The Voice of Podiatrists

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June 06, 2008 #3,265 Editor-Barry Block, DPM, JD

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FL Podiatrist Reports 90% Success Rate With Cryotherapy

The age-old adage "put some ice on it" has a whole new meaning. Cryotherapy is a pain-soothing process that uses super cold nitrous oxide to destroy diseased tissue or nerves around the pain source. Its popular use is to soothe foot-related problems, such as heel pain, Achilles tendonitis, neuromas (nerve swelling), and tumors on the feet, according to Dr. Brent Rubin of Healthcare America Medical Group Inc. in Bradenton, FL.

Dr. Brent Rubin

Cryotherapy is not the first line of treatment, says Rubin. "People often come to me after they've exhausted all other methods like cortisone shots, orthotics, you name it," he says. For external treatments, such as benign skin growths including warts, and malignant and precancerous lesions, liquid nitrogen is applied directly to the area with a cotton swab or spray (freezing lasts for about five to 20 seconds).

Rubin sees about a 90 percent success rate with cryotherapy. "You can often feel the effects almost immediately, but definitely within a week," he says. Many people often only need one treatment, although you many need a follow-up down the road.

Source: Matthew Solan, Herald Tribune [6/4/08]

NYCPM Commencement Features Keynote Speaker Karel Bakker, M.D.

Karel Bakker, M.D., Chair of the International Working Group on the Diabetic Foot and of the International Diabetes Federation Consultative Section, delivered the keynote address to the graduating class of the New York College of Podiatric Medicine (NYCPM) and received an honorary degree of Doctor of Humane Letters-Honoris Causa, during the College’s 97th Commencement Ceremony at Avery Fisher Hall in New York City on Wednesday, May 28th.

Karel Bakker, MD (center), Keynote Speaker at the NYCPM Commencement ceremony, receives his honorary degree from Maj. Gen. William F. Ward, A.U.S. (Ret.), (left), Chairman of the NYCPM Board of Trustees, and Hon. Louis L. Levine (right), President & CEO.

Louis L. Levine, President and Chief Executive Officer of the College, presided at the commencement ceremony. Dr. Bakker addressed the 79 graduating seniors—who received their Doctor of Podiatric Medicine degrees—and an audience of nearly 1,000 faculty members, parents, family and friends. In addition, Hon. Inez E. Dickens, New York City Council Member and Majority Whip, and Israel Goldstein, D.P.M., Adjunct Associate Professor of Podiatric Medicine at NYCPM, were also honored. Council Member Dickens received an honorary doctorate, and Dr. Goldstein received the College’s Distinguished Service Award.

CA Podiatrist Charged with Insider Trading Repays $384 K

The U.S. Securities and Exchange Commission said on Wednesday it had charged two people with insider trading in the securities of Animas Corp before its 2005 merger announcement with Johnson & Johnson. The SEC charged Burr McKeehan, a retired podiatrist from California, and Joseph Fontanetta, the chief executive of a privately-held medical instrumentation company.

The SEC alleges that Fontanetta tipped material nonpublic information about the merger to McKeehan two days prior to the announcement, the agency said in a statement. McKeehan, who did not admit or deny the allegations, agreed to pay civil penalties and disgorgement totaling $384,095 to settle with the SEC.

Source: Rachelle Younglai, Reuters [6/4/08]

A More Effective Way to Criticize Employees

Criticism: The mere word inspires a knee-jerk reaction. Overcome employees’ natural defensive reaction by offering praise before you criticize. Compare these examples:

• “The monthly accounts receivable report was due last Wednesday, and I haven’t received it yet. Please submit it immediately.”

• “Your accounts reports are always on time—in fact, they’re usually early. What happened this month? Although the report was due last Wednesday, I haven’t received it yet. I need you to submit it immediately.”

Bottom line: The second example is just as urgent as the first, but most people would find it easier to accept. And they will be inclined to respond to you in a spirit of cooperation rather than from a defensive position.

Source: Adapted from Communications Briefings

Query: Undiagnosed Rash

This 35 year old female presented with this rash starting on her face, chest, arms, and legs. She has never had this before.

Undiagnosed rash

What is it and how do you treat it?

Joseph Borreggine, DPM, Charleston, IL

RE: Tennis Serve Metatarsalgia (Jeff Root)
From: Multiple Respondents

A couple of possible diagnoses come to mind:

1: Dr. Arkin’s patient may be tossing the ball behind his head requiring him to arch his back too much in order to make racket contact with the ball. Or he has some other poor serve technique that is increasing the load on the left forefoot. 2. Plantar plate strain of the 2 nd/3rd MPT may be due to the elevatus 1st ray. Patients often relate the sense of forefoot numbness with plantar plate strains. 3. Excessive forefoot friction 4. Mild forefoot equinus

Suggestions:
* Have the patient have his serve evaluated by a professional.
*Make sure your patient’s shoes fit him properly. If the shoe is too wide for the foot, there may be excessive pronation in the shoe during serving. Even a perfect orthotic in a shoe that is too wide will not be effective.
* Try accommodative padding of the 2nd and 3rd MPT left.
* If the patient is wearing a flexible forefoot tennis shoe have him try a stiffer forefoot shoe.
* To treat the forefoot equinus try heel lifts.

Ayne Furman, DPM, Alexandria, VA, l_foot_r@hotmail.com

I would like to thank Jeff Root for his in-depth biomechanical analysis of this patient's condition. I now can picture what might be happening and what might not have been addressed in this patient's first orthotics. Hopefully, this patient is having plaster slipper cast done.

Robert Scott Steinberg, DPM, Schaumburg, IL, Doc@FootSportsDoc.com

I wholeheartedly agree with Dr. Root, especially his final statement indicating that orthotics usually work, and if they fail, the Rx needs to be changed. An orthotic is only as good as the clinician casting, biomechanically evaluating, and fabricating it. I also feel that not every pedal condition can be improved with an orthotic.

Simon Young, DPM, NYC, NY, simonyoung@juno.com

RE: Prescribing Systemic Drugs (Mike Boxer, DPM)
From: Multiple Respondents

The scope of practice issue is one to be addressed by a state's licensing board, not by experts who may or may not have a personal bias. Although, I personally refer most of my gout patients to their PCPs for their medical management, I would disagree that prescribing a drug such as allopurinol or probenecid is inappropriate. There are many drugs we prescribe daily as DPMs that might fall into the category of "systemic" disease management when local manifestations are presented. I am curious whether any of the posters on this subject have a conflict of interest in this area. Has anyone testified, and/or been compensated against a fellow DPM on malpractice or licensing cases of this sort? I have not.

Lloyd S. Smith, DPM, Newton, MA, lloydpod@yahoo.com

Editor's note: Extended-length letters by Dr. Gosnay can be read at:http://www.podiatrym.com/letters2.cfm?id=20001&start=1
and Dr. Mullen http://www.podiatrym.com/letters2.cfm?id=20002&start=1

RE: Hypergranulation (Craig Breslauer, DPM)
From: Douglas Pacaccio, DPM

Editor's note: This extended-length letter can be read at: http://www.podiatrym.com/letters2.cfm?id=20003&start=1

RE: MagneVu Extremity MRI (Jonathan Rosenblum, DPM)
From: Elliot Udell, DPM

Every year, companies have tried to sell podiatrists expensive new diagnostic or therapeutic modalities. Some of these companies after having sold this equipment to many of us, have either discontinued making and supporting the devices, gone bankrupt, or have had the FDA step in and tell the doctors that the devices are not valid and may not be used for the purposes that they were marketed. Whenever I attend a convention, there always seems to be a booth or two where vendors are making a hard-sell about a new modality that often costs thousands of dollars. The unwitting buyer many not know that a year or two down the line, the company might not exist and there might not be technical support or material supplies available for the product. Even worse, the FDA might take it off the market. I've had my share of being burnt by buying such products in my early years.

Make sure the product being sold is very much accepted by the entire medical profession. X-rays, diagnostic and therapeutic ultrasound, TENS units and other common modalities are here to stay and require little ongoing maintenance. Secondly, only buy from a company that has been in business for many years. Thirdly, make sure that if the product needs maintenance and repair that outside vendors are capable of servicing the product and that you won't have to rely exclusively on the manufacturer should the product break and the company is no longer in business. Lastly, make sure that the codes used to bill for the use of the product are legitimate codes and not ones given by a salesman which really are applicable to a totally different diagnostic or therapeutic modality. These suggestions may save many of us a lot of aggravation.

Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

PODIATRISTS NEEDED - CHICAGO --NORTHWEST INDIANA

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists. We are located in Chicago and Northwest Indiana. 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

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 full-time podiatrist in a multi practice location in the Chicago land and Northwest Indiana area. Must have two years of surgical residency. Please e-mail resume to d-kitchens@footexperts.com

INTERNET FOOT THEMED CANDY BUSINESS FOR SALE

Well-known foot-themed chocolate and candy company with over 6,000 customers. Unique products with trademarked names for seasonal (Mistle Toes, Valentoes, etc.) as well as everyday (A Foot of Feet, Twinkle Toes, etc.). Excellent opportunity to generate income from home with an established business. Serious inquiries to Mwolpa@ToeFood.com

IMMEDIATE OPENING - MINNEAPOLIS, MN

Associate leading to partner in well-established practice. Seeking personable, skillful, and attentive podiatrist. No nursing homes, evenings or weekends. Competitive compensation package including health insurance, malpractice, short term disability, 401(k), generous vacation, paid holidays, and excellent salary plus bonus! E-mail cover letter and CV to jbremer@associatedpodiatrists.com or fax to (612) 866-5875 attn: Jennifer Bremer

PRACTICE FOR SALE – NEW JERSEY

Well-established practice in Teaneck, NJ (10 minutes from GW Bridge). Excellent location (in Medical building) heavy traffic, great visibility and large parking lot. Fully equipped, full-time office with established patients. Grossing over 220K with tremendous growth potential. Office is currently open and busy ready to takeover with seamless transition. For additional information please e-mail doctors@gramercyparkpodiatry.com

SEEKING RESIDENT FOR PSR-24 POSITION: BALTIMORE, MD 10X

Mercy Medical Center Position for a highly motivated individual who desires a surgical residency or an individual wishing additional surgical training in a well-established Podiatric Residency Program. Busy metropolitan hospital with high surgical numbers and inpatient care. Resident is integral member of multidisciplinary team. Begins mid June 2008. Includes competitive salary/benefits. Send inquiries to rsher18@yahoo.com

BIOMECHANICS FELLOWSHIP – NEW YORK

Neoteric Biomechanics (patent pending) Nine-Month Fellowship: At The Foot Typing Center® in New York City. Practice, Research, Publish and Credentialize Yourself In This New Paradigm. $36,000 Stipend. New York License Required.Fax Interest to: 212 288 3034 or apply to Dr. Shavelson @ drsha@lifestylepodiatry.com.

PRACTICE FOR SALE - VENTURA, CALIFORNIA

Selling satellite office, fully furnished and equipped. Existing patients and room for more growth. Inquire at tkhk@sbcglobal.net

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