The Voice of Podiatrists

Serving Over 10,000 Podiatrists Daily

November 30, 2007 #3,105 Editor-Barry Block, DPM, JD

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AZ Podiatrist Advises on When Bunions Require Surgery

If you have bunions, how do you know if they need surgery?

According to Dr. Aprajita Nakra, a Gilbert podiatrist and president of the Arizona Podiatric Medical Association, bunions, which usually develop on the inner side of the foot near the base of the first toe, do not go away on their own and almost always require surgery to remove if symptomatic.

Dr. Aprajita Nakra

If you have no trouble putting on shoes, walking or exercising, he says, you might be able to live with your bunions. However, if your bunions are swollen or are causing you pain during daily activities, you should consult with your podiatrist to decide together if surgery is best for you.

Source: Nancy Neff, Arizona Republic, [11/27/07]

AZ Podiatrist Plus “Helping Hands” Equals Successful Shoe and Sock Drive

Dr. Peter Myskiw, a Casa Grande, AZ podiatrist, and his staff are encouraging patients and community members to give to those less fortunate this holiday season. His office's 19th Shoe and Sock Drive will directly aid needy Casa Grande families.

Dr. Peter Myskiw

Myskiw encourages people to donate new shoes and socks. In addition, many local businesses donate some of their stock. But the money raised to buy other shoes and socks comes thanks to the busy hands of Casa Grande resident Joyce Olson. Olson, who has been crocheting for more than 20 years, has been making holiday craft items for Myskiw's shoe and sock drive for the last seven years.

Myskiw's wife, Jenny, said she is thankful for all donations, but credits Olson's hard work for making the shoe and sock drive a success year after year. "It is her generosity and hard work that makes it possible that we are able to help all the families that we can," Jenny Myskiw said.

Source: Kris Walkinshaw, Casa Grande Dispatch [11/27/07]

Grapefruit Might Be Used To Boost Drugs' Effectiveness

Recent research suggests that grapefruit juice -- known to raise blood levels of some medications to "toxic levels" -- could potentially be "exploited to make some medicines more powerful," the Wall Street Journal reports. Research on the "grapefruit effect" aims to "tackle a major problem for drug manufacturers: the great degree of variation in how people absorb drugs," according to the Journal. Patients have varying amounts of CYP3A4, an enzyme found in the intestines and liver that can break down drugs before they enter the bloodstream.

Compounds found in grapefruits called furanocoumarins reduce the amount of CYP3A4 in the bloodstream, allowing more of the drug to be absorbed. According to the Journal, "for certain drugs that have a hard time reaching optimal blood levels at prescribed doses, some doctors are interested in intentionally boosting the effects with grapefruit" to "give a booster to all patients who are taking a weak drug."

Critics of the approach say that using grapefruit juice to boost bloodstream absorption ignores the issue of patient variability and that some patients might absorb potentially dangerous levels of prescription drugs in combination with grapefruit.

Source: Wall Street Journal Via American Health Line [11/28/07]

Query: Orange Tendon

During a recent case I encountered a bright orange defect in the extensor hallucis tendon. I had never seen this before and wondered if anyone else has.

Orange Tendon

To the best of my knowledge, the patient has not had any rifampin or azo-type meds that can stain body fluids. The biopsy indicated normal tendon with minor reactive changes.

Kathy Riffe, DPM, Trenton, TN

Query: Office Dictation Systems

Are there any physicians out there who use digital voice recorders or any of the Dragon speech recognition software for their charting? I am looking for a sensible option to dictate my notes before transitioning to EMR which we plan to do next year. So far, I have looked on-line at the Olympus digital voice recorders but cannot decide which Dragon system to buy. Some range from $200-$1,000.

Syed Ahmed DPM, Louisville KY

RE: Hyalgan Injections for Ankle Osteoarthritis (Brian Maurer, DPM)
From: Multiple Respondents

I have successfully utilized Synvisc for ankle arthrosis. I inject the full dose vial weekly for 3 weeks.

Evan F. Meltzer, DPM, Jackson, MS, Evan.Meltzer@va.gov

I have been using Hyalgen with moderate success for the past few months. You must remember that it is "off label" in this country, and the patient should be notified of this. We have them sign a waiver and consent prior to beginning the process. You should also note that Hyalgan, Sinvisc, or Supartz are similar products with subtle differences. We script out medication, and they will deliver 3 injections to the patient. The patient can either bring one syringe at a time as they are prefilled, or they can bring the entire box of three and we will keep it for them.

The protocol is one injection per week under strict aseptic technique. The area should be anesthetized first, and the patient kept for about 20 minutes after injection to check for allergic reactions. Question the patient about allergy to poultry, eggs, or feathers first. You can repeat in about 6 or 7 months if needed.

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

I have done a handful of joint fluid therapy for ankle osteoarthritis. I have use Supartz in lieu of Hylagan or Synvisc. It is a pre-package 2 cc. syringe. I followed the protocol of 5 injections, given one week a part.

The cases I did were with private patients. I had them purchase the drug and I injected it. I billed only for the arthrocentesis. I have done several workers compensation (WC) cases and WC has covered the cost of the drug.

As far as results, I only have a handful of cases and I will not make any broad statements regarding efficacy. I can tell you that some of patients got some relief and some felt no benefit. For more severe OA, it think it is a waste of time. Make sure you get consent by the patient for "off-label use."

John Levin, DPM, Atlantis, FL, John.Levin@OCPBC.com

RE: Sculptra
From: Robert Wunderlich, DPM

I contacted my local Sculptra rep after reading this posting, and was told the following:

1) Sanofi Aventis (the manufacturer of Sculptra) does not condone 'off-label' use of the product ( i.e., for anything other than restoration of facial fat loss due to HIV), and therefore will not train podiatrists on use of the product on the foot, AND:

2) Sanofi Aventis will NOT sell the product to any physician who has not completed their training course.

The rep surmised that any DPMs using the product are probably obtaining it under the group number of a multi-specialty practice (i.e. one with other MDs, such as dermatologists or plastic surgeons). Additionally, she noted that there have been several reports by DPMs who have spent thousands of dollars on seminars to teach them how to use Sculptra, only to find out later that they were unable to purchase the product. So be careful!

Robert Wunderlich, DPM, San Antonio, TX, rwunder@gmail.com

RE: Dr. Neal's Success in Foot Surgery Seminar (Mark Johnson, DPM)
From:Adam Teichman, DPM

If you are looking just to obtain a certification for a Class A surgical suite, I do not feel attending the seminar will be of great benefit. If you would like further information on guidelines on obtaining JCAHO certification, you can look at their website, which has all the information as well the guidelines. If the majority of your patients are from Medicare, the benefit of having a surgical suite (certified) should be considered when incurring the expense.

Adam Teichman, DPM, Allentown, PA, drteichman@eastpennfoot.com

ISO SOUTH JERSEY AREA OPPORTUNITIES

ABPS Certified with 20 years of experience looking to relocate to South Jersey/South Central Jersey. I am looking for a practice that appreciates and understands the value of experience and integrity. I am willing to discuss ALL options, including employment, partnerships, buy-ins, practice purchases, etc. All info will be kept confidential. E-mail panel32@comcast.net

ASSOCIATE WANTED – NEW YORK IMMEDIATE OPENING

Busy multi-dimensional practice; 70 miles north of New York City . Currently five (5)-doctor practice. looking to expand – all phases of podiatric medicine. contact: (845) 454-8308 EXT: 106

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

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