The Voice of Podiatrists

Serving Over 10,000 Podiatrists Daily

November 05, 2007 #3,084 Editor-Barry Block, DPM, JD

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James Earl Bates, DPM, 1923 - 2007

James E. Bates, DPM, a giant of the podiatric medical profession, passed away in his sleep early Friday morning, November 2, 2007 at his home in Atco, New Jersey. He was 84. Dr. Bates, a 1946 graduate of the Temple School of Chiropody, was a founder of the Pennsylvania College of Podiatric Medicine (now the Temple University School of Podiatric Medicine) and served as its president for 33 years, from 1962 to 1995. At the time of his death he was serving as the school’s chancellor, as the chairman of its Board of Visitors, and as a member of its Foundation Board.

In addition to these achievements, he was previously awarded special citations from PCPM and the Pennsylvania Podiatry Association, and received the Special Recognition award of the PPMA and a Lifetime Achievement Award from Podiatry Management Magazine.

PM News policy is to request that memorial donations be made to the APMA Education Foundation Student Scholarship Program, 9312 Old Georgetown Rd. Bethesda, MD 20814.

Diabetes Team Should Include Podiatrists: NYSPMA President

Diabetes can affect the body from head to toe. Controlling the disease takes teamwork--a comprehensive diabetes management team to be exact. During November, Diabetes Awareness Month, the New York State Podiatric Medical Association (NYSPMA) urges people with diabetes to make sure their team of specialists includes a podiatrist. Dr. Robert Rampino, president of the New York State Podiatric Medical Association, (NYSPMA) is one of hundreds of podiatrists across New York State participating at specially organized community-based diabetes centers.

Dr. Robert Rampino

Often called “wound clinics,” these centers bring together teams of specialists who work together to help patients control complications from the disease including one of the most debilitating effects--loss of lower limbs. According to Dr. Rampino, “wounds on the foot can infect and lead to serious consequences. With a podiatrist on the team, these wounds can be treated and often eliminated. “Statistics reveal as many as 80% of lower extremity amputation can be avoided when proper foot health is practiced,*” he says.

*Statistics compiled by the American Diabetes Association in conjunction with the Centers for Disease Control and Prevention.

GA Podiatrist Sentenced For Narcotics Distribution

An Atlanta podiatrist was sentenced to nearly four years in federal prison Thursday for his role in a prescription drug distribution ring operating in Atlanta and Miami.

Steven Hollander, 46, pleaded guilty in August to conspiring to distribute a variety of controlled substances. His three years, 10 months in federal prison will be followed by three years of supervised release.

A search of DEA databases showed that in 2006, Hollander ordered approximately 202,500 doses of Hydrocodone, nearly four times as much as any other podiatrist registered with the DEA in the country.

Source: Mike Morris, The Atlanta Journal-Constitution [11/02/07]

Query: Kevlar Suture Fragments

A 56 yo Caucasian female presents history of forefoot plantar fascia rupture in February 2007 when in Japan. A Japanese surgeon repaired the plantar fascia with "Kevlar" suture made in China. The "Kevlar" suture has since been identified as from a defective batch and is breaking into shards of irritating material causing pain, shallow fissuring, and delayed closure of the superficial fascia and epidermis with suppuration of apparent tiny pieces of "Kevlar." Debidement, basic wound care and appature pads have been provided since July 30, 2007 with little improvement. 1) Is there a dye that could stain the Kevlar shards for identification and removal? 2) Can anyone provide advice as to how to treat this complication of surgery?

Henry C Traska Jr DPM, Arlington, TX

Query: EMR and Paper Records

I am interested in what people are doing with the hard copies of papers scanned into their EMR so they can be paperless. Do you keep them or shred them? Examples are HIPAA acknowledgement forms, insurance authorization forms, new patient forms, consents, path reports, labs and any other type forms, reports. Does anyone know if there are legal requirements or statutes for saving the actual signatures or the forms and if so how long do they need to be saved?

Harvey Danciger, DPM Palm Desert, CA

Editor’s Comment: PM News does not provide legal advice. If one is going paperless, it’s logical not to use and/or save paper. Once originals are converted to digital form, they are generally accepted with the same weight as originals. As such, they must be maintained for the same period of time as originals.

Additionally, EMR should be backed up and secured separately at another location.

Assessing Risk of DVT/PE (Jane E. Graebner, DPM)
From: Multiple Respondents

I was truly sorry to hear about Dr. Graebner’s unfortunate experience. This must have been devastating. I wish pray this doesn't happen to anyone. Dr. Graebner made a point of mentioning in her post that the patient was not obese, a risk factor for developing DVT. Prior history of DVT would obviously be another, as would a smoker or a patient on birth control pills. Using a tourniquet on any of these patients could potentially pose a risk. In these types of patient's you can avoid a tourniquet altogether and do the procedure wet. Using Lovenox is also a very good idea.

The mild pain in the calf, while seemingly insignificant at the time, might have been a big tipoff. In my community, a 30-ish year old woman died last year after going dancing. She had mentioned to her husband her calves were hurting slightly after the dancing and chalked it up to not having been out in a while.

The lesson we can all learn from this terrible episode is - symptoms don't always show in the worst way. I applaud Dr. Graebner for sharing her experience with us.

Jeffrey Kass, DPM, Forest Hills, NY, Jeffckass@aol.com

In regards to Dr. Graebner's patient who expired from a DVT/PE; I wonder if she was a smoker. The serious consequences of a combination of BCP and smoking is well documented. I lost a young female patient a number of years ago to a DVT/PE and I blame her passing on this combination.

Michael Forman, DPM, Cleveland, OH, IM4MAN@aol.com
I understand that this patient was non-obese, active, etc, but she did have another risk factor for PE. Chronic birth control use has been shown to be a risk factor. So, although post-surgical inactivity (maybe increased by doing B/L?) might have been a factor, the birth control could have been a large factor as well. I think there is a need for prophylaxis in some people, but I am not sure in the same situation if I would have prophylaxed this individual.

Daniel Tellem, DPM, Rochester, NY, liadant@frontiernet.net

Editor’s Note: An extended-length letter from Dr. Mullen appears at: http://www.podiatrym.com/letters2.cfm?id=16431&start=1

RE: Plantar-Flexed Halluces (James Fisher, DPM)
From: Godfrey Viegas, DPM

I also have had young polio patients with similar clinical findings. When orthoses fail, I have reaped much success with primary 1st MTPJ arthrodesis. This will stabilize the first ray significantly and improve propulsion. Implant arthroplasty would arguably be contraindicated given the probability of neurologic deficit and the patient's very young age. I currently use a combination of a dorsal locking plate (either Nexa Orthopedics or Acumed, and an additional cannulated lag screw (3.0mm) that's placed outside of the plate). It might be of benefit to obtain neurological consultation to corroborate the opinion for the existence of polio. Good luck with this interesting case.

Godfrey Viegas, DPM, Crystal Lake IL, gviegas1234@sbcglobal.net

RE: DPM, MD or DPM, DO Degree (Leonard Levy, DPM, MPH)
From: Elliot Udell, DPM, Michael Forman, DPM

I read Dr Levy's comments about how dentistry was not hindered as a result of some dentists getting MD degrees. Dr Levy who is a friend and colleague of mine made me chuckle because in addressing one issue he opens up another question. I'm biased. You see, this year was not a good year for me dental wise. Between root canal, general dental work and a couple of crowns I am down four thousand dollars. Let's face facts, minute for minute spent with patients, neither we nor most MD's and DO's make that kind of money. We have to see many more patients and do much more work to make the same amount of money and many of us never get there. Insurance companies don't pay doctors that much. Most dentists don't take insurance and those that do only allow part of what they do to be covered. I wish I could buy an insurance plan that would cover dentistry, but the plans out there are not that comprehensive.

Dentists won't bolt dentistry if they were given ten MD's next to their names because dentistry in this country is still a very lucrative profession. The question is how were dentists able to prevent their profession from succumbing to the economic ravages of HMO's, control by government agencies and insurance companies in general? Why did medicine, including podiatric medicine go in that opposite unforsaken direction?

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

I believe that if you want an MD/DO degree you have two options. First, you can go to a four year accredited allopathic or osteopathic medical school before, instead of, or after a four year podiatric medical school. Second, we can use the oral surgery model of a five or six year post graduate residency program that utilizes the last two years of an MD/DO medical school in its curriculum. Anything less is unacceptable. Abe Lincoln told us about fooling some of the people some of the time......

Michael Forman, DPM, Cleveland, OH, IM4MAN@aol.com

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