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12/25/2020
RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 1B
From: Joseph Martin Quezada, DPM
Within days after the application of Pfizer-BioNTech-mRNA, 2.79% were unable to perform normal daily activities, unable to work, or required medical care from a doctor or healthcare professional. I recommend that doctors review the CDC link and make informed decisions. (cdc.gov/vaccines/acip/) In addition, in 2011, the Supreme Court declared that all vaccine designs are "unavoidably unsafe" and "unavoidably defective" due to "unavoidable adverse side-effects" presumptively caused by defective vaccine "design." The Court held that, even where vaccines are free of "manufacturing" and "labeling" defects, they are nevertheless presumed to come with a risk of "unavoidable adverse side effects" caused by defective "design."
The Court ruled that: (1) "design defects" must be the cause of any and all vaccine injuries and deaths; (2) All "design defects" are unavoidable, along with the resulting harm. In plain English, all vaccines are "unavoidably unsafe" precisely because they are "unavoidably defective." The FDA has never even spelled out in regulations the criteria it uses to decide whether a vaccine is safe and effective for its intended use." [Bruesewitz vs. Wyeth LLC, (2011) 562 U.S. 223]. I would never get a vaccine shot nor give one! I trust in nature (God) and let nature take its course!
Joseph Martin Quezada, DPM, Laredo, TX
Other messages in this thread:
01/29/2021
RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 1B
From: John Chisholm, DPM
I'm sure we all agree on one point: to quote the great Jon Hultman "podiatric physicians are either over-trained or under-licensed". We all agree that "parity" is a necessary but as yet unrealized goal for our specialty. What is challenging for us to agree on is the best strategy for achieving our goal. The California Podiatric Medical Association has been working for years to change our current, restricted license to an unrestricted, plenary license. This strategy would not require a degree change; it would require a different kind of license.
The next hurdle we have to clear is to have podiatric medical students take, and pass, the USMLE or other national licensing exams. I urge all of us to continue to support APMA and state organizations to clear important hurdles so that we can finally have a license that matches our education and training.
John Chisholm, DPM, Chula Vista, CA
01/21/2021
RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 1B
From: Elliot Udell, DPM
In this case, both Drs. Levy and Jacobs are correct. Podiatrists are as well trained as any other medical professional in the early management of a severe allergic reaction to any injected medication. As a severe allergy sufferer, I've often asked the professionals who give me my allergy shots how many times they have encountered anaphylaxis. Most said never, but they have guidelines as referenced by Dr. Jacobs hanging in the office, "just in case."
In our office, as with most of my colleagues, we stock epi and injectible antihistamines, and pulmonary support devices and have the protocol hanging in the office. In over thirty years, I have never had to treat a single case of anaphylaxis. On the other hand, I have had to perform CPR three times and was successful two out of the three times and was assured by the ER docs that my only failure had nothing to do with my technique but rather an issue of arriving at the scene way too late.
Elliot Udell, DPM, Hicksville, NY
01/20/2021
RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 1B
From: Allen Jacobs, DPM
Dr. Levy suggests that podiatrists are adequately trained and equipped to administer the COVID-19 vaccination. He further suggests that the reluctance to permit the administration of such vaccinations is political, founded in a lack of understanding of the podiatric medical education.
Dr. Levy posits that a simple injection of epinephrine is all that is required for major adverse reaction to the vaccine; anaphylaxis is believed to occur in 1 per 100,000 doses. However, the occurrence of symptoms such as tachycardia, hypotension, cardiovascular collapse, laryngeal edema, nausea, vomiting requires more than epinephrine. Supportive equipment and care must be readily and immediately available.
I believe that he is wrong. A podiatrist is no more capable of screening for or the handling of emergencies than an orthopedic surgeon, urologist, dermatologist, or any office-based community healthcare provider. Clint Eastwood as Dirty Harry famously said, "a man needs to know his limitations." This is a matter of public safety, not a political issue. I suggest those who are considering administering the vaccination read this.
Allen Jacobs, DPM, St. Louis, MO
12/28/2020
RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 1B
From: Dieter J Fellner, DPM
I have to concur with Dr. Kass. It seems the Governor was, in making this provision, inadvertently provided with the training and qualification requirements of the British chiropodist as applicable in the mid-1960s. Will someone please provide the Governor the training requirements of a 21st Century podiatrist, USA. That should resolve the issue! Whatever next, perhaps the Governor would like to legislate that the podiatrist may treat the ingrowing toenail under supervision of the pedicurist.
Dieter J Fellner, DPM, Yuma, AZ
12/24/2020
RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 1B
From: Elliot Udell, DPM
The individual states have to decide what doctors should get the COVID-19 vaccine first. A lot will depend upon the supply of the vaccine. It should not strike us as being unusual that an ophthalmologist was "first on line." Eyecare professionals have a strong disadvantage in this pandemic. Their faces are right up against the faces of their patients which renders them very likely to be infected. The same would apply to dentists, ENT doctors, and GI specialists who do upper endoscopies. Even though podiatrists tend to work close to six feet from patients' noses, make no mistake, we are all at risk from the moment we turn the key in our doors and we should not wait a day to be vaccinated when the offer is given to us.
Elliot Udell, DPM, Hicksville, NY
06/22/2020
RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 1B
From: Lee Rogers, DPM
The American Academy of Family Practice has a useful preparedness checklist for physician offices during the COVID-19 pandemic.
Lee Rogers, DPM, Las Vegas, NV
04/21/2020
RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 1B
RE: Appreciation for Those Who Stepped Up in the Pandemic
From: William H FitzPatrick, DPM
I would like to add to the appreciation we’re giving to all the frontline workers during the pandemic. In addition, I’d like to add a big "thank you" to APMA and PICA for their financial concessions to members and professionals. Also, a big thank you to the IT, digital x-ray, EHR, advertising, vascular, and others of our vendors for giving us contract fee reductions. They won’t be forgotten when normalcy returns and we continue our business associations.
William H FitzPatrick, DPM, Albuquerque, NM
04/17/2020
RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 1B
RE: Cutaneous Manifestations of COVID-19
From: Bryan C. Markinson, DPM
There has been much discussion about the livedoid podiatric skin manifestations of COVID-19 initially sparked by preliminary reports out of Europe and recent presentations in podiatry encounters in the United States. I would like to point out that at this time that so far there is no confirmed connection, just an association, and these presentations had no correlation with severity of COVID-19 respiratory decline. However, historically, viral infections definitely present with skin manifestations and it makes sense that COVID-19 should be no different. Be aware that the skin issues reported in Europe are not confined to the feet, as all extremities and the trunk areas were also prominent. This may be an important question to ask about in patients with foot lesions.
The question of referring patients for testing have come up, based on the presentation of foot lesions. Clearly, the critical issue with COVID-19 is the rapid decline in respiratory function necessitating heroic measures for survival. Still, widespread testing is lacking and it is the onset of respiratory symptoms that still drives the need for initial testing. In the coming weeks, routine testing for back to work plans may be the rule, but we are not there yet.
With that in mind, AND THIS MAY CHANGE, I would be hesitant to recommend patients with the only symptom of a livedoid eruption on the feet for COVID-19 testing at this point. Patients should be given supportive treatment for blistering lesions and referred for systemic therapy if vasculitis appears prominent. Otherwise, it is logical to assume that the lesions will resolve as the symptoms of COVID-19 infection resolve in most cases.
Bryan C. Markinson, DPM, NY, NY
04/07/2020
RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 1B
From: Vincent Gramuglia, DPM
I could not agree with Dr. Sokoloff more. I am perplexed by individuals who in the middle of a disaster feel that is an appropriate time to discuss such ridiculous nuances. These individuals are volunteering their time and they will perform to the level of their competence. Maybe they’re just monitoring patients and maybe they are getting elbow deep in their medical care. What difference does it make what rotations they had or what experience they have in these situations? Aren’t police officers who apply tourniquets to bleeding limbs or deliver babies on the highway also in over their heads? We’re not talking about an elective case in a surgery center right now; we’re talking about an unprecedented global disaster.
Having said this I will never understand what prompts certain individuals at moments like this to criticize the selfless actions of others. These residents are true doctors, not paralyzed by their insecurities, who likely are more equipped to provide these services than 80% of dermatologists, ophthalmologists, orthopedic and plastic surgeons. I am privileged to work alongside these remarkable people and I take offense to those who succumb to the absurdity of their pet peeves.
Vincent Gramuglia, DPM, DVA NY Harbor
03/31/2020
RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 1B
From: John Chisholm, DPM
Thank you, Dr. Karulak, for again highlighting some of the reasons why our profession needs to continue to embrace the 4/4/3 model of medical education that we currently have. Although we limit our practice to foot and ankle medicine, our education and training produces a final product that, after 3 years of residency, is comparable to our physician colleagues. I believe his description of his residency rotations makes this clear.
When you look at all of the provider types that might be called upon to provide physician services during this crisis, the only degree type that has 3 years of comprehensive residency training, in all of the different medical disciplines, is the DPM.
It is my hope that this crisis will help to highlight the education and training of recently graduated podiatrists, and that Dr. Karulak will be allowed to use that education and training to save lives. And that eventually all 50 states will grant a full, unrestricted DPM license to anyone who has graduated from podiatric medical school and has passed the USMLE.
John Chisholm, DPM, Chula Vista, CA
03/24/2020
RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 1B
From: Ronald F. Iannacone, DPM
I like the clean pen/dirty pen idea. In my office, I have taken away all magazines and candy. I also put a sign on the table “if you read a pamphlet please keep it. Do not put it back.” Also, since my reception area is all open, I installed a 2.5ft high Plexiglas with a small 1 foot wide 3 inch high opening to pass info back and forth. Lastly, since hand sanitizer is in such short supply, I bought extra Menda pumps for patients to dispense alcohol with a tissue to wipe off hands. I have found patients are appreciative of these precautionary measures.
Ronald F. Iannacone, DPM, Port Saint Lucie, FL
03/23/2020
RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 1B
From: Richard Simmons, DPM
When I submitted this letter for discussion on March 12th, one week ago, none of us had any idea that we would be facing what we are facing today. When I heard the request to isolate/quarantine for two weeks, I took it seriously. I have not seen patients this past week nor will I see them next week.
Mine is a house call practice and I can appreciate the difficulties my practice faces going from house to house, yet mine pale in comparison to what many of my office-colleagues are facing. From the New England Journal of Medicine, March 18, 2020, “If protecting patients is difficult, so is protecting healthcare workers, including nurses, respiratory therapists, and those tasked to clean the rooms between patients. When we spoke, Dr. D. was one of six physicians in his division to have a suspected COVID-19 infection.
Given testing lags...
Editor's note: Dr. Simmons' extended-length letter can be read here
03/19/2020
RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 1B
RE: Podiatrists and COVID-19 Pandemic
From: Richard A Simmons, DPM
Is there any action from the APMA or other national podiatric organizations, state organizations, etc. concerning the utilization of podiatrists in the containment of this pandemic? That is, not having podiatrists performing podiatric medicine, but joining in with the total healthcare community?
Richard A. Simmons, DPM, Rockledge, FL
03/17/2020
RESPONSES/COMMENTS (CORONAVIRUS PANDEMIC) - PART 1B
RE: Coronavirus Crisis - Podiatric Medical Risks
From: Robert Teitelbaum, DPM
Consumerlab.com has posted a detailed list of supplements that can be helpful with this pandemic. Zinc, Vitamin C, Vitamin D, and N-acetyl cysteine are helpful in reducing symptoms and mucus secretions. It is the latter that actually kills people who cannot clear their alveoli of these secretions. Mucinex and guaifenesin, both available in every pharmacy, may also be helpful. A cousin of mine is a father to a cystic fibrosis daughter and he told me that "in the CF community, NAC (n-acetyl cysteine) and guaifenesin are used a lot". Aerosols are preferred over pills; NAC used to come in a spray but has not been available for over a year. Why? Who knows?
I tell my patients "everything you do good for yourself counts." I am going to let that and the biology I carry around with me every day get me through this period. Remember in the beginning when experts said the coronavirus is in a family of viruses that cause the common cold? Well, welcome to your new cold. This may be deadlier than your usual flu season, but who out there thinks it's going to be like the Spanish flu epidemic of the early 20th century?
Robert Teitelbaum, DPM, Naples, FL
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