The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

October 24, 2008 #3,382 Editor-Barry Block, DPM, JD

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CA Podiatrist Runs for Healthcare District Position

Two newcomers are challenging incumbents for two four-year terms on the Eden Township Healthcare District whose directors help to govern Eden Hospital in Castro Valley and San Leandro Hospital.

Dr. Ronald Hull

Ronald Hull, D.P.M. (Challenger) has been a practicing podiatrist and resident in the Eden Township area for 20 years. He said he believes the current board has done an excellent job given the challenges, but feels it would be good to have a new perspective on the board.

“The primary challenge I see in the District is doing everything possible to keep San Leandro Hospital open as an acute care hospital,” he said. Hull said he would like to see the administration, the Township board, medical staff and employees focus on the goal of keeping San Leandro in operation and to ensure the Community Health Fund Grant, consisting of community dollars acquired from Sutter to continue to be used for the benefit of the community.

Source: Robert Souza, Castro Valley Forum [10/21/08]

CA Podiatrist Plays Lead Fabulous 50’s Fundraiser

"Uncle Phil's Diner" is going to be a blast out of the "fabulous '50s" past with Manteca podiatrist Dr. Howard Miller playing the lead role after being a 20-year-cook in the Navy. It's an interactive presentation at New Hope Church Nov. 14-15 that promises a real diner's experience of food, music and a whole lot of fun.

Dr. Howard Miller

Its purpose is to raise funds for the Manteca Police Chief David Bricker's use in his recently declared, "Chief's Initiative." Funds from the event will go back into the community where Bricker sees the greatest need in addressing gangs.

"Phil's mom" - Midwest polka queen of the 1930s - is to be played by Jill Miller right out of her husband's podiatry office on Cottage Avenue. Tina Davis, also from Dr. Miller's office, takes the character of "Christine Cunningham."

Source: Glenn Kahl, Manteca Bulletin [10/22/08]

Antibiotic Dose Fights MRSA, Study Says

Powerful antibiotic drugs are normally injected once a day -- a problem for patients who contract infections in hospital wards and are sent home. Many don't finish their treatment. But a new study found that an experimental antibiotic may work just as well when given in one gigantic dose, marking progress in the treatment of drug-resistant infections, including an often-fatal bacteria known as MRSA.

The research was conducted by Targanta Therapeutics Corp., a Cambridge, MA company that has applied to sell the antibiotic, oritavancin, in the U.S. "So many of the patients we treat are non-compliant with medication," said Lala Dunbar, a doctor at the Medical Center of Louisiana in New Orleans, who participated in the study and has advised Targanta.

Targanta's submission to the FDA was based on a normal dose of 200 milligrams per day, for up to a week. But in the new study, the company compared that treatment against one huge dose of 1,200 milligrams, given all at once in a hospital. Patients were kept in the dark about what group they were in. The results were similar: After three weeks, about 72% of the day-dose patients, and 82% of the one-big-dose patients, saw a cure or significant improvement. Each group only included about 76 patients, meaning the results are preliminary. Targanta says it's working on a bigger, more reliable study.

Source: Keith J. Winstein, Wall Street Journal [10/22/08]

Survive in a Multi-Tasking World - Part 1

The pressure may be on to "get it all done," but if you do not take time to plan, you will never make a dent in your to-do list. Use these strategies to plan your approach:

• Focus. Not sure what to tackle first? That is a surefire way to feel overwhelmed. The Key: Prioritize your to-do list, focusing not on today's urgent tasks but also on where you want to be two weeks to six months from now. Take small steps towards those long-term goals even as you do what needs to be done today.

Source: Adapted from Tips From a Multi-Tasking Mom by Robin Gorman Newman

Query: Lyme Disease During Pregnancy

I recently saw a 25 year old female with a 6-month history of pain between the 1st and 2nd toes of the right foot. She was seen initially by her internist when she noted the onset of pain and associated redness and swelling of the area. He diagnosed her as having been bitten by a spider (non-Brown Recluse) and placed her on a topical antibiotic. The area did improve to a point, but the pain and discoloration never totally resolved. Approximately 2 months later, she developed severe knee pain on the same extremity. She returned to him and was placed on Medrol dose packs until the pain subsided. While she was on this medication, she did feel better, only to have the pain return once off of the medication. After foot films (normal) and my evaluation (nothing grossly noted other than some residual hyperpigmentation of the area of alleged bite), I sent her for blood tests which included a RA panel (normal) and a Lyme titer, which was positive and high at 8.4.

So, treatment of the Lyme disease for this patient is a given. The twist to this case is that when she was bitten, she was approximately 6 months pregnant and gave birth to a little girl about 2.5 months ago. Can the spirochete that causes Lyme disease cross the placental barrier? Can it be transferred to infant in utero or during birth? What treatment would be recommended if the infant is indeed affected?

Maurice W. Aiken, DPM, Baltimore, MD

Query: VA Vendor for Diabetic Shoes

Can anyone give advice on becoming a government VA vendor for diabetic shoes? What are the benefits associated with this?

Julie Rubel, Findlay OH

RE: Surgery on Patient with Dermatomyositis (James W. Clark, DPM)
From: Paul Kesselman, DPM, Sloan Gordon, DPM

I would, at all costs, refrain from performing any elective surgery on this type of patient. While I don't mean to diminish the patient's quality of life symptoms they are obviously suffering from, this is still elective surgery. There is no acute need for a surgical remedy here. There are many non surgical treatment modes which should be attempted prior to surgery. This would include a myriad of orthotics and shoe modifications.

Since the patient may have post operative wound healing issues why possibly add to their list of problems? Stay conservative until you have truly exhausted your options!

Paul Kesselman, DPM, Woodside, NY, pkesselman@pol.net

I have been in this situation and I think you have to be a realist and very upfront with the patient regarding their potential outcome. First, the rheumatologic issues outweigh the foot problem. Second, while it's good to seek advice, you are the surgeon. I called the rheumatologist and we discussed the patient’s case and opted to lower the dose of MTX and d/c prednisone pre-operatively. I believe they have a standard just as there is one for Plavix and other complicated drugs. I had the rheumatologist "clear" the patient so there was good documentation in my chart.

Good patient communication is key in this situation to inform the patient that his healing potentially will be very slow, what the risks and complications are, including loss of the toe and/or metatarsal. My patient opted, secondary to her pain, to have the surgery performed. Healing took a long time, but she did great. Also, I recommend you do the 'easiest' procedure which may be a total or partial metatarsal head resection rather than an osteotomy.

Sloan Gordon, DPM, Houston, TX, sgordondoc@sbcglobal.net

RE: Mid-Arch and Met Pain (Kel Sherkin, DPM)
From: Philip H. Demp, DPM, MA, MS, PhD

Based on my published pilot study and an ongoing multi-research team funded by the NIH, the micromechanics of the metatarsal length pattern can be evaluated by a geometric configuration of the five metatarsal heads which corresponds to a unique equation. If this configuration turns out to be evaluated as a pathomechanical configuration, then shortening or lengthening by surgery or conservative therapy using the computer should produce precise information as to how to proceed in finding the appropriate toe(s) and amount to shorten or lengthen.

Surgeons are already doing this. However, in the literature, they talk about obtaining a parabola configuration, which is considered to be pathomechanical and may produce a clinical problem in the long run.

If you email me a weight-bearing, dorso-plantar radiograph, I will analyze it according to my research and send you a report by mail which includes possible treatment which you can consider. We assume that the problem was caused by a pathomechanical metatarsal length pattern.

Philip H. Demp, DPM, MA, MS, PhD, Cinnaminson, NJ, pdemp@dca.net

RE: Digital Scanning System (Mark K. Johnson, DPM)
From: Alan Berman, DPM

I have been using the Aetrex I-Step scanner for over 2 years. It has brought a multifunctional application to the office and has generated enthusiasm for shoes, inserts and orthotics to the patients in my practice. It is used as an adjunct to your treatment plan discussion. The I-Step's instant (20 second) weight-bearing scan of foot pressures, coupled with a color print out of the patient’s foot pressures, helps them "see" why their feet hurt.

The ability to toggle through pictures of inserts & shoes to fit their foot type also is helpful for the patients. Once you learn the basics of shoe "sizing," picking out the correct shoe or sneaker for your patient is a benefit they will appreciate. This all can be done via their touch screen computer that is part of the system software.

Alan Berman, DPM, Monsey, NY, Anbdpm@aol.com

RE: Find Passion and Balance in Your Life
From: Mitch Cooperman, DPM

Five years ago, I had a life-changing experience when I was diagnosed with prostate cancer - no symptoms, no family history, just a slight increase in my PSA from one yearly physical to the next. Suffice it to say that I experienced all the emotions you’d expect to have hearing that rather startling news at the tender age of 51- fear and anger being the most prominent. Soon, I found my way to Johns Hopkins Medical Center to have that cancerous piece of me cut out. My family and friends were all there for me but, my life was out of balance.

Somewhere in the insanity of this world and this time, I learned an invaluable lesson. I’m talking about balance- no, not the Zen-staring-at-my-navel type of balance. As important as podiatry is to a patient’s health and quality of life and to our livelihood, it is only a part of each of us. The rest is at least as important. At the end of the day, we are the sum of our parts, not only the doctor part.

Find a passion away from your work. Follow that passion wherever it takes you. It can make your life so much more complete. In my own case, it’s regional theater, mostly musical theater. Yes, I do mean performing- acting, singing, and dancing in shows like Fiddler on the Roof, Ragtime, All Shook Up, and Urinetown. In the past 11 years, I have been involved with over 40 productions and been on stage hundreds of times. But, since my cancer, performing has taken on even more meaning in my life. It gives me joy in a world all-too-often devoid of joy.

Find a passion. Love your family and friends. Cherish life. Find your balance. Please.

Mitch Cooperman, DPM, Syosset, NY, Footlite346@aol.com

ASSOCIATE POSITION - EAST CENTRAL FLORIDA

Full-time position available in large practice. We are looking for the right individual to service geriatric needs. Responsibilities include nursing home, wound care and general podiatry. Great salary with full benefits. Send Resume to cmedders@atlanticpodiatry.com

CASE CONSULTING

Dennis Shavelson, DPM is now accepting referrals of difficult cases involving biomechanics, surgical complications, non-healing wounds diagnostic and treatment dilemma’s and subtalar stenting from DPM’S. Full reporting with second opinion only, rapid return after care and assumption of care options. Medicare and Out-of-Network Only. (212) 288-3668 or drsha@lifestylepodiatry.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

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

SUBLET SPACE WANTED - NORTHERN NEW JERSEY

I am looking to sublet space in the Tenafly, Teaneck, Fair Lawn or general area. I need the office two 1/2 days per week or 2 full days, whichever is available. I can supply equipment, if needed, but prefer a turn-key operation. 516 476-1815 podo2345@aol.com

PODIATRISTS NEEDED - CHICAGO -- NORTHWEST INDIANA & BALTIMORE

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

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

HOSPITALIST POSITION - QUEENS, NY

Busy multi-specialty podiatry group looking to hire a motivated individual to work part-time, including weekends as a podiatric hospitalist. Immediate opening available. NYS license a must. Applicant should be well-trained in all aspects of surgical and wound care and have completed a 24-36 month residency. If interested please send CV to docbunion@yahoo.com

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 WANTED - SOUTH JERSEY

Part time/ Full time Full scope, well established group practice located between Phila. and the Shore. Digital X-ray, EMR, Diag U/S. Prefer PSR 24-36 individual with several years previous experience but will consider the right recent grad. Must be willing and able to provide quality palliative and surgical care. Medicare and NJ Blue Shield provider numbers is a plus. Competitive financial and benefits package. E-mail resume & references to: Toetrukr@aol.com

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