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04/22/2019    

RESPONSES/COMMENTS (NON-CLINICAL)



From: Michael Schneider, DPM


 


Keep your license at least for a few years. You never know what may come your way. 


 


Michael Schneider, DPM, Denver, CO

Other messages in this thread:


01/23/2020    

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



From: Jonathan Michael, DPM


 



With all my respect to the Drs. on the show, I was not impressed at all by the performance that highlights our profession. In one instance, the doctor says I have never seen anything like that and I really do not know how I am going to treat you. Then he made the patient custom sandals when I was expecting some sort of surgical intervention. In the other instance, the Dr. removed a fungus nail that was done distally and crumbled; in my opinion, it should have removed proximal first to avoid the struggle to remove it in pieces. I think that did more harm than good to our profession. 


 


Jonathan Michael, DPM, Bayonne, NJ


01/23/2020    

RESPONSES/COMMENTS (NON-CLINICAL)



From: Gary S Smith, DPM


 


I think the show will be good for business and the profession as a whole. It lets people know we're out there and we treat a wide range of problems medically and surgically. The extreme nature of some of the cases on the show may make it easier for people with lesser deformities seek treatment that they might otherwise not. As entertainment for me, I find it annoying and really don't care to watch it. I am a blacksmith as well, and most blacksmiths I know including myself don't watch "forged in fire" either.


 


Gary S Smith, DPM, Bradford, PA

01/14/2020    

RESPONSES/COMMENTS (NON-CLINICAL)



From: Sam Bell, DPM, Robert Kornfeld, DPM


 


I also use the Veradigm eprescribe, the $9 a month version, and I am happy with it. Once you get into it, you’ll find it is better than writing the prescription and it is at the pharmacy immediately.


 


Sam Bell, DPM, Schenectady, NY


 


I use Allscripts here in NY for $33/month. It does not require EHR. You simply sign in to their web portal and set up an account for each patient that requires a prescription, and it electronically transmits your Rx to the patient's pharmacy. It’s very easy to use.


 


Robert Kornfeld, DPM, NY, NY

01/13/2020    

RESPONSES/COMMENTS (NON-CLINICAL)



From: Elliot Udell, DPM, Vladimir Gertsik, DPM


 


There are some less expensive programs you can buy to e-prescribe. One is Veradigm.com. It’s part of Allscripts. They have plans that range from 9 to 18 dollars a month. There are other programs as well. Check them all out. 


 


Elliot Udell, DPM, Hicksville, NY


 


For those who are near retirement, you can ask your state for exemption. Go to their website and try to find it.


 


Vladimir Gertsik, DPM, NY, NY

01/08/2020    

RESPONSES/COMMENTS (NON-CLINICAL)



From: David Secord, DPM


 


As Dr. Toll is using the term "sclerosing" and says that he follows Dr. Dockery's method of using 4% dehydrated EtOH (which is not a high enough concentration to cause sclerosis), I was wondering what code he is using? I'll submit a response to that question from the late great Harry Goldsmith, DPM:


 


“Sclerosing is a term that implies a change to the tissue, in this case, nerve. It is not necessarily associated with destruction. Typically, your alcohol product package insert will note that 40% or greater alcohol solutions are destructive to peripheral nerves. If you are sclerosing a nerve using less than 40% alcohol solution, you are not destroying it, and you cannot...


 


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

01/06/2020    

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


RE: Source for Radiesse 


From: Allen Jacobs, DPM


 


Saying that “I’ve used this technique or product a bizillion times without any problems” may not be a positive defense for unindicated use. It is analogous to drunk driving, or never stopping at a red light. Most intoxicated people, or those who ignore traffic signals, are not in auto vehicle accidents while driving drunk or ignoring a red traffic signal. However, driving while drunk or ignoring a red light raises the statistical RISK of an accident. Should such an accident occur, you will likely be held accountable. Safe means safe for studies and indicated utilization.


 


Stating that you “took a course” at some seminar is like implicating the bartender for your intoxicated driving. Taking a “course” at some podiatry seminar does not provide you with a special exemption for the provision of ethical, standard of care treatment to your patients. 


 


I suggest that at a minimum, patients be informed that the use of the medication or technique has not been studied nor is FDA-approved, and that appropriate verifiable consent be obtained.
Allen Jacobs, DPM, St. Louis, MO

01/06/2020    

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


RE: Source for Radiesse 


From: Valerie Marmolejo, DPM


 


The intended use indications for Radiesse are: “RADIESSE is indicated for subdermal implantation for the correction of moderate to severe facial wrinkles and folds, such as nasolabial folds and it is also intended for restoration and/or correction of the signs of facial fat loss (lipoatrophy) in people with human immunodeficiency virus.”


 


While physicians can use Radiesse off-label as they please, the company CANNOT promote, aka sell or market, off-label product use. As podiatrists do not treat the face, there is no reason for the company to reach out to us. 


 


Valerie Marmolejo, DPM, Seattle, WA

01/03/2020    

RESPONSES/COMMENTS (NON-CLINICAL)



From: Elliot Udell, DPM


 


Dr. Ribotsky is correct. If a product is not FDA-approved for use in the foot, we can use it but it would be considered "off-label use." What this means is that if it is deemed safe, the product can be prescribed by licensed physicians; however, a quirk in the law says that the company cannot advertise the product nor promote it in any way. There are many products that we use that come under this bizarre law. Gabapentin for the treatment of pedal neuropathic pain is one of many examples. Hence, if Radiesse is used off-label in the foot, organizations such as DermFoot can run workshops to teach podiatrists how to use the product, but the company cannot promote it directly to podiatrists or they may face major fines.


 


Elliot Udell, DPM, Hicksville, NY

01/02/2020    

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



From: Allen Jacobs, DPM


 



My understanding of Radiesse is that it is not approved for, nor are there FDA studies for, the use of this calcium hydroxylapetite product for the foot and ankle. Experience in facial and hand soft tissue augmentation has demonstrated that Radiesse may be associated with vascular occlusion, downstream embolization, and tissue infarction, among other complications. The manufacturers recommend that Radiesse be utilized for indicated pathology in studied areas (face and hands), and by those TRAINED and EXPERIENCED in its use. Perhaps the reluctance to provide this product is not "anti- podiatry", but rather the responsibility of the manufacturer to not distribute the product for indications not FDA-approved. 


 


Furthermore, by undertaking Radiesse injection for foot and ankle augmentation, the podiatrist assumes a substantial potential medical-legal liability should a significant adverse sequela occur. Hiding behind a dermatologist to provide Radiesse could further legally implicate the distributing dermatologist in a ruse to provide a podiatrist with a medication for unindicated purpose. Having another podiatrist testify that in their opinion Radiesse may be used sans FDA studies and approval, and having the manufacturer testify that the dermal filler was not made for nor indicated for the purpose used, and that they (the manufacturer) would not knowingly provide ANY healthcare provider with Radiesse for non-indicated use, may be problematic. Caveat emptor!


 


Allen Jacobs, DPM, St. Louis, MO


01/02/2020    

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



From:  Bret Ribotsky, DPM


 


In response to Dr. Fellner, years ago, when I was involved with DermFoot and running workshops, I had many detailed discussions with a few different CEOs of Merz over the years. The issue is that there is NO FDA-approved use for Radiesse that is within the scope of practice of a DPM. Thus, the attorneys for the company advised not to sell to DPMs directly.  


 


Workarounds were in place for those who received training that I provided throughout the country (a short term fix). I was involved in a few research papers that were the start of a possible attempt to get an FDA indication for the feet (like the hands). Then I got injured in May 2015, so I do not know what has happened since then. 


 


Bret Ribotsky, DPM, Boca Raon, FL

01/01/2020    

RESPONSES/COMMENTS (NON-CLINICAL)



From: Dieter J Fellner, DPM


 


I applaud Dr. Ribotsky's well-intentioned solution for sourcing Radiesse. At the same time, I am truly flabbergasted. This company apparently unchallenged can, through their actions, indulge their gross and unfettered bias towards a legitimate professional medical body of healthcare professionals, such as podiatry, so much so, as to affect the company’s profit margins. At the very least, does Merz not have any fiscal responsibility for their investors? Is this company not answerable to anyone? I would strongly advise their investors to consider the extreme folly of this company.


 


I suspect I must be wrong in my assumptions - there HAS to be a rational explanation why a legitimate, state licensed and fully accredited doctor, a specialist no less, should be denied legitimate access to Radiesse. Instead of receiving the customary professional courtesy from a company such as Merz to be 'allowed' the privilege to increase their sales and profit, the doctor needs instead to consider going cap in hand to a colleague to beg for a supply. 


 


Until Merz’s CEO issues an unreserved apology and is fired and/or their abstract, discriminatory and possibly illegal policy is reversed, I will quite simply prefer to drill multiple holes in my own cranium without anesthesia, before I will consider putting a single cent towards this company and its ridiculous and shameful business policy. 



 


Dieter J Fellner, DPM, NY, NY


12/31/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Joel Morse, DPM


 


Go North! Go to MedicaDepot.com and you can order a number of dermal fillers including Radiesse for roughly $188 for the 0.8 cc syringe. You must supply them with your medical license and they will get back to you in a few days. I have bought from them, and many podiatrists have received their Merz fillers!


 


Joel Morse, DPM, Washington, DC

12/30/2019    

RESPONSES/COMMENTS (NON-CLINICAL)



From: Bret Ribotsky, DPM


 


To obtain Radiesse, contact a local dermatologist or plastic surgeon who does aesthetics. These physicians participate in a “volume purchasing discount” program with all aesthetics companies, and benefit by increasing their gross volume to lower their prices. As a result, they either increase their profit or are able to lower their prices in a competitive market. I know many DPMs who have used this method and have increased patient loads from the Derms who do not like to treat feet.


 


Bret Ribotsky, DPM, Boca Raton, FL

12/24/2019    

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



From:  Jack Ressler, DPM


 


Before I sold my main practice, I researched practice brokers and interviewed a few. The bottom line is that you pay them several thousand dollars to give your practice a "valuation" and even more money when/if they sell your practice. Don't think for a minute that they come out to see your practice first. They will, but you pay extra for that service. I cannot speak for all practice brokers but the ones I spoke with have you sign an agreement that gives them exclusivity of selling your practice. This means they are in the driver’s seat as to how much and what type of advertising they want to do to promote your practice. They do not have to do too much work. The work they do, you pay for. 


 


Yes, you can still get a buyer on your own, but when under contract with the broker, you still pay their commission. Nobody knows your practice or can sell it better than you! Take some time and look into advertising your own practice. If a sale is pending, then contact a lawyer for further guidance. I sold my own practice and the only advertising I did was on PM News


 


Jack Ressler, DPM, Delray Beach, FL

12/24/2019    

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



From: Cosimo Ricciardi, DPM, Denis LeBlang, DPM


 


Ditto that on Mr. Crosby. He's a hard worker and good communicator. He will be a great asset in your search.


 


Cosimo Ricciardi, DPM, FT Walton Beach, FL


 



I used Mike Crosby to negotiate the sale of my practice last year. He is professional, compassionate, and a wonderful human being. He was there to speak with me and literally held my hand and controlled my mindset throughout the process. It took a while for the situation to come to an end, but Mike was the voice of reason and controlled my stress and anxiety levels and calmly assured me that it would all work out. 


 


I  recommend him as the guru of podiatric practice sales. 


 


Denis LeBlang, DPM, Westchester County, NY


12/23/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Alan L. Bass, DPM


 


I highly recommend Mike Crosby of Provider Resources, LLC. Mike has been around podiatry for many years. He provides high quality evaluations of practices. I have worked with him on a number of occasions to help clients I know to either sell or acquire practices.


 


Alan L. Bass, DPM, Manalapan, NJ

12/23/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: Banner Year for Our Sock Tree


From: Andrew Levy, DPM


 


It was a banner year for socks donations for two homeless shelters and an after school program for underserved children. Our staff estimates that we will collect 1,000 pairs this year! 


 













Dr. Andrew Levy and Sock Tree



 


This idea emanated from PM News years ago. Thanks to PM News and our patients.


 


Andrew Levy, DPM, Jupiter, FL

12/19/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: David Gurvis, DPM


 


I knew what Truvada was.  A habit I picked up years ago is when I don’t know a medication a patient is on, I ask them. Later, or in the room, I look it up. I keep the epocrates app and another drug look-ups in my cell phone and rely on them extensively. We all should.


 


David Gurvis, DPM, Avon, IN

12/18/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2


RE: Importance of Keeping up with New Medicines


From: George Jacobson, DPM


 


It is important to look up medications that you are unfamiliar with. I had a new patient who was on Truvada. Many medications have similar names. Truvada, a combination of the antiretroviral drugs tenofovir and emtricitabine, is the only FDA-approved regimen to be used as pre-exposure prophylaxis, or PrEP, against HIV. How many of us knew that medication and its indications? 


 


George Jacobson, DPM, Hollywood, FL

12/18/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: Majority of U.S Medical Students are Women


From: Leonard A. Levy, DPM, MPH


 


2019 was the first year that the majority of U.S. enrolled medical students were women according to data released on December 10 by the Association of American Medical Colleges. In 2017, women comprised the majority of first-year medical students. Applicants to U.S. medical schools have increased for women while those for men declined. (Stuart Heiser, Senior Media Relations Specialist, AAMC: Dec. 10, 2019).


 


Leonard A. Levy, DPM, MPH, Ft. Lauderdale, FL

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 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

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