Podiatry Management Online


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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

Other messages in this thread:



From: Leonard A Levy, DPM, MPH


After a successful posterior tibial block, simply by touching the plantar aspect of the foot, the patient feels anesthesia and also, a significant rise in temperature occurs. This is prolonged by including 1:1000 epinephrine in the anesthetic agent. Statistically significant increases in cutaneous temperature after nerve blocks compared to the same skin area before the procedure have been reported in the literature (Anesth Analg. 2009 Mar;108(3).


An article by Lima A, et al. in Critical Care (2009; 13 (Suppl 1): p 237) also indicates that after successful regional anesthetic blocks, local vasodilatation and increased blood flow occur as a result of blockade of sympathetic nerve fibers. Of course, the posterior tibial nerve block for acute gout is not the primary treatment of the condition. It markedly reduces pain but also begins the therapeutic process of bringing more fluid to the area as a result of vasodilation. This is followed by any of the oral medications that are used during the attack as well as after the attack resolves. In addition, injection of the affected joint with a corticosteroid may also be used. 


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



From: Brian Kiel, DPM


First of all, I think the terminology should be correct. Marijuana contains THC as its active ingredient and that is the one that affects certain conditions. It is available in multiple forms, some in conjunction with CBD. Using the word marijuana has some negative connotations which some find offensive. Secondly, for those who say we are not trained to use this, that is why we go to seminars - to learn.


There are many treatment modalities that we use today that were not used or available years ago, but we went to meetings and learned the appropriate way to utilize them in our practices. The use of THC/CBD is in the future as the opioid crisis continues and more and more ERs and hospitals reduce or even eliminate the use of opioids entirely. We need to educate ourselves now, not later.


Brian Kiel, DPM, Memphis, TN



From: Michael S Krischer, DPM


Checking the online curriculum of Temple (formerly PCPM), they still do not list a course in psychiatry. Secondly, we did receive training in endocrinology, and the side-effects of steroidal and NSAID medications. Third your last statement... I agree with. I would need to have education and training regarding THC and cannaboids and pain management.


Fourth, I was merely responding to a posted question: “I am curious as to why almost 30% of respondents either said no or are unsure regarding being able to prescribe medical cannabis, when there is a plethora of data that supports its benefit for a myriad of conditions.”


Perhaps I was being naïve in assuming that someone actually wanted an answer as to why 30 percent of respondents said "no". And I have absolutely no problem with the 70 percent of the respondents who disagree. I respect the passion you have regarding the topic, but do not appreciate the snarkiness in your correspondence.


Michael S Krischer, DPM, Idabel, OK



From: Michael Krischer, DPM


Responding specifically to Dr. Morelli’s question as to why anyone would have voted no to podiatrists prescribing medical marijuana...medical marijuana can have psychological effects on patients (and they need to be monitored for them) and currently podiatric medical school curriculum does not include any psychiatry/ psychology courses.


Michael Krischer, DPM, Idabel, OK



From: Jeff Kittay, DPM


I am reading Dr. Smith's letter for the third time and still can't believe it. More self-congratulations for the APMA Board and HOD, who have just noticed that there is a problem with the number of graduates and the smaller number of residency slots. My graduating class (1979) had slots for about 50% of the graduates, and residency genesis was the only thing being talked about. Now, nearly 37 years later, it's still on the table. We have double the number of schools, many more graduates, and there are STILL insufficient slots; and some people are encouraging even more student enrollment as the solution - the same people who say lower taxes will yield increased revenues.  


RNs and NPs are taking up the "routine foot care" slack BECAUSE of Vision 2015, with its focus on turning out 3-year rear-foot surgeons to the exclusion of nearly everything else. This is a foolish and terribly misguided plan to gain "parity" with orthopedists. Dr. Smith correctly points out that a greater focus on forefoot surgery and general podiatry is the key to saving our profession from itself.


Get rid of several of the tuition-driven schools, change the curricula to an MD/DO by affiliating with allopathic institutions to achieve that elusive "parity," create and maintain residencies that reflect what is really needed by our aging population, and the profession will prosper. Continue to tweak the old paradigm and become obsolete.


Jeff Kittay, DPM (retired), San Isidro, Costa Rica



From: Ken Hatch, DPM


Like Dr. Smith, I also graduated in yesteryear (PCPM '75). I was very fortunate to be selected for one of the then top surgical programs in the country. MANY podiatric grads did not receive ANY residency, much less one recognized  by the ABPS. My training was very heavy in forefoot surgery, but was state-of-the-art, which also included hospital charting, coding, office design. risk management, as well as personal finance advice (life insurance, disability, etc.) I was very successful and practiced office and hospital-based procedures and "routine" care for nearly forty years. There is a VERY strong need for a general podiatrist who is trained to treat ALL foot complaints and NOT just very limited and sophisticated rearfoot procedures.   


Ken Hatch, DPM, Annapolis, MD



From: Joseph C. Smith, DPM


In response to Drs. Samuel’s and Ross’ comments regarding students, schools, and residencies, I first must congratulate the actions that took place last week in Washington, DC by the APMA Board and the 2016 House of Delegates. A conscious effort was made to address those very issues. Those issues are much more complex than just creating new residencies or lowering the number of students allowed in our schools. They are issues that greatly affect our profession and must be dealt with on many different levels. Our profession will fail and we will cease to exist if these issues are not addressed and changes are not made soon. 


We, as a profession, need to address three things to grow and remain relevant. First, we need to market and create additional...


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



From: Pete Smith, DPM


First, I would like to congratulate APMA and its leaders, who back in the early 1990s saw fit to move our profession forward by requiring three-year residency programs vis-a-vis Vision 2015, and who are currently working to move us forward. The recent graduates and current residents are getting a medical and surgical education on par with their MD/DO brethren and certainly much more extensive than most of us (Class of 1988) had. That being said, the move to these residencies has led to some unintended consequences including a shortfall of residencies, a capping of the school class size, and an over-reliance on rearfoot surgical residencies. 


The Pennsylvania Podiatric Medical Association saw the need to boost the number of residencies 9 years ago when, in conjunction with a few other states, we formed our own 'Residency Genesis Program' which was later ceded over to APMA which has worked to close the shortfall gap. Residencies have been created, but unfortunately...


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



From: Joseph A. Gershey, DPM


In response to Dr. David Samuel’s comment, I want to applaud the APMA Board and House for the actions that they committed to last week at the APMA House of Delegates. For the first time, the Board’s actions view the profession as a single organism. Our profession will fail to thrive if there are not sufficient residencies for graduates, sufficient graduates for healthy schools, or sufficient applicants for uncapped class size. At this House, the Alliance of Component State Associations drafted a resolution asking for an “all stakeholders” meeting at which all phases of the profession could be represented. The charge of the meeting was to draft an action plan to allow the profession to thrive once again.


The APMA Board indicated that this effort should not wait for a Resolution or a “White Paper report.” Dr. Dan Davis announced, to House applause, the scheduling of an “all stakeholders” meeting to address the student pool, residency availability, and growth in the profession. Pursuant to a Resolution of 2015, the APMA Communications arm will begin to educate the profession on PMSR residencies which are not dependent on the RRA credential. The result of this meeting should be an action plan which addresses all phases of the development of our profession in order to allow us to announce, in all coming years, that the growth of our profession has been restored and that our patients and our practices will be the beneficiaries.


Joseph A. Gershey, DPM, Immediate Past President, PPMA 



From: Jordan Sheff, DPM


Regarding the recent survey about government initiatives affecting healthcare - I wasn't surprised by the results of the poll - I wonder if anyone plans to share these poll results with the government? Shouldn't they know what their initiatives are doing to healthcare?


Jordan Sheff, DPM, Newport, RI

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