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12/30/2020    

RESPONSES/COMMENTS (PM NEWS QUICK POLLS)



From: Leonard A Levy, DPM, MPH 


 


Allen Jacobs, DPM, claims that the use of a posterior tibial block in acute gout is an unproven theory. There is nothing theoretical about the use of sympathetic nerve blocks (e.g., posterior tibial nerve block) to cause vasodilatation in acute gouty attacks. Not only does the block typically result in immediate relief of pain, but also vasodilatation created brings more blood to the innervated areas. This also results in a significant rise in temperature.


 


The chemistry of saturated solutions is clear, based on long known concepts, not merely a theory. That is, by increasing temperature and fluid volume, the sharp crystals of the supersaturated solution of sodium urate dissolve and, in addition, Ph increases. A low Ph (i.e., acid) results in the increase of crystals of sodium urate. The reason a PT block is not popular in other medical specialties is likely that the average physician does not know how to administer it, including rheumatologists. No one can administer a PT block better than a podiatric physician. 


 


Leonard A. Levy, DPM, MPH, Ft. Lauderdale, FL 

Other messages in this thread:


04/05/2021    

RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1B



From: Kenneth Meisler, DPM


 


Dr. Kass stated "like Dr. Meisler does with ultrasound guidance," he injects "into the region of the neuroma...is a pretty easy location to find without ultrasound." I agree that to be in "the region" is pretty easy. I do not inject into "the region of the neuroma." I inject directly into the body of the neuroma. I have done this for about 15 years after reading a study performed this way at the Hospital for Special Surgery. I have found injecting directly into the neuroma under ultrasound guidance is more effective than injecting in the region of the neuroma, which I did for 25 years. It is difficult to do even with ultrasound guidance. There is a definite learning curve.


 


I think you will be surprised where you are injecting as you watch yourself under ultrasound. Eventually, it becomes quite easy. Injecting directly into the neuroma also reduces complications such as fat necrosis and skin discoloration because the firm body of the neuroma holds the steroid or alcohol within it after the injection. A comprehensive review of the literature on ultrasound guided vs. non-ultrasound-guided injections in the Orthopedic Journal of Sports Medicine concluded that ultrasound-guided injections are overall more accurate than landmark-guided injections. I perform all neuroma injections under ultrasound guidance even if the insurance company will not pay for it. I cannot ethically do an injection without it if I know I am capable of being more accurate with ultrasound; that's just me. 


 


Kenneth Meisler, DPM, NY, NY

04/05/2021    

RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1A



From: Steve Tager, DPM


 


Maybe these posts about neuroma treatment are not truly representative of what the nation’s podiatrists do for this condition. I am reasonably certain that as physicians, we all try to achieve positive outcomes and do what we feel is mutually beneficial for our patients when it comes to treatment regardless of the problem. Fifty plus years of doing all that has been discussed, from steroid injections, dehydrated alcohol, DTL sectioning, excisions from both above and below, etc. Nothing compares to the success rate I’ve experienced by simply reversing the pathomechanics of lateral column overload. My experience continues to tell me that restoring rearfoot function anywhere close to anatomic neutral gives the foot optimal opportunity to heal itself.


 


How many times have we sat in front of a pair of feet and identified good upper and lower leg alignment, with the plantar surface of both feet trying to face each other? Is it not possible that...


 


Editor's note: Dr. Tager's extended-length letter can be read here.

01/20/2021    

RESPONSES/COMMENTS (PM NEWS QUICK POLLS)



From: Michael J Marcus, DPM


 


A year ago, we dealt with the uncertainty of this virus. Some thought it would be no different than the common flu, others considered it more potentially problematic. Now a year later, over 400,000 lives have been lost in the U.S. as a result of this virus. In my area of the country-LA- 95% of our inpatients are covid positive. Every day, I hear about a death from COVID. Our ICUs are flooded. Three or four patients seem to code very day.


 


The development of this mRNA vaccine is nothing short of a miracle. Many hospitals are making it mandatory for new employees. The PM News survey is very discouraging to me. I could think of no reason not to be...


 


Editor's note: Dr. Marcus' extended-length letter can be read here. 

01/07/2021    

RESPONSES/COMMENTS (PM NEWS QUICK POLLS)



From: Leonard A. Levy, DPM, MPH


 


Carl Solomon, DPM, indicates that the foot is warm during a gouty attack. However, it is actually the area surrounding the inflammation that is warm. This is due to what are among the cardinal signs of inflammation which the ancients characterized as redness (rubor), swelling (tumour), heat (calor;), pain (dolor), and loss of function (functio laesa). The first four of these signs were named by Celsus in ancient Rome (30–38 B.C.) and the last by Galen (A.D 130–200) (source: Hurley JV. Acute inflammation. Edinburgh, London: Churchill Livingstone; 1972). 


 


These are local responses to cellular injury marked by capillary dilation, not the larger vessel dilation caused by blocking sympathetic nerve fibers of the posterior tibial nerve. The block causes an increase blood flow to areas distal to the nerve block, which is a much more significant increase in fluid (i.e., blood) than there may be in an area of inflammation. Indeed, the block (and the vasodilation) lasts significantly longer when the anesthetic agent includes epinephrine. Thus, the patient gets immediate pain relief during the time it takes for the traditional anti-gout agents to be used.  


 


Leonard A. Levy, DPM, MPH, Ft. Lauderdale, FL

01/05/2021    

RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1B



From: Henry Stark, DPM


 


Almost by definition, temperature in the human foot is normally less than core body temperature. I think we can all agree that there is no need for double-blinded studies to determine this to be a fact. During a hyperuricemic episode, it is believed that urate crystals coming out of solution from a “saturated” plasma concentration, precipitate in these naturally cooler, distal articular regions which initiate the gouty attack. In conjunction with other therapeutic measures, many podiatrists utilize posterior tibial blocks to induce a temporary, localized sympathectomy for increased perfusion as well as the analgesic effect. Yet, the Arthritis Foundation, most all rheumatologists, as well as most of my colleagues would argue that ice (rather than mildly increasing the temperature of the site) is appropriate therapy for the ACUTE phase of the attack.  


 


Dr. Levy appears to suggest (as do I) that consideration towards increasing perfusion (and perhaps warming of the affected area of the gouty attack) rather than ice may be more appropriate. Yes, ice is an analgesic in this situation, yet its use seems counterintuitive since it decreases temperature, perfusion, and would tend to prolong and enhance localized urate crystal formation. I am aware that once a gouty attack has begun, uric acid concentration in the plasma often has already decreased. Why would ice be the recommended therapy simply for analgesic purposes, when it may cause further, localized urate crystal formation?


 


Henry Stark, DPM, Lake Park, FL

01/04/2021    

RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 2



From: Leonard A Levy, DPM, MPH


 


After a successful posterior tibial block, simply by touching the plantar aspect of the foot, the patient feels anesthesia and also, a significant rise in temperature occurs. This is prolonged by including 1:1000 epinephrine in the anesthetic agent. Statistically significant increases in cutaneous temperature after nerve blocks compared to the same skin area before the procedure have been reported in the literature (Anesth Analg. 2009 Mar;108(3).


 


An article by Lima A, et al. in Critical Care (2009; 13 (Suppl 1): p 237) also indicates that after successful regional anesthetic blocks, local vasodilatation and increased blood flow occur as a result of blockade of sympathetic nerve fibers. Of course, the posterior tibial nerve block for acute gout is not the primary treatment of the condition. It markedly reduces pain but also begins the therapeutic process of bringing more fluid to the area as a result of vasodilation. This is followed by any of the oral medications that are used during the attack as well as after the attack resolves. In addition, injection of the affected joint with a corticosteroid may also be used. 


 


Leonard A. Levy, DPM, MPH, Ft. Lauderdale, FL

01/04/2021    

RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1


RE: Have you received your COVID-19 vaccination yet? (Adam M Budny, DPM)


From: Robert Scott Steinberg, DPM


 


I am not sure of Dr. Budny's point. Is he rationalizing his decision? Here is what I do know. "The general recommendation is to get the vaccine, even if you were previously infected," said Dr. David Thomas, a professor of medicine and director of the infectious diseases division at the Johns Hopkins University School of Medicine. "There are some nuanced questions that we don't have the answer to yet, but from what we know now, it's the right call to get the vaccine." 


 


Everyone be as safe as you can. You owe it to your family, your patients, and yourself.


 


Robert Scott Steinberg, DPM, Schaumburg, IL

12/31/2020    

RESPONSES/COMMENTS (PM NEWS QUICK POLLS)



From: Allen Jacobs, DPM  


 


There is no dispute that a PT block provides anesthesia and thereby pain relief in the management of PAIN associated with any painful acute monarticular disorders, including gout. However, to conclude that the PT block alters the pathophysiology of gout is without any scientific evidence. The so-called sympathectomy effect may or may not be true. However, your suggestion that a PT block alters the natural history of this disorder (other than pain relief and theoretically vasodilation) is without evidence. If you have such studies to the contrary, “show me the money”.  


 


A PT block will reduce pain from septic arthritis, pseudogout, fracture, malignancy. Pain relief and “sympathectomy” do not alter the disease process. Is the administration of a PT block associated with a shortened course of the disease? Less need for steroids, NSAIDs, colchicine, or irate lowering therapy? Is there evidence that a PT block reduces the intra-articular urate burden, inflammatory cytokines, joint pH, or leukocyte/macrophage? The answer is no, you have no such evidence. There is a difference between theory and proven fact. It is called the scientific method. Absent confirmatory studies, the suggestion that a PT block “dilutes out” the uric acid (which effect would be expected to last only for the duration of the anesthetic used) is mumbo-jumbo until proven otherwise.


 


Allen Jacobs, DPM, St. Louis, MO

12/29/2020    

RESPONSES/COMMENTS (PM NEWS QUICK POLLS)



From: Joe Agostinelli, DPM


 


I have read various responses as to this question from well learned colleagues. So far, however, I have not read about some "classic treatment". First of all, a good history, regular radiographs, and physical evaluation of the great toe joint should lead you to believe you have an acute gouty attack.


 


A local or PT block, then an “aspiration” of the joint fluid is then accomplished. You should see either a gouty synovial fluid aspirate or in the rare case of a septic joint, the synovial fluid murky with purulence. After aspiration of the contents of the joint leaving the aspiration needle in the joint, swap out with another syringe for a...


 


Editor's note: Dr. Agostinellis' extended-length letter can be read here.

12/28/2020    

RESPONSES/COMMENTS (PM NEWS QUICK POLLS)



From: Jeffrey Klirsfeld, DPM, Allen Jacobs, DPM


 



A PT block works very well for a gout attack. We must tell our patients that their foot and ankle is numb for a period of time depending on type of anesthesia used (lidocaine, bupivacaine, etc.) and they must essentially do no activities until there is full sensation. It sounds obvious but we still have to tell them.


 


Jeffrey Klirsfeld, DPM, Levittown, NY



 


I have long heard the unproven theorem that PT blocks are useful for the treatment of acute gout by inducing vasodilation and helping to "wash away" the uric acid. Funny how I believe the edema, hyperthermia, and erythema observed in acute gout represented hyperemia. The inflamed joint hardly appears to require additional vascular perfusion. PT blocks provide limited temporal effects. They are helpful for immediate pain relief. However, to suggest other theoretical effects is without a scientific basis and remains theoretical.


 


Speaking of theoretical, I utilize a focal anesthetic block with epinephrine to reduce the hyperemia and pain. My observation has been that epinephrine provides a more prolonged and profound analgesic effect. I want vasoconstriction. As I previously described, I perform a wide dorsal V block apex proximal. I do not encircle the 1st ray. Obviously epinephrine containing anesthetics are not utilized when inappropriate. PT block, dorsal block, no block. This is again the art of medicine, making reasonable efforts to reduce patient suffering.


 


Allen Jacobs, DPM, St. Louis, MO

12/25/2020    

RESPONSES/COMMENTS (PM NEWS QUICK POLLS)



From: Leonard A. Levy, DPM, MPH


 


Drs. Allen Jacobs and Elliot Udell comment about the use of PT blocks in acute gout. Dr. Udell also remarks about the late Dr. Marvin Steinberg who employed PT blocks in treating acute gouty attacks. I spent a number of years in his office at least once a week which literally resulted in my love for podiatric medicine. The use of PT blocks was not only for anesthesia for virtually immediate relief from the acute pain, but also because it was a sympathetic nerve block. 


 


This resulted in vasodilatation which created a dramatic increase in temperature as well as an increase in the flow of blood by blocking the autonomic nerve component. The increase in blood flow increased the volume of fluid to the area and since much of this fluid is water and a solvent, resulted in dilution of the supersaturated solution of monosodium urate. Reducing the sharp crystals of monosodium urate also results in increasing the pH (reducing acidity). Thus, these combined effects of a PT block make such an intervention quite effective. 


 


Leonard A. Levy, DPM, MPH, Ft. Lauderdale, FL

12/23/2020    

RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1B



From: Elliot Udell, DPM


 


Dr. Tritto questions the use of posterior tibial nerve blocks in light of the fact that there are no published studies supporting their efficacy. The point he is making is well taken. Even though the late Dr. Marvin Steinberg, who was regarded as the father of modern podiatric medicine, showed that by blocking the posterior tibial nerve, a patient could be rendered almost asymptomatic within minutes, there are no studies published in any peer-reviewed journals supporting it. Why? 


 


Studies cost megabucks and no pharmaceutical company will invest millions of dollars into showing that PT blocks are helpful, when there is no way they will make money off of the procedure. What makes it worse is that most insurance companies will not pay for PT blocks because there is no research. Could there be research and publications on PT blocks? Sure! Our professional associations along with our colleges of podiatric medicine would have to fund the research without corporate sponsorship. If enough of us want it to happen, maybe it will. 


 


Elliot Udell, DPM, Hicksville, NY

12/23/2020    

RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1A



From: Allen Jacobs, DPM


 


Dr. Tritto correctly notes that little if any EBM exists to support the utilization of a PT block as adjunctive management of acute gout. While I personally do not employ a PT block, it should be recalled that medicine is both an art and science. The use of a PT block is reasonable in a effort to relieve the pain and suffering of acute gout. NSAIDs, colchicine, steroids take time to work.


 


I employ a wide V block apex proximal around the joint dorsally, using lidocaine or bupivicaine with epi. I go see other patients, return and then inject the joint. Patients are very appreciative for the immediate pain relief. No patient has yet refused due to a "lack of evidence". If all of medicine were restricted to EBM, we would be very limited indeed. And remember, EBM includes practitioner experience.


 


Allen Jacobs, DPM, St. Louis, MO

12/22/2020    

RESPONSES/COMMENTS (PM NEWS QUICK POLLS)



From: Michael Tritto, DPM


 


It is difficult to understand the results of this survey and the way the questions were asked. While 43% responded they would give a steroid injection, how many of those are giving a PT block and for what reason? There are no controlled studies that I could find that show the efficacy of a PT nerve block for acute gout in the foot, other than potential pain relief. Are there a substantial number of docs giving a PT block for acute gout and if so, for what reason?  


 


Michael Tritto, DPM, Rockville, MD

07/15/2020    

RESPONSES/COMMENTS (PM NEWS QUICK POLLS)



From: Al Musella, DPM, Robert Scott Steinberg, DPM.


 


The valves on the mask do help you breathe easier but also spread your germs.


 


Al Musella, DPM, Hewlett, NY


 


If your mask has an exhaust valve, how does it protect the patient from us?


 


Robert Scott Steinberg, DPM, Schaumburg, IL


 


Response: That's the reason why we require all patients to also wear masks. Both podiatrists and patients need to protect themselves.


 


Bret Ribotsky, DPM, Boca Raton, FL

07/14/2020    

RESPONSES/COMMENTS (PM NEWS QUICK POLLS)



From: Bret Ribotsky, DPM


 


I noticed last week’s PM News Quick Poll results and I was very surprised with the outcome. There is a difference between a surgical mask and N95 respirator. This CDC infographic should clear this up. Just like how we all used “Universal Precaution” to mean we must practice as if every person was infective with AIDS twenty+ years ago, everyone must continue to practice as if everyone has COVID-19.  


 


A surgical mask does NOT protect the wearer compared to an N95 mask. PLEASE wear an N95 mask (you and your staff deserve the best). I suggest you purchase five masks for each team member/employee and label Monday-Friday. This way each mask sits dormant for 6 days between use  (enough time for any virus captured to be neutralized). While not practicing due to my disability, I purchased boxes of 3M N95 masks with exhaust valves from Dia-Foot and received them quickly, as living in South Florida is a crisis area for COVID now. Let’s never forget common sense.


 


Bret Ribotsky, DPM, Boca Raton, FL

07/13/2020    

RESPONSES/COMMENTS (PM NEWS QUICK POLLS)



From: Dennis Shavelson, DPM


 


Dr. Busman, unless a DPM works for a hospital or group as an employee, we are all in business. The COVID-19 and post-pandemic age has extra income streams playing a vital role in practical longevity. Your muse regarding “Home Self-Podiatry Care” sent chills down my spine too.


 


My model is a “Do It yourself with professional help” methodology in response to the disruptive changes that hunkering the masses, social distancing, and health guidelines are having on one’s ability to appoint to live encounters, consultations, therapy, and hygienic procedures, creating risky and dangerous delays. My platform is a repercussion to co-morbid, unskilled, poorly educated, and disoriented individuals purchasing OTC tools and giving themselves a non-hygienic pedicure in the bathroom with disastrous results.


 


I am functioning as a virtual podiatry trained educator. I am acting as a coach, trainer, mentor, and monitor for those who cannot go to a salon or consult with a podiatrist due to the alarming health and economic times. I am dispensing tools and offering services that are being strongly disclaimed in addition to being insured. I err in the direction of advising those that do not have an assistant at home or are lacking in personal skills to use a salon or to visit a DPM in person for “podiatric care”.


      


Dennis Shavelson, DPM, NY, NY

07/07/2020    

RESPONSES/COMMENTS (PM NEWS QUICK POLLS)



From: Richard J. Manolian, DPM


 


In reference to Dr. Shavelson’s letter and his modern accommodation to mycotic nail care, I feel that the selling of instruments for patients (especially high-risk patients) to do self-care, whether monitored or not, is irresponsible and is putting patients in a position for complications.


 


Also, switching to an all telemedicine-based practice is almost assuredly a recipe for practice failure based on the RVU value of such services and the time required. Additionally, is there a tax that has to be included in the sale of such pedicure instruments and grinders? Nothing against you doctor, but let’s not take a step backwards in the reputation of podiatry in promoting such a so-called modern/tech savvy practice alteration.


 


Richard J. Manolian, DPM, Cambridge, MA

07/06/2020    

RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 2



From: Dennis Shavelson, DPM


 


Dr. Albright, I also heeded Bryan’s message but have chosen a different path then adding more expense, time, and potential danger to my practice. My laser, my instruments, my air purifiers and my super HEPA vacuum grinder are for sale (offers considered), and I have, over these last few months, successfully made the switch to teleHealth pedicures. I dispense maintenance level (not too strong) power callus files and power nail grinders as well as pedicure instruments and ingrown toenail instruments along with face shields to current and future clients. I sell them OTC products such as chemical peels and topicals, and monitor their use on Zoom. The program requires an assistant (or self-care if capable) and an initial consultation to customize their program. I then use telehealth visits to demonstrate, coach, and monitor treatments from afar and remain available to do their medical and surgical podiatry in the office.


 


My staff and I are safer, my office is cleaner, and dare I admit, more professional. I am also gaining a new type of patient who can no longer get a convenient pedicure in a salon due to "new rules" including those that are disrupting the convenience, and health and safety of salons. I can do telehealth from anywhere, anytime, and it is very marketable as a positive buzz in social media.


 


Dennis Shavelson, DPM, NY, NY

07/06/2020    

RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1



From: Steven Kravitz, DPM


 


The recent PM News poll reflected that wound care was by far the least impacted aspect of podiatric practice by the current COVID-19 pandemic. Surgery was affected nearly 60%, routine foot care nearly 30% affected, but wound care less than 2% affected. Additionally, I continue to have numerous contacts with multiple podiatrists in private practice and wound healing centers throughout the country.


 


My personal general impression is that the majority report that 75 to 80% of the pre-COVID-19 patients are returning, and there's an increasing number indicating the return approximating 100%. Most recently, a new finding is that some practices are reporting is much as 120% pre-COVID-19 because they picked up patients from surrounding practices that have been closed or otherwise had patients referred to them.


 


These observations exclude...


 


Editor's note: Dr. Kravitz's extended-length letter can be read here.

07/03/2020    

RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1B



From: Estelle Albright, DPM


 


Thank you Dr. Markinson for your advice: I will further refine my methods of nail care with improved type face masking, and face and head cover, similar to operating in the OR. Currently, I mask and glove, wear glasses, and use sharp, sterile-bagged double action bone cutters for hard nails and use Miltex 40-226A nail nippers for non-dystrophic nails. I do not grind nails.


 


I treat fungal or dystrophic nails medically with oral antifungals and/or nail softeners, or surgically with matrixectomy or nail avulsion. My aim is cure, not maintenance. Granted, this is not an option for some patients, but for most, be the physician that you are: Treat with your best knowledge and skills.


 


I use a 12 month treatment plan for non-surgical nail fungus patients. This includes ketoconazole shampoo for foot washing, topical antifungals, environmental clean- up/disinfection instructions, patient education/brochures, and UV light shoe disinfection with SteriShoe/similar device. I have a very good cure rate. Many of these patients had severe, chronic nail and skin infection (often since military service, or with poor circulation or diabetes). Patients are happy and grateful to be cleared of the infection. I follow patients at 4, 8 and 12 months. I think that ultimately podiatry will endorse protection like I see at my dentist's office; this is surely the path of the future.


 


Estelle Albright, DPM, Indianapolis, IN

07/03/2020    

RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1A



From: Steven Finer, DPM


 



I find that statistic of 34% quite shocking. From day one, in the prehistoric era in 1976 and onward, I had a Sanivac and an air cleaner in the treatment room. I modified the tube myself, adapting vacuum store parts to deliver suction to the drill head. Patients would look at the air cleaner and assume it was an air conditioner or a dehumidifier. When I would arrive at the office, I would always touch surfaces to see that they were cleaned. 


 


Disclosure: I have no financial relationship with Sanivac. 


 


Steven Finer, DPM, Philadelphia, PA 


07/02/2020    

RESPONSES/COMMENTS (PM NEWS QUICK POLLS) - PART 1B



From: Bryan C Markinson, DPM



 


A simple search of the global microbiological, occupational science, radiological, and infectious disease literature dating back 2-3 decades will reveal a plethora of citations in the potential dangers and actual incidence of respiratory illness from inhaled nail dust and the microbes that tag along with it. A British NHS study reveals 4x the incidence of asthmatic-type illness among podiatrists.


 


If Dr. Moglia won’t be convinced until he sees dramatic numbers of lung cancer cases, which he won’t, then he should stop wearing seat belts and bicycle helmets. And another word to the wise, should any podiatrist be immunocompromised by any number of medical issues and or


treatments, the risk is...


 


Editor's note: Dr. Markinson's extended-length letter can be read here


07/01/2020    

RESPONSES/COMMENTS (PM NEWS QUICK POLLS)



From: John Moglia, DPM,


 


Urban legend declares the highest rate of suicide in the medical professions is assigned to dentists. The highest rate of being murdered is associated with cosmetic surgeons. For divorce by infidelity, gynecologists. For drug addiction, the prize goes to anesthesiologists. According to the PM News Quick Poll, 34% of podiatrists are still burring down fungal or dystrophic nails without a nail dust extractor. Are there any published studies showing higher rates of lung cancer or death by lung disease attributed to podiatrists?


 


John Moglia, DPM, Berkeley Hts NJ


 


Editor’s note: We are unaware of any such study. However, in Podiatry Management's latest annual survey, 11% of podiatrists reported respiratory problems.

04/29/2020    

RESPONSES/COMMENTS (PM NEWS QUICK POLLS)



From: Elliot Udell, DPM


 


I hope that the 50 state podiatry associations and the APMA will prevail upon state boards to either suspend or reduce the amount of CMEs needed because of what is happening. I live in New York and could not renew my driver’s license because all motor vehicle offices are closed. The state has extended auto licenses due to the pandemic. It would only be fair, for the same reason, to reduce or eliminate CME credits. Not every practitioner is computer wise enough to properly get their credits online. This could change, but at this point in time, the state boards need to be more practical.


 


Elliot Udell, DPM, Hicksville, NY


 


Editor's Note: New York State has recently extended the period of time for unlimited online CMEs for those whose licenses expire between now and September 1, 2020.
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