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07/11/2019    

RESPONSES/COMMENTS (NON-CLINICAL)


RE: Failure to Diagnose PAD 


From: Allen Jacobs, DPM


 


Increasingly, I have observed that plaintiff attorneys specializing in litigation involving care of the elderly are looking at podiatry care. One major area is the failure to diagnose and treat or refer for treatment geriatric patients with PAD. 


 


The argument being advanced is as follows; the patient is qualified for care by a podiatrist by virtue of class findings consistent with PAD. Therefore, why was the patient not referred for vascular studies or to vascular surgery or interventional cardiology? Given advanced age and the common presence in elderly patients of comorbidities with which PAD is associated, a potentially compelling argument is that


 


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

Other messages in this thread:


10/22/2019    

RESPONSES/COMMENTS (NON-CLINICAL)



From: David Secord, DPM


 


I’m surprised that you were able to get Demerol (Meperidine), as I was under the impression that the FDA banned Demerol and Darvon some time ago, along with anything else containing propoxyphene. I tried to avoid it at all costs due to the nephrotoxicity of normeperidine (the 1st pass metabolite).


 


David Secord, DPM, Corpus Christi, TX

10/17/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Steven Finer, DPM, Jim Steinberg, DPM


 


When I was in full-time practice, I had these small drill engines attached to Sani-Vacs via black vinyl tubing. We had reamers to clean the tubing. In addition, we had Honeywell cleaners with charcoal filters. We had no problem in 40 years.  


 


Steven Finer, DPM, Philadelphia, PA


 


There has been a lot of input about air purification, not filters. Nail dust can only be extracted from a room or entire office if you treat the air itself. There is only one way to successfully do this and it is by ozonation and ionization. Remember, air can only be cleaned when it gets to a filter. Ozone cleans the air by using O3 to change the chemical structure of impurities and ions attack the negative change of neutral particles in the air (nail dust). Look into Alpine Industries on the Web, it makes sense.


 


Jim Steinberg, DPM, The Villages, FL

10/17/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: APMA Young Physicians' Institute


From: R. Andrew Pavelescu, DPM


 


On October 11-13, along with fellow young member Dr. Jeff Kagan (PGY-1), I attended the APMA Young Physicians' Institute in Nashville, TN. As a member of the APMA Young Physician Leadership Panel, I met with fellow panel members prior to the main YPI program for a strategic planning session. Here the panel discussed key and imminent problems facing young DPMs and established working goals for the next two years. The leadership panel is composed of young podiatrists from across the country, who serve as the intermediaries between the APMA Board of Trustees and the membership at large. The primary goal of the YPLP is to advocate on behalf of all young DPMs.


 


The formal APMA YPI program took place October 12th and 13th. Attendees representing a wide variety of component states had the opportunity to partake in lectures and workshops focused on building leadership skills. This is a phenomenal yearly program whose goal is to help build the next generation of leaders in podiatry!


 


R. Andrew Pavelescu, DPM, Fresh Meadows, NY

10/16/2019    

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



From: Richard D Wolff, DPM


 



For the past 12 years of practice, I have had zero residual nail dust in my treatment rooms, but I understand where you are coming from. During my first two years of practice, I had the same issue. When I moved to a different office, I had a central vacuum system installed. The vacuum is in a closet and shared by all treatment rooms. The rooms are connected to the vacuum via 2" PVC pipe above the ceiling tiles. The noise is contained to the closet, which has 2" thick foam added to the walls. 


 


I bought a cone nozzle (#ACC-SHEATH) from Jan L. It attaches directly to the end of a Dremel Multi-Pro and has a 1/2" tube connection. I also bought a reducer from Allegro Vaccums. It reduces the 2" outlet down to 1/2". The last item was a piece of 1/2" vinyl tubing I purchased from the local hardware store. There is strong suction noise in the treatment room, but no motor noise. The vacuum also serves as a floor vacuum for each room and we vacuum in between patients. No nails, no dust. I Dremel every patient. It is still going strong after 12 years of heavy use. I'm guessing I have about $1,500 in the system.


 


Richard D Wolff, DPM, Oregon, OH


10/16/2019    

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



From:Pamela Hoffman, DPM, Ara Kelekian, DPM


 


I have used the vacuums from Jan L attached to my Dremel drills for over 3 decades. I have had no lung issues or dust problems. I have replaced several drills, but the vacuums have lasted. 


 


Pamela Hoffman, DPM, Katonah, NY


 


In our office, we use Surround Air units Multitech XJ3000C with replaceable filters. They have timers which make it easy to turn on and forget about it.


 


Ara Kelekian, DPM, Montebello, CA

10/14/2019    

RESPONSES/COMMENTS (NON-CLINICAL)


RE: Source for Koven Hadeco SmartDop 20 Manual (Conway McLean, DPM)


From: David Secord, DPM


 


The best I could find was this manual.


 


David Secord, DPM, Corpus Christi, TX

10/07/2019    

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



From: Pete Harvey, DPM


 


I use Telemed out of Atlanta. My fee is $119/month and well worth it. However, that fee does not include scheduling, but they do offer that service. My service is automated and they tell the patient the office is closed and to call during regular hours.


 


If it is an emergency, they advise the patient to call the ER. If I get an after-hours call, they send a text to my phone with the patient’s problem, and a blue "click-on" to call the patient back.


 


Pete Harvey, DPM, Wichita Falls, TX

10/07/2019    

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



From: Donald R Blum, DPM, JD


 



We use a service based in Frisco Texas called the Appointment Desk. Your patient will dial the local number (312-***-****) for your office and it will be answered (for example):


 


Appt Desk: "Good afternoon this is Dr. Hoberman's office how can we help you?"


Patient: "I would like to make an appointment."


Appt Desk would then open the schedule and make the appointment for the patient or the patient might ask about their bill and say:


Patient: "I would like to speak to the person about my bill."


Appt Desk: "We will transfer you."


The appt desk would then connect the patient to your office.


 


During all this conversation, the patient will presume they are talking to your office. Appointment Desk could also answer your phone on the fourth ring if you wanted. Hours for the Appointment Desk are 07:00 AM - 07:00 PM.


 


Donald R Blum, DPM, JD, Dallas, TX


10/03/2019    

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



From: Steven J. Kaniadakis, DPM


 


It seems that podiatry school programs are pushing for students to get more biomechanics instruction from their residency programs and other post-graduate programs. Podiatrists have  typically been very well versed in these (and other) subjects, including reading and understanding x-rays and radiology, surgery skills, etc. 


 


Generally, podiatrists have been very well educated before residency and other post-grad programs compared to other medical school students. Even some practicing MD physicians do not even know which way to hold an x-ray (unless they were in a radiology residency or fellowship specialty program). However, generally speaking, MDs are much better versed in labs, etc. 


 


Steven J. Kaniadakis, DPM, St. Petersburg, FL

10/03/2019    

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



From: Loretta Logan, DPM, MPH


 


As chair of the Department of Orthopedics and Pediatrics at the New York College of Podiatric Medicine (NYCPM), I feel it is necessary to respond to your recent comments regarding the current state of orthopedic training at the schools of podiatric medicine. While I agree with the consensus that the younger practitioners entering practice have placed surgery at the head of their treatment plans, the first sentence in point #1, “The undergraduate level of biomechanical training is apparently shameful as compared to when I was at ICPM 1977-1981” was particularly troubling.


 


I would be happy to share curriculum documents with you, which show the evolution and expansion of orthopedic training from...


 


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

10/02/2019    

RESPONSES/COMMENTS (NON-CLINICAL)



From: Robert S. Schwartz, C. Ped.


 


Since 1973, pedorthists like me have sat on the sidelines of this discussion and approach to helping our patients, clients, and customers. Foot health professionals can significantly improve their biomechanical skills by watching their patients stand and walk with shoes on and off. Evaluating their worn shoes is equally as effective. Shoes-on...check for fit. Shoes-off...check wear patterns, areas of high and low pressure, and shear. Check the effect of size, style, heel, design and construction, and any removable insoles on their foot problems. Try the above in your practice and your biomechanical skills will fly.


 


I represent the lion's share of pedorthists who are proud to work side-by-side with podiatrists and others in our communities to help improve patient outcomes.


 


Robert S. Schwartz, CPed, NY, NY 

10/01/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Doug Richie, DPM


 


I applaud Dr. Richie’s comments about the tragic devolution of our podiatry education away from the core discipline of biomechanics. The knowledge of biomechanics and foot function lies at the heart of our profession and must never be neglected.


 


Robert Frykberg, DPM

10/01/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: Knowledge Over Experience


From: W. David Herbert DPM, JD


 


I participated in my very first malpractice jury trial as the lead counsel almost 30 years ago. I was able to garner a nice verdict for my client. The defense attorney was a partner in a fairly well known malpractice defense firm in the San Francisco Bay Area.


 


Remember that if you are even a newly-minted podiatrist, you know more about the foot and foot function than just about all other physicians! I believe when it comes to saving a foot from amputation that our service is truly priceless.


 


W. David Herbert DPM, JD, Billings, MT\

09/19/2019    

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



From: Jeffrey Root


 



Dr. Udell states he has no idea why orthotic labs stopped sponsoring biomechanics at conferences and podiatry schools. As the owner of a prescription foot orthotic laboratory I can shed some light on the subject. The short answer is that there is no/inadequate return on investment. Sponsorships are essentially a marketing expense for most businesses. If an orthotic lab can’t benefit from a sponsorship or if it can’t afford to fund one for altruistic purposes, then they are unlikely to do so.


 


The economics of the custom foot orthotic manufacturing industry have changed over the years. There was a time when the exhibit halls at podiatry conferences had many foot orthotic labs in attendance. That is no longer the case. In fact, exhibitors at podiatry conferences are down in general. It's extremely expensive to exhibit, sponsor speakers, or to otherwise financially support educational content. As Dr. Richie indicated, foot orthotic labs have relatively meager budgets and have watched their profit margins shrink for many years, in part, because podiatry has become more of a surgical specialty. Unless that trend changes, you are not likely to see orthotic labs support biomechanics like they once did.


 


Jeffrey Root, President, Root Laboratory, Inc.


09/19/2019    

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



From: Alan Sherman, DPM


 


The always erudite Elliot Udell’s call to orthotic companies to support biomechanics education is currently being generously met by Scott and his son Robert Marshal of KLM, Michael Friedman of Redi-thotics, and Pavel Repisky of 8Sole, all of whom sponsor podiatric education. 


 


Doug Richie, DPM shared an important point: for podiatrists, there is so much more to biomechanics than orthotics. While all corporate entities working in the podiatry space should do their share, I would add that while we all appreciate corporate sponsorship, we can’t and shouldn’t ever rely on it to choose what is taught at the colleges or at the post-graduate level.


 


Alan Sherman, DPM, Boca Raton, FL

09/19/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: Speaker Compensation from Commercial Organization and Institutional Review Boards


From: Leonard A. Levy, DPM, MPH


 


I served for seventeen years as a member of the university-wide Institutional Review Board (IRB) for Nova Southeastern University. Research and scientific communication developed by university faculty was required to be reviewed to protect the public. This included the potential of papers being presented or published that had the possibility of an intrinsic conflict of interest and/or to assure human participant protection. For example, if it was determined upon review that a speaker or author received or was to receive financial support for a paper he/she was presenting or submitting for publication, IRB approval would be denied. This would be done for ethical reasons including the protection of human subjects who were employed in the study.


 


I understand the frustration of Elliott Udell, DPM, in this matter; but speakers/authors to receive funds to support their scientific study from a company that has a product or other commercial interest directly or even indirectly involved in what is to be reported by the author/speaker, are violating IRB requirements. In scientific journals, the result of IRB reviews are typically reported at the end of the article. Failure to have IRB approval or indicate if financial support from some commercial source was acquired can be an ethical violation and may even have legal consequences, possibly putting at risk the journal or organization at which the author is speaking. Furthermore, the veracity of a paper that received financial support from a commercial organization making a product that a speaker was articulating may be a conflict of interest.


 


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

09/18/2019    

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



From: Dale Feinberg, DPM


 


Dr. Borreggine’s excellent analysis of the future of podiatry hit the nail right on the head. He had been prognosticating that the demise of private practice was coming and now he has put out the word that private practice is dead. 


 


I started reading the tea leaves about seven years ago when the implementation of Obamacare started affecting my practice. Denial of payment for the medically necessary diabetic shoes was the opening shot in the war with...


 


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

09/18/2019    

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



From: Elliot Udell, DPM


 



Doug, in an ideal world, corporate entities would have no say in what is presented at medical conferences. We do not live in an ideal world. When I lecture at podiatry conferences, I don't always get paid and I have sometimes paid for my own room, board, and transportation, and given multiple lectures. Why do I do this? To be of service to my profession and the public it serves. There are others like me.


 


Unfortunately, this model is not sustainable even for me. Many conferences including ones that I have chaired cannot afford to subsidize all of its speakers or depend on all of its speakers to lecture for gratis. Hence, they have to turn to the corporate world for help or scrap the seminar. As for podiatry labs, when I started practice back in the 70's, Langer labs, Schuster labs, and other labs did sponsor biomechanics at conferences and at the schools. Why did they stop? I have no idea. 


 


Elliot Udell, DPM, Hicksville, NY 


09/18/2019    

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



From: Ira Baum, DPM


 


I couldn’t agree more with Dr. Ritchie. Without mastering the fundamentals; one can never become a master. Techniques to cure a deformity develop from understanding the root causes. With the exception of congenital deformities, abnormal lower extremity mechanics play a primary factor. John Wooden, the immortal UCLA basketball coach and philosopher, once said “If you only try to learn the tricks of the trade, you will never learn the trade.” The trade of being an expert podiatrist/foot and ankle surgeon is understanding the cause of the pathology and applying the solution. 


 


Regarding foot/ankle surgery - without understanding the biomechanical fault causing the deformity, even the surgeon with the greatest hands will fail most of the time. I say most of the time because in golf lingo, "Even a blind squirrel finds an acorn once in a while." Learn what our masters in biomechanics have uncovered and you’re on your way to becoming an expert. Regarding who sponsors lectures at symposiums is an issue, but whatever the solution, lower extremity biomechanics should be an integral part of most conferences, and all surgical conferences.


 


Ira Baum, DPM, Naples, FL

09/18/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Richard A. Simmons, DPM


 


I use Sammy EHR, but I would like to emphasize one point: whenever you see a demonstration of any EHR, you are simply watching the computer aspect of the visit. My dermatologist taught me an important lesson; that is, we are procedural specialists. As such, we are using our hands on our patients during most of the encounter and then we do our charting; a primary care physician can chart during the exam. So, my dermatologist said she uses a scribe for herself and one for each of the nurse practitioners in the office. Why? Because she can see more patients in an hour that way. Even if you have to pay $50/hour for a scribe (very high end!), you will still come out ahead financially because at the end of the visits and the end of the days, it’s all done.


 


Richard A. Simmons, DPM, Rockledge, FL

09/17/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Doug Richie, DPM


 


Dr. Udell suggests that orthotic labs should subsidize lectures at podiatry meetings and at the podiatry schools. This proposal underscores exactly why teaching the science of biomechanics has disappeared from all of the major educational symposia available to the podiatry profession. The content and speakers at these meetings have become heavily dependent upon corporate sponsorship and most of this comes from the wound care and surgical technologies industries.   


 


Foot orthotic labs with their meager profits and budgets cannot and should not be called upon to fund the teaching of an essential element of the podiatric curriculum. To assume that foot orthotic therapy represents the major delivery of skill and knowledge of biomechanics of the lower extremity is a sad conclusion. No student or resident should enter the operating room and be allowed to make an incision before mastering this subject. Biomechanics is an essential pillar of podiatric medicine AND surgery and should not rely on funding from commercial interests in order to maintain priority in our educational process.


 


Doug Richie, DPM, Long Beach, CA

09/17/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Steven Selby Blanken, DPM


 


I just switched to Sammy EHR. My old company is sunsetting and I had to get a new one fast. They are excellent with transition and if I knew the trainer was excellent, I would have switched earlier. Any worthwhile EHR is not, however, simple and fast. Feel free to contact me if needed.


 


Steven Selby Blanken, DPM, Silver Spring, MD

09/16/2019    

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



From: Elliot Udell, DPM


 



Dr. Borreggine is correct. One does not need to make an appointment to see a doctor in order to acquire a set of custom foot orthotics. This is not new. Making and dispensing foot orthotics has never been a practice which required a medical license. Orthopedic shoe stores, chiropractors, and physical therapists have been dispensing custom orthotics for years. What distinguishes a podiatrist from a "Joe Blow" working in a shoe store dispensing orthotics is our training in biomechanics. It’s the knowledge and training that enables the podiatrist to add corrections into a custom orthotic that distinguishes us from shoe store employees and others who make foot orthotics.


 


To this end, it would be great if the orthotics labs could roll back the clock and once again subsidize lectures on biomechanics and foot orthotics at every one of our conventions and at every one of our schools. That would once again make a real difference for our profession as well as the general public.


 


Elliot Udell, DPM, Hicksville, NY


09/16/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Alan Sherman, DPM


 


Dr. Borreggine’s comments about the “new class of DPMs” resonated with me. Certainly the podiatrists going to work for current podiatry practices or the growing podiatric super groups are joining practices that do a broad range of services that podiatrists have always been called upon to do. I’d like to hear from the growing group of podiatrists going to work for orthopedic practices, to see if they end up as exclusively surgical orthopedic foot and ankle specialists, or if not, what part of their practice ends up being treatment of skin conditions, nail issues, infections, and the rest of medical podiatry. Certainly there have always been non-surgical orthopedists and there will always be a demand for non-surgical orthopedists. 


 


I wonder if orthopedic groups that employ podiatrists even have an opinion on how they practice and pressure them to practice one way or another? I’m sure there is productivity pressure and some are compensated based on what they bring to the practice, but we know that non-surgical podiatry can be quite lucrative and in some cases, more than surgical podiatry. Ultimately, I think we all need to acknowledge that there is ample room for diversity in podiatry and that such diversity is an advantage for us as a profession. We are so used to believing that the more we all do surgery, the more respect we deserve and will get. That’s nonsense. We will get respect as a profession in proportion to how well we serve all of the public health foot care needs of the population, and we don’t do that best with only surgery. 


 


Alan Sherman, DPM, Boca Raton, FL

09/14/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 3B



From: Leonard A. Levy, DPM, MPH


 



Dr. Udell further emphasizes the potential role of podiatric physicians in primary care . The way that those in the profession practice, and the kind of patients they see not only makes this obvious, but contemporary podiatric medical education produces DPMs who are also educated, trained, and qualified to serve in that role compounded by the rapidly growing shortage of primary care physicians. These are only a few of the factors that make it virtually an obligation for podiatric physicians to be part of the team that can fill this major gap in healthcare.  


 


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