The Voice of Podiatrists

Serving Over 9,800 Podiatrists Daily

October 20, 2007 #3,071 Editor-Barry Block, DPM, JD

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Black Toenails in Runners Due to Repetitive Pressure: IL Podiatrist

Running certainly has its charms: It can help clear your head, relieve stress, lift depression, trim fat, build bone strength and improve cardiovascular health. But like anything, overdoing it can wreak havoc on the body. Among the many conditions marathon runners can experience are black toenails.

Dr. Stephen Weinberg

These are caused by repetitive pressure on the nail plate, either by digging into the sock liner or rubbing against the top of the toe box, causes a "bruising" at its attachment under the skin at the cuticle. The microscopic attachment then rips away, and the blood drains forward under the nail plate, said sports medicine doctor Stephen Weinberg of the Weil Foot and Ankle Institute, who is running the Chicago marathon with his daughter Lindsay this year, after serving as the race's chief of podiatry for two decades.

Source: Julie Deardorff, Chicago Tribune [10/16/07]

AZ Podiatrist Handles Lower Part of Head to Toe Practice

Head to Toe Healthcare is a joint venture of the husband-and-wife team of Dr. Alan Shih and Dr. Zuraida Zainalabidin. She is the optometrist; he is the podiatrist. "The combination has worked well," Zainalabidin said.

Drs. Alan Shih (R) and Zuraida Zainalabidin (L) with staff (center)

The couple came here from the Chicago area about a year and a half ago after Zainalabidin decided she'd had enough of cold weather. "She kind of took charge and said, 'We're moving,' " her husband recalled.

Shih said he was happy to oblige. He and his wife, both 33, were familiar with the area because Shih had spent a year doing a residency here. The two met while attending college in Michigan, where he grew up. She is a native of Malaysia.

Source: Lourdes Medrano, Arizona Daily Star [10/18/07]

Senate Panel Discusses MA Cut to Reverse MD Payment Cut

Senate Finance Committee Chair Max Baucus (D-MT) at a committee meeting on Wednesday outlined a $30 billion Medicare package that could prevent a scheduled 10% Medicare physician reimbursement rate cut and provide subsidies for rural and low-income seniors, CongressDaily reports (Johnson, CongressDaily, 10/18).

Committee members discussed cuts to Medicare Advantage(MA) plan payments as a way of funding the physician payment fix, but "there appears to be considerable resistance on the committee to cutting deeply," CQ HealthBeat reports (Reichard, CQ HealthBeat, 10/17). MA plans on average are paid 12% more than traditional Medicare, and some private fee-for-service plans are paid at twice the rate as traditional Medicare. Baucus said there is going to be "some strong examination" of MA plans.

Source: CongressDaily & CQ HealthBeat via American Health Line [10/18/07]

Query: Surgically-Induced Keloid Scar

Could anyone recommend a treatment to shrink/resolve a surgically-induced keloid scar?

Frank Stoddard, DPM, Massillon, OH

Query: Practice Brokers

What experiences have PM News readers had with practice brokers with buying, selling, on bringing in a new associate? What is the best method to accomplish these goals?

Joe Burckhardt, DPM, Kingwood, TX

RE: Charcot Dilemma (Arden Smith, DPM)
From: Multiple Respondents

Dr. Smith indicates something that is very significant and unfairly receives very little attention. He points out that there is controversy in the medical profession regarding when and if to amputate an extremity. This is important because many surgeons are all too quick to remove a toe or even do a BK. What is clear is that there are NO absolute objective criteria in many of these cases. Dr. Smith points out that in the case of Charcot foot, many non podiatric surgeons recommend a BK rather than reconstructive surgery.

Others will try the reconstructive surgery first even though it may lead to greater morbidity and pain. The same holds true with deep ulcers and osteomyelitis. What makes matters worse is when one of our colleagues is being sued and plaintiff wants a large sum of money because an extremity or part of an extremity was amputated. The person being sued may be under fire in court because some other doctor was too quick to amputate. In many cases it may not have had to be a first choice.

Elliot Udell, DPM, Hicksville, NY,Elliotu@aol.com

I believe Dr. Smith has answered your own question. Charcot reconstruction is not for every patient. Additionally, it is not for every surgeon. These patients need a comprehensive approach involving multiple experienced specialties. A case-by-case approach needs to be employed, as it should for all surgical candidates, by an experienced team.

Gerald Mauriello Jr., DPM, MA, Lakewood, NJ, mauriellodpm@gmail.com

It is unfortunate that Dr. Smith has experienced many complications and morbidity when treating patients suffering from Charcot arthropathies, bringing him to think that he should refer them out for amputation.

In my experience with Charcot arthropathy, especially in the diabetic population, while complications and morbidity do occur, I have been able to add a few years of acceptable locomotion and independence to the majority of the patients I have treated. That in itself is reason enough to help them as much as possible and not just send them down the amputation line, which the vascular and/or orthopedic surgeons would be happy to perform for you.

Economics aside, the most important considerations should be, is the physician properly trained and/or experienced in treating this condition and its sequelae to make an informed decision as to what treatment to recommend in the best interest of the patient. While challenging as they are, many Charcot arthropathy cases can be treated with varying degrees of success, with the bottom line being the addition of acceptable time of function and independence to the patient’s quality of life.

Narmo L. Ortiz, Jr., DPM, Cape Coral, FL, nlortizdpm@embarqmail.com

RE: Effect of Dropping Out of Oxford (Name Withheld)
From: Bob Kornfeld, DPM

I dropped out of all insurance plans including Oxford 7 years ago. The net effect was a threefold increase in Oxford reimbursements, as the out of network benefits far exceeded the in-network fee schedule. Due to the recent slashing of Oxford out-of-network benefits, I now no longer accept Oxford out-of-network benefits. It is a cash pay situation only. Patients will then be reimbursed their out-of-network benefits directly from Oxford. I am much happier now with this arrangement. My experience is that when you don't think out-of-the-box, the box keeps getting smaller and smaller.

Bob Kornfeld, DPM, Lake Success, NY, Holfoot153@aol.com

POSITION WANTED PHOENIX METRO AREA

Office getting too busy with winter visitors? Young practitioner available for part time help. Seasonal or temporary OK. Surgically trained. Flexible schedule. Direct inquiries to dlmeb5@yahoo.com

HOME FOR RENT- CABO SAN LUCAS, MEXICO

For rent: 2 bedroom-3 full bath fractional home on the Sea of Cortez at Grand Regina Westin, Cabo San Lucas, Mexico. Week of December 29, 2006 until Jan 5, 2008. Sleeps 8, full kitchen with washer and dryer. Outside balcony with hot tub overlooking the water. Ideal for family vacation. $5000. Photos available. Contact Amogreg@aol.com

ASSOCIATE POSITION – SOUTHERN CALIFORNIA

Seeking a position in a warm, friendly, and productive environment? Well, look no further! A well established podiatry facility in North Hollywood, California has an immediate position available for a podiatrist. He/She must be motivated, reliable, and dedicated. Depending on performance, partnership is possible. If interested, email your resume to drnickoghosyan@yahoo.com

ASSOCIATE POSITION CLEVELAND CLINIC

The Section of Foot and Ankle Surgery at Cleveland Clinic is seeking highly qualified board-certified/ board-eligible podiatrists to join our faculty. High volume clinical practice consisting of general podiatric care, wound care, and diabetic foot problems, along with a research background in diabetic foot complications and/or clinical outcomes. Please contact: Joe Vitale, @ vitalej@ccf.org

THE PERFECT CHRISTMAS GIFT

Super Luxurious Custom Oceanfront Dreamhouse on Caribbean island of Bocas del Toro, Panama. FULLY FURNISHED 5000 SQ FT, 5 BED, 5 BATH, 2 KITCHENS, Infinity Pool, satellite TVs, wireless internet, Lush Tropical landscape, NEVER hurricanes. NO TAXES for 20 YEARS. $875,000. photos & info drritarae@yahoo.com

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

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

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