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New name needed for multiple puncture technique / Dry needling

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  #31  
Old 17th April 2012, 10:12 PM
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Default Re: New name needed for multiple puncture technique / Dry needling

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Originally Posted by Kevin Kirby View Post
Definition of inoculation:



The verrucae inoculation procedure is an inoculation procedure as long as the virus that is being introduced into the body by repetitive needling is being used as a means to produce or boost immunity to the virus that causes verrucae plantaris.
Yet you are not introducing the virus into the body, since it is already there and we do not know whether the process boosts immunity to the virus yet- agreed?

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Even though this seems quite obvious to most of us that have successfully used this procedure on numerous patients, we still don't know if the resolution of the verrucae plantaris lesion is due to increased immunity from the inoculation procedure or from some other cellular mechanism. We still await that research.
.
Or by some other mechanism altogether, which is my point. You are giving a highly specific name to a therapy which suggests you know exactly how that therapy works. Clearly the mode of action is uncertain given the current level of knowledge. It might work by boosting immunity, but it might not too. The name you have given it may turn out to be a misnomer.
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  #32  
Old 18th April 2012, 12:23 AM
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Default Re: New name needed for multiple puncture technique / Dry needling

Could say that there is some debate how orthotics work, but we are happy to say we treat people with orthotics , following that logic it has to be needling, i.e it is not how we do it but what we use, but I suppose that would lead to surgery being renamed blading so maybe not !
Tim
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  #33  
Old 18th April 2012, 12:31 AM
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Default Re: New name needed for multiple puncture technique / Dry needling

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Originally Posted by DTT View Post
Both

Yes painless podiatry is what we should ALL be striving for IMO , so ROB your comment is not only irresponsible but totally wrong

NO amount of pain is irrelevant !! it is VERY relevant to the patient whoever they are and as a clinician we should all be aware of that ( as I thought I had made clear ???)

Yes the duel is on between you and Bel on the arranged date ( including my theory on digital block I hope) and may the best technique win.
Looking forward to it

Cheers
D ( AKA Dad)
Bloody kids
Dad

Read what I said again. Of course we are all trying for painless podiatry and yes, its always important. I never said it wasn't. However to the true needle phobic, (as opposed to someone who merely hates injections), the phobia is entirely separate from the perceived level of pain. A true needle phobic is no more concerned with the level of pain than an arachnaphobic is comforted by the reassurance that "a little spider cannot hurt you" or a claustrophobic is reassured by the fact that being stuck in a lift is quite painless. So although they don't like pain any more than anyone else, and we should make the same level of effort to ensure they don't suffer any, the pain is far less important to them than the phobia of the needle. Thats why they go through agonisingly painful dental treatment with no LA, because the pain is less important to them than the phobia of the needle.

But A true needle phobic won't come within 200 yards of a treatment called "dry needling" unless their life is in immediate danger so they're not that relevant to us. The more common presentation is someone who has a phobia of the type of pain one has with injections and they're the ones we go to such lengths to make it painless for.

And I'm looking forward to working with bel and you to experiment with all the variations on the technique we discussed to try to find the least painful.
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  #34  
Old 18th April 2012, 01:23 AM
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Default Re: New name needed for multiple puncture technique / Dry needling

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Originally Posted by Robertisaacs View Post
Dad

Read what I said again. Of course we are all trying for painless podiatry and yes, its always important. I never said it wasn't. However to the true needle phobic, (as opposed to someone who merely hates injections), the phobia is entirely separate from the perceived level of pain. A true needle phobic is no more concerned with the level of pain than an arachnaphobic is comforted by the reassurance that "a little spider cannot hurt you" or a claustrophobic is reassured by the fact that being stuck in a lift is quite painless. So although they don't like pain any more than anyone else, and we should make the same level of effort to ensure they don't suffer any, the pain is far less important to them than the phobia of the needle. Thats why they go through agonisingly painful dental treatment with no LA, because the pain is less important to them than the phobia of the needle.

But A true needle phobic won't come within 200 yards of a treatment called "dry needling" unless their life is in immediate danger so they're not that relevant to us. The more common presentation is someone who has a phobia of the type of pain one has with injections and they're the ones we go to such lengths to make it painless for.

And I'm looking forward to working with bel and you to experiment with all the variations on the technique we discussed to try to find the least painful.
Ask yourself a question son whether you are needle phobic or not, if you are in a lot of pain everyday with a VP that is driving you mad, where would you be more likely to go if all other modalities fail?

Would it be to someone that will jab a needle straight into a nerve and make you cry out in pain wiggle it about and damage that nerve , not to forget pushing the "flatulance button" at the same time ?
Or
To someone that can give reassurance in understanding the phobia in a relaxed atmosphere and give a pain free procedure ?

Why should this group of patients be even more upset by the horror stories ( like the "friends" tell patients when they come in for nail surgery) that makes them carry on with a poor quality of life when a pain free tx is available ?

I do take on board the confines of phobia that you describe, but for those with no choice ?

I dunno son you choose

Cheers
Dad Bloody Kids
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  #35  
Old 18th April 2012, 02:27 AM
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Default Re: New name needed for multiple puncture technique / Dry needling

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Originally Posted by Simon Spooner View Post
Yet you are not introducing the virus into the body, since it is already there and we do not know whether the process boosts immunity to the virus yet- agreed?
OK Pedantic Pete. We are not introducing the virus to the `body`, we`re introducing it to the `immune system`. Yes, the infection is already established, but the immune system is unaware of its presence, as I said in my last post. I am happy to use the term inoculation as it has been well documented that humoral immunity to the virus can be achieved by stimulating the release of pro-inflammatory cytokines, which in turn induce wart regression via a localised, natural immune response.

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Originally Posted by Simon Spooner View Post
Or by some other mechanism altogether, which is my point. You are giving a highly specific name to a therapy which suggests you know exactly how that therapy works. Clearly the mode of action is uncertain given the current level of knowledge. It might work by boosting immunity, but it might not too. The name you have given it may turn out to be a misnomer.
`Tis true we do not have a full understanding of the mechanism of cell-mediated immunity in relation to HPV, thus my reluctance to `give it a name`, but there is enough evidence to conclude that induction/introduction of cytokines to the subcutaneous tissues and blood cells stimulates or enhances both the innate immune response and the cellular arm of acquired immunity. I know it`s not your bag, but immunophysiology of the skin is fascinating and I could go on for hours....but I wont bore you any more.
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  #36  
Old 18th April 2012, 02:43 AM
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Default Re: New name needed for multiple puncture technique / Dry needling

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Originally Posted by blinda View Post
. Yes, the infection is already established, but the immune system is unaware of its presence, as I said in my last post.
Isn't it a case of the immune system being aware of its presence, but not responding effectively?

From the paper you attached:
"evidence suggests that although the immune system reacts to HPV infection, it does
not respond effectively or quickly.16"
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  #37  
Old 18th April 2012, 04:17 AM
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Default Re: New name needed for multiple puncture technique / Dry needling

Quote:
Originally Posted by DTT View Post
Ask yourself a question son whether you are needle phobic or not, if you are in a lot of pain everyday with a VP that is driving you mad, where would you be more likely to go if all other modalities fail?

Would it be to someone that will jab a needle straight into a nerve and make you cry out in pain wiggle it about and damage that nerve , not to forget pushing the "flatulance button" at the same time ?
Or
To someone that can give reassurance in understanding the phobia in a relaxed atmosphere and give a pain free procedure ?

Why should this group of patients be even more upset by the horror stories ( like the "friends" tell patients when they come in for nail surgery) that makes them carry on with a poor quality of life when a pain free tx is available ?

I do take on board the confines of phobia that you describe, but for those with no choice ?

I dunno son you choose

Cheers
Dad Bloody Kids
Del, you're preaching to the choir! I was merely making a point about the nature of a phobia as opposed to a fear. The rather brutal process you described is obviously not something anyone should want or indeed tolerate! I would never and have never done such a thing.
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  #38  
Old 18th April 2012, 04:43 AM
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Default Re: New name needed for multiple puncture technique / Dry needling

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Originally Posted by Simon Spooner View Post
Isn't it a case of the immune system being aware of its presence, but not responding effectively?

From the paper you attached:
"evidence suggests that although the immune system reacts to HPV infection, it does
not respond effectively or quickly.16"

Could well be, in some instances. Hence, the statement; `it stimulates or enhances both the innate immune system and the cellular arm of acquired immunity`. As any expression of viral proteins is limited to superficial epithelial cells, there is a reduced presentation of these to the immune system, i.e. not enough to trigger a systemic response. Of course, it aint really that simple. HPV also encodes specific functions to inhibit immune responses. The attached paper by Frazer, succinctly explains the relationship between HPV and the innate and adaptive immune systems. He states “Such inhibition would be expected to reduce specific antiviral defence mechanisms and also effective presentation of antigen to the host immune system”.
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Old 18th April 2012, 04:50 AM
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Default Re: New name needed for multiple puncture technique / Dry needling

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Del, you're preaching to the choir! I was merely making a point about the nature of a phobia as opposed to a fear. The rather brutal process you described is obviously not something anyone should want or indeed tolerate! I would never and have never done such a thing.
I know that Donut

It was a generalism on choice not a personal thing, Ive always known you to be an excellent practitioner in all respects.
Thats was all the comments were about" choice to the patient"
Cheers mate
D
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Old 18th April 2012, 06:10 AM
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Default Re: New name needed for multiple puncture technique / Dry needling

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As I am sure you are well aware, viral proteins within a cell stimulate production of cytotoxic T cells (which then seek out and destroy the targeted cells) when the infected cell is damaged and leak said proteins. But HPV`s are clever fellas, they do not cause cell lysis, in fact they positively avoid damaging their host cell, so there is no release of viral proteins to the dendritic cells, thus; no antigen presentation to the immune system. The hypothesis is; (and appears to be supported by the fact that after needling just one lesion, all lesions regress) destruction of the affected tissue will initiate the desired immune response by causing cell lysis. Kinda.
If it's the cell lysis that is important, why is cryotherapy, which presumably causes cell lysis, shown to be no better than a placebo / duct tape?
http://www.ncbi.nlm.nih.gov/pubmed/12917913

And indeed, if it's the lysis that counts, how does hypnotherapy work?

http://www.psychosomaticmedicine.org...1/109.full.pdf
http://www.psychosomaticmedicine.org...3/245.full.pdf
http://www.ncbi.nlm.nih.gov/pubmed/1442635
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  #41  
Old 18th April 2012, 08:44 AM
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Default Re: New name needed for multiple puncture technique / Dry needling

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If it's the cell lysis that is important, why is cryotherapy, which presumably causes cell lysis, shown to be no better than a placebo / duct tape?
http://www.ncbi.nlm.nih.gov/pubmed/12917913

And indeed, if it's the lysis that counts, how does hypnotherapy work?

http://www.psychosomaticmedicine.org...1/109.full.pdf
http://www.psychosomaticmedicine.org...3/245.full.pdf
http://www.ncbi.nlm.nih.gov/pubmed/1442635
I did say kinda. Cell lysis would certainly happen in all physical/tissue destructive methods such as cryo, sal acid, etc but may not be enough to produce the relevant cytokines to destroy latent virus in adjacent cells (Bristow & Styles, 2011). Whilst cell death plays an important part in triggering innate immune mechanisms, it is not the only factor. To quote from Frazers` paper;

Triggering of innate immune mechanisms is a key initiator of both innate and adaptive immune effector mechanisms for viral clearance. Triggers include double stranded RNAs, single stranded DNAs, bacterial cell membrane components, intracellular molecules released following unprogrammed cell death, and cell membrane associated molecules displayed by distressed cells.


I`m no immunologist and, as I said before, “we do not have a full understanding of the mechanism of cell-mediated immunity in relation to HPV”, which is indeed complex.

The results of the latest Cochrane review (attached) of `Topical treatments for cutaneous warts` (2009) of 60 trials stated that evidence of studies was generally weak due to poor methodology and reporting. Cryotherapy, in particular, was noted as “surprisingly” lacking in evidence of efficacy and evidence of the remaining treatments as “limited”. Yet, we still utilise these methods, but with limited results.

I`m not saying that placebo does not play a part in HPV regression, but I`m not your man to explain the mysteries of suggestibility and hypnotherapy. I know a man who can.


Ref; Bristow I & Styles C (2011) The treatment of stubborn plantar warts using topical 5% imiquimod cream. Shamopody Now (10) pp14
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File Type: pdf Cochrane review 2009.pdf (653.2 KB, 1 views)
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Old 18th April 2012, 09:54 AM
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Default Re: New name needed for multiple puncture technique / Dry needling

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I did say kinda. Cell lysis would certainly happen in all physical/tissue destructive methods such as cryo, sal acid, etc but may not be enough to produce the relevant cytokines to destroy latent virus in adjacent cells
Maybe a study could be performed looking at cytokines post needling?

http://www.ncbi.nlm.nih.gov/pubmed/10811142
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Old 18th April 2012, 10:12 AM
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Default Re: New name needed for multiple puncture technique / Dry needling

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Maybe a study could be performed looking at cytokines post needling?

http://www.ncbi.nlm.nih.gov/pubmed/10811142
Maybe it could. Love to see it. But I bet my bottom dollar it wouldn`t be performed by a sole trader in private practice. Thus, I`ll have to make do with clinical assessment only. For now. Appreciate your interest, Simon
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Old 18th April 2012, 10:18 AM
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Default Re: New name needed for multiple puncture technique / Dry needling

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Maybe it could. Love to see it. But I bet my bottom dollar it wouldn`t be performed by a sole trader in private practice. Thus, I`ll have to make do with clinical assessment only. For now. Appreciate your interest, Simon
I hear that. Up against similar problems. For those that don't know: currently in the UK if your are not employed by the NHS or a University, trying to get ethical approval to carry out a research study is virtually impossible, despite the fact that you may be perceived by your peers as an expert with loads of experience in the field- right Belinda?
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Old 18th April 2012, 10:34 AM
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Default Re: New name needed for multiple puncture technique / Dry needling

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I hear that. Up against similar problems. For those that don't know: currently in the UK if your are not employed by the NHS or a University, trying to get ethical approval to carry out a research study is virtually impossible, despite the fact that you may be perceived by your peers as an expert with loads of experience in the field- right Belinda?
Right. But I aint no `expert`....just an unhealthy interest
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Old 18th April 2012, 10:41 AM
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Right. But I aint no `expert`....just an unhealthy interest
How many warts have you FIST'd / SNIVEL'd compared to anyone else in the UK??????? That probably makes you a national expert.
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Old 18th April 2012, 11:05 AM
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Default Re: New name needed for multiple puncture technique / Dry needling

Hmmmmm Wart FISTing *typed with an expression of a bad smell under my nose*
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Old 18th April 2012, 11:33 AM
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Default Re: New name needed for multiple puncture technique / Dry needling

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How many warts have you FIST'd / SNIVEL'd compared to anyone else in the UK??????? That probably makes you a national expert.

Really not liking the picture that is conjuring....but, the number of pts used in my paper should soon be made public
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Old 19th April 2012, 02:08 AM
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Default Re: New name needed for multiple puncture technique / Dry needling

Apparently this treatment for warts originated over three thousand years ago in China where it is called 'chou chou '.

During treatment the patient is encouraged to repeat this phrase with feeling each time the needle passes through his skin.

Apparently it works as an analgesic.

You learn something new every day.

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Old 19th April 2012, 02:18 AM
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Apparently this treatment for warts originated over three thousand years ago in China where it is called 'chou chou '.

During treatment the patient is encouraged to repeat this phrase with feeling each time the needle passes through his skin.

Apparently it works as an analgesic.

You learn something new every day.

Bill
Hi Bill,

Do you have a source/ref for that info?

Cheers,
Bel
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Old 19th April 2012, 02:45 AM
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Apparently this treatment for warts originated over three thousand years ago in China where it is called 'chou chou '.

During treatment the patient is encouraged to repeat this phrase with feeling each time the needle passes through his skin.

Apparently it works as an analgesic.

You learn something new every day.

Bill
People have said many things to me when they feel a needle pass through their skin. Especially for digital blocks. "chou chou" has not been one of them yet...

Best check what it means. It could well be chinese for "F*** ME!!!!!"

Thanks for that little nugget.
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Old 19th April 2012, 03:03 AM
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Default Re: New name needed for multiple puncture technique / Dry needling

Quote:
Originally Posted by Robertisaacs View Post
People have said many things to me when they feel a needle pass through their skin. Especially for digital blocks. "chou chou" has not been one of them yet...

Best check what it means. It could well be chinese for "F*** ME!!!!!"

Thanks for that little nugget.
That made tea come down my nose !!

Cheers
D
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Old 19th April 2012, 03:18 AM
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Default Re: New name needed for multiple puncture technique / Dry needling

Sorry Bel.,

Of course if you run a number of 'chou chou' together it very quickly becomes,
ch/ouch/ouch/ouch/ouch/

But give them the little story (the romance and magic of oriental medicine) and involve them with the 'chou chou's and it might make it easier? OK are you ready for a little cho chou now?

Back in 1984 when I was at LFH Two American podiatrists came across to lecture the students on biomechanics. One of them was using a technique with a similar rationale to dry needling.

He would inject the verruca with cortisone delivered with a jet injector. The idea was that the jet injector would blast viral particles along with cortisone through the capsule. The cortisone would delay the immune response giving the viral particles time to multiply (do they multiply outside the cells of the str.spinosum?) and ensuring a massive eventual immune response and thus increasing the likelyhood of cure.

I did wonder if he actually doing it or only thought that it might be a good idea?

Bill
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Old 19th April 2012, 03:42 AM
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Default Re: New name needed for multiple puncture technique / Dry needling

Quote:
Of course if you run a number of 'chou chou' together it very quickly becomes,
ch/ouch/ouch/ouch/ouch/
Facepalm!

Well played sir.
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Old 19th April 2012, 04:20 AM
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Default Re: New name needed for multiple puncture technique / Dry needling

witchcraft ??
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Old 19th April 2012, 09:47 AM
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Default Re: New name needed for multiple puncture technique / Dry needling

i'd stop messing about and call the treatment 5-flourouracil.

With the podiatrist debriding the lesions every few days to allow the medication to penetrate I would expect the cure rate to go up from 70% or so to nearly 100%. No pain. No scar.

So it would take a few weeks. So what.

Bill
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Old 20th April 2012, 09:39 AM
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Default Re: New name needed for multiple puncture technique / Dry needling

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i'd stop messing about and call the treatment 5-flourouracil.

With the podiatrist debriding the lesions every few days to allow the medication to penetrate I would expect the cure rate to go up from 70% or so to nearly 100%. No pain. No scar.

So it would take a few weeks. So what.

Bill
No, you want to give 'em a dose of radium as several of my antique texts from the 1930's recommend...
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Old 21st April 2012, 02:58 AM
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Default Re: New name needed for multiple puncture technique / Dry needling

Oxyacetylene torch. Anecdotally, 100% success rate.

Quote:
No, you want to give 'em a dose of radium as several of my antique texts from the 1930's recommend...
The question you have to ask is do we want our vps developing super powers?
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Old 25th April 2012, 08:49 PM
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Default Re: New name needed for multiple puncture technique / Dry needling

May I suggest Dry F.I.S.Ting if the good Dr Spooner hasn't already beaten my to that one.
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