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cryopen & liquid nitrogen (& needling)

Discussion in 'General Issues and Discussion Forum' started by david095, Jun 26, 2013.

  1. david095

    david095 Welcome New Poster

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    Morning all,

    We're looking to expand into cryotherapy for the treatment of VPs as whilst we're getting good results with caustics, the majority of the pts want, or seem to expect, freezing.

    Both cryopen and LN both involve a hefty investment, and the LN option quite a substantial annual cost (especially if hiring storage) and I was hoping to get some up to date feedback on personal experiences, treatment reqimes etc but also (and perhaps more importantly?) what people charge (I realise that this will differ area to area but do people charge on top of routine costs etc)

    We'd appreciate your time and feedback



    (PS - also looking into dry needling but not done or seen it done yet)
  2. You will need to do a cost benefit analysis to determine whether your investment will pay dividends for your practice. LN2 systems are the only cryogenic equipment you should purchase - forget cryopens and CO2 systems - they do not have an adequate freezing velocity to ensure cell destruction in plantar lesions. That said, I probably fractionalize more VPs these days than any other methodology - and it's much cheaper!

    I published a paper on Podiatric Cryosurgery in the BJPM many years ago, which compared at the efficacy of different cryogens on plantar VPs. If you don't have access to this, let me know and I'll forward a copy.
  3. blinda

    blinda MVP


    That is one of many things that we need to include in our tête-à-tête....

    BTW, david095. I don`t `dry needle` VPs, but I do `needle` them when appropriate ;)

  4. Pauline burrell-saward

    Pauline burrell-saward Active Member

    I use a cryopen a lot, cant say its any better than S/A but pts. seem to expect something better than a cream now a days.

    there is no way I can say I make money directly with treating V/P's and the cryopen is certainly expensive and the gas adds to it.


    the spin off is worth it (IMP), they come in every 2 weeks, you really get to know them, they then talk about ? gait problems ( orthotics) they send in mother, sister, children, they tell their friends about you ( the best advertising is word of mouth, and it's free!)

    I charge normal treatment for first visit then half for follow ups.
  5. If you can't make money from VP Rx then you are not charging enough. Why not charge a course fee at the outset - estimate how many visits the patient is likely to need then charge an appropriate fee. I charge a fee of between £250 and £300 for up to five lesions then an additional fee if there is substantially more.

    That way the patient knows at the outset what their treatment will cost and you have an incentive to make sure your treatment is as effective as possible, minimising their surgery visits and maximising your visit/fee ratio. It hasn't been the first time that I've seen a recalcitrant VP in a patient who has undergone years of Rx elsewhere and who then baulks at the upfront cost - until they consider the total amount they've paid out weekly - sometimes only a fiver a visit - as it often runs into hundreds if not thousands of pounds. Without any resolution of the original condition.

    But I guess if you find the regime works for you in terms of providing a captive audience susceptible to your charms of marketing other clinical products, then that is a matter for you.
  6. Pauline burrell-saward

    Pauline burrell-saward Active Member

    £250-£300 for a course.

    so what is a course?

    4/5 treatments or until its gone, 3/6 months, its like how long is a piece of string.

    its a lot of money when you cant guarantee a result, or maybe you can???

    bit mean to suggest I only do it my way simply to sell other treatments.
  7. I don't suggest that you do it only to sell other treatments, Pauline, but sometimes that is how the public view it - especially if the visits go on ad infinitum. A course - ideally, an assessment visit - explain the procedure, get consents, estimate the costs, second visit Rx then two follow-up visits two and for weeks ahead. If clear - a final review six weeks later. If not, schedule more Rx.

    Like everyone else, I have a good percentage - say 8 out of 10 who resolve at first Rx, the remaining, perhaps another one or two Rx visits - and of course, one glorious patient who refuses to clear despite a chemotherapeutic, cryosurgical, fractional and oral cimetidine management regime and is still visiting for Rx after several months. Improvement is slow despite the best efforts - and it will probably always be thus with one or two individuals. Everyone is different, Pauline, but I don't see the merit in charging these kind of patients each visit as it can always leave you open to the charge of maintaining a less then effective clinical approach to maximise or maintain a revenue stream. I still charge a course fee - and probably make a loss with them - but I still treat them out of professional curiosity if not a little self respect!
  8. Pauline burrell-saward

    Pauline burrell-saward Active Member


    We all have our own way of running a business, I have found the most successful way -in my area- is to charge for each visit.

    Can't say I have your high level of cures on first visit prob because I don't use LN, but I will prob have one a year that will not resolve despite every thing being thrown at it ( the latest had also been to NHS for LN and after 5 treatments it had still not gone, so I am again treating with cryo or S/A and we are slowly making progress) bit like the one you were quoting.

    until there is a definite "cure" and you only have to read the forums to see every one is trying a different regime, we have to do what works for us and our pts., yet also reading other opinions to see if there is something we can learn and gain.

    I live in a small area and if I am charging and not getting results the word will be round the town in 5 minutes, and no one would come for V/P treatment,but the opposite is happening.

    It could be because they have already been to the G/P, and also self treated unsuccessfully, but I care and am willing to try and mostly succeed.

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