1
00:00:00,800 --> 00:00:02,720
Hello, Don here. 
Welcome to Potential Practice 

2
00:00:02,720 --> 00:00:04,520
Mastery. 
We're we're trying to help you 

3
00:00:04,520 --> 00:00:07,520
get to the $1,000,000 mark and 
beyond in your private practice 

4
00:00:07,520 --> 00:00:10,120
production. 
I'm going to go over this is a 

5
00:00:10,240 --> 00:00:14,640
recording of a Friday. 
So my Fridays they tend to run 

6
00:00:14,680 --> 00:00:17,840
routine in the morning. 
So that's the the half day that 

7
00:00:17,840 --> 00:00:20,000
I do routine along with my nail 
tech. 

8
00:00:20,000 --> 00:00:22,280
My nail tech was on vacation, so
it was just me. 

9
00:00:22,280 --> 00:00:26,320
So basically nail care every 10 
minutes for the whole morning 

10
00:00:26,320 --> 00:00:28,600
and then we don't really do 
anything else the rest of the 

11
00:00:28,600 --> 00:00:30,560
week. 
So it's a kind of an efficient 

12
00:00:30,560 --> 00:00:32,280
way if you're not doing 
something like that. 

13
00:00:32,280 --> 00:00:34,760
It works really well. 
I know in the beginning you're 

14
00:00:34,760 --> 00:00:37,360
like, hey, what day do I do it? 
Or what happens if patients 

15
00:00:37,360 --> 00:00:39,080
can't make it? 
Well, if you just kind of make 

16
00:00:39,080 --> 00:00:40,680
it that way, they don't really 
have an option. 

17
00:00:41,120 --> 00:00:43,320
And if they can't see you in 
those times, it's a way to 

18
00:00:43,320 --> 00:00:45,480
decrease the amount of routine 
care. 

19
00:00:45,480 --> 00:00:47,840
And I've never really heard of 
any podiatrist that doesn't mind

20
00:00:47,840 --> 00:00:52,480
doing less routine care. 
OK, so first patient was a 

21
00:00:52,480 --> 00:00:56,160
shockwave #5 out of 6 for 
plantar fasciitis. 

22
00:00:56,160 --> 00:00:59,920
He's starting to feel better. 
The nice thing about doing 6 

23
00:00:59,920 --> 00:01:02,200
sessions of Shockwave is that 
usually about fifth or sixth 

24
00:01:02,200 --> 00:01:04,360
session patients start to feel a
little bit better. 

25
00:01:04,840 --> 00:01:07,280
So he is going to do one more in
a week. 

26
00:01:08,120 --> 00:01:12,120
Next patient was a 73 year old 
female that was here for a 

27
00:01:12,120 --> 00:01:15,640
matrix follow up. 
So just a reminder, I do one 

28
00:01:15,640 --> 00:01:18,280
matrix follow up. 
I used to do 2 but I find that 

29
00:01:18,280 --> 00:01:22,080
one at 3 weeks is sufficient. 
I've tried to go to none and 

30
00:01:22,080 --> 00:01:24,960
sometimes that kind of gives me 
a hard time because of the the 

31
00:01:24,960 --> 00:01:27,480
drainage and the redness and the
concerns that the patients have.

32
00:01:28,600 --> 00:01:30,880
I think ideally if I had a like 
a nurse practitioner, it would 

33
00:01:30,880 --> 00:01:34,360
be nice to put all those paranic
you follow or I'm sorry, matrix 

34
00:01:34,360 --> 00:01:37,840
follow-ups with that patient 
with that other physician or 

35
00:01:38,320 --> 00:01:41,520
treating provider. 
Next patient was this was 

36
00:01:41,520 --> 00:01:47,280
orthotic #1 patient that she 
came in for a an aroma wasn't 

37
00:01:47,280 --> 00:01:49,200
really having concerns right 
now. 

38
00:01:49,200 --> 00:01:52,440
Her main issue was, was frankly 
first rate elevatis and hallux 

39
00:01:52,440 --> 00:01:55,720
limitis. 
And that's what I, I noted on 

40
00:01:55,720 --> 00:01:57,160
the X-ray. 
So I spent a lot of times 

41
00:01:57,160 --> 00:02:00,240
talking about how X limit is 
kind of talking about how to 

42
00:02:00,240 --> 00:02:03,240
unlock that joint, bringing down
the first ray. 

43
00:02:04,040 --> 00:02:05,680
And I find the X-rays really 
help me with that. 

44
00:02:06,560 --> 00:02:08,120
And then she had previously had 
orthotics. 

45
00:02:08,120 --> 00:02:10,400
We made her a new pair of 
orthotics with the first ray cut

46
00:02:10,400 --> 00:02:12,880
out and just kind of explaining 
the importance of those 

47
00:02:12,880 --> 00:02:14,600
orthotics. 
And she'll be back in, it's 

48
00:02:14,600 --> 00:02:17,680
usually in two months. 
So what I usually do is patients

49
00:02:17,680 --> 00:02:20,720
come in about 3 weeks to pick up
the orthotics and then I see 

50
00:02:20,720 --> 00:02:22,680
them six weeks after. 
So that tends to be about a 

51
00:02:23,000 --> 00:02:24,560
little over two months for the 
follow up. 

52
00:02:25,240 --> 00:02:29,920
Next patient was Q tenza #6 so 
this gentleman, he's kind of a 

53
00:02:30,240 --> 00:02:34,360
challenging 1 because he has 
both diabetic neuropathy, but 

54
00:02:34,360 --> 00:02:36,800
he's also doing dealing with 
some chemotherapy induced 

55
00:02:36,800 --> 00:02:38,600
neuropathy for his cancer 
treatment. 

56
00:02:39,480 --> 00:02:44,360
He finds that the Q Tenza lasts 
about two months and then the, 

57
00:02:44,520 --> 00:02:48,400
the, the, the last month, the 
third month, he starts to have 

58
00:02:48,400 --> 00:02:50,000
more symptoms. 
And I said, well, that's really 

59
00:02:50,000 --> 00:02:51,640
ideal. 
So that's what he has. 

60
00:02:51,640 --> 00:02:55,560
So we are applying the, the 
Cutenza just for anyone that 

61
00:02:56,000 --> 00:02:58,680
doesn't do Cutenza. 
I, I find it pretty beneficial 

62
00:02:59,720 --> 00:03:02,960
for patients you're going to 
know after about 33 sessions and

63
00:03:02,960 --> 00:03:05,000
if they don't find really much 
benefit after the third one, I'm

64
00:03:05,000 --> 00:03:07,120
going to be, I stop it. 
So I'm only doing it for 

65
00:03:07,120 --> 00:03:08,560
patients that actually have 
relief. 

66
00:03:08,720 --> 00:03:11,160
I'm not going to do it forever 
on someone that has no relief. 

67
00:03:12,120 --> 00:03:15,320
The other thing that you you 
might want to consider if you're

68
00:03:15,320 --> 00:03:18,560
doing this is I, I put it on, 
but then I have my staff take it

69
00:03:18,560 --> 00:03:20,000
off. 
So it saves you some time. 

70
00:03:20,000 --> 00:03:23,280
It just really occupies a room 
for that, for that time. 

71
00:03:23,280 --> 00:03:25,280
You have to have it on for 30 
minutes and it kind of makes a 

72
00:03:25,280 --> 00:03:28,440
little bit of a mess, but the 
reimbursement seems to be, seems

73
00:03:28,440 --> 00:03:32,080
to be worth it. 
Next patient was a 58 year old 

74
00:03:32,080 --> 00:03:34,720
female. 
She had bilateral carry flex. 

75
00:03:34,720 --> 00:03:36,360
She's one that came from our 
newspaper. 

76
00:03:36,360 --> 00:03:40,840
She had kind of a really bad 
kind of onycholytic nail with 

77
00:03:40,920 --> 00:03:45,840
like that was WAVY and she had 
previously been treated by 

78
00:03:45,840 --> 00:03:47,440
another doctor said there was 
really no option. 

79
00:03:47,600 --> 00:03:50,080
She was a really good candidate 
for the the the carry flex. 

80
00:03:50,080 --> 00:03:51,200
I think it's going to look good 
for her. 

81
00:03:51,200 --> 00:03:53,480
She actually came in from one of
our newspaper newspaper ads 

82
00:03:54,160 --> 00:03:57,400
because we had it like a before 
and after for a bad toenail. 

83
00:03:58,080 --> 00:04:00,400
Next was also another carry flex
bilateral. 

84
00:04:00,400 --> 00:04:03,680
It's the tis the season for 
carry flex just so you know, and

85
00:04:03,680 --> 00:04:06,680
so she did that as well. 
Bilateral carry flex. 

86
00:04:07,200 --> 00:04:14,320
Next patient was 75 year old 
that she was seeing me a few 

87
00:04:14,320 --> 00:04:17,480
years ago. 
She had bunions and they were 

88
00:04:17,480 --> 00:04:18,920
painful. 
I've talked to her a lot about 

89
00:04:19,120 --> 00:04:20,959
shoe gear. 
I spend a lot of my time talking

90
00:04:20,959 --> 00:04:23,160
about shoe gear. 
My favorite shoes to recommend 

91
00:04:23,160 --> 00:04:28,640
are ultras and topos and also we
sell in our office LEMS as an 

92
00:04:28,640 --> 00:04:30,840
option. 
But she has bilateral bunions 

93
00:04:30,840 --> 00:04:32,240
with pain. 
I did bilateral cortisone 

94
00:04:32,240 --> 00:04:35,000
injections and then she'll be 
coming back as needed. 

95
00:04:35,640 --> 00:04:38,640
Next patient was a 66 year old 
man who came in. 

96
00:04:39,280 --> 00:04:43,120
He had been treated in Brazil 
for ingrown toenails, kind of 

97
00:04:43,120 --> 00:04:44,560
came back. 
He had the medial hallux 

98
00:04:44,560 --> 00:04:47,880
bilaterally that were affected 
and I did matrixectomies and I'm

99
00:04:47,880 --> 00:04:49,360
going to see him back in three 
weeks. 

100
00:04:50,520 --> 00:04:52,840
Next patient was a 77 year old 
man. 

101
00:04:53,760 --> 00:04:57,880
He came in, he had some balance 
issues and he was concerned 

102
00:04:57,880 --> 00:05:02,080
about some falls he had. 
He was scanned for orthotics, so

103
00:05:02,080 --> 00:05:04,720
this is orthotic #2 And then I 
prescribed him some physical 

104
00:05:04,720 --> 00:05:10,080
therapy for him as well. 
And then the, the final patient 

105
00:05:10,440 --> 00:05:12,320
was some reason she got in my 
schedule. 

106
00:05:12,320 --> 00:05:15,160
She was a routine patient that 
maybe should have been not 

107
00:05:15,160 --> 00:05:16,960
placed in that, in that 
schedule. 

108
00:05:16,960 --> 00:05:18,800
So that was the afternoon, the 
morning I didn't put in there 

109
00:05:18,800 --> 00:05:21,400
because it was basically 
basically nail care. 

110
00:05:21,840 --> 00:05:25,400
My, my goal tends to be for each
day to do 2 orthotics. 

111
00:05:25,720 --> 00:05:27,320
And so I was able to reach that 
goal today. 

112
00:05:27,680 --> 00:05:32,400
And I guess the, the MVP most 
valuable patient would be some 

113
00:05:32,400 --> 00:05:34,360
of these orthotics. 
There wasn't really any new 

114
00:05:34,960 --> 00:05:37,200
Shockwave patients that I could 
set up today. 

115
00:05:37,440 --> 00:05:40,480
OK, once again, if you guys find
this beneficial, love to hear 

116
00:05:40,480 --> 00:05:42,640
back from you, Don at Podiatry 
Practice mastery.com. 

117
00:05:42,640 --> 00:05:44,120
Also, there's other things 
you're struggling with. 

118
00:05:44,600 --> 00:05:46,120
Let me know. 
One thing I'm kind of working on

119
00:05:47,080 --> 00:05:50,760
is I have a pretty good system 
for my oral Lamisil. 

120
00:05:51,120 --> 00:05:54,400
I don't have a great system for 
my topical. 

121
00:05:54,960 --> 00:05:55,960
And I've talked to some other 
people. 

122
00:05:55,960 --> 00:05:59,920
They really, really believe in 
this entosolin or like Formula 7

123
00:06:00,560 --> 00:06:03,600
and they can do that just as 
much as I do the the trabinifen.

124
00:06:03,600 --> 00:06:09,840
I would love to know, I guess if
it, if it works, I just don't 

125
00:06:09,840 --> 00:06:13,240
really believe in much of the 
topical and what you do kind of 

126
00:06:13,240 --> 00:06:14,720
it doesn't work. 
I I've talked to some other 

127
00:06:14,720 --> 00:06:16,640
people, they say, oh, you just 
do the same thing you do with 

128
00:06:16,640 --> 00:06:18,120
the oral, like not all oral 
works. 

129
00:06:18,120 --> 00:06:20,360
And you're right. 
And so I'm trying to figure out 

130
00:06:20,360 --> 00:06:23,840
a way of offering more of the, 
the one I have is the formula 7,

131
00:06:23,840 --> 00:06:25,360
right? 
And so I would just use that 

132
00:06:25,360 --> 00:06:28,080
since I have it. 
And so all the patients maybe 

133
00:06:28,080 --> 00:06:30,840
that don't want the Tribenfin do
the Formula 7. 

134
00:06:30,880 --> 00:06:35,320
And the other question is laser 
for like lunula, I have that. 

135
00:06:35,600 --> 00:06:39,200
I have lunula, I have kutera. 
I just feel once again, it it 

136
00:06:39,200 --> 00:06:41,920
doesn't work or maybe the 
patient selection is to be so 

137
00:06:41,920 --> 00:06:45,840
selective to have it work. 
So I'd love to know if someone 

138
00:06:45,840 --> 00:06:48,760
really has a great system of how
they maybe combine the two, 

139
00:06:48,760 --> 00:06:51,680
combine the lunula with the 
formula seven. 

140
00:06:52,560 --> 00:06:55,280
I don't really think, I don't 
feel ethically I could do the 

141
00:06:55,280 --> 00:06:58,080
lunula with the oral medication 
because I think the oral works 

142
00:06:58,080 --> 00:06:59,600
by itself. 
So I don't think the lunula was 

143
00:06:59,720 --> 00:07:02,200
was needed. 
So I'd love to know other people

144
00:07:02,280 --> 00:07:04,320
to how how you guys do that. 
Shoot me an e-mail, 

145
00:07:04,320 --> 00:07:06,880
don@podiatrypracticemaster.com. 
Let me know what works for you. 

146
00:07:06,880 --> 00:07:08,880
I'd love to do that. 
And if you do share, I will 

147
00:07:08,880 --> 00:07:10,800
share it with everyone else. 
OK, have a great day.