The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

October 24, 2009 #3,683 Publisher-Barry Block, DPM, JD

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Some Runners Permanently Remove Toenails: MN Podiatrist 

Toenail removal is not for the faint of heart, but it can be a big relief to people who compete in 50- or 100-mile races. Even the most hardened ultramarathoners, for whom 26.2 miles is a warm-up, can be distressed by bleeding under a nail or a loose nail that bangs repeatedly against the front of a shoe.

Dr. Paul Langer

“From my experience, it’s the hard-cores” who choose to go without toenails, said Dr. Paul R. Langer, a Minneapolis podiatrist who has been on the medical team for a 250-kilometer 7-day race through the Gobi Desert. “Even within the ultra community, less than 10 percent or maybe even 5 percent are permanently removing their toenails.”

“Once you lose the nail once, it never adheres to the nail bed like it once did,” Dr. Langer said. “That’s why someone might be prone to the same nail getting beat up over and over.”

Source: Catherine Saint Louis, New York Times [10/21/09]

Barry University Professor Publishes Radiology Manual

Dr. Albert V. Armstrong, Jr., interim assistant academic dean and assistant professor of radiology for the Barry University School of Podiatric Medicine, recently completed a training manual for podiatric x-ray assistants titled, Radiation Safety and Training Manual. The guidebook was published by the Florida Podiatric Medical Association. The book is based on Dr. Armstrong’s clinical experience and education in radiology, his time as a  radiology scientist in the U.S. Air Force while stationed throughout Southeast Asia and the Philippines as chief technologist.

Dr. Albert V. Armstrong, Jr.

The guidebook covers the role of the podiatric x-ray machine operator, radiobiology, and radiation safety. It also explains radiographic equipment, the physics of radiography and x-ray production, and principles of exposure and image quality. The guidebook also gives details on x-ray darkroom and film processing, radiography of the lower extremity, safety and infection control, and emergency situations.

CA Podiatrist Runs for Healthcare District Seat

The Citizen has learned at least three medical professionals have submitted their intention to replace former Eden Township Healthcare District Director Dr. Walter Kran, who resigned Sept. 28. Sources close to the everyday dealings of the District say Dr. Ronald Hull, Dr. William West, and Dr. Francisco Rico have filed paperwork to be considered by the board as early as next week.

Dr. Ronald Hull

Dr. Hull is no stranger to running for a seat on the board, having lost in both 2004 and 2008. The San Leandro podiatrist garnered over 25 percent of the vote in 2004 and dropped to 15 percent last year in finishing fourth. Hull's stance on San Leandro Hospital is a bit murky according to sources, but a 2008 interview in the Castro Valley Forum indicated a desire to keep the hospital in its current configuration. "The primary challenge I see in the District is doing everything possible to keep San Leandro Hospital open as an acute care hospital," Hull said.

Source: The Citizen [10/20/09]

Bill to Scrap Doc Pay Formula Fails in Senate

A measure to scrap the physician payment formula over the next 10 years was crushed in the Senate, failing to garner 14 Democrats who could have advanced the bill. The $250 billion bill, written by Sen. Debbie Stabenow (D-MI) and rushed to the floor by Senate Majority Leader Harry Reid (D-NV), fell 13 votes short of the 60 needed to overcome a legislative block, 53-47. Under the measure, the sustainable growth-rate formula—widely seen as a flawed part of the Medicare payment system—would have been wiped clean and physician payments would be frozen for 10 years. Republicans and some Democrats, however, opposed the legislation because it would have added to the overall national debt.

The American Medical Association, which championed the bill, said it was “deeply disappointed” in the vote. “While short-term fixes have temporarily averted widespread access problems, they have also grown the size of the problem—and the cost of reform,” AMA President J. James Rohack said in a written statement.

Source: Matthew DoBias, Modern Healthcare [10/21/09]

Query: Motherboard for Midmark Podiatry Chair 414

Where can I buy a motherboard for the Midmark 414 chair?

Randy Beckman, DPM, Houston, TX

Query: New Gouty Arthropathy ICD-9 Code?

Effective October 1, 2009, ICD-9 274.0 (gouty arthropathy) became an invalid diagnosis code. Does anyone have information on a new diagnosis code for gouty arthropathy?

Laurie Lockner, Minnepolis, MN

Response: Choices were expanded - select from:

ICD-9 274.00 - gouty arthropathy, unspecified;
ICD-9 274.01 - acute gouty arthropathy
ICD-9 274.02 - chronic gouty arthropathy without mention of tophus (tophi)
ICD-9 274.03 - chronic gouty arthropathy with tophus (tophi)

Richard Papperman, MBA, CHBME, Cape May Court House, NJ

Codingline subscription information can be found at:
http://www.codingline.com/subscribe.htm

RE: Failed TMA flap (Tip Sullivan, DPM)
From: Narmo L. Ortiz, Jr., DPM, Palmer Branch, DPM

Even though the patient was successfully revascularized, any failed area on a flap is simply due to two reasons, either lack of capillary circulation, failure to properly off-load the extremity, or both. A transcutaneous oxygen measurement (TCOM) will help map the amputation level, but does not assess the viability of the graft.

I would recommend excision of any failed flap tissue, placement of a wound VAC, and a full-thickness skin graft. Consider repeat HBO treatment if there was a diagnosis of osteomyelitis. If that fails, you still have the option of a Chopart's amputation to try to avoid a BKA.

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

Obviously, first be sure you have ruled-out infection and occlusion of the vascular intervention. Also, be sure that treatment of all systemic factors are optimized (e.g. diabetes control, nutritional status, low albumin, anemia, etc.). Some, but not necessarily all, of the flap may be compromised, so you first need to determine what is or is not salvageable of the flap. It is a little difficult to see from the one picture exactly how much of the flap is adhered well to the underlying tissue.
 
I would consider debridement of the nonviable portions of the flap and use of a VAC to facilitate healing. A meshed GraftJacket can be applied under the VAC if there is a large enough wound (maybe 1 x 2 cm minimum). Integra would be another nice option under the VAC, particularly if the wound might be somewhat small to apply a GraftJacket. Both would provide a nice scaffold effect for ingrowth of new tissue, but I have had better success with the GraftJacket in general for larger wounds. I would not think a split-thickness skin graft would have good long-term durability in this setting.  Dermagraft or Apligraf may also be considered after the debridement of the flap, particularly if the wound is too small to effectively apply a VAC.
 
Palmer Branch, DPM, Cumming, GA, drcuboid@aol.com

RE: Traumeel or Zeel Injectable  (John D Lanthier, DPM)
From: Bob Kornfeld, DPM,  Mark K. Johnson, DPM
 
I have been injecting homeopathic medicine for over 22 years. I estimate having given over 40,000 of these injections. They are extremely safe. There is no fibrolysis at all, ever. I have never seen any untoward reaction or allergy. The results are very effective when these medicines are used properly. Anyone who uses them as a "cortisone substitute" will be disappointed. You need to know a lot more than filling a syringe with these medicines and injecting.  
 
Bob Kornfeld, DPM, Manhasset, NY, holfoot153@aol.com

We started using oral and/or topical Traumeel and/or Zeel several months ago for musculoskeletal foot pain: ankle tendinitis, plantar fasciitis, metatarsalgia/capsulitis often with dramatic results, including patients who had equivocal improvement with NSAIDs.

We have also started using Neuragen (topically) for relief of nerve pain or paresthesias from neuromas, again with some very good results. I've not utilized Traumeel or Zeel for injection for reasons of coverage considerations, as I recall seeing a couple of CMS statements refuting coverage for Traumeel injectable. The question would also be, would combining local + steroid + Traumeel or Zeel be okay from a covered service: Medicare or private insurance viewpoint? 

Mark K. Johnson, DPM, West Plains, MO, DDR004@centurytel.net

RE: PADnet+ System (Tamara Allen, DPM)
From: Alison DeWaters, DPM

I have been using the BioMedix Padnet system for 2 years. We started using this product since it supports collaboration between ourselves and the vascular specialist. This is an easy to use and well-supported in office vascular testing machine that offers a lot of one-on-one training in the podiatry office. This is also a reimbursable study with proper indication as it provides a PVR waveform.

Alison DeWaters, DPM, Howell, NJ, jenalirob@aol.com

RE: Obama’s Healthcare Plan (Jason Kraus)
From: Douglas Pacaccio, DPM
 
With all due respect, I am curious if Mr. Kraus could provide clarity on his facts by explaining exactly how each of those other 27 "comparable high income democracies" defines "infant mortality"? If I have to explain that challenge of the data, then…

Editor’s comment: Dr. Pacaccio’s extended-length letter appears at: http://www.podiatrym.com/letters2.cfm?id=29864&start=1

RE: A Sign of the Times

Sign of the Times

Source: Submitted by Dr. Robert Steinberg

DIABETIC RURAL OUTREACH PROGRAM - FLORIDA AND GEORGIA

ASSOCIATE POSITION – RESEDA, CA

Podiatrist needed in Reseda, CA office 2-3 days/wk, 6hrs/day @ $375/day to senior community. Please have an active Medicare #. Position starts immediately. Please email CVs to coasttocoastpodiatry@yahoo.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

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.

PODIATRISTS CHICAGO/NW IND/BALTIMORE/WASHINGTON, DC

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 Jake Shimansky, Director of Physician Recruitment. Phone-773-342-5221 FAX 773-486-3548-E-Mail jshimansky@homephysicians.com  www.homephysicians.com

ASSOCIATE POSITION - AUSTIN AND SAN ANTONIO AREAS

Seeking well-trained ABPS board certified/qualified foot surgeons for surgical practice with national foot/hand/orthopedic surgery group. Excellent salary/benefits. Email CV and cover letter to: slb99@pdq.net

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 - 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

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

PRACTICE FOR SALE- SEATTLE, WA

Beautiful office for sale in the heart of Seattle, WA. Newly renovated, 2,500 sf, new digital x-ray, vascular lab, state of the art physical therapy equipment, paper-less system, all new podiatric furniture and equipment, popular podiatric products store and beautiful diabetic shoe display. Office is located in the medical building and open 3 days a week. Great opportunity for expansion to full-time. Please send us a letter of interest to the: podiatrygroup@yahoo.com

ASSOCIATE POSITION-INLAND EMPIRE, CA

Busy 2 office multi doctor practice looking for dedicated, dependable, honest doctor to work 3-4 days per week. Must be ABPS BC/BE. Send cover letter and CV to bkatzman2@earthlink.net

ASSOCIATE POSITION FULL-TIME - SUBURBS OF CHICAGO

PSR 36 - month-trained podiatrist needed for busy suburban Chicago practice. Office and diagnostic equipment state-of-the-art. Full benefit package included. If interested, please fax your curriculum vitae to 847.352.0270 or email to foot1st@yahoo.com

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