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From: Dieter J Fellner, DPM


I applaud Dr. Ribotsky's well-intentioned solution for sourcing Radiesse. At the same time, I am truly flabbergasted. This company apparently unchallenged can, through their actions, indulge their gross and unfettered bias towards a legitimate professional medical body of healthcare professionals, such as podiatry, so much so, as to affect the company’s profit margins. At the very least, does Merz not have any fiscal responsibility for their investors? Is this company not answerable to anyone? I would strongly advise their investors to consider the extreme folly of this company.


I suspect I must be wrong in my assumptions - there HAS to be a rational explanation why a legitimate, state licensed and fully accredited doctor, a specialist no less, should be denied legitimate access to Radiesse. Instead of receiving the customary professional courtesy from a company such as Merz to be 'allowed' the privilege to increase their sales and profit, the doctor needs instead to consider going cap in hand to a colleague to beg for a supply. 


Until Merz’s CEO issues an unreserved apology and is fired and/or their abstract, discriminatory and possibly illegal policy is reversed, I will quite simply prefer to drill multiple holes in my own cranium without anesthesia, before I will consider putting a single cent towards this company and its ridiculous and shameful business policy. 


Dieter J Fellner, DPM, NY, NY

Other messages in this thread:



RE: NY Podiatrist Authors a Light-Hearted Novel from a Glorious Era Long Gone

From: Steven Kravitz, DPM


I recently read a novel by Dr. Elliot Udell titled Monticello: A Borscht Belt Catskills Tale. During the 60s, 70s, and into the 80s, the New York Catskills mountains was a vacation haven for a large Jewish resorts, with 2,000 rooms and more, top headliner evening entertainment, endless amounts of kosher foods and activities for the entire family. Along with this were small bungalows, less expensive hotels and motels to fit anyone's budget so they could enjoy the winter and summer away from the city.    


The novel uses the metaphor of a simple childhood story to share with the reader a brief moment of going back in time and getting the feeling of this innocent time and place. There's a good bit of subtle humor in a number of the passages that make it an enjoyable diversion without having to take a plane or travel to spend a lot of money to destinations unknown. Sit down in your favorite chair to take a quick voyage and get away from it all.


Steven Kravitz, DPM, Winston-Salem, NC



RE: It’s Time for Our Leaders to Step Up

From: Bret Ribotsky, DPM


Recently, I posted “Should DPMs charge a PPE fee”?  Dr. Udell said that dentists are more of a cash business while podiatry is “regulated by insurance companies.” That was the point I was making. Dr. Busman made a comment that it’s reasonable to charge a fee, and that he was willing to pay $15 for PPE at his dentist. So why aren’t DPMs doing this? Why don’t we have guidelines like the dentists? It’s time to step up and make changes. During this covid time, it’s time for our leaders to “buck” the system. 


The media is looking for stories, and with Covid toes, they want to hear from us. Dr. Nirenberg created a covid foot registry and the APMA talked about working with the dermatology association (AAD). So far, nothing has occurred with the AAD. Why not work with a podiatry registry? I know being a leader takes risks, but I know I’d rather strike out swinging than watch the pitch go by for a strike. We all should respect the leaders who take risks.


I am a big fan of APMA President Dr. Seth Rubenstein but he can’t do it alone. All of our leaders need to support podiatry NOW as the world will be different, and now is the time to make changes. I know with focus, this crisis can become an incredible opportunity. 


Bret Ribotsky, DPM, Boca Raton, FL 




I purchased the Swift immunotherapy device in August of 2019. I found that I had a significant amount of patients, both adult and pediatric, with lesions that often times were referred from dermatologists and colleagues specifically for CO2 laser excision after failing various conservative treatments. I had a 16-year-old patient scheduled for CO2 laser excision in September of 2019. I called his parents after purchasing the device and recommended that we try the Swift procedure before CO2 laser excision. After three treatments, all of the patient’s lesions (greater than 30 on both feet) resolved.


The Swift device can cause discomfort. This discomfort is far less than surgical excision. I find it is extremely helpful to prescribe EMLA cream and apply this for 5 to 8 minutes prior to Swift treatment. Patients feel discomfort/pain in the form of heat. Once the treatment is over, the discomfort dissipates. The patient can exercise or go about their activities of daily living immediately post treatment without any discomfort.


The device is very easy to use. It is extremely effective in pediatric patients with young, healthy immune systems. I often find that lesions are completely resolved after 3 to 4 treatments. In adult patients, with older immune systems, often times they need between four and six treatments.


Disclosure: I recently became a consultant for the Swift device company.


Rachel Balloch, DPM, Avon, CT



From: Richard Goldstein, DPM


We have been very pleased with our purchase of the Swift machine. We purchased it in November 2019 and are on track to pay for it in full this year. So far, the results have been incredible, especially on recalcitrant warts. We are still working on our process. Some people need local anesthesia and some have not, but either way they are tolerating it. I was really glad to be an early adopter and I feel that within the next few years, microwave technology will be the treatment of choice for warts. I also feel like we have only touched the surface of what medical microwaves can be used for.


Richard Goldstein, DPM, NY, NY



RE: 40th Anniversary OCPM Class of 1980

From: Tom Silver, DPM


I too would like to take a moment to "wax nostalgic" to offer congratulations to all my OCPM classmates on the 40th anniversary of our graduation. It's hard to believe it has been so many years! I hope you too have fond memories from school days and that many of the hopes and dreams for the future that you had back then have been fulfilled! 


Tom Silver, DPM, Minneapolis, MN



From: Daniel Kormylo, DPM


I have used Rick Pruzan for all my Midmark repairs. He is a great guy and certified by Midmark. He is based out of Northport, NY


Daniel Kormylo, DPM, Rocky Point, NY



From: Alec Hochstein, DPM


I like to consider myself a progressive podiatrist. I try to add something to my practice at least yearly that brings a certain polish and a new technology to the office. This past year after seeing the initial advertisements for the Swift Emblation unit, I just couldn’t resist bringing it into my office, as I find verrucae to be extremely frustrating entities to treat (as I’m sure many podiatrists and dermatologists do as well).


I could not be happier with my decision to add this to my treatment armamentarium as the results and adoption by my patients have been nothing short of miraculous. I have no problem stating that my resolution rates for my verruca treatments with Swift Emblation is over 90%. The treatment is extremely well tolerated by my patients. It has been a great addition to the office. 


Disclosure: I am a consultant for Saorsa North American distributors of Swift. 


Alec Hochstein, DPM, Great Neck, NY



From: Thomas A. Graziano MD, DPM


I decided to buy this new modality/technology because I believe in its mechanism, i.e. stimulating one's immune system to "naturally" eradicate the virus. My experience with the modality has been very favorable. Initially, I was seeing patients who had multiple unsuccessful attempts utilizing different modalities (surgical excision, chemo, cryo, etc.). At the onset, I must admit that I was questioning whether or not anything was happening during treatment, for as advertised, there is no smoke, no visible burn, or heating of the tissue. Don't be discouraged though; this is a very powerful therapeutic modality.


It is not painless. At times, it is necessary to administer local anesthesia, often a PT nerve block if the warts encompass a large region or subdermally in sensitive areas. Each treatment requires that the operator use a new tip. Each tip costs around $75, so be mindful of that if you’re charging a “case fee.” The mechanism of action relies on an intact immune system, so those patients with compromise in this area may require more treatments or be recalcitrant completely. Typically in patients with healthy immune systems, even those who have been resistant to other forms of treatment, from 3 to 5 sessions may be required. "Virgin" solitary warts can be handled in 1 to 3 treatments.


Thomas A. Graziano MD, DPM, Clifton, NJ



From: Corey Fox, DPM


We use Henry Schein. Sometimes repairs can be onsite, other times it will have to be boxed up and shipped out. If you're lucky, they may have a loaner. When it comes time to buy a new autoclave, don't wait until this one is completely dead. Keep the old one serviced and operational for times like this. They do NOT make things like they used to.


Corey Fox, DPM, Massapequa, NY



From: Alan Bass, DPM


I heard about the Swift device in 2019 and I leased it in November 2019 while at the AAPPM conference in Daytona. I leased it specifically because of one patient with recalcitrant interdigital warts. I have been very happy with my decision. I leased the unit for 5 years. I have had very good results with several patients in this short period of time. The unit is very easy to use. The treatment protocol is very easy to follow. I have heard from other DPMs that they are also happy with their investment.


Disclosure: I am a consultant for Saorsa, the distributors of Swift.


Alan Bass, DPM, Manalapan, NJ



From:  Craig H. Thomajan, DPM


I can report good to excellent results with this technology. I have been using Swift therapy for native and recalcitrant plantar verruca for approximately 6 months. Generally speaking, the younger the patient, the stronger the immune system, the less treatments are required. We see visual improvement in dermatoglyphics after one treatment regardless of the number of lesions presenting. We have used the system approximately 50 times with no adverse side-effects, no scarring.  


The device is simple to use. We have found that using a needleless injector to deliver a small aliquot of anesthesia prior to the therapy allows us to start at maximum wattage to deliver the energy needed to elicit an immune response with little to no pain. We are averaging resolution between the second and third treatment.


Craig H. Thomajan, DPM, West Lake Hills, TX



From: Paul M Taylor, DPM


Thank you Sam Bell for your note regarding the PCPM class of 1970. I have been retired for a few years but still follow what is happening in podiatry. The changes over the last 5 years, including scope of practice, surgical procedures, electronic records, new medications, public recognition, group and mega-practices, and now COVID-19 exceed what happened over the previous 45 years.


Congratulations to this year’s class; you have an exciting and challenging time ahead of you.


Paul M Taylor, DPM, Silver Spring, MD



From: Paul Busman DPM, RN


For me, the point is moot since I'm no longer in practice but it seems to me that charging a fee to recover the extra cost is reasonable. A podiatry practice is different from a dental practice in that due to the nature of a dental practice, the dentist is literally and figuratively in the patient's face. Drills and water spray can aerosolize contaminated droplets, raising the danger of cross-infection. This also means that they probably need more time and labor to disinfect the entire treatment room and all of its equipment between cases. That said, I'm getting a new crown placed next week and I'll gladly pay the extra $15.


For podiatry, may I suggest charging a fee to cover the actual cost of masks, face shields, and other disposables? Let the patients know that you are just charging what those items cost you and that you're not trying to profit from a bad situation. 


Paul Busman DPM, RN, Frederick MD



RE: 50th Anniversary of PCPM Class of 1970

From: Sam Bell, DPM


Please permit me a moment to wax nostalgic. I want to offer congratulations to my 27 classmates on this the 50th anniversary of our graduation. I know it’s a cliché, but it really did go by in the blink of an eye. I hope you are all well 


Sam Bell, DPM, Schenectady, NY



From: Elliot Udell, DPM


Yes, podiatrists as well as dentists, will incur lots of extra expenses with protective gear as well as a mandate to not see too many patients at once. The problem with comparing podiatry with dentistry is that, by and large, dentistry is a "cash for service" profession, whereas podiatry and most of medicine is regulated by insurance companies. For those podiatrists who do not take insurance assignment, by all means, charge extra for masks, gloves, and whatever; but for most of us, it would be mighty hard to get an extra Lincoln off of a Lincoln penny from most carriers.


Elliot Udell, DPM, Hicksville, NY



RE: Hydroxychloroquine for Inflammatory Conditions or Neuropathy

From: Robert D Teitelbaum, DPM


I have had ankylosing spondylitis for 54 years. My first attack came in textbook fashion in my late twenties. Basically, you cannot stand up straight and there is a sciatica fire-like pain that runs around your sacrum and down your upper legs. My father, who gave it to me, got his first attack when he was 28. That was in 1941. He wanted to enlist in the armed forces but spent 6 months in a hospital getting only supportive care. There were no steroids nor effective NSAIDs available, nor any blood tests to accurately pin this down as a rheumatoid variant. He also developed multiple plantar heel spurs and had the infamous Gaenslen procedure performed on his heels where they flap down the entire fat pad from the posterior heel to gain access to the spurs which were resected.


Thirty seven years later, I experienced my first attack during my residency. I took a week off and since I had an iron stomach and the help of effective NSAIDs like phenylbutazone, I was able to...


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



From: Elliot Udell, DPM


Dr. Werter shined a light on a problem that we may all be facing in our post-Covid world. The problem may be a lot greater than we realize. Forget the couple of employees working at small medical offices who may choose not to return to work because unemployment insurance pays more than coming back to work. What about big companies where many skilled workers may choose to not return to work? This is a ticket to a great economic depression. I hope someone in Washington is aware of this problem.


Elliot Udell, DPM, Hicksville, NY



RE: Employees Not Wanting to Return to Work

From: Ron Werter, DPM


The question has come up as to why an employee would want to return to work if they are getting full salary plus $600 for not working. The rules may have changed in many years but I seem to remember that if you’re on unemployment, you still have to look for a job and not refuse to take a reasonable offer. So if you the employer offers your resistant furloughed employees their job back and they refuse, I assume that you could let unemployment know about that and the employee would have to have a discussion with unemployment. I am not a lawyer and my opinion may be incorrect but it may be worth an inquiry.


Ron Werter, DPM, NY, NY



From: Richard J. Manolian, DPM


In regard to Dr. Flippin’s post, so why are we going to go to the extent of forgiving student loans? Because we have a pandemic and you should therefore be discharged of all federal loan responsibility? The government is not in the position of predicting whether calamity will occur and therefore forgive a loan due to it.


The government can provide temporary assistance to aid in recovery. Otherwise, we would never make any progress in this country for all the possible problems that can and will occur.


Richard J. Manolian, DPM, Cambridge, MA



RE: Pandemic-Induced Shortages of Peroxide and Isopropyl Alcohol

From: Robert D Teitelbaum, DPM


What used to cost $24 for sixteen quarts (4 gallons) of 91% alcohol from Sam's Club now costs about the same amount for two quarts with the hefty additional hazmat shipping charge from a catalog/web site/amazon link. But if you think and look outside the box, equivalents may be found (not witch hazel). While shopping at one of the dollar stores, I looked down at the bottom shelf and saw those round pint size plastic bottles that IPA used to come in, before the quart containers became common. The fluid was pink, not clear and the bottle said it contained "Arthritis and Sports Medicine Pain Relieving Rub". The label said it contained IPA, methyl salicyate, (the active ingredient of Ben-Gay) and capsaicin.


I had to crack open the cap of one of them, knowing that I would have to at least buy that one. But that is risking all of one dollar. It reeked of alcohol, which of course is...


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



RE: Kudos to Amerx Corporation

From: Ted Mihok, DPM


I am writing to recognize Amerx Corporation again for their donations of wound care supplies for our joint project of Lions Club and Rotarians in Mexicali. They were delivered the first week of April to the General Hospital Mexical, MX. Over the years, Amerx has been instrumental in sending thousands of dollars in goods to support our efforts. Kudos to Amerx and Jennifer Creel and her staff.


Ted Mihok, DPM, Alameda, CA



RE: Podiatrists and FQHC

From: James Burruano, DPM


Podiatrists can be strong, progressive influencers in healthcare and health outcomes. Podiatrists in the state of New York are not recognized as physicians. In my own experience, the need for a podiatrist to be considered a physician is important in certain circumstances. I wanted to share my experience(s) as a podiatrist in a Federally Qualified Health Center (FQHC) in Buffalo, NY. I was hired in 2013 as a staff podiatrist. At the time, there was no scope of practice for podiatrists in an FQHC at Neighborhood Health Center (NHC).


Once added, NHC became my new practice that I worked part-time at while I closed my private practices. After meeting with our CEO to discuss full-time status, she asked whether I wanted to interview for a position as the chief medical director. After taking time to think about this, I decided to...


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



From: Jack Ressler, DPM


I’m sure after reading the query about Anthem being charged with massive Medicare fraud, some podiatrists, myself included, are shaking their heads. These hired companies harass us to no end with these money-making audits. They send us long lists of requested patient charts to be sent only for the sake of making money off Medicare. I get their requests, send them invoices, get calls promising payment, and nothing comes of it. I do not send charts until payment is received. I rarely receive payment.


My understanding is that Medicare actually mandates the Medicare advantage plans to do these audits.


Jack Ressler, DPM, Delray Beach, FL



From: Martin Pressman, DPM


I don’t know for sure what the diagnosis is in this case. That said, High on my list is neuroma. Neuromas need to be 4mm before they are visible on MRI. Intermittent forefoot  pain that is severe with “ fullness” sounds to me like a neuroma. Diagnostic nerve block may help and test interspaces for hypoesthesia sharp/dull. Neuromas are great pretenders!


Martin Pressman, DPM, Milford, CT



From: Joseph Borreggine, DPM


Since every podiatrist in the country will be affected by the COVID-19 pandemic financially in an unprecedented way, then federal assistance may have to considered. This can be obtained through an SBA loan program which will cover necessary business expenses, needed inventory, payroll, and outstanding liabilities. 


This may be your best option to keep your practice afloat until things return to “normal”.  Here is the SBA site online. What is interesting is that the ADA is lobbying Congress to help protect dental practices from undue financial stress at this time. They recently stated, “The ADA will be working to ensure that those provisions will benefit our dentist owners.” 


I wonder what the APMA and the ACFAS are doing to fight for the same thing for podiatry? 


Joseph Borreggine, DPM,  Port Charlotte, FL


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