The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

October 28, 2011 #4,291 Publisher-Barry Block, DPM, JD

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Iaaac E. Willis, DPM

Dr. Isaac E. Willis, who died recently, has been rightly remembered for the positive impact he had not just on the people he cared for medically, but on the civic life of Longview and East Texas. As a recipient of Longview’s Unity Award, he chose to credit others who played roles in integrating our city’s schools in the 1970s. 

Dr. Isaac E. Willis,

Dr. Willis was picked by two governors to serve on the Texas State Board of Podiatry Education. In the mid 1980s, Willis was president of the National Podiatric Medical Association. He also was a former adjunct professor at the Illinois College of Podiatric Medicine.

Source: News-Journal.com

FL Podiatrist Discusses Gout

Gout is a form of arthritis that occurs when there’s too much uric acid in the blood. The acid crystallizes and forms deposits in the joints, causing painful inflammation, most commonly in the fingers, wrists, knees, elbows and toes. “The crystals are like having small spikes in the joints,” said Dr. Federico Auger, a podiatrist at the Ankle and Foot Center in Carrollwood, FL. He typically sees gout patients during an initial bout, when they don’t yet know they have the disease. 

Dr. Federico Auger

The affected joint — often the big toe — suddenly becomes hot to the touch, red, swollen and intensely painful. Why is the big toe affected? Extremities are the coolest parts of the body, and lower temperature is thought to be associated with flare-ups. “An attack can be so painful that they can’t even put a sheet on their foot,” Auger said. “It can be red all the way to the ankle.”

Source: Irene Maher, Daily Herald [10/24/11]

High Heels Create Many Risks to Models: Canadian Podiatrist

Toronto podiatrist Dr. Hartley Miltchin says long-lasting damage won't happen overnight from wearing high-heeled shoes, but anything higher than one-and-a-half inches can cause a problem. "We're just not meant to walk that way," explains Miltchin, whose clients include Miss Universe contestants. "Probably the biggest risk a model has is ankle sprains or fractures because of going over on a heel, but there's a whole host of problems that are associated with heels. Stilettos are the worst culprits." 

Dr. Hartley Miltchin

Fragile toes are the first to suffer, because high heels are designed with narrow toe boxes. "If we think of our toes as cars, you're putting five cars into a three-car parking space. Those toes are going to get squashed." Miltchin recommends investing in a good quality moisturizer. "The skin on the bottom of your feet is about 20 times thicker than anywhere else, so using a moisturizer for the rest of body just isn't going to cut it," he said. "Keep your feet supple and hydrated so they're able to take more abuse."

Source: Charlotte Percival-Gonzalez, CANOE [10/19/11]

SGR Repeal, Healthcare Cuts Among Ideas Sent to Supercommittee

Leading congressional lawmakers advised a debt reduction committee to enact a mix of health care cuts, including tighter prescription drug spending, but maintain many existing health programs.
 
The Budget Control Act of 2011 -- adopted in August to allow an increase in the nation's debt ceiling -- gave congressional committee leaders until Oct. 14 to submit their ideas to the Joint Select Committee on Deficit Reduction. The debt panel faces a Nov. 23 deadline to approve at least $1.2 trillion in savings, which Congress must adopt by Dec. 23. Otherwise, broad automatic cuts affecting Medicare and defense spending would kick in.

Source: Douglas Trapp, AM News [10/24/11]

The Power of 'No'

Successful people don't just do the right things: They know what not to do. Saying "No" to some opportunities allows you to say "Yes" to the right ones. If you didn't have time last week for everything you should have done, look at your calendar and completed to-do lists to find the times when you should have said "No".

Source: Adapted from Darren Hardy, "The Overachiever vs. The Superachiever" via The Organized Executive [November 2011]

Query: ACell

I recently had a patient come in for a bunionectomy pre-op consulation, and she requested that I incorporate ACell into her wound closure protocol. Has anyone used this product and with what kind of success?

Saera Arain-Saleem, DPM, Elnhurst, IL

RE: Vital Signs (A.L. Green, DPM, R. E. Ehle, DPM)
From: Elliot Udell, DPM

It's not only podiatrists who are being coaxed with the "meaningful use" carrot stick to take vital signs, but doctors from all medical specialties. As Drs. Ehle and Green reported, many of us are uncovering some serious cases of hypertension in patients and making important timely referrals to physicians trained in managing it.
 
These reports of pathologic findings may make all of us feel like heroes, but ultimately the true value in all of this will be when and if it can be statistically shown that by having specialists take vital signs, there is a significant decrease in strokes and other cardiac events.
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: SuperGroup Formation in Maryland (Ira Baum, DPM)
From: David N. Helfman, DPM

I have mentored physicians around the country and have received literally hundreds of calls from podiatrists about the SuperGroup model over the past two years. I have seen the flaws, the pitfalls, and misconceptions that many podiatrists are led to believe when signing on with a consultant or fellow colleague in our profession.

First, I have stopped marketing our model because the demand is so great that we are building up our infrastructure and methodically assessing each market and state to make sure it fits the criteria for a super group model. I would caution all of you to ask the following questions when you are considering putting together a SuperGroup model:

1. Why are you...

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

RE: Stay Away from Trimming Toenails (Michael Forman, DPM)
From: Howard J. Lepolstat, DPM

In his comments concerning the trimming of toenails, Dr. Forman references dentistry. The fact is that the entire dental profession is built upon a well established system of referrals to which most, if not all, dentists adhere. Specialists do no general work and generalists do no specialty work. I know there are certain minor exceptions to this (e.g. general dentists doing simple extractions and root canal, etc.). However, for the most part, this work is referred. In exchange, the specialist returns the patient to the referring dentist for the general work needed to complete the treatment.

The entire system is based on the trust that a referred patient will return to the referring office ASAP. I am retired from active practice for quite some time. But, I do remember that this type of referring was not the safest thing to do. Perhaps podiatry has reached the point where this type of system is appropriate. It would require some restructuring of protocols, but the benefits might very well be worth the effort.
 
Howard J. Lepolstat, DPM, Sun City West, AZ, TeachrComp@aol.com

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

Dr. Satterfield hit the nail on the head. These types of practices are restraint of trade. We are all in the same profession. In order for the profession to become stronger, which is what we should all ultimately want, we need to help each other, not hurt each other. There are so many struggles the profession faces in and of itself, e.g., pay discrimination, scope discrimination, etc. Fratricide clearly is not going to help the cause.  

By the way, is there any other medical discipline that has/had more than one board? Do orthopedists get boarded in surgery? orthopedics? and primary orthopedic medicine? How ridiculous is it to have so many boards for a foot?
 
Jeffrey Kass, DPM, Forest Hills, NY jeffckass@aol.com

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