Was this patient neuropathic? Did you even need to numb them up? Doing a simple avulsion on neuropathy it's fine to just rip that baby off, no local needed.
Feeling pulses is overrated. You would never do any ingrowns then....i maintain use your brain. This is an ingrown nail. How can you kill a tow with the physical act of removing a nail. First of all, if ever a concern it's a total not a partial. Can generally do a total much less a traumatically than a partial. Anyway....takes time and experience. Obviously this approach works until it doesn't.
I have about 10 vasculopaths that return about every 6-9 months for their partial nail avulsion
Wait... Total is less traumatic than a partial?
I think I posted about this before, but I once did a matrixectomy on an 80 year old lady who probably had pad. She developed a patch of skin necrosis at the nail fold that never really healed. I lost her to follow up but heard about her a few months later from another podiatrist with whom I had a cordial relationship. Toe was gangrene. Not completely, but enough to probably require amputation. I didn't get blamed, but I dodged a bullet.
Yeah.... and this would be the rare circumstance where the toe amp even heals. (most often gets chased more and more proximal)
Any update on this. I am looking at maybe trying it on a patient or two.
I was doing Qutenza on about 10 pts and never got past round 3. Nobody had severe pain. Nobody got any better. A lot of them felt like their time was wasted.
Yeah, but you're missing the point... you got $400 for each application?
Nah I just billed 99213s for doing it. I was skeptical about getting reimbursed and being stuck with the purchase price for the drug so I ordered the patches through a specialty pharmacy and stayed out of the buy-and-bill game completely. The specialty pharmacy did give me a very nice travel mug as a gift, however.
I had one guy who I thought might kill me cuz he was in so much pain post-operatively but this guy his nerves were just fried. He was on Suboxone every possible neuropathy drug topical stuff and crazy. He did not come back for a second application.
64640 (plus e/m) if you do it again.
64640 is a nice paying code that the rep tells you to use. It is described in the cpt manual as a targeted destruction of a peripheral nerve however, and I don't believe a patch satisfies that description. Just my opinion.
pays a whopping 2 wRVU
Yeah, I agree fully. ^^
Yeah, I don't think it's anything viable in the hospital setting... you'd probably just have wound RN apply it and be "supervising" from the next hallway or whatever. That is assuming you believed in it.
Exactly. Losing a room for 1hr is not in any way shape or form worth it.
Depends on where you are and who is standing behind you.
It's a poo dollar bro
Also almost always
This means you're normal. During gait, the foot is supposed to supinate during heel strike, then pronate through midstance, then re-supinate as you propulse forward. So wearing out the posteriorlateral aspect of the outsole is consistent with a supinated foot in heel strike and a normal gait pattern.
What's your take on Lasik surgery? I have a couple of ophthalmologist patients (not a joke, crazy how many of you cross paths with me) and they say it restores distant vision but close up is out of focus, so you end up passing restaurant menus to the person next to you saying "read me this"
Very much age dependent on your ROI. Refractive surgery as a whole (LASIK/PRK/SMILE etc.) is generally very successful and well tolerated.
I concur... Brooks makes good shoes, but Hyperion and Ghost and and Glycerin and some of those are for the whipper snappers.
Other big pearl - if you need glasses but can tolerate contacts, you’ll almost always see better with the contacts. You get a more stable starting point for light entering the eye, so fewer high order aberrations, meaning better fine details.
Gonna study this for boards thx
An ophthalmologist presents with chronic heel pain from walking to the bank. Physical exam and imaging are unremarkable. Do you:
You forgot "PRP injection"
This is why I still don’t have my board certification
I appreciated the brevity of these options though I would have enjoyed some classic podiatric excess.
