The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

November 17, 2009 #3,703 Publisher-Barry Block, DPM, JD

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APMA's Diabetes Logo Runs NASCAR Laps at 200 MPH

Jeff DeSantis, past President of the California Podiatric Medical Association and David G. Armstrong, Professor of Surgery and Director of the Southern Arizona Limb Salvage Alliance (SALSA) were pit-crew VIP's at the unveiling of the "Diabetes is A Family Affair" initiative supported by the American Podiatric Medical Association (APMA).

(L-R) Drs. David Armstrong and Jeff DeSantis on pit row.

"It is a privilege to be a part of this enormously important program in such a splendid venue like the Sprint NASCAR series", noted Professor Armstrong, "Nearly one in 5 of the population at this event will have diabetes and everyone here knows someone with the disease. What we need to tell them is that the problem is preventable-- and the most common of diabetic problems-- foot infections and amputations-- are even more preventable."

APMA Logo on Ask.com #96 Car

The pair of podiatric leaders were guests of Hall of Fame Racing's number 96 Ask.com Ford, driven by Kevin Harvick.

GA Podiatrist Basketball Star Has Jersey Retired

Lawanna Monday simply went by the nickname, "Kita," when she raced up and down the floor at Christenberry Fieldhouse. Now known as Monday-Hardin, she remains the all-time leading scorer (men's or women's) in Augusta State basketball history, with 2,143 points. Monday-Hardin had her jersey retired in a ceremony prior to Augusta State's game against West Georgia.

Dr. Lawanna Monday

Former Augusta State women's basketball coach Lowell Barnhart said Monday-Hardin was one of a kind. "She's the kind of player every coach wants," said Barnhart, who coached his star player from 1994-98. "She was like a Michael Jordan, a Kobe Bryant, a Larry Bird, and a Magic Johnson. When the game was on the line, she wanted the ball. Not everybody is like that."

Monday, a podiatrist in the Atlanta area, earned a full scholarship through a tryout in spring 1994. It was then Barnhart said he knew he had someone special. Now, her No. 44 jersey, will hang from the rafters. "She's very deserving of it," Barnhart said. "I'm glad to see it."

Source: Chris Gay, Augusta Chronicle [11/15/09]

CA Podiatrist Celebrates 5th Anniversary of HealthyFeetStore.com

HealthyFeetStore.com, one of the largest on-line providers of orthopedic shoes and foot care products, announced today that it is celebrating its fifth anniversary. More than just an orthopedic shoe store, HealthyFeetStore.com is a source of fashionable, comfortable and supportive shoes for people with healthy feet who want to keep them that way.

Dr. Jeffrey Hurless

Dr. Jeffrey Hurless, a board-certified podiatric surgeon in Thousand Oaks, CA founded the HealthyFeetStore.com to provide a convenient source for purchasing doctor-recommended foot and ankle products. Only products that have been tested and used by his patients are included in the store’s inventory.

“About three of every four people will experience foot health problems at some time in their life, due to both the foot’s complexity and the fact that the pressure put on feet can exceed a person’s body weight,” Dr. Hurless said. “I’m delighted to have the opportunity to help those who have foot issues, and those who want to prevent them, by providing an outstanding online shopping experience.”

Query: Brown Cyst Aspirate

These photos pertain to brown cyst aspirate (approx 5cc) from the medial left foot of a 61 y/o diabetic male patient. He states that the cyst has been present for 30 years, but is becoming bigger and more painful.

Cyst and Aspirate

The cytology report of the brown turbid viscous fluid revealed "anucleated squamous cells." No malignancy was noted. Any ideas on what type of cyst this may be, without obtaining actual cyst lining?

Chris Seuferling, DPM, Portland, OR
 

Query: Positioning Device For Axial X-Rays

Does anybody know where I can order a positioning device for sesamoidal axial x-rays? I used to have one made out of plexiglass that worked very well but has since broken. 

Bryant A Tarr, DPM, Sudbury, MA

RE: Platelet-Rich Plasma (Jason M. Grossman, DPM)
From: Paul V. Ledesma, DPM

I have been utilizing PRP for injections and other various applications for the past year for common conditions such as heel pain, Achilles tendonitis, tendon repair, fractures, and wound care.  I think it makes sense to use as a first-line treatment, however, if insurance is involved, you will more than likely hit resistance getting reimbursed. Our office did have some success with getting reimbursed using the injection as a last resort type treatment. As far as protocol, there is nothing well-defined. For heel injections/Achilles, it was recommended by the company we used to have the patient be non-weight-bearing the first two days, and then partial weight-bearing for two weeks. Also, no blood-thinning medications should be used at least 7 days prior to the injection. 

There are also several companies that you can use to harvest the solution, and they vary in how much blood you need to draw. The company we used (Cascade) only required 9 ml (one standard tube) which typically yielded 4-6 ml worth of plasma injection. We were also told that the window of maximal benefit was typically seen within 4-6 weeks for this particular product. If no significant benefit was seen by then, another injection could be considered. I don't think there is any recommendation on how many one could receive; therefore, it is left up to the physician to determine how well or effective the treatment course is going. 

Disclosure: I have no financial relationship with Cascade.

Paul V. Ledesma, DPM, Paradise Valley, AZ, dr.ledesmaaz@gmail.com

RE: Article on The Use of Dietary Supplements in Diabetic Peripheral Neuropathy By Robert G. Smith DPM, MSc, RPh (Lawrence Kollenberg, DPM, D Pharm)
From: Elliot Udell, DPM
 
Dr. Kollenberg makes some significant points with regard to the use of dietary supplements. One additional point that needs to be added is that since dietary supplements are not regulated by the FDA, there is no government control as to what is really in a bottle of supplements. A physician in my area told me that his office took a bottle of dietary supplements purchased in a health food store to a lab for analysis. Not only did they find that the dosages in each capsule did not correlate to what was on the label, but the composition in each pill in the same bottle differed considerably. There is an independent company that evaluates dietary supplements and determines what products are legitimate. As doctors who cater to patients who take these supplements, and especially if we are to prescribe them, we should be aware of this website. It’s called Consumerlab.com

For a small annual fee, you will have access to lists of what products are good and which ones to avoid. 
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: MIS
From: Name Withheld (NY)

Since there has been mention of minimal incision technique, I will outline the wrath it has imposed on our profession:
 
1) older orthopedists (often in power today) recall the heyday of MIS, and hold podiatry to a lower standard.
2) it promoted NO sterile technique or gloves since there was "no incision."
3) it promoted OSS (on the spot surgery) so the patient didn't have to go home and have anxiety about having "surgery."
4) it promoted major bone work without fixation.
5) it promoted fragmentation of procedures for maximum reimbursement.
6) it promoted lunch time bunionectomies.
7) it promoted learning surgical technique in a weekend course.
8) it should never be confused with smaller incisional technique using visualization via arthroscopy or endoscopy.
9) it was the single most destructive force to our profession in gaining parity and hospital privileges. 
 
Let us not rewrite history.

Name Withheld (NY)

RE: Backlit Scanner (Robert Kuvent, DPM)
From: Gary Friend, DPM

An easy and inexpensive alternative to a backlit scanner for digitizing x-rays is to use a digital camera to photograph the films on a view box. This will give you the same .jpg file that a scanner provides.

Gary Friend, DPM, Glenview, IL, gjfriend@aol.com

RE: Keeping DPMs In "Allied Health"
From: Michael M. Rosenblatt, DPM

"Nail cutting and orthotics will be the anchors that keep podiatric medicine as an "allied health field..."  This comment is interesting because it suggests that there are certain procedures and tasks that are "below" the dignity of healthcare providers. When I was a resident at a V.A hospital years ago, I went to morning meetings (along with) the general and urology residents. 

The issue of "evacuating obtunded lower intestinal fecal obstructions" came up in a lecture on diverticulitis. The chief of surgery, Dr. Brauer, had lots to say about this: "Any resident who refuses to do this for their patient, or sends a nurse to do it instead, will be fired on the spot. This is a part of your surgical practice. You either learn to do it properly and when necessary, or you are finished as a surgeon here."

He also had strong ideas about prostatic digital examinations: "If they were not performed at EVERY physical exam; that too was grounds for being fired." That applied to podiatric residents as well, and probably still does.

Michael M. Rosenblatt, DPM, San Jose, CA, Rosey1@prodigy.net

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

ASSOCIATE POSITION - MINEOLA, NEW YORK

Full-time associate position with future partnership potential available with busy multi-office practices on Long Island. Must be proficient in all phases of podiatry with emphasis on surgery, biomechanics and RFC. Minimum standards include either a three-year PSR, or board qualified/certified status with ABPS. Existing hospital privileges with a NY based facility helpful. Interested doctors are encouraged to e-mail their CV to mets724@gmail.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

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

ASSOCIATE POSITION - CHICAGO AREA
 
Well-established, state-of-the-art medical-surgical podiatry practice seeking well-trained motivated individual to work full-time with future partnership possible. Will start with full schedule. PSR-24 a minimum. Email resume to Howard4624@gmail.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.

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

SEEKING ASSOCIATE - MIAMI, FL

Buy-in and purchase if you are interested. Well-rounded practice (EMR, Digital X-R) seeing 250+ pts/wk .30 yrs same location. Competitive salary + benefits + incentives. I am winding down my practice after 30 yrs. Will feed you my surgical load until you generate your own. Send resume to doctorinhialeah@aol.com

ASSOCIATE POSITION - PHOENIX, ARIZONA
Part Time/Full Time well-trained, ethical and hard working graduate of a PSR 24+/36 Residency to join our growing multi-location practice. Good mix of Surgery/Pediatric/General Podiatry. ER/Hospital Call a must. Very modern offices with EMR, U/S, Digital X-Ray, ESWT, Vascular Testing. Excellent referral base, and a well-trained staff. Base salary, bonus structure, benefits. Current AZ License a Must. Please e-mail CV and references to azpodiatrists@hotmail.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.

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