The Letter To Minh To
Minh To is a high school student at Central Gwinnett High School. (Does
anybody know where Central Gwinnett is located?)
Minh To send me the a series of questions about podiatry care.
Below is a list of the questions and answers i gave her
Dear Dr. Zapf,
I'm a student from Central Gwinnett High School. I'm
doing an interview.
I was hoping that you answer my questions in an e-mail form.
You will be one of my resources. IF you can please sent be what I ask in
your
next letter. The questions are below. Thank You.
1.What do you do in general and what a typical day is like??
I work in an office most days from 9 am to 6 pm and I see
from 25 to 35 patients. They range from adolescents with ingrown nails to adults
with bunions and heel pain to senior citizens with thick nails, ulcerations and
diabetic foot infections. Occasionally I see a kid younger than 6 for intoes
gait and tripping and falling when walking.
2.Can you describe what you do in general or your main responsibilities?
I take care of the various ailments of my patients with
heel pain, ingrown nails, wart removal and the like. On Thursday morning I do
surgery at the local hospital where I will do two bunion surgeries and one other
surgery, perhaps removal of a bunion or a hammertoe deformity.
3.what educational background or experience is required?
To be a podiatrist in California, like most states, you
need to finish college and complete a 4-year program in podiatric medicine
and surgery. There are 7 Podiatric Medical Colleges in the US (from San
Francisco to Florida) and several in Canada. Following podiatry college you need
to complete a podiatric postgraduate residence: either in straight surgery or
rotating in all aspects of the hospital from the anesthesia department to
radiology, internal medicine, emergency medicine and the like. During the
training years there are no limitations on the kinds of medicine you can learn
and experience. I even helped to deliver babies during a rotation in Seattle.
4.Are there advantages and disadvantages and what the future holds for
someone?
The advantages are that after six or seven years of
education you can hang out your shingle and practice in a surgical sub
specialty. Equivalent MD and DO students need 4 years of school and 4 years of
residency to do what we do in just 6 oftentimes. The disadvantages are the
struggle that comes with being the "new kid on the block". Some MD and
Do practitioner regard you as "not a doctor' but many, many more appreciate
and applaud your talents. I ger referrals from all medical specialties, even
orthopedists. Your income is not in the same ballpark as your orthopedic surgeon colleagues
(whose is?) but it is more than many pediatricians and family
practitioners.
5. If you can please tell me if you had any interesting things happened.
Three cases;
First I saw a 25-year-old supermarket cashier with heel
pain. She has seen two family practice doctors, one internist, one
orthopedic surgeon, one acupuncturist, received physical therapy three times a
week for three months and consulted an eastern medicine specialist. She still
had heel pain. In just one visit to my office I saw the problem and suggested we
try applying just a few pieces of tape in a manner to keep her feet from flattening.
Would you believe it worked and she called the taping a "Miracle” Later
she received orthotics and is doing spectacularly well. No pain when she walks
and she is working full time without problems. She is delighted,
Case 2: Carol is a 70-year-old lady with a huge callus on
the bottom of her right foot behind her second toe. It has been present for many
months and has caused an ulceration several times. On one of these times a very
talented Orthopedist st the hospital recommended she get a below the knee
amputation. Her infectious doctor suggested she see me instead. Using tricks and
talents readily available she has now kept hoer foot for almost three years, She
is delighted as are her children and grand children. She ans I say "Thanks,
Dr. B, for this referral.
Case 3. Ashley is an 11-year-old girl with a bunion
deformity. It is unusual, of course, to see a girl this young with a bunion, but
it happens. It is called a Juvenile Bunion. She was treated with a surgical
procedure designed to "staple" one side of the growth plate in her
foot that will cause her bunion to, in essence, melt away over the next few
years. In a one hour surgery her bunion was stapled and now, over he last 3
years, I have watched it get smaller and smaller. The nice thing about this
procedure is that she will never need the big "bone cutting"
procedures adults often require to get rid of their bunions.
Minh To, I hope this helps. If you want more information,
please let me know.
________________________________________________
HI Dr. Zapf, this is the girl that wanted to interview you!
I have the questions ready:
1.) What is the main reason you decided to be a
podiatrist?
I wanted a medical job that was intimately involved with
people, such as a doctor, and one that involved knowing many areas of science
and medicine. To know feet properly you need to know muscles, bones,
circulation, nerves and dermatology. You need a good grounding in biochemistry
to understand pharmacology and physiology. You need to know many disease states
like arthritis and diabetes and how they show up in the feet and legs. Finally I
wanted a job that rewarded the worker, financially and otherwise, directly
according to how hard and how successful the efforts. Previously I worked in a
civil service position and neither of these features were present.
2.) How do you feel every morning when you wake up
for work and you think about your work that you'll be doing the rest of the day?
I look forward to every day, although there are some days
that I wish I could get another hour of sleep – but that is what Saturdays are
for. My patients want to see me, are overwhelmingly happy with the care they
receive and are grateful for my efforts. I get rewarded verbally from my
patients every hour I work. Who could want more than that?
3.) What type of atmosphere do you work in?
I work in a small office setting with three to four
employees helping me. My practice is in a small suburban town and my patient
load consists of kids, their parents and their grandparents. It is truly a
family practice and I see all kinds of problems. I rarely see the dame thing
more than twice in any one day (except heel pain – I see a lot of patients
with heel pain)
4.) How long did you go to school to become a podiatrist?
You need a 4-year bachelor’s degree from a college to get
to podiatry school. Podiatry school is 4 years long and it is followed by a
residency in a hospital for one, two or three years. I did my residency 14 years
ago and it was 1 year long. In my one year I worked on more than 350-foot
surgery cases. In each case a senior doctor (the surgeon) would teach me, the
resident, who to do foot surgery.
5.) *optional* estimate yearly income?
Podiatrists earn about the same amount of money as family
practitioners that, on the average, is about $90,000 to $110,000. Some make more
and some less. Those who work in the big cities can make a lot more but it
usually takes a lot longer to “get there.”
6.) How do you feel about working with feet?
When a student like you, Kristi, ask me this question I
suspect that they think that feet are less than glamorous. I respond by asking
them what medical profession deals only in glamorous parts of the body. They are
stumped. Some boys, thinking of models, say plastic surgery. Only the rare
plastic surgeon, however, sees this type of patient. Most see cosmetic patients,
of course, but they also see post-cancer surgery reconstruction, post-auto
accident reconstruction and zillions of 70-somethings that want to look
50-something. These are worthy patients and are grateful for everything the
plastic surgeon does, but they are not glamorous in the customary sense. Some
girls will suggest a dermatologist as someone who does not have to deal with
less than glamorous patients, thinking, of course, of their dermatologist who
treats their acne. But dermatologists see some of the most unattractive things
in the world – just look at a dermatology textbook.
The more you look at medicine the more you realize that no
doctor has a lock on glamorous patients. Pediatricians see kids at their worse
and sometimes have to tell mothers and fathers that their kids have a severe
disease. Dentists have patients that often fear just going to their office. When
you think of it podiatrists have it pretty good. We have the advantage of seeing
a complete range of patients (not just one gender or just one age group). Out
patients most always have a straightforward non-life threatening problem with a
relatively straightforward solution. We nearly never have to tell someone they
have a life threatening disease or that they will die.
Think of it this way: If your doctor listened to your heard
and said you needed to see the cardiologist, it cannot be for anything good. The
best you can hope for is that there was really nothing wrong. – just a weird
heart sound. Same with the neurologist or gastroenterologist. When the very same
doctor tells you to see the foot doctor, how bad can it be? You come to my
office with a good attitude and we have a great time
7.) How long have you been a podiatrist?
I started working as a podiatrist the day I was licensed on
July 1, 1985. I started my own practice 9 months later on March 1, 1986.
8.) When was it that you realized that you wanted
to be a podiatrist?
I hope that you realize that few people have just one thing
they ever wanted to be or just one thing that they could be. I can see me in any
of hundreds of jobs doing hundreds of things. Almost every patient I interview I
say, “I could do that”. I find all these jobs interesting. What seems to
happen is that your inclination for a variety of jobs meshes with the
opportunity to pursue one of them. My desire to pursue medicine and science
meshed with an opportunity to go to into a profession that allowed me to be home
every night with very little weekend call and very few night calls. Couldn’t
turn it down although there are hundreds of things that I could have done and
enjoyed.
9) Were your family and friends supportive of your
career choice?
Once they understood what podiatry was and the
opportunities it presented, everyone loved the idea.
10) If you could have it over again would you choose the
same career?
Every time and place presents different opportunities. Of
course if I were there again, I would have chosen the same path. If you mean if
I was 29 years old now and had to choose a profession, would I choose podiatry?
Probably. But I might get a health related MBA and work for the Red Cross of an
International Relief Agency. Maybe medical management. It honestly depends on
the choices available to me.
I realize you have so much other important things to do, but if you could
The Doctor Has A Question: Who is Kristi?
Her answer: Thanks for all your help. I loved the way
you set up the website for my answers. It was perfect! Well, what
can i tell you about Kristi...I am a senior and will be attending UNF next fall.
I will be playing on their tennis team (which is awesome). The coach is
giving me some scholarship money and I'm going to receive half academic
scholarship. I have played tennis for about 6 years. It's probably
the main part of my life. I have done every other sport, but this is the
only one I stuck with because I can't quite master it. Not that I ever
will, but I always set goals and I have not reached them in tennis yet.
That's what intrigues me about it. The challenge. I hate my feet.
Yet, I love feet (just not mine). It doesn't bother me to work with them
either. I want to be a doctor and this "intrigues" me. I'm
not saying I'll do it, but it's my priority for career
goals. That's a big chunk of my life to know. Thanks for taking the
time to care (I'm assuming you do because you asked, but I could be wrong) and
to read this. Also, for helping me with the interview.
_______________________________
Hello. My name is Takuya Fujii. I am a middle
school student. This time, my school gave me a project that I have to ask
some questions to you guys. So can you guys help me? If you can,
please answer these questions.
Thank you for sending back me a mail. I am living in
Ohio. I came from Japan a years ago. So I needed your help.
I am 14 years old and I am little interesting in health. I found
about you using yahoo, but I don't understand these kind of stuff. So it
took 2 hours to find your site. Anyway, thank you very much.
The questions are
1.What type of physician/doctor are you?I am a podiatrist also known as a
foot doctor. You probably do not have a specialist of just the foot in your
country (Japan?). In America the profession is over 100 years old. Podiatrists
do everything there is to do with the foot from surgery to dermatology to
wounds, injuries and fractures. We also understand the biomechanics of the foot
and help people who are having pain in their feet or legs when they walk or run.
Podiatrists do surgery at hospitals or in their own offices and are able to
prescribe all medications, including narcotic painkillers. Elsewhere on my web
site you will find a link to the American
Podiatric Medical Association that will give you more information
2.How do obtain degree? After receiving a college
degree (B.S. or B.A.) you need to spend 4 years in podiatric medical school and
one to three years in a surgical residency in a hospital. A few of the 50 states
in America do not require a residency for licensure, but the vast majorities do.
3.How long does it take to obtain degree (year)? Podiatry
school is 4 years long.
4.What is the best college(s) for you to attend? A
degree from any accredited college or university with good grades is necessary
for college admission. There are 8 colleges of podiatric medicine in America
and several in Canada, Australia and possibly England. I do not know which
college is currently thought of as being the best.
5.What are the best places in the world for your
specialty? (Is there a famous treatment center)? The famous treatment
centers for podiatric medicine probably center around the colleges of podiatric
medicine or locations of the 3-year residencies. Off the top of my head I can
list Boston, New York, Philadelphia, Chicago, Atlanta and Seattle as great
centers of podiatric medicine and surgery. I am sure there are a lot more (and
if some of my podiatry colleagues ever see this, they will probably want to
expand the list.)
6. What are some different types of treatments you
would give? (State ailments and treatments) Common treatment provided by a
podiatrist are for: in-toe and out-toe walking in children, ingrown nails, heel
pain (plantar fasciitis), plantar warts, bunions, hammertoes, corns and
ulcerations of the foot. All of these are thoroughly described elsewhere on
my web site.
7. Is there surgery involved in your practice--explain
a couple of different types? There most certainly is surgery involved in the
practice of podiatric medicine. The most common surgeries performed are: bunion
corrections, hammertoe corrections, permanent correction of ingrown nails and
heel surgery. These are all described elsewhere on my web site.
8.What are some common ailments/dilemmas in your
practice? See the answer to number 6 and 7.
9.Who are recognized as some of the best people in
your field? The best people in the field are the ones that are “Board
Certified” by either of the two certifying boards in podiatric medicine and
surgery. You can see them by linking to either the
American Board of Podiatric Surgery and the American
Board of Podiatric Orthopedics and Primary Care Medicine. (I, by the way, am
certified by both).
10.What type of drugs do you prescribe the most?
The most common drugs I prescribe are:
Hydrocodone for pain
Celebrex, Vioxx, Relafen and DayPro for inflammation
Lamisil tablets and Sporanox tablets for fungal nails and
skin
Penlac nail lacquer, Loprox, Lamisil and Mentax topical
medicine for skin and nail fungus.
Bactroban cream, Silvadene cream and Cortisporin otic
solution for topical anti-bacteria treatment
Keflex, Kef-Tab, cephalosporins, Augmentin and Levaquin for
bacterial infections
11.What age group(s) do you treat the most?
I see tiny children, their teenage siblings, their parents
and their grandparents. Getting to treat both genders and all ages is one of the
special joys of practicing podiatric medicine. In general foot problems get more
numerous as we go through life (mature.)
12.What are the requirements for you to obtain your
practicing license? I am licensed in the state of California. California
requires graduation from a 4-year school of podiatric medicine, a minimum of a
one-year residency in podiatry 9usually surgery), the completion of 25 years of
continuing education every year and a valid certificate for CPR
(cardio-pulmonary resuscitation).
13.What are most common problems with surgery (If
applicable)? The second most common surgery problems are infection, slow
healing of the tissues involved, under-correction or over-correction of the
deformity and recurrence of the problem that may require another surgery.
The most common problem with surgery is Unrealized Expectations where he
patient believes (or was led to believe) that the results would be different
from what they are. Rarely is any part of the body ‘as good as new” after a
surgery of any kind. Surgery is not meant to make a bad part new again. Surgery
is designed to make a bad part less bad.
14.What was your most interesting "New"finding(s)?
The most interesting new finding is a method to treat heel
pain that has resisted treatment with all the regular and conservative
treatments. The method is called ESWT: extra
corporeal shock wave therapy. This involved using the same machine that has been
used for years to break up kidney stones with high-powered shock waves. For heel
pain this machine is directed to the bottom of the heel and in just 20 minutes
the process is complete. Eventually this machine will be used to treat shoulder
pain, tennis elbow, knee pain and pain in the Achilles’ tendon in addition to
the pain on the bottom of the heel. I have described this elsewhere in my web
site.
15.What is the annual average income for your field?
I honestly do not know. My guess is that the average annual
income for practices that are 5-10 years old is probably about $90,000-100,000.
Those practicing in big cities make more and in rural areas make less.
16.In your area, how often does a person visit your
office (average)?
The times a person visits an office varies on what is
wrong. Someone who visits with an ingrown nail or a wart may make just tow
visits to the office. Heel pain patients and patients with pain in the ball of
the foot may make 5-10 visits. People needing bunion surgery make about 4 to 6
appearances in the office.
17.Are there any particular drugs used for your
profession?
See the answer to number 10
18.What are some common misconceptions about your area?
I know it must be hard for a resident of another country to
understand the role of podiatric medicine. It is hard for everybody here to
understand as well. We are as well trained in the surgery for the foot as an
orthopedist, as well trained in the dermatology as a dermatologist and certainly
more trained than the average internist, family practitioner or general
practitioner. Yet many people do not understand that we are not MDs.
On the other hand many people think that, because we are
not MDs that we do not do surgery or prescribe drugs. As you have learned, we do
both of those things.
Finally people do not understand how important podiatry is
to patients with diabetes. This devastating disease is the leading cause of
non-traumatic amputations in the world. Yet more than 80% of all amputations
could have been prevented with a little care at the right time Podiatrists
are experts at providing just the right care at just the right time. If you do
not have podiatrists in your country, diabetes is one reason to reconsider.
19.Does your field require any particular emergency
training?
All podiatrists need to be familiar wit the emergencies
that he or she is likely to see in the office: allergic reactions to a
medication (especially if injected), diabetic hypoglycemia, diabetic
ketoacidosis or insulin shock and the more common fainting. As a precaution
podiatrists should know CPR to help their patients if an emergency arises.
20.Is your field usually a private practice?
Explain.
Podiatric medicine is one of the last holdouts in medicine.
More than 90% of podiatrists practice in single offices.
If you cannot answer these questions, can you tell me
where can I find these questions? Please send me back this mail. Thank
you.
Takuya Fujii
