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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

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


01/06/2020    

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

01/02/2020    

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

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

12/24/2019    

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 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 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 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

11/27/2019    

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 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

11/21/2019    

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

11/11/2019    

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


11/11/2019    

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

11/07/2019    

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

11/06/2019    

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

11/05/2019    

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



From: Leonard A, Levy, DPM, MPH


 


Brent D. Haverstock, DPM said, "It would seem that if podiatry is to become a branch of medicine (MD/DO), the APMA would have to meet with the American Medical Association (AMA) and the American Osteopathic Association (AOA)..." This remark and so many others from podiatric physicians seem to indicate that the "appetite" for DPMs to acquire an MD or DO degree is rapidly increasing. However, before any meetings take place with the AMA or AOA and the APMA, it is essential that strategic planning take place to determine exactly what the profession needs to do and what needs to be done to get there. 


 


Such an activity must, at the least, include representation from the APMA, the Association of Colleges of Podiatric Medicine, representatives of the current licensing examination body (i.e., American Podiatric Medical Licensing Examination), and the bodies within our profession that represent both the accreditation of undergraduate podiatric medical education and graduate podiatric medical education (i.e., residency training). 


 


It would be a disaster if such a plan was not properly developed and members of our profession were not on the same page. Our effort needs to be one having a uniform voice devoid of bickering by individuals and groups in the profession. The strategic plan developed should be articulated in a document containing the background of the proposal, the state of the profession, including its current education and training, and a detailed description of what is being proposed. I suggest that the time is ripe to undergo such an effort but that it needs to be done very carefully. This formal process must begin now.


 


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

11/05/2019    

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



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

11/04/2019    

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



From: Alan Sherman, DPM


 



I’m confused by Leonard Levy’s most recent message in this discussion in the October 31, 2019 #6,539 issue, in which he refers to the “highly controversial proposal to have two specialty boards in the podiatric medical profession (i.e., podiatric surgery and podiatric medicine”. It’s not a proposal. We currently have these two specialty boards, ABPS and ABFAS. What we don’t have is two medical specialties. We have two specialty boards that represent one specialty, podiatry, and that structure is what is confusing the public and the medical establishment.


 


The proposal made by Jeff Robbins, DPM, supported by myself, Joe Borreggine, and now Brent Haverstock, DPM, is that our two specialty boards MERGE and form one board with sub-specialties, including advanced foot and ankle surgery and...


 


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

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