Newbie seeking advice

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Hi everyone. I have recently qualified and looking for work in the Northwest of England. This site is an absolute gem. I love the fact that someone somewhere is happy to give you a helping hand with advice on subjects which (so far) are out of our depth/ experience. And boy have i got a list of questions!

For the moment though I am just trying to get some equipment together for doing some home visits (if i can drum up any business). I have got a long list of stuff most of which is probably going to come in useful. I'd really appreciate a bit of feedback about what you other guys out there doing home visits are using:


Firstly can anyone recommend a dressing (other than melolite... jelonet... ) that would serve me really well as an allround dressing for superficial wounds? Obviously i have learned all about the various ones that are available to those in NHS practise, but won't have such an array of marvels available to me. Just something that isn't astronomically expensive and a good all rounder.


Secondly what caustic are you guys using on straightforward verrucas? We covered Vp's at Uni but didn't do any training with them (useful hey?). I'm assuming that the standard approach is to mask healthy skin with a suitable dressing and use a plug of a caustic agent etc. But which one? Something that is slightly stonger than the over the counter stuff but not so strong that i go blowing craters into peoples feet. If anyone can just give me details of what they use and how they use it i'd be really grateful.


Thirdly how many of you do sanding / drilling on your patients? If you sand what are you using? i need to purchase something so recommendations would be appreciated.

Lastly please feel free to offer me any advice about starting out. It would be a big help at this stage.

Finally finally-- if anyone is looking for a podiatrist in the northwest region then please get in touch. I'm really nice! If you aren't offering employment then i'd love to shadow anyone who is willing to have me

Thanks in advance to anyone who bothers to reply!
AliceP

 

Hello Alice, and welcome to the forum, I am sure you will find a lot of useful information here.

I do not know if you are a member of the Society of Chiropodists & Podiatrists, but if so I would suggest you make contact with your local Branch and your local Private Practice Group. This information is available from the SCP head office.

If you feel you could do with more practical knowledge in certain areas then "shadowing" another practitioner is the best way to go. Your local branch should be able to help you with this. However, you must not undertake any treatments using agressive agents until you are familiar with the modalities concerned, as this could compromise your professional liability insurance.

Hope that helps

regards

Catfoot

 

Hi Catfoot,
Thanks for your reply.Yes I certainly will follow your advice and shadow someone to gain some experience. I have treated vp's before on my kids and friends' kids just using over the counter salicylic acid preparations. I had good success with them, but It would still be helpful to me if you and others can suggest a caustic agent that isn't available commercially for non- podiatrists. This would be for in the event of a patient approaching me having unsuccessfully tried their own vp treatment with over the counter stuff.
What do most people have in their toolkit for VP's?

WOW 2 posts in the first few days of joining the arena. I must be getting brave in my old age!

 

Hi again Alice,
Please do not take offence what I am going to say next, as it is meant to be helpful.

If you have no practical experience with treating VPs then do not treat then until you do.

The same remarks apply to sanding and drilling. Only do what you have been taught to do. If you are unsure then find a mentor and skill-up.

It would be unethical and irresponsible for any pod to recommend the use of any agressive chemical to someone who does not have the appropriate hands-on experience.
There is a world of difference between the OTC preparations for VP and the specialist ones, which is why the latter are restricted.

If you are going to treat VPs on a domiciliary basis have you done the costings to make sure it is viable? Most VPs treated by chemical means will need repeated weekly visits which can be expensive in both time and materials. You will also need to provide an emergency service in case of a tissue breakdown, as caustic products can be notoriously unpredictable in their actions.

I know you are keen to start working and using your skills, but do not try to run before you can walk.

regards
Catfoot.

 

Hi Catfoot,
Thanks for your advice. indeed I'm just in the process of arranging to spend time observing these skills. Hopefully some time soon I'll be sufficiently informed and competent with regards to this clinical skill.

Your suggestions are appreciated.
AliceP

 

Drilling, sanding nails and callouses: Dremel. You can buy different "bits" - sanding, grinding. and you can get it portable.

For veruccas: canthacur without a doubt.

 

sdenisar,

As our newbie pod only has one set of lungs and presumably wants to keep them free from nail dust I would not advise purchasing any drill that does not have a dust extraction facility. I was not aware that Dremel has this?

Your advice re Canthacur is IMO dowright irresponsible. Canthacur is a potent vesicant with contraindications and side effects that make it totally unsuitable for use by anyone without appropriate experience.
In any event I doubt if is available in UK and would probably have to be sourced from North America.

CF

 

Yes a few people have recommended Dremels and they would seem like the convenient solution. I do however agree that dust extraction is an important consideration, even if i do always wear a mask when drilling.

What are these water sprays that i have seen in several of the catalogues?
If anyone can recommend a good drill that serves them well on doms then i'd appreciate it.

 

In reply: there is no definitive long term studies regarding "nail dust," though I would not disagree with you in either regard (nail dust or skin dust). Although, there are face shields and masks that can be used and I would highly recommend.

If you have no practical experience with treating VPs then do not treat then until you do.

It never hurts to get experience with such, and I couldn't agree more. I don't know the experiences (US versus overseas), but this is something every podiatrist in the US sees. I guess I am assinine, and I would have had to "assume" that you have had experience with chemical treatment, as we do as students, residents (and many who do have still are unaware of canthacur). So, I would have to apologize, in the event I could not truly understand, or know, the training experience a podiatrist has overseas.

As you well know, verruccas can be very difficult to treat. Canthacur has become more of a standard versus other forms, including chemical forms (even at the Cleveland Clinic - where it is used). I've seen much better results versus any other method, with far less complications (versus surgical, laser, yeast injection therapy). And far more predictability, and healing. Of course there will be some sort of tissue breakdown, like most other forms of chemical treatments, it is a blistering agent. Treatments: biweekly. Contraindications/side effects minimal.

Though, yes, depending on your experience, as with anything in this world - please, it is highly recommended that you seek additional training and/or experience with this form of treatment, or any form for that matter. As with anything, don't do something you are uncomfortable with (example: that in mind, as a surgeon, if you know your anatomy and have great basic surgical technique, than you should be able to conquer new technique's, products, and treatment modalities without difficulty - just because you have not performed that very specific technique, does not mean you are irresponsible or unethical in performing it).

As well: I guess you need to define "newbie" podiatrist. A newbie podiatrist to me is a graduate of a podiatry school or residency program (in the US) and should have no problem handling the use of canthacur. So in any event........... I will admit that my assumptions are based on solely on US experience. (I would be very interested in hearing about the training experiences you have overseas, and whether you are able to pursue advanced training surgically).


I couldn't agree with the following anymore.

If you feel you could do with more practical knowledge in certain areas then "shadowing" another practitioner is the best way to go. Your local branch should be able to help you with this. However, you must not undertake any treatments using agressive agents until you are familiar with the modalities concerned, as this could compromise your professional liability insurance.

Do not Run before you learn to walk.

 

Hi Alice the Dremel Is a great domicillary tool to carry I work as a mobile Podiatrist in the NW of England and its what I carry and its an essential piece of equipment! As for VP its a Virus so these things have a shelf life.They will disappear without any treatment in time unlike a corn.Modern research points to debriding the stubborn VP making it bleed slightly to initiate an immune response which in theory will speed up the removal of the thing by drawing white blood cells to the site of the inflammation caused by the trauma! Good Luck Alice!Any more questions just ask?

 

Hi again sdenisar,
After reading your post I feel I may have been a bit harsh in my cricticism of your response to Alice P, and for that I apologise.

If I may bring you up to speed with UK training for pods. In UK the level of Podiatry training is far below that of USA and any surgical training here has to be done as a post graduate (this excludes minor surgical procedures such as those performed under LA, such as blunt dissection of VP or partial/total nail avulsion.)

Sadly, some Univesity Podiatry courses now do not give much coverage to VPs and their treatment. This is because these training programmes are funded by the National Health Service and most of the graduates will be looking for placements within the NHS. The NHS podiatry departments no longer treat VPs which is why this (very necessary part of training IMO) is poorly addresssed.

The outcome of all this is that Podiatry graduates in UK who are unable to secure a place within the NHs may be poorly prepared, in some areas, to embark on Private Practice.

I hope that clarifies the situation from this side of the pond.

regards

Catfoot

 

Catfoot -

Thank you for the reply. Honestly, I am sure there is somewhere that may delineate that the thread may apply to, or was started, 'overseas,' I probably simply overlooked it, though I must admit, I don't really ever post much on here so I must plead my ignorance.

I find "culture" fascinating - and I'd liken this to such.... I've never known. Once, while in graduate school, I looked up foreign podiatry study, but never really came across much at that time. That is very interested, more about your experiences would be very fascinating for me to hear/learn. In all actuality, I considered, and still would, podiatry opportunity overseas. I guess, the old teacher in me brings some of this fascination. It is very interesting, especially to think that here we are so concerned with our surgical privileges in the podiatry profession (foot and ankle orthopedics vs podiatry). New graduates spend 4 years in undergraduate, 4 years in podiatry, 2-3 years surgical training, with intern time outside podiatry (ER, internal med, etc).

So, I wonder. Would someone like me be able to pursue a surgical career overseas, and what would its limitations be?

Thanks for the reply.

 

Hi again sdenisar,
I don't have the knowledge to answer your query but I know there are UK Pod Surgeons and USA Podiatrists who can.
Maybe Admin could move this post somewhere else where they can see it and help you out?

regards

Catfoot

 

Does admin, ir should I repost somewhere?

 

Hi sednsar, if admin doesn't move it maybe you could repost in the "foot surgery" forum?

You'll get the right audience there !

regards

Catfoot