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09/16/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B



From: Elliot Udell, DPM


 



Dr. Borreggine is correct. One does not need to make an appointment to see a doctor in order to acquire a set of custom foot orthotics. This is not new. Making and dispensing foot orthotics has never been a practice which required a medical license. Orthopedic shoe stores, chiropractors, and physical therapists have been dispensing custom orthotics for years. What distinguishes a podiatrist from a "Joe Blow" working in a shoe store dispensing orthotics is our training in biomechanics. It’s the knowledge and training that enables the podiatrist to add corrections into a custom orthotic that distinguishes us from shoe store employees and others who make foot orthotics.


 


To this end, it would be great if the orthotics labs could roll back the clock and once again subsidize lectures on biomechanics and foot orthotics at every one of our conventions and at every one of our schools. That would once again make a real difference for our profession as well as the general public.


 


Elliot Udell, DPM, Hicksville, NY


Other messages in this thread:


01/24/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B



From: David Krausse, DPM


 



I hope that the new TLC show is helpful in spreading the good work of podiatry around and I hope that the 2 podiatrists featured make good decisions and help their patients. That being said, does it not bother anyone that neither of these doctors are board certified in surgery? 


 


David Krausse, DPM, Flemington, NJ


01/23/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B



From: Jonathan Michael, DPM


 



With all my respect to the Drs. on the show, I was not impressed at all by the performance that highlights our profession. In one instance, the doctor says I have never seen anything like that and I really do not know how I am going to treat you. Then he made the patient custom sandals when I was expecting some sort of surgical intervention. In the other instance, the Dr. removed a fungus nail that was done distally and crumbled; in my opinion, it should have removed proximal first to avoid the struggle to remove it in pieces. I think that did more harm than good to our profession. 


 


Jonathan Michael, DPM, Bayonne, NJ


01/06/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B


RE: Source for Radiesse 


From: Allen Jacobs, DPM


 


Saying that “I’ve used this technique or product a bizillion times without any problems” may not be a positive defense for unindicated use. It is analogous to drunk driving, or never stopping at a red light. Most intoxicated people, or those who ignore traffic signals, are not in auto vehicle accidents while driving drunk or ignoring a red traffic signal. However, driving while drunk or ignoring a red light raises the statistical RISK of an accident. Should such an accident occur, you will likely be held accountable. Safe means safe for studies and indicated utilization.


 


Stating that you “took a course” at some seminar is like implicating the bartender for your intoxicated driving. Taking a “course” at some podiatry seminar does not provide you with a special exemption for the provision of ethical, standard of care treatment to your patients. 


 


I suggest that at a minimum, patients be informed that the use of the medication or technique has not been studied nor is FDA-approved, and that appropriate verifiable consent be obtained.
Allen Jacobs, DPM, St. Louis, MO

01/02/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B



From: Allen Jacobs, DPM


 



My understanding of Radiesse is that it is not approved for, nor are there FDA studies for, the use of this calcium hydroxylapetite product for the foot and ankle. Experience in facial and hand soft tissue augmentation has demonstrated that Radiesse may be associated with vascular occlusion, downstream embolization, and tissue infarction, among other complications. The manufacturers recommend that Radiesse be utilized for indicated pathology in studied areas (face and hands), and by those TRAINED and EXPERIENCED in its use. Perhaps the reluctance to provide this product is not "anti- podiatry", but rather the responsibility of the manufacturer to not distribute the product for indications not FDA-approved. 


 


Furthermore, by undertaking Radiesse injection for foot and ankle augmentation, the podiatrist assumes a substantial potential medical-legal liability should a significant adverse sequela occur. Hiding behind a dermatologist to provide Radiesse could further legally implicate the distributing dermatologist in a ruse to provide a podiatrist with a medication for unindicated purpose. Having another podiatrist testify that in their opinion Radiesse may be used sans FDA studies and approval, and having the manufacturer testify that the dermal filler was not made for nor indicated for the purpose used, and that they (the manufacturer) would not knowingly provide ANY healthcare provider with Radiesse for non-indicated use, may be problematic. Caveat emptor!


 


Allen Jacobs, DPM, St. Louis, MO


12/24/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B



From:  Jack Ressler, DPM


 


Before I sold my main practice, I researched practice brokers and interviewed a few. The bottom line is that you pay them several thousand dollars to give your practice a "valuation" and even more money when/if they sell your practice. Don't think for a minute that they come out to see your practice first. They will, but you pay extra for that service. I cannot speak for all practice brokers but the ones I spoke with have you sign an agreement that gives them exclusivity of selling your practice. This means they are in the driver’s seat as to how much and what type of advertising they want to do to promote your practice. They do not have to do too much work. The work they do, you pay for. 


 


Yes, you can still get a buyer on your own, but when under contract with the broker, you still pay their commission. Nobody knows your practice or can sell it better than you! Take some time and look into advertising your own practice. If a sale is pending, then contact a lawyer for further guidance. I sold my own practice and the only advertising I did was on PM News


 


Jack Ressler, DPM, Delray Beach, FL

11/11/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B



From: Allen Jacobs, DPM


 



CBD topical preparations appear to be very helpful for symptomatic treatment of musculoskeletal disorders (e.g. arthritis, tendinitis ). I offer this has an alternative to those patients in whom oral NSAID therapy is not appropriate or concerning, e.g.: renal concerns, cardiac concerns, anticoagulation therapy, history of GI pathology). Typically, high NSAID risk patients are given the choice of topical NSAIDs, CBD topical, or no treatment. I personally use the CBD products from EBM pharmacy. The results have been excellent. I prescribe CBD topical daily.


 


Disclosure: I have lectured for EBM pharmacy in the past.


 


Allen Jacobs, DPM,  St. Louis, MO


11/05/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B



From: Leonard A, Levy, DPM, MPH


 


Brent D. Haverstock, DPM said, "It would seem that if podiatry is to become a branch of medicine (MD/DO), the APMA would have to meet with the American Medical Association (AMA) and the American Osteopathic Association (AOA)..." This remark and so many others from podiatric physicians seem to indicate that the "appetite" for DPMs to acquire an MD or DO degree is rapidly increasing. However, before any meetings take place with the AMA or AOA and the APMA, it is essential that strategic planning take place to determine exactly what the profession needs to do and what needs to be done to get there. 


 


Such an activity must, at the least, include representation from the APMA, the Association of Colleges of Podiatric Medicine, representatives of the current licensing examination body (i.e., American Podiatric Medical Licensing Examination), and the bodies within our profession that represent both the accreditation of undergraduate podiatric medical education and graduate podiatric medical education (i.e., residency training). 


 


It would be a disaster if such a plan was not properly developed and members of our profession were not on the same page. Our effort needs to be one having a uniform voice devoid of bickering by individuals and groups in the profession. The strategic plan developed should be articulated in a document containing the background of the proposal, the state of the profession, including its current education and training, and a detailed description of what is being proposed. I suggest that the time is ripe to undergo such an effort but that it needs to be done very carefully. This formal process must begin now.


 


Leonard A, Levy, DPM, MPH, Ft. Lauderdale, FL

11/04/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B



From: Alan Sherman, DPM


 



I’m confused by Leonard Levy’s most recent message in this discussion in the October 31, 2019 #6,539 issue, in which he refers to the “highly controversial proposal to have two specialty boards in the podiatric medical profession (i.e., podiatric surgery and podiatric medicine”. It’s not a proposal. We currently have these two specialty boards, ABPS and ABFAS. What we don’t have is two medical specialties. We have two specialty boards that represent one specialty, podiatry, and that structure is what is confusing the public and the medical establishment.


 


The proposal made by Jeff Robbins, DPM, supported by myself, Joe Borreggine, and now Brent Haverstock, DPM, is that our two specialty boards MERGE and form one board with sub-specialties, including advanced foot and ankle surgery and...


 


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


10/28/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B



From: James J DiResta, DPM, MPH


 



Many graduating podiatric medical students would benefit from an Intensive Podiatric Medicine Residency option. Providing this option for our graduates who do not want to be surgeons can have real value IF done correctly. That would work if we were able to engage Dr. Levy in this process in creating such a program, i.e. a 3-year residency curriculum in "podiatric medicine" that could provide for training in areas of general medicine, obstetrics, psychiatry, and make up for those clinical deficiencies our graduates presently have, provide for an allopathic or osteopathic medical school to sponsor the program so the resident can be provided a DO or MD degree, and get the residency in "podiatric medicine" ACGME recognized with accreditation.


 


I know those are considerable barriers to cross. As a profession, we may need to financially support such an effort in the initial roll out. We would need our students to take and pass the USMLE step 1 which we have known for some time is essential no matter what we do going forward. The completion of this type of residency would provide equal footing with our medical and surgical colleagues for OUR profession "podiatric medicine". Dr. Levy has provided alternative pathways for DPMs to the DO degree before. Perhaps this time, we can obtain a successful solution in a time span equal to that of our podiatric surgically approved programs and that would provide the value many of our graduates want who do not expect to be reconstructive foot and ankle surgeons. 


 


James J DiResta, DPM, MPH, Newburyport, MA 


10/16/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B



From: Richard D Wolff, DPM


 



For the past 12 years of practice, I have had zero residual nail dust in my treatment rooms, but I understand where you are coming from. During my first two years of practice, I had the same issue. When I moved to a different office, I had a central vacuum system installed. The vacuum is in a closet and shared by all treatment rooms. The rooms are connected to the vacuum via 2" PVC pipe above the ceiling tiles. The noise is contained to the closet, which has 2" thick foam added to the walls. 


 


I bought a cone nozzle (#ACC-SHEATH) from Jan L. It attaches directly to the end of a Dremel Multi-Pro and has a 1/2" tube connection. I also bought a reducer from Allegro Vaccums. It reduces the 2" outlet down to 1/2". The last item was a piece of 1/2" vinyl tubing I purchased from the local hardware store. There is strong suction noise in the treatment room, but no motor noise. The vacuum also serves as a floor vacuum for each room and we vacuum in between patients. No nails, no dust. I Dremel every patient. It is still going strong after 12 years of heavy use. I'm guessing I have about $1,500 in the system.


 


Richard D Wolff, DPM, Oregon, OH


10/07/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B



From: Pete Harvey, DPM


 


I use Telemed out of Atlanta. My fee is $119/month and well worth it. However, that fee does not include scheduling, but they do offer that service. My service is automated and they tell the patient the office is closed and to call during regular hours.


 


If it is an emergency, they advise the patient to call the ER. If I get an after-hours call, they send a text to my phone with the patient’s problem, and a blue "click-on" to call the patient back.


 


Pete Harvey, DPM, Wichita Falls, TX

10/03/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B



From: Steven J. Kaniadakis, DPM


 


It seems that podiatry school programs are pushing for students to get more biomechanics instruction from their residency programs and other post-graduate programs. Podiatrists have  typically been very well versed in these (and other) subjects, including reading and understanding x-rays and radiology, surgery skills, etc. 


 


Generally, podiatrists have been very well educated before residency and other post-grad programs compared to other medical school students. Even some practicing MD physicians do not even know which way to hold an x-ray (unless they were in a radiology residency or fellowship specialty program). However, generally speaking, MDs are much better versed in labs, etc. 


 


Steven J. Kaniadakis, DPM, St. Petersburg, FL

09/04/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B



From: Dave Williams, DPM


 



I have used HelloRache for about a year and have been happy with their services. They use ZOOM as their video chat and it hasn’t failed yet. My scribe can hear us clearly and we can hear her. She has direct access to my EHR and creates a “draft” note for me to review and sign later. She is based in the Philippines, but the company’s main office is in Arizona. All scribes have medical experience. You can interview your scribe before you hire them. You pay HelloRache every 2 weeks and they take care of the rest. 


 


Dave Williams, DPM, El Paso, TX


08/30/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B



From: Justin Sussner, DPM


 



Last summer, I had the pleasure of getting a perfect bull’s eye on my back. My PCP put me on the standard dose of doxycyline. I went to my local chain pharmacy, who happily filled it and took $60 from me, the allowed amount on my insurance. 


 


About 2 months later, my wife was diagnosed with Lyme disease, and was given the exact same prescription. She went to our local mom and pop pharmacy who, when looking up the insurance info, stated "this isn't right", and then ran our info without insurance, and, for about $10, gave us the same doxy, same quantity.  


 


The moral of the story is: always look up your medication costs before walking into a drugstore, and it always pays to know a good locally-owned business.


 


Justin Sussner, DPM, Monroe, NY


08/05/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B



From: David Gurvis, DPM


 



While neither solidly pro nor against “Medicare for all”, I would ask Dr. Hrywnak to back up some of his statements. A few pro and cons as I see them, in no particular order.


 


While true that Medicare as it is now handles the older population from the young healthy 70 year old to the chronically ill 65 year old, that would change as it would then include the young and healthy as well as the older and ill and everyone in between. As always, the young or the healthy would fund the ill.


 


As to taxes, yes, they would go up and in many cases... 


 


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


07/30/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B



From: Raymond Posa, MBA


 



VoIP is Voice over Internet Protocol; basically, your voice communications are transmitted over the Internet instead of the traditional phone lines. That service is called POTS which stands for plain old telephone service. In the early days of VoIP, there were issues with voice quality, but those days are long gone. The quality of VoIP is top notch and the systems have all the advanced features any practice could want.


 


One of the biggest differences between VoIP and traditional phone service is price. VoIP tends to be much less expensive. Another huge plus with VoIP is its portability. If you were to move your...


 


Editor's note: Raymond Posa's extended-length letter can be read here.


07/10/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B



From: Judith Rubin, DPM


 



I too took the boards in 1988 and thank God passed the first time. Now taking the Boards is almost impossible. One of my associates handed in his cases, some from residencies and some from private practice. His cases were rejected because of ridiculous things such as a cavus foot in which he performed a Dwyer osteotomy. They wanted to know why he didn’t do NCS and EMGs. Really? I think the whole thing was ridiculous. That’s my opinion. 


 


Judith Rubin, DPM, Cypress, TX


06/26/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B



From: Richard M. Maleski, DPM


 



I have not used the Epifix Micronized Amniotic membrane allograft for plantar fasciitis, but I have used the Epifix Amniotic Membrane for wound healing, and I have not had a good experience with Mimedx. When I was being sold on the graft, the sales rep and someone in their home office who helped us get the pre-authorization assured me that we would only be responsible for what we were actually reimbursed, and they were aware that the patient was insured through Medicare/Medicaid.


 


Needless to say, I wasn't reimbursed the full cost of the graft, and Mimedx now insists that it is not their policy to only accept what was reimbursed. I paid them what I was paid, had dozens of communications with them, sent them copies of the EOB as proof of payment, had my billing service send them the EOBs, but they continue to harass me about the balance. Maybe it's just me, but I would not take any billing advice from them. Be forewarned.


 


Richard M. Maleski, DPM, Arnold, PA


06/25/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B



From: Joseph Borreggine, DPM



 


“Practice burnout” is not the issue, but rather it is the fact the we are just “too late to the game”. We figured that our practices would exist for many years and when it was time to “retire”, then we would sell it off for a hefty sum and enjoy the fruits of our labor in our sunset years. 


 


Unfortunately, this is not the case because all the young DPMs over the last ten years have chosen to make their careers into a “vocation” rather than an...


 


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


06/19/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B



From: Neil Scheffler, DPM 


 



One of these clinics is in my area in SW Florida. They run full-page ads in the newspaper for free seminars on stem cell therapy, (no mention of chiropractic in the ads). I took my painful shoulders and knees with me and went to one of these "seminars" held in a meeting room of a nearby hotel. The nurse practitioner was the speaker, but first they showed a video of actor Mel Gibson with a story of how he flew his father out of the country for stem cell treatment before it was available in the U.S. and had a miraculous cure.


 


The NP seemed a bit upset that she could not practice independently in Florida and had to have an MD on board. It appears the MD has no patient contact, the visits are in the chiropractor's office, and the NP does the treatment. Follow-up physical therapy is done by the chiropractor and staff.


 


I asked about what they used to direct the injection, hoping to hear diagnostic ultrasound. Instead the answer was that "I aim the needle where you point to the pain." I asked about platelet rich plasma and was told they are looking into that now. And then we were told of the special pricing for seminar attendees. Only $5,000 for an injection. 


 


Neil Scheffler, DPM (retired), Estero, FL


04/24/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B



From: James DeWitt, DPM


 



I have been prescribing balance AFOs for patients at risk for falls since 2011 and have found them to be an important and effective component of my comprehensive fall prevention program. I conduct a fall risk assessment with any patient who has admitted to falls/unsteadiness or whom my staff and I observed demonstrating a balance deficit as they ambulate about the office.


 


I refer you to the randomized controlled trial by Bijan Najafi, et al. from November 2018 published in Gerontology entitled "Effectiveness of Daily Use of Bilateral Custom-Made Ankle-Foot Orthoses on Balance, Fear of Falling, and Physical Activity in Older Adults: A Randomized Controlled Trial". I feel that podiatry has a tremendous opportunity and is very well positioned to make a difference in this rapidly developing medical issue. I would be happy to answer any questions you may have.


 


James DeWitt, DPM, Wyoming, MI


04/16/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B



From: Nicholas A. Ciotola, DPM 



 


We tried this for a short period since it dovetailed well with our MIPS reporting. I found them to be poorly tolerated. The AFOs are cumbersome and don't fit easily into patients' shoes. This is extremely problematic in a deconditioned patient. I did have one patient with a reducible equinovarus deformity who found the AFO helpful, but the feedback was lukewarm to unfavorable. You will need to spend time responding to patients' complaints and returning the AFOs to the lab for adjustments. If you really want to help your fall risk patients, a PT referral can go a long way. Establish a relationship with a home nursing agency to set up home PT if needed. Your patients will return to you with a spring in their step.


 


Nicholas A. Ciotola, DPM, Methuen, MA


04/15/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B



From: W. David Herbert, DPM, JD


 



It was the first day or two that I spent at OCPM in the fall of 1972 that our dean Abe Rubin, DPM told us why real doctors (i.e.. MDs) did not consider podiatrists real doctors. He stated they said this because podiatrists did not deliver any babies during their training. Dr. Rubin stated that beginning with our class, that would all change!


 


I remember spending 6 weeks in an externship at an osteopathic hospital in Texas in the fall of 1975. While there, every Wednesday I observed podiatric surgery. For 24 hours a day, one of us was on call for assisting on obstetric deliveries. I remember assisting on 27 deliveries while I was there. I am not sure this experience made me feel more like a real doctor when I graduated. I do know that it convinced me that I would not have become an obstetrician even if I was able to!


 


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


04/13/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B


RE: Using the DPM Degree Outside of Podiatry 


From: Ty Hussain, DPM


 


I have to commend all these great physicians and their inputs as to basically answer our question of who we are and where our profession is headed. I would love to be on a panel at any of our national or regional meetings as this topic and anything relevant to it will draw crowds by the thousands.


 


After reading much of what has been stated, the need for DPMs to be equal or this so called parity to our MD colleagues will only begin with us having the initials MD behind our names. That being said, discussion has now led us to...


 


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

04/12/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B


RE: Using DPM Degree Outside of Podiatry 


From: Robert Kornfeld, DPM


 


In the almost 39 years since I graduated from NYCPM, it is my assertion that very little has changed in the world of parity with MDs and DOs. I will also say that very little has changed in podiatric medical education in terms of teaching our students cause and effect. We still focus on attacking symptoms and when we fail, we turn to surgery. The reality is that if every podiatrist understood the reasons why patients presented to his/her office with a problem, we would be light years ahead in our transition to parity. 


 


Here is an example: I lectured to a group of podiatric residents. I asked them what could be the underlying cause of...


 


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


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