1 00:00:00,840 --> 00:00:03,200 Welcome to Podiatry Practice Mastery, where we're trying to 2 00:00:03,200 --> 00:00:06,440 get you to the $1,000,000 mark and beyond in your personal 3 00:00:06,440 --> 00:00:08,440 production in your Podiatry clinic. 4 00:00:09,200 --> 00:00:14,080 Want to talk today about how a recent patient found me? 5 00:00:15,000 --> 00:00:18,840 I had two patients today that came in because they found me 6 00:00:18,840 --> 00:00:23,760 with my YouTube videos and I had one patient that Googled my name 7 00:00:23,760 --> 00:00:25,560 and all she what she said was funny. 8 00:00:25,920 --> 00:00:32,400 She said put she put in like a podiatrist with the best or the 9 00:00:32,400 --> 00:00:36,840 most reviews. And when she did that, my name 10 00:00:36,840 --> 00:00:38,600 came up probably because I was in her vicinity. 11 00:00:39,160 --> 00:00:43,320 So one thing I want to share kind of our little secret for 12 00:00:43,320 --> 00:00:48,120 getting online reviews. So our practice has about 1000 13 00:00:48,120 --> 00:00:50,360 or a little over 1000 and everyone else has maybe a couple 14 00:00:50,360 --> 00:00:52,800 100 reviews. So the first thing I'm going to 15 00:00:52,800 --> 00:00:54,400 share about that. And then the second thing, I'm 16 00:00:54,400 --> 00:00:59,040 going to share my my little log algorithm for doing YouTube 17 00:00:59,040 --> 00:01:02,920 videos. And, and yeah, so first thing, 18 00:01:03,080 --> 00:01:05,400 how we get reviews. We've tried a couple of things, 19 00:01:06,520 --> 00:01:09,760 but what works best for us is we have an automated system that we 20 00:01:09,760 --> 00:01:13,400 used to use called Swell. And so swell after every patient 21 00:01:13,400 --> 00:01:15,600 comes in, it integrates with your medical record and it sends 22 00:01:15,600 --> 00:01:19,280 them a review request about 5 or 6 in the evening and they give a 23 00:01:19,280 --> 00:01:21,000 review. It's a really easy one step 24 00:01:21,000 --> 00:01:24,800 process. Hey, did you have a good visit 25 00:01:25,600 --> 00:01:26,840 and then would you give us a review? 26 00:01:26,840 --> 00:01:29,120 That's pretty much it. The newer system we have right 27 00:01:29,120 --> 00:01:31,080 now is a little more cumbersome with Mod Med. 28 00:01:31,640 --> 00:01:38,040 It is with Clara and it asks first it sends something that 29 00:01:38,040 --> 00:01:40,960 says you have a message, so you have to put in your date of 30 00:01:40,960 --> 00:01:43,240 birth and things like that, which makes it that's one 31 00:01:43,240 --> 00:01:45,640 difficult step. Then when you read the message, 32 00:01:45,640 --> 00:01:46,960 it says did you have a good experience? 33 00:01:46,960 --> 00:01:50,520 And depending if you say yes or no, either one, it'll ask for a 34 00:01:50,520 --> 00:01:52,720 review. So I think that two step adds a 35 00:01:52,720 --> 00:01:55,960 little bit more of complexity into the system and that's why I 36 00:01:55,960 --> 00:01:57,000 don't think it's working as well. 37 00:01:57,000 --> 00:02:00,080 So we are considering switching back to swell because the 38 00:02:00,080 --> 00:02:03,760 current one, even though it's less expensive, who cares how 39 00:02:03,760 --> 00:02:05,640 expensive it is if it doesn't work as well. 40 00:02:06,240 --> 00:02:09,120 So that's the first thing. The second thing is how how does 41 00:02:09,120 --> 00:02:14,200 content work for me? So I am not a influencer on 42 00:02:14,560 --> 00:02:20,200 YouTube by any means, but I like to create content to make my 43 00:02:20,200 --> 00:02:24,280 life easier and I'd like to make use the best use of my time in 44 00:02:24,280 --> 00:02:29,120 terms of efficiency. So the the YouTube videos that 45 00:02:29,120 --> 00:02:32,280 have the most traction, I know this is obvious, are the oldest 46 00:02:32,280 --> 00:02:34,600 ones. OK, so the oldest ones, the 47 00:02:34,600 --> 00:02:36,720 longer they've been up there, the more traction they pull and 48 00:02:36,720 --> 00:02:41,280 the more revenue they bring in. I used to do kind of ugly 49 00:02:41,280 --> 00:02:44,560 ingrown toenail videos. I got a little bored after doing 50 00:02:44,560 --> 00:02:47,520 like 15 or 20 of those. So they do produce some revenue, 51 00:02:48,160 --> 00:02:50,320 but I don't really enjoy doing them. 52 00:02:51,360 --> 00:02:56,960 The full length version videos, which are basically recordings 53 00:02:57,000 --> 00:03:00,280 of my patient presentations. So if you're not familiar with 54 00:03:00,280 --> 00:03:01,680 what a patient presentation is, you can go to 55 00:03:01,680 --> 00:03:04,680 patientpresentations.com. You can kind of learn about how 56 00:03:04,800 --> 00:03:06,680 I make patient presentations. So basically they're 57 00:03:06,680 --> 00:03:10,240 PowerPoints, and I would share these PowerPoints on a screen 58 00:03:10,240 --> 00:03:12,880 with my little head talking. Those are the ones that have the 59 00:03:12,880 --> 00:03:16,520 most traction because they're really, really comprehensive and 60 00:03:16,520 --> 00:03:19,280 it explains exactly how I treat those conditions. 61 00:03:19,280 --> 00:03:21,000 So those are the ones that have the most traction. 62 00:03:21,000 --> 00:03:24,840 What do I do today? Well, today basically the issue 63 00:03:24,840 --> 00:03:30,200 is I don't have is I don't, I don't have like a schedule for 64 00:03:30,200 --> 00:03:33,680 recording these longer videos. So I do YouTube shorts and I do 65 00:03:33,680 --> 00:03:35,920 that in between or during patient visits. 66 00:03:35,920 --> 00:03:38,840 So I have a cell phone on me. I have two phones. 67 00:03:38,840 --> 00:03:41,920 So one phone is with my scribe. That's that's listening to me. 68 00:03:41,920 --> 00:03:45,240 And the other one I use something called Sub Magic 69 00:03:45,240 --> 00:03:50,160 SUBMAGIC and that automatically puts subtitles, but not by me. 70 00:03:50,160 --> 00:03:53,440 So what I do is on there you can upload a video or record a 71 00:03:53,440 --> 00:03:55,080 video. I record a video on the device, 72 00:03:55,320 --> 00:03:58,040 it automatically uploads it to the cloud and then my virtual 73 00:03:58,040 --> 00:04:01,040 assistant goes in there and puts subtitles and puts the and it 74 00:04:01,040 --> 00:04:05,880 automatically gets some really good type of titles and 75 00:04:05,880 --> 00:04:07,080 descriptions and things like that. 76 00:04:07,360 --> 00:04:10,880 And then they post one per day. And this is how many patients 77 00:04:10,880 --> 00:04:13,760 are coming in now for my YouTube videos, because I'm consistently 78 00:04:13,760 --> 00:04:16,160 posting YouTube shorts once a day. 79 00:04:16,160 --> 00:04:20,800 I think patients their their attention span is lower and then 80 00:04:20,800 --> 00:04:23,440 the then I re can re utilize those videos. 81 00:04:23,440 --> 00:04:26,400 Then for the best videos for your your ads for like your 82 00:04:26,400 --> 00:04:28,720 Google ads, your Facebook ads, you can re utilize them by 83 00:04:28,720 --> 00:04:30,200 putting a call to action at the end. 84 00:04:30,560 --> 00:04:33,280 So that is not my idea. I did steal it from Alex 85 00:04:33,280 --> 00:04:35,320 Harmozzi. So it's a it's a good idea. 86 00:04:35,560 --> 00:04:37,000 And that's kind of what's working right now. 87 00:04:37,000 --> 00:04:39,960 And that's how I make videos in the office. 88 00:04:40,960 --> 00:04:42,440 I don't want to always just go over the good things. 89 00:04:42,440 --> 00:04:46,840 I want to go over some bad things today with with the 90 00:04:46,840 --> 00:04:49,400 office. So the bad thing is I came back 91 00:04:49,400 --> 00:04:52,040 from a little like 12 days of vacation. 92 00:04:53,200 --> 00:04:56,400 And one of the challenges with Mod Med is the paperwork. 93 00:04:56,400 --> 00:04:59,640 So the, the signing of paperwork in fax, this is kind of a pain. 94 00:04:59,640 --> 00:05:01,640 It's laborious. It's not there's not really a 95 00:05:01,640 --> 00:05:05,800 lot of efficiency in it. And you have to kind of like use 96 00:05:07,720 --> 00:05:10,280 like a, which one of those pens, right? 97 00:05:10,280 --> 00:05:12,600 You can, it only works on the iPads. 98 00:05:12,600 --> 00:05:14,360 You have to have a separate iPads because I don't do all my 99 00:05:14,360 --> 00:05:19,280 work on iPads, separate iPad. I, I log in and it always logs 100 00:05:19,280 --> 00:05:21,680 me out because although otherwise you do everything else 101 00:05:21,680 --> 00:05:23,880 on the desktop, but you can't sign documents on the desktop. 102 00:05:23,880 --> 00:05:26,480 So I have to sign them in and some documents I have to sign, 103 00:05:26,840 --> 00:05:29,040 other documents I have to review and send to my staff. 104 00:05:29,040 --> 00:05:30,640 So it's just a cumbersome process. 105 00:05:30,640 --> 00:05:32,480 It's not the best feature in my opinion. 106 00:05:32,480 --> 00:05:33,800 In modved. I always like to be clear of 107 00:05:33,800 --> 00:05:34,840 like what are the good and the bad? 108 00:05:35,720 --> 00:05:37,520 And So what I ended up doing today is I just the ones that 109 00:05:37,520 --> 00:05:38,920 were kind of a pain, I just printed out. 110 00:05:39,360 --> 00:05:41,120 I printed out, gave it to my staff and had them sign. 111 00:05:41,120 --> 00:05:42,960 I know some other doctors, they have them print everything 112 00:05:43,400 --> 00:05:46,200 because the amount of time and frustration that it took me was 113 00:05:46,200 --> 00:05:49,040 not worth it. Same thing with refill requests. 114 00:05:49,040 --> 00:05:51,000 Refill requests for like medication sometimes can be a 115 00:05:51,000 --> 00:05:53,720 pain because they're sending me these ones to actually fill out. 116 00:05:54,520 --> 00:05:57,720 So I usually just delete those and I put in a new prescription 117 00:05:57,720 --> 00:06:00,000 for the patient. So that is something that's a 118 00:06:00,000 --> 00:06:03,840 challenge. Another challenge today was a 119 00:06:03,840 --> 00:06:08,760 patient asked for a refund for six sessions of Shockwave. 120 00:06:08,760 --> 00:06:10,280 And I don't usually have this that much. 121 00:06:10,280 --> 00:06:12,720 I had AI called them. I didn't get a chance to talk to 122 00:06:12,720 --> 00:06:17,200 them, but their thought was they saw three other specialists for 123 00:06:17,200 --> 00:06:19,280 their sesmoid pain and I don't know if it got better. 124 00:06:19,280 --> 00:06:21,640 That's what I want to ask them and they're there. 125 00:06:21,640 --> 00:06:23,840 They said, well, you shouldn't use shockwave or shockwave 126 00:06:23,840 --> 00:06:26,440 doesn't work on sesmoiditis. Now I find it does work on 127 00:06:26,440 --> 00:06:28,400 sesmoiditis. Maybe in her case it didn't. 128 00:06:28,840 --> 00:06:30,840 And you know, I'd like to know what you guys would do. 129 00:06:30,840 --> 00:06:33,800 I, I, I may just because I don't like headaches, I may just 130 00:06:34,320 --> 00:06:37,280 refund it. I may refund a part of it, I may 131 00:06:37,280 --> 00:06:39,040 not refund anything really. I just want to see if she got 132 00:06:39,040 --> 00:06:41,600 better and and kind of see what was going on and I'd like to see 133 00:06:41,600 --> 00:06:45,240 who said that shockwave doesn't work for sesamoiditis. 134 00:06:45,240 --> 00:06:47,800 That's what I'd like to know. Most likely would be someone 135 00:06:47,800 --> 00:06:49,480 that does not do shockwave therapy. 136 00:06:49,920 --> 00:06:51,160 That's another bad thing for the day. 137 00:06:52,200 --> 00:06:56,600 Another bad thing. A patient came in and asked for 138 00:06:56,960 --> 00:07:00,560 a refund of her orthotics. So she had shockwave for her 139 00:07:00,560 --> 00:07:02,120 foot pain, for her Achilles pain. 140 00:07:02,120 --> 00:07:05,920 She is totally better but she still has pain. 141 00:07:05,920 --> 00:07:09,600 Now to her actually she's not paying. 142 00:07:09,600 --> 00:07:11,040 She just can't wear her orthotics. 143 00:07:11,600 --> 00:07:15,040 And So what I did with her is I actually sent them back to the 144 00:07:15,040 --> 00:07:17,960 lab to have them redo because I think the arch was just in the 145 00:07:17,960 --> 00:07:22,960 wrong spot for this patient and this is something I may refund 146 00:07:22,960 --> 00:07:25,000 her. So I tend to refund if they ask 147 00:07:25,000 --> 00:07:28,760 minus the lab fee for orthotics. I don't have a ton of refunds, 148 00:07:29,600 --> 00:07:34,160 maybe one or two a year. So really I'm OK with refunding 149 00:07:34,160 --> 00:07:36,280 it because she got better and she also did 6 sessions of 150 00:07:36,280 --> 00:07:39,160 Shockwave. That was another kind of a 151 00:07:39,160 --> 00:07:43,160 negative thing. Another last negative thing was 152 00:07:44,800 --> 00:07:47,800 AI had a lot of my first day back, I had many routine 153 00:07:47,800 --> 00:07:49,120 patients. I'm like what the heck is going 154 00:07:49,120 --> 00:07:51,360 on with all these routine patients? 155 00:07:51,360 --> 00:07:53,240 I didn't understand why because it's not my routine day. 156 00:07:53,920 --> 00:07:57,680 We ended up looking into it and we have a new virtual assistant 157 00:07:57,680 --> 00:08:00,880 making appointments for us. So they are just answering 158 00:08:00,880 --> 00:08:02,280 questions and then just fitting them in. 159 00:08:02,280 --> 00:08:05,320 But I guess they didn't know or they didn't get the memo or they 160 00:08:05,320 --> 00:08:07,640 forgot. For routine appointments, 161 00:08:07,960 --> 00:08:10,880 they're not supposed to do them otherwise at any time except a 162 00:08:10,880 --> 00:08:14,800 Friday morning. So this is kind of a challenge, 163 00:08:14,800 --> 00:08:16,840 frustrating thing. But I didn't know the answer to 164 00:08:16,840 --> 00:08:18,320 that. And so I asked my staff to look 165 00:08:18,320 --> 00:08:20,840 it up and they said, oh, it was the virtual virtual Podiatry 166 00:08:20,840 --> 00:08:24,640 assistant and they put them in the wrong place. 167 00:08:24,800 --> 00:08:29,920 OK, so that was the kind of the good, the bad and the ugly for 168 00:08:29,920 --> 00:08:34,039 the for the day. OK, in terms of patients, once 169 00:08:34,039 --> 00:08:36,720 again, because of the routine, it didn't make the day too 170 00:08:36,720 --> 00:08:37,840 great. So let me go into this. 171 00:08:37,840 --> 00:08:42,240 So first deation was a least LVPLVP, least valuable patient 172 00:08:42,240 --> 00:08:45,520 was a routine patient. Next patient was a 52 year old 173 00:08:46,320 --> 00:08:48,240 man with Kanthordin. I did a wart. 174 00:08:48,720 --> 00:08:51,360 Now this was a a couple of things I wanted to talk about 175 00:08:51,360 --> 00:08:54,520 our add-ons for office visits. So when you change the the 176 00:08:54,520 --> 00:08:57,600 course of treatment, you can add an an office visit. 177 00:08:57,600 --> 00:08:59,920 So this one since I added a Mikkelmod, he had done 4 178 00:08:59,920 --> 00:09:03,120 sessions of Kanthridin was not seeing much progress. 179 00:09:03,120 --> 00:09:05,840 We added a Mikkelmod to that I I think that condones for an 180 00:09:05,840 --> 00:09:08,600 office visit. But I also talked to him once 181 00:09:08,600 --> 00:09:11,440 again about Swift. So I think in his case he 182 00:09:11,440 --> 00:09:15,520 already did 4 treatments like once every 3 or 4 weeks and so 183 00:09:15,520 --> 00:09:17,720 he may have been better off if he did swift because it may be 184 00:09:17,720 --> 00:09:20,040 gone by now. So I did remind him of that but 185 00:09:20,040 --> 00:09:21,760 he didn't he wasn't ready to go to that yet. 186 00:09:22,440 --> 00:09:27,000 Next was a 76 year old male who had this was a newer patient so 187 00:09:27,000 --> 00:09:29,280 we did a diabetic foot exam and we did nail care for him. 188 00:09:29,280 --> 00:09:32,840 So this wasn't because of the the Podiatry assistant 189 00:09:32,840 --> 00:09:35,680 scheduling. Next was a patient with a 64 190 00:09:35,680 --> 00:09:39,040 year old female with bilateral IPJ hallux ulcers. 191 00:09:39,440 --> 00:09:42,200 Debrided those going to see her back in about 6 weeks. 192 00:09:43,120 --> 00:09:45,680 She these are chronic ulcers that just really almost never 193 00:09:45,680 --> 00:09:48,760 heal. I think she really needs some 194 00:09:48,760 --> 00:09:52,920 work on the 1st MPJ to help the the bunion slash hallux lumitus 195 00:09:53,240 --> 00:09:57,960 in that area that she has. Next was a 40 year old man with 196 00:09:57,960 --> 00:09:59,600 a follow up for peroneal tendonitis. 197 00:09:59,600 --> 00:10:02,080 This is a good patient. He's a young man, he was in a 198 00:10:02,080 --> 00:10:04,520 Cam boot, took some meloxicam foam rolling. 199 00:10:04,520 --> 00:10:09,280 He's 100% better so not so much LVP I call LVP is basically 200 00:10:09,280 --> 00:10:13,440 level 2 visits which very rare. So he was like a just a follow 201 00:10:13,440 --> 00:10:18,800 up next was a 79 year old female had a poor keratoma or IPK on 202 00:10:18,800 --> 00:10:23,880 the 3rd digit hammer toe with a treated with a Crest Crest pad 203 00:10:23,880 --> 00:10:25,640 and new peroneal tendon pain. So she did. 204 00:10:26,320 --> 00:10:28,320 I gave her a physical therapy prescription so she had the 205 00:10:28,320 --> 00:10:31,880 office visit that lesion destruction for that and I'll be 206 00:10:31,880 --> 00:10:35,160 seeing her back in in after the PT if her foot pain doesn't go 207 00:10:35,160 --> 00:10:37,720 away. Next was a 31 year old for an 208 00:10:37,720 --> 00:10:39,360 orthotic follow up. She's doing much better. 209 00:10:39,840 --> 00:10:42,480 She had some Achilles tendonitis that's feeling better for she is 210 00:10:42,680 --> 00:10:46,680 APA and so I think she might need a little bit more shockwave 211 00:10:46,680 --> 00:10:48,240 but she can't afford it right now. 212 00:10:48,240 --> 00:10:51,640 She may do that in the future. The next patient was a fifth 213 00:10:51,920 --> 00:10:54,960 toe. She has pain in the lateral 5th 214 00:10:55,120 --> 00:10:59,520 digit and we ended up doing a actually the medial 5th digit 215 00:10:59,520 --> 00:11:01,400 and we'd end up doing a matrixectomy on the 5th toe. 216 00:11:01,400 --> 00:11:05,240 I don't do many 5th toe matrixes but I I I originally thought it 217 00:11:05,240 --> 00:11:07,960 was due to her tighter shoes. She said she's tried wider 218 00:11:07,960 --> 00:11:10,840 shoes. I somewhat wonder because 219 00:11:10,920 --> 00:11:14,040 there's very few reasons we do these but we did a matrix for 220 00:11:14,040 --> 00:11:15,160 her. Unless you're back in three 221 00:11:15,160 --> 00:11:16,720 weeks. Next was a nail care patient. 222 00:11:17,200 --> 00:11:20,400 Next was a 85 year old female. This is the one I've been 223 00:11:20,400 --> 00:11:22,680 seeing. She's on 6 of 6 of shockwave for 224 00:11:22,680 --> 00:11:25,240 the mid. Really big mid foot arthritis. 225 00:11:25,880 --> 00:11:30,640 Now last visit I did a sinus tarsi injection and it made most 226 00:11:30,640 --> 00:11:34,320 of her foot pain go away. So I wonder if the midfoot pain 227 00:11:34,320 --> 00:11:37,040 really isn't the isn't the culprit and it's more the sinus 228 00:11:37,040 --> 00:11:38,880 tarsi or the subtalar joint pain. 229 00:11:40,240 --> 00:11:42,920 And I don't mind doing cortisone in a different place in my doing 230 00:11:42,920 --> 00:11:44,280 shockwave. I think it that's fine. 231 00:11:44,680 --> 00:11:48,640 But then again, I'm just she's not a good surgical candidate. 232 00:11:48,640 --> 00:11:52,600 She's got this huge dorsal spur on the midfoot that I I thought 233 00:11:52,600 --> 00:11:54,320 it was like bone marrow oedema from that. 234 00:11:55,080 --> 00:11:57,400 But really if the cortisone helped her, I just going to 235 00:11:57,480 --> 00:11:59,880 she's 8080 some. So I just see her back as needed 236 00:12:00,000 --> 00:12:02,720 for cortisone. Next was a fungus follow up 237 00:12:02,720 --> 00:12:05,920 where I did a booster dose. So those are always easy 238 00:12:05,920 --> 00:12:08,920 follow-ups. Next was a 42 year old female 239 00:12:08,920 --> 00:12:11,240 for an orthotic. This was that redo that I had to 240 00:12:11,240 --> 00:12:14,560 do. Next was a 64 year old female 241 00:12:14,560 --> 00:12:20,800 for right Achilles follow up. She wasn't really able to do 242 00:12:20,800 --> 00:12:22,560 anything that I recommended and these ones are kind of 243 00:12:22,880 --> 00:12:26,000 frustrating. So what I, what I tend to do now 244 00:12:26,000 --> 00:12:30,120 is since she didn't do what I recommended, I told her again to 245 00:12:30,120 --> 00:12:34,200 do it. I gave her meloxicam, I gave her 246 00:12:34,560 --> 00:12:36,560 foam rolling. She already has a night splint, 247 00:12:37,160 --> 00:12:39,720 talked about the morning stretch, talked about shoes that 248 00:12:39,720 --> 00:12:42,600 UFOs, which she didn't get. And I'd said, well, why don't 249 00:12:42,600 --> 00:12:45,480 you just give me a call if you want either physical therapy or 250 00:12:45,480 --> 00:12:47,560 if you want to do shockwave. Though I think really shockwave 251 00:12:47,560 --> 00:12:50,240 would be the best thing for her. But I find patients that don't 252 00:12:50,240 --> 00:12:52,800 want to do anything, I, I tend not to see them back. 253 00:12:52,800 --> 00:12:57,520 I tend not to make follow-ups for them because they're not 254 00:12:57,520 --> 00:13:00,240 really wanting what what I think would help them to get better. 255 00:13:00,240 --> 00:13:04,440 So this one I just kind of left it open-ended for her versus 256 00:13:04,440 --> 00:13:06,640 like what seeing them back at a certain time and then kind of 257 00:13:06,840 --> 00:13:10,720 trying to talk them or you know, educate them into doing what 258 00:13:10,720 --> 00:13:13,560 would help them get better. Next was a 55 year old man. 259 00:13:13,560 --> 00:13:16,080 He had bilateral tineopedis, bilateral fungus. 260 00:13:16,440 --> 00:13:21,480 So he did the fungus kit and LFTS and he also had a mild 261 00:13:21,480 --> 00:13:25,360 haglunds on the right, which wasn't painful for him and I'm 262 00:13:25,360 --> 00:13:27,960 going to see him back in three months after that. 263 00:13:28,400 --> 00:13:32,880 Next was a 78 year old man with an ulcer of the IPJ hallux, kind 264 00:13:32,880 --> 00:13:36,560 of a a fissure that he has going on there due to a a previous 265 00:13:36,560 --> 00:13:38,680 first MPGA fusion. So he has a fissure at the 266 00:13:38,680 --> 00:13:42,960 distal tip because of the the way it was fused and it's just 267 00:13:42,960 --> 00:13:44,760 not healing. He's been using collagen using a 268 00:13:44,760 --> 00:13:49,120 lot of things I recommended like a carbon fiber inlay. 269 00:13:49,160 --> 00:13:51,600 I recommended a rocker bottom shoe. 270 00:13:51,600 --> 00:13:54,960 I've recommended an ortho wedge, orthoed shoe. 271 00:13:56,360 --> 00:14:00,680 So and I recommended him go to the wound center, but but this 272 00:14:00,680 --> 00:14:02,400 guy didn't want to go to the to the wound center. 273 00:14:02,400 --> 00:14:05,480 There was another ulcer as well of another patient with an IPJ 274 00:14:05,480 --> 00:14:06,920 and he did go to the wound center. 275 00:14:06,920 --> 00:14:10,520 I try to send as many wounds just because I don't do a lot of 276 00:14:10,520 --> 00:14:12,520 wounds as you if you're listening to this anytime you 277 00:14:12,520 --> 00:14:14,280 realize. And so I try to have them go to 278 00:14:14,280 --> 00:14:15,560 the wound center. I just think they'll get better 279 00:14:15,560 --> 00:14:18,640 faster there. And so that one I sent to the 280 00:14:18,640 --> 00:14:20,160 wound center. I did add an office visit even 281 00:14:20,160 --> 00:14:21,960 though I've been riding the ulcer for a while because I 282 00:14:21,960 --> 00:14:27,720 think it's appropriate considering that because of the 283 00:14:27,960 --> 00:14:32,240 medical decision making. The next patient was a 76 year 284 00:14:32,240 --> 00:14:34,600 old for right hallux. Limitis recommended the fiber, 285 00:14:34,760 --> 00:14:38,000 carbon fiber insert anatomic shoe and possible fusion. 286 00:14:38,720 --> 00:14:42,680 And then the next was a 65 year old man within that ulcer, 287 00:14:44,600 --> 00:14:48,000 another ulcer. Next was a 75 year old female 288 00:14:48,000 --> 00:14:50,760 for a fracture. Follow up for the hallux, it's 289 00:14:50,760 --> 00:14:52,440 much better. Got X-rays. 290 00:14:52,720 --> 00:14:55,280 That's the least valuable patient because all I got was 291 00:14:55,280 --> 00:14:57,000 the X-ray. I did not even do an office 292 00:14:57,000 --> 00:15:01,040 visit because it was a fracture. Follow up next was a 55 year old 293 00:15:01,040 --> 00:15:03,360 for left Achilles. So this is number 2 out of 6. 294 00:15:04,000 --> 00:15:07,680 And then next was a 50 year old man with Lex left hallux Limitis 295 00:15:08,520 --> 00:15:12,080 only had pain when he was like kind of down on like kind of 296 00:15:12,480 --> 00:15:14,760 doing like a forward lunge and putting his weight on there. 297 00:15:15,400 --> 00:15:17,520 But I explained it was more for functional hallux Limitis. 298 00:15:17,520 --> 00:15:21,120 So I talked to him about that. So that was the day once again, 299 00:15:21,600 --> 00:15:24,560 if you guys have any other thoughts, shoot me an e-mail. 300 00:15:24,560 --> 00:15:26,400 I would like to hear from people kind of what's working for your 301 00:15:26,400 --> 00:15:27,800 practice. I'll be happy to share it here. 302 00:15:28,360 --> 00:15:29,440 Any other things that are working? 303 00:15:29,720 --> 00:15:32,600 OK Don at Podiatry practice mastery.com. 304 00:15:32,800 --> 00:15:33,600 OK, thanks.