The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

December 03, 2009 #3,717 Publisher-Barry Block, DPM, JD

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Toenails Tell a Story About Your Health: UT Podiatrist   

Dr. Glenn Gold can tell if you had a high fever four months ago, just by looking at you. "People say, 'How did you know that?' " he said. The answer? "Nails tell a story," said Gold, a podiatrist at Tanner Clinic in Layton. He can read the story because it's written on the toenails. "The presence of any disease process which would cause high fever over a period of seven to 10 days will leave a permanent line across all the nails, until the nail grows out," Gold explained.

Dr. Glenn Gold

If you squeeze the nail and it's slow in returning to its normal pink color, Gold says, it demonstrates a decrease in circulation. If part of the nail is blue, it could indicate trauma, said Gold. If an entire toenail is blue, it can be caused by the nail hitting the end of the shoe during exercise.

Source: Beck Wright, Standard-Examiner [11/30/09]

NYCPM's President/CEO Receives Elk President's Award

Recently, at Sylvia's Restaurant, a cross-section of healthcare professionals, community leaders, and just plain folks came together to attend the Elks President's Luncheon. An award is given every year to an outstanding resident of New York State who has given of his time and energy to enrich the lives of the people of New York State.

Lou Levine receives Elk President's Award from Henry Ritter

In addition to his duties as President of the New York College of Podiatric Medicine, Lou Levine, a visionary, has taken foot care to the people by working in the community with the community. Henry Ritter, President of IBPOE Of W. (Improved Benevolent Protective Order of Elks) said, "it is a pleasure to bestow the annual President's Award to President Levine and to extend to him the title of Honorary Elk. In the turbulent years when businesses and people were deserting the inner cities, Lou Levine kept the College of Podiatric Medicine in Harlem, thus saving the jobs of staff members."

Source: Marie Beaudouin, The Culvert Chronicles {Nov 18, 2009]

NY Podiatrist Discusses Giant QB’s Foot Injury

Quarterback Eli Manning has been playing for the past few weeks despite a stress reaction in his right foot, increasing the likelihood that one bad step could end his season. The Giants believe this is a byproduct of the plantar fasciitis Manning endured in his right heel early in the season, a condition that turned more serious when he suffered an injury to the plantar fascia in the Oct. 4 game at Kansas City. "When you compensate for plantar fasciitis, typically you roll your foot out laterally to offload the stress," explained Dr. Lance Greiff, a sports podiatrist in Great Neck. "It could be a stubborn problem to alleviate."

Dr. Lance Greiff

The stress reaction is an inflammation in the area of the cuboid bone and it makes Manning more susceptible to a stress fracture -- an overuse injury that occurs when the muscle becomes fatigued and is unable to absorb added shock. Eventually, the fatigued muscle transfers the overload of stress to the bone, causing it to crack.  Although the recovery time for a stress fracture is 4-6 weeks, Greiff said a cuboid stress fracture typically "does not fit that formula" and requires a more extended rehab.

Source: Paul Schwartz, NY Post [11/30/09]

Three EHR Systems Pass Stimulus Certification

Three electronic health-record systems are the first to pass muster with the Certification Commission for Health Information Technology (CCHIT) under its new preliminary testing program for compliance with the "meaningful-use" criteria under the American Recovery and Reinvestment Act of 2009, the Chicago-based not-for-profit organization has announced.

The three products are eHealth Made Easy, Version 3, supporting two of 27 applicable meaningful-use objectives for eligible providers; KIS Track, Version 5.1, by Kaulkin Information Systems, supporting two of 27 applicable objectives for eligible providers; and Medios, Version 4.5, by IOS Health Systems, supporting 27 of 27 applicable objectives for eligible providers, according to CCHIT.

The new testing regime differs from previous CCHIT certification programs in that it does not require that a vendor pass all test criteria. Checklists of those criteria passed for each product are listed on the CCHIT Web site. The certification also is considered “preliminary,” since the CMS is not expected to issue its first interim definitions of meaningful use until later this month. CCHIT based its testing criteria and standards on those that have been proposed but not yet finalized by HHS, the organization said. CCHIT officials have said they intend to upgrade the certification criteria and retest systems once the final meaningful-use criteria are released, which is expected sometime in the spring.

Source: Joseph Conn, Health IT Strategist [12/1/09]

The Santa Surprise

Want to wow your office team? Hire someone with a Santa outfit. Buy gift certificates for  manicures from a local nail salon and have Santa show up during office hours to hand them out to all staff members. You can step it up a level and have Santa hand out a one dollar scratch off lottery ticket to each patient in the office.

Source: Hal Ornstein, DPM, Howell, NJ. For information of membership in the American Academy of Podiatric Practice Management, click here.

Query: Prophylactic Antibiotics for Bunion Surgery

Our hospital is now mandating that all bunion surgeries, along with hip and knee replacements, must have prophylactic antibiotics on board. It doesn't matter what the procedure or anything about the patient; if it's a bunion, it requires antibiotics. I've done a PubMed search and I haven't been able to find any articles regarding prophylactic antibiotics in bunion surgery. Any suggestions from anyone on where to look or if there are such articles would be appreciated.

Theresa Hughes, DPM, Galesburg, IL

Query: Radiologic Atlas

I am looking for a copy of The Radiographic Atlas of Skeletal Development of the Foot and Ankle (circa 1962). Unfortunately, it is long out-of-print. Does anyone have any suggestions for a comparable reference guide?  

Jenna Garnet, Miami,  FL

RE: Hyperpigmentation Over Toe Joints (Joel Greenwald, DPM)
From: Jeffrey Kass, DPM

Although there is no "rigid hammertoe deformity", Dr. Greenwald states in his posting that the toes are elongated and buckle in the shoes. Hence, for all purposes, the joint is flexing and the heads of the bones are rubbing on the shoes. This gets fixed the same way a hammertoe would. In these cases, I like the incision to be transverse elliptical at the level of the joint. Once the toe is no longer elongated, and therefore not buckling, you should not have a problem.
 
Jeffrey Kass, DPM, Forest Hills, NY, jeffckass@aol.com

RE: Unilateral Spasm (Thomas Graziano, DPM, MD)
From: Multiple Respondents

There is a case report of similar types of hysteric conversion (Michelson, JD, Psychogenic Equinovarus: The Importance of Recognition and Non-Operative Treatment. Foot and Ankle International 21:31-37, 2000), which describes similar contractures that relaxed under general anesthesia, and were successfully treated with psychotherapy. I can offer a copy of the article via fax.
 
Ernest Isaacson, DPM, New York, NY, ernestisaacson@hotmail.com

When one sees unilateral spasm such as seen in this 14 year old, a diagnosis dystonia must be considered. Trauma and neurapraxia, as etiologic factors, are not very likely. This patient is at the exact age when dystonia has its onset.

Mike Boxer, DPM, Woodmere, NY, mcbdpm@aol.com

I think the patient pulled her L4 nerve or somewhere L4 to S1-2, or combination -- check her back, buttock and gait exam. Maybe, she should try some back massage / manipulation to relax the nerve -- I say popliteal block over the more distal ones. Maybe have PT to do some ultrasound anti-inflammatory muscle modalities, and stretching.  My initial thought was to warm her up - she's frozen.

Roody Samimi, DPM, Sacramento, CA, roody.samimi@gmail.com

RE: Osteomyelitis (Elliot Udell, DPM, David Samuel, DPM)
From: Wm. Barry Turner, BSN, DPM

In response to Dr. Udell, I had a similar experience with a general surgeon and a three-phase bone scan. I insisted on a WBC tagged bone scan, proved that there was no bone infection and lost a referral base, but saved a patient from surgery and six weeks of IV therapy. I hope when I am proven wrong, I am more receptive and amiable. Ego can be our worst enemy and our patients deserve a better quality of physicians.
 
In response to Dr. Samuel's response, I agree that pathology is the gold standard, but we were discussing non-invasive evaluation, and particularly that the WBC tagged bone scan is more definitive than the MRI. Both radiological evaluations are subject to error, but the MRI is less specific when it comes to diagnosing osteomylitis.
 
One final point and going back to Dr. Udell's reference that these test are just tools to help put the "puzzle" together, I was once told, "treat the patient, not a bunch of fancy tests." I still treat the patient, while looking at the pieces of the puzzle.  
 
Wm. Barry Turner, BSN, DPM, Royston, GA, claret32853@gmail.com

RE: Adolescent Verucca Treatment (Simon Young, DPM)
From: Barry Mullen, DPM

Cimetidine's immunomodulatory effectiveness against warts is, in fact, anecdotal. A key factor that validates its consideration for use against warts is...

Editor's Note: Dr. Mullen's extended-length letter appears at: http://www.podiatrym.com/letters2.cfm?id=30901&start=1

RE: Expedited Negotiation Fees (Stephen Bui, DPM)
From: Multiple Respondents

Over the course of 6 months, I received about 15 of these faxes from Multiplan, After signing and faxing as requested, I would get a statement back with $0 payment, stating the amount that I had agreed to has to be collected from that specific patient due to "patient responsibility-- deductible". What my staff found out is that these patients had high deductible plans, and Multiplan would negotiate a lower rate for their members. Good luck collecting it...

Greg Khaimov, DPM, Fort Lee, NJ, gregkhaimov@yahoo.com

My experience is they will pay MORE if you DON'T sign. It just may take slightly longer. They are just preying on your fears.
 
Neil Levin, DPM, Sycamore, IL, drfeet1@aol.com

It is important to note that the negotiated fees that these companies propose to you are gross and not net fees. You are subject to the patient's policy limits and the deductible. For example, if they offer you $1,000 and the patient has an 80% policy with $300 dollars deductible, you will get $500 although the offer was for $1,000.
 
When I get these offers, which are usually from separate third-parties that are paid based on the savings they provide the insurance company, I reject them immediately. However, I also include, in my rejection, the law in my state which mandates payment on claims within 30 days.
 
Brian Kashan, DPM, Baltimore, MD, drbkas@worldnet.att.net

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

PODIATRISTS CHICAGO/NW IND/BALTIMORE/WASHINGTON, DC

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists in Chicago, Northwest Indiana, and Baltimore, MD. Full and part-time positions are available. Competitive Compensation including malpractice. Contact Jake Shimansky, Director of Physician Recruitment. Phone-773-342-5221 FAX 773-486-3548-E-Mail jshimansky@homephysicians.com www.homephysicians.com

ASSOCIATE POSITION – PORTLAND, OR

Busy foot and ankle clinic located in Portland, OR. Multi-offices. Excellent referral base. Good mix of conservative care and surgery. Emphasis on and known for diabetic foot wounds. Brand new office/equipments. Excellent supportive staff. Seeking well-trained foot and ankle surgeon. Prefer at least 2 years of training. Best quality is eagerness and willingness to learn, and the ability to adapt. cyberpod@yahoo.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.

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 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

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.

PRACTICE FOR SALE - CENTRAL SOUTH CAROLINA

Practice grossing $400,000 annually based on one full-time doctor with two offices. Surgery is currently about 10-15% but can easily be increased. Medicare makes up 52% of revenues. May be able to take over practice with no money down. Interested parties email to footdocsc@gmail.com

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