The Voice of Podiatrists

Serving Over 10,000 Podiatrists Daily

November 27, 2007 #3,102 Editor-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2007- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

Preventing MRSA Infections From Feet Easy When You Know How : IN Podiatrist

One of the most common places MRSA organisms can attach themselves to us and enter our bodies is through our feet. These infections can start very innocently, perhaps with a simple ingrown toenail, a cut or a nick. You might pick up these infection-causing bugs while walking across the locker room floor, around a swimming pool, or even on your back porch.

Dr. Michael Nirenberg

Dr. Michael Nirenberg, an Indiana podiatrist, has just published the booklet, “MRSA and Your Feet: 12 Ways to Protect Your Feet and Your Family’s Feet.” As a practicing podiatrist, Dr. Nirenberg has treated over 10,000 pairs of feet and sees serious infections in the foot routinely. MRSA causes the worst of these. It is so virulent that it can actually burrow into the bones of the foot and destroy them. In other cases, it can cause gangrene and result in amputation of a toe or foot, or even death.

“People don’t realize how easy it is for MRSA to enter their foot,” Dr. Nirenberg says. “Preventing MRSA from entering your feet is easy, once you know what to do.”

Long Appointed To TN Podiatry Board

Governor Phil Bredesen announced that he has appointed Dr. David Long, of Martin, TN to the Board of Podiatric Medical Examiners. This is the 2nd time Long, a podiatrist, has served on the Board. Dr. Long has practiced medicine in Tennessee for 19 years, and is currently a member of East Wood Clinic, in Paris.

Dr. David H. Long (L) and Tennesee Governor Phil Bredesen

Long is Board Certified by the American Board of Podiatric Surgery, has served as President of the Tennessee Podiatric Medical Association, and is active in several civic activities, including coaching youth baseball and football.

Source: The Paper [November 20, 2007]

House to Offer Bill for Registry of Drug Firm Gifts to Doctors

A U.S. House lawmaker plans to introduce legislation to create a registry in which pharmaceutical manufacturers would have to report any gifts that are given to physicians.

The measure by Rep. Peter DeFazio (D-OR) would be similar to legislation that already was offered in the Senate. But the House bill might apply to companies with less than $100 million in revenues, the threshold set by the Senate bill, said Ed Hill, a legislative assistant for DeFazio. The House and Senate bills would require manufacturers to list both gifts of $25 or more and the physicians who received them.

Between five and eight Democrats have agreed to co-sponsor the House measure, Hill said, adding that DeFazio hopes to get some Republicans to join them. A House vote by the end of 2007 is probably too optimistic, Hill said, but the lawmaker plans to promote the legislation next year.

Source: Dave Hansen, AMNews [11/26/07]

Query: Dr. Neal's Success in Foot Surgery Seminar

I’m looking for feedback on Dr. Neal's Success in Foot Surgery Seminar for Office Surgical Accreditation. Are there any advantages for practices with a mostly Medicare payer mix?

Mark K. Johnson DPM, West Plains, MO

RE: Gray/Black Bone? (Michael Nirenberg, DPM)
From: Multiple Respondents

Black pigmentation of bone has been reported in long-term minocycline use. It is a tetracycline derivative with side-effects that may cause pigmentation of many tissues, such as stains on teeth, skin and bone pigmentation. Perhaps this is the cause of your patient’s bone discoloration?

Sharon M. Root, DPM, Succasunna, NJ, drsroot@verizon.net

Assuming that you weren't dealing with osteomyelitis here, the most likely metabolic cause for dark discolored bone is ochronosis. This results from homogentisic acid oxygenase (HGAO) deficiency, which causes alkaptonuria. Check your patient's urine, skin and, iris of eye for additional evidence of brownish-blue discolorations.

Alkapotnuria has a genetic predisposition and there is no known cure, but low purine diets, especially reduced aspartame intake, are helpful. Lastly and most importantly, this patient should be worked up by their internist specifically to check their cardiovascular and respiratory symptoms, often affected in alkaptonuria patients.

Barry Mullen, DPM, Hackettstown, NJ, YAZY630@aol.com

Sometime last year I operated on a women with a similar presentation. She had been on multiple immunosuppresive medications such as Enbrel, and Methotrexate. Did your patient have any history of being on these medications at one time or another?

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

I have seen the same thing in several of my surgical patients who have/had reactive or rheumatoid arthritis treated by Minocycline or tetracycline. The staining is similar to that seen in the teeth of (growing) children who were prescribed these medicines in the 70's. Pathology reports of bone specimens have ben unremarkable. Ask your patient if they have been on one of these medicines and you'll probably hear "yes!"

Gene Mirkin, DPM, Kensington, MD, gsmirkin@comcast.net

RE: Epocrates For Blackberry
From: Bret Ribotsky, DPM

You may have heard of Epocrates, which is downloadable medical software for mobile devices (check drug information, formulary coverage, etc.). I helped the company create a version of their free drug reference for BlackBerry devices. The company just launched the product and I thought you might like to try it. The best part is that it's free! Here's what you get:

* Continually updated drug information for more than 3,300 medications, including dosing, interactions, safety/monitoring, and pricing
* Drug-drug interaction checker
* Health insurance drug formularies, including Medicare Part D
* Medical news alerts
* Wireless installation and free content updates

If you already use Epocrates, you can simply point your browser to http://get.epocrates.com to download. If you are curious to see what I'm always looking at before prescribing medications, and are ready to give it a try; visit http://www.epocrates.com/rx/blackberry to register and download. You'll thank me later! *Installation may take up to 30 minutes; it requires BlackBerry OS 4.1 and above, and 9 MB of main memory; be sure you have an unlimited data plan.

Bret Ribotsky, DPM, Boca Raton, FL, Ribotsky@Doctorbret.com

ASSOCIATE POSITION - NORTHWEST PENNSYLVANIA

Multi-specialty group is looking to add another Podiatric Surgeon or General Podiatrist to our well-established group. Office locations in northwestern Pennsylvania. Unlimited opportunities exist for the right Associate, wound care experience is a plus. Please forward your CV to adminsec@ips-mso.com

PODIATRISTS NEEDED - CHICAGO --NORTHWEST INDIANA

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists. We are located in Chicago and Northwest Indiana. Full and part time positions are available. Competitive Compensation including malpractice. Contact Scott Schneider. Phone-773-342-4201 FAX 773-486-3548-E-Mail sschneider@homephysicians.com -- www.homephysicians.com

WEEKLY SPECIAL - One week of ads (5x) for only $85

PM Classified Ads Reach over 10,000 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 10,000 DPM's. Write 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 Ext 110

• To Post a message, send it to:    bblock@podiatrym.com
• Notes should be original and may not be submitted to other publications or listservs without our express written permission.
• Notes must be in the following form:
  RE: (Topic)
  From: (your name, DPM)
  Body of letter. Be concise. Limit to 250 words or less). Use Spellchecker
  Your name, DPM City/State
• Subscribers are reminded that they have an ethical obligation to disclose any potential conflicts of interest when commenting on any product, procedure, or service.