Hi, Don here. Welcome to Podiatric Practice
Mastery. We're helping you get to the
$1,000,000 mark and beyond. So I'm going to go over, this is
a recording of a Wednesday in my office.
So it was a, it was a nice day. We, we put up this new web page
on urgent care. So it's nice because it's
filling up the, the, the actual schedule.
So I had kind of a light schedule that it ended up
filling up thanks to my, my staff.
Just so you know as well, we are training a new virtual
assistant. She was being trained yesterday
by my surgery scheduler and she's going to be only answering
the phones because we're having a little bit of a hard time
answering phones. I just heard we had a little
rebellion in the clinic, not really rebellion, but like the
staff because they don't want to answer the phones.
They just turn the volume down so they can't hear them.
So they just show up visually and they're not answering them.
So just so many calls, which is kind of a good thing and kind of
a bad thing. But the problem is just letting
them all go to the recording and then they get the transcript of
the recording and then they take care of them in that in the
system that we have called Clara.
So just kind of a funny thing that I heard.
Funny or sad? OK, first patient, she's a 62
year old female. She had a nail sample.
Follow up, did not show fungus, so I did not do anything for her
toenail. She also has a plantar fibroma I
am not dealing with right now because it's not bothering her.
Next patient was a 33 year old. This was a little girl.
She came in, little girl. She's 33, I guess I'm 40, I'm
47, so I can call her a little girl.
She has some Taylor's bunions bilaterally.
That's where she came in for. That's it.
And when I looked at this young woman's X-rays, I was like, Oh
my goodness, what happened? Because she had like no
subtaylor joint in the right foot and beaking between the
Taylor and the vicular joint and just all this arthritis and I
was like, what's going on here? You're here for this Taylor's
Bunny. Is there something else going
on? She said yeah, I had a car
accident years ago and my foot's all messed up and like, do you
want that fixed? And she says yeah, it just
hurts. I'm just used to having it hurt
every day. So I referred her to one of my
colleagues for possible fusion of the of the rear foot for her.
Next patient was a 45 year old young man.
He was on Terbenefin many years ago and he did the whole
protocol and it came back. And so for this guy, I'm doing
the protocol again. I gave him tribenophen.
He has the UV light, shoe spray, biotin, stuff like that.
And I just talked to him about possibly after using a topical
like Lamisil cream once everything is gone, Lamisil
cream once a week. I don't know if anyone else does
that but I've heard about doing that along with the shoe
treatment so it doesn't come back, but it came back right on
the same toe and he was totally cleared out in the past.
So I started that process. Next patient was a 57 year old
follow up for Achilles tendonitis.
Now he is OF there are certain patients as I mentioned before,
they just don't want to spend money.
So these ones I don't spend much time on.
I just sent him to physical therapy and I'm like if this
doesn't work then we're going to do shockwave for him.
I don't really have as much patience.
I think shockwave would be better.
He just doesn't want to to spend.
Next patient was a 71 year old female.
She had on the right foot a hammer toe.
It looked like a fifth hammer toe.
But when I got an X-ray it showed like a calcific Bursa on
that area and I I told her, you know, you could remove that or
you can just kind of wear wider shoes.
I recommended wider shoes for her.
Next patient was a patient that came in for a Trybenfin follow
up and wasn't really clearing out.
So I put that patient on Diflucan.
Next patient was a 88 year old person that had a kissing corn
between the 4th and 5th toes. Talked about wider shoes,
something to space the toes out, and an exostectomy if that
doesn't work. Next patient was a 63 year old
that had a neuroma so I did an ultrasound guided cortisone
injection for that and those neuroma symptoms.
No follow up as needed. Next patient was a 65 year old
female. She had bilateral second pain
and I did bilateral shockwave on her.
This was a pet #4 out of 6 so she has another two and she's
already starting to feel a little bit better.
Next patient was a 56 year old that had a carry flex 1 toenail.
She's the one that comes in. She likes to do this.
She comes in every three months for this.
I'm trying to get her to see my my nail tech but she keeps
wanting to see me. Next patient was a 48 year old.
This is a kind of a nice active guy.
He has pain. We reviewed an MRI and he has
some sub tailor joint arthritis, a bone marrow oedema and kind of
the anterior aspect of it based on the the MRI.
So there's not many options for this young guy.
He likes to be active. So he's done cortisone that
helped a little bit. But really what I'm going to do
focus shockwave just on that area of bone marrow oedema.
So if I can help him feel better with that.
So we're going to set up four sessions of shockwave kind of
because it's for the bone. I'm doing 4.
Maybe I should have done 6, but for this guy, I'm just going to
do 4 to start out. I didn't have time to do it with
him there. Next patient was E pad #2 on a
six for plantar fascial pain. Next patient, this gentleman, he
was kind of a guess, a train wreck I guess.
Unfortunately he had a Liszt Franc injury from a motocross
accident on his right foot. And he had already had had a
actually on his left foot and he had a fusion already of the 1st
and 2nd tarsal metatarsal joints and they were going to do the
inter cuneiform joints. That's what they were planning
on doing. But he didn't come in for the
left foot. He came in for the right foot
where he had sesmoiditis from probably his change in his gait.
So I talked to him about different sesmoid treatment,
shockwave, cortisone injection, but he opted for doing nothing
because he I think he was here just more for a second opinion.
Next patient was a foreign body that she had on the on that this
is 1. These are some of these that are
added on. So that's why I had them written
down here. Foreign body that was added on.
It was I got X-ray. I forgot to get an ultrasound on
this one. I probably should get an
ultrasound. She has a little bump that was
there. I didn't really see anything she
didn't want like an an incision and drainage.
If I could do it over again, I probably would have done the
ultrasound. For some reason I'm always
thinking ultrasound, but I didn't think it was funny.
My my scribe actually reminded me afterwards.
Did you do an ultrasound? I'm like, no, I didn't do an
ultrasound so I probably should have.
Next patient was a patient with a DIPJ 2nd digit cyst and we
popped it and wrapped it with Cobain.
She has popped it a couple of times.
I I went through my whole spiel about the high recurrence rate
and needing to fuse the joint if the the popping and wrapping
doesn't work. And then there was also a, this
is a 64 year old that she had bilateral second Med head as
well. Pain.
And she is a shockwave #9 out of nine out of nine.
So she's done. She, I'm going to see her back
in three months. She's substantially better than
when I originally started. Originally she couldn't tolerate
anything. I think it's partially like a
nerve issue and she's better, but she's not perfect.
So that, that's a struggle that one.
There next was a 37 year old with a left fibula fracture.
Gave her a tall Cam, but she came in from the urgent care.
Next patient was patient had bilateral heel pain, talked
about foam roller. Since she had bilateral heel
pain, I gave her bilateral night splints so she only had to wear
them three hours instead of 6 hours.
Right. Switching feet and and then
we're still yeah then we're still struggling with mod Med.
I think we figured out one problem with Mod Med for us has
been we put in like all the shockwave stuff.
I put in like a bill where it shows up when they check out,
but the problem is when the staff checks them out, they
can't reconcile that bill. So they have the bill I put in
and then they have the payment. They can post payment for 2:50
for the Shockwave, but they can't post it to the actual bill
that I put in there. For some reason.
It's an accounting issue, so it's a pain.
So we have to figure out a different way.
A workaround is for us just when we do the follow up, just to
write in kind of what they have going on and how to how to bill
them, what the staff should build them.
So anyway, that's what has been going on in the office.
Tell me kind of what's working for you.
Reach out to me. I'd love to hear what things are
going well. Any new ideas that you have so I
can share it with others here in the program?
Okay, have a good one.