The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

December 04, 2009 #3,718 Publisher-Barry Block, DPM, JD

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NY Podiatrist Discusses Cold Weather Protection For Feet

Wearing the wrong shoes can cut off circulation or exacerbate existing problems such as bunions or neuromas (a neuroma is a benign growth of nerve tissue frequently found between the third and fourth toes; the principle symptom associated with neuroma is pain between the toes while walking), said podiatrist Dr. Mark Schug.

Dr. Mark Schug

The wrong footwear and the wrong socks can also lead to cold, wet feet, he said. Cold feet are bad for anyone with circulatory problems, especially diabetics. Cold, wet feet are worse, even if you don’t have circulation problems. “One of the biggest concerns is you can actually get a type of frostbite, which can cause necrosis, or loss of tissue. It’s very painful. And also, you worry about infections, too,” Schug said.

Source: Amy Neff Roth, Utica Observer Dispatch [12/1/09]

PA Podiatrist Discusses Rocker-Soled Shoes

Want to trim and tone your shape or supplement your usual workout while performing your day-to-day tasks? Another fitness tool is on the market that may make that wish a reality. Funky-looking, rocker-soled shoes that manufacturers claim will help you burn calories and tone muscles are turning up everywhere, including several major retailers.

Dr. Stephen Brigado

Dr. Stephen Brigado, a podiatrist at Coordinated Health in East Stroudsburg, said, "For the right patients, we have seen significant benefits. We've recommended them to patients after ankle surgery or to arthritic patients. With the rocker bottom, there is less impact throughout the extremities and a better transfer of energy from heel to toe."

But the idea isn't really new. "In the past, if we had a patient with stiff joints, we might prescribe a rocker sole to attach to the patients' shoes. It seems that manufacturers have taken that idea and created this shoe style," he said.

Source: Linda Burns, The Pocono Record [12/1/09]

                                      UK Podiatrists Become Supplementary Drug Prescribers
 
Two NHS staff members have become the first podiatrists in Wales to qualify as supplementary prescribers. Rosalyn Thomas, the Swansea deputy head of podiatry and Kath Brenton, deputy head of podiatry, University Health Board, gained the qualifications. It means that the pair will be able to prescribe a range of medicines from an agreed list of drugs to patients within a care plan.

Supplementary prescribing has previously been available to nurses and pharmacists and some other professions allied to medicine. Supplementary prescribing is defined as a “voluntary prescribing partnership” between an independent prescriber and a supplementary prescriber, to implement an agreed patient-specific clinical management plan with the patient’s agreement.

The independent prescriber – usually a doctor or dentist – is responsible for setting the parameters of the clinical management plan. The supplementary prescriber has discretion in the choice of dosage, frequency, product, and other variables in relation to medicines only within the limits specified by the clinical management plan. Only those drugs which have been included in the plan can be prescribed.

Source: Madeleine Brindley, Western Mail [11/30/09]
 

Technique May Aid Skin Cancer Diagnosis: Study

High-frequency ultrasound coupled with a technique called elastography can help physicians determine whether a skin lesion is malignant or nonmalignant, researchers said during a news briefing at the annual Radiological Society of North America conference in Chicago.

The study was conducted on 56 prospective skin cancer patients at the University of Maryland School of Medicine in Baltimore. Researchers used widely available ultrasound equipment set at a frequency of 14 megahertz to 16 megahertz to scan patients' skin lesions. They then took a second ultrasound of the area using elastography, which uses specially developed software and additional compression of the ultrasound device against the skin to measure the elasticity of the lesion and surrounding tissue.

“The question we had was, could we use the hardness of the lesion compared to the surrounding tissue to determine whether a lesion is cancerous,” said Eliot Siegel, lead author of the study and vice chairman of the radiology department at the University of Maryland Medical School. The study found that malignant tissue was stiffer and that there was a definite ratio of stiffness separating malignant and nonmalignant lesions, Siegel said. Researchers also found elastography allowed them to accurately measure the depth and surface of a malignancy.

Source: Shawn Rhea, Modern Healthcare [12/1/09]
 

Face Problems to Solve Them

When you face unpredictability, anxiety, frustration and challenges, your first action should be to acknowledge the reality of your situation to yourself and to others.

Best bet: State the facts as you know them, share the big picture, recognize the difficult issues and ask people to work with you to resolve them. Tell them: “We face an extraordinary challenge with serious potential consequences. I do not have all the answers, and I need your help to find solutions.

Source: Communication Briefings

Query: Cimetidine Use and Side-Effects

One of the side-effects of cimetidine is gynecomastia. Does anyone warn patients of this potential side-effect? Has anyone had any side-effects from using cimetidine? Also, has anyone had success in using it in adults, as the studies indicate that it's only effective on 18y/o or younger.

Harold Koehler, DPM, Auburn Hills, MI

RE: Prophylactic Antibiotics for Bunion Surgery (Theresa Hughes, DPM)
From: Multiple Respondents

You are now part of the "SCIP" mandate [Surgical Care Improvement Project], which interestingly does not include DPMs.  This is a program that requires most surgeons to give prophylactic antibiotics prior to surgery or to document the reason why the antibiotic is unnecessary.  Our hospital is using a very long form and it's a mandatory program. It's a new mandate and hospitals are following it along with DVT (VTE) prophylaxis.

Enjoy the new form of medicine; it's not getting any easier. Here is the algorithm for SCIP. In addition, if you Google SCIP, you will find an excellent pocket card with details.
 
Sloan Gordon, DPM, Houston, TX, sgordondoc@sbcglobal.net

This type of prophylactic antibiotic dosing is part of SCIP, or the Surgical Care Improvement Project. SCIP is "a multi-year national campaign and partnership of leading public and private healthcare organizations aimed at reducing surgical complications by 25 percent by the year 2010." Among the recommendations for surgical care improvement is the reduction of post-operative infection rates by administration of a single dose of an appropriate antibiotic within one hour of incision time. The recommendation applies to a wide variety of surgical procedures. More and more hospitals will be adopting these guidelines, as they are required by JHACO for hospital accreditation.
 
Paul Busman DPM,RN, Clifton Park, NY, brewerpaul@aol.com

Our hospital is not mandating prophylactic antibiotics for bunion surgery. If antibiotics are not given pre-operatively the chart falls out during Quality Assurance Review for failure to administer antibiotics for bunion surgery. I was told that this could result in decreased reimbursement to the hospital.

Ira Cohen, DPM  Downey, CA, icohen613@gmail.com

RE: Unilateral Spasm (Thomas Graziano, DPM, MD)
From: Heather Kaufman, DPM

Has Dr. Graziano considered use of Botox to try to relieve the spasm? I myself do not have personal experience with this drug but I know that it has been found to be quite useful in management of spasm secondary to CP. Also, I am assuming that CP has been ruled out?

Heather Kaufman, DPM, Grand Junction, Colorado, CO, kaufmandoc@yahoo.com

RE: Variations of Practice Patterns in Podiatric Medicine
From: Michael Turlik, DPM

After reading the following article: The Need to Confront Variation in Practice. BMJ 339:1007, 2009. I re-read a series of postings regarding the treatment of pedal warts posted on PM News. A podiatric physician wrote to request advice in treating a 15-year-old female patient with worsening pedal verruca. I counted 12 distinct treatment recommendations for this case.

Admittedly this is a small unscientific sample, but the responses demonstrate a large range of variability in the treatment of a common condition in podiatric medicine. Are some treatments more effective than others? Do some treatments cause more harm than good? Do they all cost equally as much?

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

RE: Radiologic Atlas (Jenna Garnet)
From: David Secord, DPM, Adam Landsman, DPM

Go to Google Books and read it. It’s there.
 
David Secord, DPM, Corpus Christi, TX, david5603@pol.net

The Harvard Bookstore in Cambridge has a device which can generate copies of many out of print books at a very low cost.  Give them a call.  They may be able to help.

Adam Landsman, DPM, Cambridge, MA, alandsma@bidmc.harvard.edu
 

RE: Expedited Negotiation Fees (Stephen Bui, DPM)
From: Michael B. DeBrule, DPM, Jeffrey Kass, DPM

Thank you, Dr. Bui, for calling attention to this important issue.  I would advise you to never agree to an expedited discount. My office staff has received many similar faxes or even phone calls in the past. We have always faxed back a form letter stating we will not accept further discounts of our fees. In the form letter, we also threaten to contact the Better Business Bureau, our lawyer (although I can’t afford to take on a big insurance company), the local newspaper, and our Congressman if these attempts at discounting an already negotiated fee persist. 

After we have faxed the form back dozens of times, the incoming faxes and phone calls eventually disappear. If an insurance company doesn’t pay you in a timely fashion, simply end your contract. Patients who appreciate your excellent work will continue to visit you. You will probably make more money with fewer headaches. 

Michael B. DeBrule, DPM, Marshall, MN, Dr.DeBrule@InnovativeFootCare.com

I think one usually receives these letters when they are out of network. Whether in or out-of-network, I would not accept!! Final answer. Why take less money? It makes no sense. They owe you the money. 
 
Jeffrey Kass, DPM, Forest Hills, NY, jeffckass@aol.com

ASSOCIATE POSITION- TAMPA BAY AREA, FL 

Excellent opportunity for a hard working, ethical and outgoing podiatrist to join a vibrant, successful and growing podiatric medical and surgical practice. A Florida license and a minimum 2-year residency are required. Salary commensurate with training plus benefits. Email CV to podiatryfl@yahoo.com

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

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.

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