PM News –February 15, 2006 #2,510 Editor-Barry Block, DPM,
JD
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---------PODIATRISTS IN THE NEWS--------
NY DPM Aids in Saving Rock Legend's Life
March 15, 2005, New York City: Neil Young is shaving in the
bathroom
of his hotel room when he notices something weird going on
in his
left eye. Little shapes -- squiggles, spirals -- float on
the top
half of his eye. He blinks. Same thing. Squiggles, spirals.
Seconds
later, Young realizes the shapes he is seeing look more like
pieces
of broken glass. "I closed my eyes; then I opened one
eye and pushed
on it, but this thing stayed right where it was,"
Young recalls. "So
I thought, Okay, this is not my eye. This is my
brain."
On that late winter day a year ago, the first call went out
to ROCK
POSITANO, a New York podiatrist. Young had seen him just the
day
before, complaining that his foot felt numb. Positano had
noted that
his patient's ankles weren't the same size, a symptom that
can
indicate a blood pressure problem. Young knew he had high
blood
pressure but, like many people with the condition, he had
never
bothered to treat it.
Now, as the podiatrist heard about Young's blurred vision,
he told
the singer to come to his office right away. By the time he
arrived,
Young's eyes were fine. No squiggles, no broken glass, no
wobbly
room. Still, Positano insisted that his patient get further
tests.
Dr. Dexter Sun, a neurologist, ordered an MRI and a brain
study.
When the results came back, Sun called Young and his wife,
Pegi,
into his office and closed the door. "Everything in
the pictures
looks good," he explained, in a classic physician's
under-
statement, "except for one thing. You have an aneurysm
in your
brain."
Source: Alanna Nash, Reader's Digest [March 2006]
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-------- APMA NEWS ----------
Women Weary of Stiletto-Induced Sprains: Glickman
In a survey in November by the American Podiatric Medical
Association, 35% of women said comfort trumps style when
choosing
shoes; previously, 18% of women said so. Women are
"unhappy," says
APMA president HAROLD GLICKMAN, weary of stiletto-induced
sprains
and "the dreaded plantar fasciitis," or heel
pain.
Source: Olivia Barker, USA Today, [2/13/06]
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-------------PROFESSIONAL MISCONDUCT----------
License of WA DPM Revoked
In December 2005 the Podiatric Medical Board revoked the
license
James R. Alderson, a doctor of podiatric medicine
(PO00000498). He
must also pay a $22,000 fine. Alderson's surgical facility
was
unsafe and unsanitary. Alderson also wrote prescriptions for
patients without examining them, prescribed narcotics to
patients
beyond legitimate need and had patients give him part of
their
prescriptions. Alderson was convicted of driving under the
influence, hit-and-run and driving with a suspended license.
Source: Washington State Department of Health [2/14/06]
-------- MEETING NOTICES/ COURSES --------------
The Spring 2006 Aesthetic Podiatry Symposium will take place
at the
Venetian Resort in Las Vegas, March 31-April 1, 2006.
Presented by the International Aesthetic Foot Society, these
courses
are approved for CME Category 1 credits.
Day 1 will feature lectures on Botox and fillers, Laser/IPL
leg vein
treatment and hair removal, skin resurfacing and tightening,
injection sclerotherapy, mesotherapy, and more. Day 2 will
feature
hands-on training and discussion of business models and
marketing
plans. Guest Speakers include Everett Lautin, MD, and
Suzanne
Levine, DPM, authors of The Botox Book and You Don't Need
Plastic
Surgery.
For more information and online registration, visit
http://www.institutebe
aute.com
-----------
ATTEND DFCON 06 IN LOS ANGELES 23-25 MARCH 2006
Join more than 1,000 of your colleagues from the U.S. and
20+ other
countries at DFCon 06, the premier multidisciplinary
international
Diabetic Foot conference, 23-25 March 2006 at the
Renaissance
Hollywood Hotel in Los Angeles. On-line registration and
downloadable brochure at http://www.dfcon.com
Earn 20 CMEs/24 Contact Hours and get the latest on Diabetic
Foot
research and treatment from a stellar international faculty.
This
conference is for the entire DF team—podiatrists, vascular
surgeons,
and diabetes and wound healing specialists. Special rate of
$175 at
the deluxe Renaissance Hollywood. Food catered by Wolfgang
Puck.
Call for abstracts--must be submitted by 20 February.
Conference Co-
Chairmen David G. Armstrong, DPM, PhD and George Andros, MD
------------
For a list of all meetings go to:
www.podiatrym.com/meetings.pdf
-------------QUERIES--------------
Query: Standard of Care Plantar Fasciitis
I would like to open a discussion regarding the
"standard of care"
for the treatment of plantar fasciitis. The traditional
standard, I
believe, has always been quoted as 4-6 months of reasonable
non-
operative care, with invasive procedures reserved for those
patients
with symptomatology which has failed to be ameliorated
following the
traditional standard.
In the last 3 years or so, I have had the occasion to review
quite a
number of malpractice cases in which a patient (plaintiff)
has
sustained an injury (typically to the lateral plantar nerve)
following surgery which was performed subsequent to really
minimal
non-operative management. The most common scenario has been
one or
two injections, 1-4 weeks of an anti-inflammatory, and maybe
one
month or two of arch supports, rarely orthotics. Also most
commonly,
these injuries have followed endoscopic plantar fascial
release. My
questions are:
1. Has the standard of care changed? Is this, in fact, the
manner by
which the average podiatrist treats plantar fasciitis? Are
the
charts which I have reviewed typical of the manner by which
the
average podiatrist does treat heel pain?
2. How much, really, is enough "conservative
care" ?
3. Do newer modalities ( ESWT, growth factor injection,
cryosurgery, radiofrequency management, semi-closed
techniques)
permit earlier intervention and bypass the traditional 4-6
month
rule ?
4. Is it just the cases I have reviewed, or in endoscopic
plantar
fascial release associated with a higher incidence of nerve
injury
and symptomatic lateral column pain that we have been lead
to
believe?
5. If a patient is informed of the "traditional
standard of care",
and willingly, with a complete understanding and knowledge
of
alternatives and risks, declines all non-operative care and
elects
to allow his/her health care provider to proceed with an
invasive
procedure, would it be ethical for the healthcare provider
to do so?
Allen Jacobs, DPM, St. Louis, MO, allenthepod sbcglobal.net
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--------- CODINGLINE CORNER --------------
Query: Wart Debridement
What is the proper way to code the debridement of verrucae
plantaris
(plantar wart) on a New York Medicare patient who is being
treated
on a weekly basis?
Bob Kornfeld, DPM, Lake Success, NY
Response: If all you are doing is "debriding"
the plantar wart(s),
then you are performing routine foot care. You should bill
using the
CPT 11055-11057 series codes. Without "at-risk"
qualifiers, however,
Medicare will not cover the treatment. Non-Medicare payers
may or
may not pay for CPT 11055-11057 series codes.
If you are debriding the wart, and then treating it with
acid, cryo,
laser, or some other definitive destruction technique, then
bill the
CPT 17000 series of codes as appropriate. The debridement is
included, and not separately reimbursable.
Mark Schilansky, DPM, Catskill, NY
-----RESPONSES / COMMENTS------------
RE: Amputation of 2nd Toe (Steve Abraham, DPM)
From: Multiple Respondents
I have had two such patients over the years with the same
pathology
that Dr. Abraham speaks of. Both patients were in their
eighties. I
performed a second toe amputation on both patients with
excellent
results. The goal being the elimination of pain from the
second
overlapping digit. The severe HAV deformity remained. Since
their
was no bone healing required and pedal circulation was
adequate,
soft tissue healing occurred rapidly and without incident,
unlike
some of the diabetic/PVD patients we often deal with. In my
limited
experience, this is a great alternative to reconstructive
surgery.
Bob Kornfeld, DPM, Lake Success, NY , Holfoot153aol.com
I have encountered one such case very similar to Dr.
Abraham's
patient. During my residency training, there was a patient
with a
dorsally dislocated, nonfunctional toe that caused pain with
footgear. The underlying etiology of the deformity was the
patient's
rheumatoid arthritis. Elective toe disarticulation at the
MPJ was
performed and the patient went on to heal without
complications.
One item of note is that I believe this patient was
considerably
younger than yours, so age was not as much a factor in
deciding on
the procedure here. I think it should be a reasonable
choice of
procedure to do for certain situations and communication of
the
various options with the patient is vital to the
"success" of your
surgery.
Marc Greenberg, DPM, Dayton, OH, tripperdpmyahoo.com
I have performed a handful of these procedures and am
currently in
the process of considering another. An amputation most
certainly can
be a therapeutic procedure. You said it yourself - the digit
in your
case, as in the ones I performed is completely
non-functional. In a
78 year old, I think amputating the second toe will give you
a quick
solution with little post op recovery time compared to
performing
corrective bunion surgery and straightening out the second
toe.
Obviously, when discussing the procedure with the patient
you must
approach the subject cautiously as the patient's first
reaction
might be "what is this doctor talking about?".
However, after
explaining your reasoning for doing the procedure and the
relative
quickness to recovery plus the fact the outcome is very
predictive,
I think you will find your patient to be happy.
Jeffrey Kass DPM, Forest Hills, NY. Jeffckassaol.com
-----------
RE: Prophylactic Antibiotics (Judith Sullivan)
From: Elliot Udell, DPM
Patients with certain cardiac ailments especially valve
disease are
told to take prophylactic antibiotics in order to prevent
the
possibility of a strep infection which may travel to the
cardiac
valves. We are generally not as concerned with streptococci
in
routine podiatric treatment. The main microorganism we deal
with in
staph. Major joint implants pose another threat and some
experts say
that prophylactic antibiotics are indicated prior to major
foot
surgery if the patient has a large joint implant in some
other part
of his or her body. Others are not in favor of it. I would
like to
cite a review article on this very topic titled Routine
prophylactic
antibiotics for arthroplasty patients receiving dental care.
Is it
necessary? by Rose RE. of Division of Orthopaedics,
Department of
Surgery, Radiology, Anesthesia and Intensive Care,
University of the
West Indies, Kingston 7, Jamaica, West Indies.
This review paper elucidates the controversy and cites many
papers
on the topic. In my practice I routinely prescribe
antibiotics prior
to foot surgery, so this would be a moot point. For others
who do
not routinely prescribe antimicrobials prior to bone
surgery, I
suggest that they read the above paper and its references
and then
decide.
Elliot Udell, DPM, Hicksville, NY, Elliotuaol.com
-----------
RE: Certifying Patient as Disabled
From: Jeffrey Miller, DPM
It has always been my policy, when encountering a patient
who has
pain out of proportion to what you observe clinically, to
refer that
individual to a pain management specialist who is well
versed in the
treatment of CRPS. I inform the patient that I will not fill
out any
forms until they have had a pain management consultation. If
the
findings are WNL then go with your clinical judgment and be
truthful
in filling out any forms the patient requests.
Jeffrey Miller, DPM , Clifton, NJ, Drjm8aol.com
------------------
RE: Missing Rx Pad
From: David Secord, DPM
Shortly after starting to practice in Texas, I had the Texas
Department of Health and a DEA official breeze into the
office one
day. The charge: 3 prescriptions for Lortab 5/500, dispense
250!!
attributed to me. Just the thing you want to start the day.
It turns
out that a local pharmacist had a gambling problem and
decided that
the best way to generate some extra funds for his bookie was
filling
an Rx with a new practitioner's DEA and forging the
signature of the
doctor and then selling the pills on the street. This might
have
worked and been undiscovered if not for the absurd number of
Lortab
on the Rx. 250 Lortab? Who in their right mind would write
an Rx for
that amount, unless they were restocking the dispensary at
the
hospital? All I had to do is sign the form that stated it
wasn't my
Rx or signature and they headed off to put the pharmacist in
the
pokey.
David Secord, DPM, Corpus Christi, TX, ledocdaveaol.com
-----------CLASSIFIED ADS--------
ASSOCIATE POSITION – TEXAS
Mature 3-DPM general podiatry and surgery practice in the
Rio Grande
Valley of Texas is seeking a DPM to fill an Associate
position,
partnership will be considered after a period of 2-3 years.
Applicants should have at least 2 years of residency
training and
enjoy diabetic foot and wound care. Diverse patient
populations.
(VA, Community Health Clinics, Hospitals and 3 offices)
Good
practice environment in hospitals and community. Salary,
bonus and
benefit package offered. Interested DPMs should send a
letter of
intent along with a current C.V. to Complete Family Foot
Care, 812
Lindberg Ave. McAllen, TX 78501. Fax 956 971-9109
-----------
ASSOCIATE POSITION- NEW ENGLAND
Associate wanted to start this summer. Routine care,
diabetics,
biomechanics, sports injuries and steady surgery. Buy-in
for
partnership and ownership of building a possibility.
PSR-24.
Office podiatry skills (residency experience, office
observation or
work) important. Surgical training with focus on core skills
(bunions, met. osteotomies, neuromas/neurolysis, tendon
repairs,
some rearfoot) is important. facne11aol.com, give evening
number
(not cell), hospital name and residency director's name.
-----------
EQUIPMENT FOR SALE - ESWT
If you are using or thinking of using ESWT, I have a new
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country
priced like this one. Will provide training and
installation. Take
a look at http://www.orbasone.com.
Call 1-856-229-2939.
---------
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------------
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