The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

March 31, 2009 #3,507 Publisher-Barry Block, DPM, JD

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VA Podiatrist Discusses Treatment for Gout

The causes of gout can vary, said Dr. Michael Donato, a podiatrist at Rappahannock Foot and Ankle Specialists as well as a spokesperson for the American College of Foot and Ankle Surgeons. "A person having a crab-fest cookout and a few beers on the weekend--that's the classic way we think of gout, but it’s not the only way," Donato said.

Dr. Michael Donato

People always come down with gout because of an imbalance of uric acid in the body, but that imbalance can come from secreting either too much or too little uric acid, Donato said.  Donato initially prescribes colchicine for treatment until the swelling goes down. However, he said the drug has some nasty gastrointestinal side-effects such as severe nausea and diarrhea.

"Literally, when we prescribe it, we say that a patient should use a certain amount every few hours either until the pain goes away or until they can no longer put up with the gastrointestinal side effects," he said. For people who can't stand to use colchicine, an alternative treatment is to use large doses of painkillers such as ibuprofen.

Source: Lauren Orsini, The Free Lance-Star [3/29/09]

CSPM Announces New Surgical Textbook

The Department of Podiatric Surgery at the California School of Podiatric Medicine (CSPM) at Samuel Merritt University has produced a new surgical textbook, Lesser Forefoot Surgery, published by Data Trace. This textbook is a compilation of 30 years of experiences by the members of the surgery department in evaluating and determining the most effective surgical therapies for the more common problems of the lesser forefoot.  

(L-R) Drs. Albert Burns, Joshua Gerbert (editor),  William Jenkin (chairman), and Joel Clark

Lesser Forefoot Surgery presents the pathomechanics and evaluation of the most common lesser forefoot pathologies in a problem-specific manner that cannot be found in any currently published textbook. It also presents in a “cookbook” format the indications and contraindications for the common surgical procedures utilized to correct lesser forefoot pathology, along with a detailed description of the surgical techniques. Each chapter involving the surgical procedures also discusses the recommended post-operative management and the inherent complications associated with the procedure. 
 

Podiatry Shines at NAP National Meeting

The 2009 National Academy of Practice (NAP) forum was held in Alexandria, VA March 27 and 28. The Podiatry Academy, led by Rosaria LaBarbera, DPM and Harold Glickman, DPM, both past APMA Presidents, organized a special session in conjunction with the Psychology Academy entitled “Head to Toe: Patient Centered Care.” The session generated much interdisciplinary conversation that kicked off the NAP Forum.

(L-R) Drs. Lester Jones, Rosario LaBarbera, Janet Simon, Mark Dollard, and Harold Glickman

The Podiatry Academy featured John Steinberg, DPM from Georgetown University Medical School who led the case study presentation by relating how podiatry in the management of chronic disease patients utilizes an interdisciplinary management model. The NAP has earned the ear of important policy makers and is spearheading dialogue on the need for interdisciplinary collaboration in health policy reform efforts.

The Podiatry Academy welcomed its newest inductee Mark Dollard, DPM who practices in Sterling, VA and is a clinical instructor at Georgetown University and with the Inova Fairfax Podiatric Residency Program. Additional information about NAP and its health policy initiatives can be found at NAPractice.org.

Wellpoint Sued for Underpaying for Out-Of-Network Services

The American Medical Association (AMA) and several medical societies filed a class-action lawsuit against WellPoint, Inc., accusing it of underpaying physicians for out-of-network medical services, resulting in patients paying an excessive portion of the medical bill. The suit, filed March 25 in Los Angeles federal court, follows similar class-action lawsuits last month against Aetna Health, Inc. and CIGNA Corp.

The three AMA lawsuits claim that each insurance company conspired with Ingenix, a unit of UnitedHealth Group, on a price fixing scheme that relied on an obscure database to set artificially low reimbursement rates for out-of-network care. An investigation by New York Attorney General Andrew Cuomo (D) found that the Ingenix database was intentionally rigged to allow insurers to shortchange reimbursements. WellPoint said in a statement that it was committed to providing appropriate reimbursement for out-of-network services. The company said it was reviewing the suit and had no further comment. 
 
Source: Health Plan Week [3/30/09]

Build Influence Through Mentoring

Look around you at all the well-meaning and talented yet inexperienced people on your staff. Take them under your wing and you will build strong relationships that can buoy your career. Here are some easy ways to mentor others:

• Schedule “sit-ins.” Invite them to observe silently while you hold interviews, attend important meetings and the like. Afterward, discuss why you said and did certain things.
• Talk about your problems. When you face a workplace dilemma, tell employees about the options you are weighing and the factors you are considering. They will hone their own instincts, especially after you share what you decided and why.
• Increase their responsibilities. Assign tasks that are just beyond their comfort level. Stay available to guide them, helping them determine their approach. Then discuss their results.
• Spotlight their goals. Seek ways to realize progress. Provide honest feedback to allow employees to see what more they are capable of.

Source: Adapted from “The 8 Best Ways to Mentor Someone,” by Alison Green via Communication Briefings

Query: Hyperuricemia Management
From: Dean Clement, DPM
 
I had a rep in my office talking about a new drug for managing hyperuricemia. I was a little surprised that she was calling on me, as my recollection of school and residency was that we let the PCPs manage hyperuricemia and we deal with acute gouty episodes. 
 
Is anybody out there medically managing hyperuricemia, and if so, what has been your experience with scope of practice challenges, etc.?
 
Dean Clement, DPM, Chandler, AZ

RE: Chronic Calluses and Skin Fissures (James M. Petko, DPM)
From: Multiple Respondents

When I have a heel with chronic skin fissures, I treat it like a chronic wound and I debride the callused skin until it is bleeding (acute wound) and then I place Steri-strips across the fissures and place a 4 inch piece of Elastoplast over the site and have them PWB with no showering foe three days - usually it heals them up and then they start with the urea lotions after showering.

Joel Morse, DPM, Washington, DC, foxhallfoot@aol.com

If other parts of her body are affected (hands, tongue, etc.), you may want to consider a diagnosis of pachyonichia congenta. This a rare autosomal dominant palmoplantar keratoderma. More information can be found at: PC-project.org

David L. Nielson, DPM, Roanoke, VA, drdavidnielson.com

Debride the fissure. An exfoliate ointment under occlusion, such as Keralac qhs is indicated. Open back shoe wear should be avoided. A rubber heel cup in closed shoes reduces friction, and pain if present. Double check her thyroid levels to ensure the cutaneous manifestation isn't a variant of thyroid acropachy, which is not uncommon in the heels of people w/ hypothyroidism.

Barry Mullen, DPM, Hackettstown, NJ, yazy630@aol.com

RE: Heel Pad Stabilization (Calvin Britton, DPM)
From: Tip Sullivan, DPM

If your conservative efforts fail, I would certainly try the thick GraftJacket and pull it across the entire heel so that it can incorporate around the edges and stay there. Also, I might see if she was willing to use a posterior rocker bottom @20 degrees. If she has the other things that you say — pronated calcaneal position -- I would inform her of potential structural changes that may likely occur in the future, and offer her some options of treatment--- i.e.,-see if she wants to treat the problem at hand or the whole ball of wax.
 
Tip Sullivan, DPM, Jackson, MS, tsdefeet@msfootcenter.net

RE: Should I Keep My DEA Number Active? (Name Withheld)
From: Joel Lang, DPM

Rather than taking advice from various practitioners who may or may not know the right answer, call the DEA and get to the office that issues these licenses.

Get the right answer from them. Government agencies are not the "enemy." On the contrary, they are anxious to help people do the right thing and give good advice when you get to the right person.

Joel Lang, DPM, Cheverly, MD, langfinancial@verizon.net

PRACTICE FOR SALE - FLORIDA—CENTRAL/SOUTH

Turn-key operation grossing $570,000 annually based on one full-time doctor. Great opportunity for growing the top-line. Surgery is only 14% of the professional man-hours; it can significantly increase income. Medicare makes up 64% of revenues. Seller will assist with transition. Call 863-688-1725, ask for Chas.

ASSOCIATE POSITION - CHANDLER/GILBERT/PHOENIX, ARIZONA

Seeking a well-trained, ethical and hard working graduate of a PSR 24+/36 Residency to join our growing multi-location practice. This is a practice with a nice mix of 35% surgery/trauma, 20% diabetic/wounds, 25% biomechanics, 20% pediatric. ER Call. Opportunity for partnership at 2 surgery centers. Very modern offices with EMR, U/S, Digital X-Ray, ESWT, Vascular Testing Machine. Excellent referral base, and a well-trained staff. Board eligible/certified a plus. Competitive salary, bonus structure, benefits. Please e-mail CV and references to  FootAnkleAZ@aol.com

OFFICE SPACE/ MRI RENTAL – NYC, LI

Turn-key space available, daily, monthly; East 60th off Park Ave, East 22nd St. off 3rd Ave, and Plainview Long Island. JACHO-certified operating rooms available, as well as all surgical equipment and anesthesia. Extremity MRI Rental. Stark compliant. All exams read by board certified radiologist. Call for details. 516 476-1815

ASSOCIATE POSITION - CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for a full-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to f-massuda@footexperts.com

ASSOCIATE NEEDED - MIAMI DADE FLORIDA

Partnership/buy out opportunity for the right candidate. Well-established modern practice. EMR , digital x-rays, gait scan etc. Excellent hospital privileges. SALARY...two options. $50,000 starting, 40% of everything you generate over $120,000, 50% over $200,000, 55% over 250,000 and 60% of everything you generate over $350,000. Want a fixed salary instead? $80,000 a year. I feed you patients and provide an excellent well-trained staff. Contact doctorinhialeah@aol.com

PRACTICE FOR SALE - CENTRAL FL

Practice sale, in beautiful, high quality of life, growing area; 2000 sf bldg. fully equipped/ designed for podiatry; excellent location, features & exposure; near hospital, wound and HBO center. Great opportunity for expansion; good insurance climate. 352-357-7499 / E-mail: windnwave@earthlink.net

PRACTICE FOR SALE-SOUTHEAST MICHIGAN-BRIGHTON

Great opportunity. Established 11 years. Excellent location. Large illuminated sign on busy main road. Mid to high income growth area.  Supplies, furniture, and equipment included: X-Cell X-Ray w Hope Autoprocessor, Pelton-Crane Autoclave, Parks Lab, Bircher, Burton Floor Light, OR with Lighting, bone instruments and power equipment, Midmark Chairs. Quality 1,350 sf build-out. convenient parking. Must sacrifice. Call (248) 565-5266. Docpod@aol.com

NEEDED CHICAGO -- NW IND & BALTIMORE/WASHINGTON, DC PODIATRISTS

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists in Chicago, Northwest Indiana, and Baltimore, MD. Full and part-time positions are available. Competitive Compensation including malpractice. Contact Scott Schneider. Phone-773-342-4201 FAX 773-486-3548-E-Mail sschneider@homephysicians.com Visit our website

PODIATRIST NEEDED FOR MIAMI-DADE COUNTY

Multi office practice needs doctor of podiatry for full time and/or part time for private office, clinics, and nursing homes. Great opportunity to grow with and unlimited income potential. Offices in Miami, Hialeah, Westchester, and Cutler Ridge. Email to feetdoctor@aol.com

ASSOCIATE POSITION – VICTORIA, CANADA

Beautiful Victoria, B.C. Canada on the ocean, fast growing area. Associate for multi-office full scope practice. Licenser exam to be given in June 2009. Reply to dr.cole@shaw.ca

ASSOCIATE NEEDED - MIAMI DADE FLORIDA

Partnership/buy out opportunity for the right candidate. Well-established modern practice. EMR , digital x-rays, gait scan etc. Excellent hospital privileges. SALARY...two options. $50,000 starting, 40% of everything you generate over $120,000, 50% over $200,000, 55% over 250,000 and 60% of everything you generate over $350,000. Want a fixed salary instead? $80,000 a year. I feed you patients and provide an excellent well-trained staff. Contact doctorinhialeah@aol.com

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