The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

October 31, 2009 #3,689 Publisher-Barry Block, DPM, JD

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Diabetics at Greater Risk of Developing Dry Skin: NY Podiatrist

As American Diabetes Month approaches, leading experts like Dr. Jacqueline Sutera, DPM, stress the importance of foot care, especially for those with diabetes. People with diabetes are at a greater risk of developing dry skin due to nerve damage.

Dr. Jacqueline Sutera

"There are many preventive steps people with diabetes should take to reduce the likelihood of complications from dry skin on the feet," said Sutera. "Regular visits with a podiatrist, who can examine your feet, along with meticulous daily foot care, are vital to helping feet stay healthy."

Source: Las Vegas Review-Journal [10/29/09]

NY Podiatrist Charged with Healthcare Fraud

A local podiatrist is charged with healthcare fraud. Authorities say he filed false claims with Medicare to the tune of $750,000. The doctor's arrest is part of the government's new focus on health care reform. Doctor Michael Akyuz is a podiatrist. Prosecutors say he was falsifying information in health insurance claim forms by billing for routine services that aren't covered.
  
Assistant U.S. Attorney Bret Puscheck said, “For example, he was doing such things as clipping toenails and charging for complicated surgical procedures on people's feet." The doctor's billing practices came to light after an audit by the justice department set out to identify the top 20 medical providers who billed home-bound patients. If he's convicted, he could be looking at 10 years in prison, a $250,000 fine, and restitution of the $750,000 he's accused of stealing.

Source: WHEC (Rochester) [10/29/09]

Query: Bunion Surgery

I am looking for surgical options for a 69 yo female with a long-standing painful bunion, semi-reducible at the first MTPJ with hypermobile 1st met-cuneiform joint.

Pre-op x-rays

She is fairly healthy other than having osteoarthritis and GERD. Suggestions?

Richard Frost, DPM, Spokane, WA
 

Query: Custom Latex Bunion Shield

I would like to order a custom latex bunion/hallux shield for a patient. I have not ordered one of these in many years, but in the past, I have sent a plaster impression of the medial forefoot with the areas to accommodate marked inside the cast. Does anyone know of a lab that presently fabricates these appliances? 

Lorraine Loretz, DPM, Worcester, MA
 

RE: Sarapin for Morton's Neuromas (David Alper, DPM)
From: Stan Rosen, DPM, Elliot Udell, DPM
I have been using a Serapin mixture for over 10 years. I use it in all blocks for diabetics instead of cortisone that raises blood sugars. I actually combine 1 cc. of Serapin, 1 cc. of Vit B12 and 1 cc. of 2% lidocaine plain. This is administered as a nerve block into the affected nerve. The anti-inflammatory effect of the Serapin, the B12 for neuritis and the local anesthetic, all acting on the affected nerve, seems to alleviate the neuroma pain. This condition usually is caused by a biomechanical imbalance which needs to be addressed in order for any type treatment to be effective. Morton's neuroma is usually caused by a biomechanical problem

Stan Rosen, DPM, Tuscaloosa, AL, SRosen5730@aol.com
 

In our office we use two methods to treat Morton's neuromas. One is an injection of Sarapin combined with dexamethazone and lidocaine and the other is Dr. Dockery's method of injecting 4% alcohol. Both methods are successful in many cases. We have found that if one method does not yield optimal results, we switch to the other and achieve our clinical objectives. 
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com 

RE: Transmetatarsal Amputation in a Sensate Patient (Jared Clifford, DPM)
From: Jared Clifford, DPM

I would hope that most readers would assume that all other options had been explored, but just to be clear: my original posting is the result of multiple visits and discussions with this patient. I had her go home and consider all other options (both conservative and surgical) and then come back to see me before the ultimate decision was made.
 
One factor in the decision-making process is that when she had her original surgeries years ago, she was told that she would one day need a TMA due to the eventual deformity of the lesser digits. Right or wrong, that was what she was told and had been preparing for it for years.
 
Second, she is very active and felt that any reconstructive surgery (that may be less definitive than a TMA) was not for her. I agree that the patient's request for surgery should not be the only factor in deciding a procedure, but I feel that she is still part of the decision-making process. She is otherwise very healthy, very intelligent, and has studied this very thoroughly. 
 
I appreciate any feedback regarding the original question as to whether any extra attention needs to be given to the nerves during a TMA on a sensate patient. From my own inquiries to local colleagues, the consensus so far is that the nerves retract well enough to prevent any issues post-operatively.
 
Jared Clifford, DPM, Prosser, WA, jared.clifford@gmail.com
 

RE: Recommendations for Bunionectomies
From: Allen Mark Jacobs, DPM, Ed Cohen, DPM

With regard to the "recommendations for bunionectomy" question recently addressed in PM News, the eclectic variety of conclusions suggested by the readers speaks loudly to one answer: in many cases, there are often multiple correct or reasonable alternatives for a given problem. The correct answer is one often posited by the late James Ganley, DPM...call the office of a plaintiff's lawyer. They ALWAYS seem to know the correct answer for every problem.
 
Allen Mark Jacobs, DPM, St. Louis, MO, allenthepod@sbcglobal.net

There seems to be a lot of interest in how to treat bunions. It might be a good idea to allow doctors to submit pre- and post-op x-rays and to discuss the treatment as well as how fast the patient recovered from various bunion surgeries. I feel if a patient has high IM angles, PASA and DASA and goes back to work early, it would have merit to allow a discussion on these cases. Complications and poor results are also important to discuss.

 Ed Cohen, DPM,  Gulfport, MS, ECohen1344@aol.com
 

RE: PADnet+ System (Robert Wunderlich, DPM)
From: David J. Freedman, DPM, Elliot Udell, DPM

The concern raised regarding oscillometry is from the waveform section of the LCD, and PADnet does not use mechanical oscillometry. To clarify, PADnet uses pneumoplethysmography or more specifically, calibrated pulse volume recording (PVR) for waveform generation. There is no comment or limitations for pressure-taking techniques.

David J. Freedman, DPM, Silver Spring, MD, DJFREEDMAN@aol.com

I acknowledge Dr. Wunderlich for questioning whether PadNet+ vascular testing would be covered by certain insurance carriers if its basic mechanism which is oscillometry is disallowed by many carriers.
 
All too often when sales reps sell us new modalities which includes certain portable nerve testing modalities, they are quick to take thousands of dollars from us but are not willing to tell us that many carriers might not reimburse us, based on the device's technology. Some carriers might even demand the return of money months or years later if they find out that they paid for a test which they do not approve of. This does not mean that PadNet+ or some of the portable nerve testing modalities are not effective. Based on what I have seen at conventions, it appears that if more vascular testing was done by podiatrists using  devices like PadNet+, many patients would benefit.

Even old-fashioned oscillometric devices can yield information that could result in a limb being saved. When we purchase a vascular or neurologic testing device, we need to make sure that we will not be left holding an eight to twenty thousand dollar bill or lease with no visible means of paying for it.
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com
 

RE: PM News Tops 12,000 Subscribers
From: Edward R. Nieuwenhuis Sr.,  DPM

Congratulations to Barry Block and PM News on reaching another milestone. Having been a long-term reader and subscriber, I can attest to the timeliness of the information offered and the value of this public forum for our profession. May I echo the recent comments of one of the contributors; please use decorum in responding to other colleagues. There is no place in a public medium such as this for caustic remarks. If such comments must be made, write the person a personal note, not a public one
 
Edward R. Nieuwenhuis Sr., DPM, Hawthorne, NJ, edfeet@aol.com

HAPPY HALLOWEEN

 Submitted by Lynn Homisak

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 – MINNESOTA

Well-established podiatry clinic located in the Twin Cities area has an immediate opening for a full-time podiatrist. The clinic is located just minutes from a surgery center as well as 2 major hospitals. Associate position is also open for partnership or purchase. Please email CV and inquires to rmccoy@associatedpodiatrists.com

ASSOCIATE POSITION - NW IOWA (SIOUX CITY AREA)

Well-established, diverse, growing practice. Excellent referral base. Seeking an ethical, hardworking, motivated, caring podiatrist to fill a full-time position. Multiple hospital affiliations. Generous income with room for growth, leading to partnership for the right candidate. See our community www.siouxlandchamber.com. Fax CV, resume, three references to 712-258-9977.

OFFICE SPACE/ MRI RENTAL – NYC, LI

Turn-key space available, daily, monthly; East 60th off Park Ave, East 22nd St. off 3rd Ave, Hicksville and/or Plainview Long Island. JACHO-certified operating rooms available, as well as all surgical equipment and anesthesia. Extremity MRI Rental. Stark compliant. All exams read by board certified radiologist. Call for details. 516 476-1815

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.

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 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

DIABETIC RURAL OUTREACH PROGRAM - FLORIDA AND GEORGIA

Seeking DPM to join our program due to a high demand for Podiatric Care to off-site settings in SNF, ALFs and House Calls. Applicants must be willing to travel and must have experience. Current State License, Medicare and Medicaid numbers required. Seeking highly motivated individuals who can be team players, yet work independently. Must have strong work ethic and excellent communication skills. APPLY: Fax CV to: 866-258-9993 include 3 professional references. Please provide the geographic area where you can provide services. Further information call 800-779-8551 or email: info@DROPInternational.org. Visit our website

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.

ASSOCIATE POSITION – BROOKLYN, NY

Busy medical office in Brooklyn seeking part-time podiatrist. Good conditions. (718) 259-6666 phone (718)259-7000 fax, email zg0109@yahoo.com 

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 - 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

PM News Classified Ads Reach over 11,500 DPM's and Students

Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 11,500 DPM's. Write to bblock@podiatrym.com or call (718) 897-9700 for details. THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451

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