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01/30/2020    

RESPONSES/COMMENTS (NON-CLINICAL)



From: Simon Young, DPM 


 


Who cares? This is entertainment. Dr. Schaeffer is a much more handsome practitioner than me and has a good TV presence, as does the woman practitioner who, by the way, is very pretty. It’s great professional advertisement for our profession. The general public likes to see gross pathology corrected and a happy ending. 


 


Only thing I would ask is that they provide accurate information and do procedures by accepted medical techniques. Recently, a patient had an issue with onychomycosis. The nail was avulsed and was treated with laser, but was never sent for PAS. But what if it tested negative? Although laser is FDA-approved for onychomycosis, the literature does not back these findings. He should have discussed treatment options and chosen a treatment with correct medically-accepted information.


 


Simon Young, DPM, NY, NY

Other messages in this thread:


07/09/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 3



From: David Haile, DPM


 


“A foot conversation is a whole body conversation." I say this to every patient almost at every visit. 


 


David Haile, DPM, Sebastian, FL

07/09/2020    

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



From: Steve E Abraham, DPM


 


I had two patients who needed special attention for mask issues! Both were deaf and communicated by reading lips. I explained as much as I could by writing on a pad, and at times I felt like taking my mask off and just talking. I resisted and did the right thing.


 


Steve E Abraham, DPM, NY, NY

07/09/2020    

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



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

07/08/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Steven J. Kaniadakis, DPM


 


I feel that the quote by the Greeks, which has been cited or reported by Leonard Levy, was in fact, updated in podiatry schools to an expression as follows: "The feet don't just walk in to the office, the whole body walks in." It is one among my expressions in my practice I delivered to patients. 


 


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

07/08/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Mark Spier, DPM


 


There is no evidence to support that the general public, which doesn't typically wear masks for prolonged periods of time, will experience significant reductions in oxygen intake level, resulting in hypoxemia. While CO2 can build up in face masks, it is unlikely that wearing a mask will cause hypercapnia, according to the CDC. Anyone with a note from a physician with a purported medical exemption to wearing a mask for a few minutes in your office is not hypoxic, nor hypercapnic, but probably just full of hot air.


 


Mark Spier, DPM, Reisterstown, MD

07/07/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Elliot Udell, DPM


 


Dr. Shea gives one good example of why we need to be members of the American Podiatric Medical Association. There are many other reasons ranging from conferences, webinars, and day-to-day ways in which the APMA is only a telephone call away from each of our offices. There is, however, one master reason why in this troubling economic time we need to stay on the saddle and maintain our membership. The APMA represents and defends our right to exist.


 


If we did not have a unified body representing and defending our profession legally and politically, other professions would see to it that we would cease to be in the way we are entitled to exist. If you want to know what that would look like, ask any of us what the practice of podiatry was like thirty-five years plus ago. We have come a long way and will only stay that way if we continue to be unified under a common banner.  


 


Elliot Udell, DPM, Hicksville, NY

07/07/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Robert Kornfeld, DPM


 


And that is precisely why I have practiced functional medicine for the past 33 of my 39 years in practice. Treating the foot as if it isn’t attached to a complex body with genetic AND epigenetic influences is folly in terms of long-term management of good foot health. We are obligated to understand why our patients develop problems, and it’s not only biomechanics. Inefficiency in the repair pathway is often the reason for chronic pain. Finding the mechanism leads to successful treatment AND leaves the patient in a better state of health. Didn’t we take an oath to “do no harm”?


 


Robert Kornfeld, DPM, NY, NY

07/06/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2


RE: HHS Check and APMA 


From: Timothy P. Shea, DPM


 


How much is membership in the APMA worth? Recently, I was one of the few providers who did not receive stimulus checks from HHS. In spite of fulfilling all the requirements and continuing to work seeing patients, the program for HHS stimulus did not send any of the funds promised. In spite of numerous efforts on my part (contacting banks, local Medicare carrier, local CAC representative, and the HHS hotline provided (to name a few), it was a classic catch-22 where I was advised that I should be receiving the funds but nobody could  do anything about it.


 


I contacted the APMA and they assigned one of their very able attorneys to assist in trying to figure out what happened. Gail M. Reese, JD began to investigate this. After utilizing many avenues, yesterday, I finally received the funds appropriate to those promised. Because I provide care to a fair amount of patients on Medicare, the amount was substantial and will definitely assist in allowing me to continue with keeping the practice open.


 


Over the 40+ years practicing podiatric medicine, I have heard many excuses why podiatrists won't join the APMA. The most common is the dues! I can unequivocally state the amount of this one HHS stimulus check more than offsets the dues for APMA for many years. That is not taking into account all the other numerous other activities provided which benefit us every year. It's time for all podiatrists to join in our common effort spearheaded by the APMA. 


 


Timothy P. Shea, DPM, Concord, CA

07/06/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: The Part Can Never be Well Unless the Whole is Well


From: Leonard A. Levy, DPM, MPH


 


I truly believe that the following quote may have been written 2,400 years in preparation for podiatric physicians. In a play entitled Charimedes or Temperance written by Plato in 380 BCE, there is the following statement: “{A}s you ought not to attempt to cure the eyes without the head, or the head without the body, so neither ought you to attempt to cure the body without the soul. And this … is the reason why the cure of many diseases is unknown to the physicians of Hellas (i.e., Greece), because they disregard the whole, which ought to be studied also, for the part can never be well unless the whole is well.”


 


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

07/01/2020    

RESPONSES/COMMENTS (NON-CLINICAL)



From: Tiffany Kildale


 


Thank you, Dr. Udell, for serving as a mentor in the Mentor Network! Your service to the future of the profession is invaluable, and we’re grateful to have you.


 


APMA strongly encourages virtual shadowing, for both the comfort level of the prospective students, as well as mentors participating in the network. While the Mentor Network was briefly suspended during the height of pandemic in April, an email was sent to mentors in the network upon reopening, encouraging them to meet with prospective students via Zoom, FaceTime calls, or other virtual platforms. We encourage physicians to limit in-person interaction as a way to minimize risk and limit the number of people physically present in an office based on local capacity guidelines. Students have been made aware that in-person shadowing is not a guarantee, as every office has different rules and guidelines regarding reopening.


 


Thank you again for taking the time to talk with students considering a career in podiatry—you are encouraged to do so at your own comfort level!


 


Tiffany Kildale, APMA Career Development Manager

06/29/2020    

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



From: David Gurvis DPM


 



Wearing a mask in the office will not lower your O2 saturation (hypoxemia) nor cause an increase in CO2 (hypercapnia). There are some slight differences with the wearing of a well fitted N95 mask but even those are most likely non-consequential, but there are no current recommendations or need to wear an N95 mask in the office. Regardless, there should be no reason for supplemental O2 from wearing a normal face mask in the office. You can find many well written articles on line but I will offer just one.  


 


My goal here is not to put anyone down, but there is too much information out there and too many people refusing to wear masks and that is just one, of many, excuses they are making. As a disclaimer, I am forced to admit that never in our history have so many needed to wear masks for so long during a day so that there may be some conditions wherein a mask may cause hypercapnia or hypoxemia, but I propose they are rare.


 


David Gurvis DPM, Avon, IN


06/29/2020    

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



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 

06/26/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Tim Shea, DPM 


 


What a great question Dr. Simmons presents. My associate and I are both above 60+ and we were wondering why we were short of breath after about 4-5 patients, especially if we were talking. I think it is a combination of re-breathing CO2 and not getting as much O2 volume through the masks. We may try to have O2 available in the office. Thank you Dr. Simmons.


 


Tim Shea, DPM , Concord, CA

06/26/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: Advanced Beneficiary Notification


From: Paul Kesselman, DPM


 


CMS has announced today that providers should continue to use the current ABN despite the March 2020 expiration. A new form is currently awaiting approval and should be released later this summer, which should be good for 3 years.


 


Paul Kesselman, DPM, Oceanside, NY

06/25/2020    

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



From: Dennis Shavelson, DPM


 


In changing our focus and training towards surgery, as a profession, we are forced to become more and more vestigial regarding closed-chain lower extremity biomechanics. In medicine, a surgeon’s card reads that he/she is a surgical specialist. A physiatrist's card reads rehabilitation specialist, and a dermatologist's reads skin specialist, etc. They can and do consult outside of their specialty at a lesser level, but remain dedicated to one or more specialties. They consult with other specialists when their training and experience falls short of the problem at hand by putting the patient in the hands more expert than their own.


 


I can count the number of biomechanical consultations that I have received from surgeons in my 40+ years of podiatry on nine or ten fingers. Instead, I have fostered relationships where I can confidently refer the few surgical cases I am asked to consult on and in return, I am called upon to assist them biomechanically pre- and post-op. In summary, in becoming podiatric foot and ankle surgeons, we are practicing a stunted version of biomechanics and orthotics without incentivizing non-surgical podiatric consultants in integrative biomechanics, making DPMs like me more and more vestigial.


 


Dennis Shavelson, DPM, NY, NY

06/25/2020    

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



From: Marc A. Benard, DPM



 


I agree with Dr. Ribotsky with respect to a distinct absence in gait analysis and applied biomechanics, as well as his indicating “… are we losing the skill to determine the difference between open chain kinetics and closed chain kinetics pathology? If so, how can correct surgical procedures be explained?” I can attest that I observe this deficiency at close hand through my didactic lectures to residents both in person and recently via webinars, as well as through on-site observation at Operation Footprint (formerly The Baja Project for Crippled Children) during patient screenings, grand rounds, and intra-operatively. I’ve also engaged in discussion with program directors on the problem.


 


In truth, the problem has always existed, if my 43 years of dealing with the issue holds any validity. Fundamentally, the partitioning of “biomechanics” and “surgery” fractionated the...


 


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


06/25/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: DEA Fee Proposes Increase of 21%


From: Paul Kesselman, DPM


 


If things were not financially taxing for all providers right now, the government has found another instrument to take some hard-earned money from healthcare practitioners and any entity involved in the distribution or manufacturing of controlled substances.


 


The DEA is now proposing a 21% increase ($731 to $838) for the triennial registration. This is especially outrageous for many podiatrists or healthcare providers who have chosen to discontinue performing procedures or seeing patients where prescribing...


 


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

06/24/2020    

RESPONSES/COMMENTS (NON-CLINICAL)



From: Steven E Tager, DPM


 


No Bret, you're not alone. I have experienced the very same emotional response at almost every seminar attended over the last 54 years of my practice life. Frustrated, I've reached my limit and no longer wish to hear about the surgical exploits that continue to evolve in favor of newer and better procedures. It's possibly for the best that it has taken its toll on me, for it has forced me to think more about cause and effect, what works and what doesn't, and to do it without doing harm.


 


Credit for my actions must go to Drs. Mert Root, John Weed, and Bill Orien for an eye-opening education, giving me the insight to evolve and learn on my own. Recognizing that surgery may well be the answer for many. I too am concerned that many procedures performed today (and yesterday) are without considering the underlying bio-mechanical etiology.    


 


Steven E Tager, DPM, Scottsdale, AZ

06/23/2020    

RESPONSES/COMMENTS (NON-CLINICAL)


RE: Where Did Biomechanics, the Foundation of our Profession, Go?


From: Bret M. Ribotsky, DPM


 


Over the past few months, I have been spending many hours on webinar after webinar and two significant observations have become crystal clear to me. 1) It’s incredible how bright and surgically talented the young presenters are with their operative skills and 2) The foundation that separated our profession from orthopedics has been overlooked. From lectures on bunion surgery discussing hypemobility of the 1st met-cuneiform joint to hammertoe surgical reconstruction, there is ZERO discussion on the biomechanical etiology of these conditions.   


 


Gait analysis and applied biomechanics are what has and will make our profession catapult forward. I often ask about the biomechanics on these webinars, but the question, if chosen is barely answered. With ABPOPPM (now ABPM) and ACFAOM (now ACPM) dropping the word “orthopedics”, are we losing the skill to determine the difference between open chain kinetics and closed chain kinetics pathology. If so, how can correct surgical procedures be explained? As a past president of ACFAOM (1999-2001) I am very worried with the direction our profession is going. Am I alone?


 


Bret M. Ribotsky, DPM, Boca Raton, FL

06/12/2020    

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



From: Richard M. Maleski, DPM, RPh


 



Although I am now retired, while I was still practicing, I was gradually reducing the number of nail patients that needed grinding. I had many patients use either Vicks VapoRub or BenGay Rub on their nails a few days before their appointment. These inexpensive and readily available products work extremely well to soften the nails. They contain menthol and /or methyl salicylate; both are salicylates, and thus both are keratolytic. I practiced in a low income area and I was never comfortable with office dispensing of higher priced products, and very often PA Medicaid didn't cover urea products. Practically everyone could afford Vicks VapoRub. We all know that these products aren't useful as antifungal agents as many people believe, but they work remarkably well to soften the nails. That, in addition to sharpened nail nippers, will reduce the need to grind most of the nail patients.


 


Richard M. Maleski, DPM, RPh, Arnold, PA


06/12/2020    

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



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

06/11/2020    

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



From: Elliot Udell, DPM


 


Thank you Dr. Markinson for once again reminding us of the non-COVID-19 risks associated with grinding toenails. Several responders have legitimately asked how to adequately soften nails so as to properly debride them without the use of an electrical drill. 


 


As an allergy sufferer, I had to limit nail grinding very early in my career. I coughed and wheezed, even with the use of dust extractors. When papers came out showing that breathing in nail dust was an occupational hazard, I took all of the drills and extractors to the nearest dumpster. Some papers showed that the dust remains in the air for over 11 hours. 


 


There are ways to soften nails so that they can be adequately debrided. Spraying the nails with "Three Way Solution", often works. Another way is to dispense some of the nail softening products and insist that the patients use them daily between visits. We get great results with Bako's 40% urea nail gel as well as other products such as Formula 7. We have found that if the patients use these as well as other urea containing nail products, there is no need to mourn the use of nail grinding devices. 


 


Elliot Udell, DPM, Hicksville, NY

06/11/2020    

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



From: Charles Morelli, DPM


 


You asked to "detail your techniques for reducing toenail hypertrophy". It has nothing to do with technique and all to do with having sharp instruments. If, and only if, your instruments are sharp, can this be done relatively easily and without pain to the patient. A dull instrument will do a less than optimal job and be painful for the patient if you are trying to reduce nail thickness. That being said, I do grind nails, have used a vacuum extractor for the past 30 years, and I now also wear a mask and will continue doing so, long after COVID is gone. I'd be embarrassed to have some patients leave my office without my doing that, but that is just me, as I know others will disagree. 


 


Charles Morelli, DPM, Mamaroneck, NY

06/11/2020    

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



From: Alan Bass, DPM


 


Let me begin by saying that this is my opinion only. In the last 25+ years of practice, I have seen some, if not most, of the governmental programs that have been rolled out by CMS. I understand that CMS has tried to reinvent how physicians practice medicine and guide them towards providing quality care. Even without this push from CMS, I believe that all physicians have tried to provide quality care to patients. Are there physicians out there who have tried to “beat the system”? Sure, but I believe that most physicians have always tried to do the right thing.


 


The MIPS system, as it currently is, and what it is morphing into in the coming years is about one thing, data gathering. It was the same thing with Meaningful Use. The Meaningful Use program was supposed to move physicians away from quantity and towards quality. Did it do that? Not at all. What did it do? All it did was...


 


Editor's Note: Dr. Bass' extended-length letter can read here

06/11/2020    

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



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
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