1 00:00:01,320 --> 00:00:03,960 Hello, down here, welcome to Podiatry Practice Mastery, where 2 00:00:03,960 --> 00:00:06,640 we're helping you take your practice to the $1,000,000 mark 3 00:00:07,160 --> 00:00:09,960 and beyond in your own personal production. 4 00:00:09,960 --> 00:00:15,200 So I, I wanted to start today with a couple of questions. 5 00:00:15,200 --> 00:00:19,880 I got as I've been talking about urgent cares, there was a doctor 6 00:00:19,880 --> 00:00:23,000 that reached out to me and said, hey doc, how about insurance 7 00:00:23,000 --> 00:00:26,360 coverage for your urgent care? How is that? 8 00:00:26,360 --> 00:00:30,680 How is that working? And I said let me check because 9 00:00:30,680 --> 00:00:32,520 I don't know, I just see patients. 10 00:00:32,880 --> 00:00:36,040 And so I asked my one of my office managers here and they 11 00:00:36,040 --> 00:00:40,560 said for the most part, when patients make an appointment 12 00:00:40,560 --> 00:00:45,080 online, there is a kind of a scrubbing field, meaning it says 13 00:00:45,400 --> 00:00:48,440 we do not take this and this and this insurance, You know, just 14 00:00:48,440 --> 00:00:50,960 want you to know that if you want an appointment, there is a 15 00:00:50,960 --> 00:00:55,240 cash pay amount. But otherwise, you know, pretty 16 00:00:55,240 --> 00:00:57,320 much don't make the appointment. That's how it is online. 17 00:00:57,920 --> 00:00:59,680 If they do it on the phone, same thing. 18 00:01:00,040 --> 00:01:02,560 We tell them the insurances we take and we don't take and then 19 00:01:02,560 --> 00:01:06,240 they can choose to see us if they're in a hurry. 20 00:01:06,240 --> 00:01:08,560 Sometimes they do see us and we have a reasonable cash pay 21 00:01:08,560 --> 00:01:11,320 amount. It's usually the amount that 22 00:01:11,320 --> 00:01:14,200 insurance would pay us. I think for probably a new 23 00:01:14,200 --> 00:01:17,680 patient, it might be 150, depending on level Level 3, 24 00:01:17,680 --> 00:01:20,720 maybe level 4 is 200. And then X-rays might be, I 25 00:01:20,920 --> 00:01:22,640 don't know, 50 bucks or something like that. 26 00:01:23,760 --> 00:01:27,520 And then any other things that we do would just be kind of a la 27 00:01:27,520 --> 00:01:29,600 carte for those patients. So I'm, I'm having patients that 28 00:01:29,600 --> 00:01:31,640 come in and pay. We've had a few patients that 29 00:01:31,640 --> 00:01:34,000 make the appointment and they don't know that we don't take 30 00:01:34,000 --> 00:01:36,600 their insurance because for example, there's something here 31 00:01:36,600 --> 00:01:39,680 called Tufts Direct. So we take Tufts, but Tufts 32 00:01:39,680 --> 00:01:43,760 Direct is a, a Medicaid or mass health product and we don't take 33 00:01:43,760 --> 00:01:44,400 that. So they'll come in. 34 00:01:44,400 --> 00:01:45,560 There's a little bit of confusion there. 35 00:01:45,560 --> 00:01:48,640 So it's not perfect in terms of checking insurance. 36 00:01:48,640 --> 00:01:50,640 So this is something that we're learning as we're doing it, but 37 00:01:50,640 --> 00:01:54,320 I still think filling up the schedule is worth it with this 38 00:01:54,320 --> 00:01:58,320 urgent care model right now. Another question that someone 39 00:01:58,320 --> 00:02:01,840 asked me is they said, I want to start using a virtual scribe 40 00:02:01,840 --> 00:02:05,000 like you do. What is really necessary for a 41 00:02:05,000 --> 00:02:08,440 virtual scribe? So I've, I've talked extensively 42 00:02:08,440 --> 00:02:11,360 about Murali. He is my third virtual scribe. 43 00:02:12,280 --> 00:02:15,400 I, we chose virtual versus in person just because our, our 44 00:02:15,400 --> 00:02:19,920 office, our, our rooms are small and we didn't, frankly, I didn't 45 00:02:19,920 --> 00:02:23,520 want someone's in my space all the time when I'm there. 46 00:02:23,520 --> 00:02:27,920 And So what I need for a virtual scribe is a cell phone. 47 00:02:27,920 --> 00:02:33,560 So I have a second Samsung cell phone and we have basically I do 48 00:02:33,560 --> 00:02:37,000 a phone call via Microsoft Teams. 49 00:02:37,000 --> 00:02:40,120 So Microsoft Teams, the same number, like I don't know if 50 00:02:40,120 --> 00:02:42,760 you've noticed this, but with Zoom or Teams, you can connect 51 00:02:42,760 --> 00:02:45,280 via a link or there's a phone call number that you can do. 52 00:02:45,280 --> 00:02:48,040 And so this is the same phone call that I make every single 53 00:02:48,040 --> 00:02:52,760 day and it connects me to India where Murali is now Murali was 54 00:02:52,760 --> 00:02:56,840 ascribed. So all I really need to do my to 55 00:02:56,840 --> 00:03:01,080 do it would be a teams account, which my my scribing company 56 00:03:01,120 --> 00:03:05,320 does the and the one I use currently is IKS that they 57 00:03:05,320 --> 00:03:10,560 changed companies recently. It's called IKS and they they 58 00:03:10,560 --> 00:03:15,640 have ACA teams repeating event on my calendar. 59 00:03:15,640 --> 00:03:20,440 I click that event actually now it's just this auto save on my 60 00:03:20,560 --> 00:03:22,880 on the phone. I do it and I don't use that 61 00:03:22,880 --> 00:03:25,080 phone for anything else. I just basically I recharge it 62 00:03:25,080 --> 00:03:27,640 every night. I put it in my backpack and I 63 00:03:27,680 --> 00:03:33,160 that's all I need to, I need a phone and I need a Teams account 64 00:03:33,160 --> 00:03:35,040 that they give me. That's really it. 65 00:03:35,920 --> 00:03:40,240 And then when I'm training him, I use the team's video or the, 66 00:03:40,240 --> 00:03:42,360 you know, the actual video to share my screen. 67 00:03:42,360 --> 00:03:47,480 So I have in my office, I use daily, I use 7 computers, so six 68 00:03:47,480 --> 00:03:49,200 treatment rooms and then one in my office. 69 00:03:49,600 --> 00:03:52,440 And usually the one in my office is my base where I will come 70 00:03:52,440 --> 00:03:54,560 back. And when I was training Raleigh, 71 00:03:54,560 --> 00:03:56,960 I was sharing my screen, showing him how to do the notes, 72 00:03:57,520 --> 00:03:59,720 checking my notes with him. He could see me as I'm going 73 00:03:59,720 --> 00:04:01,520 through the notes. So in the beginning it takes a 74 00:04:01,520 --> 00:04:04,160 little bit, especially since we just switched medical records, 75 00:04:05,040 --> 00:04:08,040 but that is all you need. Now someone asked about do I do 76 00:04:08,040 --> 00:04:10,400 like a written consent saying that they're there? 77 00:04:10,400 --> 00:04:12,120 No, but I introduce morale to everyone. 78 00:04:12,120 --> 00:04:15,080 I don't do a written consent. I just say hey, there is someone 79 00:04:15,360 --> 00:04:20,519 on this device and I point the phone in my pocket and he is 80 00:04:20,519 --> 00:04:22,960 going to be taking notes for me. There are a couple of other 81 00:04:22,960 --> 00:04:27,440 methods that use video and you would put an iPad, a small 82 00:04:27,440 --> 00:04:29,800 little mini iPad and they can see things. 83 00:04:30,680 --> 00:04:32,640 The one that I use doesn't use visual. 84 00:04:32,640 --> 00:04:35,160 I, I think it takes a little bit more bandwidth to be on a video 85 00:04:35,160 --> 00:04:39,080 call and I try to verbalize what I'm doing with the, with the 86 00:04:39,080 --> 00:04:41,040 patients like, and he, he gets used to it. 87 00:04:41,040 --> 00:04:43,000 You know, he knows, I talk about, you know, thickened 88 00:04:43,000 --> 00:04:46,800 toenails and he, he learns now what I'm doing and everyone, all 89 00:04:46,800 --> 00:04:48,680 the patients always ask me, is he AI? 90 00:04:48,680 --> 00:04:50,600 And I always say he's like five times a day. 91 00:04:51,000 --> 00:04:55,200 Murali is not AI. And for anyone that is Indian, 92 00:04:55,200 --> 00:05:00,640 his real name is Murli. But it took me about six months 93 00:05:00,640 --> 00:05:03,440 to learn how to pronounce Murli. And so I just call him Murali 94 00:05:03,440 --> 00:05:05,320 because I've been doing that for for so long. 95 00:05:05,320 --> 00:05:08,000 And one day I actually tried to change and called him the right 96 00:05:08,000 --> 00:05:08,920 thing. And he said, why are you calling 97 00:05:08,920 --> 00:05:12,160 me my real name? I said, because I finally 98 00:05:12,160 --> 00:05:16,080 learned how to pronounce it. But he is he's my age. 99 00:05:16,480 --> 00:05:20,280 He is worried about his job because all of his colleagues 100 00:05:20,280 --> 00:05:23,560 there are, are losing their jobs because of AI. 101 00:05:23,560 --> 00:05:28,000 Now, I don't think AI can do what Murali can do. 102 00:05:28,000 --> 00:05:33,280 I, I do not think right now it can he, like I, I've, I've 103 00:05:33,280 --> 00:05:35,720 talked about this before, but like, for example, today I'm, 104 00:05:36,640 --> 00:05:39,960 I'm, I'm, I'm going to record my, my day of a Thursday, but 105 00:05:39,960 --> 00:05:42,480 this is a Friday and we're going to probably see 45 patients. 106 00:05:42,920 --> 00:05:44,760 He's going to do all the notes. He's going to remind me, he's 107 00:05:44,760 --> 00:05:47,360 going to send prescriptions, he's going to order PT, he's 108 00:05:47,360 --> 00:05:50,480 going to review MRI's. He's going to, he just, he gets 109 00:05:50,480 --> 00:05:52,920 bogged behind and he just kind of like catches up with me. 110 00:05:53,680 --> 00:05:56,560 So it's, it's, he's busy just doing notes and I just sign off 111 00:05:56,560 --> 00:05:59,400 on them. So it makes it a lot easier for 112 00:05:59,400 --> 00:06:01,360 me. And I'm just at this point, I 113 00:06:01,360 --> 00:06:03,240 don't think AI is there. It might be there in the future. 114 00:06:03,240 --> 00:06:07,080 I think if you're doing AI for like an HPI review of systems 115 00:06:07,680 --> 00:06:11,200 discussion, I think things like that are OK, but currently it's 116 00:06:11,200 --> 00:06:13,360 not quite there and it is worth the investment. 117 00:06:13,360 --> 00:06:17,320 So the investment for me anyways, about thirty $35,000 a 118 00:06:17,320 --> 00:06:22,640 year and I think it's well spent and I and I pay it, it kind of 119 00:06:22,640 --> 00:06:26,600 goes through the office meaning so then it actually comes 120 00:06:26,600 --> 00:06:30,240 directly out of my salary, not even out of operating expenses 121 00:06:30,240 --> 00:06:31,480 because I'm the only one that uses him. 122 00:06:31,480 --> 00:06:32,960 So it comes directly out of my salary. 123 00:06:33,720 --> 00:06:38,680 So it's it's worth it in my opinion for how much benefit I 124 00:06:38,680 --> 00:06:42,360 get from it. OK, let's go into the day. 125 00:06:43,560 --> 00:06:48,960 First patient was swift #3 on the right foot, a 61 year old 126 00:06:48,960 --> 00:06:51,320 man. I usually do 4 Swifts. 127 00:06:51,320 --> 00:06:53,840 So he's going to schedule one more in a month and then I do a 128 00:06:53,840 --> 00:06:57,400 three month break. I am seeing improvement with the 129 00:06:57,400 --> 00:07:01,160 Swift. Next was a 33 year old man with 130 00:07:01,600 --> 00:07:05,560 right plantar fasciitis #3 out of 6 for Shockwave. 131 00:07:06,240 --> 00:07:10,560 Next was a 56 year old female. She had right Achilles 132 00:07:10,720 --> 00:07:15,040 insertional tendonitis. She got the Pelto special night 133 00:07:15,040 --> 00:07:16,520 splint foam rolling morning stretch. 134 00:07:17,240 --> 00:07:23,640 The dynamic demonstration with I do a orbival and then I 135 00:07:23,720 --> 00:07:25,560 prescribed her meloxicam. I'm going to see her back in 136 00:07:25,560 --> 00:07:28,160 three weeks for possible ultrasound and shockwave. 137 00:07:28,160 --> 00:07:33,400 So she is aware of that. And next patient was a 40 year 138 00:07:33,400 --> 00:07:36,120 old female. She had a care reflex done on 139 00:07:36,120 --> 00:07:39,080 the right toenail and she also had a wart. 140 00:07:39,080 --> 00:07:41,080 So we did lesion destruction on that wart. 141 00:07:42,240 --> 00:07:44,520 She didn't want canthroidin because it made her blister too 142 00:07:44,520 --> 00:07:46,240 much. That's why she didn't want 143 00:07:46,240 --> 00:07:49,000 canthroidin. So I just did salicylic acid. 144 00:07:49,840 --> 00:07:54,560 Next patient was a 68 year old female with left heel pain and 145 00:07:55,480 --> 00:07:59,640 she also had some midfoot pain. Last visit I gave her two 146 00:07:59,640 --> 00:08:02,360 injections into the midfoot with cortisone and she is totally 147 00:08:02,360 --> 00:08:05,200 better so I'm not going to see her back unless that midfoot 148 00:08:05,200 --> 00:08:07,040 pain comes back. She already has orthotics. 149 00:08:07,040 --> 00:08:11,040 Next was a 70 year old female #3 out of 6 for bilateral plantar 150 00:08:11,040 --> 00:08:15,000 fasciitis. She is going to start feeling 151 00:08:15,000 --> 00:08:16,840 better. I tell patients usually at the 152 00:08:16,840 --> 00:08:20,200 5th visit. Next patient was 61 year old 153 00:08:20,360 --> 00:08:25,360 female for Q 10's and #1 and we did that. 154 00:08:25,360 --> 00:08:27,960 I finally figured out the correct template and I recently 155 00:08:27,960 --> 00:08:32,679 did on our on my YouTube page. I'm starting a mod Med kind of 156 00:08:32,679 --> 00:08:34,400 video series. The same thing I used to do with 157 00:08:34,400 --> 00:08:37,559 Athena kind of sharing how to do different types of templates 158 00:08:37,559 --> 00:08:39,679 that are kind of challenging and different types of tips. 159 00:08:39,679 --> 00:08:45,040 So if you have any cool mod Med tips tell me or or any questions 160 00:08:45,040 --> 00:08:47,120 I'll try to figure them out because it was kind of a 161 00:08:47,120 --> 00:08:48,240 struggle. So I'm trying to make some 162 00:08:48,600 --> 00:08:52,760 resources on the on the Podiatry practice mastery YouTube page. 163 00:08:53,560 --> 00:08:57,440 Next was a 44 year old male. He was here for only a nail 164 00:08:57,440 --> 00:08:58,800 evaluation. I've really never had this 165 00:08:58,800 --> 00:09:02,800 before. He had some like longitudinal 166 00:09:02,800 --> 00:09:06,160 lines in his nails and he was concerned and so his nails look 167 00:09:06,160 --> 00:09:07,680 fine. But I really talked to him. 168 00:09:07,680 --> 00:09:09,280 He had some hallux limitis. So I talked to him about 169 00:09:09,280 --> 00:09:11,520 functional hallux limitis, gave him some information and said 170 00:09:11,520 --> 00:09:13,440 that could just be hitting the top of the shoes. 171 00:09:13,720 --> 00:09:15,600 And I talked to him about the shoe liner test to make sure 172 00:09:15,600 --> 00:09:17,520 that they were big enough. He was actually pleased with the 173 00:09:17,840 --> 00:09:19,360 the consult. I thought it was kind of a 174 00:09:19,360 --> 00:09:23,680 weird, weird one. Next was a 50 year old female 175 00:09:24,120 --> 00:09:26,920 for right plantar fasciitis. She did number six out of six 176 00:09:26,920 --> 00:09:28,560 Shockwave. She is already feeling better. 177 00:09:28,560 --> 00:09:32,480 I'm going to see her back in six weeks and I did an office visit. 178 00:09:32,480 --> 00:09:34,400 So always the last shockwave I have. 179 00:09:34,400 --> 00:09:35,600 I haven't talked about this for a while. 180 00:09:35,600 --> 00:09:39,000 So I have a last shockwave handout. 181 00:09:39,000 --> 00:09:40,840 So I give them that. It kind of prepares them for 182 00:09:40,840 --> 00:09:43,040 what's next. And so since I'm discussing 183 00:09:43,040 --> 00:09:46,600 about that, I think that that is appropriate for an office visit. 184 00:09:46,600 --> 00:09:49,360 So once again, these are all within my treatment sheets that 185 00:09:49,360 --> 00:09:51,080 I that I use and I print out for patients. 186 00:09:52,040 --> 00:09:54,880 Next Whiskey tenza #4. So this gentleman I made a 187 00:09:54,880 --> 00:09:59,080 little video on 75 year old man has neuropathy pain. 188 00:09:59,760 --> 00:10:05,600 Q tenza #4 So the first three, first two he didn't feel 189 00:10:05,600 --> 00:10:08,000 anything. Third one, he's like, wow, all 190 00:10:08,000 --> 00:10:11,640 of a sudden my feet don't hurt. So if you're new to Q Tenza or 191 00:10:11,640 --> 00:10:13,960 considering doing it, and this is what the reps say, it usually 192 00:10:13,960 --> 00:10:16,200 takes about 3 applications before they notice some 193 00:10:16,200 --> 00:10:18,600 improvement. And now he's like, wow, I can 194 00:10:18,600 --> 00:10:21,360 like my feet feel good, I can sleep, I can everything else is 195 00:10:21,360 --> 00:10:23,120 fine. And he was like, how long is 196 00:10:23,120 --> 00:10:24,720 this going to last? And I said, I don't know, 197 00:10:24,720 --> 00:10:26,800 probably 3 months. That's why you do it every three 198 00:10:26,800 --> 00:10:29,800 months. So he is feeling better most of 199 00:10:29,800 --> 00:10:32,960 our Qutenza. So kind of a snafu about 200 00:10:32,960 --> 00:10:35,480 Qutenza. There are two ways you can do 201 00:10:35,480 --> 00:10:37,320 it. One is called buy and bill. 202 00:10:37,320 --> 00:10:40,680 That means we buy it for like an absurd amount of money. 203 00:10:40,680 --> 00:10:44,280 I think it's like $4000. And then we bill the insurance 204 00:10:44,280 --> 00:10:47,120 that $4000 and you make a little bit maybe like 10%. 205 00:10:47,920 --> 00:10:51,320 The other option is you go through a specialty pharmacy and 206 00:10:51,320 --> 00:10:53,960 then they pay for it and then you just do the application fee. 207 00:10:54,440 --> 00:10:57,600 I prefer doing the application fee because you make, I don't 208 00:10:57,600 --> 00:11:00,280 know, maybe $400.00. I think it is 4 or 500 for the 209 00:11:00,280 --> 00:11:02,960 application. Real easy thing to do the buy 210 00:11:02,960 --> 00:11:04,840 and bill. The problem is it messes up our 211 00:11:05,000 --> 00:11:06,520 billing. That really messes it up. 212 00:11:06,520 --> 00:11:09,560 But like it's one of those things, just like when I used to 213 00:11:09,560 --> 00:11:15,000 do like Dermagraft it, it's a, it's a high capital expense and 214 00:11:15,000 --> 00:11:17,160 you have to cut that out of your production. 215 00:11:17,160 --> 00:11:22,040 So we did a six month review for the doctors and I had like, I 216 00:11:22,040 --> 00:11:24,560 don't know, however much money I had produced, maybe, I don't 217 00:11:24,560 --> 00:11:28,760 know, 5 or $600,000. And so I had to take out like 50 218 00:11:28,760 --> 00:11:31,920 of that or 40 of that because it was the buy in bill for the Q 219 00:11:31,920 --> 00:11:33,760 10s. Just like we don't really cut 220 00:11:33,760 --> 00:11:35,440 out other stuff from the doctors. 221 00:11:35,440 --> 00:11:38,680 But like these things that it's not really just a cost like you, 222 00:11:38,840 --> 00:11:41,560 you, you buy it for 4000, you earn 4000. 223 00:11:41,560 --> 00:11:43,840 It's not you don't, you know, we just cut those things out. 224 00:11:43,840 --> 00:11:45,600 We don't do it for AF OS and everything else. 225 00:11:45,720 --> 00:11:47,760 We just do it basically for these high ticket items. 226 00:11:47,760 --> 00:11:51,040 So it kind of inflated my my monthly number. 227 00:11:51,240 --> 00:11:53,720 So like when you see the numbers, I try to get 80 a 228 00:11:53,720 --> 00:11:55,960 month, 80,000 a month, I'll get to the $1,000,000 for some 229 00:11:55,960 --> 00:11:59,880 months it's 90 some it's 100. And so some of that that shows 230 00:11:59,880 --> 00:12:06,000 it might be falsely inflated. Next patient was he had a 78 231 00:12:06,000 --> 00:12:08,600 year old man with a left 5th digit corn. 232 00:12:09,520 --> 00:12:11,960 Basically just had a hammer toe. I've really, I just talked to 233 00:12:11,960 --> 00:12:15,720 these ones about shoes, anatomic shoes and I trimmed his little 234 00:12:15,720 --> 00:12:19,080 corn for him. Next was a little 2 year old boy 235 00:12:19,080 --> 00:12:21,840 that kind of jumped off something and his feet hurt for 236 00:12:21,840 --> 00:12:23,240 a couple of days. They were concerned about a 237 00:12:23,240 --> 00:12:26,160 first metatarsal fracture, got X-rays. 238 00:12:26,440 --> 00:12:28,280 You know at a 2 year old you can't really see much in the 239 00:12:28,280 --> 00:12:30,400 X-rays, but we got the X-rays. He went to the urgent care and 240 00:12:30,400 --> 00:12:32,920 they were still concerned so they came and saw us. 241 00:12:33,040 --> 00:12:36,280 Everything looked fine. Next was a 72 year old man with 242 00:12:36,280 --> 00:12:44,680 a left 5th MPJ pain and I did an ultrasound. 243 00:12:45,240 --> 00:12:47,320 I saw some a fusion around the joint. 244 00:12:47,440 --> 00:12:52,720 I did a cortisone injection and I recommended him to have more 245 00:12:52,720 --> 00:12:55,920 of a an anatomic shoe. I think it happened with his 246 00:12:55,920 --> 00:12:58,680 golf shoes that were a little too narrow or some other type of 247 00:12:58,680 --> 00:13:00,280 shoe that didn't have any give on the side. 248 00:13:00,560 --> 00:13:03,560 So I did X-ray, ultrasound and then the cortisone He talked to 249 00:13:03,560 --> 00:13:05,960 me about there is a golf shoe if you if you need an anatomic golf 250 00:13:05,960 --> 00:13:09,720 shoe to recommend, I think it's called squares squares shoe and 251 00:13:09,720 --> 00:13:12,680 I and I don't it's kind of a weird spelling with AZ, but if 252 00:13:12,680 --> 00:13:16,280 you need a one to recommend, I have a shoe buying guy. 253 00:13:16,280 --> 00:13:17,880 That's how I tend to do it for my patients. 254 00:13:18,200 --> 00:13:21,560 Next was a 79 year old female. My buddy, he had to go do a Liz 255 00:13:21,560 --> 00:13:25,200 Frank repair during lunch and so I had to take over one of his. 256 00:13:25,200 --> 00:13:26,840 His routine morning is Thursdays. 257 00:13:27,320 --> 00:13:29,280 And so I did one of his nail care patients for him. 258 00:13:29,640 --> 00:13:33,280 Next was a 69 year old female that I did a a biopsy. 259 00:13:33,280 --> 00:13:36,680 She came in for like a skin lesion on the dorsal lateral 260 00:13:36,680 --> 00:13:39,120 foot. I did a two 2mm punch biopsies 261 00:13:39,640 --> 00:13:43,080 and since I have to do a lecture on biopsies or dermatology here 262 00:13:43,200 --> 00:13:46,120 at a local conference I took little pictures to show how easy 263 00:13:46,120 --> 00:13:48,240 it is. Basically it should take like 264 00:13:48,240 --> 00:13:51,800 one minute and if it takes longer let me know I'll try to 265 00:13:51,800 --> 00:13:55,280 help you out. Next was a 43 year old female 266 00:13:55,520 --> 00:14:00,960 that had wart with a kanthordan and and she is this she's a 267 00:14:00,960 --> 00:14:02,360 runner. She's back to running because 268 00:14:02,360 --> 00:14:07,880 she had a tib Ant insertional issue going on and she is 269 00:14:08,640 --> 00:14:11,400 getting better with shockwave. Shockwave #5 out of 6 basically 270 00:14:11,400 --> 00:14:13,480 no pain. I'm going to do one more and 271 00:14:13,480 --> 00:14:15,840 then she should be fine. Next was a 56 year old man new 272 00:14:15,840 --> 00:14:17,560 patient got a diabetic foot exam. 273 00:14:17,960 --> 00:14:19,560 He had a wart in the right heel as well. 274 00:14:19,560 --> 00:14:22,440 I did canthered in on that and he had a one thickened nail so I 275 00:14:22,440 --> 00:14:26,240 did nail debridement and actually a nail sample for him. 276 00:14:26,240 --> 00:14:30,240 Next was a 68 year old female for left anterior ankle. 277 00:14:30,280 --> 00:14:33,000 Kind of a neuritis. She had a anterior ankle. 278 00:14:33,000 --> 00:14:35,720 She had like a ganglion I think that popped and kind of adhered 279 00:14:35,720 --> 00:14:38,360 some of the tissues down there with kind of a nerve impingement 280 00:14:38,400 --> 00:14:41,120 kind of pain. And I'm doing shockwave. 281 00:14:41,120 --> 00:14:43,920 She's on number session #2 out of four. 282 00:14:44,560 --> 00:14:46,600 She's not really seeing much improvement yet, but we're we're 283 00:14:46,600 --> 00:14:50,080 doing that. Next was a 71 year old man. 284 00:14:50,520 --> 00:14:54,560 He's post MRI. I was concerned for him. 285 00:14:54,680 --> 00:14:56,800 I did 2 injections to the first MPJ. 286 00:14:57,680 --> 00:15:00,400 He did not get better on the MRI. 287 00:15:00,560 --> 00:15:02,200 We got an MRI because it wasn't getting better. 288 00:15:02,200 --> 00:15:04,080 And it was actually one of these or I don't know how you guys do 289 00:15:04,080 --> 00:15:07,360 it there, but it was like an orange, an orange alert, meaning 290 00:15:07,360 --> 00:15:10,040 they sent me like a text message, e-mail, all from the 291 00:15:10,240 --> 00:15:12,360 MRI place. And it was because he had a 292 00:15:12,360 --> 00:15:14,800 stress fracture in the first metatarsal neck. 293 00:15:14,800 --> 00:15:17,920 And I'm not sure exactly sure what happened for that, but it's 294 00:15:17,920 --> 00:15:19,280 been painful for a while for him. 295 00:15:19,280 --> 00:15:22,720 So what we ended up doing is shockwave #1 out of four, 296 00:15:22,920 --> 00:15:26,960 focused only or non radial only. This was the soft wave that we 297 00:15:26,960 --> 00:15:30,320 had in this office and I, so I build the fracture code. 298 00:15:30,600 --> 00:15:32,680 I gave him a dispensed him a Cam boot. 299 00:15:32,680 --> 00:15:35,600 Actually he had his own Cam boot and then I did number one out of 300 00:15:35,600 --> 00:15:37,840 four. He's going to set those up. 301 00:15:37,840 --> 00:15:41,200 And usually for I'm offering patients now, just so you know, 302 00:15:41,200 --> 00:15:43,800 with Shockwave, I'm saying, hey, most patients do it once a week. 303 00:15:44,280 --> 00:15:46,440 That's fine. If you want to kind of get the 304 00:15:46,560 --> 00:15:49,320 get them done faster, you can do them every 72 hours. 305 00:15:49,320 --> 00:15:51,480 So I do offer doing it twice a week for some patients. 306 00:15:51,480 --> 00:15:54,840 They just want to get it done faster versus like spreading it 307 00:15:54,840 --> 00:15:57,600 out. Next was a 78 year old man after 308 00:15:57,600 --> 00:16:02,120 PT he had some balance issues and he he's going to be getting 309 00:16:02,120 --> 00:16:05,480 orthotics. He, he forgot to pay for them or 310 00:16:05,480 --> 00:16:08,960 we forgot to ask him for money so didn't get his orthotics. 311 00:16:08,960 --> 00:16:11,800 He's going to be getting them. Next was a 44 year old female 312 00:16:11,920 --> 00:16:15,120 left second toe cyst. This was kind of interesting. 313 00:16:15,120 --> 00:16:18,680 She had a cyst in the proximal phalanx, probably like a maybe 314 00:16:18,680 --> 00:16:22,720 like an echondroma. So I recommended that she get an 315 00:16:22,720 --> 00:16:25,440 MRI and then we'll see you kind of like offloading in a surgical 316 00:16:25,440 --> 00:16:26,720 shoe or a boot or something like that. 317 00:16:27,480 --> 00:16:31,600 Next was a left hallux 70 year old female that had a WAVY left 318 00:16:31,600 --> 00:16:33,480 hallux that was kind of lytic and thickened. 319 00:16:33,840 --> 00:16:37,760 I took a nail sample for her. I don't think it's a fungus. 320 00:16:37,760 --> 00:16:40,720 I think it's an onycolytic nail that's kind of WAVY because it's 321 00:16:40,720 --> 00:16:43,000 detached and so I'm not going to see her back. 322 00:16:43,840 --> 00:16:45,480 I am going to call her with the results in. 323 00:16:45,480 --> 00:16:49,040 The last patient of the day was a 49 year old female with left 324 00:16:49,040 --> 00:16:53,040 fourth met base fracture. This is the she's #3 out of four 325 00:16:53,320 --> 00:16:58,920 for non radial only that for that fracture and we're going to 326 00:16:58,920 --> 00:17:01,000 get one and the next one in the fourth visit, we're going to get 327 00:17:01,000 --> 00:17:03,920 an X-ray and then I usually do a six week follow up. 328 00:17:04,680 --> 00:17:07,240 So she is doing well. So that was the day. 329 00:17:07,400 --> 00:17:09,359 Once again, I'm putting together a challenge. 330 00:17:09,359 --> 00:17:11,240 If you want to challenge yourself to get to the 331 00:17:11,240 --> 00:17:14,640 $1,000,000 mark, I'd love to do it with a, with a few people. 332 00:17:14,640 --> 00:17:17,680 I've had some people that are interested in the, in the emails 333 00:17:17,680 --> 00:17:19,000 that are coming out. You should see them. 334 00:17:19,680 --> 00:17:21,920 If you don't get the e-mail, shoot me one Don at Podiatry 335 00:17:21,920 --> 00:17:25,480 practice mastery.com looking for a few practices that want to 336 00:17:25,640 --> 00:17:27,599 kind of if you're struggling, I don't like it's hard to 337 00:17:27,599 --> 00:17:29,920 implement. That's the thing I find like I, 338 00:17:30,000 --> 00:17:32,960 I talk about these ideas here, you might like them, but 339 00:17:32,960 --> 00:17:35,440 actually making change when you're in a busy practice is 340 00:17:35,440 --> 00:17:36,840 hard to do. That's why I put together this, 341 00:17:37,080 --> 00:17:39,040 this six month challenge, basically this we can all 342 00:17:39,040 --> 00:17:40,400 challenge. Yeah, I can be challenged, you 343 00:17:40,400 --> 00:17:43,000 can be challenged and we're going to put together like it's 344 00:17:43,000 --> 00:17:44,480 a mastermind. So we're going to be a group of 345 00:17:44,480 --> 00:17:47,200 docs working together. So that's what I'm working on. 346 00:17:47,200 --> 00:17:49,320 If you're interested, let me know and we'll talk to you more 347 00:17:49,320 --> 00:17:49,760 tomorrow.