The Voice of Podiatrists

November 01, 2006 #2,729 Editor-Barry Block, DPM, JD

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Carstell "C.O." Stewart, DPM, 85

Dr. Carstell "C.O." Stewart was known as a man of few words whose good works spoke for him. As a podiatrist, Dr. Stewart took care of the maladies of many an Akronite's feet. As a person who cared about the downtrodden, he was one of the doctors who helped start Akron's free clinic at Opportunity Parish Ecumenical Neighborhood Ministry (OPEN M). As a member of the Army's first black paratrooper unit, he took a stand during World War II. Dr. Stewart died Monday of cancer at age 85.

Dr. Carstell "C.O." Stewart

Dr. Stewart was recognized for professional accomplishments, receiving a Lifetime Achievement award in 2005 from the Mideastern Academy of the Ohio Podiatric Medical Association. ``He was one of the quiet leaders in our profession,' said Dr. Richard Hofacker, an Akron podiatrist and friend of Dr. Stewart. ``He was always interested in helping the younger doctors and he would tell them, `Be ethical, because in the final analysis, it's your name that matters.' '

PM News policy is to encourage memorial donations to the APMA Educational Foundation, 9312 Old Georgetown Rd, Bethesda, MD 20814.

Source: Jewell Cardwell, The Beacon Journal [10/31/06]

OCPM Professor Leading the Charge to Change OH Radiology Rules

Dr. Lawrence Osher, Professor at the Ohio College of Podiatric Medicine, member of the Radiation Advisory Council (RAC) and Chairman of the Radiation Equipment Generating Committee (REC) to the Ohio Department of Health (ODH), is leading an effort to change the General X-ray Machine Operator (GXMO) Ohio State Law.

Dr. Lawrence Osher

Dr. Osher is the first ever podiatrist to chair the Radiation Equipment Generating Committee, a sub-committee of the RAC. The REC is currently assisting the Ohio Department of Health in developing a new educational model for its often contentious GXMO licensure program. In general, it is hoped that these changes will impact the chronically low state exam pass rates, provide for digital image receptor training, and shift the emphasis away from a heavily-weighted classroom program to more practical, “hands-on” training.

TX Podiatrist Raises Thoroughbreds on Kentucky Bluegrass

Grazing on Dr. Donald Stran's land, a thoroughbred colt, his horse buddies and his surroundings make a picture straight out of a Kentucky Derby countryside postcard. Only this scene is in Texas. "Dr. Stran takes it as a sincere compliment that his land resembles the bluegrass area of Kentucky," Council member Jim Hill recently said. Stran is a podiatric surgeon who offices in both Clear Lake and the Lake Jackson area.

Dr. Donald Stran

"When he bought the property in Rancho Viejo, he was faced with huge mounds of dirt on the land that he had leveled at great expense," said Hill. Apparently the previous owner had loaded up between 3,000 and 4,000 truckloads of dirt on the property. "It used to be called Mount McKinney," said Hill. "Dr. Stran moved the dirt across the 17 acres. That did more to improve the looks of Rancho Viejo than anything else."

Hill said Stran takes a lot of pride in the thoroughbreds he raises. And the crop, hybrid Jiggs Bermuda grass, that he feeds them with."The colts can sell for $20,000 apiece."

Source: Colleen O'Brien, Firewood Journal [10/26/06]

Query: Tinea Versicolor

Can someone recommend a practical and effective treatment for Tinea Versicolor?

Frank DiPalma DPM, Athens, GA

Query: Staff Dating Patients

Of course I know it is unethical for a doctor to date a patient, but what is the guideline for staff dating patients?

Larry Aronberg, DPM, Lake Worth, FL

Query: Terminal Symes Coding

Would a CPT 28285 (correction, hammertoe [e.g., interphalangeal fusion, partial or total phalangectomy]) be the correct code for terminal Syme procedure performed on 3rd digit? The patient had previous failed arthroplasty. The Op report states bone resected distal from the base of the proximal phalanx.

Patti Smith , Lake Havasu City, AZ

Response: A terminal Symes is an amputation of the tip of the toe which has nothing to do with the correction of hammertoe deformity. CPT 28285 (correction, hammertoe) would not be appropriate to bill.

If the toe was amputated at the interphalangeal joint, use CPT 28825. If the distal tuft of the distal phalanx is amputated with a matrixectomy performed, then consider CPT 11752 (some people just bill CPT 28108 which pays more), but don't bill CPT 28285.

Tony Poggio, DPM, Alameda, CA

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

RE: Wisdom Problem (Tom Cerillo, DPM)
From: Ira Weiner, DPM

Although I do not use Wisdom, I have been having similar problems with my clearinghouse within the past few weeks. Perhaps it has something to do with their updating of the internal program due to the new NPI initiative. My clearinghouse Medadvant has been doing updates for the past few weeks.

We traced the problem to the clearinghouse and their program updates.

Ira Weiner, DPM, Las Vegas, NV, vegasfootdoc2005@yahoo.com

RE: Name for Lesion (Bryan Markinson, DPM)
From: Carl Ganio, DPM

The slang term I was taught...was "pinch callus." This is obviously a description of the mechanism causing the lesion.

Carl Ganio, DPM, Vero Beach, FL, drcarlganio@bellsouth.net

Editor’s Note: Thanks to the 50+ subscribers who sent in similar responses.

RE: Bariatric Surgery Referrals
From: Multiple Respondents

The procedure as described is a justified and sound medical procedure (not without its faults as stated-vitamin absorption among them and long term morbidity and mortality data are not clear but already some insurers are withdrawing coverage based on at least a cost analysis.) and has changed the lives of many morbidly obese patients I have known. Correctly applied, the procedure does not normalize life- but may save it.

The problem, like any new procedure or medication is in the application of the technique. Bariatric surgery does change people's lives and necessarily requires consultation with mental health professionals prior to the procedure. As bariatric surgery is "learned" by more and more surgeons, inevitably, there will be those whose criteria for acceptance and whose goals in doing the surgery are not as they should be. It is not a procedure for every obese person (unlike the radio adverts would suggest), but performed for the right reasons on a patient who has been prepared for the procedure, it can be the end of present or future health issues. Let's not blame the procedure; surgical outcomes most often are the result of what's between the ears, not in the hands, of the surgeon.

Robert Eckles, DPM, NYCPM, reckles@nycpm.edu

I am not going to debate the pro’s or con’s of a podiatrist referring a patient to a bariatric surgeon. I personally feel it is in order on occasion. It is the job of the bariatric surgeon to notify the patient of the risks of bariatric surgery. Not mine. It is a surgery
with a higher than average M&M.

I do disagree with Dr. Gary S. Smith however when he says the “vast” majority regret having had the surgery. I have not yet seen one of my patients say that. Some have said they wished they had done better, but not one has regretted it. I am sure there are many who do, but I just have to doubt in the term the “vast majority”.

David E. Gurvis, DPM, Avon, IN, deg1@comcast.net

Sure, bariatric surgery has risks but so does vascular surgery and we as podiatrists are required to refer patients with peripheral vascular disease to surgeons who might need to bypass or put stents into their arteries. I refer my morbidly obese patients to New York University's bariatric surgery center. At NYU, Dr Christine Ren and her associates won't operate on obese patients unless they pass a thorough and rigid screening and agree to be counseled by their team of nutritionists after the surgery.

The procedure that most of my obese patients are having is called the laparoscopic band procedure. It involves making two small incisions and inserting a band around the stomach. This can be removed or adjusted in the future if need be and the procedure has much less side affects and risks associated with it than the older radical bariatric procedures. Because of the relatively low rate of complications associated with the procedure (assuming the surgeons are competent), this procedure along with nutritional counseling should be recommended for patients who are 100 lbs or more overweight. For people in this category the morbidity and mortality associated with being so overweight far outweighs the risks of this procedure if done by the right hands and with the appropriate screening and post op counseling. For people who are mildly overweight nutritional counseling done by professionals is the way to go and I even send many people to Weight Watchers.

Elliot Udell, DPM, Hicksville, NY Elliotu@aol.com

Ed’s note: This topic is now closed

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