Hi here, welcome to Practice Mastery.
We're helping you get your practice to the $1,000,000 mark
and beyond. Before I begin, I just want to
offer you this daily tracking sheet that I have.
This is something that I use every every day in the office.
It's basically a piece of paper. It's a Google doc.
It says daily tracking sheet and it has just reminders of what
I'm trying to optimize for in my practice, such as ultrasound,
swift, orthotic, shockwave, amnio, things like that.
And it has a just a list. I used to I've, I've been kind
of working on different ways. I used to print out my schedule
and and do it on the schedule. I found that just just one piece
of paper makes it really good for keeping top of mind.
What is what is my production? I think if we, what we track
tends to get better. So I tend to track the number of
orthotics, right? That, that's like the main thing
in like these packages that I'm doing of, of Shockwave.
Those are kind of the main like MVPS that I talk about the most
valuable patients each day. But I think as we keep our mind
this, this helps us get to the, get to the, the $1,000,000 mark,
that kind of what we're trying to do here.
And also it helps you realize what kind of what are the
patients that you maybe didn't put in the right slots and what
wasn't the most efficient for your practice.
So I think these are good habits to do.
This is something I do daily and this is how I make this little
little podcast on it. OK, so let me if you want that
you shoot me an e-mail down at Podiatry practice mastery.com.
That's going to be the best way. OK, first patient, 55 year old
female. She was here for epat #9.
So let me tell you her situation.
She has she originally did 6 paid bilateral Shockwave.
So that was my MVP. She has been seeing me once a
month now for these for these other shock waves.
And I did 1 today. I did not charge her.
OK, very rarely do I not charge. She is kind of a neighbor.
I'm treating her, but she has two issues.
She has a on the right side, she has a little bit of pain
proximal to the Achilles insertion and on the left she
has at the medial insertional Achilles tendonitis.
And she also has quite severe Aquinas.
So I think like this is 1. I don't know how much longer I
can do more shockwave. So I kind of let her go at this
point and said, I think, you know, you're much better than
you were before, but you're not 100%.
So this is one that I consider like that that 15% that doesn't
totally resolve with shockwave. And I don't really have many
great other options for her. And she is OK living with it.
She she doesn't have pain most of the time.
Once in a while she gets a little Zing or pain.
So this is this is these are kind of the the struggle
patients. Next patient was a 40 year old
male with a matrix follow up. This patient I did 3 edges, 3
toenail edges and I'm not going to do any follow up.
So just see, you know, with my matrixes, I just do one follow
up at 3 weeks. The next was a 45 year old male
with a right how it's fracture. So we're in the global fracture
period. So all I was able to do for that
was get the X-rays. So for fractures, I'm usually
doing a four week follow up. And then for him, for example,
I'm not going to do another follow up.
Next patient was a 40 year old female left plantar fasciitis
pain originally do X-rays. Then I did an ultrasound to show
the thickness on one side compared to the other.
And then she got the, the my, my Pelto special, which is a night
splint foam rolling in morning stretch.
And then she scheduled 6 shock waves And I talked to her
usually on the third one, we will scan her for orthotics.
So this would be one of my favorite MVP type of patients
for the for the practice. Next patient was a 45 year old
female with right fifth met head.
So she had right fifth met head non union.
She was seen for MIS procedure from a physician in New York.
She went in for kind of like a same day MIS kind of bump and
slide on the 5th metatarsal for a tailor's bunion and she did.
She developed a non union. It kind of shifted over,
endorsed Lee a little too much and it there wasn't enough
contact or there was maybe a little bit too much movement
afterwards. And she had six sessions of
shockwave focused only or non radial.
We're starting to call things non radial only because for us
non radial would either mean the focus shockwave we have or the
soft wave we have one in each location.
So she is much better after these 6 sessions.
I can see Bony consolidation. So we did an X-ray today and we
did just a regular office visit for her.
So she is much better. She's pleased.
This is one kind of a success story for Shockwave in terms of
getting bone healing for non unions.
So she was, she came over, she wasn't really referred over by
her doctor, but she just did this procedure in New York and
it didn't, didn't really resolve.
Next patient was a 43 year old female for teenyapedis Follow
up. This is kind of an interesting
patient. She's the one that I don't know
if I think we all have these patients.
She sends me, I don't know, multiple messages, whether and
somehow she, she got my e-mail and she sends it within the
medical record within the portal.
She sends it via e-mail and, and I still treat her nice.
I think I don't have that many of these patients, but these are
one of these that can kind of drain you.
So this is just an office visit. And she, I recommended Amerigel
Blue for her. So I recommended the that just a
lotion for her feet. Next patient was a 26 year old
man. He had bilateral first
metatarsal, had warts for years and years.
And he, he's, he's in school and going to be traveling.
So I wasn't able to start the treatments.
I put solenocate on there. I didn't want to do the
canthrodin because it just blistered too much and he's
going to go on a trip. I didn't want to start swift
because he's going to be going back to school so he might have
to find someone there where he goes to school.
But he also had a 5th digit fungus.
So I started the fungus treatment process with with
Lamisil and then the fungal kit that my patients get and I
debrided the nail. So you can get a nail debride
and you get the office visit for him and the lesion destruction
for those. There's a two siblings, 12 and
14 that they both had matrices. They were both together at a
follow up appointment. Next was a 40 year old female.
She had a right fracture came from the urgent care.
They thought it was a fracture. They kind of called it a
fracture. I looked at the urgent care
X-rays. I didn't really see the
fracture. So I got new ones.
Those were non weight bearing. I tend to get new ones when they
come in. I'm finding some patients that
are ringing in their phones and they wanted me to look at it on
their phone, but I still find I can see a little bit better.
I can mess with the kind of the contrast and the bone like pop
out the, the on the bone, like there's different bone settings
on my on my X-ray. So I can see a little bit
better. I didn't see any fracture.
I think it was more of a sprain. So X-ray ultrasound to look at
the ligaments and then I did an ankle brace.
I didn't do a Cam boot for this patient only because the, the,
the, the urgent care did their own Cam boots.
So that's kind of a struggle these days.
A lot of patients are coming in. If they're coming from an urgent
care, they're getting a Cam boot there where they might not have
needed a Cam boot. And also I couldn't give them
the Cam boot if they didn't need it.
Next was a 18 year old female. She came back, she has a
onycholytic great toenail and it was, she had some type of trauma
to it. So only like the proximal 1/4
was there and it's kind of thickened.
What I did is I offered her either carry flex, which is this
fake nail I put on for the summer, or Anifix, which is like
this speed bump I put on there to help it to grow a little bit
straighter. She opted for the Anifix.
So I applied that and she's going to come back as needed if
that falls off. Next was a 27 year old female.
She had she had three nails that were very thickened.
I, I did debridement talk to her about Carrie flex.
She's going to come back for my nail tech to do the Carrie flex
on her in a couple of days. But she also did the, the
trybenophan LFTS and the kit. So once again, just a reminder
when I explain this to patients, I have a little treatment sheet
I call it and I just print it out and I go through it and this
is how all of my patients get the ultraviolet light shoe
sterilizer and the biotin, it's all on that treatment sheet.
So once again, if you want my treatment sheet for nail fungus,
if you want to try to use that in your practice, it really
makes things a lot easier. The main three treatment treats
I use are 4 would be wart, nail fungus, Achilles tendonitis, and
plantar fasciitis. So if you want to try using
those, let me know. Just shoot me an e-mail down at
Podiatry practice master.com. I'm happy to send those over and
let me know how it works for you.
Next was a 60 year old male for a matrix follow up.
He's doing fine. Next was a 55th year old 55 year
old female. Now she is one.
This is one that I haven't done that much.
She had a deltoid injury and the MRI showed like a like a partial
tear of the deltoid. And I actually had her see one
of my colleagues because she had a tailored Dome lesion, but it
was a little too small for him to to fix or need to do
anything. So what he recommended is he
recommended 4 sessions of shockwave.
So this is going to help the deltoid.
It's also going to possibly help that that tailored Dome lesion.
So I'm going to, I'm going to set those or she was set up for
me to, to, to do those. She had four of them.
The reason does 4, he does 4 and I tend to do 6.
So that's why she's going to only have 4.
Now, one of the challenges in in our office, and I don't know how
your office is, but for our office, they can prepaid.
So it's good for me because I get the payment under my
billing. So she prepaid the gets a 10%
discount. But the problem is if, if one of
them are done by the other doctor, they don't get that.
So I don't really have a good solution for doing that.
We're not like taking out portion of it and giving it to
the other doctor. I guess it doesn't happen a ton,
but it's just something that I feel a little bit bad that the
the 4th session the other doctor's going to be doing, but
they're not going to get any of the reimbursement.
They'll probably get like the office visit for that for that
last one though. Next patient was a 37 year old
male follow up matrix. Once again, there was no fungus
in the nail sample. Next patient was a 78 year old
female. Their carry flex fell off, had
like a crack on it and so I repaired it.
So what I do with carry flex, Carry flex it it is.
I would love my male type to do more of these because they are
kind of a time drain there there.
Maybe if you do 2 of them it makes a little bit more sense in
terms of profit, but to do it it, it takes a long time.
So with this one, I did them both because they're going to
look better that way, but I only was able to get an office visit
out of this. So if you're looking at like
most valuable patient and least valuable patient, this is
probably one of the least just because the amount of time.
Thankfully, I didn't have a ton of other patients like
stampering around or, or I was able to be efficient enough with
the other ones. Next was a 45 year old female
X-ray ultrasound and did a had plantar fasciitis and, and this
is an interesting patient. I actually saw a we saw her son
in the office receivers and one of my colleagues did shockwave
for the sievers and patient got totally better with the sievers.
And then that's why she came back and she actually said she
wanted shockwave. So she got the Pelto special
night splint foam rolling, running stretch 6 chests and
sister shockwave. And once again, I talked to her
about doing the orthotics at the third third visit.
So that's kind of the, the, the, the way I do it.
The the kind of that MVP patient for these plantar fasciitis next
was a 48 year old fracture follow up of the DIPJ of the
hallux. And this patient also has some
left midfoot gout flare up. And so I was able to do the
fracture follow up and I with a separate and identifiable for
the gout. So talking to that patient about
the gout as well. So this is 1 where usually
you're in the global period for the fracture.
But because there was a new condition with the scout, I was
able to get the office visit for that patient as well.
Next was a 58 year old follow up after 7 shock waves for the
plantar fasciitis. Now this is one that she did 6
she did a 7th at the six week follow up and now she's six
weeks again and she's feeling quite a bit better, but not
100%. So this one, what I did is I did
an eighth and I did not charge her.
So once again, once you get past six, in my opinion, 7-8, I have
AI don't know, maybe it's just my own conscience.
I just feel bad and it doesn't really take me that long.
So I did focused only for her and and and I'm going to see her
back in three months like these ones.
When you invest this much time and, and things like that, I
think sometimes doing a couple of them pro bono is is an okay
thing. Next was a 57 year old female
for I and D with the right great toe.
Next was a 14 year old. This is a patient.
She had a hallux interphalangius bilaterally and the big toe is
kind of hitting against the second toe causing an ingrown
toenail. So I never do this right because
I've done it twice in the last couple weeks.
So I guess shouldn't say never anymore.
But they really didn't want the an Ind or like a partial nail
abulsion. So I trimmed it back and I used
like 1/2 of a Band-Aid to pull the side of the nail down.
I don't do that that much. I just I don't think it works in
the long term, but I just explained to them.
But I also had X-rays bilaterally for this patient
because of the hallux interphalangius.
Next was a 51 year old female for number one out of 6 for
Shockwave to the right heel. And I also talked to her once
again planting the seed. At the third visit, we're going
to scan her for orthotics. Why do I scan for orthotics at
the third visit? Not the first visit.
Usually it's because at the first visit or like by the third
visit, like let's say 3 weeks in when we get the orthotics,
they're never comfortable and it's mostly because of comfort
because by this 5th or 6th visit their foot starts to feel
better. They can tolerate the orthotic a
little bit better. I'm just thinking kind of out
loud. Logistically though, it's
probably better to scan them in the first visit and just not
have them start wearing it till a little bit later because their
foot type really doesn't change. Or it might just be easier to
get get everything done at the at the same time.
I'd like to know what other people do.
Like when do you when do you tend to do your orthotics?
Do you do the first visit? Do you do it a little bit later?
Very rarely do I do orthotics only.
I'm usually doing it in conjunction with something else.
Next patient was a this was a second opinion, a 75 year old
female that had a left 2 to 4 hammertoe and she had a really
kind of a bulbous tip on the 3rd digit with a chronic ulcer
there. And her primary care is going to
send her for an MRI since the other podiatrist did not.
And I talked to her about two options.
One would be flexortonotomies of 2-3 and four.
The other option would be arthroplasties of those due to
her age. I got X-rays.
I didn't see any lytic changes to the tip of that third toe but
there always could be since there was a chronic ulcer there.
So I'm going to wait for the MRI to and she's going to see what
she's going to do next. Was a 71 year old 71 year old
male with a right second toe. Bulbous change.
This gentleman as well, he came in for so he has a BKA on the
left. He had he nagged, he kind of
pulled off his toenail. It got a little infected put he
was put on antibiotics by the urgent care came to follow up
with me. It was looking fine, but then it
didn't look good like a week after it just didn't look good.
So I sent him he had some Cellulitis on his toe and a
little bit going up his legs. So I sent him to the Ed for
treatment and IV antibiotics and I'm hoping he doesn't have to
amputate that toe or amputate anything else.
Next was a 58 year old for a right foot neuritis.
She had some right neuritis that did get better.
She was also placed on Lamisil. It's too soon to tell how it's
doing. I'm going to see her back in for
the Lamisil follow up in two months.
And then finally there's a 15 year old boy.
He had a subaggle hematoma to 2nd 3rd digits bilateral.
He'd previously lost a big toenail because of that.
And I think it all has to do with his soccer cleats.
He's got kind of big feet, a wide, nice beautiful wide foot.
But the problem is I don't know of any anatomic soccer cleats.
So if anyone knows of an anatomic soccer cleat, please
shoot me an e-mail dot at Podiatry practice master.com.
Like what do you recommend for kids?
Because most of these cleats are too small and or too narrow.
I'm sorry, in the toe box. Do you know of any anatomic
ones? Anyway, hope you guys find this
beneficial. If you did, I have $1,000,000
practice Brooklyn that I give away.
As you can tell I like to give give away a lot to help you get
your practice. The $1,000,000 mark can get it
up, put practice mastery, just put in your name and e-mail and
it goes through kind of everything that I look at and if
that you can look at to do that. Okay, until tomorrow.
Thanks.