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Hi Kevin - thank you very much for this - just one question - do you use the stream type ethyl chloride or the aerosol type?
Steve
Steve:
I use the stream type. It works great.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Hi
6 weeks ago I treated a 15 year old female using the needling technique, she had several plantar VP and had had a previously unsuccessful needling. She presented last week with multiple warts around the proximal nail folds of almost every finger. Has anyone encountered this before? Is is the virus going into panic mode before it dies?
Help gratefully accepted.
Janet
__________________
Success is just a matter of luck. Ask any failure.
Hi
6 weeks ago I treated a 15 year old female using the needling technique, she had several plantar VP and had had a previously unsuccessful needling. She presented last week with multiple warts around the proximal nail folds of almost every finger. Has anyone encountered this before? Is is the virus going into panic mode before it dies?
Help gratefully accepted.
Janet
Janet:
In the 10+ years I have been using this technique, I have never seen new warts pop up elsewhere after doing the needling procedure. Oral cimetidine also is known to work well in children and adolescents for verrucae. You may want to consider referral to a dermatologist for a case such as this.
Here is a good article on various treatments available for warts.
Good luck.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Apologies to Bel and Tim for not replying - I think something went wrong with my thread subscription - anyhoo
Yes this is where I get it from !!! - I have both and the jury's out as to which one is better - I think the aerosol direct stream version is easier to use but that's a personal preference.
Bel maybe we should have a session to experiment!!!!!
Steve
The Following User Says Thank You to stevewells For This Useful Post:
Apologies to Bel and Tim for not replying - I think something went wrong with my thread subscription - anyhoo
Yes this is where I get it from !!! - I have both and the jury's out as to which one is better - I think the aerosol direct stream version is easier to use but that's a personal preference.
Bel maybe we should have a session to experiment!!!!!
Steve
You know i cant resist an invitation to experiment just say when.
You know i cant resist an invitation to experiment just say when.
Nice article, BTW Kevin
Cheers,
Bel
Bel:
That was a "sick" article....
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
I've been this technique for the past 6 months. I usually talk through all the verruca treatment options and the brave opt for needling, others prefer to save it for a last resort. I would say the results I am getting a not as good as publicised above - I'm getting around 60% clear up on 1st treatment. This is definitely not due technique problems I think that it is due to the fact the ones that are coming to my clinic are on mature patients with long standing lesions that have not responded to any other form of treatment and are therefore by nature more resistant to treatment. I can confirm though that apart from the initial local angalgaesic post operative pain is very low and well tolerated by patients. They definitely seem to prefer to cryo and it's a more convenient patient for the working person who does not want to be coming in every week.
I've been this technique for the past 6 months. I usually talk through all the verruca treatment options and the brave opt for needling, others prefer to save it for a last resort. I would say the results I am getting a not as good as publicised above - I'm getting around 60% clear up on 1st treatment. This is definitely not due technique problems I think that it is due to the fact the ones that are coming to my clinic are on mature patients with long standing lesions that have not responded to any other form of treatment and are therefore by nature more resistant to treatment. I can confirm though that apart from the initial local angalgaesic post operative pain is very low and well tolerated by patients. They definitely seem to prefer to cryo and it's a more convenient patient for the working person who does not want to be coming in every week.
Thanks for posting Leah - I seem to be getting similar results to yours - somewhere between 60 and 70% and I was thinking along those lines too.
I hope that no one was under the impression that verrucae needling is 100% successful. Like any other verrucae treatment procedure, it is not perfect. For solitary lesions, I would guess that my treatment results are approximately 80%. However, for mosaic verrucae, where I first described my experiences with the needling procedure in this thread nearly 3.5 years ago, I don't think there is any better procedure.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
I hope that no one was under the impression that verrucae needling is 100% successful. Like any other verrucae treatment procedure, it is not perfect. For solitary lesions, I would guess that my treatment results are approximately 80%. However, for mosaic verrucae, where I first described my experiences with the needling procedure in this thread nearly 3.5 years ago, I don't think there is any better procedure.
Agreed.
It is important to remember that; ultimately, any VP treatment is only as good as the patients` immune system, as with any viral infection.
well i am so pleased my original post has generated so much interest. sorry i havent been posting much as i have been setting up my own clinic! all going well and looking forward to trying this treatment again.
i do have a lady who i have been seeing for sometime who i feel may benefit but money is prohibiting her from taking up my offer so wondered if there are any NHS pods that are doing this in the South East...we are in Shoreham-by-Sea but she is willing to travel to get this sorted...she has tried bazuka extra, cryo, sal acid, thuja, duct tape with no effect....gets emotional about it still being there and this week it was seemingly larger...eeek!
thanks
poppet
The Following User Says Thank You to poppet For This Useful Post:
Hi
i cant seemed to work out how to write a new thread on here so i thought i'd just jump in here as its the most relevant to my questions.
I wanted to know how you do a local infiltration with LA for a plantar VP. Is Scandonest plain ok to use or should i have adrenaline in it.
I couldnt seem to get the injection in right to begin with. Even had some LA squirting straight back out!!!! aargh..
can someone help guide me how to get this part of the procedure right please.
thanks
Nav
__________________
It's like a finger pointing away to the moon...
Would it be correct to assume that patients are being charged a similar fee for nail avulsion for this procedure?
I would be very interested to know what people charge for this. If you're brave then please post it up, otherwise a private message would be appreciated.
I don't mind putting it out there how much I charge for this.
I don't think it is right to charge the same as a PNA.
I charge £75 - probably going to get my had blown off for sticking my head above the parapet here. It only takes 20 mins from start to finish including gaining consent. It's a low cost procedure the most expensive part being the using of a sterile pack procedure pack.
I've contributed to this thread before stating I think the success rates are exaggerated. Since posting last I personally have found this treatment is no better than any of the other treatments available. I think patients are impressed by the "theatre" of this procedure and because rather than the traditional treatments of acids and cryo it is perceived as 'proper treatment' that cannot be duplicated at home.
It's such a pity that my results have been so disappointing. Verrucas are a nightmare to deal with and to have been able to offer a truly effective treatment would have been fantastic addition to our weaponry against this infection.
I would have felt professionally embarrassed if I had charged £300 for this procedure if it had not worked.
I don't mind putting it out there how much I charge for this.
I don't think it is right to charge the same as a PNA.
I charge £75 - probably going to get my had blown off for sticking my head above the parapet here. It only takes 20 mins from start to finish including gaining consent. It's a low cost procedure the most expensive part being the using of a sterile pack procedure pack.
I've contributed to this thread before stating I think the success rates are exaggerated. Since posting last I personally have found this treatment is no better than any of the other treatments available. I think patients are impressed by the "theatre" of this procedure and because rather than the traditional treatments of acids and cryo it is perceived as 'proper treatment' that cannot be duplicated at home.
It's such a pity that my results have been so disappointing. Verrucas are a nightmare to deal with and to have been able to offer a truly effective treatment would have been fantastic addition to our weaponry against this infection.
I would have felt professionally embarrassed if I had charged £300 for this procedure if it had not worked.
Leah
Hi Leah
20 mins from start to finish including consent ???????
Might I suggest respectfully you re-assess your technique and thereby improve your outcomes ?
We get around 85% success with this modality but the actual Tx is around 45 mins with a further 15 mins to ensure all bleeding is controlled befor the Pt leaves my surgery.
We charge more than you but a fair charge for the time and Tx involved .
Cheers
D
"Political Correctness" is a doctrine, fostered by a delusional, illogical minority, and rabidly promoted by an unscrupulous mainstream media, which holds forth the proposition that it is entirely possible to pick up a turd by the clean end
I have been trying the needling procedure under ankle block for some time now and have good results so far.
Few questions:
What is the likelyhood of leaving callus/corns on needled sites in the plantar foot?
Has anyone experienced the VP not anesthetising even when all around the VP is anesthetised and is well within the specific dermatome which is also numb!??
I think you would need a lot more than the amount needed to put in a foot bath. Is that how it was used? I remember gargling with it when I had a sore throat so it must have some antibacterial properties, but how does attack a VP which is under the skin?
It is an oxidising agent.
Regarding the treatment of vp's. Using history-taking, I normally find that the vp has been brought on by stress or that it could be a pre-emp to something like glandular fever . I always make a point of making the patient aware of this. I then debride the vp, get it to bleed slightly and then apply the silver gaffa tape. I tell the client to re-apply the tape as soon as it comes off. I make an appoint for 2 weeks time and repeat. I do this up to about 4 more times.
This has been in the main very successful.
Thank you for your suggestion. I will try it. I have used a similar method before with Sleek tape but I did not recall so soon after the first treatment.
i wondered if i could get some feedback on treatments for mosaic verrucae. a patient attended my clinic with the plantar aspect of one foot almost coverec with verrucae. this extended to the dorsum of one toe and is also evident on the other foot. this patient has seen a consultant dermatologist who said to put tape on it. she has had the verrucae for approx 7 years and it gets painful as the hyperkeratosis builds up. she is near desperation and is seeking treatment. has anyone successfully treated such large lesions? a colleague suggested the use of potassium pomangernate footbaths (very weak solution). has anyone heard of its use in VP's or tried this treatment option?
thanks
poppet
I've read all the posts here about mosaic verruca treatments. I have a patient whom I would like to try the needling technique, unfortunately my degree course did not cover the administration of anaesthetic for an ankle block - so that means I can't try it, or is there another way???
I'm a 1st year Podiatry student at Durham, UK and have been reading this thread with interest!!!! I'm writing an assignment on Verrucae and have found an article in Podiatry Now (May 2011) written by an NHS podiatrist in Hounslow on needling. In the article 70% results were on single lesions (although the technique was only used on 14 patients).
I hope this helps!
Mike Taylor
__________________
When you look into the Abyss...
I've read all the posts here about mosaic verruca treatments. I have a patient whom I would like to try the needling technique, unfortunately my degree course did not cover the administration of anaesthetic for an ankle block - so that means I can't try it, or is there another way???
podhugh
You could do it the way Kevin suggested - i.e. local infiltration after 20 secs or so of ethyl chloride spray over the area to be injected.
Thanks I read through again - have bought the cryoanalgesic and will try next week.
Thanks to Durham student too. I did my course there and qualified 2008. Good Luck it's a great school.
You could do it the way Kevin suggested - i.e. local infiltration after 20 secs or so of ethyl chloride spray over the area to be injected.
Steve
Generally, the ethyl chloride spray freezes the skin within 5-10 seconds, at which time I pierce through the skin with the hypodermic needle. I don't think I have ever used the ethyl chloride spray for 20 seconds in the same location for needle anesthesia. Too long of a spray time may cause thermal injury (i.e. frostbite).
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Generally, the ethyl chloride spray freezes the skin within 5-10 seconds, at which time I pierce through the skin with the hypodermic needle. I don't think I have ever used the ethyl chloride spray for 20 seconds in the same location for needle anesthesia. Too long of a spray time may cause thermal injury (i.e. frostbite).
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
I have successfully used, what I call, the "multiple puncture technique" for treating mosaic verrucae. Under local anesthesis, take a 18 gauge hypodermic needle and punch through the skin to the subcutaneous fat about 100 times to the worst of the "mother lesions" (lesions with worse appearance) of the mosaic verrucae. Bleeding should occur at each puncture hole. Then place a bandage on the foot for 12 hours with the patient bathing normally the next day. The patient has only slight soreness in the area the following day.
In most cases, this will stimulate a immune response within the body that will eradicate all the verrucae plantaris lesions of the foot within about 4-8 weeks. I have found it very successful (over 90% cure rate) in the approximately 10 patients I have performed this technique on. My technique is based on an article published about 25 years ago where a podiatrist used a modified electric tootbrush-hypodermic needle tool where he used the same technique to heal plantar verrucae. I don't have the reference now.
I have also seen a study where verrucae plantaris lesions are excised from one area of the body and then implanted in the subcutaneous fat of the abdomen, to stimulate the immune response to the virus, to accomplish the same effect as the multiple puncture technique. Again, don't have the reference at hand but you may try looking up these articles on the internet.
Certainly worth a try, in my opinion, since there are few side-effects, potential problems with this technique.
Hello, Dr Kirby mi nombre es Mario Mencía, soy podólogo y enfermero en España más concretamente en la provincia de Toledo en la ciudad de Talavera de la Reina, en mi práctica diaria me he encontrado algún papiloma en mosaico aunque aún soy demasiado novato como para hablar con la maestría con la que lo hace usted, pero quería comentarle un caso de un paciente que tengo de 12 años que vino a mi consulta hace 3 meses y estoy tratando con ácido nítrico al 60% en cura oclusiva con vaselina salicílica al 30% y en tto coadyuvante con THUJA OCCIDENTALIS 30 CH EN GRÁNULOS, al principio fue bien y parecía que iba a resolverse al primer mes, en la siguiente sesión a los diez días volvió y el paciente presentaba las lesiones igual que el primer día así que volví a empezar de nuevo y así llevo dos meses. le incluyo en 2 archivos adjuntos imagenes del primer día cuando llegó y otra imagen a los quince días previa deslaminación como verá hay 2 VP madre y lo demás son lesiones ides a distancia.
Por lo que he leído en su post , a lo que usted se refiere es a producir una inoculación del virus en el organismo para producir digamos una vacunación del paciente a través del propio virus, como ocurre con el virus de la gripe cuando no lo inoculan a través de una vacuna, no?
agradecerle de antemano su respuesta, muchas gracias.
Last edited by MENCI : 29th November 2012 at 06:57 AM.
Reason: personal
Re: Mosaic verrucae-help with treatment
just say when.
Re: Mosaic verrucae-help with treatment
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