the Biomedix PAD system. I love the machine and am currently leasing it. My break-even point is doing 3 Dopplers per month. It has a great printout with waveforms and ABI's, as well as digital toe pressures. The company will set everything up and has great tech support. After I perform the test, for which we bill the technical component (modifier TC), I send it over a secure connection to a local vascular surgeon who then interprets it and sends it back to me. The vascular surgeon then gets a small fee to interpret, and of course possible income from those with PAD in need of vascular consultation.

Frank Lattarulo, DPM, New York, NY, doclatt@aol.com

RE: Louis Newman, DPM

In 1979, I had been out of undergraduate school for 11 years, disgruntled with my federal position, and doing a bit of furniture refinishing as a hobby. I saw a career counselor at the Phila Free Library who suggested that podiatry might be a good fit for me and gave me the name and number of the podiatrist who treated her son. It was Louis Newman. Several months later, I called his office and related my story to his receptionist. Much to my surprise, Dr. Newman got on the phone, asked me where I went to undergrad school (St. Josephs, Phila), to which he responded that he went to La Salle and was Jewish, but would not hold it against me. Obviously a fellow with a sense of humor, I was immediately impressed with him. He invited me to his office THAT afternoon, later took me on rounds at Rolling Hills Hospital and had me in the OR watching him and the residents do surgery the following week. I graduated from PCPM in 1983, and was honored to have received an award in his name.

I have been a happy podiatrist for the past 25 years, and I can't be more thankful to Lou Newman for taking my call so many years ago. He was a wonderful example of the great people in this profession, and he will be missed.

Bill March, DPM, Cherry Hill, NJ

PRACTICE FOR SALE - FLORIDA—CENTRAL/SOUTH

turn-key operation grossing $570,000 annually based on one full-time doctor; practice is in a growing retirement area in the center of the state. Option to purchase or lease real estate. Great opportunity for growing the top-line. Surgery is only 14% of the professional man-hours, so it can significantly increase income. Medicare makes up 64% of revenues. Seller will assist with transition. Call 863-688-1725 for details and ask for Lee.

ASSOCIATE POSITION - NORTHWEST IOWA

Great opportunity for hard-working, ethical podiatrist to join Midwest multi-physician, podiatric group with multiple locations. A well-established, successful, growing practice with strong hospital affiliations seeking FT and PT surgically trained physician. Applicant should be well-trained in all aspects of surgical care, completed a 24-36 month residency, & at least board eligible. Diverse practice offering high surgical volume, advanced wound care and good mix of general podiatry. Competitive salary, excellent benefits. Fax resume to: 712-258-9977

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

ASSOCIATE POSITION – ILLINOIS

Quality Podiatry Group provides quality services to residents at long term care facilities. We are currently offering full-time or part-time positions for motivated ethical podiatrists. Immediate openings available. If interested fax curriculum vitae to 312 225-9366 or e-mail feetwork@aol.com

EQUIPMENT WANTED – AUTOCLAVE/CHAIRS

Wanted to buy – Used New Style (not pressure cooker) desktop digital autoclave (e.g. Midmark Ritter) and 2 waiting room chairs. Call 212-724-4457 or e-mail frottenberg@juno.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

PODIATRISTS NEEDED – DALLAS/ FT WORTH – TEXAS AREA

Texas Home Footcare Associates, a podiatry exclusive company specializing in house calls and visits to facilities for the elderly, is looking to hire podiatrists. We are located in the Dallas area. Full and part-time positions are available. Immediate Openings Available. Must have a Current Texas license. Competitive Compensation Package. If interested fax curriculum vitae to 972 931-4819 or e-mail gjmdpm@tx.rr.com. For further information, call 972-380-8028.

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

WEEKLY SPECIAL - One week of ads (5x) for $89 One month of ads (20x) for $340 .

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