Monday, January 23, 2012
"I can't afford that!"
Everyone is complaining about "Obama-Care". I don't have any answers for you on that, but I can tell you that the system that we have today is very broken. Just today I had a patient that would have had to pay $700 out of pocket for Physical therapy, but I know that if she had the Physical therapy, she would be better by now. I had another patient that was unable to get an MRI because her deductible is $1500 and she was told that she needed to come up with every bit of it in cash before she could have the procedure done. Another patient had to pay $800 up front before she could get her vascular studies. And lastly, I had a patient that has MRSA, you know that awful, antibiotic resistant staph infection that we all hear about. Two of the antibiotics that would cover this infection, she is allergic to. One is Tetracycline, which is cheap, but they have pulled it off the market. Another one is not too inexpensive, but she would have to come in for shots everyday for two weeks and may lose her hearing. The last one her infection is sensitive to and the pharmacist worked with me to get the co-pay down to $200, as the medication is $1500. So the patient had to tell me "I can't afford it!" I long for the day when I can provide treatment that is good for the patient that they can afford! I don't know if I will every see it, but it is a good pipe dream for now!
Sunday, January 15, 2012
Oh my aching feet
There are few things that can bring a person down as quickly as a problem with their foot can. What can you do to prevent this?
1. Wear shoes that fit well. Before you go shopping for shoes, make a tracing of your foot, place that on each pair of shoes that you would like to try on. If your foot is wider then the shoe, that is NOT the shoe for you!!
2. Shop for your shoes at the end of the day. This is when your feet will be most swollen.
3. Get more then one pair of shoes. This will allow your shoes dry out in-between wearing.
4. Check your feet daily, if you notice any rashes, red spots, swelling or other problems, get to your Podiatrist immediately.
5. Ingrown-toenails, warts, ulcers, infections and other problems, require immediate attention.
1. Wear shoes that fit well. Before you go shopping for shoes, make a tracing of your foot, place that on each pair of shoes that you would like to try on. If your foot is wider then the shoe, that is NOT the shoe for you!!
2. Shop for your shoes at the end of the day. This is when your feet will be most swollen.
3. Get more then one pair of shoes. This will allow your shoes dry out in-between wearing.
4. Check your feet daily, if you notice any rashes, red spots, swelling or other problems, get to your Podiatrist immediately.
5. Ingrown-toenails, warts, ulcers, infections and other problems, require immediate attention.
Saturday, January 14, 2012
More about PA's "Prior Authorization"
For many patients and doctors offices this is a very difficult area! Patients and doctors assume that if they A. Evaluated you B. Come up with a diagnosis C. Come up with a treatment plan, then this will all occur. This could not be further from the truth. Every insurance company is different. Even if you and another person have blue/cross or united health care. They many have very different benefits. Even if you work for the same company as another patient, they may have selected a "lesser" plan. At times an MRI will be approved that day with no more then a list of diagnoses. Other times they may want office notes. Still others the doctor may need to have a physician to physician peer review. This may all take a day or a week, depending upon schedules and when this can be accomplished between other patients. Prior authorizations are required for some x-rays, MRI's, cat scans, durable medical equipment, medications and any other services that your insurance deems necessary. It is important for each person to check their coverage and work with the doctors to get these approvals. Although it may be very stressful for patients, remember that the doctor does want you to have this service and they are working on prior authorizations for other patients as well!
Thursday, January 12, 2012
Prior Authorization is not a guarantee of payment!
If you work in a doctors office, these words can strike fear into the hearts of all personnel. Whether it is for surgery, braces, newer medications, physical therapy, MRIs, CT scans and other medical tests, many require prior authorization. This can cost the office staff an entire day in trying to track this down. We as doctors are trained to know what is going on with our patients and what they need. Unfortunately, we spend a large part of our day being told that we are not able to get what we feel is necessary for the best care of our patients. This leads to a large amount of dissatisfaction among doctors. There has to be a better way to treat our patients well and not spend time fighting with "Peggy" to get their treatment plan instituted!!
Wednesday, June 29, 2011
Cost for the doctor to see you!
Recently Shopdme posted a great article breaking down how much your doctor actually makes when you go in.
The approximate breakdown of a $100 new-patient appointment:
$9 for malpractice insurance
$4 for equipment and maintenance
$8 for supplies
$6 for rent and utilities
$10 for office expenses such as telephones, accounting fees, advertising, medical journals, licenses, and taxes
$28 for staff salaries and benefits
$35 for the doctor
This does not include billing costs, legal fees if needed, the cost of implementing electronic health records or the cost of new equipment to keep up with the changes in medicine.
Most doctors graduate with large student loans.
I personally pay $2400 a month in student loans and have been for over 11 years. This means that I must see 69 patients a month just to cover my student loans. Then I can start earning money to cover food, housing, clothing, car costs, health insurance, and other expenses. If this cost $3000/month, it would take another 90 patients a month to see. That's 159 total. Reimbursement is lower for established patients. This doesn't include day care if the doctor has children or the cost of repairing equipment or their car.
The next time that you come in to your doctor. Please don't say, well, you're a doctor you can afford it. They have sacrificed many years of their lives and are usually in serious debt, to take care of people!
The approximate breakdown of a $100 new-patient appointment:
$9 for malpractice insurance
$4 for equipment and maintenance
$8 for supplies
$6 for rent and utilities
$10 for office expenses such as telephones, accounting fees, advertising, medical journals, licenses, and taxes
$28 for staff salaries and benefits
$35 for the doctor
This does not include billing costs, legal fees if needed, the cost of implementing electronic health records or the cost of new equipment to keep up with the changes in medicine.
Most doctors graduate with large student loans.
I personally pay $2400 a month in student loans and have been for over 11 years. This means that I must see 69 patients a month just to cover my student loans. Then I can start earning money to cover food, housing, clothing, car costs, health insurance, and other expenses. If this cost $3000/month, it would take another 90 patients a month to see. That's 159 total. Reimbursement is lower for established patients. This doesn't include day care if the doctor has children or the cost of repairing equipment or their car.
The next time that you come in to your doctor. Please don't say, well, you're a doctor you can afford it. They have sacrificed many years of their lives and are usually in serious debt, to take care of people!
Saturday, May 7, 2011
Your Leg Is a Mirror Of Your Body - ModernGhana.com
Your Leg Is a Mirror Of Your Body - ModernGhana.com
This a very good article to discuss the many complications that may occur with diabetes.
The best way to deal with a diagnosis of diabetes is this:
1. Educate yourself. The more you know, the better you can protect yourself.
2. Check your feet every day!
3. If you have any small wounds or sores, contact your doctor immediately!
4. Educated yourself. Yes I am repeating myself!! Things change regularly in treatments and how to manage your diabetes, if you keep up to date, you won't miss anything.
5. Make sure to wear shoes with a wide toe box and good cushioning. If you draw a picture of your foot on a white piece of paper and put your shoe on top of it.... if the drawing is wider then your shoe. You need a new shoe! It will be much cheaper to throw away a shoe that is too small and rubs your foot, then to deal with the cost of an ulcer and possible amputation.
There will be more on foot care coming up.
Monday, April 11, 2011
Children's Feet
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Monday, February 28, 2011
Sunday, February 27, 2011
Heel Pain Plantar Fasciitis Part 4
Heel Pain Plantar Fasciitis Part 4
How to prevent heel pain or plantar fasciitis:
- Make sure that you have properly fitted shoes. Many patients come into my office with shoes that are too big or too small. If you need help, call shoe stores or your Podiatrist to get your feet measured. Unfortunately for many people, their feet do not stay the same size throughout their lifetime.
- Replace your shoes regularly. Although shoes can get expensive, it is usually cheaper then visits to your doctor or time off from work due to foot pain. Check the bottom of your shoes; if you see that there is a lot of wear in the heels or soles of the shoes, it is time to get new shoes!
- Make sure that you get shoes that are supportive and have cushioning! A good way to check both of these is to bend the shoe from the heel to the toe, if you can fold the shoe in half, it doesn’t have the support that you need. If you can press down on the inside of the shoe at the heel and there is no cushioning then that is not the shoe for you unless you can remove the innersole and put your orthotics in for your cushioning.
- Prepare yourself before exercise; make sure that you stretch before and after exercise as well as getting warmed up.
- Although exercise is important, it is also very important to pace yourself. Many people want to start out by running or walking 10 miles the first day. If you have not been exercising start out with 5 minutes. Always remember no matter how far you go, say 5 minutes from home; you still have 5 minutes to go back, unless you have just gone around the block that leads back to your home!
- Make sure that you are taking care of your total body when exercising, if you do not have proper nutrition and support for the rest of your body, you will not be able to sustain any activity properly.
- Although no one wants to talk about this, if you are overweight, you need to lose weight. Multiply your weight by gravity: g = 9.8 m/s2 and 32 ft/s2 and that will be the force that is hitting your feet when you walk.
- Remember if you are overweight, you didn’t put it on in a day or a week or even a month, so you want to take it off at the same pace that you put it on! Small changes can make a huge impact, such as swapping out a soda or pop for a glass of water. Only eating half of the bag of M & M’s, and leaving at least a small portion of food on your plate at every meal!
Plantar Fasciitis Heel Pain Part 3
Heel Pain Plantar Fasciitis Part 3
Other Causes of Heel Pain:
Excessive Pronation:
Pronation is what allows the foot to absorb shock as it hits the ground in walking. When you have too much of this flexible motion and flattening of the arch, it is called excessive pronation.
If you will notice, when you are walking, your heel will hit the ground first, then the foot rolls toward the big toe before it lifts up for your next step. As the foot rolls toward the big toe, it becomes rigid and lifts the arch up. If you have excess pronation, you get excessive inward motion which puts extra stress on all of the ligaments and tendons that attach to your heel bone. This can also lead to extra stress and injury on your lower back, hips and knees.
There are some other conditions that can lead to heel pain:
1. Bone Bruise: this can occur as the result of trauma.
2. Haglund’s Deformity or Pump Bump, this is an enlargement of bone where the Achilles tendon attaches to bone. As your shoe presses on this area, you develop increased pain in this area.
3. Arthritis: Psoriatic Arthritis, Reiters Syndrome or Rheumatoid Arthritis can create pain in this area.
4. Bursitis: This is similar to tennis elbow where a small sack of fluid fills up and creates pressure in this area.
So, as you can see so far there are many different causes of heel pain. Which will lead to the next portion of our discussion: treatment. With so many different causes of heel pain, there are many different treatments for heel pain.
Even though your neighbor, or cousin or friend had heel pain and received a certain type of treatment for their heel pain, your treatment plan may be very different.
Friday, February 25, 2011
Diabetic Foot Ulcers
Foot Ulcers Independently Linked to Mortality in Diabetes Patients
Over the years as a Podiatrist I have seen many patients with Diabetic Foot Ulcers. I have also been fortunate enough to see many patients with Diabetes that have never had an ulcer. There are many things that you can do to prevent Diabetic Foot Ulcers.
1. Monitor your diet. Spikes in Blood sugar have been shown to predispose patients to neuropathy and diabetic foot ulcers.
2. Have your Hemoglobin A1C checked! This gives you a recording of how your sugars have been running for the past 3 months.
3. Check your feet daily. If you notice any sores or wounds come in to see your Podiatrist or Primary Care Physician Immediately!!
Dermagraft is one of the ways that we treat Diabetic Foot Ulcers here at Surprise Foot and Ankle Specialists.
If you are having any foot problems come in to see us at:
dpmkirk.vpweb.com
Over the years as a Podiatrist I have seen many patients with Diabetic Foot Ulcers. I have also been fortunate enough to see many patients with Diabetes that have never had an ulcer. There are many things that you can do to prevent Diabetic Foot Ulcers.
1. Monitor your diet. Spikes in Blood sugar have been shown to predispose patients to neuropathy and diabetic foot ulcers.
2. Have your Hemoglobin A1C checked! This gives you a recording of how your sugars have been running for the past 3 months.
3. Check your feet daily. If you notice any sores or wounds come in to see your Podiatrist or Primary Care Physician Immediately!!
Dermagraft is one of the ways that we treat Diabetic Foot Ulcers here at Surprise Foot and Ankle Specialists.
If you are having any foot problems come in to see us at:
dpmkirk.vpweb.com
Plantar Fasciitis Part 2
What are heel spurs?
This is a bony growth on your heel bone. We all think of bone as the skeleton in the
corner of the classroom in high school biology. Bone is actually a dynamic living tissue. When bone is put under stress at the site of
a tendon or ligament, such as the Achilles Tendon or the Plantar Fascia, it can
make the bone bleed. When bone bleeds,
it forms new bone to heal. These spurs can be seen
on X-rays and can extend out as far as half an inch. Fortunately, the spur is not the actual
source of the problem.
corner of the classroom in high school biology. Bone is actually a dynamic living tissue. When bone is put under stress at the site of
a tendon or ligament, such as the Achilles Tendon or the Plantar Fascia, it can
make the bone bleed. When bone bleeds,
it forms new bone to heal. These spurs can be seen
on X-rays and can extend out as far as half an inch. Fortunately, the spur is not the actual
source of the problem.
What is plantar fasciitis?
The band of tissue that runs on the bottom (plantar
surface) of the foot is called the plantar fascia. If you add an itis onto a word it means
inflammation, so this is inflammation of the plantar fascia. This is very common in athletes that need to
do a lot of jumping. This can be
devastating for basketball players and is quite painful!
surface) of the foot is called the plantar fascia. If you add an itis onto a word it means
inflammation, so this is inflammation of the plantar fascia. This is very common in athletes that need to
do a lot of jumping. This can be
devastating for basketball players and is quite painful!
The plantar fascia can become stretched over time beyond
where it normally should go. This can
lead to small tears in the fascia which leads to inflammation. This in turn may lead to a heel spur.
where it normally should go. This can
lead to small tears in the fascia which leads to inflammation. This in turn may lead to a heel spur.
Improper shoes with no support may aggravate this condition. I must say that the majority of patients that
come into my office, are sporting a pair of cute flip flops or other shoes with
no support.
come into my office, are sporting a pair of cute flip flops or other shoes with
no support.
With plantar fasciitis the first step after a period of
rest is often the most painful. This is
due to the plantar fascia elongating or stretching out suddenly. Most people find with walking that the pain
decreases or lessens, but will return after a period of rest.
rest is often the most painful. This is
due to the plantar fascia elongating or stretching out suddenly. Most people find with walking that the pain
decreases or lessens, but will return after a period of rest.
Stay tuned to learn more about plantar fasciitis!!
Thursday, February 24, 2011
Plantar Fasciitis Heel Spur Syndrome Part 1
Heel Pain/Plantar Fasciitis: What is it?
This is part one in a series of articles about heel pain. Why do I have this? I like to tell patients that it is caused by telling lies, but they quickly realize that this will not help their foot. So on to the real causes of foot pain. And why you should go to see your Podiatrist and not your neighbor for this problem.
There are a number of different causes of heel pain that we will go over. These will include: Bone bruises, heel spurs, plantar fasciitis, excessive pronation and other diseases of the heels.
Heel pain is usually caused by a problem with your walking gait or biomechanics. This will put excess stress and pressure on the soft tissues that attach to the heel bone and the bone itself. The causes of this stress can vary from wearing improper shoes, being overweight, or a bruising that occurred while walking, jumping or running on hard surfaces.
There are 26 bones in each of your feet and the heel bone or calcaneus is the largest one. There are over 100 tendons, muscles and ligaments in the foot and 33 joints. All of these are exposed to outside influences such as your shoes and the ground we walk on. So our choices of where we work, what surface of floor we have in our homes and what type of shoes we wear will all influence whether or not we have pain in our heels.
One of the main reasons to see your Podiatrist about your heel pain is that you can have some arthritic conditions such as rheumatoid arthritis, infectious problems such as osteomyelitis or a bone tumor. A quick set of x-rays and sometimes blood work can rule this out!! And hopefully, although you had to go to your Podiatrist, take time out of your day, and pay your co-pay or deductible, you will be lucky enough to just have your regular old heel pain that can be treated simply. Continue to follow along and I will go over more causes, and treatment options for your heel pain!
This is part one in a series of articles about heel pain. Why do I have this? I like to tell patients that it is caused by telling lies, but they quickly realize that this will not help their foot. So on to the real causes of foot pain. And why you should go to see your Podiatrist and not your neighbor for this problem.
There are a number of different causes of heel pain that we will go over. These will include: Bone bruises, heel spurs, plantar fasciitis, excessive pronation and other diseases of the heels.
Heel pain is usually caused by a problem with your walking gait or biomechanics. This will put excess stress and pressure on the soft tissues that attach to the heel bone and the bone itself. The causes of this stress can vary from wearing improper shoes, being overweight, or a bruising that occurred while walking, jumping or running on hard surfaces.
There are 26 bones in each of your feet and the heel bone or calcaneus is the largest one. There are over 100 tendons, muscles and ligaments in the foot and 33 joints. All of these are exposed to outside influences such as your shoes and the ground we walk on. So our choices of where we work, what surface of floor we have in our homes and what type of shoes we wear will all influence whether or not we have pain in our heels.
One of the main reasons to see your Podiatrist about your heel pain is that you can have some arthritic conditions such as rheumatoid arthritis, infectious problems such as osteomyelitis or a bone tumor. A quick set of x-rays and sometimes blood work can rule this out!! And hopefully, although you had to go to your Podiatrist, take time out of your day, and pay your co-pay or deductible, you will be lucky enough to just have your regular old heel pain that can be treated simply. Continue to follow along and I will go over more causes, and treatment options for your heel pain!
Diabetic Amputation
Patriot Guard Rider looks beyond amputation wfaa.com Dallas - Fort Worth Local News
Many patients over the years will experience an amputation associated with diabetes. There are some things that you can do to prevent this.
1. Watch your diet. Limiting the amount of sugar you take in will help.
2. Get moving, even if you exercise for 10 minutes at a time, it will add up to your 30 minutes a day!
3. Check your feet daily. If you notice any open wounds or sores, come in to see your Podiatrist or your Primary Care Physician immediately.
For all of your Foot Care Needs: Come on in to:
Surprise Foot and Ankle Specialists
14800 West Mountain View Blvd. Ste 160
Surprise, AZ 85374
623-584-5556
623-584-0755
dpmkirk.vpweb.com
fixingfeet.com
Many patients over the years will experience an amputation associated with diabetes. There are some things that you can do to prevent this.
1. Watch your diet. Limiting the amount of sugar you take in will help.
2. Get moving, even if you exercise for 10 minutes at a time, it will add up to your 30 minutes a day!
3. Check your feet daily. If you notice any open wounds or sores, come in to see your Podiatrist or your Primary Care Physician immediately.
For all of your Foot Care Needs: Come on in to:
Surprise Foot and Ankle Specialists
14800 West Mountain View Blvd. Ste 160
Surprise, AZ 85374
623-584-5556
623-584-0755
dpmkirk.vpweb.com
fixingfeet.com
Wednesday, February 23, 2011
Hammertoes - Causes And Cures
Hammertoes - Causes And Cures
Hammertoes are when the toe bends at the first joint of the digit. This usually occurs in the smaller toes 2-5 and is more common in women then men.
Some hammertoes are flexible and some are rigid. This can be seen when you can no longer straighten out the toe with your hand.
Hammertoes are caused by a muscle imbalance that causes increased pressure in the joints and tendons of the toe leading to the toe bending. They can also be caused by trauma or it can be hereditary. Wearing tight shoes can also contribute to the pain associated with hammertoes.
What you can do:
1. Wear shoes that have a deep-wide toe box that allow your toes to wiggle a little bit.
2. Apply non-medicated padding to the toe.
3. Visit your Podiatrist
4. Avoid shoes with a heel greater then 2 inches.
Your Podiatrist May:
Tape or Pad your toes
Make Custom Orthotics
Perform Surgery
It is important to see your Podiatrist early to avoid surgical treatment if possible.
Come on in to:
Surprise Foot and Ankle Specialists
14800 West Mountain View Blvd. Ste 160
Surprise, AZ 85374
623-584-5556
623-584-0755
dpmkirk.vpweb.com
fixingfeet.com
Hammertoes are when the toe bends at the first joint of the digit. This usually occurs in the smaller toes 2-5 and is more common in women then men.
Some hammertoes are flexible and some are rigid. This can be seen when you can no longer straighten out the toe with your hand.
Hammertoes are caused by a muscle imbalance that causes increased pressure in the joints and tendons of the toe leading to the toe bending. They can also be caused by trauma or it can be hereditary. Wearing tight shoes can also contribute to the pain associated with hammertoes.
What you can do:
1. Wear shoes that have a deep-wide toe box that allow your toes to wiggle a little bit.
2. Apply non-medicated padding to the toe.
3. Visit your Podiatrist
4. Avoid shoes with a heel greater then 2 inches.
Your Podiatrist May:
Tape or Pad your toes
Make Custom Orthotics
Perform Surgery
It is important to see your Podiatrist early to avoid surgical treatment if possible.
Come on in to:
Surprise Foot and Ankle Specialists
14800 West Mountain View Blvd. Ste 160
Surprise, AZ 85374
623-584-5556
623-584-0755
dpmkirk.vpweb.com
fixingfeet.com
Tuesday, February 22, 2011
Diabetic Foot and Wound Care Part 3
Amputations: This is by far the worst part of my job!! As I frequently tell patients: "Keeping your feet and toes, is job security for me."
No one wants to prevent an amputations more then your Podiatrist!
The things that you can do to help out:
1. Check inside your shoes before putting them on!
2. Wear properly fitted shoes at all times, many people with Diabetes and Neuropathy can step on things and not know it.
3. Check your feet everyday! You can use a mirror on the floor, or a mechanics mirror, or ask a loved one to look for you!
4. If you notice any open areas or wounds, come in and see your Podiatrist or Primary Care Physician immediately.
No one wants to prevent an amputations more then your Podiatrist!
The things that you can do to help out:
1. Check inside your shoes before putting them on!
2. Wear properly fitted shoes at all times, many people with Diabetes and Neuropathy can step on things and not know it.
3. Check your feet everyday! You can use a mirror on the floor, or a mechanics mirror, or ask a loved one to look for you!
4. If you notice any open areas or wounds, come in and see your Podiatrist or Primary Care Physician immediately.
For all of your footcare needs, come in and see us at:
Surprise Foot and Ankle Specialists
14800 West Mountain View Blvd. Ste 160
Surprise, AZ 85374
623-584-5556
623-584-0755
dpmkirk.vpweb.com
fixingfeet.com
14800 West Mountain View Blvd. Ste 160
Surprise, AZ 85374
623-584-5556
623-584-0755
dpmkirk.vpweb.com
fixingfeet.com
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