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Podiatric Health
Section Newsletter
Winter 2009

Chair's Message

Janet Simon, DPM

The Future of Podiatric Public Health: Where do we go from here?

Having been in the supportive wings of our section for eight years, I am pleased to step forward into the chair position. Through the previous eight years, our Section has mirrored what certainly has been occurring in our larger spheres of life. With a clear public mandate for public policy change, I truly hope to again infuse our Section and the podiatric profession with the ideals of those leaders who founded our Section over 35 years ago.

For too long our country’s public policy has had little focus on improving health or moving the dialogue from treatment to prevention. It is evident that podiatry has roles to play in this policy dialogue, and it is through the collaborative efforts of our small profession that this needs to continue. Our current policy has also lagged at ensuring that we all have equal assess to quality programs that will improve the health of our communities. Podiatry has been fighting this battle for too long as we recognized the inequity within Title XIX and Medicaid that does not define podiatrists as physicians similar to Title XVIII and Medicare. As our country’s new health policies are being discussed, it is absolutely necessary that podiatric physicians are recognized once and for all in a consistent manner in all health programs.

Certainly, we must advocate for those unable to advocate for themselves and work toward eliminating health disparities while improving access to educational opportunities and social justice.

What’s next? The continued building of working relationships with APMA, APHA and the many other partners that are members of our healthy communities. The 2009 National Public Health Week (NPHW) observance, April 6-12, is a great starting point with its focus on Building a Foundation for a Healthy America. Our Section will be readying a walking manual that will be useful for direct patient care as well as a good health promotion tool with other health care providers. I encourage each Section member to do their part for promoting a healthy foundation.

Medical Mission Round Table

International  Missionary  Medicine Round Table

Humanitarian/Missionary Medicine is an interest area that many of our Section members have and participate in. Our Section is leading the effort to develop a useable database of information for our podiatric profession, and our Round Table panel will provide valuable supplemental information.

(DA) Donald Adams, DPM  Framingham Podiatry Associates, Framingham, Mass.

(AKN) Ajitha Karunakaran Nair, MPH , California School of Podiatric Medicine, Berkeley, Calif.

(DW) Darren M. Woodruff, BSc, BA , Podiatric Medicine, Midwestern University, Glendale, Ariz.

(BR) Barry Rodgveller, DPM , Founder and retired director of the Baja Crippled Children’s Project

Q 1 :   From your perspective, what are your three best suggestions for preparing to go on an international medicine or missionary (IM) project for the first time ?
1. Learn some basics of the language.
2. Research a little about the area that you will be visiting in regards to culture.
3. Learn what medical facilities are in the area which could be used if needed.

1.  I have found it critical to ensure that you have encouragement of your institution and to keep them updated on any progress. 
2.  It’s never too early to start thinking and preparing for your project.
3.Maintain contact with institutions and stakeholders that you want on board.

1. Get local support from a civic organization in the host country to help with non-medical logistics and to market your presence in the region.
2. Need local medical cooperation with hospital and doctors(preferably orthopods) for follow up after you leave the country.
3. Contact Peace Corps volunteers in host country that help promote your presence in outlying areas.

Q 2:    What are suggestions for obtaining monetary sponsorships for travel expenses?
BR - local civic support  (rotary , lions, etc.) in the United States to help raise funds and that has an international organization that can give you local contacts in the host country.

Q3: Since many of these projects take place in areas that may have governmental/political instabilities, what are recommendations for planning for secure travel?
I think that physicians that go into these areas need to keep their wits about them as any good tourist who ends up in an unstable situation. Keep copies of passports, and records away from the originals, know a little about what is going on in the areas and try to stay removed from extreme areas of unrest.
1. Check travel advisories on the U.S. Department of State Travel and Business Web site and be sure to register at the U.S. embassy or consulate of the country you are visiting.
2. Ask local staff or coworkers about safety issues in the area.  They have a better idea of what’s dangerous than most Web sites.
3. Trust your intuition.  As with anything, if you don’t feel safe in a location or a particular situation, get out of it.

BR - Get government approval for your being in the country and providing free medical care. The local civic organizations or the other international groups that work in that region/country may be able to help you acquire this. Do not go to areas that are politically
unstable. The last thing you want to do is put you or your project in

Q4:  What are your suggestions for personal health safety in preparation and during IM projects?
Be careful about where your food and water are coming from; personally, if it is not bottled water than I don’t drink it. Keep a small supply of personal meds for things like dysentery or other problems that may arise.

1. Visit the travel clinic and make sure your vaccinations and titers are sufficient.  You can check out the CDC Web site for suggestions on vaccinations and health precautions.
2. Take your prophylactic meds even if you don’t’ think it’s necessary.  Be sure to complete the course of the meds.
3. Be cautious with food for the first two weeks.  Wait to see what foods others are eating and subsequently getting ill from and wait for your body to adapt to the change in the environment.  Then, transition into eating local foods from sources that have proven to be safe.  Bring dry food like granola and nutrition bars to sustain you when you first arrive.

Q5: What are your suggestions for coordinating medical supplies and pharmaceuticals to take on IM projects?

DW - I think that there should be some kind of central record of which companies donate supplies and how much they donate. Then physicians will know where supplies are available. Samples from reps and other places can be saved and collected as well.

BR – Contact other international medical humanitarian agencies that go to the same region/country to make sure you are not duplicating services or competing with them and perhaps you can piggyback care with them.



Medical Mission to Kathmandu

Healing the Children Medical Mission to
Kathmandu, Nepal

Sept. 20-27, 2008
Report submitted by Stephen Miller, DPM

Host Hospital: Nepal Orthopedic Hospital * (NOH)
  Nepal Disabled Association
  Khagendra New Life Center
  Narayantar, Jorpati -4
  Kathmandu, Nepal
  Tel: 00977-1-4911725, 4911274
  FAX: 00977-1-4911467
  Web Site:

Hospital Director & Mission Liaison: Anil Shrestha, MD
Healing the Children Team Liaison: Stephen Miller, DPM

Team Members:
Stephen Miller, DPM,  Team Leader,  Anacortes, Wash.
Don van Nimwegan, MD, Team Administrator, Anesthesia, Seattle
Dan Baldini, MD,  Anesthesia,  Seattle
Tom Ballestreri, MD,  Anesthesia,  Anacortes, Wash.
Elizabeth Lin, MD,  Family Practice/Team Physician,  Seattle
Matt Williams, DPM,  Surgeon,  Seattle
Kai Olms, MD,   Surgeon,  Bad Schwartau, Germany
Craig Camaasta, DPM, Surgeon,  Atlanta
Lopa Dalmia, DPM  Resident/Assistant Surgeon,  Atlanta
Bojan Kuure, RN,  OR Nurse,  Anacortes, Wash.
Mary Dennison, RN,  OR Nurse,  Seattle
Barbara van Nimwegan, RN, OR Nurse,  Seattle

* This hospital was conceived and built by funds raised by Rotary Clubs in Nepal, the United States, Canada, Belgium, Holland and France under the direction of Jim Sinclair (U.S./Canada) and Luc Salens (Belgium) with the help of volunteer orthopedic surgeon Dr. Pierre Soete (Belgium). This medical mission coincided with the 10th Anniversary of the NOH which, in those 10 years 1998-2008, achieved financial self-sufficiency.

Screening – Patients were initially procured via the local system of Orthopedic Rehabilitation Clinics throughout Nepal and screened by the cooperating medical staff at NOH. These patients were then evaluated by the HTC Team to assess each of them for surgery and medical status.

Pathology – The goal of the HTC medical mission team was to treat children with foot and ankle deformities and to donate equipment to the hospital to enable treatment of more complicated orthopedic conditions. The majority of pathology encountered was the neglected clubfoot, although other problems treated included postpolio deformity, cerebral palsy, isolated equinus, recurrent clubfoot, partially corrected clubfoot and valgus deformities of the lower extremities. These were cases of exceptionally complicated pathology.

Children Evaluated:  21
Surgical Cases:  18
Surgical Procedures:  49
Ponseti Casting (feet):   4
Referred for Bracing:    2

Rotarians from Rotary Club of Fidalgo Island, Anacortes, Wash. *

Pam Putney - Rotary Team Leader
Jack Frisk - Wheelchair Foundation Coordinator
Sarah Fenton
Pat Barrett
Carole Minor

* The primary goal of the Rotary Team from the RC of Fidalgo Island was to distribute 100 new wheelchairs in cooperation with the Wheelchair Foundation. Simultaneously, members of the RC of Saskatoon, Saskatchewan, Canada arrived to distribute another 180 wheelchairs. The RC of Mount Baker, Wash. also donated funds to pay for 15 orthopedic surgeries on indigent patients at NOH.

** In addition, the five members of the RC of Fidalgo Island who accompanied the HTC Medical Mission Team provided invaluable assistance: carrying inbound and outbound bags of medical equipment and supplies, packing equipment and supplies, helping with set-up and take-down and helping to organize the patients and support and comfort the families.

Team Approach to Diabetes Care

Materials from National Diabetes Education Program

Promote a Team Approach to Diabetes Care

 People with diabetes are at increased risk for heart attack and stroke as well as other complications, including blindness, kidney disease, amputations, and oral health problems such as tooth loss and periodontal (gum) disease.  The National Diabetes Education Program (NDEP) has released a newly updated set of materials that can help health care professionals and people with diabetes “team up” to prevent or delay complications from this disease.

 Comprehensive diabetes care is a multidisciplinary effort involving both the patient and the team of health care professionals who provide preventive care services.  The newly revised NDEP materials promote team care and offer action steps for both health care professionals and people with diabetes.

 The new NDEP materials include: 
*  “Working Together to Manage Diabetes: A Guide for Pharmacists, Podiatrists, Optometrists, and Dental Professionals” – an interdisciplinary primer focusing on diabetes-related conditions affecting the foot, eye, and mouth, including issues related to drug therapy management. (CME credits available.)
*  “Working Together” patient education poster, available in English and Spanish, with specific action steps that people with diabetes, their pharmacists, and their eye, foot, and dental care professionals together can take to prevent or delay the complications of diabetes.
*  “Diabetes Medications Supplement” – a companion piece to Working Together that can be used as an at-a-glance reference booklet; provides a brief profile of medications used to control blood glucose, blood pressure, and cholesterol levels.
*   “PPOD Diabetes Primary Prevention” brochures addressing the roles pharmacists, podiatrists, optometrists, and dental professionals can play in promoting diabetes prevention among those at risk. 
These materials are available free from the NDEP by calling (888)693-NDEP (6337); shipping and handling charges may apply. Or, they can be downloaded from .  All materials are copyright-free and can be duplicated.
NDEP is providing continuing education credits for physicians, nurses, pharmacists, and general Continuing Education Units for reading “Working Together to Manage Diabetes” and the English patient education poster, either online or in hard copy, and then completing a post-test and evaluation form online through the Centers for Disease Control and Prevention’s Continuing Education Program.  If you would like to learn how to obtain continuing education credits for some of these materials, please visit http:/ for more information. 

The U.S. Department of Health and Human Services' National Diabetes Education Program is jointly sponsored by the National Institutes of Health and the Centers for Disease Control and Prevention with the support of more than 200 partner organizations.  APMA is an active, contributing member of this coalition representing podiatric medicine interests.

Dennis R. Frisch, DPM
APMA Board of Trustees
30 S.E. 7th Street
Boca Raton, FL  33432
(O) (561) 395-4243
(F)  (561) 392-8353


2008 Physical Activity Guidelines

2008 Physical Activity Guidelines
Intially published in APMA E-News

The Podiatric Health Section has identified the following 2008 Physical Activity Guidelines as important public health information to be shared with its section members. The Guidelines were designed to complement the Dietary Guidelines for Americans, which were developed by Health and Human Services (HHS) and the U.S. Department of Agriculture. When used together, these guidelines may help promote good health and reduce the risk for chronic diseases by emphasizing the importance of being physically active and eating a healthy diet.

When writing the guidelines, HHS primarily used a report from an appointed external scientific advisory committee (the Physical Activity Guidelines Advisory Committee) as well as comments from the public and government agencies.

Major research findings on the health benefits of physical activity, gathered by the Physical Activity Guidelines Advisory Committee after a review of the literature and other available evidence, are as follows:

• Regular physical activity lowers the risk for many adverse health outcomes.
• Although some physical activity is better than none, higher intensity, greater frequency, and/or longer duration of physical activity provide additional benefits for most health outcomes.
• At least 150 minutes per week of moderate-intensity physical activity, such as brisk walking, is needed for most health benefits, but more physical activity provides additional benefits.
• Aerobic (endurance) and muscle-strengthening (resistance) physical activity both promote better health.

In every studied racial and ethnic group, and in children and adolescents, young and middle-aged adults, and older adults, physical activity is linked to health benefits. People with disabilities also receive health benefits from physical activity. The benefits provided by physical activity far outweigh the risk for harms.

Key guidelines for physical activity for children and adolescents are as follows:

• Children and adolescents should engage in at least 1 hour of physical activity daily, preferably in physical activities that are appropriate for their age, that are enjoyable, and that offer variety.
• Most of this activity should be either moderate- or vigorous-intensity aerobic physical activity.
• Vigorous-intensity physical activity, muscle-strengthening physical activity, and bone-strengthening physical activity should each be performed at least 3 days per week.

Key guidelines for physical activity for adults, including older adults, are as follows:

• All adults should avoid inactivity. Participation in any amount of physical activity is associated with some health benefits relative to no physical activity.
• At least 150 minutes per week of moderate-intensity, or 75 minutes a week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic activity offers substantial health benefits.
• Aerobic activity should preferably be spread throughout the week and performed in episodes of at least 10 minutes.
• Aerobic physical activity of 300 minutes per week of moderate intensity, or 150 minutes per week of vigorous intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity activity, is associated with additional and more extensive health benefits.
• Engaging in physical activity beyond this amount provides additional health benefits.
• Muscle-strengthening activities that are moderate or high intensity and involve all major muscle groups should be performed on 2 or more days per week for additional health benefits.
Additional guidelines specific to older adults are as follows:
• When chronic conditions prevent older adults from doing 150 minutes of moderate-intensity aerobic activity per week, they should be as physically active as their abilities and conditions allow. They should understand whether and how their conditions affect their ability to do regular physical activity safely.
• Older adults at risk of falling should do exercises that maintain or improve balance.
• Older adults should determine their level of effort for physical activity relative to their fitness level.

Adults, children, and adolescents with disabilities should follow the guidelines for their age group if possible, or if not, they should be as physically active as their abilities allow, with guidance from their healthcare provider. They should avoid inactivity.

Healthy pregnant and postpartum women who are not already engaged in vigorous-intensity physical activity should get at least 2 hours and 30 minutes of moderate-intensity aerobic activity per week, preferably spread throughout the week. Those who regularly engage in vigorous-intensity aerobic activity or in high amounts of activity can continue with this regimen, provided that their condition remains unchanged and that they consult with their health care provider regarding their activity level throughout their pregnancy.


Pressure Ulcers Increase Among Hospital Patients

Pressure Ulcers Increasing Among Hospital Patients

Hospitalizations involving patients with pressure ulcers — either developed before or after admission — increased by nearly 80 percent between 1993 and 2006, according to a recent report from the Agency for Healthcare Research and Quality (AHRQ).

Pressure ulcers, also called bed sores, typically occur among patients who can't move or have lost sensation. Prolonged periods of immobility put pressure on the skin, soft tissue, muscle, or bone, causing ulcers to develop. Older patients, stroke victims, people who are paralyzed, or those with diabetes or dementia are particularly vulnerable. Pressure ulcers may indicate poor quality of care at home, in a nursing home, or hospital. Severe cases can lead to life-threatening infections.

AHRQ's analysis found that of the 503,300 pressure ulcer-related hospitalizations in 2006:
• Pressure ulcers were the primary diagnosis in about 45,500 hospital admissions — up from 35,800 in 1993.
• Pressure ulcers were a secondary diagnosis in 457,800 hospital admissions — up from 245,600 in 1993. These patients, admitted primarily for pneumonia, infections, or other medical problems, developed pressure ulcers either before or after admission.
• Among hospitalizations involving pressure ulcers as a primary diagnosis, about 1 in 25 admissions ended in death. The death rate was higher when pressure ulcers were a secondary diagnosis — about 1 in 8.
• Pressure ulcer-related hospitalizations are longer and more expensive than many other hospitalizations. While the overall average hospital stay is 5 days and costs about $10,000, the average pressure ulcer-related stay extends to between 13 and 14 days and costs between $16,755 and $20,430, depending on medical circumstances.
• These findings are based on data from Hospitalizations Related to Pressure Ulcers Among Adults 18 Years and Older, 2006. The report uses statistics from the 2006 Nationwide Inpatient Sample, a database of hospital inpatient stays that is nationally representative of inpatient stays in all short-term, non-federal hospitals. The data are drawn from hospitals that comprise 90 percent of all discharges in the United States and include all patients, regardless of insurance type, as well as the uninsured.

What's Happening

Art Helfand writes:  In early 2009, I have two text chapters due in two different geriatric texts. That will mark my 139th and 140th text chapters. Little did I dream almost 51 years ago that I should be able to contribute to our profession in this way. Those chapters will also mark my 381st and 382nd publication. I also have been re-elected as chair of the Board of Directors of the Philadelphia Corporation for Aging (PCA).

The Section sends our prayers to Tom Ertle, one of our Section Councilors, who was diagnosed with lung cancer in December and is undergoing treatment.


Annual Meeting Pics