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I want to talk today about my 
first patient ever that has 

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asked me for a refund for 
Shockwave. 

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I've never really had that 
before, so I want to go kind of 

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unbox that for you guys and then
I'll go over my $1,000,000 

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minute. 
My name is Don Pelto. 

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I'm trying to help you get your 
practice to the $1,000,000 mark 

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and beyond. 
So this patient, she is a 65 

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year old female. 
She came in and I was looking at

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her note because she sent me a 
little message through our 

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medical record. 
She had been a patient that had 

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sesmoid pain, sesmoiditis, did 
not have a sesmoid fracture. 

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I was, I think I was probably 
Dr. #2 or 3. 

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She saw before seeing me, I 
recommended Shockwave for her 

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and I think she already had an 
orthotic that she was using to 

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offload the sismoid. 
And she communicated to me, she 

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said, hey doc, I saw three other
doctors and so she saw other 

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opinions in Boston. 
Some of them she had to wait 

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like four months. 
I think most of them were 

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orthopedist. 
One of them did do Shockwave 

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and, and they said, well, you 
probably shouldn't have had 

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Shockwave because it's not good 
for, for sismoiditis. 

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And if if anyone does shockwave,
you know that shockwave I have 

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both focused and radial and it 
works very, very well on 

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sesamitis. 
In her specific case, it didn't.

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And so I've never had a doctor 
do that, say, hey, you call the 

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doctor up and ask for a refund. 
So I was kind of probing just to

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talk to her a little bit and 
say, OK, well, how are you 

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doing? 
Are you totally better? 

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It's been a couple years since 
I've seen you. 

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Are you better? 
Oh, I'm not better. 

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OK, what's happened since then? 
Well, I had another two or three

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pairs of like orthotics that 
didn't work and the, and the, 

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and the guy that I'm seeing now 
wanted me to go to his guy to 

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get an orthotic to try to 
offload this test point. 

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And he didn't want to do surgery
on me, which which I don't think

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anyone would want to do surgery 
on her. 

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So I asked, well, did the, did 
the orthotic people give you the

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money back and did the other 
doctors that didn't get you 

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better? 
I wasn't, I was nice about it. 

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I was not being, trying to be 
mean about it. 

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And she said that one of the, I 
think one of the orthotic, they 

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just charged the, the, the fee 
for making it and for the 

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orthotic and they gave her like 
50% back. 

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And so I said, you know, I'm 
fine with that. 

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I gave her, I said I can do 50% 
back for you. 

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I do still believe I kind of 
stuck my ground. 

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I think it was appropriate for 
her. 

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In her case, it didn't work. 
But for a lot of patients it 

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does work. 
So that was kind of a 

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frustrating thing. 
I don't know if anyone else has 

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had people ask for for for money
back for Shockwave. 

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This is the first one I've been 
doing it in a long time. 

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So I think a few, a few give 
backs are probably OK. 

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I always joke because every time
my partner has to do a cut a 

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check for a refund, he always 
gets real pissed. 

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He's the one that does more of 
the, the check writing and stuff

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like that. 
It's like, why do I have to do 

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that? 
And then that's the, the, I 

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guess the least valuable 
patients, right? 

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But in the in the end of things,
I know some people like, so 

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there's different ways of 
thinking about this. 

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I kind of think of well, OK, 750
my actual 30% of what I get from

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that. 
So basically our take home here 

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is usually 30%. 
So that is going to be 200 

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dollars 2-10 something like 
that. 

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And for the amount of stress 
that would cause me to kind of 

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argue with the person and the 
bad will and everything else 

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like that, I sometimes think 
it's better just to give the 

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money back because you don't 
want the bad will that goes with

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it. 
You want, you want goodwill. 

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And she said she was OK with the
50%. 

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That's what she got from someone
else. 

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I'm I'm OK with that. 
I think there's some, I don't 

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mind doing that. 
I don't know. 

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Some people are blatantly 
against doing that. 

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Doesn't happen a lot. 
But I just, I wanted to talk 

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through that with you. 
So my most valuable patient, it 

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was actually a double patient. 
There was a 15 year old female 

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and a 49 year old female. 
So it was mother and daughter. 

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They both made an appointment. 
They found us online. 

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The mother was really the most 
valuable patient. 

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She had a neuroma on her right 
side. 

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She had been seen in the Mayo 
Clinic, not not in Minnesota 

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where I'm from, but some 
somewhere else. 

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And she'd got some cortisone 
injections and she's been having

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pain. 
She also had a couple of Ipks 

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that were painful. 
So I did lesion destruction on 

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the Ipks I did for the neuroma. 
I talked to her about anatomic 

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shoes. 
She's had like a metatarsal pad.

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And I talked to her, Well, you 
can either do the cortisone, you

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can do the shockwave, or you can
try like an orthotic in your 

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shoe. 
And she opted for the shockwave.

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So we are going to set up 
shockwave. 

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So wish I don't do a ton of 
shockwave for neuroma, but from 

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what I've read and from from the
ones that I've done, you do it 

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very light because it's a nerve.
So you're trying to reduce the 

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inflammation around that nerve. 
If you go too heavy-handed with 

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the with the shockwave, it can 
actually aggravate the nerve. 

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So she's going to set up six 
sessions of shockwave for that. 

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And then she had that the office
visit in the X-rays and stuff 

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like that. 
The daughter, she had bilateral 

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Achilles tendonitis, not 15. 
She originally thought she had 

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seavers. 
So she maybe was treated 

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receivers in the past, very kind
of tight calves. 

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And I was able to once again, 
I'm just repeating myself here 

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about this dynamic 
demonstration. 

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So what I do is I take a orb or 
AB ball, which is like a foam 

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roller, but it's just smaller 
for my office, put their leg on 

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it. 
And as I'm talking to them, I'm 

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foam rolling the the posterior 
calf and the posterior tibial 

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tendon, kind of rolling it back 
and forth. 

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Basically what I did, I roll it 
back and forth and I have them 

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do like 5 or 6 circles to the 
right and then 5 or 6 circles to

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the left and then lift their 
foot and drop it down. 

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And that is kind of loosening up
the back of the calf. 

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And, and what I find is usually 
that takes care of the 

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institutional Achilles 
tendonitis and also helps with 

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their plantar fasciitis. 
So basically I, I push and then 

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I do that foam rolling and then 
I push after and there's less 

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pain. 
So this is called a dynamic 

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demonstration. 
It really builds confidence in 

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patients that, you know, doing 
the actual exercise is going to 

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help them because it helped 
them. 

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So she's going to do that. 
She's going to do my Pelto 

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special. 
So reminder what that is? 

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It's she's going to get 
bilateral night splints that she

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doesn't have to wear at night 
that wears in three hours a day.

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The reason she does bilateral is
so she doesn't have to wear it 3

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hours on one and three hours on 
the other. 

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No one has 6 hours a day. 
She's going to do a morning 

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stretch and then that that foam 
rolling or the roller to start 

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out. 
I got X-rays for her and I'm 

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going to see her back in about 
four weeks to see how she's 

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doing. 
OK, so getting into the rest of 

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the day, the there was a matrix 
and 22 year old female with a 

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matrix and she got the post op 
kit. 

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I've started to I don't know how
to say this nicely. 

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That was maybe I won't say it 
nicely. 

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I've been trying to it's it's a 
training problem on my end about

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my staff. 
So I'm they're not always asking

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about soaking and, and the 
marriage gel kit. 

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So I just tend to go through the
marriage gel kit with the 

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patients and then just my staff 
fulfill it versus having them go

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over the options. 
Many times when they're going 

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over the options, they don't 
believe in it or maybe they 

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think it's too expensive or 
whatever type of judgement call 

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that they're making. 
And I just think instead of 

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soaking twice a day for 30 
minutes, it's much easier to do 

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the kit and it's you don't have 
to soak and things like that. 

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So I find that when when I 
explain it and I just tell the 

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patients, tell the staff to 
fulfill it or works better, it's

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probably a problem on me with 
training most likely because 

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there we have a lot of new staff
that are kind of coming in. 

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Next was a 48 year old female. 
This is kind of a drain. 

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This patient was a drain and we 
have these patients. 

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She has bilateral hallux nails 
that are only attached to the 

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base. 
She's one that comes in every 

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couple of months for Care Flex. 
So the Care Flex takes me a 

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while. 
She was seeing Marjorie, my nail

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tech. 
For some reason, Marjorie is on 

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vacation, ended up seeing me. 
She is kind of super paranoid 

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about her toenails. 
She's currently on Terbenefin. 

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They're not reattaching, are 
growing out and reattaching. 

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She had some green underneath 
the the nail, so we have carry 

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flex on for too long and she 
swims every day. 

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It's got a little superficial 
Pseudomonas infection, but she 

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didn't want to go time without 
the nail on there because it's 

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summer and she does karate. 
She wants her nails to look good

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for karate, so we can't really 
treat the Pseudomonas. 

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I talked to her about it. 
I said, well, maybe in the 

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winter time or when you take a 
break and you want to put a 

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Band-Aid on it or something like
that, then you would do either a

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dilute bleach or dilute vinegar 
soak to get rid of those. 

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But I don't think it'll work 
with the carry flex on there. 

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It wasn't all that bad. 
The greenness was just a little 

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bit of greenness. 
So I tried to grind it down 

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before I put on the carry flex. 
So that was a time drain. 

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OK, time drain right there. 
Next patient was a 67 year old 

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man. 
He had IP, KS, 1st and 5th Med 

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heads bilaterally. 
He has orthotics. 

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They were quite painful. 
I, the bride of them, put 

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salicylic acid, deadly lesion 
destruction. 

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So the way I think about this, 
this is just the way I think 

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about it. 
If it's a regular kind of 

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callus, most people aren't 
really complaining about those, 

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so I'll trim those down. 
I tend to make them pay if 

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insurance doesn't cover $75. 
I tend to be nice the first time

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someone comes in with these Ipks
because they're really deep, 

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they're really painful and I 
treat them as lesion destruction

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with possible wart, possible 
IPK, and because sometimes there

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may be a verrucas nature to it 
that that's what the people at 

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Swift tell me and that's kind of
what I think. 

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And so when I do leads and 
destruction on them, I can do 

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that. 
Now I'm not going to do that 

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every month or every three weeks
or every three months to 

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trimming off calluses and doing 
that. 

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No, it's like a one time thing. 
If they come back in a couple 

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years, I would do it again that 
way using the leads and 

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destruction. 
I'm just kind of letting you 

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know the way I think about it, 
you guys think differently, let 

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me know. 
And then usually they're 

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offloading with like an 
orthotic. 

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If they start to have to come 
back periodically for that, I 

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would just charge them the $75 
every time. 

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But the first time I try to do 
it through kind of through 

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insurance. 
Next patient was a 16 year old 

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female. 
She was here with her mom. 

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She had a bilateral warts and I 
went through my wart treatment 

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sheet and they opted for swift. 
So if you guys, I've, I've had a

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lot of not a lot, but I've had a
couple of doctors say, hey, you 

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know, I have a hard time 
explaining it and having 

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patients choose Swift, they just
kind of struggle with it. 

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So I want to tell you what 
really helps me is my treatment 

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sheet. 
So if you don't have my 

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treatment sheet and you wanted 
to try to use it, feel free to 

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use it. 
You just, it's like a Google 

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doc. 
You just change, put your logo 

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on there and you don't have to 
use my logo. 

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It, it really makes it simple. 
It says, well, you can do, I put

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Swift at the top. 
It's usually about four visits 

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there a month apart. 
Doesn't hurt at all afterwards 

222
00:10:47,120 --> 00:10:50,440
or you can do Canthrodin, which 
is usually A4 to 8 visits. 

223
00:10:50,560 --> 00:10:55,080
It hurts a lot afterwards. 
Our laser which hurts during or 

224
00:10:55,080 --> 00:10:57,360
you can do like a removal, which
I would only do if there's like 

225
00:10:57,360 --> 00:10:59,760
one or two, but it hurts and it 
takes about four or four or four

226
00:10:59,760 --> 00:11:02,720
or six weeks to heal. 
So when I explained it that way 

227
00:11:02,720 --> 00:11:05,600
and I say that yes, Swift costs,
costs 250 a visit. 

228
00:11:05,600 --> 00:11:08,280
But if you look at all the added
up co-pays and lesion 

229
00:11:08,280 --> 00:11:11,000
destruction codes that we're 
going to be billing your 

230
00:11:11,000 --> 00:11:13,080
insurance, if you have a high 
deductible plan, usually Swift 

231
00:11:13,080 --> 00:11:15,840
is just the, the best way to do 
it. 

232
00:11:16,440 --> 00:11:19,160
Then I also say, you know, it 
doesn't always work at 4:00. 

233
00:11:19,160 --> 00:11:22,800
So I do set up four once a 
month, so 1 Swift per month for 

234
00:11:22,800 --> 00:11:24,080
four of them. 
And I see them three months 

235
00:11:24,080 --> 00:11:26,560
later like they recommend. 
But if it's not improving, like 

236
00:11:26,560 --> 00:11:30,840
when we're in into the second or
third or fourth, I usually will 

237
00:11:30,840 --> 00:11:35,040
do combination. 
So I'll add on can thread in and

238
00:11:35,080 --> 00:11:36,800
then I'm not going to, I'm not 
going to double dip. 

239
00:11:36,800 --> 00:11:38,600
I'm not going to, I'm going to 
charge them for the Swift. 

240
00:11:38,600 --> 00:11:40,680
And then just because the can 
thread and I just drop a little 

241
00:11:40,840 --> 00:11:43,480
stuff on there. 
And then when they come back at 

242
00:11:43,480 --> 00:11:47,160
three months, I might even do 
the Swift and the Kantharin, but

243
00:11:47,160 --> 00:11:48,760
this time build a Kantharin, you
know what I'm saying? 

244
00:11:48,760 --> 00:11:51,800
So I might switch it around that
way to make it more feasible for

245
00:11:51,800 --> 00:11:53,880
the for the patients 
economically if they don't have 

246
00:11:53,880 --> 00:11:55,760
a high deductible. 
And then they're also getting 

247
00:11:56,160 --> 00:12:00,600
Aldera or Carac topically. 
So this one, this girl's going 

248
00:12:00,600 --> 00:12:07,200
to do the Aldera initially for a
couple of weeks until she gets 

249
00:12:07,200 --> 00:12:09,680
back from summer camp and then 
she's going to be seen in the 

250
00:12:09,680 --> 00:12:11,280
office for the Swift. 
So that's kind of the way I 

251
00:12:11,280 --> 00:12:14,480
think about it. 
Next patient was a 67 year old 

252
00:12:14,880 --> 00:12:19,960
man that had a first 
intermetatarsal space, kind of 

253
00:12:19,960 --> 00:12:21,360
like a possible neuroma in 
there. 

254
00:12:21,800 --> 00:12:25,400
Previously I'd seen him about 3 
or 4 weeks ago for a cortisone 

255
00:12:25,400 --> 00:12:31,120
injection to the first MPJ that 
was painful and I did the 

256
00:12:31,120 --> 00:12:32,720
injection didn't really help 
that much. 

257
00:12:32,720 --> 00:12:34,480
So this time I did it in the 
interspace. 

258
00:12:34,480 --> 00:12:35,560
I don't exactly know what's 
going. 

259
00:12:35,560 --> 00:12:37,400
I don't know if it's a neuroma 
or something like that. 

260
00:12:37,400 --> 00:12:39,360
He does have a cyst in his first
Med head. 

261
00:12:40,000 --> 00:12:42,480
He has some pain in that joint 
so we'll see how this helps him.

262
00:12:43,000 --> 00:12:47,240
Next was a 66 year old man that 
had a Melania and I did a nail 

263
00:12:47,240 --> 00:12:51,360
sample for his Melania and it 
didn't. 

264
00:12:51,560 --> 00:12:53,760
They couldn't really determine 
and they recommended a nail 

265
00:12:53,760 --> 00:12:58,400
matrix biopsy and I did not why 
I explained it. 

266
00:12:58,400 --> 00:13:01,800
I recommended that for him. 
I usually do a 3mm punch biopsy 

267
00:13:01,800 --> 00:13:07,880
at the nail matrix. 
And so his melanonicia was the 

268
00:13:07,880 --> 00:13:12,240
dorsal portion of the nail. 
So there's like top and bottom 

269
00:13:12,240 --> 00:13:14,120
parts of the nail. 
So I was going to do more of a 

270
00:13:14,120 --> 00:13:18,000
proximal aspect of the biopsy at
the nail matrix. 

271
00:13:19,320 --> 00:13:21,320
And the reason is because there 
was a black line, but there was 

272
00:13:21,320 --> 00:13:24,960
also cracking of the nail. 
And I was concerned, but he just

273
00:13:24,960 --> 00:13:28,240
like didn't want to do that. 
And I'm not sure if it was 

274
00:13:28,240 --> 00:13:29,920
because of his job or something 
else like that. 

275
00:13:29,920 --> 00:13:33,240
So I did take a picture. 
I told him I'm concerned and 

276
00:13:33,240 --> 00:13:36,320
he's going to come back in six 
months for an evaluation for 

277
00:13:36,320 --> 00:13:41,280
that. 
So that one, unfortunately, is 

278
00:13:41,280 --> 00:13:43,400
kind of a lower, lower visit 
patient. 

279
00:13:43,400 --> 00:13:45,120
The biopsy would have been 
better, but he may be back for 

280
00:13:45,120 --> 00:13:46,920
that in the future. 
Next patient's a 49 year old. 

281
00:13:47,480 --> 00:13:51,040
She had fungus on 2 nails on the
right foot first and second. 

282
00:13:51,040 --> 00:13:52,600
She also had bunions and tailors
bunions. 

283
00:13:52,600 --> 00:13:53,720
They weren't really bothering 
her. 

284
00:13:53,720 --> 00:13:59,520
Her main issue was the nail 
fungus and she also had ingrown 

285
00:13:59,520 --> 00:14:01,880
toenails. 
So sometimes those ingrown nails

286
00:14:01,880 --> 00:14:03,160
can make the nails look a little
bit thicker. 

287
00:14:03,160 --> 00:14:04,960
What I did for her is I took a 
nail sample. 

288
00:14:05,520 --> 00:14:07,720
I'm going to see her back in 
three months, three weeks to go 

289
00:14:07,720 --> 00:14:09,840
over the nail sample and then we
can start the process because I 

290
00:14:09,840 --> 00:14:15,280
wasn't totally convinced that 
her nails had fungus in them. 

291
00:14:15,840 --> 00:14:17,640
They could have been just 
thickened from the rubbing. 

292
00:14:17,960 --> 00:14:20,000
Next was this is an urgent care 
patient. 

293
00:14:20,000 --> 00:14:22,840
So just so you know, I think 
I've talked about this before. 

294
00:14:22,840 --> 00:14:24,160
We do have an urgent care page 
now. 

295
00:14:24,160 --> 00:14:26,400
It's kind of cool because in my 
schedule now it tells me who 

296
00:14:26,400 --> 00:14:31,560
comes in from the urgent care 
and because it comes in on my 

297
00:14:31,600 --> 00:14:33,160
schedule that way. 
So it's kind of a neat, I can 

298
00:14:33,160 --> 00:14:34,600
see this. 
This is kind of a complicated 

299
00:14:34,600 --> 00:14:36,040
man. 
He's a 71 year old man. 

300
00:14:36,200 --> 00:14:38,080
He got up and he just he was 
biking. 

301
00:14:38,080 --> 00:14:42,360
He had like hemosiderin changes 
to his lower legs and he's he's 

302
00:14:43,320 --> 00:14:47,360
reminds me of he's just he's an 
Italian, older Italian man and 

303
00:14:47,360 --> 00:14:50,800
he just talks loud and just 
reminds me of like a gangster or

304
00:14:50,800 --> 00:14:52,520
something like that. 
The only reason I'm thinking of 

305
00:14:52,520 --> 00:14:54,960
gangster because I was I took my
trip recently and I watched this

306
00:14:54,960 --> 00:15:00,520
gangster movie on the way back. 
But he had really bad planter. 

307
00:15:00,520 --> 00:15:03,920
I think it's plantar fasciitis, 
but with like really no 

308
00:15:03,920 --> 00:15:07,240
instigating incident and he had 
could just the tightness, but 

309
00:15:07,240 --> 00:15:08,840
it's really, really painful. 
So I had for him. 

310
00:15:08,840 --> 00:15:11,760
I actually I did 2 cortisones. 
I did plantar medial heal and 

311
00:15:11,760 --> 00:15:15,840
then the medial arch, which 
isn't all that common for him 

312
00:15:16,160 --> 00:15:19,240
and I put him in a Cam boot 
because because he was in so 

313
00:15:19,240 --> 00:15:20,680
much pain. 
So I'm going to give him a call 

314
00:15:20,680 --> 00:15:23,600
today and see how he's doing. 
But he came in from urgent care 

315
00:15:23,600 --> 00:15:26,080
and he just really couldn't walk
and his wife was tired of 

316
00:15:26,360 --> 00:15:28,160
listening him to complain him 
and complain. 

317
00:15:28,960 --> 00:15:30,880
Another patient came in, 74 year
old man. 

318
00:15:31,600 --> 00:15:34,400
I've been finding now I don't 
know if it's due to social media

319
00:15:34,400 --> 00:15:36,760
or due to our website or or 
something like that. 

320
00:15:36,760 --> 00:15:40,080
He came all the way from New 
Hampshire to see us and he had 

321
00:15:40,080 --> 00:15:43,720
flat feet bilaterally and he 
really couldn't tolerate any 

322
00:15:43,720 --> 00:15:45,280
orthotic with an arch in the 
past. 

323
00:15:45,520 --> 00:15:48,320
I, I did recommend a medial 
Blaze AFO because I think that 

324
00:15:48,320 --> 00:15:50,080
one works well. 
It has some cut outs for those 

325
00:15:50,840 --> 00:15:54,120
prominent, you know, medial 
aspects of the feet when their 

326
00:15:54,120 --> 00:15:56,480
foot everything collapses in. 
But he, he wasn't interested in 

327
00:15:56,480 --> 00:15:58,880
that. 
But I did recommend that. 

328
00:15:58,880 --> 00:16:00,840
And he had some like weird 
neuropathy pain. 

329
00:16:00,880 --> 00:16:05,000
And he was recommended 
gabapentin by his, his PCP and 

330
00:16:05,000 --> 00:16:06,880
they're also going to do a back 
MRI, which I agreed with. 

331
00:16:06,880 --> 00:16:08,640
And, and I just kind of talked 
him off the Cliff with the 

332
00:16:08,640 --> 00:16:10,040
gabapentin. 
I found a lot of patients are 

333
00:16:10,040 --> 00:16:12,920
just fearful of the gabapentin, 
but I said you know, if your 

334
00:16:12,920 --> 00:16:14,600
pain's mostly at night, just 
start it at night time. 

335
00:16:14,640 --> 00:16:16,280
So then I'm not going to see him
back. 

336
00:16:17,040 --> 00:16:18,800
Next patient was a 51 year old 
female. 

337
00:16:18,800 --> 00:16:24,120
She had a right foot sprain and 
she had pain to the peroneals. 

338
00:16:24,360 --> 00:16:28,800
So I did X-rays for her. 
I gave her NSAID's and if it's 

339
00:16:28,800 --> 00:16:31,800
not better I'm going to be 
putting her into a boot. 

340
00:16:31,840 --> 00:16:34,080
So I think it was just a sprain.
I'm going to see her back as 

341
00:16:34,080 --> 00:16:36,040
needed. 
The next was a 45 year old 

342
00:16:36,040 --> 00:16:38,840
female that had plantar 
fasciitis #4 out of 6 for 

343
00:16:38,840 --> 00:16:40,320
Shockwave. 
She's getting a little better. 

344
00:16:40,640 --> 00:16:43,640
Next was a 78 year old man. 
This guy had a a right hallux 

345
00:16:43,640 --> 00:16:45,160
extensis. 
I've told you about this before 

346
00:16:45,160 --> 00:16:47,280
in the past he had just like 
right foot that's like cocked 

347
00:16:47,280 --> 00:16:49,360
up. 
I tried to do Nuboso splays for 

348
00:16:49,360 --> 00:16:52,600
him and it didn't really work 
and he came in kind of wanting 

349
00:16:52,600 --> 00:16:55,720
orthotics and and this happens, 
I don't know for you, but it 

350
00:16:55,720 --> 00:16:59,000
happens for me quite a bit. 
So they, they want orthotics and

351
00:16:59,000 --> 00:17:00,680
then when they hear the price, 
they don't really want them. 

352
00:17:00,680 --> 00:17:03,840
So it's amazing how that desire 
can just totally change when, 

353
00:17:03,840 --> 00:17:07,800
when someone hears about price 
and I there's a just kind of as 

354
00:17:07,800 --> 00:17:10,560
a side note, I was talking, 
there's AI have a WhatsApp group

355
00:17:10,560 --> 00:17:15,000
of some people that talk about 
like a different business things

356
00:17:15,520 --> 00:17:18,680
podiatrist and this one doc, 
they're saying, you know, Hey, 

357
00:17:18,680 --> 00:17:20,839
I'm not that good at doing 
orthotics. 

358
00:17:21,400 --> 00:17:23,720
And she said, I think I was 
thinking about reducing the 

359
00:17:23,720 --> 00:17:26,599
price. 
And so if anyone's thinking 

360
00:17:26,599 --> 00:17:29,520
about reducing price, I would, I
would tell you, I would just 

361
00:17:29,520 --> 00:17:31,600
recommend like don't reduce 
price. 

362
00:17:31,600 --> 00:17:35,520
Get better at explaining 
orthotics like get better at, 

363
00:17:36,160 --> 00:17:39,600
you know, practicing how, how to
explain it in even if insurance 

364
00:17:39,600 --> 00:17:43,000
doesn't cover it, which which is
my case, you have to get better 

365
00:17:43,000 --> 00:17:45,360
at explaining it in the value 
proposition. 

366
00:17:45,360 --> 00:17:47,600
You have to get better at doing 
them too, frankly, because the 

367
00:17:47,600 --> 00:17:49,640
more orthotics you do, the more 
people you're going to have with

368
00:17:49,640 --> 00:17:51,280
problems with the orthotics, 
meaning they're not going to 

369
00:17:51,280 --> 00:17:52,600
fit, they're not going to be 
comfortable. 

370
00:17:52,600 --> 00:17:54,560
So you have to get better at 
troubleshooting the orthotics as

371
00:17:54,560 --> 00:17:57,880
well. 
If you want to do a lot of 

372
00:17:57,880 --> 00:17:59,760
orthotics. 
It it, I always say you don't 

373
00:17:59,760 --> 00:18:02,360
have to be good if everything is
covered by insurance. 

374
00:18:02,360 --> 00:18:04,200
It's like easy to give away 
stuff that's for free. 

375
00:18:04,200 --> 00:18:08,200
It's it's hard to to explain 
stuff in a way and be confident 

376
00:18:08,200 --> 00:18:10,400
enough in your abilities for 
like shockwave and orthotics 

377
00:18:10,400 --> 00:18:11,800
that it's going to work for the 
patient. 

378
00:18:12,360 --> 00:18:14,120
So anyway, that's just my, my 
thought. 

379
00:18:14,120 --> 00:18:15,680
Like don't, don't like cheaping 
yourself. 

380
00:18:15,680 --> 00:18:18,400
We charge 600. 
I know that's maybe some people 

381
00:18:18,520 --> 00:18:20,920
probably charge more like 800 or
I've heard of 1000. 

382
00:18:20,920 --> 00:18:25,120
We do 600 for our orthotics, but
some are doing like less and 

383
00:18:25,120 --> 00:18:26,640
they're wanting to reduce the 
amount. 

384
00:18:26,640 --> 00:18:29,840
I don't think patients buy based
on price. 

385
00:18:30,560 --> 00:18:33,520
Patients buy based on the 
confidence that you're able to 

386
00:18:33,520 --> 00:18:36,200
show them in what you're 
recommending is going to work. 

387
00:18:36,520 --> 00:18:38,200
OK, and you do what's best for 
them. 

388
00:18:38,200 --> 00:18:40,560
Now, if you don't believe in the
orthotics, then you can't offer 

389
00:18:40,560 --> 00:18:42,200
them. 
You can't quote UN quote sell 

390
00:18:42,200 --> 00:18:43,280
them because you don't believe 
in them. 

391
00:18:43,280 --> 00:18:44,600
So you need to believe in them 
yourselves. 

392
00:18:44,600 --> 00:18:46,000
You need to make sure these 
things are going to work and 

393
00:18:46,000 --> 00:18:47,160
they're the best thing for the 
patient. 

394
00:18:47,760 --> 00:18:50,560
OK, that's kind of my rant about
orthotics. 

395
00:18:50,560 --> 00:18:51,800
Anyway, he didn't get the 
orthotics. 

396
00:18:51,800 --> 00:18:56,320
Maybe I wasn't too confident 
that they would help his 

397
00:18:56,320 --> 00:18:58,240
condition, which I really wasn't
in his specific case. 

398
00:18:59,760 --> 00:19:04,520
OK, next patient was shockwave 
#1 out of 6, this is a unique 1 

399
00:19:04,520 --> 00:19:06,000
and I did a little video on this
patient. 

400
00:19:07,160 --> 00:19:10,640
She had a year and a half old 
fracture of her 4th digit. 

401
00:19:11,080 --> 00:19:13,760
Her 4th digit swelled up and the
swelling never came down. 

402
00:19:13,760 --> 00:19:17,320
The fracture never healed. 
She wasn't really treated. 

403
00:19:17,320 --> 00:19:19,080
She was treated for a short time
in a Cam boot. 

404
00:19:19,480 --> 00:19:23,120
But then you know, thinking well
it's just a fourth toe and but 

405
00:19:23,120 --> 00:19:26,240
The thing is just so swollen. 
And so due to this non union, 

406
00:19:26,880 --> 00:19:29,080
I'm going to do 6 sessions of 
shockwave for this patient. 

407
00:19:29,080 --> 00:19:31,440
So the other option was to take 
out the intermediate failings. 

408
00:19:32,000 --> 00:19:35,960
So we're going to do the 
shockwave for her and we're 

409
00:19:36,080 --> 00:19:37,920
going to, that usually kind of 
heals things in and then 

410
00:19:37,920 --> 00:19:39,720
hopefully the swelling would 
come down because I think the 

411
00:19:39,720 --> 00:19:42,560
swelling is there because it's 
trying to buttress the fracture.

412
00:19:43,400 --> 00:19:46,880
Next patient was a 63 year old 
female left plantar fasciitis. 

413
00:19:47,120 --> 00:19:49,400
This is one that I did that 
dynamic demonstration with the 

414
00:19:49,400 --> 00:19:51,520
roller ball. 
We're going to do ice contrast 

415
00:19:51,520 --> 00:19:54,080
pass. 
She also has nail fungus and I 

416
00:19:54,080 --> 00:19:56,440
did a nail sample. 
I'm going to see her back in a 

417
00:19:56,440 --> 00:19:58,480
couple of weeks. 
We're going to do an ultrasound 

418
00:19:58,480 --> 00:20:00,280
for planter fascia. 
It doesn't get better. 

419
00:20:01,640 --> 00:20:04,360
I didn't jump right to shockwave
for this patient because her her

420
00:20:04,400 --> 00:20:07,080
her symptoms weren't that long 
and they weren't that bad and I 

421
00:20:07,080 --> 00:20:09,880
think she might be able to get 
better with the with the foam 

422
00:20:09,880 --> 00:20:12,360
rolling. 
Next was a 68 year old man with 

423
00:20:12,360 --> 00:20:14,200
a right posterior tibial 
tendonitis. 

424
00:20:14,480 --> 00:20:16,960
Did shockwave #3 out of 6. 
He's starting to feel better. 

425
00:20:16,960 --> 00:20:20,440
Next was Amri follow up for a 
gentleman 48 year old man. 

426
00:20:20,760 --> 00:20:24,560
He had a kind of spontaneous 
pain on his second Med head. 

427
00:20:25,560 --> 00:20:30,320
MRI was done and it showed a 
possible kind of a planter 

428
00:20:30,320 --> 00:20:33,920
avulsion fracture kind of from 
the planter plate region, but no

429
00:20:33,920 --> 00:20:36,640
planter plate tear. 
He had originally been in a Cam 

430
00:20:36,640 --> 00:20:38,680
boot, but he wasn't very 
compliant with it. 

431
00:20:38,880 --> 00:20:41,480
And so I said, hey guy, just try
the Cam boot for about four 

432
00:20:41,480 --> 00:20:43,160
weeks. 
If it's not getting better than 

433
00:20:43,160 --> 00:20:45,000
the plan is going to be to do an
MRI. 

434
00:20:46,000 --> 00:20:48,440
And I'm sorry to do shockwave. 
I talked to him about doing 

435
00:20:48,440 --> 00:20:49,640
shockwave. 
I think that would be the best 

436
00:20:49,640 --> 00:20:50,800
thing for him. 
I don't want to repair. 

437
00:20:50,800 --> 00:20:51,720
He's a little bit of a hammer 
toe. 

438
00:20:51,720 --> 00:20:54,840
I don't not a huge hammer toe. 
I said the OR we're going to 

439
00:20:54,840 --> 00:20:57,080
hammer fix your hammertoe and 
we're going to pin it for five 

440
00:20:57,080 --> 00:20:59,040
to six weeks and maybe do a 
planter play repair. 

441
00:20:59,680 --> 00:21:01,040
This was the least valuable 
patient. 

442
00:21:01,040 --> 00:21:04,160
The reason for this is because 
we use an MRI follow up and 

443
00:21:04,760 --> 00:21:06,560
originally when I saw him, I 
used a fracture code. 

444
00:21:06,560 --> 00:21:08,000
So he's still within that global
window. 

445
00:21:08,160 --> 00:21:11,560
So this one, I'm going to see 
him back in about four weeks. 

446
00:21:11,560 --> 00:21:18,760
Next was a right Achilles pain. 
She had a #2 out of 6 for 

447
00:21:18,760 --> 00:21:21,760
Shockwave and she was one that 
had Achilles tendon repair by a 

448
00:21:21,760 --> 00:21:24,640
local orthopedist. 
I think you put a little anchor 

449
00:21:25,280 --> 00:21:30,080
in her Achilles and she had just
been pain for like a year and a 

450
00:21:30,080 --> 00:21:31,880
half. 
She tried grasped and she tried 

451
00:21:31,880 --> 00:21:34,520
other types of treatments. 
She's very tight in there and, 

452
00:21:34,520 --> 00:21:38,360
and she's the incision was on 
the like posterior medial 

453
00:21:39,080 --> 00:21:42,200
Achilles and down to the heel. 
But her pain is lateral. 

454
00:21:42,200 --> 00:21:43,600
So I think she has all because 
of her. 

455
00:21:43,600 --> 00:21:45,320
She's limping because it's 
hurting on one side, she's 

456
00:21:45,320 --> 00:21:47,600
walking more on the other side. 
And now she has insertional 

457
00:21:47,600 --> 00:21:50,320
Achilles tendonitis all around. 
And so we're doing shockwave #2 

458
00:21:50,320 --> 00:21:53,160
out of 6. 
She's actually my kids Taekwondo

459
00:21:53,160 --> 00:21:55,880
instructor or one of the 
instructors, not the main 

460
00:21:55,880 --> 00:21:58,640
instructor. 
So she's hopefully she'll 

461
00:21:58,640 --> 00:22:00,200
hopefully she'll get better. 
Although I have to look at her 

462
00:22:00,200 --> 00:22:02,360
for a long time and after I 
charge her a lot of money. 

463
00:22:03,160 --> 00:22:05,280
OK, so that was the day once 
again, I hope you guys found 

464
00:22:05,280 --> 00:22:09,480
this beneficial. 
I am putting together a 

465
00:22:09,480 --> 00:22:13,960
challenge for some doctors I'd 
like to work with, like more 

466
00:22:13,960 --> 00:22:15,520
people. 
I think it would give me more 

467
00:22:15,560 --> 00:22:19,320
fodder for this content and it 
would help people with their 

468
00:22:19,320 --> 00:22:20,600
practice. 
So if you're interested, shoot 

469
00:22:20,600 --> 00:22:23,520
me an e-mail, 
don@podiatrypracticemaster.com, 

470
00:22:23,760 --> 00:22:25,680
kind of tell me what your issues
are. 

471
00:22:25,680 --> 00:22:28,160
I think we all have issues. 
I have issues but I think 

472
00:22:28,160 --> 00:22:31,320
sometimes having someone else 
you can talk to them about might

473
00:22:31,320 --> 00:22:33,400
help. 
OK, happy to help you out and 

474
00:22:33,400 --> 00:22:35,560
also gives me content for doing 
this podcast. 

475
00:22:35,560 --> 00:22:37,720
Thanks for all that listen. 
I really really appreciate you 

476
00:22:38,000 --> 00:22:40,000
listening to this podcast and 
sharing it with other 

477
00:22:40,000 --> 00:22:42,200
podiatrists. 
I think I think more people 

478
00:22:42,200 --> 00:22:43,800
could be listening to it. 
Not many people do. 

479
00:22:43,800 --> 00:22:45,760
So please share this if you have
fun, it's beneficial.