I recently got a new batch of canthrodin in the office and my
wart treatments got infected 2 times.
Hello, welcome to Podiatry practice mastery.
My name is Don Pelto, I'm going to go over the $1,000,000 minute
here. So I had a couple of patients
recently. After we got some new canthrodin
in the office, I used to have patients leave it on till the
following morning. Now I'm starting to have them
take it off in four to six hours because I got this big blister.
And I got a call this weekend and they sent me a picture and
it had like pus underneath it. So they popped the pus and, and
the infection went down. But I did have another gentleman
that I put it on his wart and he actually had a, a bad infection
from it and had to get admitted to the hospital.
So like these are things that I think depending on the, the
quality of the products that we use.
So I think the old Catherine got a little bit old and didn't
wasn't as potent and this newer 1 is, is more potent for us or
maybe just even the vendor. So I have to be be careful, be
careful because that can, can ruin my day and ruin my weekend
of getting those calls. They're concerned.
It was easy to treat, but it's just, it's just a frustration.
OK, let's go into the day here. The, the most valuable patient
today was a the shockwave patient, a 51 year old female.
She had #4 out of 6 for Shockwave and then she was
scanned for orthotics. What I, what I usually do is I
tell patients that they're going to be scanned on the third
visit. This was actually the fourth
visit. And the way I explain it is I
explain the the shockwave is good at getting rid of the pain,
but to help it not come back and help the mechanics of the foot
is specifically high contouring orthotic on that thickened
fascia can help reduce the re injury rate for the patient and
that and that's kind of how I'm doing the the orthotic.
So that was the most valuable patient.
Next patient was a this was a another cancer in this the
second cancer in doing for this patient, 40 year old female.
Next was a 46 year old man bilateral foot pain got X-rays.
He he actually went to Six Flags, which is great America,
one of the amusement parks here anywhere.
He wore Aqua socks the whole day.
And I've heard injuries due to flip flops.
I've never heard injuries due to Aqua socks, but he was wearing
Aqua socks and his feet were really hurting, you know, but
for the 46 year old guy with with he has a 2 year old
daughter. He's just walking around too
much and that's why his feet hurt And it took a couple weeks
to get better, but now he's better.
But I don't think he had anything else.
Next was a 53 year old female with a left fracture follow up.
She had a fibula fracture after PT.
She's out of the global so I was able to get the the office
visit. She also had some fissures
through her heels and I just reminded her of how to take care
of the the fissures at my. My routine tends to be the
sleeping heel socks at night and then during the day or in the
morning the 40% urea cream with a pumice bar for that
occasionally. Next was a 55 year old female.
She came in because her carry flex fell off.
You know, this would be least valuable patient, I guess.
I got an office visit out of it. Had to put the carry flex back
on. She's a nice, nice patient, but
those kind of glut the schedule a little bit and I'd like to get
more of those on. Marjorie, my nail tech schedule
for that. Next was a 76 year old female.
She had a new patient. She had a left matrix on both
edges. She's had a couple of ingrowns
before in the past and she opted for that.
She had had a couple of just I and DS before.
Next was that plantar fasciitis #4 out of 6.
There was a lot of a lot of shockwave yesterday.
So let me go. Might as well go through do all
the shockwave here. So plantar fasciitis 4 out of 6.
There was a Achilles tendonitis, a 60 year old female #2 out of
6. There was a 68 year old man with
#4 out of 6 posterior tibial tendon.
The other one was Achilles tendon.
Next was a 38 year old female with left ankle pain.
She had number actually arch pain, arch pain.
She had #1 out of 6. Now this is a funny one.
I have some patients someone just always want a discount.
And this was one, and this is one that would like had three
phone conversations with Blue Cross Blue Shield wanted their
shockwave to be covered and thinking it would be covered and
this and that and oh boy, so this one, but these ones do also
do Taekwondo with my kids. And so I wanted them to feel
like they're getting a deal. So I did both feet because she
does have it on both arches and I did both and I only charged
for one. I occasionally do that.
I, I feel like it doesn't really take me extra time and I don't
always double dip on these, these bilateral cases.
Next was a 57 year old female and #3 out of 6 for Achilles
tendonitis. Now there was a 45 year old
female with left plantar fasciitis #5 out of 6.
And those were the a lot of the the shock waves of the day.
Now I'm going to get back into that other stuff.
Next patient was a 42 year old female with bilateral bunions
and hammer toes. And she was wondering about
doing if she had to do anything because her mom is a really bad
hammer toe. So I really just talked to her
about shoe changes, did X-rays. My shoe recommendations are
usually anatomic shoes like lems, topos, ultras and I always
say shoes 1st and then correct toes 2nd and then surgery after
after they try those things. Next was a 25 year old man.
This gentleman I think he's a a medical student or a post doc or
a PhD student. He had a little red, a little
black line on his left 5th digit.
He was concerned about like a mulatto Nikkia.
I took a nail sample I think was more from rubbing.
He also had a little mole on his right 4th toe.
And I didn't even biopsy. It was just so small.
I took pictures of him and I'm going to see him in a year.
Next was a 61 year old female. She traveled all the way from
New Hampshire because she had ingrown toenails and she saw
that we were like one of the only ones that actually did Ani
fix. And so she came all the way for
that now. Yeah, Mind you, these words were
kind of curved toenails that were curved in on both edges of
both Gray toenails. And I did the Onifix.
I do not do a ton of Onifix. I do it occasionally when they
need it. This hers is really not getting
never gotten infected, but they just bother her.
So I put Onifix on bilaterally and then she'll come back when
they fall off. That's when I I used to have
them come in every three months and then I would apply another
one proximately. But at this point I try to keep
it on as long as it keeps on stays on and if it falls off, I
don't charge them to put it on it.
I, I, I kind of guarantee it for three months.
If it falls off, then I just charge an office visit for that
one. Next was a a 64 year old female
with a, a right a foot lesion. And I kind of did X-rays did
offloading. She had a kind of a prominence
on the extensor hallucis longus just proximal to the to the
first met head. So I think she has rubbing and
bow stringing of the extensor that's causing like an ulcer.
I think it's because she was wearing slip on shoes and then
you're just pushing your foot in there and it was hitting on that
area. So I made a little offloading
pad. I felt like I was in school
again with XM do a ton of padding.
I did like some felt and offloaded it and stuck it on her
foot with the elastoplast and put right and left on it.
I felt so crafty. OK, next was a Q Tenza consult.
This is a, this is a 72 year old man.
He has non diabetic neuropathy. You know, these ones are just
like willing to do anything for the neuropathy.
He was thinking about going to Columbia for stem cell
injections. He has seen a number of
different providers. He's doing some vibration plate.
I don't exactly know what it is, some vibration plate where he
pays $250 just to vibrate his feet.
He's considering a nerve stimulator and he was referred
over from the nerve stimulation pain management at a hospital
for us to do Q 10s of the problem is they didn't preface
it that Q 10s usually isn't covered for non diabetics.
And so I'm going to try to get it covered because he's on all
these other medications and things like that.
And he, he, he can feel. So it's like a non he, he has
symptomatic painful neuropathy and so we'll see if that's
that's covered for him. I'm going to try, try to, we've
had some patients, some insurances that cover that.
Next was my oh, this is, I don't think I talked about this, but
this isn't one of my favorite shock waves of the day.
This is #4 actually #3 for the 4th digit fracture.
This is a fracture non union that's been there for a year and
a half that didn't get better. Really swollen digit after the
first and second. She's already feeling better.
She's she's on #3 for this focused only.
So when it's a fracture, it's a little toe come on, it's a small
area. I'm not going to do radial on
that. It's just too so.
But she's doing focused only for that one.
Next patient was a 40 year old female had 4 foot pain quite
possible neuroma I she does have a lot of tight Aquinas and so I
talked about anatomic shoes and she's going to do the the Pelto
special at night, split foam rolling, morning stretch and
then see her in one month and see how she does.
And the last patient of the day was a 82 year old male for a
right right Aquinas as well. He had painful Achilles once
again, foam rolling and stretching.
This guy, he was great. He was a one of The Pioneers
with pickleball. So he's like got this pickleball
shirt and I started talking about pickleball and he's like,
yeah, Massachusetts. He was like 15 years ago, he
started to play pickleball and he learned it from a guy that
played it in Florida. And then he made his own little
pickleball courts. Like they went to the rec center
and asked them to do the pickleball courts.
See anyway, he was really, I think the main issue is he was
tight and he needs some help with that, with that tightness.
I did not do a night spin because he's not having any pain
getting out of bed in the morning, but he's very, very
tight. So I had to work on foam
rolling, stretching, things like that.
If it doesn't get better, then I will do probably physical
therapy for him. OK, so that was the day.
I hope you guys found this beneficial.
I am putting together kind of a six month challenge for some
people that are interested. If you want to learn more, you
can go to podiatrypracticemastery.com.
There's, there's, I think there's going to be something up
top that says challenge or it'd probably be back slash challenge
to find that looking for some other practices that want to
bring their practice to the $1,000,000 mark and beyond.
And I was thinking, I think the best people for this are people
that are, are already busy. I think there's two, I, I did a,
a podcast recently. I think there's two groups of
people. The in terms of practices, not
people in general, just practices, some that are they're
supply constrained, meaning they don't have enough supply of
patients. Those are harder to deal with.
Those are harder to like, I don't know if you get the best
benefit from from the mastermind because you're not busy enough,
you don't have the the the number of patients that you can
optimize. If you're, if you're still
trying to get in patients that that's your whole focus is like
marketing is AdWords newsletter, getting referrals, everything
else like that. Once you get to a certain amount
of patience, then you're looking to go from like 600,700 thousand
up to the $1,000,000 mark. And then so it's doing that
transition. Once you're totally busy and you
don't have any more room for patience, then I feel like
that's where that's a better area to help with to optimize,
to optimize your practice production.
OK, So those are those are things that would be the better
people for this challenge. OK, Once again, hope you guys
enjoy this. Have a great day, talk to you
tomorrow.