01/05/2021    

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

RE: How do you most commonly treat acute gout? (Leonard A Levy, DPM, MPH)

From: Carl Solomon, DPM

      

Common sense (admittedly not high on the scale of levels of evidence) causes me to take issue with the notion that a posterior tibial block affects the solubility of Na urate crystals in joint fluid during an acute gouty attack. The studies that were cited support that a posterior tibial block increases blood flow by vasodilation. I can't argue with that. But those studies were done on normal intact feet. The reason a patient's foot is warm, red, and swollen in a gouty attack is that it's inflamed...vasodilated! Do you truly believe that a foot which is already swollen, warm, and red can be additionally dilated just because you give it a nerve block?

 

Posterior tibial block for pain relief...why not? But I think we're kidding ourselves if the intent is to provide any therapeutic benefit. Again, my conclusions are based upon my own logic and I'm willing to be proven wrong by a study looking at the effect of a posterior tibial block on an already vasodilated foot.

 

Carl Solomon, DPM, Dallas, TX

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11/11/2016    

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

RE:  Have you ever performed a type of procedure just to fulfill a certification requirement when you thought a different procedure might be better for the patient?

From: Allen Jacobs, DPM

 

Selecting any procedure contrary to the medical interest of the patient is unethical and frankly, in my opinion, borders on malpractice. By doing so, you have placed your self-interest over that of the patient. Anyone answering yes to this question does not deserve to hold any degree with responsibility for decision-making in healthcare. 

 

Allen Jacobs, DPM, St. Louis, MO