buckley

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Dont know the answer but the guy who does it in my institution did a neuromuscular fellowship
 
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ask1288

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at our institution the movement faculty do it... if anyone has any info on what certification to do this involves please do post
 

bustbones26

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Dont know the answer but the guy who does it in my institution did a neuromuscular fellowship
I don't know if there is any "certification" but keep a list in a procedure log. I did and there is not question that I have proof that I did a number of procedures during residency, even though there is not set number yet.

Check with Allergan, sometimes they sponsor courses. Also, the Callosal Connection based in Atlanta is always running courses (scholarships to residents!!!) and these courses are pretty much run by the movement guys at Emory.
 

Ribless

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Explain to me how you can assure the patient that the BOTOX or any injected product stayed in the targeted area once the patient gets up and moves around. Even under visual guidance during injection, there is no way for any physician to assure the patient that the product did not bath other structures without the use of injected dye and follow up imaging.
 

bustbones26

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Explain to me how you can assure the patient that the BOTOX or any injected product stayed in the targeted area once the patient gets up and moves around. Even under visual guidance during injection, there is no way for any physician to assure the patient that the product did not bath other structures without the use of injected dye and follow up imaging.
Honestly, I can't say that a patient of mine ever asked this or was really concerned about it. They seem to like the fact that this medication significantly reduces their dystonia, spasticity, or in the cases of headaches, significantly reduces the frequency of their headaches.

Also, BOTOX typically IS NOT suppose to stay in the area injected, it diffuses throughout the muscles injected. Its not rocket science actually. Let us say that I want to inject BOTOX into your bicep, well, if I stick an EMG needle in your bicep muscle, ask you to activate said muscle, and it recruits, well, then I am in your bicep muscle and proceed to inject.

Per the guys at Emory, if you do accidently inject into say a vein, the dosage is not toxic and no harm is done, unfortunately, the patient will not have a therapeutic effect of the medication then.

As with anything, their are risks versus benefits. Your job is to counsel a patient of these things. I think most will agree, especially in the cases of spasticity and dystonia, when this stuff works, patients like it and come back for more.
 

RAD345

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To Ribless,


Botox is not supposed to stay there, it should get absorbed by nervous system in antidromic fashion to treat dystonia while it release the spam locally

The amount of injection is too small and there is no permanent results from Botox injection. So the risks of the procedure are very minimal.

Dye injection to follow the medicine puts patients at risk because of its side effect profile and doubtful benefits for patient, so it is not practiced.