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12/23/2020    

RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1A



From: Allen Jacobs, DPM


 


Dr. Tritto correctly notes that little if any EBM exists to support the utilization of a PT block as adjunctive management of acute gout. While I personally do not employ a PT block, it should be recalled that medicine is both an art and science. The use of a PT block is reasonable in a effort to relieve the pain and suffering of acute gout. NSAIDs, colchicine, steroids take time to work.


 


I employ a wide V block apex proximal around the joint dorsally, using lidocaine or bupivicaine with epi. I go see other patients, return and then inject the joint. Patients are very appreciative for the immediate pain relief. No patient has yet refused due to a "lack of evidence". If all of medicine were restricted to EBM, we would be very limited indeed. And remember, EBM includes practitioner experience.


 


Allen Jacobs, DPM, St. Louis, MO

Other messages in this thread:


04/05/2021    

RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1A



From: Steve Tager, DPM


 


Maybe these posts about neuroma treatment are not truly representative of what the nation’s podiatrists do for this condition. I am reasonably certain that as physicians, we all try to achieve positive outcomes and do what we feel is mutually beneficial for our patients when it comes to treatment regardless of the problem. Fifty plus years of doing all that has been discussed, from steroid injections, dehydrated alcohol, DTL sectioning, excisions from both above and below, etc. Nothing compares to the success rate I’ve experienced by simply reversing the pathomechanics of lateral column overload. My experience continues to tell me that restoring rearfoot function anywhere close to anatomic neutral gives the foot optimal opportunity to heal itself.


 


How many times have we sat in front of a pair of feet and identified good upper and lower leg alignment, with the plantar surface of both feet trying to face each other? Is it not possible that...


 


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

07/03/2020    

RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1A



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 


02/25/2020    

RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1A



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

02/24/2020    

RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1A



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

02/20/2020    

RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1A



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

01/27/2020    

RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1A



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

01/24/2020    

RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1A



From: Michael M. Rosenblatt, DPM


 


I usually agree completely with Dr. Herbert in his advice on retiring and other issues peripherally related to podiatry. I disagree, however, on his assessment of the securities industry and stock markets. My argument is statistical. If you invested and stayed in the S&P 500 index from 1973 to 2016, your rate of return would be about 11.69%.


 


10,000 initial starting balance+1,000 dollars/month (forced saving) over 30 years at 11.69% interest= 3,146,317 dollars. If you survive life, you will...


 


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

01/23/2020    

RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1A



From: Lloyd Bardfeld, DPM


 


I disagree with Dr. Herbert's analysis of retirement. Contrary to his analysis of the stock market as "the great casino", the stock market statistically performs better than any investment. Many podiatrists do not have the knowledge or time to invest in real estate. A well-diversified portfolio will grow over time. If the market corrects or even crashes, it will still continue to grow. The stock market has generated returns at more than four times the rate of real estate appreciation.


 


My advice is to maximize what you put into your retirement account, use a good honest financial adviser, and stay invested. At the end of the day, you will enjoy a financially secure retirement.


 


Lloyd Bardfeld, DPM, Far Rockaway, NY

12/12/2019    

RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1A



From: Ed Cohen, DPM


 



I found the PM News survey interesting and also noted that 83% of the respondents only do one bunion surgery or less a week and that 20% don’t do any bunions. 


 


I have been in the Academy of Minimally Invasive Foot Surgery for 42 years and remember seeing many orthopedists come to our meetings from all around the world to learn MIS surgery. Dr. De Prado, an orthopedist, was fascinated by MIS surgery and also got a PhD in MIS foot surgery. He told us that before he learned MIS foot surgery, he was doing one or two bone surgeries a week and after he learned MIS at our LSU MIS foot surgery meetings and working with Dr. Isham, his bone surgeries increased to 20 surgeries a week.


 


Ed Cohen, DPM, Gulfport, MS


10/12/2019    

RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1A



From: George Jacobson, DPM


 


As this discussion is taking place, I received an attestation from one the hospitals that I am on staff. I have to attest to receiving the flu shot and provide evidence. If I am not immunized, I must wear a mask in clinical areas of the hospital. This is not a new policy. 


 


George Jacobson, DPM,  Hollywood, FL

10/10/2019    

RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1A



From: Kim G. Gauntt, DPM


 


It was an interesting response from Dr. Steinberg. The part about "believing in medicine". A few years ago, I spent 3 days researching this topic. Most of the information came directly from the CDC website. I read the bulk of the studies available at the time, their statistics, and conclusions. The fact is that influenza is not a reportable disease, therefore all of the numbers that they publish in regard to those suffering from influenza and the deaths associated with it are made up numbers, extrapolated from very small samples; the website actually states that.


 


The fact is most people do not die from influenza; they die from secondary pneumonia, and those numbers are also extrapolated from a very small population samples. Deaths for the most part are...


 


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

02/20/2019    

RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1A



From: Steven Selby Blanken, DPM


 


All podiatric surgeons are podiatrists, not visa-versa. I did a podiatric surgical residency and certified by a board recognized by APMA and most hospitals (ABFAS). I also was a residency director of a PSR program for 5 years. I taught my residents that if they perform surgery as part of their practice, to refer to themselves as podiatric surgeons. Yes, you have to pay dues and recertify every 10 years...I do feel you should refer to yourself as podiatric surgeons. 


 


Most DPMs have hospital privileges under a department of surgery, not medicine. There should be no discredited feelings or embarrassment if you do not do surgery every day or just once or twice or month. It doesn’t matter. I know orthopedists who limit themselves primarily to sports medicine and do not operate most of the time. There are ENTs who do a lot clinic work and operate once a week. Be proud to call yourself a podiatric surgeon if you are certified and trained in it. My grandfather was a podiatrist and not a surgeon. That was fine with him and with me.


 


Steven Selby Blanken, DPM, Silver Spring, MD

10/18/2018    

RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1A



From: Elliot Udell, DPM


 


Dr Kass raises a good point. Why shouldn't podiatrists be allowed to cut fingernails when manicurists with no college education are permitted to do so? I looked up what a manicurist must do to be licensed in my state. He or she must take a 250-hour course and then pass an exam. There are also separate licensing fees as there are with any other profession. 


 


The solution to those who feel impelled to cut someone’s fingernails in a state where it is out of scope for podiatry can choose to take such a course at one of the cosmetology schools, pass the exam, pay the licensing fees, and then if a patient asks you to cut his or her fingernails, you will be able to do it  without worrying about violating the law.


 


Elliot Udell, DPM, Hicksville, NY

05/16/2018    

RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1A



From: George Jacobson, DPM, David S. Wolf, DPM


 


My experience is exactly as Dr. Charles Morelli describes it but I still wear an embroidered lab coat over the scrubs.  We also pay for the staff's uniforms (embroidered scrubs ). I let them pick matching colors that they coordinate on different days of the week and with holidays. 


 


George Jacobson, DPM, Hollywood, FL


 


In my experience, patients don’t care how you are dressed or how much you know; they want to know how much you care.


 


David S. Wolf, DPM  (Retired)  Houston, TX

05/15/2018    

RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1A



From: Jerry Roberts, DPM


 



Physician attire is a regional decision. I’ve practiced in areas where wearing a tie is a requirement and the absence is considered unprofessional. I’ve also worked in areas where scrubs are worn by many and wearing jeans with or without a lab coat is common. The primary focus is establishing trust with your patients while delivering the care they need. Any attire that detracts from this goal, whether it’s too formal or too casual or otherwise inappropriate, makes quality care more difficult to deliver. 


 


Jerry Roberts, DPM, Somerset, KY


03/15/2018    

RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1A



From: Dan Michaels, DPM


 


We have banned all forms of grinding of nails. We use Miltex double-action nail nippers with straight jaws for debriding nails. These are very similar to double-action bone cutters. Patients are satisfied with this. You can get the thickness and the length with this method. You don't put yourself at risk of inhaling any irritants this way, and you can sterilize (with autoclave) your instruments when done. I published my instrument preparation protocol in PM News (and in Podiatry Management Magazine) a few years ago.


 


Dan Michaels, DPM, Frederick, MD

04/01/2017    

RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1A



From: Ken Malkin, DPM                              


 


As a delegate to the APMA House of Delegates, I actually asked for the straw poll from our delegates. There was no deep thoughtful discussion before the vote, just a number of events that occurred during the meeting making it clear that the 4-4-3 year model of training young podiatrists should lead to a more enhanced scope of practice. My first comment to those 10% who voted against a name change was that they were a bunch of dinosaurs.


 


One young bright New York delegate, Andy Shapiro, said he was one. Since then, I have heard many more opinions against the name change that I think have merit. On Thursday, APMA sent an email to its members explaining that a long process was planned before anything is POSSIBLY proposed. So stay tuned.  Sorry, I was wrong and caught up in the moment. 


 


Ken Malkin, DPM, Boynton Beach, FL

03/31/2017    

RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1A



From: W. David Herbert, DPM, JD,  Eric J. Lullove, DPM


 



I believe the better way to go would be to change the name to "The American Association of Podiatric Physicians and  Surgeons (AAPPS)." There would be no restrictions on pursuing an expanded scope of practice because of the specificity of the name.


 


W. David Herbert DPM, JD, Billings, MT


 


While I can respect the need to eventually make a name change with regard to the American Podiatric Medical Association, I am not sure that the name change to the American Association of Foot & Ankle Specialists is appropriate. My recommendation to the APMA would be to take a page out of big business….hire a PR Firm to re-brand the APMA to something that will hit on social media, the Internet, marketing, and BRAND podiatrists to a degree and level that the AMA, AAOS, SVS, and other organizations have built.  


 


If we all learn one thing from the last presidential election — branding is everything. Messaging follows. If this is the best name we can come up with, fine, then run with it. Otherwise, walk the name back and figure out a better name to rebrand ourselves. 80% of Americans own a smartphone. Do the math. If someone is looking for a DPM, most bets would be it is on their smartphone. Brand the APMA to something that is easily searchable, readable, and palatable.


 


Eric J. Lullove, DPM, Boca Raton, FL

03/30/2017    

RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1A



From: Marc Jay Pinsky, DPM


 


I feel a possible name change for the APMA is a bad idea! It is not in our profession’s best long-term interests. The name: American Podiatric Medical Association carries with it “professionalism” – as does the: AOA, AMA, and ADA. “Podiatric” can be considered all encompassing! Whereas “foot and ankle” connotes a finite scope. No room is left for professional expansion. If the name change goes through, then any state wishing to expand their scope of practice into the leg or above, will be hampered by our national association’s name. 


 


“Why should we allow you to treat into the lower leg, when your own national association states you are just foot and ankle specialists?” How will we answer that? In Virginia, we are allowed to treat wounds on the entire “lower extremity”. We plan other scope expansions in the...


 


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

11/21/2016    

RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1A



From: Anoosh Moadab, DPM


 



Based on the responses, the question may have been misinterpreted. I read the question as does insurance affect your treatment plan, and not necessarily your treatment recommendations.  Obviously, as a physician we are obligated to offer the best evidence-based treatment options to our patients. However, I would argue that insurance coverage and deductibles "often" play a role in the treatment plan.  


 


Anoosh Moadab, DPM, Fresno, CA


08/01/2016    

RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1A



From: Robert Scott Steinberg, DPM


 


There you go, making this purely political, but since you did, let me remind you that the PPACA has been blocked from any and all improvements, by a do nothing GOP Congress, more interested in demonizing the POTUS than helping people. The PPACA did have a section addressing excessive insurance companies' admin expenses, which include CEOs' salaries. You are not doing yourself any favors if you keep thinking and using the "they don't deserve" complaint.


 


Let me remind you, if you have a PPACA insurance plan, it got rid of the pre-existing condition exclusion. It also added much needed protection from having to declare bankruptcy due to a major illness or injury. The glass is half-full, and rising. 


 


Robert S. Steinberg, DPM, Schaumburg, IL

07/29/2016    

RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1A



From: Dennis Shavelson, DPM


 


Dr. Smith and I look at the ACA differently. I query, “why do people have to get less care, have less money for college, less money for their own medications, and less money for their families” so that insurance company execs can fly in helicopters, wear $2,200 suits and Chinchilla coats, and have their children play baseball with a $400 bat? “I'm not trying to be uncaring,” but why do politicians deserve better healthcare than us and a 20 room home at the expense of my children’s and grandchildren’s education, health, and well-being?


 


Dennis Shavelson, DPM, NY, NY

07/28/2016    

RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1A



From: Elliot Udell, DPM


 


Judging the Affordable care Act is akin to going into a fine department store and buying a new suit. Sometimes, the tailor will look at it, shake his head, say "no good," and the clothing goes back on the shelf. In other cases, he may look at it and say, "it is fine but needs to be taken in a bit here or there."


 


One candidate running for high office feels that the ACA is such a bad "suit" that it needs to be "put back on the shelf" or in another words, repealed. The other candidate believes that the "suit can be tailored" or in other words modified, so as to protect the interests of consumers as well as healthcare providers. In November, the people will decide which "tailor" to choose and what the outcome will be of the ACA suit.


 


Elliot Udell, DPM, Hicksville, NY

07/27/2016    

RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1A



From: Michael L. Brody, DPM


 


There has been a very interesting 'side effect' of the ACA. In Ohio, an appellate court upheld the use of the Affordable Care Act to substantially reduce a jury’s award of future damages. "However, given the ACA’s mandate that all Americans must obtain health insurance or face penalties, defense lawyers can and do oppose future damage claims by arguing that, because plaintiffs’ future damages will be paid by federally-mandated insurance, they may not be compensated through jury verdicts. In a handful of cases decided in 2015, trial courts first addressed these efforts by defense counsel to utilize the ACA to reduce awards for future damages." A complete article on this appellate court decision can be found here.


 


This unintended consequence of the ACA is just one thing to take into account when evaluating the law. I enjoyed reading about this ruling, though it does not change my opinion on the law. The law and associated regulations are over 20,000 pages long, and there is no way any member of Congress who voted for or against this law read the entire law. I am sure, as time goes on, we will find many more unintended consequences, some good some bad.  


 


Michael L. Brody, DPM, Commack, NY

03/31/2016    

RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1A



From: Joel Lang, DPM


 


Along with the advantages Dr. Udell already identified, this system is also designed to identify doctors who over-prescribe narcotic medications and patients who “shop” doctors for their narcotics. It will also prevent dispensing incorrect meds because of handwriting issues and the sale and exchange of written prescriptions on the streets as well as modifying written prescriptions to change the quantities or dose.


 


Patients can still shop online for the best prices for their medications for long-term medications and refills. We really need to relinquish the paranoid attitude that everything the government does is an “encroachment” on everyone’s rights.


 


Joel Lang, DPM (retired), Cheverly MD
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