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October 27, 2011 #4,290 Publisher-Barry Block, DPM, JD

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CA Podiatrists Among First to Use Mobile Cadaver Lab

The nation's first mobile cadaver lab stopped next to Valley Presbyterian Hospital to give doctors a stab at cold feet. "I think it's one of the greatest skills to learn," said Dr. Ronald Belczyk, of the hospital's Amputation Prevention Center, cutting a precise incision across a cadaver foot, still attached to a cadaver shin, in a surgical demonstration for resident surgeons. The big-rig lab has toured hospitals across the nation since April with its cargo of cadavers. Its purpose: to show off medical equipment while giving surgeons a chance to practice on real bone and tissue. 

Dr. Ronald Belczyk, center, explains a surgical procedure on a human foot to Dr. Kariim Mansi, left, and Dr. Keith Penera, right (Photo: Andy Holzman)

Operated by Synthes, the expandable cadaver coach parked in a dirt lot at Valley Presbyterian in its first stop in Los Angeles. Throughout the afternoon, doctors stepped inside to wield scalpels on their L-shaped human parts. "Cutting into a foot isn't new," said Dr. Keith Penera, a resident at Long Beach Memorial Medical Center, before the primer by Belczyk. "But this is state-of-the-art equipment and great training."

Source: Dana Bartholomew, LA Daily News [10/25/11]

Regular Podiatric Visits Prevent Amputations: Aussie Podiatrist

October is Australian Foot Health Month and Mr. Graham Appo has shared his story to help raise awareness. Podiatrist Sam Robinson said that the blisters on Mr. Appo's feet were ulcers resulting from diabetes and other factors, including his foot shape. Along with regular visits to the Foot Protection Program, Mr. Appo now wears special shoes (with no seams to aggravate injury) and insoles to prevent foot ulcers. 

Sam Robinson

"People with diabetes can lose sensation to the legs and feet which means they need to take extra care with their feet," Robinson said. "Podiatrists at the Foot Protection Program treat people with a high risk of foot problems including ulceration or amputation, often as a result of complications related to systemic diseases such as diabetes."

Source: The Morning Bulletin [10/24/11]

3-Steps Can Prevent Serious Consequences to Diabetics: NY Podiatrist

60-70% of diabetics suffer from nerve damage that can affect many parts of the body but most commonly involves the hands and feet (peripheral neuropathy). “Nerve damage typically shows up first in the feet and is the primary cause of foot problems for people with diabetes,” says Dr. Alan Berman, Podiatrist of Somers Orthopaedic Surgery & Sports Medicine Group. 

Dr. Alan Berman

“Our P-E-T guidelines give the patient three primary things to remember in caring for their feet,” says Dr. Berman, “PROTECT your feet, EXAMINE them daily, and TELL your doctor immediately if you detect any irregularity. These steps will help prevent the serious consequences of diabetes-related foot problems.”

Source: Health News Digest [10/25/11]

Immigration Laws a Challenge to Potential Podiatry Student

The far-reaching immigration debate in Florida and the nation has been going on for years, but until last week, the plight of students like Wendy Ruiz -- an aspiring podiatrist -- had been largely invisible. Born and raised in Miami, Ruiz is a U.S. citizen. But in the eyes of Florida's higher education system, she's a dependent student whose parents are undocumented immigrants -- and not considered legal Florida residents. As such, Ruiz is charged higher-priced out-of-state tuition, even though she has a Florida birth certificate, Florida driver's license and is a registered Florida voter.

Source: Career College Central [10/24/11]

WA Podiatrist's License Restricted for Allowing ETOH Injections by an Assistant

The Podiatry Board and the Washington State Department of Health have  restricted the license of Yakima podiatrist Dr. Curtis T. Holden. The charges say that Holden directed a healthcare assistant to do alcohol sclerosing injections on a patient, creating the risk that the procedure would be ineffective or harmful. It’s not legal to delegate these types of injections to healthcare assistants. Holden did not order tests to identify the cause of patients’ pain and continued to recommend the injections, even though the injections had not resolved the patients’ symptoms.

The allegations say that Holden charged and was paid by the State of Washington Department of Labor and Industries as if the injections were given by a podiatrist. Holden’s license will be restricted to disallow the delegation of any injections until the charges are resolved.

Source: Washington Department of Health [10/24/11]

RE: Correction - Similar Name, Different Person
From: Ben Pearl, DPM

Please note that Mel Chrestman was inadvertently identified as Mel Cheskin in the October PM article "Minimalist Shoes and Barefoot Running." Mel Chrestman is an outdoor footwear specialist.

Ben Pearl, DPM, Arlington, VA, abenpearl@netscape.net

RE: Vital Signs (A.L. Green, DPM)
From: R. E. Ehle, DPM
 
My office has routinely recorded vital signs for years, including those of children. Some time ago, my assistant identified an elevated blood pressure in an adolescent, which was corroborated with repeated BPs during his visit. He was referred back to his pediatrician, although his mother was skeptical about our findings.

We received a very grateful call from his mother sometime later.  Apparently, her son suffered from a previously undetected renal condition, which ultimately led to a renal transplant. He has done very well, and I occasionally have the opportunity to provide further care as he has grown up as an adult. Despite all the good care we provide our patients day to day, it is this type of event that makes practice so worthwhile.
 
R. E. Ehle, DPM, Bristol, CT, LT6161@aol.com

RE: A Matter of Semantics
From: G. Stephen Gill, DPM

"Routine foot care" is dated terminology and should be permanently replaced by "preventive foot care services."  

G. Stephen Gill, DPM, MBA, Denver, CO, georgestephengill@gmail.com

RE: SuperGroup Formation In Maryland (M. W. Aiken, DPM)
From: Ira M. Baum, DPM
 
I have experience in developing a “supergroup” in S. Florida. There are no guarantees that the group will be able to negotiate improved re-imbursement rates. From my experience, reimbursement rates are market driven. If there are a limited number of podiatrists in a given geographical area,  and your group has almost every podiatrist within that area, then the group may have a chance to negotiate better rates. If you don’t, they won’t. 

I don’t want to sound callous, but insurance companies are in business to make profit. Their only obligation is to provide a service, not necessarily the best quality service. If an insurance company can circumvent your group, they will. Unlike essential allopathic and osteopathic medical specialties, our specialty is not perceived as essential and, although we provide a much needed service, the impact of our patients on their carriers to modify their position is minimal.

As an aside, upfront costs of $2K, is not the cost to join a group. Guaranteeing a loan to capitalize the group is the cost of joining a group. The % of operating costs is a different cost. Don’t be discouraged. Without legal collective bargaining, single-specialty groups have been a method for some specialties to improve reimbursements.
 
Ira M. Baum, DPM, Miami, FL, miamifootandanklecare.com

RE: Stay Away from Trimming Toenails (Barry Mullen, DPM)
From: Michael Forman, DPM

Barry Mullen's letter was right on. I hope those who missed it can go back to their "recently deleted" box and read his October 21st post.  Conservative foot care has been a part of our profession since Dr. Zacharis treated Abraham Lincoln's feet.
 
I feel that podiatry is in the same place as dentistry was fifty years ago. At that time, the dentist performed all of the clinical work in his office, including tooth prophylaxis, drill and fill, etc. Dental medicine began to develop dental hygienists and dental assistants to help the dentist. Podiatry needs to do the same. 

A graduate of one of our fine three year program does not want to cut toenails or trim calluses. He should employ a podiatric technician to perform these duties so that he can concentrate on more challenging cases. Conservative foot care, including the trimming of nails must be kept in our profession. We need well-trained assistants to perform this work.
 
Michael Forman, DPM, Cleveland, OH, IM4MAN@aol.com

RE: OH Court Rules That Podiatrists Need ABPS Certification for Staff Privileges (Thomas Graziano, DPM, MD)
From: Kathy Satterfield, DPM

My personal thoughts are that I have read everyone’s response on this subject, and I find that of all of them, Dr. Graziano’s comments hit the nail on the head most acutely. He said, “Certainly some in our profession who have been unable to achieve board certification are excellent surgeons with pristine surgical outcomes. And some are not. That goes for those that are certified as well.“

The emphasis is mine. The very fact that there are surgeons with “bad hands” and equally bad outcomes, who claim the entitlement of...

Editor's note: Dr. Satterfield's extended-length letter can be read here.

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