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Hi, Don here. 
Welcome to Podiatric Practice 

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Mastery. 
We're helping you get to the 

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$1,000,000 mark and beyond. 
So I'm going to go over, this is

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a recording of a Wednesday in my
office. 

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So it was a, it was a nice day. 
We, we put up this new web page 

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on urgent care. 
So it's nice because it's 

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filling up the, the, the actual 
schedule. 

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So I had kind of a light 
schedule that it ended up 

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filling up thanks to my, my 
staff. 

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Just so you know as well, we are
training a new virtual 

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assistant. 
She was being trained yesterday 

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by my surgery scheduler and 
she's going to be only answering

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the phones because we're having 
a little bit of a hard time 

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answering phones. 
I just heard we had a little 

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rebellion in the clinic, not 
really rebellion, but like the 

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staff because they don't want to
answer the phones. 

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They just turn the volume down 
so they can't hear them. 

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So they just show up visually 
and they're not answering them. 

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So just so many calls, which is 
kind of a good thing and kind of

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a bad thing. 
But the problem is just letting 

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them all go to the recording and
then they get the transcript of 

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the recording and then they take
care of them in that in the 

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system that we have called 
Clara. 

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So just kind of a funny thing 
that I heard. 

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Funny or sad? 
OK, first patient, she's a 62 

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year old female. 
She had a nail sample. 

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Follow up, did not show fungus, 
so I did not do anything for her

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toenail. 
She also has a plantar fibroma I

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am not dealing with right now 
because it's not bothering her. 

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Next patient was a 33 year old. 
This was a little girl. 

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She came in, little girl. 
She's 33, I guess I'm 40, I'm 

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47, so I can call her a little 
girl. 

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She has some Taylor's bunions 
bilaterally. 

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That's where she came in for. 
That's it. 

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And when I looked at this young 
woman's X-rays, I was like, Oh 

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my goodness, what happened? 
Because she had like no 

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subtaylor joint in the right 
foot and beaking between the 

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Taylor and the vicular joint and
just all this arthritis and I 

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was like, what's going on here? 
You're here for this Taylor's 

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Bunny. 
Is there something else going 

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on? 
She said yeah, I had a car 

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accident years ago and my foot's
all messed up and like, do you 

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want that fixed? 
And she says yeah, it just 

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hurts. 
I'm just used to having it hurt 

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every day. 
So I referred her to one of my 

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colleagues for possible fusion 
of the of the rear foot for her.

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Next patient was a 45 year old 
young man. 

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He was on Terbenefin many years 
ago and he did the whole 

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protocol and it came back. 
And so for this guy, I'm doing 

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the protocol again. 
I gave him tribenophen. 

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He has the UV light, shoe spray,
biotin, stuff like that. 

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And I just talked to him about 
possibly after using a topical 

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like Lamisil cream once 
everything is gone, Lamisil 

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cream once a week. 
I don't know if anyone else does

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that but I've heard about doing 
that along with the shoe 

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treatment so it doesn't come 
back, but it came back right on 

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the same toe and he was totally 
cleared out in the past. 

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So I started that process. 
Next patient was a 57 year old 

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follow up for Achilles 
tendonitis. 

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Now he is OF there are certain 
patients as I mentioned before, 

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they just don't want to spend 
money. 

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So these ones I don't spend much
time on. 

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I just sent him to physical 
therapy and I'm like if this 

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doesn't work then we're going to
do shockwave for him. 

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I don't really have as much 
patience. 

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I think shockwave would be 
better. 

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He just doesn't want to to 
spend. 

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Next patient was a 71 year old 
female. 

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She had on the right foot a 
hammer toe. 

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It looked like a fifth hammer 
toe. 

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But when I got an X-ray it 
showed like a calcific Bursa on 

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that area and I I told her, you 
know, you could remove that or 

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you can just kind of wear wider 
shoes. 

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I recommended wider shoes for 
her. 

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Next patient was a patient that 
came in for a Trybenfin follow 

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up and wasn't really clearing 
out. 

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So I put that patient on 
Diflucan. 

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Next patient was a 88 year old 
person that had a kissing corn 

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between the 4th and 5th toes. 
Talked about wider shoes, 

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something to space the toes out,
and an exostectomy if that 

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doesn't work. 
Next patient was a 63 year old 

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that had a neuroma so I did an 
ultrasound guided cortisone 

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injection for that and those 
neuroma symptoms. 

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No follow up as needed. 
Next patient was a 65 year old 

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female. 
She had bilateral second pain 

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and I did bilateral shockwave on
her. 

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This was a pet #4 out of 6 so 
she has another two and she's 

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already starting to feel a 
little bit better. 

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Next patient was a 56 year old 
that had a carry flex 1 toenail.

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She's the one that comes in. 
She likes to do this. 

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She comes in every three months 
for this. 

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I'm trying to get her to see my 
my nail tech but she keeps 

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wanting to see me. 
Next patient was a 48 year old. 

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This is a kind of a nice active 
guy. 

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He has pain. 
We reviewed an MRI and he has 

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some sub tailor joint arthritis,
a bone marrow oedema and kind of

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the anterior aspect of it based 
on the the MRI. 

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So there's not many options for 
this young guy. 

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He likes to be active. 
So he's done cortisone that 

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helped a little bit. 
But really what I'm going to do 

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focus shockwave just on that 
area of bone marrow oedema. 

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So if I can help him feel better
with that. 

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So we're going to set up four 
sessions of shockwave kind of 

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because it's for the bone. 
I'm doing 4. 

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Maybe I should have done 6, but 
for this guy, I'm just going to 

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do 4 to start out. 
I didn't have time to do it with

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him there. 
Next patient was E pad #2 on a 

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six for plantar fascial pain. 
Next patient, this gentleman, he

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was kind of a guess, a train 
wreck I guess. 

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Unfortunately he had a Liszt 
Franc injury from a motocross 

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accident on his right foot. 
And he had already had had a 

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actually on his left foot and he
had a fusion already of the 1st 

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and 2nd tarsal metatarsal joints
and they were going to do the 

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inter cuneiform joints. 
That's what they were planning 

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on doing. 
But he didn't come in for the 

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left foot. 
He came in for the right foot 

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where he had sesmoiditis from 
probably his change in his gait.

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So I talked to him about 
different sesmoid treatment, 

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shockwave, cortisone injection, 
but he opted for doing nothing 

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because he I think he was here 
just more for a second opinion. 

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Next patient was a foreign body 
that she had on the on that this

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is 1. 
These are some of these that are

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added on. 
So that's why I had them written

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down here. 
Foreign body that was added on. 

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It was I got X-ray. 
I forgot to get an ultrasound on

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this one. 
I probably should get an 

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ultrasound. 
She has a little bump that was 

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there. 
I didn't really see anything she

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didn't want like an an incision 
and drainage. 

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If I could do it over again, I 
probably would have done the 

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ultrasound. 
For some reason I'm always 

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thinking ultrasound, but I 
didn't think it was funny. 

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My my scribe actually reminded 
me afterwards. 

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Did you do an ultrasound? 
I'm like, no, I didn't do an 

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ultrasound so I probably should 
have. 

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Next patient was a patient with 
a DIPJ 2nd digit cyst and we 

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popped it and wrapped it with 
Cobain. 

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She has popped it a couple of 
times. 

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I I went through my whole spiel 
about the high recurrence rate 

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and needing to fuse the joint if
the the popping and wrapping 

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doesn't work. 
And then there was also a, this 

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is a 64 year old that she had 
bilateral second Med head as 

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well. 
Pain. 

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And she is a shockwave #9 out of
nine out of nine. 

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So she's done. 
She, I'm going to see her back 

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in three months. 
She's substantially better than 

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when I originally started. 
Originally she couldn't tolerate

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anything. 
I think it's partially like a 

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nerve issue and she's better, 
but she's not perfect. 

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So that, that's a struggle that 
one. 

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There next was a 37 year old 
with a left fibula fracture. 

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Gave her a tall Cam, but she 
came in from the urgent care. 

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Next patient was patient had 
bilateral heel pain, talked 

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about foam roller. 
Since she had bilateral heel 

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pain, I gave her bilateral night
splints so she only had to wear 

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them three hours instead of 6 
hours. 

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Right. 
Switching feet and and then 

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we're still yeah then we're 
still struggling with mod Med. 

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I think we figured out one 
problem with Mod Med for us has 

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been we put in like all the 
shockwave stuff. 

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I put in like a bill where it 
shows up when they check out, 

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but the problem is when the 
staff checks them out, they 

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can't reconcile that bill. 
So they have the bill I put in 

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and then they have the payment. 
They can post payment for 2:50 

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for the Shockwave, but they 
can't post it to the actual bill

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that I put in there. 
For some reason. 

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It's an accounting issue, so 
it's a pain. 

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So we have to figure out a 
different way. 

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A workaround is for us just when
we do the follow up, just to 

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write in kind of what they have 
going on and how to how to bill 

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them, what the staff should 
build them. 

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So anyway, that's what has been 
going on in the office. 

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Tell me kind of what's working 
for you. 

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Reach out to me. 
I'd love to hear what things are

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going well. 
Any new ideas that you have so I

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can share it with others here in
the program? 

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Okay, have a good one.