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Hey guys, Don here. 
Welcome to Podiatry practice. 

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Master. 
I'm going to go over the 

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$1,000,000 minute. 
So these are things that I go 

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over that would help what things
that help me get to the 

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$1,000,000 mark and beyond. 
So I, I'm still struggling a 

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little bit with my new medical 
record of, of writing down all 

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the patient information. 
I think it's because I'm more 

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preoccupied with my charting 
right now that I am like 

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documenting these things. 
I just, a lot of times just want

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to get, get done. 
It used to be a little bit 

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easier. 
The, the print out of the 

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patient list was a little bit 
easier. 

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The, the newer 1 doesn't leave 
me enough room. 

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So I'm, I'm trying a different 
1. 

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So I'll go over the main ones 
here. 

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So the first one was a 53 year 
old female. 

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They got a Lamisil booster. 
They originally had tinipedis. 

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Things are doing better. 
So kind of medication management

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that's continuing with this 
medication. 

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Next was a 45 year old man. 
He got the Pelto special. 

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So that night splint foam 
rolling morning stretch due to 

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plantar fasciitis and we're 
starting a shockwave number one 

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out of three. 
The reason I'm doing less versus

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the like the 6th probably 
because I think I prejudged this

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patient, frankly, I, I, and also
I think he only had pain for a 

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couple of months and so that's 
why I put it down to three. 

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I'm trying to do more 6, but I'm
still finding that my tendency 

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of if they haven't had it 
longer, I'm starting on with a 

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lower number and then I can do 
more later. 

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I also did an ultrasound same 
day. 

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I think there's a big key with 
doing shockwave and doing it the

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same day and along with the 
ultrasound. 

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I find that when I'm doing 
ultrasound the same day, I can 

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show them the anatomy on one 
side, the other, and that's 

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really my number one thing that 
helps explain to patients that 

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the anatomy is different. 
That's the reason for the 

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shockwave. 
And then if I can start the 

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shockwave the exact same day, it
really speeds things up with 

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patients adherence because they 
already start the process and 

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then they'll continue on with 
the other treatments. 

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It makes it much more efficient 
for them. 

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I think in the past I used to, I
was like I was too busy and I 

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was kind of scheduling things 
out. 

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I just find if if I can take the
five to seven minutes and just 

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do it that day, it's much better
to start treatment same day when

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you're doing when you're doing 
shockwave. 

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So just so everyone knows when I
talk Shockwave, we have two 

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radial machines and then we have
a focused and a soft wave. 

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So we have radial in both 
offices and then one of our 

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offices focused and one of them 
has a soft wave when we kind of 

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use them interchangeably. 
And my results seem to be 

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interchangeable at this point. 
Just so you guys know, next was 

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a 73 year old female, kind of 
had a bad ankle sprain and I put

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them in an ankle brace and I'm 
going to follow up in about 3 

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weeks with possible ultrasound 
to look at the ligaments. 

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I, I don't, I didn't do the 
ligaments the first day just 

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because of all the swelling and 
I was going to do it at the 

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follow up one. 
It might be more of a like a 

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confidence level on my, on my 
end of things looking at the 

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lateral ankle ligaments and 
maybe I should be doing it the 

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first visit for these patients. 
But I, I, I wasn't doing the 

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ultrasound. 
If anyone was really good at 

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ultrasound looking at the 
ligaments, let me know if you do

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it the first visit. 
I'd like to know what other 

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people are doing next. 
Was this is that that anterior 

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calcaneal kind of beak fracture 
that we're doing? 

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We're #5 out of 6 for this 
female. 

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She's feeling better kind of 
getting out of her Cam boot. 

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I'm hoping that's healing in 
there. 

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I'm going to do #6 next time and
I'll get an X-ray at that time. 

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Next was a 62 year old. 
This is a woman that came in. 

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She had previously had a kind of
a midfoot fusion, first, second,

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third, my cuneiform joints. 
And that was about four years 

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ago. 
That that surgery looks solid 

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and she is here now. 
She had a ankle sprain and she 

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fractured her fibula. 
So I put her in a tall Cam boot.

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She's a very active like 
pickleball player, at least 

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pickleball. 
I tend to find that they're 

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really active and they want to 
do anything they do they can to 

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get better faster. 
And so for her, I am doing 4 

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sessions of, of shockwave, both 
to get down the swelling, but 

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also to help kind of heal things
a little bit faster with the, 

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with the focused shockwave. 
So we're going to be doing that 

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for her. 
Now. 

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This would be kind of an MVP 
most valuable patient because of

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the shockwave for this patient, 
because you get the, you get 

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the, the non operative fracture 
treatment, you get the office 

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visit, you get the Cam boot and 
then you get the four sessions 

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of shockwave. 
Who are the ones that are 

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wanting to do shockwave for 
fractures? 

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It's usually the ones that are 
in a hurry to get back to 

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activity. 
Now, can the shockwave heal the 

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bone faster? 
It might heal a little bit 

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faster, but what the research 
shows is that return to play or 

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return to activity is speeded 
up. 

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And for her, this is what's 
important. 

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So because we know it's longer 
than the six to eight weeks that

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takes to heal this the return to
activity because of the the 

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tissue around it as well. 
So I'm going to be treating the 

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tissue around with the radial 
and then the fracture side 

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itself. 
And then I think you might speed

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it up maybe 20% with the 
fracture healing, but the return

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to activity will be increased 
that that's anyway the way I 

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understand it. 
I'd like to know what other 

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people think about this. 
Shoot me an e-mail 

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don@podiatrypracticemastery.com 
if you have any comments on 

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these things or if you guys 
practice a little bit different 

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and I will share it with with 
other people. 

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Next was a, this was a patient 
that had a fourth and 5th digit 

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maceration. 
I want to talk through this one.

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So 4th and 5th digit maceration 
kind of have toes that were 

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tight been that way for years 
kind of has a bunion, tailor's 

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bunion that are pushing the toes
together. 

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So the kind of the take away to 
make this like kind of more of a

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larger check is when I, when I 
originally when she came in, 

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there was a Cellulitis. 
So I put her on antibiotic. 

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There was an ulcer. 
So I had to briided the ulcers 

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was ulcer to bribe the first 
time had lambs wool betadine 

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dried out. 
Second visit today wearing kind 

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of wider shoes. 
Maceration is getting better and

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we, I talked to her about 
possibly doing an arthroplasty 

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in the future because the toes, 
the bones are kind of rubbing 

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against each other. 
So I, I think the mistakes I've 

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made in the past is when there 
was a maceration in there, I 

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just kind of curetted some of 
the maceration out, but I did 

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not debride the ulcer. 
So in this case, debride in the 

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ulcer really kind of brings up 
the level of the visit, 

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especially with the antibiotics.
And then instead of just like, 

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OK, C maceration or a lot of 
these ulcers, I think we're 

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seeing the ulcers, we're 
dividing the ulcers, but we're 

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maybe treating them as calluses 
or not billing fully. 

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So I think this is something 
just to keep keep in mind. 

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And I think a lot of times, 
frankly, it's because the 

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documentation is, is challenging
and we're doing it because we're

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lazy, because it's easier just 
to trim a callus and, and even 

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though it is an ulcer and but 
the documentation for the ulcers

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a little bit more challenging. 
So just something to to kind of 

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think about. 
Next was a 13 year old. 

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I did an Ind for an ingrown 
toenail. 

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No follow up. 
Next was a 35 year old. 

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This was a this fibular 
sesmoidectomy. 

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She had a little bit of sutures,
some vicryls that were kind of 

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coming out of the incision. 
So I removed those. 

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She's still kind of recovering 
from that. 

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Next was a 55 year old that a 
partial nail avulsion and 

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debrided a couple of the nails. 
Next was a 69 year old female 

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with posterior tibial 
tendonitis. 

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So this is kind of a challenging
one. 

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She has a lot of ankle 
arthritis, midfoot arthritis, 

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but what's hurting her is the 
posterior tibial tendon. 

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And she thought she had gout. 
So she had a kind of a slightly 

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elevated uric acid and she was 
treated kind of with gout with 

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like a Medrol dose pack. 
But where her pain really is is 

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the medial ankle towards the 
tendons like the posterior 

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tibial tendon, maybe the flexor 
digitorum. 

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I did an ultrasound today. 
I saw some thickening and 

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effusion around those tendons 
and she's going to be going on a

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vacation. 
So I, I did a little bit of 

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cortisone in that area and I 
talked to her about when she 

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gets back from vacation to start
shockwave. 

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So that'll be, I'm going to see 
her back in about four to six 

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weeks. 
I tend to, if I do cortisone, I 

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don't do shockwave for four to 
six weeks to get that out of 

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their system. 
And then I'll start some 

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shockwave because you know, she 
has kind of a Pez planovalgus 

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type of a foot and versus like a
surgical repair. 

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I think getting her with a 
shockwave with that tendon and 

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then getting her into some type 
of an AFO would if she's willing

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to do that, either AFO or an 
orthotic. 

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I find a lot of times females 
are quite vain and are not 

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wanting to wear the AF OS. 
They do a little bit better with

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a more of a stability orthotic. 
Next was a 72 year old. 

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This is a female that has she 
had a cyst trained twice and she

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had a bilateral bunion. 
So she had said there was a 

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ganglion over the bunion. 
It didn't really come back. 

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She she said she didn't want to 
get X-rays. 

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So this was 1. 
I don't know if I was just busy 

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or what. 
Usually patients come in a lot 

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of times they tell my staff they
don't want X-rays. 

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I can usually have them get 
X-rays when I talk to them 

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explaining that to them. 
I, I sometimes find when 

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patients have a strong accent, I
have a hard time being more kind

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of authoritative with them or 
telling them what they need 

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because of, because, because of 
the language barrier. 

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I find sometimes this language 
barrier can be a challenge like,

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and, and so this, this patient, 
she was, I have a lot of 

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Albanian patients and I just, I 
just find it hard with the, with

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the accent. 
Maybe I'm afraid they're not 

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understanding me why they need 
the X-rays, but she does need 

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X-rays. 
She just did not want to do them

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yesterday. 
And, and, and then I then I get,

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I get struggle with the accent 
and I just kind of go on and, 

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and OK, forget about it. 
But probably would have been 

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better to get the X-rays, at 
least some baseline X-rays for 

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her. 
She said she had them somewhere 

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else. 
That's why she didn't want to 

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repeat them and she was worried 
more about the quote UN quote 

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cyst. 
But she does know me from the 

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hospital. 
She works at the hospital and 

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she's wanting to consider bunion
surgery, but maybe just not 

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today. 
So I, I did not get the X-rays 

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today. 
Probably for practice management

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would have been better to get 
those X-rays. 

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And she did bring a friend with 
her that had bunions as well. 

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So we talked to her about her 
friends bunions as well. 

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Next was a 82 year old female. 
She had kind of like 2nd and 3rd

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digit hammer toes that were 
dorsally dislocated or 

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contracted and she had painful 
second metatarsal head and a 

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callus down there. 
So I trimmed the callus but I 

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really said she needed more work
with that second metatarsal. 

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There's really no fat pad 
underneath there. 

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So we talked to her about 
orthotics. 

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She didn't, I think she was a 
little upset. 

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I think she might have been 
waiting a little bit. 

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And this was one that was kind 
of a struggle when they're 

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waiting and you feel bad because
you're already you're already 

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starting behind and they're 
already frustrated. 

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So I didn't do much for her and 
I felt like she wasn't too 

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pleased. 
So I'm probably going to call 

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her and make sure she's doing OK
today. 

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So these are those ones that, 
you know, she came in, I didn't 

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really help her that much. 
She didn't have much of A callus

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down there. 
And I actually felt guilty for 

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charging her for the callus 
because I was running behind. 

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So these are I'm just kind of 
sharing kind of the emotions 

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that I feel throughout the day. 
And so for this one, I feel like

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I didn't do too much. 
I, I didn't, I didn't she feel 

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like she was connecting with me.
She was kind of like 

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standoffish, you know, wanted to
get out of there, you know, very

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curt in her in her responses. 
And then the last patient was a 

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onycolytic nail bilaterally that
this patient kind of got it 

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snagged on something. 
I didn't trim it all the way 

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back to where it was attached. 
And in a couple weeks she'll 

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come in for a carry flex. 
And I actually had another 

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patient that came in for 
bilateral carry flex as well 

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this day. 
So this was the day I think the 

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MVPS were these would tend to be
the shock waves that I was doing

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for these patients. 
And I feel like now that things 

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are calming down with the new 
medical record, I'm able to 

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focus more on and these types of
patients once again, I'm doing 

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a, a new kind of a, a section in
Podiatry management and, and the

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next article is going to be on 
how to get a new associate busy.

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So I'd like to know if, if 
you've had associates and if 

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you've been successful getting 
them busy, what you kind of did?

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Because I think one of the 
struggles when doctors are 

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starting out, they don't have 
very many patients. 

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And how do we get them busy 
besides just kind of giving it 

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time? 
Do you throw money at AdWords? 

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Do you have them get out into 
the community? 

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What, what is it that you do to 
get the patients busy? 

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If, if, if you have good tips or
things that don't work, let me 

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know. 
Okay, So I can include that 

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newsletter. 
Shoot me an e-mail 

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don@podiatricpracticemastery.com.
Also, just let me know how 

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you're liking this if you find 
this beneficial. 

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Okay, have a great day.