Podiatry Management Online


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RE: Long-Term Care Insurance Increases

From: Bret Ribotsky, DPM


Keep your eyes out regarding your long-term care Insurance policy. In today’s mail, I received a letter from MassMutual Insurance company regarding my LTC insurance policy. They informed me that my monthly rate is increasing 25.98% for 2022 and 25.99% in 2023 and 25.98% for 2024, effectually more than doubling the premium cost.


If you are young and able to “shop for a new policy,” you might want to consider this, if you notice these changes coming your way.  


Bret Ribotsky, DPM, Ft. Lauderdale, FL

Other messages in this thread:



RE: Availability of Local Anesthetics

From: Robert D Teitelbaum, DPM


It seems that every year there is some shortage of a supply like Celestone, local anesthetics with epinephrine, or the pandemic caused shortage of isopropyl alcohol. But the very long absence of lidocaine and bupivacaine is getting serious. My suppliers say that there is no indication from the manufacturers as to when there will be a resumption of supply. Does that mean we have to wait to the end of the year?  They have no answer.  How can we perform injections or local anesthesia when necessary without them? 


Are there alternatives, like carbocaine, that dentists use, that work in the extremities? Can 30ml 'single dose' vials of anesthetic be used as multiple dose vials?  I have purchased a .75% (higher than the .25% or .5% we are familiar with, although they too are available) 30ml 'single dose' vial of bupivacaine.  It "looks" almost the same, but looks can be deceiving. I draw 2ml of bupivacaine with a sterile loading needle and then use another loading needle to draw the steroid into the syringe. 1.7ml ampules of various anesthetics are available but the cost can be quite large---but versus none at all---they become acceptable.


I am searching for some knowledge or input on this issue beyond my own musings.


Robert D Teitelbaum, DPM, Naples, FL



From: Jeffrey Kass, DPM


Dr. Bregman’s commercial idea juxtaposing CEO pay vs. patient denial of care or poor pay of doctors is spot on. Any profession is best served being proactive. 


Jeffrey Kass, DPM, Forest Hills, NY



RE: Donations to Our Volunteer Clinics

From: Drs. Maria Buitrago, Richard Rees, Eugenio Rivera, Andrew Schneider, and David Wolf


We would like to thank Marlinz Pharma for their generous donations to help with our volunteer podiatry clinics at San Jose, St. Mary’s and Healthcare for the Homeless programs. These programs benefit the less fortunate people in our Houston communities by helping patients who are not able to otherwise seek treatment for their foot care issues.  


Kudos to Megan and Perry with Marlinz Pharma who have generously donated these products (as well as paid for shipping) which demonstrates true generosity without seeking any recognition. 


Drs. Maria Buitrago, Richard Rees, Eugenio Rivera, Andrew Schneider, and David Wolf



RE: Being There

From: Allen Jacobs, DPM


A podiatrist’s office manager calls the director of a recent meeting which I attended. The office manager states that they had paid tuition for the meeting, but had not yet received the link for the virtual transmission of the meeting which was to begin in 30 minutes. The manager was informed that the meeting was not virtual, but required attendance. The manager responded, "but that’s impossible. the doctor has patients all day both days, and cannot possibly be there." 


Thinking about this, I have started a new business. Remember during Covid, the cardboard cut-outs people had in the stands at sporting events? I am now producing these for use at live meetings (protects you from Covid) or to be placed in front of your computer during a virtual meeting. If you would like one, send $65 and your photo. Options include your name on a white coat, with either DPM or foot and ankle surgeon imprinted. Please request white coat, scrubs, or business casual.


Allen Jacobs, DPM, St. Louis, MO


Editor’s comment: This would have made a great April Fool’s story!



RE: Educate Patients About Insurance Companies  

From: Peter J. Bregman, DPM


People need to be educated on what insurance companies really are. They are money exchangers or money transferring entities. They transfer money from their subscribers or customers, keep a large chunk of it, and give a small percentage to the actual health caregivers. It is funny that when you ask patients what is the purpose of health insurance, most of them say, "I have no idea; they just take my money." 


It would be great if we could post how much money all of the CEOs and CFOs and COOs make and put it into commercials, and juxtapose that with all the times they deny patients any type of care, or show how much they pay for a three-hour surgery, etc. People need to wake up.


Peter J. Bregman, DPM, Las Vegas, NV



From: Mike Lawrence, DPM


I have had great success with IMS Medical.


Mike Lawrence, DPM, Chattanooga, TN



RE: Source for Company That Buys Used Equipment (Name Withheld)

From: Stephen Doms, DPM 


When I closed my office last year, I used Atlas Resell Management in Boise, ID. I just took pictures of the equipment and they handled the rest.


Stephen Doms, DPM (Ret), Hopkins, MN



RE: Malpractice and Billing

From: W. David Herbert, DPM, JD


When I was a malpractice attorney, the first thing I would look at was the billing records. If the billing records raised some red flags, I found in most cases that the medical care was also at least questionable. Of course, that was years ago. I guess it is still applicable not only for podiatry but for other specialties also.


W. David Herbert, DPM, JD, Billings, MT



From: David J. Freedman, DPM


AAPC owns the designation CSFAC. Unfortunately, even though I and others were instrumental in getting them to offer the CSFAC designation, they have stopped credentialing for people in obtaining it. If you want to reach out to ask, you need to contact AAPC; I would contact Rae Marie Jimenez. Her email is


David J. Freedman, DPM, CPC, CSFAC, CPMA, Silver Spring, MD



From:  Alexander Terris, DPM


Kudos to Dr. Brody for his response. I could not have summarized it better. Yes, there are benefits to in-person seminars. In addition, there are many benefits to a streamed event. Why not both?  


Major corporations such as banks and even large law firms have yet to require their employees to come back to work. Covid taught us a lot and forced us to be flexible and pivot to online lectures. We have the technology to continue streaming lectures. Let's use it and make these educational lectures easier for anyone who wants to utilize that platform. Let's not forget, there are some of our colleagues that don't get around as well as they used to or have disabilities that make it harder for them to attend lectures. 


Alexander Terris, DPM, Wilmington, DE 



From: Michael L. Brody, DPM


I have been following this thread with a fair degree of interest and now wish to chime in. Usually the disclosure for a post comes at the end but I believe that my comments need to start with mine. I am the CEO of CME Online. We regularly stream podiatry continuing education lectures. After each of our events, attendees are asked to provide feedback on their experience. I wish to share what I have learned from the feedback of attendees, speakers, and exhibitors with the readers of this forum.


1) Many attendees feel that being able to sit at their desk with less distractions allows them to have a richer educational experience.


2) On the other hand, there have been a number of comments that attendees of live events...


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



From: Leonard A. Levy, DPM, MPH


Bart Holt, DPM queries, “Why Don't Dentists Become MDs and Why Don't MD Specialists Practice Primary Care?” (PM News April 11, 2022). During my tenure as Associate Dean for Research and Innovation at the College of Osteopathic Medicine of Nova Southeastern University, I worked with the dean of the college (the late Lawrence Jacobson, DO) and the chair of the Department of Oral Surgery in the School of the College of Dental Medicine (Steven I. Kaltman DMD, MD, FACS, now dean of the College of Dental Medicine) to develop a program for dentists who also wanted to obtain a DO degree.


In 1940, the Harvard School of Dental Medicine (HSDM), to place stronger emphasis on the biological basis of oral medicine and to institute...


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



From: Bret Ribotsky, DPM


I have been reading this string of thoughts, live vs. streaming lectures, and I believe that the BIG answer seems to be missing. Let’s start with the fact that “time” is a constant, but realize that perception of time is NOT. For example, your first date with who became your spouse, I’ll bet, time seemed to stand still. You fly across the country for 5 hours and when the plane stops, you hear the chimes, and everyone stands-up, but the door is not open; those moments seem like hours. Thus, if the speaker is exciting, engaging, with great visuals, you never look at your watch, and if the speaker is boring, it seems like hours. 


For those wishing an online experience, I’ll suggest the Peloton method be considered in the future. Have lectures given by the most exciting speakers, and have each state subscribe and choose what lectures to include in seminars they produce. Let’s never lose the visceral experience that comes from live events. Attending a rock concert always beats listening to the music online. Who’s your favorite podiatric speaker?


Bret Ribotsky, DPM, Fort Lauderdale, FL



From: Elliot Udell, DPM


I definitely can buy into the concept that if a listener is interested in a specific topic, he or she may pay more attention to what is presented. A podiatrist who does not perform major bone surgery might be less attentive to a lecture on ankle surgery than on topics more relevant to his or her practice. 


Be that as it may, both of us are in a unique position to test the system. Why don't we arrange with a conference sponsor to allow us and any other speakers interested, to give lectures and have volunteers from a podiatric audience take a short quiz to see what they retained? Obviously, we would have to have some professionals structure the testing to rule out "methodological flaws." We can do it for 60-minute lectures as well as much shorter lectures. The data would help sponsors of seminars properly structure their programs. 


Elliot Udell, DPM, Hicksville, NY




Based on what you have said, to make owning a digital machine more affordable, I would recommend buying a used machine.


Ivar E. Roth, DPM, MPH, Newport Beach, CA



From: Robert Dale, DPM


I use a pharmacy here in West Virginia for that: Med-a-save Pharmacy in Keyser, WV. 


Robert Dale, DPM, Clarksburg, WV



From: Name Withheld


There are two current CPT codes for arthroereisis. CPT code S2117-arthroereisis, subtalar, which is considered a surgical services temporary national code. There is also CPT code 0335T—insertion of sinus tarsi implant. It has been suggested by some that providers use an unlisted code, which in my opinion is incorrect. As per NCCI policy, a procedure must be billed to the highest specificity. And an unlisted code should also only be used when there is NO code to describe the service. In this case, there is a CPT code.


Many have tried to dance around this issue by billing as a subtalar arthrodesis or ORIF of a talo-tarsal dislocation. This is 100% insurance fraud, whether someone has “gotten away with it” or not. I assure you it would...


Editor's comment: Name Withheld's extended-length letter can be read here.



From: Kevin A. Kirby, DPM


What was said before in a previous post on PM News that “humans do not follow Newton’s Laws” is pure and utter nonsense. Newton’s Laws are important underpinning principles in both biomechanics and engineering, the two sciences that the international biomechanics community use to study and describe the motions and forces acting on and within the human body during weight-bearing activities. Open up any high school physics textbook and you will **not** find the words….. “humans do not follow Newton’s Laws”. Any podiatrist who does not understand Newton’s Laws and their importance to the human body, cannot possibly understand biomechanics of the foot and lower extremity. 


Kevin A. Kirby, DPM, Sacramento, CA


Editor's note: This topic is now closed.



From: Connie Lee Bills, DPM


I am very happy with Ovation Medical. I’m not sure if they have pediatric sizes, but the boots are great. 


Connie Lee Bills, DPM, Mount Pleasant, MI



From: Dennis Shavelson, DPM


Newton’s Laws are the foundation of physics, mathematics, and astronomy, not biomechanics. They work in a vacuum with solid objects like planets.They do not apply well when dealing with viscoelastic, adaptable, thinking or living tissues. Dr. Kirby admits that “biomechanics is largely based on Newton’s Laws” not totally. If the same mass of stones, feathers, and a bird were dropped from a tree in an atmosphere having particles, electricity, and gases, the stone and feathers would land at the same moment but the bird might fly away. Newton’s Laws fail where there is friction, shear, and electrical and physical external forces and biological internal forces causing objects in motion to slow down, speed up, or adjust their linear course.  


2-D drawings and stick figure diagrams, like x-rays, fall short of explaining our 3-D architecture and functionality. They need replacement and upgrading if we are to take human movement to neoteric heights and purpose. Kevin’s thinking is segmented and chained together, not holistic. It does not research and treat human stance or movement, injury risk reduction, performance enhancement, and quality of life issues.


I theorize that the best we can do is diagnose, treat, train, and monitor human stance and movement using a qualitative or hybrid model. That means reducing deterministic research principles and replacing them with stochastic principles that should produce better educated and practiced professionals and models to move mankind into the future.  


Dennis Shavelson, DPM (retired), CPed, Tampa FL



RE: Why Don't Dentists Become MDs and Why Don't MD Specialists Practice Primary Care?

From: Bart Holt, DPM


When I last saw my dentist for a check-up, a primary care medical resident was observing this visit. At the end of the visit, I asked if the dentist and primary care resident were each willing to answer a question. They agreed. I asked the dentist if she wished that she had the MD designation, instead of the DMD or DDS. She said she would not, because she was satisfied with her scope of practice. If a dentist wanted to be an MD, then that dentist would be specializing as an oral surgeon, and would no longer be practicing as a dentist.


I then asked the primary care resident if an MD specialist should also practice primary care in addition to their specialty. She said that was not realistic, because there is so much educational material to keep up on that the MD specialist would not be able to also practice their specialty. In addition, the expense of the malpractice insurance required for primary care would be...


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



From: Kevin Kirby, DPM 


I feel that I must comment on a recent PM News posting regarding walking on uneven or uniform surfaces. A statement was made within this post that claimed “humans do not follow Newton’s Laws”. This statement is false and misleading. Newton’s Laws of Motion apply to all living things, including humans, other animals and even plants. Newton’s Laws also apply to non-living things, solid, liquid, and gaseous. In fact, biomechanics, the science which examines the forces acting upon and within a biological structure and the effects produced by such forces, is largely based on Newton’s Laws.


I normally wouldn’t take the time to correct such nonsensical statements, but, with the current state of decline in biomechanical knowledge within the podiatry profession here in the U.S., I feel it is very important to issue these corrections so that misinformation is not spread to the members of our great profession.


Kevin Kirby, DPM, Sacramento, CA



RE: Walking on Uneven or Uniform Surfaces

From: Dennis Shavelson, DPM, CPed


Kevin Root Medical’s statement, “Humans were designed to walk on bare ground, not uniform surfaces” needs clarification to those practicing biomechanics. Our feet were not designed at all. In reality, over the centuries, feet have evolved since we clustered homes, flattened and hardened the ground, and began living a civilized, shod lifestyle. Earth’s gravity supplies the platform we adapt to in a Mendelian fashion, culling out the weak, poorly grounded, less skilled humans. There are fewer and fewer PTTD feet over time. We have minimal control over the pace and direction of how we evolve. We can only manage our patients as each individual changes their habits, health, weight, shape, lifestyle, stress level, diet, and footgear.


Our surgical toolbox and skills, regenerative medicine options, and wound healing science have evolved to great heights in my lifetime, but the biomechanical paradigms (subtalar joint neutral, pronation and flat feet) of the past forty+ years are failing. The best we can do is deliver a qualitative, holistic, theoretical, kinesiology-based model from which to research, diagnose, treat, coach, train, and monitor us individually.


Humans do not follow Newton’s Laws. We are not related to solid objects of the same size and shape. We are not robots. Our ability to morph and adapt instantaneously to our changing environment is not the same as a lever in physics or a stick figure, geometric drawing, or graph. There is no benefit from algorithms that remove outliers. We are humans!


Dennis Shavelson, DPM, CPed (retired), Tampa, FL



From: Elliot Udell, DPM


Thank you Dr. Moglia for bringing our attention to a potentially new drug that can help us in the treatment of recalcitrant viral warts. The mechanism of action of this drug is to cause a hypersensitivity or an allergic reaction which can cause verrucae to abate. This is not the first time that we have used a drug that causes hypersensitivity to treat warts. Injections of Candida is one example, the topical use of cantharone is another. The problem with all of us jumping on the wagon and using diphencyprone is that the literature also reports a fair number of potential side-effects such as severe eczema which can become systemic and even one case of anaphylaxis.


Because the amount of patients studied is still very small, it is hard to tell whether these side-effects are common or extremely rare; do we need special training to handle them. Perhaps before using this particular drug, we should not be "the first kid on the block" but better wait for more clinical studies to make sure it is completely safe for use in private practice settings. 


Elliot Udell, DPM, Hicksville, NY



From: Steven Kravitz, DPM


Having lectures and conferences online for further review is always a good idea. The Academy of Physicians in Wound Healing (APWH) has a video library available for our members at no charge. This includes our annual conferences. The recorded 2021 conference has available CME. Members can view the lectures 24/7 on demand and get the same CME  they would have if they attended live streamed meeting. The CME availability remains for one year. 


Steven Kravitz, DPM, Winston-Salem, NC

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