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From: John Moglia, DPM,


Urban legend declares the highest rate of suicide in the medical professions is assigned to dentists. The highest rate of being murdered is associated with cosmetic surgeons. For divorce by infidelity, gynecologists. For drug addiction, the prize goes to anesthesiologists. According to the PM News Quick Poll, 34% of podiatrists are still burring down fungal or dystrophic nails without a nail dust extractor. Are there any published studies showing higher rates of lung cancer or death by lung disease attributed to podiatrists?


John Moglia, DPM, Berkeley Hts NJ


Editor’s note: We are unaware of any such study. However, in Podiatry Management's latest annual survey, 11% of podiatrists reported respiratory problems.

Other messages in this thread:



From: Al Musella, DPM, Robert Scott Steinberg, DPM.


The valves on the mask do help you breathe easier but also spread your germs.


Al Musella, DPM, Hewlett, NY


If your mask has an exhaust valve, how does it protect the patient from us?


Robert Scott Steinberg, DPM, Schaumburg, IL


Response: That's the reason why we require all patients to also wear masks. Both podiatrists and patients need to protect themselves.


Bret Ribotsky, DPM, Boca Raton, FL



From: Bret Ribotsky, DPM


I noticed last week’s PM News Quick Poll results and I was very surprised with the outcome. There is a difference between a surgical mask and N95 respirator. This CDC infographic should clear this up. Just like how we all used “Universal Precaution” to mean we must practice as if every person was infective with AIDS twenty+ years ago, everyone must continue to practice as if everyone has COVID-19.  


A surgical mask does NOT protect the wearer compared to an N95 mask. PLEASE wear an N95 mask (you and your staff deserve the best). I suggest you purchase five masks for each team member/employee and label Monday-Friday. This way each mask sits dormant for 6 days between use  (enough time for any virus captured to be neutralized). While not practicing due to my disability, I purchased boxes of 3M N95 masks with exhaust valves from Dia-Foot and received them quickly, as living in South Florida is a crisis area for COVID now. Let’s never forget common sense.


Bret Ribotsky, DPM, Boca Raton, FL



From: Dennis Shavelson, DPM


Dr. Busman, unless a DPM works for a hospital or group as an employee, we are all in business. The COVID-19 and post-pandemic age has extra income streams playing a vital role in practical longevity. Your muse regarding “Home Self-Podiatry Care” sent chills down my spine too.


My model is a “Do It yourself with professional help” methodology in response to the disruptive changes that hunkering the masses, social distancing, and health guidelines are having on one’s ability to appoint to live encounters, consultations, therapy, and hygienic procedures, creating risky and dangerous delays. My platform is a repercussion to co-morbid, unskilled, poorly educated, and disoriented individuals purchasing OTC tools and giving themselves a non-hygienic pedicure in the bathroom with disastrous results.


I am functioning as a virtual podiatry trained educator. I am acting as a coach, trainer, mentor, and monitor for those who cannot go to a salon or consult with a podiatrist due to the alarming health and economic times. I am dispensing tools and offering services that are being strongly disclaimed in addition to being insured. I err in the direction of advising those that do not have an assistant at home or are lacking in personal skills to use a salon or to visit a DPM in person for “podiatric care”.


Dennis Shavelson, DPM, NY, NY



From: Richard J. Manolian, DPM


In reference to Dr. Shavelson’s letter and his modern accommodation to mycotic nail care, I feel that the selling of instruments for patients (especially high-risk patients) to do self-care, whether monitored or not, is irresponsible and is putting patients in a position for complications.


Also, switching to an all telemedicine-based practice is almost assuredly a recipe for practice failure based on the RVU value of such services and the time required. Additionally, is there a tax that has to be included in the sale of such pedicure instruments and grinders? Nothing against you doctor, but let’s not take a step backwards in the reputation of podiatry in promoting such a so-called modern/tech savvy practice alteration.


Richard J. Manolian, DPM, Cambridge, MA



From: Dennis Shavelson, DPM


Dr. Albright, I also heeded Bryan’s message but have chosen a different path then adding more expense, time, and potential danger to my practice. My laser, my instruments, my air purifiers and my super HEPA vacuum grinder are for sale (offers considered), and I have, over these last few months, successfully made the switch to teleHealth pedicures. I dispense maintenance level (not too strong) power callus files and power nail grinders as well as pedicure instruments and ingrown toenail instruments along with face shields to current and future clients. I sell them OTC products such as chemical peels and topicals, and monitor their use on Zoom. The program requires an assistant (or self-care if capable) and an initial consultation to customize their program. I then use telehealth visits to demonstrate, coach, and monitor treatments from afar and remain available to do their medical and surgical podiatry in the office.


My staff and I are safer, my office is cleaner, and dare I admit, more professional. I am also gaining a new type of patient who can no longer get a convenient pedicure in a salon due to "new rules" including those that are disrupting the convenience, and health and safety of salons. I can do telehealth from anywhere, anytime, and it is very marketable as a positive buzz in social media.


Dennis Shavelson, DPM, NY, NY



From: Steven Kravitz, DPM


The recent PM News poll reflected that wound care was by far the least impacted aspect of podiatric practice by the current COVID-19 pandemic. Surgery was affected nearly 60%, routine foot care nearly 30% affected, but wound care less than 2% affected. Additionally, I continue to have numerous contacts with multiple podiatrists in private practice and wound healing centers throughout the country.


My personal general impression is that the majority report that 75 to 80% of the pre-COVID-19 patients are returning, and there's an increasing number indicating the return approximating 100%. Most recently, a new finding is that some practices are reporting is much as 120% pre-COVID-19 because they picked up patients from surrounding practices that have been closed or otherwise had patients referred to them.


These observations exclude...


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



From: Estelle Albright, DPM


Thank you Dr. Markinson for your advice: I will further refine my methods of nail care with improved type face masking, and face and head cover, similar to operating in the OR. Currently, I mask and glove, wear glasses, and use sharp, sterile-bagged double action bone cutters for hard nails and use Miltex 40-226A nail nippers for non-dystrophic nails. I do not grind nails.


I treat fungal or dystrophic nails medically with oral antifungals and/or nail softeners, or surgically with matrixectomy or nail avulsion. My aim is cure, not maintenance. Granted, this is not an option for some patients, but for most, be the physician that you are: Treat with your best knowledge and skills.


I use a 12 month treatment plan for non-surgical nail fungus patients. This includes ketoconazole shampoo for foot washing, topical antifungals, environmental clean- up/disinfection instructions, patient education/brochures, and UV light shoe disinfection with SteriShoe/similar device. I have a very good cure rate. Many of these patients had severe, chronic nail and skin infection (often since military service, or with poor circulation or diabetes). Patients are happy and grateful to be cleared of the infection. I follow patients at 4, 8 and 12 months. I think that ultimately podiatry will endorse protection like I see at my dentist's office; this is surely the path of the future.


Estelle Albright, DPM, Indianapolis, IN



From: Steven Finer, DPM


I find that statistic of 34% quite shocking. From day one, in the prehistoric era in 1976 and onward, I had a Sanivac and an air cleaner in the treatment room. I modified the tube myself, adapting vacuum store parts to deliver suction to the drill head. Patients would look at the air cleaner and assume it was an air conditioner or a dehumidifier. When I would arrive at the office, I would always touch surfaces to see that they were cleaned. 


Disclosure: I have no financial relationship with Sanivac. 


Steven Finer, DPM, Philadelphia, PA 



From: Bryan C Markinson, DPM


A simple search of the global microbiological, occupational science, radiological, and infectious disease literature dating back 2-3 decades will reveal a plethora of citations in the potential dangers and actual incidence of respiratory illness from inhaled nail dust and the microbes that tag along with it. A British NHS study reveals 4x the incidence of asthmatic-type illness among podiatrists.


If Dr. Moglia won’t be convinced until he sees dramatic numbers of lung cancer cases, which he won’t, then he should stop wearing seat belts and bicycle helmets. And another word to the wise, should any podiatrist be immunocompromised by any number of medical issues and or

treatments, the risk is...


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



From: Elliot Udell, DPM


I hope that the 50 state podiatry associations and the APMA will prevail upon state boards to either suspend or reduce the amount of CMEs needed because of what is happening. I live in New York and could not renew my driver’s license because all motor vehicle offices are closed. The state has extended auto licenses due to the pandemic. It would only be fair, for the same reason, to reduce or eliminate CME credits. Not every practitioner is computer wise enough to properly get their credits online. This could change, but at this point in time, the state boards need to be more practical.


Elliot Udell, DPM, Hicksville, NY


Editor's Note: New York State has recently extended the period of time for unlimited online CMEs for those whose licenses expire between now and September 1, 2020.



From: Daniel Chaskin, DPM


Every state society that has CME meetings should also offer those meetings online. They should also send letters encouraging every state podiatry board to advocate for 100% of online CME credits be accepted to renew a license from now on. The coronavirus may re-occur anytime in the future. Currently, some of those podiatrists whose licenses renew soon who want to get CMEs are forced to put their health at risk by attending in-person meetings.


Daniel Chaskin, DPM, Ridgewood, NY



From: Jeffrey Bean, DPM


Don’t panic about our profession losing its expertise in wound care. Lack of a specific wound clinic rotation does not mean lack of wound care experience. Most podiatry clinics in most residency programs have a high volume of intensive wound care without a dedicated wound clinic rotation.


Think about it. Just because a residency program doesn’t have a dedicated “bunion rotation” doesn’t mean it does not adequately train its residents in treatment of bunions. I don’t work in a wound clinic, but I still treat a lot of wounds in my office and at the hospital. So do the residency affiliated podiatry clinics. It’s okay, take a deep breath and relax.


Jeffrey Bean, DPM, Carson City, NV



From: Chris Seuferling, DPM


I was surprised to learn that wound care is NOT part of many podiatric residency programs. How did this happen? Was it financial... logistics....oversight? Do some residency programs lack access to wound care centers or similar resources? Or are we trending away from wound care training in order to focus more on achieving foot/ankle surgery numbers during residency?


This lack of unified wound care training in residency is having a palpable effect on podiatry scope of practice. In Oregon, we have been working on legislation that would allow DPMs to treat ulcers on the leg above the ankle (i.e.: venous stasis ulcers). We thought it would be a slam-dunk to find data to show our MD/DO colleagues that our national residency programs have well-defined wound care rotations. We were disappointed and surprised to find out this is not the case.  How do we prove we are the specialists, if it's not part of our formal training?


We need to mandate intense wound care training in residency in order to justify ourselves as the "experts" in wound care. Wound care, particularly diabetic ulcer treatment, has been critical to the identity of podiatry. Many of our referring physicians and colleagues send us their wound care patients with the assumption that this is our niche... similar to ingrown toenails and custom orthotics. It is part of our DNA and the groundwork needs to be laid in podiatry school, externships, and residency. Are we okay with our current evolutionary trajectory of losing this area of practice?


Chris Seuferling, DPM, Portland, OR



From: Clifford Wolf, DPM


Dr. Peacock, what should a wound care rotation consist of? Even if non-existant in your area, I don't believe you understand the scope of a wound care rotation. The reason I asked you this question is to find out what is your concept of a wound care rotation. It can be to be competent in an evidence-based approach to learn the skills required to do a gastrocnemius recession, when indicated, but it is so much more. 


The medical and surgical competence required for a podiatrist to be part of the interdisciplinary wound care team might take a career to master. Advanced evidence-based medical knowledge and surgical skills required to manage these patients in the hospital toward successful outcomes is what we aspire to. In this regard, our profession is continually advancing. It's nice to know you are part of this.


Clifford Wolf, DPM, Oceanside, CA



From: Don Peacock, DPM


Residents need to be trained in surgery. During school, we are taught how to assess a patient from a biomechanical standpoint and how to cast for orthotics. We certainly are taught how to administer palliative care and even contact casting. We are taught how to interpret vascular exams and do rotations through vascular departments while in school.


We were also taught how to do ingrown nails in school. I did ingrown nails with phenol procedures while I was in school. These things can easily be taught in a busy podiatric medical school clinic. In our fourth year, we do rotations through the various disciplines that we pick or we rotate through podiatric surgery residencies that perform both...


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



From: David G. Armstrong, DPM


Can we move from "care" to "closure"? Can we work to doctor these wounds rather than just nurse them? I have read with some interest the dialogue and discourse regarding the above. It has prompted me to (politely) suggest a small change in syntax. I notice that many of my friends and colleagues use the term "wound care". I think that's great. However, I think it somehow abrogates our responsibility to take action-- surgical action-- to treat these patients. 


The fact of the matter is that physicians and surgeons literally and figuratively washed their hands of taking care of tissue loss in the mid-1800s following the germ theory. They turfed it to Florence Nightingale and her colleagues. Our nursing colleagues have been doing a historically spectacular job in nursing these wounds (addressing pain, addressing appropriate dressings, etc.) for the last 150 years. It is not until very recently that we have begun to doctor these wounds as well as nurse them - i.e. angiogenesis, tissue coverage, reconstruction, regeneration. 


We in podiatry have the capacity to do this pretty dang well along with our colleagues. I urge all of us to consider this. In addition to caring for these folks, can't we work toward closure?


David G. Armstrong, DPM, Los Angeles, CA



From: Lee C. Rogers, DPM


The PM News Quick Poll is very timely since CPME is currently rewriting the standards for podiatric medicine and surgery residencies (Document 320). Wound care currently represents a large and rapidly growing area of practice for podiatrists. There is an urgent public need for knowledgeable, skilled providers to care for lower extremity wounds, to reduce the rate of amputations. This is reflected in the PM News Quick Poll where 95% of almost 800 respondents declare the need for mandatory, and specific, wound care training in podiatric residencies.


The APMA BOT, in 2019, wrote a letter to the 320 Re-Write Committee, in part, expressing the opinion that there be a larger emphasis on wound care in standardized residency training. Additionally, the ABPM recently published a position statement on residency training declaring, "Wound care should be a required, separate, and defined residency training experience." 


It is the responsibility of the CPME 320 Re-Write Committee to respond to the community of podiatric educators, public health officials, and associations to ensure that residents have adequate, standardized training to address the public need for lower extremity wounds.


Lee C. Rogers, DPM, BOD, American Board of Podiatric Medicine



From: Joe Agostinelli, DPM


I respectfully disagree with Dr. Peacock’s comments on doing away with waste of time rotations and only teaching surgery to our podiatric residents. I come to this because of my background as a DPM in the USAF for 23 years in orthopedic clinics, then 13 years in private practice with a large orthopedic surgical group as their DPM.


During my first assignment at a USAF hospital that trained 25 orthopedic surgeons, I quickly realized the need to become a “good doctor first“, then a surgeon after that. The four years of podiatry school gave us the background in biomechanics, surgery, palliative care, etc. and the mostly...


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



From: Michael M. Rosenblatt, DPM


Robin Lenz, DPM recently wrote a letter explaining how important wound care issues are and should be a part of every DPM residency. I strongly agree. Some years before I retired, I heard an orthopedist who routinely used Achilles Tendon lengthening and gastrocnemius recession to treat very severe diabetic ulcerations, even for patients with very poor circulation. He presented sound evidence that this should be a “part of podiatric care” for diabetic ulcers. He made the point that DPMs should be doing MANY more of these than presently done. He also used some tendon releases in other tendons, but most of his surgery was gastroc recession and Achilles tendon lengthening.


When questioned about malpractice risk for patients with very poor circulation, he provided data that showed virtually NO...


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



From: Don Peacock DPM, MS


I agree with everything Dr. Robin Lenz states in his post. The only exception I have is regarding time spent in rotational programs. A surgical residency should be dedicated to surgery of the foot and ankle and lots of it. The wound care procedures such as total contact cast are skills to be learned in school and practice. In our area, nurses apply the total contact cast and they are good at it. 


Residents should be taught surgery and the non-useful rotations should be dropped. My residency was surgical and I am grateful for it. In today's rotation-style residencies, the residents are wasting their time. We are creating a number of residency-trained podiatrists who do not receive adequate surgical training - even with some 3-year programs. 


Don Peacock DPM, MS, Whiteville, NC



From: Robin Lenz, DPM


I work in a 14 podiatrist group, with 4 doctors dedicated to wound care. We work in 4 wound care centers. We have residents rotate with us. Podiatry school taught me much of the basics, but my residency is where I learned the majority of my wound care knowledge.


The residents rotating through our facilities learn about gastrocnemius recessions for plantar forefoot ulcers, selective plantar fascial release for IPJ ulcers, flexor and extensor tenotomies to heal ulcers, peroneus longus to brevis transfer for plantar first metatarsal head ulcers and the Level 1 JBJS evidence behind it, plus the problem solving skills to surgically off-load ulcerations from...


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



From: From: Joseph Borreggine, DPM


The bad news is that many physicians are saving little to nothing. According to the same study, nearly 60 percent of female doctors were not making maximum contributions to a retirement plan. Roughly 45 percent of male physicians were not either. In a 2013 survey by the American Medical Association, about half of responding physicians said they consider themselves behind in preparing for their financial futures.


A recent Medscape survey of physicians showed that 34 percent between the ages of 50 and 64 have a net worth under $1 million. And nearly a quarter of doctors 65 and older have a net worth under $1 million. Since a person’s net worth includes more than retirement savings, it’s likely these physicians do not have enough money for a comfortable retirement.


Joseph Borreggine, DPM, Port Charlotte, FL



From: Jon Purdy, DPM


There are things to consider with investments that are not often discussed. In real estate, people often talk about their return on investment as what they sold minus what they bought the property for. They often fail to include the over-time expenditures of interest, insurance, taxes, utilities, and maintenance. Often, these investments are a loss after the positive sale of a property. Often not included is the calculation of what those monies, had they been invested in the market, would have returned in those years. True analysis of monetary return on investment is very complex. I find people in business routinely do not understand their true costs of doing business, not having taken into account numerous cost considerations.


Jon Purdy, DPM, New Iberia, LA



From: Bruce Lebowitz, DPM


I’ve read the various responses to this question. One commonality is the belief that you should hire a financial planner and expect to safely withdraw 4% from your life savings each year. I humbly reject that notion. I have hired and then fired more that one “financial expert”. They are, in my opinion, guaranteeing their financial future, not yours. One can draw 4% of your nest egg each year through dividends and interest without selling off your life savings one year at a time. Do the research, read about dividend growth investing. I’ve been retired 6 years and have yet to sell one share of stock or bonds. No one cares about your money like you do!


Bruce Lebowitz, DPM, Baltimore, MD



From: Bob Hochron, DPM


The survey question is an interesting one, because it really refers to only one side of the important equation. Having retired almost five years ago, I have been asked this question by many friends and colleagues. The quickest way to answer this is to pose the rest of the question: How much do you need to live on?


My suggestion is to start with a clear and comprehensive idea of what it actually costs you to live for 3 years. I recommend every dollar spent be tracked with a simple program like Quicken, which...


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

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