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11/19/2019    

RESPONSES/COMMENTS (NON-CLINICAL)


RE: The Richard O. Schuster Memorial Seminar


From: Chuck Ross, DPM


 


I recently attended the Richard O. Schuster Memorial Seminar and had two immediate thoughts. First, I was incredibly impressed with the presentations and the manner in which Dr. D'Amico and his dedicated staff managed the entire weekend. Congratulations on a superb job.


 


My second thought brought me back to the recent discussions on PM News about the "lack" of appropriate education in the area of biomechanics with some blaming the shortcomings on the colleges of podiatric medicine. After the many superb and timely presentations, I must beg to differ and perhaps place blame...


 


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

Other messages in this thread:


08/04/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Richard A. Simmons, DPM


 


The fee is going up from $731 to $888 for the three year registration. I gave up my DEA license more than ten years ago. I first contacted the State Board to see if there was any need for me to have it and there was not. Depending on the amount of controlled substances you prescribe or if you dispense medications from your office could help you decide if it is financially feasible or not. Not having that license has not had any adverse effects on my practice.


 


Richard A. Simmons, DPM,  Rockledge, FL

08/04/2020    

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



From: Dieter J. Fellner, DPM


 



Dr. Lombardi's question to the ABPM raises an interesting point. Such a concern would be founded, one might assume most assuredly, on a sound scientific basis. I will be extremely interested then to see the scientific evidence. 


 


Could it be true that three year residency-trained ABPM boarded surgical podiatrists fare so poorly in the surgical arena as to be denied surgical privileges by a hospital. All of the hard-gained surgical training in a three year residency will then amount to nothing.


 


Can a three year residency trained, and ABFAS boarded podiatrist outperform his brethren so magnificently that...


 


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


08/04/2020    

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



From: Lee C. Rogers, DPM


 


Dr. Lombardi asks what ABPM’s position is regarding the criteria for granting surgical privileges. Quite simply, the ABPM believes that hospitals should follow State law and Medicare Conditions of Participation when evaluating a podiatrist for surgical privileges, and those privileges should be based on their education, training, and experience, not their board certification. This opinion mirrors that of the APMA, which can be found in the "Hospital Credentialing and Privileging Resource Guide", on apma.org. For further information, please see the ABPM’s Position Statement, "Hospital and Surgical Privileges for Doctors of Podiatric Medicine," published in JAPMA in 2019. 


 


That said, the ABPM is committed to providing the resources necessary to protect the credential from illegal discrimination. We encourage diplomates to contact the Board for assistance if they’ve experienced such discrimination in hospital or surgical privileges.


 


Lee C. Rogers, DPM for the ABPM BOD, Los Angeles, CA

08/03/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2


RE: Questions to the ABPM BOD 


From: Charles M Lombardi, DPM


 


I recently sat through the BOD meeting of the ABPM last Friday (I am a diplomate). Lee Rogers, DPM stated ABPM is spending 100K to defend the right of an ABPM member to obtain hospital privileges with just the ABPM credential. My hospitals have always allowed ABPM members to obtain admitting privileges and wound care, etc., but not surgical privileges.


 


Does the ABPM Board believe that an ABPM certified person should be given surgical privileges? My residents are getting the insinuation that this is the case, and if they do, how can they claim that their diplomates are trained and evaluated in surgical skill sets without any methodology in their testing? Please answer.


 


These questions are my personal questions that do not represent any organization that I may presently serve or have served in the past.


 


Charles M Lombardi, DPM, Flushing, NY

08/03/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: In Support of Students' Request to Cancel CSPE


From: Janet Simon, DPM


 


The COVID-19 pandemic has certainly brought forth unprecedented challenges for all of healthcare, and our podiatric medical students have not been exempted. American Podiatric Medical Student Association (APMSA) President Israel Bowers has clearly voiced the concerns our students are dealing with pertaining to the APMLE Part II Clinical Skills Patient Encounter (CSPE) exam.


 


The request of APMSA to cancel the 2020 CSPE is reasonable during these unusual and stressful times. Our MD counterparts have done so. I encourage my peers to let the National Board of Podiatric Medical Examiners (NBPME) know our profession is fully supporting our students. NBPME Telephone: (814) 357-0487 E-Mail: NBPMEOfc@aol.com


 


Janet Simon, DPM, Albuquerque, NM

07/30/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B



From:  Brian Kiel, DPM


 


Dr. Secord is absolutely correct that this is not really sclerosing. The term is used by podiatrists to describe the injection of 4% alcohol/local anesthetic. We bill this as a CPT 64455, injection of a local anesthetic. I do think this procedure is very effective but it is not sclerosing; the term differentiates this for clinical diagnosis of a neuroma.


 


Brian Kiel, DPM, Memphis, TN

07/30/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A



From: Judith Rubin, DPM


 


Surely, there is a chemist in the profession or in one of the smaller Pharm labs that can make it cheaper. I had a bad neuroma in 1986 in my left foot, third interspace. I used the combo of .5% Marcaine and alcohol 7 times in my left foot. I never had surgery and never had a problem again. This combination has worked on thousands of my patients. I am sounding the alarm for the pharmacologists or chemists that are in our profession to make an affordable denatured alcohol. 


 


Judith Rubin, DPM, Cypress, TX

07/30/2020    

RESPONSES/COMMENTS (NON-CLINICAL)


RE: New Tsunami of Toenail Fungus Advertising


From: Bret M. Ribotsky, DPM


 


What’s with the new tsunami of toenail fungus advertising? Last night in one hour, I saw four different advertisements for OTC onychomycosis products including, Nonyx, Kerasal, Fungi-Nail, and Lamisil AT. Is there something new? Or is it that just most people are working/learning at home and not wearing socks and noticing their feet? 


 


If this is what’s happening, let’s all encourage APMA that NOW is the time to launch an advertising campaign about seeing your podiatrist, or entrepreneurial DPMs to advertise locally for these patients. Let’s remember the John F. Kennedy quote, “When written in Chinese, the word 'crisis' is composed of two characters. One represents danger and the other represents opportunity.”


 


Bret M. Ribotsky, DPM, Boca Raton, FL

07/29/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Ron Werter, DPM, David Secord, DPM


 


According to the recent post, a vial is now costing $1,100 each if you can find others to share the box of 10. I figure that one 5ml vial makes 100ml of 5% solution. Medicare allows $60 for a CPT 64455 in my area. So one 5ml vial of the alcohol can bring in about $6,000; not as good as when the vials were $100 each but still financially a win. That being said, it’s also a good idea to offer a surgical alternative to excision such as the decompression procedure to those who want faster relief.


 


Ron Werter, DPM, NY, NY


 


As the 4% alcohol injection meme has come to the fore yet again, I thought I’d reach out and ask those folks doing this for neuritic pain: As a fairly large number of people continue to refer to a 4% alcohol injection as “sclerosing”, when it clearly is not, do these same people bill a code for a “sclerosing injection”, which they are clearly not performing? I’m going to make the assumption here that everyone knows that a 4% concentration of alcohol in a local anesthetic is insufficient to sclerosis anything. Do people simply use the term “sclerosing” because it is in common parlance or because they believe they are sclerosing something at that concentration and bill in like manner?


 


David Secord, DPM, McAllen, TX

07/29/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Pete Harvey, DPM


 


Like Dr. Shea, I congratulate Dr. Mark Block on spotting a DPM omission in an important publication. It behooves all podiatrists to be continually vigilant on this front. A local case in point is the department responsible for licensing Texas DPMs, TDLR. TDLR has a recent requirement for Texas DPMs to take an online course in Human Trafficking. TDLR refers DPMs to a course offered by TRAIN. Yet, when trying to register with this group, the DPM is faced with an array of circuitous routes to register. In navigating that maze, one quickly discovers that the DPM is relegated to a non-physician role. This omission is noted in many fields of the registration. Hopefully, this will be corrected in the future.


 


Pete Harvey, DPM, Wichita Falls TX

07/28/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B



From: Anthony Hoffman, DPM


 



I have a couple of scenarios in which I like the ability to offer the series of 4% alcohol sclerotherapy injections. The first scenario is for injection of a nerve other than a Morton's neuroma (it happens to be a branch of the lateral calcaneal nerve around the lateral wall of the calcaneus) where there is no need to do a decompression in that there is no entrapment of the nerve. The other scenario is a patient who is not a surgical candidate for various reasons. Having 4% alcohol in our treatment armamentarium is beneficial. By the way, FFF enterprises charges $11,000 for 10 vials (and they will not send only 1 or 2; you have to purchase 10.)


 


Anthony Hoffman, DPM, Oakland, CA


07/28/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A



From: Jeffrey Kass, DPM


 


I have used 4 percent dehydrated alcohol injections in my practice ever since attending the first podiatric dermatology and plastic surgery seminar given by Dr. Dockery in Chicago. This treatment became my primary treatment when steroids were not working consistently and I was seeing patients coming to me for second opinions which MRIs revealed plantar plate ruptures. 


 


Since giving these injections, I think I have done one decompression as there is no need to do surgery due to the effectiveness of this treatment. I have the utmost respect for Dr. Peacock, who is an incredible teacher, and would love for him to expound on the damage caused by this injection. I can’t recall any patient complain of any side-effect from this injection. (I give 1ml, inject directly between met heads, series of three injections every two weeks). There are published articles of radiologists giving much higher concentrations under ultrasound guidance directly into the neuroma. If a patient has pain and the pain is eliminated with no complaint of post-injection pain or numbness, what is the damage to the nerve? I think a patient would have a complaint if the nerve is damaged, no? 


 


Jeffrey Kass, DPM, Forest Hills, NY

07/28/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Tim Shea, DPM


 


Congratulations to Dr. Mark Block on his pick-up of the omission of DPM from a recent government publication. Through his efforts and APMA, we received a 2 for 1 result. Inclusion in the program and the clear delineation of DPMs as physicians with MDs and DOs. Congratulations - job well done. 


 


Tim Shea, DPM, Concord, CA

07/27/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Martin M Pressman, DPM, Dieter J Fellner, DPM


 


I have a source for alcohol for neurolysis - Compounded Solutions in Pharmacy (Monroe, CT). You can get denatured alcohol for injection in vials that are good for 90 days after opening. A 5ml vial is $70.


 


Martin M Pressman, DPM, Milford, CT


 


I greatly respect the opinion of my esteemed colleague, Dr. Peacock. With his extensive practical experience, I have no reason to doubt the veracity of his personal opinions. It will be germane to supplement a Level 5 professional opinion with supportive substantive research evidence of a higher level to address the view that: 1. Alcohol sclerosing injection provides little benefit and, 2. That nerve decompression with transection of the intermetatarsal ligament can provide a superior outcome. 


 


Dieter J Fellner, DPM, NY, NY

07/27/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: A Win for the Profession with the Assistance of APMA


From: Mark S Block, DPM


 


Several months ago, I received a communication from the Federal Government regarding “Guidance on the Essential Critical Infrastructure Workforce.” While reading through the numerous pages, I came across the following: “IDENTIFYING ESSENTIAL CRITICAL INFRASTRUCTURE WORKERS... Healthcare providers including, but not limited to, physicians; dentists; psychologists; mid-level practitioners; nurses; assistants and aides; infection control and quality assurance personnel; pharmacists; physical, respiratory, speech and occupational therapists and assistants; social workers; optometrists; speech pathologists; chiropractors; diagnostic and therapeutic technicians; and radiology technologists.”


 


Having noticed that DPM was not included, I reached out to APMA for assistance in rectifying this significant exclusion. I am pleased to announce that the APMA Health Policy and Legislative departments were successful in accomplishing and expediting a favorable result for the profession. This win continues to validate my belief that without APMA’s advocacy for the profession and our patients, we would be at a distinct disadvantage. Their skilled, professional staff and consultants have the appropriate infrastructure and experience to facilitate these types of positive results.


 


The new edited version contains the following correction that is a result of APMA’s initiative and efforts to correct this significant error: “Healthcare providers including, but not limited to, physicians (MD/DO/DPM); dentists; psychologists; midlevel practitioners; nurses; assistants and aides; infection control and quality assurance personnel; phlebotomists; pharmacists; physical, respiratory, speech and occupational therapists and assistants; social workers; optometrists; speech pathologists; chiropractors; diagnostic and therapeutic technicians; and radiology technologists.”


 


Mark S Block, DPM, Boca Raton, FL

07/24/2020    

RESPONSES/COMMENTS (NON-CLINICAL)



From: Don Peacock, DPM


 


The sclerosing alcohol injection we have all used for years has been active in the podiatric practice's historical options. However, there is a substantial number of patients who receive minimal benefit from this treatment. Besides, the technique damages the nerve. As a result of this, we abandoned alcohol injections years ago. 


 


We also try to avoid more than one cortisone injection for patients that have Morton's neuroma. Neuromas can be very frustrating to treat, but we believe that decompression is the best treatment for the neuromas. We perform the decompressions using the tarsal tunnel scissors set sold by GraMedica (no financial connection). We have performed many of these decompression surgeries on Morton’s neuroma with superb results using this technique. 


 


It is much better not to damage nerves, which includes not doing nerve resections unless necessary. Decompression should be the gold standard for the treatment of a neuroma. 


 


Don Peacock DPM, MS, Whiteville, NC

07/23/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B



From: Elliot Udell, DPM


 



Dr. Roth asks a good question when he questions why certain companies are charging so much money for sclerosing alcohol. He should also ask why the cost of masks and gloves have skyrocketed in price. I took a deep breath when I called a supplier yesterday to re-order disposable masks and was told that the price went from $5.95 a box to $35 a box. Gloves also went up 20%. The question is whether this is allowable supply and demand or are these examples of companies ripping off consumers. If it’s the latter, especially during the pandemic, government agencies need to look into this, and we as consumers need to make these agencies aware of what is happening. 


 


Elliot Udell, DPM, HIcksville, NY 


07/23/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A



From: Howard R. Fox, DPM


 


This whole mess started when Belcher Pharmaceuticals won approval for its version of the drug Ablysinol for use in treating hypertrophic obstructive cardiomyopathy. Because hypertrophic obstructive cardiomyopathy is a rare cardiac illness, Belcher Pharmaceuticals won orphan designation, which means no other pharmaceutical company could manufacture denatured alcohol until Belcher’s patent expires in 2025. Supply companies have run out of their old stock of denatured alcohol and are forced to stock the Blecher product Ablysinol at its ridiculous orphan drug price.


 


I expect denatured alcohol will once again become available at a more reasonable price in 2025.


 


Howard R. Fox, DPM, Staten Island, NY

07/23/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Jay Seidel, DPM, Richard D Wolff, DPM


 


I use faxage.com. It's $7.95/month for 300 minutes incoming, which is usually enough for my 3 offices. I can also fax out using their web portal, which is pretty user-friendly. They also are happy to sign a BAA, which I believe is a requirement, while other fax companies would not agree to that for me.


 


Jay Seidel, DPM, Deerfield Beach, FL


 


Windows Fax and Scan comes standard with Windows operating systems. A USB fax modem runs $15 to $25. You plug in your existing fax line and there is no additional cost. You can fax anything that can be printed. You don't have to be a computer genius to use it. You can also store the fax numbers of all your contacts. There is no third party.


 


Richard D Wolff, DPM, Oregon, OH

07/22/2020    

RESPONSES/COMMENTS (NON-CLINICAL)



From: Ivar E. Roth DPM/MPH


 


I do not understand why this alcohol is so expensive, and what is so special about it? Can one of our colleagues explain this? Also, can’t we just find another source, say buy a big bottle and draw from that bottle?


 


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

07/21/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: COVID-19 and its Effect on Physician Demand


From: Leonard A. Levy, DPM, MPH


 


According to Bruce Japsen in Forbes (July 14, 2020), the ability of a U.S. physician to land a job was easy until a surge of U.S. cases of COVID-19 “flipped” the job market, reducing the demand for doctors during the pandemic. As hospitals curtailed elective procedures to make way for COVID-19 patients, doctor offices, clinics, and other health facilities closed across the country due to safety and shelter-at-home orders. Physicians lost their jobs or had their hours curtailed dramatically. 


 


Since March 31, “search engagements” on behalf of clients like hospitals that hire physicians, dropped more than 30%. A growing number of physicians are unemployed with a limited number of roles available. COVID-19 essentially flipped the physician job market in a matter of 60 days. However, primary care physicians as well as nurse practitioners and physician assistants remain in high demand.


 


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

07/21/2020    

RESPONSES/COMMENTS (NON-CLINICAL)



From: Leonard Vekkos, DPM


 


I found a pharmaceutical company FFF Enterprises and they have (as of yesterday) in stock a limited number of packages of ten 5cc vials of dehydrated alcohol for $2,500 ($250/vial). They were very helpful and the purchase was smooth and the delivery on time. I shared the cost with several other podiatrists and was able to sell 8 vials. Hopefully, they will continue to have the product available.


 


Leonard Vekkos, DPM, Woodridge, IL

07/17/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Jeffrey Kass, DPM


 


I, like most readers, have attended both live webinar and in-person lectures. Simply put, they both have pros and cons and I feel they both can be highly effective. The major point to consider and which were missed in prior postings is that podiatry should be pro-choice. The choice to attend an in-person lecture or seminar should be up to the licensed podiatrist. The fact that some posting here feel the need to fraternize with colleagues is truly irrelevant to the critical aspect of this discussion. If that helps you learn, good for you. Then, go to live lectures. The point is to learn. 


 


Learning can be accomplished online just as well as in person. After 25 years of practice, I have learned a lot from both resources. When done correctly, online lectures can be done with amazing engagement. Proof of this is to participate in any lapiplasty webinar. I have participated in these multiple times. Each one is unique and refreshing. It is unfortunate there are states that are not pro-choice and force doctors to get in-person credits, particularly in light of COVID-19. Shame on these states.  


 


Jeffrey Kass, DPM, Forest Hills, NY

07/16/2020    

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



From: Alan Sherman, DPM


 



As co-founder of PRESENT e-Learning Systems, podiatry’s largest online education provider and among its largest live CME conference providers, Dr. Sasiene rightfully questions why his state of Texas limits online education to only 40% of what is required. We have been running an extensive information campaign to raise the awareness of our colleagues as to this issue. And yes, I have skin in both games here, but it continues to seem wrong to me that any state limits online CME, as 22 states currently do, especially this year.  


 


Dr. Ribotsky finds a lack of passion in online education compared with live CME events. We’ve been thinking about that a lot as we plan to run our first live meeting in the COVID era, Superbones Superwounds East 2020 in Teaneck, NJ, August 14-16, because besides live conferences offering us lectures by passionate speakers, they also are satisfying professional networking experiences. I find them to be a lot of fun. We are confident we can keep our attendees, who are all foot surgeons and as well trained in safe and effective infection control procedures and practices as anyone, safe. The challenge is making it fun. We will do our best. Our model for running a safe meeting will likely be studied carefully by so many entities that hope to run meetings in this period before we have an effective vaccine. 


 


Alan Sherman, DPM, CEO, PRESENT e-Learning Systems


07/16/2020    

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



From: Elliot Udell, DPM


 


When live conventions became, at least temporarily, a thing of the past, it was hard to imagine how online programs would be a substitute. Could you discuss, ask questions, get to shmooze with some of the speakers, visit booths, etc.? It is true that the first few attempts at providing Zoom programs where the speakers and attendees were not in the same room lacked something.  


 


Because this problem has affected all aspects of American life, from school children to college students to doctors learning the latest techniques, society was forced to improve online learning at lightning speeds. In three months, we have come a long way. Even news media talk shows which featured panels of speakers fumbled in the beginning when they went into a format where people were not in the same room with each other. They corrected these problems fast. 


 


Today, things are much better. I am taking a ten-session course right now on dealing with upsets in the news, the virus, medical practice, personal life, etc. Needless to say, the course is packed. The technology for this course has gotten so good that it is in some ways better than courses given by the same school in live format. Bottom line, I miss attending and lecturing at live seminars, but I think that online programs in their current and future formats will be here to stay. 


 


Elliot Udell, DPM, Hicksville, NY
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