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01/10/2019    

RESPONSES/COMMENTS (NON-CLINICAL)



From: Jeffrey Kass, DPM


 


I would like to respectfully challenge the assertion that NYSPMA offers free CME to their members at the NY Clinical Conference. Members pay $2,321 to be members. Claiming CME are free is a little silly. Most members belong because they see value in obtaining the required CME in the course of one weekend. Non-members can go claim that same weekend of credits for $949. Hence, NYSPMA is claiming the value of those CME is roughly $949. 


 


Jeffrey Kass, DPM, Forest Hills, NY

Other messages in this thread:


03/19/2019    

RESPONSES/COMMENTS (NON-CLINICAL)



From: David E Gurvis, DPM


 


I love what I do and look forward to going to work every day as a podiatrist. Some may find otherwise as this writer has. Just to toss this out, I have a friend, a podiatrist, who teaches anatomy part-time at a local city college to medical assistant students and nursing students. I know he could go full-time if he wanted.


 


I am sure the opportunities are, perhaps not endless, but numerous. I agree with the advice from Dr. Block  to “follow your passion”. Let your imagination flow free and I am sure there are many places who would need you to teach some subject or other that you are already partially or well versed in.


 


David E Gurvis, DPM,  Avon, IN

03/12/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Robert S Steinberg, DPM, Howard R. Fox, DPM


 


I have given up on carbocaine. No excuse not keeping up with demand, or at least letting physicians know what's going on. I switched to 2% lidocaine and add sodium bicarbonate. I’m happy to report that it works just fine.


 


Robert Scott Steinberg, DPM, Schaumburg, IL 


 


Polocaine (mepivicaine) 1% and 2% is in stock and available from McKesson.  I just bought 4 50-cc vials from their Farmington, CT location. It appears that carbocaine is no longer available. 


 


Howard R. Fox, DPM, Staten Island, NY

03/12/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: David Secord, DPM, Robert S. Schwartz, CPed


 


I don't really have a suggestion of a shoe for this person and don't know how they would be affordable, as it would likely be a custom-made job and not reimbursed by insurance. I did just read this article and thought it topical.


 


David Secord, DPM, Corpus Christi, TX


 


One of the great pedorthic custom shoemakers, Arnie Davis, practices in San Francisco. Hopefully, your patient can get there. Eneslow celebrates 110 years in New York City helping patients like the one described with custom shoes for Charcot and any other deformities requiring custom made footwear. Often the best route for the patient and doctor is to send patients to pedorthists who specialize in customizing ready-made shoes and custom shoes for Charcot and other deformities outside the available ready-made shoes on the market. The American Board for Certification in Pedorthics and Pedorthic Footcare Association are resources to help find skilled career pedorthic professionals and custom shoemakers.


 


Robert S. Schwartz, CPed, Eneslow Shoes

03/11/2019    

RESPONSES/COMMENTS (NON-CLINICAL)



From: Itamar Rosenbaum, CPed, Paul Kesselman, DPM


 


We have developed a special line of custom shoes that are geared towards critical care and are capable of accommodating the most sensitive feet. We have been working with limb salvage physicians for several years and have had tremendous success with this modality.


 


Itamar Rosenbaum, CPed, Rosenbaum’s Foot Health & Comfort Center


 


I have used Hersco in LIC, NY for more than twenty years for patients with severe Charcot foot deformities. They also manufacture custom foot orthotics and AFOs. They are reasonably priced and their management and customer service team are superb. Mr. Kennedy is a CPed and has had many articles appearing in several publications on a regular basis. I would definitely reach out to Mr. Kennedy and review the case prior to submitting an order. 


 


Some simple tips from thirty five+ years of ordering custom shoes for patients: Be sure to take a good plaster cast with the patient in a...


 


Editor's note: Dr. Kesselman's extended-length letter can be read here.

03/06/2019    

RESPONSES/COMMENTS (NON-CLINICAL)



From: Gail Zucker


 


Yes, The Sammy Systems has a solution that will meet your needs.


 


Gail Zucker, The Sammy Systems, Director of Sales

02/28/2019    

RESPONSES/COMMENTS (NON-CLINICAL)


RE: Axolotl Biologics (David Kahan, DPM)


From: Steven E Tager, DPM


 


I practice podiatry within a family practice with MD and PA providers. Feet, as well as other body parts, are also treated. The practice has injected Axolotl A about 9 times in both feet and knees. I must admit that I am a skeptic and considering the alternative in these cases, I felt the patient had very little to lose (except some money) since the alternative was surgery. To our mutual surprise, all but one case improved dramatically.


 


The failure was a hand with end-stage O/A of the 1st metacarpal phalangeal joint. The remaining cases were B/L end-stage hallux rigidus (95% relief), 4 knees with O/A after multiple steroid injections, PRP, and Hyalgan by others, with almost 100% relief, one slap tear of a shoulder with 100% relief, and one attenuated AT with 100% relief. The hallux rigidus and knees were also treated with rigid rear foot posted Root functional orthotics to control the involved pathomechanics.


 


Disclosure: I have no association with the company other than being a customer.


   


Steven E Tager, DPM, Scottsdale, AZ 

02/25/2019    

RESPONSES/COMMENTS (NON-CLINICAL)



From: Richard Silverstein, DPM


 


I have been utilizing Axolotl products for a year and a half now with great success. "Intriguing time" indeed sir! I commonly refer to this point and time in medicine as a "regenerative boom" because we are at the beginning stages of literally transforming the way we treat our patients. The reach is limitless from inflammatory conditions to wound care. 


 


Over this time period, I have injected over 75 patients with Axobiofluid A (A is for ambient temperature). The volume of injection ranges...


 


Disclosure: I sit on the medical advisory board for Axolotl Biologix.


 


Editor's note: Dr. Silverstein's extended-length letter can be read here.

02/15/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B



From: Tip Sullivan, DPM


 


For the immediate complaints--


 


1- Remove the screw in the second metatarsal and shorten the second met.


2- Repair the plantar plate. Remove the base of the second proximal phalanx only as the last resort. This foot is biomechanically unstable and you can bet that the second toe will not stay where you want it. 


 


I would also discuss repair of the 1st MTPJ (the sesmoids are not in good position) as well as some soft tissue adjustment at the 3rd MTPJ. You need to follow this up with functional orthoses.


 


Tip Sullivan, DPM, Jackson, MS

02/15/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A



From: Ira Baum, DPM


 


Dr. Shavelson proposes a reasonable question, but I fail to understand its purpose. From the statistics from the 2019 CASPR Directory describing program offerings to podiatric medicine graduates, there is an overwhelmingly number of PMSR/RRA vs. PMSR. That indicates podiatry is or is becoming a surgical specialty. I don’t think that prescribing orthotics and performing rehab or skilled maintenance defines a podiatrist with surgery as a sub-specialty. 


 


If, on the other hand, podiatry offered respected post-graduate residencies in other areas, for example podopediatrics, pododermatology, lower extremity manifestations of endocrine diseases, etc., maybe there could be a discussion, but that isn’t likely to occur. The real question is: if podiatry pigeonholes itself into a surgical specialty, why is it necessary? If podiatry remains on its current course, the AOFAS has an insurmountable advantage. If podiatry remains on its current course, will it survive? Should it survive?


 


Ira Baum, DPM, Miami, FL

02/11/2019    

RESPONSES/COMMENTS (NON-CLINICAL)



From: Elliot Udell, DPM, Allen Jacobs, DPM


 


The question we should all be asking is what a diabetic foot exam should consist of. If you ask ten colleagues including those in academia, you will get eleven protocols. 


 


Elliot Udell, DPM, Hicksville, NY 


 


If I may be permitted to analogize, patients with diabetes receive yearly ophthalmologic examinations for the earliest detection of eye disorder, which is occurring with increased frequency in the patient with diabetes.


 


With direct response to your inquiry, patients should be evaluated in detail for the presence of sensory, motor, and autonomic neuropathy. It should be recalled that up to 50% of patients may have manifestations of neuropathy although they do not present with...


 


Editor's note: Dr. Jacobs' extended-length letter can be read here

02/08/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: Practice Management and CPME


From:Alan L. Bass, DPM


 


By way of personal history, during my time at NYCPM in the early '90s there was very little, or any business management education given to us as students. The mission of the college at the time was to prepare us for residency. Then during [residency], as it most likely is today, there was no little to no time for this either. When I started in private practice and returned to NYCPM in the late '90s as part of the Department of Medicine, I thought it was important to discuss what I had learned in my early career about business management with the students. 


 


Shortly after beginning in private practice, I was also lucky to find the American Academy of Podiatric Practice Management (AAPPM), where members/speakers are willing to share their business management knowledge. Over time, ...


 


Editor's Note: Dr. Bass' extended-length letter can be read here.

02/07/2019    

RESPONSES/COMMENTS (NON-CLINICAL)



From: Al Musella, DPM, Steven Finer, DPM


 


Go to https://connex.ngsmedicare.com. You can check the deductible remaining and even look up the new medicare numbers. And it is free!


 


Al Musella, DPM, Hewlett, NY


 


If you have Novitasphere portal, you can check eligibility, deductible status, etc. Novitas Solutions handles about ten states for Medicare.


 


Steven Finer, DPM, Philadelphia, PA

02/06/2019    

RESPONSES/COMMENTS (NON-CLINICAL)


RE: Teaching Practice Management


From: Chuck Ross, DPM,


 


Having been involved in teaching for many years, I have always had an open door policy for students to visit. We always stayed long after the office was closed to discuss what the students saw podiatrically, BUT also to discuss our scheduling, billing, return policy, etc. These included everything from how to answer the phone to dealing with an occasional problem patient.


 


This is not a new concern but I am certain that there are many others in the podiatric community who would love to have students eager to learn from their expertise. I hope that the students will push a little bit harder to obtain this information which also includes how to select an employer if that is their choice for entry-level practice.


 


Chuck Ross, DPM, Pittsfield, MA

02/04/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Thomas Graziano DPM, MD


 


Kudos to Dr. Sol for waking up the elephant in the room if you will. We as a profession have accepted our place in the healthcare arena. We as a profession have been given some crumbs to feed on and accepted them willingly while mainstream medicine, insurance companies, and hospitals continue to consider us outliers. We continue to steer every podiatric student towards a career as a foot and ankle surgeon without regard for their aptitude or skill for the job. Our focus is misguided in my opinion. 


 


Until we make them physicians first with a well-rounded medical education, their skillset won't match even that of a nurse practitioner or physician assistant. Those who don't have the desire or dexterity for surgery shouldn't be led to believe that they must be surgeons to be "accepted." Recognizing the pedal manifestations of systemic disease is an art in itself and doesn't require one to raise a scalpel in order to reach a diagnosis. Teach the students what it means to be a physician first and give them a legitimate recognized certification so they can fit in once they enter hospital and private practice settings. 


 


Thomas Graziano DPM, MD, Clifton, NJ

02/04/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 3


RE: Medical Marijuana and Podiatry (John Chisholm, DPM)


From: Allen Jacobs, DPM


 


I suggest that readers of PM News view the following article:


 


This might serve to clarify some of the misconceptions expressed regarding the use of marijuana for the treatment of disorders encountered in our practices. As a podiatrist, my interest in patient use primarily involves the treatment of neuropathy, post-operative pain management, and chronic inflammatory disorders. 


 


Allen Jacobs, DPM, St. Louis, MO

02/01/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 3



From: John Chisholm, DPM


 


I have enjoyed this discussion, especially as it relates to the issue of differences in licensure between DPMs and MD/DOs. In the specific case of medical marijuana, this scope of practice issue is governed by state law. Here in California, DPMs were recently added to the list of provider types, along with MD and DO, that can legally prescribe medical marijuana to treat foot and ankle pathology. The reason this change was made without opposition was that the current education and training of graduates of podiatric medical school and residency programs warranted it. 


 


I want to take this opportunity to broaden the discussion to, again, point out that this issue, like so many other differences in scope of practice, is based on licensure, not the initials after your name. DPM, MD, and DO refer to degrees, not licenses. For example, MDs and DOs have different degrees, but hold the same license in California. 


 


Our profession has been talking about an MD or a dual DPM/MD degree for decades, with no workable plan or pathway for doing so. I urge all of my DPM colleagues to join with CPMA and APMA to support the concept of changing the DPM license in each state to one that reflects our current education and training.


 


John Chisholm, DPM, President, California Podiatric Medical Association

02/01/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2


RE: Double Board Success at WesternU


From: Lester Jones, DPM


 


I want to send congratulations to the members of the WesternU College of Podiatric Medicine Class of 2019 who recently learned that they achieved a 100% pass rate on both the APMLE Part 2 written exam and the Clinical Skills Performance Exam. This stellar outcome represents the diligence and hard work that are hallmarks of the students at CPM. You are a class apart!


 


This is the second year in a row that the fourth-year class has scored 100% on both of these board examinations. The College leads the nation in residency placement as well as with a five-year history of 100% placement of all graduates into some of the best hospitals in America for their three-year residency programs.


 


I also want to thank the WesternU community of faculty and staff who work hard to make this College and University such an outstanding place for learning. Strong work all.


 


Lester Jones, DPM, Interim Dean, WesternU College of Podiatric Medicine

02/01/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: Parity and Basic Medical Skills


From: Nicholas Sol, DPM


 


This is a period of great change in American medicine, with an array of opportunities and threats. Perhaps the greatest threat to podiatry is that we are unprepared to meet the opportunities to come. We lack some basic medical skills that marginalize podiatry. Medicare was unsuccessful in their recent attempt to marginalize podiatry with lower level E&M codes only for DPMs. We can choose to not be vulnerable. I can think of no other surgical specialty that cannot perform its own admission H&P. Many of my admission H&Ps are performed by PAs and NPs. 


 


If we are to attain any level of parity, we must possess basic medical skills at least equivalent to all providers. Physical exams for schools, commercial drivers licenses and others are only acceptable if performed by MD, DO, PA, and NP providers. Despite our extensive education and training, DPMs are not included on those provider lists. We all can and should be performing routine head-to-toe physical examinations if we hope to achieve parity. For those without this training, a certification course is available. This weekend certification course is approved by IPMA and Chicago Medical Education Group, and can be given in any state. I urge all DPMs to discuss this with colleagues, attain certification, and make head-to-toe physical exams a routine part of modern podiatric practice. We cannot achieve parity without this basic medical skill set.   


 


Nicholas Sol, DPM, Colorado Springs, CO

01/31/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B



From: Dan Klein, DPM


 



When will podiatrists realize that having a DPM license will never allow you the privileges of your counterparts in the MD/DO arena. It doesn’t matter how many courses or certifications of training in marijuana dispensing you take, at the end of the day, you are still a podiatrist. I have advocated and others have advocated for getting a dual license DPM and MD/DO license. Until the schools offer an avenue to obtain these licenses, podiatrists need to recognize their limitations. MD/DOs rule the land! Final word. 


 


Dan Klein, DPM, Fort Smith, AR


01/31/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A



From: Tip Sullivan, DPM, David E Gurvis, DPM


 


Where did Dr. Gary Smith get his data regarding the ill effects of chronic marijuana use? I could not find convincing data to support his claims or assumptions as to the results of chronic pot use. Dr. Smith brought up an ethical debate regarding the legitimate use of marijuana for medical conditions (medical marijuana). If marijuana is prescribed for legitimate use in approved medical/ podiatric conditions, to assume that it is unethical to use makes no sense to me. Like opioids, the problem is when physicians over-prescribe or prescribe them for illicit use. I would say that is the ethical issue here lies not in the drug itself but in the way it is used by the persons prescribing it. 


 


Disclosure: I am a 63 y/o male and went through a "chronic pot phase" in high school and college. 


 


Tip Sullivan, DPM, Jackson, MS


 


With all due respect to Gary S. Smith, DPM, his letter is not filled with one verifiable fact or known effect of marijuana. "Marijuana is a 'gateway' drug … marijuana causes diabetes, neuropathy, and renal failures!?" He cannot back up even one of these statements with medically accepted fact. If he can, please do. Otherwise, make it known in advance that these are your beliefs, and not medical facts.


 


Yes, there truly are some downsides to marijuana. Several to be exact. But not one you stated is any more than a myth or a belief you hold. Additionally, if a patient had depression, no, marijuana often would not make them feel better (as a rule of thumb but if medical intervention had failed, and it did, who are you to take that away from someone?), and if they had terminal cancer, then personally I wouldn’t care even if all your misstatements were true.


 


David E Gurvis, DPM, Avon, IN

01/31/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: Podiatry College Core Curriculum 


From: Robert Scott Steinberg, DPM


 


I was talking to a former resident, the other day. Though his son could get into medical school, he wants his son to follow in his footsteps. We talked about the medical courses podiatry students do not receive.


 


Time is long overdue that colleges of podiatric medicine provide identical courses that medical colleges provide. These should include gynecology and psychiatry, and a few others. Does anyone know which podiatry colleges are already doing this, and which are not? 


 


Robert Scott Steinberg, DPM, Schaumburg, IL 

01/30/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Sam Bell, DPM


 


I use Mesa labs and I am satisfied with their service.


 


Sam Bell, DPM, Schenectady, NY

01/30/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A



From: Gary S Smith, DPM


 


I realize this is a controversial subject with many points of view. I am not against the legalization of marijuana. I do believe that doctors and users need to be better educated because any view that comes across anti-pot seems to be a source of contention. First of all, there is no such thing as "medical marijuana". Any ailment you have from terminal cancer to depression and pain, marijuana will make you feel better. 


 


Snorting coke, shooting heroin, and over using opioids will make you feel better as well. This doesn't mean...


 


Editor's note: Dr. Smith's extended-length letter can be read here

01/30/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B



From: Dia McCaughan, DPM


 



I actually took the 4-hour certification course for this at my local hospital, for a fee. Afterward, I logged onto the PA Department of Health and the medical cannabis website to register my practice with the Commonwealth. It was then that I discovered I was not permitted to register since I was not an MD/DO.  


 


I comprised a thorough letter to my local representative, who is now the Speaker of the House of PA, discussing the issue why podiatry should be included and the qualifying conditions we manage on a daily basis. He responded immediately, agreeing with me, and stated he would look into it. Three weeks later, I received a call from the PA Department of Health, letting me know podiatrists cannot register at this time, and no expected approval date has been set. So, back to square one again, I suppose. 


 


Dia McCaughan, DPM, New Providence, PA


01/29/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Christopher A Orlando, DPM


 


I have been using Spore-wise sterilizer monitoring service. It is a very good company. You get a kit to test monthly for one year.  


 


Disclosure: I have no financial interest in this company.


 


Christopher A Orlando, DPM, Hartsdale, NY
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