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Home , Podiatrist, Podiatry

Practice Perfect

By Jarrod Shapiro, DPM

Why Should Know 45 It’s a necessary part of being a .

Practice Perfect is a continuing ev- to emphasize a bit more the “physician” arch of her feet. Anyone focusing en- ery-issue column in which Dr. Shapiro part of this. It’s a simple talk the talk, tirely on her feet would have called offers his unique personal perspective walk the walk argument. We need to this tinea pedis or dermatitis, pre- on the ins and outs of running a po- be able to speak the same language and scribed a cream and been done with diatric practice. function similarly to our colleagues in it. However, upon further questioning, the medical community. This requires it turns out that her father had a CVA hould all podiatrists know training that is similar (not the same, at 35-years-old. This raised an index of medicine? In reality, the an- mind you, just similar) to MDs/DOs. suspicion, so a battery of autoimmune swer to this question is a simple ‘yes.’ The reason it’s so simple is that it is in our Understanding and finding this diagnosis requires Sbest interests as and also incredibly helpful to our patients. a more global view of the body. For example: it’s not uncommon to see patients for bilateral plantar pain (sometimes bilateral heel pain) Additionally, it allows us to simply tests were ordered, including a hyper- who present with complaints that provide better care. How many medi- coagulable panel, and lo and behold, don’t sound like typical plantar fas- cations are your diabetic patients cur- she had a factor V Leiden deficiency. ciitis. They’ve been treated by sever- rently taking? Do you understand how Upon learning this, she was referred al other physicians, often podiatrists, these various medications might inter- back to the with a variety of ways, none of which act with something you prescribe? Do after a phone conference. Hopefully, helped the patients. After some inves- you know what terbinafine will do to the patient will not have to suffer the tigation, it turns out to be lumbosa- a patient’s anticoagulation status if the same fate as her father. This demon- cral radiculopathy. Understanding and patient is on warfarin? Do you know strates the importance of the podiatric finding this diagnosis requires a more how to identify and treat a duodenal visit and the opportunities to help our global view of the body. Obviously, ulcer that occurs as a result of the an- patients if we keep a more global view. the treatment for this problem is highly ti-inflammatory you’ve prescribed? It’s entirely possible that your gout different from that of . A while back, there was a patient could suffer from gout as a re- Since we podiatrists like to call our- young female patient with a bilateral sult of cancer. The increased metabolic selves “podiatric physicians”, we need non-blanching purpuric rash on the Continued on page 46

www.podiatrym.com APRIL/MAY 2016 | MANAGEMENT PRACTICE Perfect

Medicine (from page 45) thopedists don’t know everything; they 3) Podiatrists in practice should be consult other doctors and focus on the required to maintain and demonstrate state and tissue breakdown may lead bone and joint diseases, and they are a certain level of medical knowledge. to hyperuricemia and subsequent gouty still doctors.” This may be true, but we This could be documented by designat- arthropathy. Are you aware of this re- podiatrists have a different charter than ing an amount of yearly CME require- lationship? There was never a hema- orthopedists. We are not only bone and ments for medicine the way tology class or rotation while in train- joint doctors, but also dermatologists, CME is currently required in a few states. ing. This is learned while in practice. neurologists, rheumatologists, and endo- 4) Other types of CME should be More commonly, podiatrists need to crinologists, among others. At least that made available online for general understand the role of antihypertensive is what we advertise—that we cover a medical knowledge expansion, the way medications and renal disease in the eti- large number of conditions that mani- PRESENT e-Learning Systems has made ology of gout. How can a rec- fest themselves in the lower extremities. many of these topics available. ommend a reasonable course of action Agreed that we are required to have if he doesn’t understand that thiazide a certain level of knowledge of these We need to teach our students and diuretics alter the excretion of uric acid various specialties, since we are gener- residents to look above and beyond from the kidney? alists of a particular body region, but to the foot and ankle when treating their This list goes on and on: psycholog- do this effectively, we need to be better patients. In fact, this is easily the more ical in many of our patients, educated in the overall medical aspects. complex part of podiatric medicine. Un- cardiac disease and various endocrinol- If we want to be considered equal derstanding why a patient should or ogy problems. Is your idiopathic neu- or equivalent to our MD and DO peers, should not have a surgical procedure ropathy patient suffering from occult then we should do the following: and the medical issues leading up to that undiagnosed or cervical my- 1) Increase the amount of medi- are as important as acquiring opathy? Does bilateral hand and foot cine training our colleges provide to skill in dissecting the foot or inserting 46 numbness and paresthesias raise your podiatric students. A few of the schools a screw. We all know there’s a patient suspicion for another diagnosis? Do you already do this, especially the ones that attached to that ankle, but do you know ask about hand numbness, or is that too are actually integrated into an allopathic enough medicine to understand what’s far above the ankle to matter? Are you or osteopathic medical college. happening with that patient? Are we able to perform a full body neurological 2) Increase the amount of med- physicians? Or is that just podiatric lip examination when necessary, or do you icine rotations our residents re- service? The answer is up to you. PM just check protective sensation? There ceive while in training. Rotations are so many new medications our pa- that have our residents functioning Dr. Shapiro is editor of PRESENT Practice tients take. Do you stay up-to-date? as an integral member of the service Perfect. He joined the faculty of Western Uni- One argument often made regarding should be favored over “observation- versity of Health Sciences, College of Podiatric orthopedists: Someone once said, “Or- al” types of rotations. Medicine, Pomona, CA in 2010.

Present Podiatry PRESENT Podiatry (podiatry.com) is a podiatrist-owned-and-run company that proudly serves as the largest provider of online CME to the podiatry profession. One of the key lectures in their online CME collection is highlighted below.

APRIL/MAY 2016 | PODIATRY MANAGEMENT www.podiatrym.com