The Voice of Podiatrists

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October 29, 2007 #3,078 Editor-Barry Block, DPM, JD

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You Don’t Have to Spends Hundreds For Good Sport Shoes: ND Podiatrist

If you spend a lot on the wrong shoe, you may as well throw your money away, because your feet will be kicking you. But it`s safe to say that nobody wants to take out a loan to dress up their feet for the gym. "We`re talking about 130 dollar shoes that you have and you can get a shoe for about half that price that is a good, supportive shoe," says Dr. Kevin Koester, a podiatrist.

Dr. Kevin Koester

When selecting footwear, just follow these buying guidelines. First, set your sights on support. "What we feel is a good shoe is one that is stable in the mid arch so if you grab your shoe when you try to bend it right in the middle, you should either not be able to do it or have it bend at the ball of the foot," Koester says.

If you`re tackling the track or treadmill, pick a name that`s known for running. "You`re looking at New Balance, Asics, Saucony," Koester says. Joggers, says Koester, should steer clear of most Nike and Reebok models because they are typically designed for specific sports. Koester says even though you don`t have to spend hundreds for a good pair, you can still expect to buy shoes in the $60 to $80 range.

Source: Joanna Small, WFYR Bismarck, ND [10/26/07]

Patient Publically Lauds IL Podiatrist

In my opinion, doctors don't receive much notoriety unless they make a mistake and are sued. I want to give my podiatrist Dr. Ronald Dickey a pat on the back for curing an infection in my left foot that I picked up in Mexico in January of this year.

Dr. Ronald Dickey

Being a person whose body usually heals pretty well by itself, I did not go to Dr. Dickey until the end of February. Of course he scolded me for not coming in sooner. But with his prescribing antibiotics and making a new appliance to take the weight off of the infected area, the infection finally got better and I could put weight on the foot and play golf again.

I want to publicly thank Dr. Dickey for doing what he does best, treat his patients. This letter also gives credit to all the doctors who care for us. --- James N. Kleindl, Freeport, IL

Source: Journal Standard [10/26/07]

Biden, Kucinich Discuss Healthcare at Forums

Presidential candidates Sen. Joe Biden (D-DE) and Rep. Dennis Kucinich (D-OH) on Thursday spoke at health care forums in Washington, D.C., sponsored by Families USA and the Federation of American Hospitals and hosted by the Kaiser Family Foundation. Summaries of their comments appear below.

Biden said that the "biggest distinction" between his proposal to extend health coverage to all U.S. residents and those of other Democratic candidates is that his plan would reimburse employers, health insurers or associations for 75% of catastrophic health care costs, a provision that he said would reduce costs (Kapochunas, CQ Today, 10/25). In addition, he said that the proposal would not require U.S. residents to obtain health insurance (Goldstein, "Health Blog," Wall Street Journal, 10/25).

Kucinich said that he is the only candidate "who is talking about a single-payer, not-for-profit health care system," which he called "Medicare for all." Kucinich promoted a bill (HR 676) he has introduced in the House with Rep. John Conyers (D-MI) that would establish a publicly financed and privately-delivered healthcare system funded through the elimination inefficiencies in the current system and an increase in the Medicare part of the income tax from 1.45% to 4.75% (Horrigan, CQ Today, 10/25).

Source: CQ Today and Wall Street Journal via American Health Line [10/26/07]

Query: Supplier for Stainless Steel/Carbon Fiber Insert

I am trying to locate a supplier for a full-length stainless steel or carbon fiber insert for a patient with bilateral TMAs, to maintain the shape of his shoes (i.e., the toes of the shoes turn upward distal to the amputation site even with toe filler). Any help would be appreciated.

Kurt Gustafson, DPM, Lehighton, PA

RE: Source for UAM Burrs (Cosmina Dragomir, DPM)
From: Samuel Cox, DPM, Jeffrey Siegel, DPM

Try Medfix, Inc. they have new and refurbished Stryker and Hall Systems with burrs and blades along with screw sets, etc. They are exclusively a surgical hardware dealer of all kinds of new and refurbished equipment. They are located in Tucson, AZ. Their website is: http://www.medfixinc.com

Samuel Cox, DPM, Goodyear, AZ scoxdpm@gmail.com

UAM is now Vilex (1-800-521-5002 for the power equipment division). You can obtain these supplies from them, along with service for UAM and the older Ergo Storz power equipment. Here are a couple of websites that will help:

http://vilex.com/ http://vilex.com/newpower/rotary_acc_mp.htm

Jeffrey Siegel, DPM, Long Beach, CA, 4petra@sprintmail.com

RE: Medication Use for Diabetic Peripheral Neuropathy (E Udell, DPM, A Kalker, DPM)
From: Multiple Respondents

Metanx (L-methyl folate, B6, B12) does more than lower homocysteine levels. B6 and B12 are important co-factors for maintenance of neural function. In addition, Metanx has been demonstrated in PUBLICATION to increase nitric oxide levels with resultant improved wound healing and measurable improvement in sensory nerve function. The polymorphism in the American population also results in frequent undetected relative folate deficiency even with "normal" diet or vitamin supplements, hence the L-methyl folate.

The medications cited by Dr. Udell (.e.g- Cymbalta, Lyrica) are used for positive neuropathy symptoms such as parasthesias and dysethesias. Such symptoms represent only 10-20% of patients with diabetic neuropathy. Autonomic neuropathy (eg anhidrosis, vasomotor and sudomotor changes, neuropathic edema), motor neuropathy (eg-intrinsic minus foot with associated deformity) and negative symptoms (eg numbness) represent the MAJORITY of those patients with diabetic neuropathy, IF the examining health care practitioner would take the time to look (as well documented by EBM; references available on request).

Agents such as Metanx (1-2 daily), Inositol (500 mg TID), alpha-lipoic acid (600 mg daily) appear to be very useful for such patients as the offer the potential for remissive therapy. Antinociceptice agents such as anticonvulsant of antidepressant medications are NOT indicated for negative symptoms

Many patients undergoing monochromatic infrared therapy for neuropathy did quite well. I do not recall any publications suggesting that nitric oxide levels be measured prior to such therapy.

Allen Jacobs, DPM, St. Louis, MO, allenthepod@sbcglobal.net

Dr. Katz, and others like him who subscribe to the use of non-FDA regulated or insufficiently studied substances, like to believe that other doctors “just don’t know what he knows.” I beg to differ. The medical community is well aware of “natural” substances. That is why one will see a wall chart in almost every OR that details the adverse and sometimes life threatening interactions of herbal supplements with anesthetics.

I find the sentence “When used in their cheap synthetic form they are useless” not only amusing but also enlightening. Synthesis of pure substance is just that, pure. All other unregulated substance are known to vary in potency and the amount of contaminants they contain. I personally prefer to know what I’m giving my patients.

I do agree with Dr. Katz that one should follow the money. Pharmaceutical companies are profiting greatly from prescribed medications. I know of no doctor that benefits more than a meal or two from those prescriptions. However, those subscribing to and prescribing “naturopathic” drugs and the like, are personally profiting billions annually. You tell me where the incentive lies.

I have said, and will continue to say, “show me the studies.” The fact of the matter is they don’t exist. Well, they do, but aside from all the junk science and exceedingly flawed research, there are no good compelling studies indicating the magic Dr. Katz speaks of.

As an aside, Spectracell is a company not a blood test. Stephen Barrett, MD, the vice president of the non-profit organization National Council Against Health Fraud, has added Spectracell to a list of suspect laboratories performing “non-standard” practices.

Jon Purdy, DPM, New Iberia, LA, podiatrist@minspring.com

I am not here to produce studies. However, there are studies supporting the practice of natural medicine http://www.raysahelian.com/diabeticneuropathy.html . I disagree with your comments and several misquotes of what I actually stated in my note. Believe it or not, I practice just like you do, but I research alternative methods for my patients and break through the blinders placed around our eyes. I don't need a lecture on the etiologies of neuropathy and treatment of homocysteine.

I'm sure that every treatment that we perform in our practices is not backed by double blind studies. There were double blind studies on Bextra and many other drugs that have been pulled. However, I do know that I have significant success with natural treatments for neuropathy, as do others. I also see significant side effects from the Rx drugs for neuropathy as I'm sure many others can confirm. I work up my patients just like you do and practice safe effective medicine.

Here is my point. We need to become knowledgeable and integrate natural medicine into our practice to become well-rounded practitioners. This is common practice by physicians in other countries and is true in the US as well.

I don't buy the canned arguments that you make. The safety profiles are often misleading. It all boils down to what happens in true practice. You can't lead your life believing everything that "they" say, it’s not all about "good science" and "well controlled studies." It’s about helping people. You need to step out of your box and expand beyond pure academics.

Marc Katz, DPM, Tampa, FL, dr_mkatz@yahoo.com

Editor’s note: an extended-length letter by Dr. Mannn appears at: http://www.podiatrym.com/letters2.cfm?id=16324&start=1

RE: Phones and Multiple Offices (Daniel Reznick, DPM)

We use ATT's call forwarding with a "distinctive ring" feature which identifies calls from our second office by producing two short rings, (as opposed to one long on our main lines). This avoids booking patients at the wrong office. A multi-line phone system is not needed to use this feature.

Robert Hall, DPM, Ft. Lauderdale, FL, robertkhalldpm@bellsouth.net

PARTNER WANTED FOR GROUP PRACTICE LOCATED 1 1/4 HOURS NORTH OF NYC

BE AT THE RIGHT PLACE AT THE RIGHT TIME. YOU CAN'T BEAT THIS OPPORTUNITY. Respond to: mhudes@footcaregroup.com

IMMEDIATE ASSOCIATE NEEDED - SOUTH MIAMI

Approximate $100,000 position available now. 6-doctor, 8-office group
needs a replacement for a doctor who is leaving soon. 40 patients per
day already scheduled for you. Partnership track available. Spanish
speaking is a major benefit. Email CV and letter of intent to
lianadpm2@aol.com or mail to 2441 SW 22nd street, Miami, FL 33145

PRACTICE FOR SALE - BUFFALO, NY

Part Time Practice with full growth potential. Mix of conservative, biomechanics and diabetic foot care. Great surgical potential. Gross 170K. Willing to stay through transition. Call 716-432-7092.

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