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| PM News | |
The Voice of Podiatrists
Serving Over 15,680 Podiatrists Daily
December 12, 2013 #4,939  Publisher-Barry Block, DPM, JD
A partner of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2013- No part of PM News can be reproduced without the
written permission of Barry Block
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| PM NEWS QUICK POLL | |
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| PODIATRISTS IN THE NEWS | |
Telemedicine Provides for Early Detection of Diabetic Ulcers: FL Podiatrist
Early intervention is key to saving diabetics from amputation, said Dr. Howard Umansky, a Miami-based podiatrist. Umansky is founder of Mobile Health Inc., which provides home visits to podiatry patients who have trouble getting to a doctor, and the Diabetes Rural Outreach Project, or DROP, a telemedicine program to monitor diabetes patients in rural areas. About 60 to 70 percent of diabetics will develop neuropathy, which is a loss of sensation, Umansky said.
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Dr. Howard Umansky |
With DROP, patients use smartphones to take and email pictures of foot wounds to medical personnel to be monitored daily, if needed, Umansky said. Smartphone apps also can be used to measure the depth and skin temperature around a wound. “The earlier we can detect it, the earlier we can treat it. If we treat it, we can prevent gangrene, and we can prevent amputation,” Umansky said.
Source: Julie Landry Laviolette, Miami Herald [12/10/13]
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| INTERNATIONAL PODIATRY IN THE NEWS | |
BCPMA Receives Regional Outstanding Partnership Award From CDA
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Dr. Joseph Stern and Dona Van Wellegham |
The British Columbia Podiatric Medical Association (BCPMA) was recently presented with the Regional Outstanding Partnership Award from Dona Van Wellegham, Manager, Volunteer Engagement, of the Canadian Diabetes Association (CDA). The award, which was accepted by Dr. Joseph Stern, was given in recognition of the BCPMA's world-class volunteers.
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| QUERIES (CLINICAL) | |
Query: DVT Prophylaxis
I am performing a standard Austin bunion procedure on an otherwise healthy 24 year-old college student. I use an ankle tourniquet. She is 5"4", 130 lbs, and maintains an active lifestyle. She runs and plays tennis. In addition to anti-depressant meds, she uses an oral contraceptive and admits to smoking less than one pack per day for the past 4 years. I've counseled her about her smoking.
In previous years, I probably would have done nothing more than place her on low-dose aspirin, fit her with TED-type compression hose, and encourage her to exercise her calf and remain mobile during her recovery. Is this a case that requires additional DVT prophylaxis measures based on the current standard of care? Any opinions or references are appreciated.
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| QUERIES (NON-CLINICAL) | |
Query: Administration of IM Antibiotics
I am writing to seek the readership's view on administering IM antibiotics in the office in those instances where an infection seems to call for more than PO medication. Is anyone doing this?
Gary M. Mantell, MS, DPM, Memphis, TN
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| RESPONSES/COMMENTS (CLINICAL) - PART 1A | |
From: Brian Timm, DPM
This clinical presentation could represent a mild form of a variety of spastic conditions related to a variant of a multitude of developmental delay rooted conditions. Having speech delay is a relatively vague diagnosis termed 'alalia'. This could be associated with numerous cognitive as well as structural concerns which could even include deafness or behavioral or emotional conditions as well, which may alter a patient's development into adulthood.
Have you spoken with the pediatrician regarding the extent of this patient's medical history? In my opinion, these cases can be addressed non-surgically until a spastic condition or diagnosis is identified. If there is a functional equinus, physical therapy and even speech therapy could be ordered for now.
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| RESPONSES/COMMENTS (CLINICAL) - PART 1B | |
From: Ron Raducanu, DPM
Her lack of speech can be significant. Is she seeing a speech therapist for this, and what is the origin of this pathology? When you say "neurologically intact", does that mean no clonus? It also sounds like the "deformity" is flexible. Is there any rigidity to the midfoot/rearfoot at all? Have the parents agreed to an x-ray? If so, what were the findings? I'd like to check an x-ray if the parents agree, and if there is even a hint of rigidity.
When she walks initially, what is her...
Editor's note: Dr. Raducanu's extended-length letter can be read here.
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| RESPONSES/COMMENTS (CLINICAL) - PART 2 | |
From: Barry Mullen, DPM
I agree with Dr. Markinson on his panniniculitis call, yet erythema nodosum, lupus, numular eczema, and necrobiosis lipoidica diabeticorum should also be considered in the differential diagnoses.
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| RESPONSES/COMMENTS (CLINICAL) - PART 3 | |
From: Larry Huppin, DPM
When addressing the mechanical aspects for this patient, it is important to note that both pressure and friction play a role in callus formation. Pressure can be decreased most effectively by using an orthosis that conforms very close to the arch of the foot in order to transfer pressure from the areas of callus formation at the metatarsal heads and heel to the arch. For the forefoot calluses, a Poron metatarsal pad or metatarsal bar on top of the orthosis will further act to transfer pressure from the met heads to the area of the metatarsal neck and shaft. Rocker-soled shoes can also decrease localized metatarsal head and heel pressure depending on the location of the rocker.
The orthosis alone, however, will have a limited role in decreasing friction. Using socks with a lower coefficient of friction and that wick moisture (acrylic rather than cotton) will help decrease friction. Decreasing moisture with the use of antiperspirants can also help. A more effective method to decrease friction is to apply an ultra-low coefficient material such as a polytetrafluoroethylene (PTFE) patch to the orthosis topcover at the location of callus formation. A PTFE patch has a coefficient of friction of .16, compared to between .5 and .9 for common topcover materials such as leather, Spenco®, and polyethylene forms such as EVA. In addition, PTFE is the only material that can be applied to a shoe or orthosis which will not have an increased coefficient of friction when it becomes wet. By reducing the coefficient of friction, local skin trauma is reduced.
Disclosure: I am the medical director at ProLab Orthotics; a manufacturer of foot orthoses and distributer of the PTFE Patch™
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| RESPONSES/COMMENTS (JURY VERDICT REPORTER) - PART 1A | |
RE: Botched Bunionectomy Caused Deformity, Plaintiff Claimed (NY)
From: Peter Smith, DPM, Peter Bregman, DPM
I can’t decide which surprises me more - $800K for a sore 5th toe with “loss of independent mobility” or Myron Boxer testifying against another colleague. Oh no wait, neither one surprises me!
I am appalled to see that some woman got over 800k because her 5th toe remained elevated. This is sad for two reasons. 1) The amount 2) I'm pretty sure the toe could have been put rectus by MIS surgery. Biomechanically, it does not make sense that she could not walk normally, as the fifth toe is not needed for ambulation.
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| RESPONSES/COMMENTS (JURY VERDICT REPORTER) - PART 1B | |
From: Gerald Mauriello Jr., DPM, MA
Does anyone else think this is ridiculous? Maybe it's just me, but the major problems are the lack of tort reform and podiatrists who make a living capitalizing on it. Remedy this, and there is plenty of money for healthcare. Eliminate the need to practice defensive medicine, wow. One can dream. What goes around comes around.
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| RESPONSES/COMMENTS (MEDICAL/LEGAL) | |
From: Jeffrey Kass, DPM
Dr. Kruper brings up a valid point in terms of pathology - that a podiatrist is more likely to see non-bony surgical issues than bony surgical problems. I think full allopathic scope is a pipe dream here in New York. It seems the atmosphere is to take baby steps. Considering we have the oldest podiatry school, one would think our scope would be advanced compared to that of the other states.
I am trying very hard to understand why it is possible to pass a scope bill to allow 3-year trained RRA certified podiatrists to perform bony ankle surgery and skin and soft tissue to the knee, while the rest of NY podiatrists are deemed incompetent to treat the non-surgical problems (skin and soft tissue) above the ankle. This law seems very "egosurgical-centric".
The surgical trained person gets to perform surgery and non-surgical care, while everyone else is left out. ABPM, where are you? Can you hear me now? Any dues-paying member in the NYSPMA or ABPM should voice their concerns to the societies they pay dues to. The assumption seems to be if you don't call them, you don't oppose what is taking place.
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MEETING NOTICES - PART 1
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| YOU CAN'T MAKE THESE THINGS UP | |
RE: Outrageous Shoe of the Day
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| Would you call this a "Loafer"? |
Source: Submitted by Pearl Herman
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MEETING NOTICES - PART 2
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| CLASSIFIED ADS |
PRACTICE FOR SALE – GLENDALE, CA
Retiring from part-time practice averaging 15 hours a week practice, grossing well over $130,000 a year. No HMO, PPO or hospital surgeries (but located 20 minutes from 5 major area hospitals). Only accepting private insurance, Medicare and cash. Not participating in the diabetic shoe program. Unique practice specializing in off label liquid SILICONE injections (no insurance…cash only), Cryoneuroablation, x-rays, ultrasound imaging, Lixiscope, soft tissue surgeries, and some palliative care. In same great location, in the center of everything for the past 43 years. Unlimited potential. Call 818-384-2479.
PART-TIME PRACTICE FOR SALE - NYC
Great Opportunity! Retiring podiatrist selling part time (18-20 hrs/wk), fully equipped, multi-disciplinary practice upper West Side of Manhattan. Densely populated, street level location near subway. 27 years at location. Option available to expand to full time or to share with eventual purchase. Reply to kappy105@yahoo.com. In subject please write: West Side Office.
LOOKING TO PURCHASE A PRACTICE IN PALM BEACH COUNTY, FL
Obamacare!? Looking to get out...or stay? I am looking to purchase a practice in Palm Beach County, FL. Contact Ian S. Goldbaum, DPM at (561) 702-5637
ASSOCIATE POSITION –OH
Group practice in Ohio seeks a well-trained surgeon, PSR24/36 preferred. Our practice provides all of the latest technology needed to provide patients with the best care, including Lasers, PAD Testing, DME, EMR and Digital X-ray. Competitive compensation package including salary and bonus. Please send CV to: DPMgroup1@yahoo.com
ASSOCIATE POSITION - CT (GREENWICH, FAIRFIELD AND NORTH HAVEN)
Join one of the largest podiatric groups in Connecticut. Well-established and progressive offices, including EMR, digital x-ray, vascular and NCV studies, Pinpointe and CO2 lasers, diagnostic ultrasound and electrical stimulation therapy. You can expect a full schedule of patients the day you start, and a very competitive salary. For more info www.greatfootcare.com. Send resume to: Dr.Kassaris@yahoo.com
ASSOCIATE POSITION - TAMPA BAY AREA
Excellent opportunity to join a well-established multi-office group practice in the beautiful Tampa Bay area starting July 2014. We are seeking a highly motivated, ethical and outgoing physician with Florida license to join our growing practice. Competitive salary, excellent benefits, bonus structure with partnership opportunity. Please email CV to: Kpontious9@yahoo.com
ASSOCIATE POSITION - CHICAGO, IL
full-time position to treat homebound patients in Chicago; salary $100K plus bonus based on 40% of collection; car allowance plus malpractice insurance offered; full logistical support provided. If you interested in part-time position, similar conditions can be prorated. If interested, email to dpms2@hotmail.com
ASSOCIATE/PARTNER - CENTRAL FLORIDA
Busy two office, two doctor practice looking for a motivated, hard-working individual for associate leading to partner. Current partner wants to retire. Our practice enjoys a diverse patient population from general podiatry, diabetic, wound care and surgical patients. Full podiatry privileges at two hospitals and surgical center. We are offering a competitive salary with incentives. Malpractice and health insurance, as well as all fees and dues covered. Must have active Florida license and be at least board eligible. Please forward CV and surgical log to: footpainbegone@gmail.com.
ASSOCIATE POSITION – BRITISH COLUMBIA
Beautiful Victoria, British Columbia. Needing experience associate for 3-office practice Reply todr.cole@shaw.ca
ASSOCIATE POSITION - NEW YORK/ NEW JERSEY
Looking for experienced podiatrist or 2013 residency graduate who is currently seeking to run a practice within a multi-specialty practice(s). Must currently be on Medicare and at least three to five insurance plans or have been accepted by those plans. Should be motivated and committed to be part of a healthcare team. Extremely competitive salary with the long term relationship in mind. Must have a minimum of one full day per week available and could be up to five days. Opportunities in several areas of NY and NJ areas with new opportunities becoming available. Podiatry8888@yahoo.com
IMMEDIATE ASSOCIATE POSITION AVAILABLE IN THE HEART OF CENTRAL FLORIDA.
Largest podiatry group in Polk County featuring EMR, muscle laser therapy, digital x-rays, vascular and NCV studies, ultrasound machines, shockwave therapy, and much more. We are a very busy office so expect patients the day you start and a competitive salary with bonuses. E-mail CV tocontactus@flfootandankle.com
ASSOCIATE POSITION – CONNECTICUT (HARTFORD AREA)
Available immediately. Looking for a Board Certified Surgeon with strong RF and ankle skills. This 20 year established practice offers EHR, digital x-ray and Noveon laser. All dues, malpractice and health insurance paid as well as 401K available. Excellent compensation. email lynnleblanc@cox.net
ASSOCIATE POSITION - CENTRAL FLORIDA
Associate wanted for well-established practice in central Florida. Experienced support staff, malpractice coverage and health insurance provided. Excellent opportunity for a promising future. To apply please go to www.yourcareerinpodiatry.com
ASSOCIATE POSITION - BOSTON SUBURB
Excellent opportunity to join a well-established practice. Located in western suburb of Boston. Office includes EMR, digital x-ray, orthotic scanner. Seeking personable, enthusiastic, motivated associate with goal to become partner. Practice includes surgery, sports medicine, general podiatry. PSR 24/36. Send CV to: jstewartdpm@comcast.net
IMMEDIATE OPENING - SOUTH JERSEY
Exceptional opportunity for a full-time, surgically trained podiatrist to join a busy, well rounded practice covering all aspects of podiatry including; surgery, wound care, and sports medicine. Must be highly motivated, personable, and have good communication skills. The practice is affiliated with a hospital residency program. Opportunity for future buy-in/partnership. Please send cover letter and CV tosuperstarstaff1@gmail.com. In the subject line, please write, "I am your next associate."
ASSOCIATE POSITION - SOUTHERN CALIFORNIA
Very busy, two location group practice seeking a full-time, self-motivated and hard-working podiatry associate. Competitive salary offered. Please email CV to: podiatrists@icloud.com
EQUIPMENT FOR SALE – USED PINPOINTE LASER
EQUIPMENT FOR SALE - USED CUTERA GENESISPLUS LASER
Purchased new July 2011, new handpiece, updated software and re-calibrated in September 2013. This is a great laser for treating toenail fungus, scar reduction & warts. $33,500.00 OBO. Please email dman1hansen@gmail.com or call 801-870-4161
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Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 15,500 DPMs. for details, click here or write to:bblock@podiatrym.com or call (718) 897-9700 for details. Weekly ad rates start as low as $119 for a 50-word ad. THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451.
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| Disclaimers |
Acceptance and publication by this newsletter of an advertisement, news story, or letter does not imply endorsement or approval by Barry Block or Kane Communications of the company, product, content or ideas expressed in this newsletter. Podiatric Medical News does not represent the views, and is a separate entity from Podiatry Management Magazine and Podiatry Management Online. Any information pertaining to legal matters should not be considered to be legal advice, which can only be obtained via individual consultation with an attorney. Information about Medicare billing should be confirmed with your State CAC.
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