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So you're telling me its the equivalent of patients putting Vick's on their toenails for fungus.
Sir, wait till I tell you about a thing called MLS laser
Probably getting some dry eye, throw some (preferably preservative free) artificial tears in when you’ve been staring for too long.
White sneakers? How gauche. I’ve gone with well made vintage-ish stuff for what little formalwear I use. Scored a pristine off white silk tux for $75. Probably sold for over $2k retail. Wife told me I couldn’t wear it to a wedding last year because “only the bride etc.” So I got back home, called up the boys, and went to a cash only dive (not strip) bar in it.
If you’re gonna TFO it, may as well go full tilt. I’m pretty sure I saw BubbaWub there.
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Sir, those individuals have not completed rigorous 3 year surgical residencies with possible fellowships.
I did a monofilament exam the other day. Turns out the patient had had a BKA, but he appreciated me fixing the laces on his prosthetic’s shoe afterwards.
Soccer leagues have lasers? That sounds pretty sick.
This is technically TFP-adjacent, but it looks like a few podiatry websites have changed. PM News, which I used to look at for practices for sale and just to see what jobs are out there out of curiosity, has completely changed, and there's not even a classified section anymore that you can access. It's only been a couple of months since I last looked at it when it was normal, but now, can't even see any classified ads.
Podiatry Institute used to have surgical technique guides, which were basically their old textbook pages just floating around online. So if you search for any specific surgery, you would just have the whole chapter there. But now that's all gone too.
Not podiatry specific, but I recently tried to look up something on ortho bullets that I've seen multiple times while I was a resident, and now it makes me make an account to see it.
I get why they're all doing it, but dang, it's annoying that everything that was free is now commoditized or scrubbed from the internet
Podiatry Institute used to have surgical technique guides, which were basically their old textbook pages just floating around online. So if you search for any specific surgery, you would just have the whole chapter there. But now that's all gone too.
Not podiatry specific, but I recently tried to look up something on ortho bullets that I've seen multiple times while I was a resident, and now it makes me make an account to see it.
I get why they're all doing it, but dang, it's annoying that everything that was free is now commoditized or scrubbed from the internet
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Would you be willing to pay a monthly fee to read memes? Asking for a friend.
edit: typo
edit: typo
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hahaha I hope me mentioning these observations on here doesn't give anyone any bright ideas for SDN.
I don't even get why PM News would do that. Barely anyone used that website as it is. And this just seems like a surefire way to end all traffic to the website.
At least on PM News, the classified ads for practices for sale was easy to see and find the info. The other two websites that exist specifically for podiatry practices for sale, like Podiatry Broker, are so horribly laid out. Who designs this stuff? lol
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I don't think you're a boomer, but this is a very boomer thing to say. "Things that cost money to produce are no longer free, why aren't they free still? What do you mean my insurance won't cover my nail trim, it's been 8 weeks!"
Also PM News is under new ownership and getting a much needed overhaul
Yeah Barry took it as far as he could. Good for him. Legend.
Dr. Block is running a separate site Podiatric Medical News, which is just the "current issue" section of the old PM News - complete with all the old heads that you know and love lol
hahah I don't disagree with you. I'm getting old, but not quite that old.
I never used PM news for anything, but it was more just the entertainment of going through the classifieds to see how royally screwed this field is.
In particular, there was a practice that popped up for sale where every single doctor there is less than 45 years old, and they were involved with our school quite a bit. And I wanted to see what the heck happened to them, 'cause it was a pretty nice practice, in a nice area, and all three that worked there were well-trained.
I don’t understand why he sold one newsletter and is running another. It’s not very TFP to not have a non-compete.
Nice summary thanks
BeaverBlade
Full Member
PM News changing.
SDN changing.
life is moving too fast.
SDN changing.
life is moving too fast.
The SDN change sux
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BeaverBlade
Full Member
it's way worse no doubt.
Thanks a lot @Weirdy
Ok boomers
The only constant in life is change
The only constant in life is change
I couldn't even tell the difference until someone sent me a screen shot of what they saw
Looks like it changed a while ago for us but I changed it to blue style cause I couldn't stand it.
Click on your user profile/icon --> preferences --> SDN style
I really only don’t like having to pull up a column to see messages and notifications. No reason to add an extra step to see those imo.
I don't think there's a hard line age rule - everything is about maturity, parental willingness, and anatomy.
If you are the go to person for pediatric ingrowns then you will be faced with some problematic situations - very young children with infected, visibly ingrown toenails that are often small and may even be recurrent if treated non-permanently. I don't find these cases enjoyable, but I still work through them with the parent and I've done nail surgery on some incredibly young children. Like - mom held the baby while I did something young.
Still haven't taken anyone to an ASC/hospital.
In 15 years, I've taken 2 to have general anesthesia for it. One was a 14 year old normal looking male whose mom insisted. I'm 100% certain he should have been done in the office and the anesthesiologist essentially told the mother that this is the last time she insists that he doesn't get local anesthetic in the office as it's more dangerous.
The other was an autistic 9 year old who started screaming immediately upon seeing a needle so loud that she could probably be heard from across the street. In 15 years, I'd say 1-5 to do under general is normal.
There are some kids I've done recently who have been surprisingly great. I 100% attribute it to the parents. I did one 3 year old who was as good as some adults. Her dad just started counting in English/Spanish and she repeated him. It was awesome. I had like another 2 year old who did essentially the same. She stayed completely still when I injected her, although of course she screamed.
We had one at one of my hospitals a couple weeks ago. I only know because all of nursing freaked out about a “needle phobia” kid with ingrowns bilaterally. They don’t do much peds so it was the talk of the town.
I finish a case and go to talk to family while they’re breathlessly but very loudly talking to the kid in preop. Kid’s like “uh, I’ve got no problem with blood draws so an IV sounds fine.”
I was legitimately worried because this is the place where they previously postponed 3 retinal detachments (ironically my caseload again) for an amp.
I've done one adult OR matrixectomy. It was hilarious. I had my favorite/best OR tech - so serious, such a perfectionist. She's trying to hand me instruments and its like - lady, I do these solo 1999 times out of 2000.
All right, figure I'll use this thread for its intended purposes.
I did a matrixectomy for a Ramshorn deformity to bilateral big toes six months ago. Was healing up well at his two week follow up. Saw him a couple months later for routine ARFC, nothing wrong.
He comes in 1.5 months later (about 4 months out from the matrixectomy) with a small pustule at the medial corner of the proximal nail fold. I numbed the toe up and basically kind of explored that medial corner to see if maybe there was a small spicule or something, but there was nothing.
For the past two months, I have had him on antibiotics (for 2 weeks), daily dressing changes with betadine, and that little area continues to drain serous fluid all day every day. Doesn't appear infected. I've gotten multiple x-rays over the past 2 mos just in case there was Osteo underlying but don't see any erosions. I did feel some bone however during the second procedure when I explored the medial corner, but x-rays haven't changed in two months.
That medial corner continues to drain to this day and I'm not entirely sure what else to do now. It also doesn't really hurt him unless I start pushing and poking around.
Has anyone else ever encountered this and have any recommendations? He has mild PAD, well controlled DM. The other toe, and the lateral part of this toe healed well. It's just this one corner. And the fact that it has not stopped draining for close to 4 months now kind of worries me.
I did a matrixectomy for a Ramshorn deformity to bilateral big toes six months ago. Was healing up well at his two week follow up. Saw him a couple months later for routine ARFC, nothing wrong.
He comes in 1.5 months later (about 4 months out from the matrixectomy) with a small pustule at the medial corner of the proximal nail fold. I numbed the toe up and basically kind of explored that medial corner to see if maybe there was a small spicule or something, but there was nothing.
For the past two months, I have had him on antibiotics (for 2 weeks), daily dressing changes with betadine, and that little area continues to drain serous fluid all day every day. Doesn't appear infected. I've gotten multiple x-rays over the past 2 mos just in case there was Osteo underlying but don't see any erosions. I did feel some bone however during the second procedure when I explored the medial corner, but x-rays haven't changed in two months.
That medial corner continues to drain to this day and I'm not entirely sure what else to do now. It also doesn't really hurt him unless I start pushing and poking around.
Has anyone else ever encountered this and have any recommendations? He has mild PAD, well controlled DM. The other toe, and the lateral part of this toe healed well. It's just this one corner. And the fact that it has not stopped draining for close to 4 months now kind of worries me.
Maybe the bone is infected? I have had a couple pts let their infected nails go so long that they get dormant osteomyelitis. Like my instrument sinks into the bone
Maybe numb him up and irrigate the area heavily in case some random thing is in there
Maybe, but I have done serial radiographs on him and there has no erosions. I had cultured the pustule 2 months ago, and it was MSSA. He was also placed on antibiotics for two weeks, twice already (so 1 month total). And if it was infected, I would have expected to see a reaction earlier in his recovery from the matrix ectomy and not a few months afterwards
My leading theory was that there is a piece of the matrix that was not affected by the phenol is causing all of this, and maybe now there is a nail growing now that it's been ~6mos since the original procedure.
I have him scheduled next week to basically re-explore and probably use phenol all throughout that corner again, hoping that takes care of it.
1. You could medically work it up. MRI, ESR, CRP, WBC etc. You've already cultured.
2. You could treat it like its still some sort of ingrown problem though normally you'd expect to see it at least some sort of spicule poking out. Ellipsis, down to bone.. Scrape around. Look for feathery matrix tissue... close.
3. You could treat it like its osteo - ellipsis, down to bone, try to scrape/abrade bone/remove/culture-path. If you had the equipment you could bone biopsy.
4. You could just keep him on antibiotics forever.
Some of these are probably "right" and some are "wrong". When I find myself getting into a bad problem what I'm finding is doing what we were taught/what the literature says is actually the right answer. When you undertreat it make you look and feel foolish.
One of my attendings used to call it "going all American". I sometimes thought it was overkill, but the longer I practice the more I think you just have to follow the steps and do the work.
You have the right mindset though - the problem isn't over. However you choose to resolve it - it needs to be followed until its fixed.
2. You could treat it like its still some sort of ingrown problem though normally you'd expect to see it at least some sort of spicule poking out. Ellipsis, down to bone.. Scrape around. Look for feathery matrix tissue... close.
3. You could treat it like its osteo - ellipsis, down to bone, try to scrape/abrade bone/remove/culture-path. If you had the equipment you could bone biopsy.
4. You could just keep him on antibiotics forever.
Some of these are probably "right" and some are "wrong". When I find myself getting into a bad problem what I'm finding is doing what we were taught/what the literature says is actually the right answer. When you undertreat it make you look and feel foolish.
One of my attendings used to call it "going all American". I sometimes thought it was overkill, but the longer I practice the more I think you just have to follow the steps and do the work.
You have the right mindset though - the problem isn't over. However you choose to resolve it - it needs to be followed until its fixed.
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BeaverBlade
Full Member
What does mild PAD mean exactly? ingrown procedures are done on toes. If the microvascular sucks then even benign procedures like ingrown nails can be a problem. I’d be cautious about doing more phenol without doing more workup
Anytime there is a concern for PAD I highly suggest not using phenol unless you’ve quantified it with noninvasive vascular studies (get toe brachial index as a part of these studies.. these procedures are done on toes)
Anytime there is a concern for PAD I highly suggest not using phenol unless you’ve quantified it with noninvasive vascular studies (get toe brachial index as a part of these studies.. these procedures are done on toes)
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Yeah that should be standard of care
How old is your pt? Did you avulse the entire nail or just the border?
I've had pts who just healed slowly, especially if I take the entire nail. I doubt it's a bone infection. It would have deteriorated more rapidly in those first 1.5 months. Even if it was, you've had him on antibiotics long enough. Check esr/crp/procalcutonin just because it's easy to do
I think like 82 or 83. It was a total nail matrixectomy due to long standing rams horn (but wasn't growing into his skin ever AFAIK).
I have very low suspicion of bone infection given that it's been darn near 6 months now Since I did the matrixectomy. If the bone was going to be infected, it would have eroded a while ago, and his X-rays have been benign every time (Probably taken 4 so far now).
The thing is, he was healed when he came in about 2 months later for his normal appointment. And then all of a sudden, they get added to my schedule a month and a half later, and there's a pustule there. And then ever since I popped it and did a little I&D/Exploration to make sure there wasn't a spicule, it just hasn't closed, and that was probably 3-4 months ago now.
Has never particularly had any erythema and only had purulent drainage that first day I saw the pustule. After that, it's just been serous drainage. The concerning part is just that it's been basically 4 months of this serous drainage, and it was initially fine for a couple months prior to that.
I should note that he's had ABI/TBI done here at our clinic prior to getting the matrixectomy, and it was fine. Not even in the moderate category (on the software).
This is the tfp thread
So he's healing at an octogenarian rate. He knows he's already beaten the US life expectancy. He won't care how long it takes.
In other TFP news, my wife has sinned. She went to Target and bought the kids new flip flops for the beach and also got knock off insoles. After all these years on here, clearly my new found knowledge has not been passed down.
I’m ashamed. I would consider divorce, but she’s also obviously my office manager, so extra awkward.
Carry on.
I’m ashamed. I would consider divorce, but she’s also obviously my office manager, so extra awkward.
Carry on.
To deal with the resultant flip flop associated injuries (FFAI), your children will need extra-expensive custom foot orthotics
Will trade you orthotics for some colored contact lenses. Dailies please.
This is the way.
My wife came to my office this morning while I was operating. I've asked her to learn some billing entry work from my receptionist, but she's 3 days in and still has managed not to open the EHR yet. She's also informed me she doesn't answer phonecalls or ask people for money.
I'm going to need to hire an associate for her to screw over to justify her existence at this rate.
If you stop reading here it makes the post more entertaining
Good call on dailies, less maintenance and infection risk. I was today days old finding out those were a thing. Man I wish I did more cash pay.
You could also take the (highly unrecommended) route and go to Mexico to get surgical iris implants. More than happy to horribly back my clinic up arguing they need to come out. Yes, because your uncontrollable inflammation and eye pressure are blinding you.
Never mind, no extra cash pay. Trades are still cool.
