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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:


12/06/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: T. Nat Chotechuang, DPM


 


Our intake form simply asks, "Gender: ________" and the patient fills in the blank however they wish.


 


T. Nat Chotechuang, DPM, Bend, OR 

11/29/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 3



From: Robert Kornfeld, DPM


 


I do not know Dr. Smith, but his comment highlights his lack of knowledge regarding CBD oil. It’s always best to do some research prior to a blanket condemnation of “claims”. The stoichiometry of CBD oil is very similar to our own endogenous endocannabinoids. It binds to receptor sites in the ECS and starts a chemical cascade that stimulates detoxification, repair, replacement and replenishment. This is why so many different conditions respond. 


 


Needless to say, it does not help everyone, but after using it on myself and my patients for 3 years, I can say the greater majority report improvements. With the lack of associated side-effects, it is a great addition to your armamentarium. It is far safer than any drug you can prescribe. But please, do not recommend it to your patients until you have an informed and comfortable position with how it works and possible drug interactions.


 


Robert Kornfeld, DPM, NY, NY

11/29/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Chris Seuferling, DPM


 


I agree with Dr. Alan Sherman's comments. In addition to biomechanics, I would add wound care to the list. In Oregon, we are trying to pass a scope bill that would allow podiatrists to treat venous stasis ulcers up to the level of tibial tubercle. During my research to gather supporting documentation to "prove" our expertise in this area, I was disappointed to find that there is nothing specific in CPME 320 regarding treatment of venous stasis ulcers, only vague generalizations. The level of training in wound care and particularly venous ulcers varies from residency to residency. This makes it difficult to convince MD/DO associations and legislators that we are "experts". 


 


I fear we are going to lose our "podiatric" identity unless we assess and standardize our residency programs to include essential elements that define our specialty.  Otherwise, podiatry will evolve solely into a backdoor route to becoming orthopedic foot and ankle surgeons. This may be okay for some, but I believe the essence of podiatry offers so much more than that to patient care and to the medical community.


 


Chris Seuferling, DPM, Portland, OR

11/29/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Kevin C. McDonald, DPM


 


I do ANS and sudomotor testing in my office on occasion, as it is available on my ABI vascular testing device. The test involves heating up the soles of the feet and measuring a) the dilation of the small blood vessels beneath the skin and b) the sweat response (as a measure of the function of the sudomotor nerves controlling the sweat glands). A decreased response indicates damage to the autonomic nerves on the soles of the feet while the absence of a response indicates a complete loss of autonomic nerve function. 


 


Sudomotor testing is considered "investigational" and thus non-covered by the vast majority of insurance companies. I hope that this changes because ANS/sudomotor testing has advantages over epidermal nerve biopsies including a) no injections, b) no wounds, c) immediate, quantified results, d) measuring the nerves of the feet rather than the nerves of the lower legs, and e) a much lower cost. In summary, it's a good test but it's typically not covered by insurance.


 


Kevin C. McDonald, DPM, Concord, NC

11/28/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Elliot Udell, DPM


 


Dr. Moore is being very astute in asking whether a new modality is covered by insurance companies. Every year, like clockwork, there is some new diagnostic or therapeutic modality being promoted at our conventions. Very often the sales reps will swear that the new device is covered by insurance and gullible practitioners find out, too late, that the codes given by the salesperson is really specific for a different modality, and under an audit the practitioner will have to pay back all that he or she received. 


 


In most cases when this happens, the doctor will have little recourse because the manufacturer is long out of business. The bottom line is this: Yes there are new and exciting modalities being developed that can help our patients. As Dr. Moore has done, before becoming a buyer, we need to give a "shout out" and find out whether the device is therapeutically beneficial and whether it will be legitimately covered by insurance companies. 


 


Elliot Udell, DPM, Hicksville, NY

11/28/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Gary S Smith, DPM


 



I came across advertisements from the late 1800s for snake oil and I was struck by the almost identical claims of cure by CBD oil dealers. I heard CBD oil repels giant emu attacks so I keep a bottle in my office. It works too! I haven't seen one emu!


 


Gary S Smith, DPM, Bradford, PA


11/27/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2


RE: Source for CBD Oil (Jack Ressler, DPM)


From: Robert Kornfeld, DPM


 


The best medical grade CBD oil I have found comes from Canbiola, Inc. 


 


Disclosure: I am on the medical advisory board of Canbiola.


 


Robert Kornfeld, DPM, NY, NY

11/27/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: The Rebalancing of Podiatric Medical and Surgical Residency Education


From: Alan Sherman, DPM


 


Chuck Ross started an interesting discussion triggered by his attending the always excellent Richard O. Schuster Memorial Seminar in biomechanics last week. He makes the statement that the concern regarding the lack of emphasis on biomechanics should be focused on the 3 years of residency education, where he notes that there is a “dramatic lack of a continuum once students graduate and enter residency programs, with few exceptions as the emphasis is solely upon surgery.”


 


Allen Jacobs shares his experiences with speaking to residents, “that it is distinctly uncommon to see gait analysis performed on most patients, including those being evaluated for...


 


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

11/26/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Bob Hatcher, DPM


 


This website for Charlotte's Web has a variety of CBD products plus information on production and cost.


 


Bob Hatcher, DPM, Raleigh, NC

11/25/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Steven Selby Blanken, DPM


 


The point people miss with the name plates is that the title of all the representatives always says “Dr., Mr., Ms., Miss, or Mrs.” Name plates don’t show the degree for anyone. I’m surprised by Dr. Jacobs’ comments that may have been interpreted in a negative tone by some about Dr. Wenstrup. I am so proud of Dr. Wenstrup. I have met him and hope he is President one day. I also feel Dr. Jacobs has been a great icon in our profession.


 


Steven Selby Blanken, DPM, Silver Spring, MD

11/25/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Todd Lamster, DPM


 


I respectfully disagree with a recent post from my colleague Dr. Werter. A bone surgery of any kind, whether it be a simple exostectomy or joint reconstruction, is much different than a P&A in terms of wound depth and potential for infection. An OR should be much cleaner than anyone's office, and in today's age of drug resistant bacteria, anything we can do to limit post-operative infection (especially osteomyelitis) should be considered and most likely carried out. With respect to anesthesia, light sedation to perform the digital block and keep the patient comfortable during the surgery is a good thing. 


 


In patients who have very high anxiety, it is proper and a necessary course of action. What about the pediatric patient who is screaming, crying, carrying on about "the shot" before doing a toenail procedure? I have taken quite a few of these patients to the OR simply to make sure that I can actually carry out the procedure safely and efficiently. In those cases, sedation for a P&A is absolutely necessary!  Lastly, pain is VERY subjective. We all know this. 


 


Patients' pain varies widely from the simplest skin closure or P&A to the most complex reconstructive procedure. Post-operative pain, in my opinion, tells you very little about the surgery, the technique, or the surgeon. I never tell patients in absolute terms how much or how little pain they should expect after any procedure I perform. Manage the patient, the pain, the wound, and move on.


 


Todd Lamster, DPM, Scottsdale, AZ

11/23/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 3


RE: The Richard O. Schuster Memorial Seminar


From: Kevin A. Kirby, DPM


 


I have been reading with interest about the discussions regarding the biomechanics education within podiatry here on PM News. Drs. Ross, Jacobs, and Udell have all made some very good points which I would also like to elaborate on.


 


I have spent the last 35 years of my professional life teaching podiatry students, podiatric surgical residents, and podiatrists here in the U.S. about the intricacies of foot and lower extremity biomechanics. I have also had the honor of lecturing abroad multiple times over the past 28 years to podiatrists in other countries who consider biomechanics of the foot and lower extremity to be a very important subject, and not a subject that is somehow secondary or isolated from surgical correction of...


 


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

11/23/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Keith L. Gurnick, DPM, Allen Jacobs, DPM


 


It would be a better and more accurate and honest representation of who he is if his nameplate read "Brad Wenstrup, DPM" and not "Dr. Brad Wenstrup". That alone would do a lot to promote podiatry. Typically, nameplates for medical doctors read “MD," not "Dr.” 


 


Keith L. Gurnick, DPM, Los Angeles, CA


 


Yes, I was proud of Brad Wenstrup’s actions in the recent impeachment hearings. However, that pride was as an American not as a podiatrist. Dr. Katzen points out that the name plate states “Dr.” not DPM. I watched numerous interviews in all of which representative Wenstrup refers to himself as a surgeon, a doctor, or as a healthcare provider. The term podiatrist or podiatry never is utilized. While I am personally proud that a fellow podiatrist has risen to such prominence, and while I would believe that Dr. Wenstrup is likely in a position to assist the advancement of our profession, Brad Wenstrup, DPM on that plate would have been nice. His self-identification as “doctor” may be appropriate, but let’s not anoint him as an ambassador of podiatry. 


 


Congresman Wenstrup is typical of today’s students who “graduated medical school" or have “ Dr.” prefixing their name. The issue is not whether you are a graduate of a podiatric medical school, whether you are a “foot and ankle surgeon”, or if you are a doctor. The issue is that ultimately you hold a DPM degree. Not MD. I ask how in the world do you expect recognition of the DPM degree and the excellent care the DPM provides when no one hears or is aware of the degree and the training and excellence in care which that degree represents.


 


Allen Jacobs, DPM, St. Louis, MO

11/23/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Bill Beaton, DPM


 


I use DoctorDefender.com which is not a collection agency, but a collection tool that is more effective and far more affordable than collection agencies. I designed the system and had it built several years ago to help solve my personal patient collection issues and when I saw how well it worked for me. I decided to share it with other providers as an add on service through my partner's billing company, PracticeDefender.com. After two billing statements, I send a DoctorDefender notification letter for best results.


 


Disclosure: I am co-owner with PracticeDefender.com


 


Bill Beaton, DPM, Saint Petersburg, FL

11/21/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Robert Scott Steinberg, DPM


 


We are using Transworld Systems. Easy to use.


 


Robert Scott Steinberg, DPM, Schaumburg, IL

11/21/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 3



From: Elliot Udell, DPM


 


Dr. Jacobs cites seven problems with the teaching of biomechanics to the profession in 2019. His seventh critique was that many CME seminars are filled with "pay to play' biomechanical presentations which are "edgy and unproven." This made me chuckle because I have sat in on biomechanical lectures where a speaker espoused theories to justify his or her line of orthotics and two hours later a different speaker representing a different company says something that is the exact opposite. Too often, true experts are not invited to the podium.


 


This problem leads into Jacob's third critique (The overwhelming number of journal publications in the area of biomechanics are by professionals other than podiatrists). Criticism without solutions is blowing into the wind. The only solution is for the APMA, the schools, the labs, and private donors to make the sacrifices, fund the research, do it at an affordable price at our colleges, and publish good papers in our journals. That way we can take biomechanics out of the realm of private opinion and into the realm of evidence-based medicine.


 


Elliot Udell, DPM, Hicksville, NY

11/21/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2


RE: OH Podiatrist Shines at House Intelligence Committee Hearings


From: Burton J. Katzen, DPM, Bret M. Ribotsky, DPM


 


Hats off to Congressman Dr. Brad Wenstrup for being such an eloquent representative of our country and our profession.


 


Burton J. Katzen, DPM, Temple Hills, MD


 


While I know very few PM News readers have the opportunity to be watching the hearings of the House Intelligence Committee on TV this week (and last week), I just want to report something no news media is reporting. Our own representative, podiatrist Brad Wenstrup, DPM, is clearly making all of us very proud. His name plate says “Dr.” and his questions have all been very thought-out, probing, and a clear demonstration that he is well learned on the subject. All DPMs should be proud of the voice we all have in Congress, and we can only hope that Brad wishes to continue to stay in Congress, as it’s clear he has the respect from both-sides. Once again, we should all be proud of our 2018 PM Podiatry Hall of Fame inductee.


 


Bret M. Ribotsky, DPM, Boca Raton, FL

11/20/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Allen Jacobs, DPM


 


The question of biomechanics/kinesiology education in podiatry is an important one.


Some observations:


1. Residents with whom I speak tell me that it is distinctly uncommon to see gait analysis performed on most patients, including those being evaluated for surgical intervention;


2. As an ABFAS reviewer, I can tell you that a detailed documented weight-bearing examination is typically not present;


3. The overwhelming number of journal publications in the area of biomechanics are by professionals other than podiatrists;


4. Most biomechanics education at CME programs is corporate supported, and lectures are biased toward the products distributed by the corporation providing the grant or speaker;


5. There is too much reliance on radiographs in surgical decision-making when such data cannot be interpreted in a vacuum;


6. Gait analysis must include requisite knowledge of interrelated factors such as neurology and pathology above the foot and ankle;


7. Too many unproven and edgy theories, always product driven, are allowed to be presented at CME meetings; it is another example of so called scientific directors of programs allowing the “pay and you can play” construction of CME programs. Students and residents know what they see. What they do not see is the incorporation of serious biomechanics/kinesiology evaluation in patient care. Until they do, a minimal appreciation and application of these sciences will continue to be relegated to the status of a rite of podiatry passage no more considered in daily practice than the Krebs cycle.


 


Allen Jacobs, DPM, St. Louis, MO

11/19/2019    

RESPONSES/COMMENTS (NON-CLINICAL)


RE: The Richard O. Schuster Memorial Seminar


From: Chuck Ross, DPM


 


I recently attended the Richard O. Schuster Memorial Seminar and had two immediate thoughts. First, I was incredibly impressed with the presentations and the manner in which Dr. D'Amico and his dedicated staff managed the entire weekend. Congratulations on a superb job.


 


My second thought brought me back to the recent discussions on PM News about the "lack" of appropriate education in the area of biomechanics with some blaming the shortcomings on the colleges of podiatric medicine. After the many superb and timely presentations, I must beg to differ and perhaps place blame...


 


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

11/11/2019    

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



From: Steven Finer, DPM


 


I recently purchased Quantum Rub at a seminar. It contains polarized CBD, menthol, and various herbs and oils including vitamin E. My wife has used it after our trips to the gym. She said that it helps with generalized soreness, not strong pain. Naturally, this is anecdotal evidence. It seems all rubs contain menthol for their cooling effect. Many can contain ingredients that produce warmth and new evidence shows it may speed healing. As to the claim of polarization, it is unproven. Ingested CBDs in the form of pills and gummies may be taken off the market due to lack of standards. I personally prefer Voltaren gel on a limited basis, as there is some systemic absorption.   


 


Steven Finer, DPM, Philadelphia, PA

11/11/2019    

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



From: Allen Jacobs, DPM


 



CBD topical preparations appear to be very helpful for symptomatic treatment of musculoskeletal disorders (e.g. arthritis, tendinitis ). I offer this has an alternative to those patients in whom oral NSAID therapy is not appropriate or concerning, e.g.: renal concerns, cardiac concerns, anticoagulation therapy, history of GI pathology). Typically, high NSAID risk patients are given the choice of topical NSAIDs, CBD topical, or no treatment. I personally use the CBD products from EBM pharmacy. The results have been excellent. I prescribe CBD topical daily.


 


Disclosure: I have lectured for EBM pharmacy in the past.


 


Allen Jacobs, DPM,  St. Louis, MO


11/07/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From Paul Kesselman, DPM


 


I have also been attempting to secure new blood on several committees which I participate in both at the state and national level. While I understand the newbees have other priorities (raising kids, etc.), the future of this profession cannot be dictated (nor should we want it to be dictated) by generations who came before you. We have come a long way since I came back from Chicago in 1981 but there are many more roadblocks ahead, for which we need a younger person's stamina and perspective. Please consider Dale's invitation to participate in whatever way you can. The future of this profession needs your contributions!


 


Paul Kesselman, DPM, Woodside, NY

11/07/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2


RE: Shortage of PMSR/RRA Programs (Daniel Chaskin, DPM)


From: Charles M Lombardi, DPM, Alan A. MacGill, DPM


 


First, Dr. Chaskin is in error on several fronts. Most programs are PMSR/RRA. Second, it is only select states (that used the unified residency training model) in which one cannot do leg soft tissue procedures. 


 


Charles M Lombardi, DPM, Flushing, NY


 


According to the 2020 CASPR Directory, nearly all of the podiatric residency programs in the country are PMSR/RRA with the exception of only 9 programs.


 


Alan A. MacGill, DPM, Boynton Beach, FL

11/06/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: Shortage of PMSR/RRA Programs


From: Daniel Chaskin, DPM


 


Currently, there are two residency models. Model number one is a PMSR. Upon completion of this model,  podiatrists are unable to become licensed to treat the ankle (with the exception of contiguous foot wounds) throughout every state in our country. Model number two is a  PMSR/RRA which does allow a path for a podiatrist to possibly qualify to medically and surgically treat the ankle. 


 


The problem is that there is a shortage of PMSR/RRA programs. Some podiatrists only are able to participate in a PMSR. A PMSR/RRA is required to ultimately allow podiatrists to medically treat the ankle in all states throughout our country. Medically treating the ankle regarding conditions such as melanoma, etc. is so important. Podiatric medicine includes the excision of melanomas on the ankle. Even if PMSR podiatrists actually completed a PMSR and became board certified in podiatric medicine, they still could not medically treat the ankle regarding conditions such as excision of melanoma. This may be one reason to replace all PMSRs with PMSR/RRAs.


 


Daniel Chaskin, DPM, Ridgewood, NY

11/06/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 3



From: Alan Sherman, DPM


 


In Charles Lombardi’s comments on the discussion regarding the need for a separate medically intensive podiatric medical residency, he criticizes certain unnamed people for being schizophrenic, for changing their minds as to whether such a program is needed between 2000 and 2019. To be clear, I am not for such a program. But I would point out that we are all scientists, trained to collect data and draw the best possible conclusions from that data, and that data has changed as podiatric practice and training has evolved in the past 19 years.


 


The situation is now quite different than it was in 2000. That “certain people” have changed their opinions during those 19 years is not only reasonable, but it is admirable. In fact, those who cling to obsolete opinions in the face of new and changed data are not...


 


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