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From: Ira Baum, DPM 


Dr. Levy speaks from experience and knowledge, but the practical response from Dr. Purdy would be more effective and efficient. Taking into consideration the healthcare environment today with respect to student debt, years in training, and reimbursement schedules for podiatrists, it doesn’t make a lot of sense to pursue a regional specialty that other medical professionals serve based on a system specialty. There was a time for that type of specialty, but that time has passed. The train has left the station.


The obvious obstacle to transitioning DPM to MD/DO is the solid structure of the podiatric medical systems. Until those systems realize the future of the profession and see the value for those in leadership positions of our associations, educational institutions and boards to change, podiatrists' recognition will remain unchanged, and our war for parity will be never ending. Unfortunately, it is the grassroots podiatrists who will suffer for their inaction. I strongly recommend those in leadership positions to consider these points and begin to explore options and opportunities for change.


Ira Baum, DPM, Miami, FL

Other messages in this thread:



From: Robert Scott Steinberg, DPM


Sorry Dr. Spier, but CO2 does not "build up" behind the mask. Yes, there is a minuscule amount that may be retained within the mask, but since masks are exceeding loose-fitting, it could never be a physical problem, and most likely just a psychological one. I have a right to protect myself and my staff. I would refuse treatment of such a patient, and if it is an urgent problem, I would send them to the ED. We tell patients they must wear a properly fitting mask that completely covers their mouth and nose, made out of appropriate material. No pantyhose or bandana-like materials. 


Robert Scott Steinberg, DPM, Schaumburg, IL



From: Robert Scott Steinberg, DPM


Your surgical mask is not the cause of your low oxygen saturation. Look elsewhere. Here is some science


Robert Scott Steinberg, DPM, Schaumburg, IL 



From: Roy Perles, DPM


I never liked grinding toenails because of the inhalation risk of nail dust, difficulty sterilizing the burrs, and it's cost prohibitive to use fresh sterile burrs. Nail dust extractors are expensive, especially if you have to buy multiple units. About 15 years ago, my last Dremel drill broke, and that day I just picked up a sterile #15 blade, and with an alcohol-saturated gauze pad essentially "whittled" the sharp edges. I have not grinded a toenail since then.


At 15-25 cents per blade, you're delivering quality safe routine foot care with no risk of cross contamination from the re-use of burrs. There is a learning curve, but with practice, it's just about as fast as grinding. Occasionally, a patient may say, ''my other podiatrist grinded my toenails, why don't you?'' My answer is simple, ''You always get a sterile blade." I would ask the patient if their other doctor used a fresh sterile burr? Most patients replied ''no''. I am surprised that using a sterile scalpel blade for nail grinding has not been mentioned before.


Roy Perles, DPM, Cambria Hgts, NY



From: Gregory T. Amarantos, DPM


Prior to MIPS, we had MeaningLESS use. Unless you are an epidemiologist employed by the government, there has been no value to the populace at large. It is a way for those in the ivory towers to penalize those sheep who refuse to be led to slaughter.


Gregory T. Amarantos, DPM, Glenview, IL



From: Todd Lamster, DPM


Since this topic has resurfaced, it is likely that some (or a lot) of us are grinding toenails. Many of my patients experience pain when cutting from the dorsal surface, or I find that the nail bed and hyponychium have become hypertrophied as well, reducing my ability to thin the nail due to risk of bleeding. Those of us using a rotary device would likely say that both hazards are reduced. In an effort to collectively end this practice of nail grinding (which I advocate), I ask my colleagues who are not using a rotary device to please detail your techniques for reducing toenail hypertrophy.  Specifically, address two items:


1) How to reduce a truly thick nail or dome-shaped nail structure without cutting through the elevated or thickened nail bed and hyponychium? 2) How to reduce the jagged edges that are the result of nail cutting using standard clippers? If hand instrumentation is used (as was suggested in an earlier post), what device is being used specifically?


Although this ongoing discussion may seem naive to some, I think now more than ever, it is important to standardize this process to reduce occupational risk and exposure.


Todd Lamster, DPM, Scottsdale, AZ



RE: Grinding Nails During the COVID-19 Pandemic (Elliot Udell, DPM)

From: Bryan C. Markinson, DPM


I am surprised that it takes the COVID pandemic to raise old questions and concern about hazards of nail dust inhalation for those clinicians still doing nail grinding. For all of you new or young in practice, I beg you to read almost any article on the long-term hazards of nail dust inhalation, (not to mention what it does to your work environment) having nothing to do with COVID and the potential heath effects on clinicians that may not be evident for many years, and hope that you stop doing it ASAP. For older clinicians, to continue to do it is insanity in my opinion. I have not grinded a nail in 25 years and do as much nail care as anyone.


The occasional patient who complains about a sharp edge doesn’t fit into my reconstructive foot and ankle persona anyway. (Tongue in cheek just in case someone thinks I may be self-misrepresenting ). Nail dust extractors? Water jets? Use them when you assign your grinders to the hobby space in the garage. But don’t take my word for it. Take the time to read about it and remember the ill effects can take decades to manifest.


Bryan C. Markinson, DPM, NY, NY



From: Michael J Marcus, DPM


1.  For our patients who require nail debridements, I have recommended that mechanical debridements be performed with hand instrumentation only. Use of power instrumentation causing plume must be avoided if possible. Refrain at this time – two months from now things may be better. We haven't had any patient complain - just inform them and most should understand.


2. In surgery, my concern is with electrocautery and its plume. I attempt to avoid its use when possible. Use ties or just compress. Use close suction systems if needed. Treat all patients as if they are possible covids.


Michael J Marcus, DPM, Montebello/ Irvine CA



From: Elliot Udell, DPM


By and large, the transmission of this deadly virus has been found to be from inhaling respiratory droplets. The big "but" is that everyday things are changing with regard to how this virus can spread. What would make an interesting research project would be for some podiatrists to collect nails from patients infected with the coronavirus and have a lab determine if the virus is present on the toenails. If so, than grinding would be dangerous. 


Elliot Udell, DPM, Hicksville, NY



From:  Craig H. Thomajan, DPM


I can report good to excellent results with this technology. I have been using Swift therapy for native and recalcitrant plantar verruca for approximately 6 months. Generally speaking, the younger the patient, the stronger the immune system, the less treatments are required. We see visual improvement in dermatoglyphics after one treatment regardless of the number of lesions presenting. We have used the system approximately 50 times with no adverse side-effects, no scarring.  


The device is simple to use. We have found that using a needleless injector to deliver a small aliquot of anesthesia prior to the therapy allows us to start at maximum wattage to deliver the energy needed to elicit an immune response with little to no pain. We are averaging resolution between the second and third treatment.


Craig H. Thomajan, DPM, West Lake Hills, TX



From: Martin Pressman, DPM


I don’t know for sure what the diagnosis is in this case. That said, High on my list is neuroma. Neuromas need to be 4mm before they are visible on MRI. Intermittent forefoot  pain that is severe with “ fullness” sounds to me like a neuroma. Diagnostic nerve block may help and test interspaces for hypoesthesia sharp/dull. Neuromas are great pretenders!


Martin Pressman, DPM, Milford, CT



From: Lorraine Loretz, DPM, MSN, NP


Knowledge of the foot and related specialties varies greatly among primary care providers, regardless of credentialing. NP classes and clinical rotations focus on internal medicine, family practice, geriatrics, and pediatrics. Exposure to Ortho and other surgical specialties is minimal during NP school, and most NPs who work in these fields receive post-grad training on the job and through continuing education. 


Working in vascular surgery as a dually-credentialed DPM/NP, I am fortunate to be involved with NP/MD post-grad education and often deliver lectures or workshops on my areas of expertise, especially on the diabetic foot. The education is very much appreciated by all providers: NPs, PAs and MDs. I think the important thing with your experience is that the NP knew to reach out to you for help, and was grateful for the information you imparted.


Lorraine Loretz, DPM, MSN, NP, Worcester, MA



From: David S. Wolf, DPM


Kudos to both podiatrists in this reality TV series, who exemplify the finest in our profession. They will educate the public of the scope of our practice and will augment what the APMA has attempted to accomplish. We have all seen the pathology of these TV patients but at least now, it will be seen by millions of viewers. What a positive PR coup for our profession. Wish I would have thought of it.


David S. Wolf, DPM, (Retired) Houston, TX 



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



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



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



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



From: Robert Scott Steinberg, DPM


Yes, the train has left the station, and I hope for good. Those who think differently just don't get it. Just as we get our schools to move to a complete set of courses, matching those of medical students, the last thing we need is to divide us into tiny pieces, each of which will be ignored and lost on other physicians and patients.


More than anything else, doctors of podiatric medicine need to become a stable, cohesive profession, and anyone attempting to divide us should be shown the door.


Robert Scott Steinberg, DPM, Schaumburg, IL



From: Charles M Lombardi, DPM


All this musing about two separate training programs is amusing to someone who has been around for some time and has been intimately involved in the progression of this profession. In 2000 or 2001, the CPME ad hoc committee to rewrite the 320 document recommended to the HOD and the community of interest three separate programs: A 2-year surgical, a 3-year surgical, and a 2-year primary podiatric care program. The APMA HOD and the community of interest REJECTED it outright, stating that ALL podiatrist must be trained the same. Some of the SAME people that were opposed to a separate primary podiatric care program are now in favor of it. The ABPS argued against a unified program, but lost the battle.


Now looking back, the unified program allowed many states to change the scope of practice laws because one of the arguments against us was a lack of unified training. Much good came from that decision. I was always in favor of two separate training tracks, but that train has left the station. To hear the SAME people who were opposed to a separate training program in 2001, but now say our profession must have two separate training programs are in psychiatric terms schizophrenic. Our profession would be considered a schizophrenic profession by lawmakers.


Charles M Lombardi, DPM, Flushing, NY



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



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



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.



From: Jay Berenter, DPM


In response to the question about to where to find a scribe, I have been using HelloRache, a virtual scribe service for over 2 years. They provided me with an excellent virtual scribe who is based in the Philippines and is "in" our office daily. He is efficient, on-time every day, and dedicated to his job. My staff and I consider him a vital and trusted employee (I even got an invitation to his upcoming wedding next month). This service comes at a fraction of the cost of a scribe that is based locally. I highly recommend taking a look.


Jay Berenter, DPM, San Diego, CA



From: Peter Smith, DPM


Robert Teitelbaum states that he hopes the verdict against Johnson and Johnson is the beginning of a turnaround. In my opinion, the verdict against J&J is a joke!  They make pills that help people. They do not prescribe them, dispense them, or hold people’s mouths open and force them to swallow them! Our culture of passing blame instead of assigning personal responsibility is poisoning our youth and may be the downfall of our society. Should Anheuser Busch be blamed for alcoholism? Should Smith and Wesson be blamed for murders committed with their guns? Some might say yes, but not me.


And by the way, since the post was really about the cost of medicine, the next time Johnson and Johnson raises their prices, ask them if it has anything to do with the half a billion dollar verdict against them.


Peter Smith, DPM, Stony Brook, NY



From: Simon Young, DPM


Adding healthier people to this pool might result in lower costs. But "Medicare for all" will result in a government program and when government runs out of money, they usually cut medical, school, arts and sciences, sports, and school lunches.


Listening to the debates, I think a Medicare public option will be the correct path, and let private insurances compete. Private insurances made (according to Sen. Bernie Sanders) $100 billion stealing from doctors and stealing more from DPMs. I have no pity for these middlemen. These middlemen have harmed a lot of private practitioners and, in my opinion, are intent on burying private practice for hospital-based treatment.


Simon Young, DPM, NY, NY



From: Joseph Borreggine, DPM


I have been using VoIP for the last 4 years. There is a definite difference in phone voice quality since it is digital. There are also many extra features beyond the scope of this answer that will benefit your business. The only thing that is bad about VoIP is that when the Internet goes down, you lose your phone service. I use Consolidated Communications based in many states throughout the U.S.


Joseph Borreggine, DPM, Charleston, IL

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