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Mosaic verrucae-help with treatment

Discussion in 'General Issues and Discussion Forum' started by poppet, Feb 27, 2009.

  1. Can't anyway. You're in all my address books as Blinda. I'd struggle to think of you as anything else now!! ;)

    Blinda IS a proper name!
     
  2. DaveJames

    DaveJames Active Member

    Hi All,

    I've been following this thread intently for a long while and finally got the chance to undertake a needling procedure. I've put some pictures below and here's some history.

    • Female - mid 30s - VP to left 1st MTP joint for 10 years plus
    • No allergies, medical or surgical history
    • Has tried over the counter preparations and cryotherapy via the GP

    Ethyl chloride spray and local infiltration with mepivicaine. The VP was needled until no more resistance in the tissue was felt; this took a surprising long time and I'm assuming this was due to the long standing nature of the lesion.

    A simple sterile non-adherent dressing was applied post op and advice given on how to manage this. The photos below show pre-op, directly post-op, 24 hours post-op and 3 weeks post op.

    The only reported symptom was pain 24 hours post op which soon settled.

    If you have any comments then please get in touch. Many thanks to Dr Kirby for his feedback so far. :drinks

    Kind regards,

    Dave

    Pre-op.jpg
    post-op.jpg
    24-hours-post-op.jpg
    3-weeks-post-op.jpg
     
  3. Mr C.W.Kerans

    Mr C.W.Kerans Active Member

    Going back to post #473, I think ionisation of air by an electrical discharge produces ozone - the smell of the London Underground. I don't see how ozone would act selectively on VP tissue?
     
  4. Kaleidoscope

    Kaleidoscope Active Member


    But IS it though?? Isnt 'Blinda' an affectionately shortened name for Belinda??

    What say you about the efficacy of combos of debridement +'needling' + Bleomycin (local infiltration) plus other more unusual combos into the mix ??

    Cheers
     
  5. blinda

    blinda MVP

    Indeed.

    Actually, `blinda` was originally a typo :eek:. Then, it became useful as other `Belindas` were posting. For a short while I was `Belinda L` but I received so many complaints about it that I changed it back.....

    Anyhoo, yep. I`m all for combo`s. One of my needled pts is a GP and had mosaic VP virtually covering the entire left plantar surface. The first needling treatment reduced them but they did not resolve completely. She then took oral Cimetidine and requested a second needling treatment. Bingo. Complete resolution. And, more referrals to me from her :cool:

    Cheers,
    Bel
     
  6. healthyfeet

    healthyfeet Active Member

    Doesn't anyone still use monochloracetic acid?
    What do you guys charge typically for the needling procedure?
    Regards
    Martyn
     
  7. Kaleidoscope

    Kaleidoscope Active Member

    Bel, Im REALLY enjoying this thread!

    Ive read about Cimetidine [immunomodulating H2-receptor antagonist ] clearing up 82% of recalcitrant warts (apparently it inhibits supp. T-cells + inc. lymphocyte proliferation giving enhanced immune response)(Rogers, Gibney, Siegfried, Harrison, Glaser, 1999)

    and also in combo with Levamisole [Anthelmintic - roundworms!] (Parsad, Saini, Negi 1999)

    {all in: Lipke, M.M. (2006) 'An Armamentarium of Wart Treatments', Clin. Med & Res Vol. 4 (No. 4) pp. 273-293}

    So it seems to make sense to inject these into the Wart War!

    Didnt realise there were 118 different types of Warts! No wonder they are such buggers to get rid of!!!! I wonder how your GP came to suggest Cimetidine ? (Or did you plant the seed?). Michelle Lipke's paper certainly gets one thinking and realising why their treatment is SO complex and fraught with failures....

    I LIKE your 'handle' .... makes one think of 'Beloved Linda' and makes you unique too, taking your place among the ranks of Cher and Sting etc. !

    Regards

    Linda

    P.s. I chose my handle because (as new grad) Im an 'ever-changing landscape of ideas and opportunities' (and hopefully new job!)
     
  8. blinda

    blinda MVP

    Jolly good. I admire your enthusiasm. I`m involved with some research on the subject, if you want to jump on board PM me.


    Hey, I`m a child of the seventies. However, my mother was often likened to Cher ;)

    Cheers,
    Bel
     
  9. DaveJames

    DaveJames Active Member

    Hi All,

    We're currently at 7 weeks post procedure and I've reviewed the patient today.

    In terms of overall size, I think they look pretty much unchanged; however, the feedback from the patient is that the area is much more comfortable, and she doesn't feel discomfort anymore. She also reports that a wart to her hand is resolving, which is encouraging.

    The pictures below are pre and post debridement today.

    VP-pre-debridement.jpg

    VP-post-debridement.jpg

    I'll try to keep posting updates as I review her.

    As a general question for those who've been undertaking a number of these procedures, what are your criteria for considering a second procedure? For example, how many weeks/months do you wait, or what signs are you observing for?

    Kind regards,

    Dave
     
  10. ginger

    ginger Active Member

    I have a patient who has a long standing VP on her right medial heel. No health problems or history. She has tried various caustic treatments and cryotherapy without success. She had been reducing the callous herself before contacting me so callous build up in initial pictures is less than it would have been had she not done any reduction. I mentioned needling to her and she was keen to try it as she felt most other avenues had been exhausted. I referred her to a colleague as I wasn't sure about performing the anaesthetic. The area which was seen to be the 'primary' site was needled approx 200 times, there wasn't a great amount of bleeding after the procedure at all. She reported minimal pain afterwards but said that she could feel a "stabbing" feeling in the area where the needling was performed during the night after the procedure. I saw her today for a follow up treatment, she had not removed any callous since the needling treatment was performed. I have attached some photos...

    Pre debridment and pre needling....
    [​IMG]

    Post needling....
    [​IMG]

    Today, 4 weeks after needling treatment....
    Pre debridment....
    [​IMG]

    Post debridment....
    [​IMG]

    The peripheral area of the mosaic VP has definitely reduced but she still has significant callous forming over the main area of the VP (where the needling was carried out).
    I am interested too in the answers to Dave's questions re what is indicative that a second procedure is required.
    Thank you.
     
  11. thecarl

    thecarl Welcome New Poster

    short time lurker here so firstly hello all...

    This has been one of the threads I've been following with interest and I have identified 3 patients I'd like to do this on.
    I have a bit of a cheeky request...has anyone put together an information leaflet for their clients to look at before they agree to treatment, if they have could I have a looksie / use it for my clients please...... If noone has done this then once I've done mine I'll make it available for anyone else on here...but beware it could take time as im a computer dullard!!!
     
  12. sean

    sean Welcome New Poster

    I have recently treated a client (37yr old male, no circulatory problems etc) who had more then 20 mosaic VP's on his left foot (plantar surface) for approximately 2yrs. I thoroughly debrided the HK then treated the VP's with liquid nitrogen (3x15sec applications for each mosaic VP). The client complained that his foot hurt for 2 days post the 1st treatment but the client is now VP free after 6 treatments (over an 8 week period).
     
  13. RachWadd

    RachWadd Member

    Hello all,

    I stumbled across the thread this morning and have successfully wasted an entire day reading it all! It's been incredibly interesting and as most of you have stated I also have a number of patients in mind that I would love to try this on.

    My only hesitation would be the initial anaesthesia...I studied in NZ 10 years ago and we were shown an ankle block but I haven't seen or used it since. I would be happy to use 2% plain lignocaine for injection into the webbing and also plantarly as per VP blunt excision but would appreciate a demonstration as it has been a few years since I have used the technique.

    I understand this is an old quote from over a year ago:

    But if you are still around yvonneg can you tell me where in Australia you practice? I'm in Melbourne and would be happy to travel in the greater area for the demo.

    Or anyone else in Melbourne who would be happy for me to observe?

    Many thanks everyone for keeping me enthused!
     
  14. stevewells

    stevewells Active Member

    Surely it wasn't a waste then!
     
  15. RachWadd

    RachWadd Member


    The "waste" pertained to missing an awesome Victorian spring day after a long cold winter...a balmy 21C with cloudless blue skies.

    Ah sweet sweet sun, we love you so!!


    Rach

    PS

    Blue is the same colour of your fingers and toes in a UK summer in case you couldn't quite place it when associated with the sky ;)
     
  16. twirly

    twirly Well-Known Member


    I'll have you know that our summer has been so hot this year I have turned dark grey. :D

    In all holiday photos we are the family in coats, scarves & wellies.

    Winter is on its way now so floor to ceiling flannelette soooo this season. :drinks
     
  17. RachWadd

    RachWadd Member

    Hehehe!

    I was there for the heatwave of '06. over 30C in London for 2 weeks solid...it was death on the tube and I wore sandals to work OH+S be damned!

    Have no fear, it will come again :empathy:

    Rach
     
  18. Joanne Moore

    Joanne Moore Member

    Hi all,

    I'm working as a podiatrist in the Republic of Ireland, and have been told by the chairman of my society that it is likely that I wouldn't be covered to carry out 'autoimmunisation therapy' by our insurance unless I could show that I had been trained in the procedure. Does anyone know of any courses offered anywhere in the UK or elsewhere?

    Joanne
     
  19. Joanne:

    Just tell them that you are performing multiple injection therapies, without anything being injected.:rolleyes:
     
  20. Joanne Moore

    Joanne Moore Member

    I've put this to the chairman and we'll see where we go from here. The situation with our insurance (regarding local anaesthetic use) is ridiculous at the moment due to a loop/glitch with the Irish Medicines Board - where we have to administer LA in the presence of a GP. A very embarassing, frustrating on a personal and professional basis. So you see, we may even encounter problems with the multiple injection therapy route. I'll keep you posted either which way.

    Many thanks for the suggestion,

    Joanne
     
  21. carolethecatlover

    carolethecatlover Active Member

    Please give me the name of someone in LONDON who does this auto-innoculation treatment.

    As I am now just a FH, I can't get my hands on LA to do it to a patient who needs it.
     
  22. Connie D

    Connie D Member

    oops!
     
  23. blinda

    blinda MVP

    Hi Carole,


    Del (DTT) runs a VP clinic in Croydon, which offers the needling procedure for suitable candidates. Might be worth PMing him.

    Hope that helps!
    Bel

    PS. Winchester isn`t that far ;)
     
  24. stevewells

    stevewells Active Member

    Dont forget Epsom!!
     
  25. blinda

    blinda MVP

    Oh yeah, sorry Steve. :eek:

    Wellsie is cool too, Carole!
     
  26. Tim VS

    Tim VS Active Member

    Tunbridge Wells is very nice at this time of year!
     
  27. Kaleidoscope

    Kaleidoscope Active Member

    ......But best of all .... today whilst the sun was shining I got to see 'needling' first-hand with the lovely Bel in Winchester, and a willing patient anxious to be rid of his VPs, and happy for me to watch.

    Wonderful experience, performed effortlessly, with the minimum of fuss or pain...perfect!

    I even got to practice an ankle block on Bel..... what more could a fellow pod ask for?

    Wonderful site this, full of (mostly) wonderful helpful Pods

    Cheers

    And thanks again Bel, it was awesome!

    x
     
  28. DTT

    DTT Well-Known Member


    Thanks Bel for the referral;)

    Carole

    Sorry to come back on the forum but as I explained I'm having I T connection problems.

    As I said in reply to your email, we are unable to offer your patient an appointment till the end of October simply because the needling lists are full.

    Both Bel and Steve are very competent pods and I'm sure either will let you sit in and may have an earlier appointment than I can offer??

    If you still want to come to me thats fine if your patient is not in pain,if so email me and I will arrange a suitable date for you.
    Cheers
    D;)
     
  29. blinda

    blinda MVP

    And here is the lovely Bell in Winchester, my frequented local where all the best reps, and pods, buy me lunch ;)

    http://www.myfavouritepubwalks.co.uk/shopping/shopexd.asp?id=557

    Have a good weekend:drinks
    Bel
     
  30. twirly

    twirly Well-Known Member

    Hi Joanne,

    A bloody disgrace! Why we bother to complete a degree programme including competence in administering L/A then treat us like children!!!

    Personally I would look for alternative insurance.

    Kindest regards, Grrrrrrrrrrr :bang:

    Mandy.
     
  31. Joanne Moore

    Joanne Moore Member

    Hi Mandy,

    don't get me started. It's a very long story, and one the Irish societies/instutes etc have been battling for a while now. Very unfortunately for all qualified pods (with qualification in POMs and LA), it may be a couple of years yet before the loophole in question gets ironed out. It's a relatively small profession fighting a bit of a goliath.

    So if you were thinking about emigrating over here to practice I'd think twice!!

    Joanne
     
  32. dr.foot

    dr.foot Welcome New Poster

    For those who are interested... I have posted a few articles.
    Also, which I found interesting, Indigenous Australians of the NT have been "dry needling" warts for hundreds of years using acacia spines- A friend of mine from NT told me this a year ago and I thought nothing of it at the time.
     

    Attached Files:

  33. DTT

    DTT Well-Known Member

    Hey Freebie sorry mate missed this one :eek:

    Yep another good pod ;)

    Gimme and email fella Ive got a new PC and yep my addy book has gone and Ive lost yours.

    Need some advice please

    Cheers
    D;)
     
  34. Blue123

    Blue123 Active Member

    Hi,

    I would definately go for the needling technique here, the chances of success with Thuja tablets or potassium permanganate i would say are nil

    Have you tried cryotherapy?
     
  35. Kaleidoscope

    Kaleidoscope Active Member

    I had a brilliant time last month watching the lovely Bel 'needling' a young boys hallux VP.

    It was his second needling (the other foot last time). Very interesting case as the VP went quickly last time and his belief in Bel's expertise was palpapable and I/we were really worried that when he returned for his second needling session (that I travelled hundreds of miles to see!) it would be gone because of THAT belief !

    Thankfully (well for me) it hadn't, so I was able to see the whole process, completed in minutes.... Usual pod toe-block with LA, liberal jabbing of shortened needle (good tip) into the area until there was no resistance and resembled minced beef. Minimum of fuss, and a clearly happy patient!


    [The reason it was 'interesting' was because he was on a strong anti-acne drug which clearly affected his immune response, but needling still did its magic, but not enough to clear the whole body]

    I can't wait to see more/do myself. Thanks again Bel.... your ears must be burning as I talk about it alot! Also thanks again for allowing yourself to be 'ankle-blocked' by me! (although Im not sure the 'alcohol' we added to the mix as you dragged your leg to The Bell pub did it any good!)

    Cheers Linda
     
  36. DTT

    DTT Well-Known Member

    Hi Linda

    Now there's a first !!!

    I've never seen any part of Bel being dragged INTO a pub !!! She usually has to be dragged OUT !!!:D:D:D

    Cheers
    D ;)
     
  37. Kaleidoscope

    Kaleidoscope Active Member

    Ops! I may JUST have blotted my copybook !!!

    Sorry Bel! (I'm sure your reputation will remain intact!)
     
  38. blinda

    blinda MVP


    An' I don't really care
    If ya think I'm strange
    I ain't gonna change
    An' I'm never gonna care
    'Bout my bad reputation.....oh no, not me.

    Cunningly played from the dook box at the start ;)
    http://www.youtube.com/watch?v=u0ZicY7Oqmg&feature=related

    Have a good weekend :drinks
     
  39. DTT

    DTT Well-Known Member

    Look Bel just coz I can run faster than you and get to the bar first...........:confused:

    That is the repuation we're talkin about innit ?? I can run faster than you??????

    Mind you I can run faster than all my mates at the golf club too ( Griff excluded) and I get to the bar first then too :wacko:

    My shout next time were at a CPD event you beat me too it and brought em last time :drinks

    Be lucky Hun
    cheers
    D;)
     
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