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02/03/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: ABPM Non-Recognition of Residencies


From: Vladimir Gertsik, DPM


 


Since primary podiatric medicine, podiatric orthopedics, and other names are gone (with their respective residencies), it is time to acknowledge that most non-surgical podiatrists are pretty much the same. Some see more kids than others, some do more orthotics than others, but we are still mostly podiatrists. I appreciate the name change. But what I do not appreciate is the stubborn refusal of the Board to recognize their own residency types (now obsolete but nevertheless CPME-approved at their time). 


 


All podiatrists who have in good faith completed a residency program should have a pathway to board qualification. ABPM does not recognize its own residencies! Why should these pathways ever be closed? This is absurd. If a 2-year residency was acceptable 20 years ago, why is it no longer acceptable? Do 20 years of practice count for anything? Apparently not. What are these boards trying to prove, and to whom? Since there is no logic in all this, I feel that this board is not legitimate.  


 


Vladimir Gertsik, DPM, NY, NY

Other messages in this thread:


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 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 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 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

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 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 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.

06/12/2020    

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 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

06/10/2020    

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



From: Michael M Rosenblatt, DPM 


 



Bryan C. Markinson, DPM, warned us about the risks of grinding nails and breathing in the detritus and fomites that erupt in that “cloud.” He states he has not ground nails for years. I practiced during the HIV-AIDS crisis. I treated infections, did open debridements, and ground nails for those patients. Those who grind nails all recall the experience of accidentally touching the nail groove with the spinning grinder and erupting into a shower of blood that would go into our face, nose, eyes, and mouth, even if partially covered by a mask and eye protection.


 


Unfortunately, avoiding this is not an easy answer. Sometimes hypertrophic, fungal nails are a real problem in fitting into footgear for diabetics and other fragile patients. Removing thse nails surgically is not always an answer, as some of these people have very poor...


 


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


06/10/2020    

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



From: Jack Ressler, DPM


 



I cannot give an answer as to the effects concerning catching COVID-19 by inhaling nail dust during debridement. I have included a short video we made a few years ago which shows the difference between using and not using a nail dust extraction system. This video shows the amount of nail dust that becomes airborne during debridement. As you can see, the amount of particles/dust that is produced is very concerning. The video shows the difference in the amount of nail dust produced with and without using our nail dust extraction system. I am sure eventually there will be studies showing the possibilities of contracting COVID-19 from inhaling nail dust particles during debridement. Even without that threat, we all know the significant health hazards to ourselves, staff, and patients breathing in nail dust during patient care. 


 


Jack Ressler, DPM, Delray Beach, FL


06/10/2020    

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



From: Brian Kiel, DPM


 



I have not used a drill to grind nails in at least 35 years. When patients ask if I will do so or ask why not because their other podiatrist did so, my answer is always the same. The nail dust is aerosolized and there is no way to prevent it from getting into the environment; therefore it is in the air that we and the patient breathe, and on the chair in which they sit. I tell them I don’t want them breathing in or sitting in someone else’s nail dust. This resolves the problem in 99.9% of the cases. In those that it doesn’t, I am happy to refer them elsewhere as I don’t think it appropriate to endanger my or my staff's health. 


 


Brian Kiel, DPM. Memphis, TN


06/10/2020    

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



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

06/09/2020    

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


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


From: Daniel Chaskin, DPM


 


I would like to thank Elliot for his suggestions. If T. Rubrum or Candida dust were to bind to the ACE-2 receptors, there might be possible problems with too much vasoconstriction, etc. Combine this with COVID-19 and there just might not be enough receptors to convert angiotensin 2 to a more benign form.


 


Daniel Chaskin, DPM, Ridgewood, NY

06/09/2020    

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


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


06/08/2020    

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



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


06/08/2020    

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



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

05/25/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Daniel Kormylo, DPM


 


I have used Rick Pruzan for all my Midmark repairs. He is a great guy and certified by Midmark. He is based out of Northport, NY


 


Daniel Kormylo, DPM, Rocky Point, NY

05/22/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Corey Fox, DPM


 


We use Henry Schein. Sometimes repairs can be onsite, other times it will have to be boxed up and shipped out. If you're lucky, they may have a loaner. When it comes time to buy a new autoclave, don't wait until this one is completely dead. Keep the old one serviced and operational for times like this. They do NOT make things like they used to.


 


Corey Fox, DPM, Massapequa, NY

05/21/2020    

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



From: Alan Bass, DPM


 



I heard about the Swift device in 2019 and I leased it in November 2019 while at the AAPPM conference in Daytona. I leased it specifically because of one patient with recalcitrant interdigital warts. I have been very happy with my decision. I leased the unit for 5 years. I have had very good results with several patients in this short period of time. The unit is very easy to use. The treatment protocol is very easy to follow. I have heard from other DPMs that they are also happy with their investment.


 


Disclosure: I am a consultant for Saorsa, the distributors of Swift.


 


Alan Bass, DPM, Manalapan, NJ


05/21/2020    

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



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
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