The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

November 20, 2009 #3,706 Publisher-Barry Block, DPM, JD

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TUSPM Shines Light On Diabetes Epidemic

Temple podiatry students, staff, and faculty were joined by Mayor Michael Nutter on Saturday to shine a spotlight on the diabetes epidemic in Philadelphia, which has one of the highest rates of diabetes in the country - roughly 3 percent higher than the national average.

Diabetes educator Carol Otte counsels a patient during one of the event's free screenings (Photo David Lee)

“This epidemic is not just a health matter,” said Kathya Zinszer, chair of podiatric medicine and orthopedics, and organizer of the event. “It affects our everyday lives by extending into our families, the community, employers and our children, therefore affecting all sections of our Philadelphia community.”

Throughout the day, members of the community were offered free flu vaccines, various health screenings, consultations with medical professionals and several educational workshops on topics such as diabetes and heart disease, exercise and nutrition.

Portnoy Receives's PPMA's Edward L. McQuaid Award

Leonard Portnoy, DPM, a PPMA member from Warminster, PA, received the Edward L. McQuaid Award at PPMA’s recent House of Delegates banquet. Dr. Portnoy has been a member of the Association since 1968 and received his DPM from the Temple University School of Podiatric Medicine in 1967. He is Board Certified by the American Board of Podiatric Orthopedics and Primary Podiatric Medicine. “I am honored and sheepishly humbled to have my name associated with so many of the leaders of our profession who have received this award,” says Dr. Portnoy.

Dr. Leonard Portnoy

The Edward L. McQuaid award is presented in the name of PPMA’s late Past President Edward L. McQuaid, DPM, who achieved a place of honor in PPMA’s history through honest hard work and dedication. It’s given to a member who has performed distinguished service to the profession and made outstanding contributions to the community. Dr. Portnoy has given exceptional service to the Region Three Scientific Committee since 1974, becoming its Chairman in 2008, taking the place of the late James Bates, DPM.

Medicare Fee-for-Service Payment Error Rate More Than Doubles

Medicare and Medicaid improperly paid out $54.2 billion in fiscal 2009, with the rate of Medicare fee-for-service errors more than doubling over the previous year, White House's budget chief Peter Orszag said.

Orszag, director of the Office of Management and Budget, said in a conference call with reporters that President Barack Obama intends to issue an executive order within the week aimed at stanching the billions of federal dollars lost as a result of the improper payments. The federal health programs are responsible for more than half the government-wide sum of $98 billion, which compares with $72 billion in fiscal 2008.

CMS is reporting a 2009 fee-for-service error rate of 7.8%, or $24.1 billion, compared with 3.6% in 2008.

Source: Gregg Blesch, Modern Physician [11/17/09]

Stay Positive

The most dynamic writing is emphatic. Yet negatives like "not" and "no" slow the reader down. So you should make an effort to express even negatives in positive language.

Example: Instead of writing “The office had no accidents last month,” write “The office was accident-free last month.”

Source: Adapted from Associated Press Guide to News Writing, Rene Cappon, Macmillan USA via Communication Briefings

Query: Pediatric Foot Deformity

The mother of a 6 y.o. male presented with the complaint of "my son walks funny. He seems flatfooted and he has "crooked toes." The child was born 7 weeks premature. The child is slightly overweight. On exam, the patient has fairly normal-looking feet, NWB. Ankle joint ROM is normal with no laxity. STJ ROM was WNL. Muscle strength WNL. Deep tendon reflexes are normal to the Achilles. Patient’s toes are really long, like fingers, and are in a varus rotation, 3-5 degrees. They splay with WB, but are reducible. Gait analysis: pronation through gait cycle, early heel lift, bilateral. His feet just don’t look normal with the toe deformities and ambulation. Any comments on what, if anything, should I look for with these feet? Is it just hammertoes in a 6 y.o.?

Theresa Hughes, DPM, Galesburg, IL

RE: Midmark parts and Hill Chair Opinions
 
I am looking for any leads for an inexpensive tilt cylinder for a Midmark 117 chair.   Also, I would appreciate any critique of Hill chairs.

 Dennis R. Frisch, DPM, Boca Raton, FL

RE: Increased Cancer Risk Associated With Supplements Containing Folic Acid
From: Elliot Udell, DPM
 
In the November 18th 2009 issue of the Journal of the American Medical Association, there is a paper titled Cancer Incidence and Mortality After Treatment With Folic Acid and Vitamin B12 by Ebbing, Bonaa, et al. This paper which studied 6,837 patients in Norway over a period of seven to nine years, showed an increase in cancer in patients given these supplements. The paper did say that they studied a population with a deficiency in folate, and the authors suggested that further studies be performed on populations with normal levels of folate. They did, however, conclude with the following: "…treatment with .8 mg/d of folate was associated with increased cancer incidence , cancer mortality, and all-cause mortality." The authors called for "safety monitoring following wide spread consumption of folic acid from dietery supplements and fortified foods."
 
The above study is relevant to podiatrists because many of us are prescribing Metanx for the treatment of diabetic neuropathy and Metanx is a folic acid and Vit B12 supplement. I am certain in the coming days that the company that manufactures Metanx will address the issues raised by the above research paper. Until then, we should all be cautious in terms of prescribing this or any other supplements that contain folic acid. 
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: Gabapentin for Treatment of Diabetic Peripheral Neuropathy
From: Michael Turlik, DPM

There is a great deal of interest in the EBM community regarding a recent article (1) published in NEJM. Since the example used is Neurontin(gabapentin), this article may also be of interest to podiatric physicians. It is clear that published industry-funded studies are likely to be associated with statistically significant pro-industry conclusions (2, 3). One explanation may be selective outcome reporting bias (1)  P < 0.05 = $$$.

Industry sponsored studies; good research or good marketing?

1. Outcome Reporting in Industry-Sponsored Trials of Gabapentin for Off-Label Use. NEJM 361: 1963, 2009.

2. Association between industry funding and statistically significant pro-industry findings in medical and surgical randomized trials CMAJ 2004;170(4):477-80.

3. Cochrane reviews compared with industry supported meta-analyses and other meta-analyses of the same drugs: systematic review BMJ 333: 782, 2006.

Michael Turlik, DPM, Cleveland, OH, mmturlik@aol.com

RE: Article on The Use of Dietary Supplements in Diabetic Peripheral Neuropathy By Robert G. Smith DPM, MSc, RPh (Lawrence Kollenberg, DPM)
From: Robert G. Smith, DPM

I would like to offer my motivation and reasoning for my style of presenting the information in the most recent manuscript to Podiatry Management: "CME article on The Use of Dietary Supplements in Diabetic Peripheral Neuropathy By Robert G. Smith DPM, MSc, RPh."

1. When preparing this manuscript, I was...

Editor's note: Dr. Smith's extended-length letter appears at: http://www.podiatrym.com/letters2.cfm?id=30572&start=1

RE: MIS
From: Multiple Respondents

MIS is a misnomer that it is not about the term, but about what is done and how it is done through the incision. Whether is a stab incision (MIS) or a long, wide-open one, it is all about technique.
 
That being said, I do not think that I am wrong by stating that the unfortunate legacy of MIS of the 70's and 80's was the unscrupulous billing and overcharging that was done by many who thought that the "pot of gold" would last forever.

Narmo L. Ortiz, Jr., DPM, Cape Coral, FL, nlortizdpm@embarqmail.com

I have given much thought to MIS procedures over the years, because I feel I have a different perspective. My father practiced MIS procedures and taught MIS procedures for over 25 years.  I took a different career path. Upon my graduation from NYSPMA in 1993, I took a PSR-24 residency at Kern Hospital in Michigan to learn open podiatric surgery. I have never performed a MIS osteotomy, and I fixate all my osseous procedures. But I do have some observations.
 
Although I do feel that it is…

Editor’s note: Dr. Liswood’s extended-length letter appears at: http://www.podiatrym.com/letters2.cfm?id=30568&start=1

It is unfortunate to read some of the "vitriol" regarding the uses  and abuses of MIS. Podiatry has had some "growing pains" over the years, but for the most part, our profession has developed into the premier foot care profession in this country, if not in the world. I believe that our willingness to learn from each other has been the foundation of our present success. We should never tolerate unethical practices regardless of what branch of the profession we belong to. We should, however, listen to each other, in the hope that the patient will receive the best care possible.

The present discussions brought back to memory how I was able to gain staff membership in our local allopathic hospital which had been closed to us. One of the local podiatrists had taught MIS to one of his orthopedic friends. This orthopod used his considerable influence to open the hospital to Board eligible/board certified podiatrists. When I entered the OR to do my first case, the first question which I was asked was, "What kind of little burrs do you use?" We were able to use our new-found staff membership to show off our skills in traditional "open" surgery, and today virtually all foot surgery at the hospital is performed by podiatric surgeons.

Let's move on, and continue to grow as a profession, in the most ethical and humane manner possible.
 
Edward R. Nieuwenhuis, Sr. DPM, Hawthorne, NJ, edfeet@aol.com

Editor’s Note: This topic is now closed and no further letters will be accepted.

RE: Podiatrists and Flu Shots (Kathleen Neuhoff, DPM)
From: Leonard A. Levy, DPM, MPH

I appreciate the remarks of Kathleen Neuhoff, DPM (PM News Nov 19) but there are a number of points that she raises that need to be clarified. I direct a national.... 

Editor's note. Dr. Levy's extended-length letter appears at:http://www.podiatrym.com/letters2.cfm?id=30566&start=1

No further notes will be accepted on this topic.

ASSOCIATE POSITION - NW IOWA (SIOUX CITY AREA)

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 - PHOENIX, ARIZONA

Part Time/Full Time, ethical and hard working graduate of a PSR 24+/36 Residency to join our growing multi-location practice. Good mix of Surgery/Pediatric/Trauma. Very modern offices with EMR, U/S, Digital X-Ray, ESWT, ABI 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

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 - 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

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

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

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

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