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Standard of care for verruca

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  #1  
Old 11th February 2009, 02:54 PM
john83 john83 is offline
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Default Standard of care for verruca

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Hi all,

I am a GP and I recently referred a patient to a podiatrist for treatment of verruca on a toe. When I saw the patient again, they mentioned that the podiatrist's assistant had taken an x-ray of the foot before the patient met with the physician.

What is the use of an x-ray?
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  #2  
Old 11th February 2009, 03:09 PM
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Craig Payne Craig Payne is offline
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Default Re: Standard of care for verruca

Quote:
Originally Posted by john83 View Post
What is the use of an x-ray?
Its of no use
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  #3  
Old 12th February 2009, 02:01 AM
DAVOhorn DAVOhorn is offline
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Default Re: Standard of care for verruca

Here in Aus it seems most people can have a full family photo graph album with the number of X rays they have.

There are so many path Xray MRI facilities here it obviously means my supposition is right.

I find it concerning that so many X Rays are done for conditions that can be diagnosed with simple visual observation.

Another strange one is peoples here and their fascination for PLANTUS WARTs. I say yup its a Verrucca Pedis and it is as if they are different and that a vp is less dangerous than a Plantus Wart.

Strange souls here .

regards David
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Old 12th February 2009, 02:01 PM
joseph Paterson joseph Paterson is offline
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Default Re: Standard of care for verruca

Podiatrists assistant taking an x-ray

Of no use at all

Perhaps it is a good money earner:

Joseph a poor podiatrist
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Old 12th February 2009, 03:05 PM
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Kevin Kirby Kevin Kirby is offline
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Default Re: Standard of care for verruca

Quote:
Originally Posted by john83 View Post
Hi all,

I am a GP and I recently referred a patient to a podiatrist for treatment of verruca on a toe. When I saw the patient again, they mentioned that the podiatrist's assistant had taken an x-ray of the foot before the patient met with the physician.

What is the use of an x-ray?
John:

The only possible reason for a radiograph of a foot when a verrucae plantaris lesion is suspected is if the patient said they thought that they had stepped on something before getting the lesion, you could rule out a metallic foreign body. Otherwise, the use of foot radiographs in this situation is unnecessary.
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Old 12th February 2009, 05:00 PM
Gibby Gibby is offline
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Default Re: Standard of care for verruca

There are far too many unknown factors to make any judgements on the treatment. Where was the verruca? Verrucae? Were there signs of infection? X-rays may have been taken to rule-out a foreign body, or a weight-bearing radiograph can be used to investigate underlying osseous pathology- accessory bones, etc.
More information is needed to make judgements on the use of x-ray here---
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Old 12th February 2009, 10:17 PM
posalafin posalafin is offline
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Default Re: Standard of care for verruca

As others have mentioned I suspect the reason why an x-ray may have been taken is that the podiarist may have had reason to suspect a foreign body. However what strikes me as unsual is that it is the patient that reported back to the GP what had taken place. I would have thought that if the patient had been referred by a GP that it would have been a professional courtesy for the treating podiatrist to write a letter explaining what examinations had been undertaken, the results of those examinations and the type and outcomes of any treatment proposed and/or undertaken.
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Old 14th February 2009, 04:21 PM
Dr. DSW Dr. DSW is offline
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Default Re: Standard of care for verruca

I also hate to jump to conclusions, since we do not have the full story. And as others have already stated, there is always the possibility that a foreign body, bony prominence or pathology, etc., may have been suspected that warranted an x-ray.

However, what I find "suspicious" is the statement that the x-ray was taken PRIOR to the patient meeting with the podiatrist. Therefore, if this is in fact true, how could the podiatrist determine the x-rays were necessary if he/she never evaluated the patient?

Additionally, I also agree that it's odd that the patient would have to report back to the G.P., unless the patient's visit back to the G.P., preceded the podiatrists referral report.

I must state that I have observed more than one podiatry office where it was "routine" to basically take bilateral x-rays of all new patients as a "base-line" for almost any pathology that walked into the office. I personally find this particular practice disgusting and a complete abuse.

So, although we don't have the whole story, if the patient's account is correct and the x-ray was taken prior to the doctor ever meeting the patient, then I will take the view that the x-ray was unnecessary and that the G.P. should consider finding a new podiatrist that examines his/her patients prior to ordering tests.
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Old 15th February 2009, 01:01 AM
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Craig Payne Craig Payne is offline
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Default Re: Standard of care for verruca

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Originally Posted by Dr. DSW View Post
However, what I find "suspicious" is the statement that the x-ray was taken PRIOR to the patient meeting with the podiatrist. Therefore, if this is in fact true, how could the podiatrist determine the x-rays were necessary if he/she never evaluated the patient?
......
I must state that I have observed more than one podiatry office where it was "routine" to basically take bilateral x-rays of all new patients as a "base-line" for almost any pathology that walked into the office. I personally find this particular practice disgusting and a complete abuse.
PYBM - "protect your butt medicine". It also smacks as a potential insurance scam, that may come back to haunt the entire pprofession (BTW - from the IP address, John83 is in the USA)
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  #10  
Old 15th February 2009, 02:21 AM
Heather J Heather J is offline
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Red face Re: Standard of care for verruca

John, of on a different tangent, welcome!
Perhaps if you have the time and inclination you could go to the introduction forum.
As you are aware there are often 2 if not more sides to each and every story, perhaps the client also mentioned some other complaint? Or perhpas I am just wishful thinking?
I did have a 20 + year old with a H/D HPV sub 4th MPJ lesion not resolving, did organise an ultrasound to see if something else was going on.
U.S. agreed possible HPV lesion. It did go, disappear, on its own over a 12 month period.

Recently due to ongoin injury trauma with martial arts we did organise X-Rays.
I think now 26y.o, feet a mess, bony spurs, mid foot, destruction of mid foot joints, look like she should be 100+.
So perhpas innocent until proven guilty??

Cheers
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  #11  
Old 15th February 2009, 07:30 AM
Dr. DSW Dr. DSW is offline
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Default Re: Standard of care for verruca

Once again, although we don't have all the facts and I would truly like to believe in the "innocent until proven guilty" rule, IF indeed the story is being told correctly we can not ignore the statement that the x-rays were taken PRIOR to the podiatrist examining the patient.

That would seem as if x-rays were a "routine" practice in that office. And in my opinion, that's not "protect your butt medicine", but is clear out insurance fraud and abuse.

Please let's not forget that x-rays are NOT benign, and do expose patients to radiation. And IF these x-rays were taken prior to evening examining the patient, there is ZERO justification.

To play "devil's advocate"......let's say the podiatrist didn't examine the patient, but the assistant "filled in" the doctor on the patient history. I STILL believe the doctor should not determine whether x-rays should be taken until he/she performs the exam, unless the "assistant" is a qualifed physician assistant, nurse practitioner, etc., with the qualifications and skills to make that judgment call.

Still smells fishy to me.
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Old 19th February 2009, 03:55 AM
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Don ESWT Don ESWT is offline
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Default Re: Standard of care for verruca

John,
Over 20 years ago at college we were informed that X-Ray therapy was another way of ridding the body of warts. Maybe that is what the Podiatrist was trying to achieve??

I am not sure of any studies carried out doing X-Ray therapy to bombard the VP but the dosage would have to be very high and the area of X-Ray bombardment vast.

VP's do not show up on X-ray

Patient better off with chemical or laser Tx to remove
L.A. then using a 25W Co2 laser pulse the area, debride VP
Most plantar VP's are 1cm diameter * .5cm deep although there are exceptions to the rule. I have treated 75mm diameter 1cm deep.

Good Luck
Don Scott
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Old 26th February 2009, 03:31 AM
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Don ESWT Don ESWT is offline
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Default Re: Standard of care for verruca

Just this morning I had a patient in Bourke. As a young girl some 40 years ago she had a lead apron draped over her and had radiation therapy to remove a VP about 1.5cm diameter. She only recalled one treatment. There is some scar tissue present.

Back home in Wollongong by 6pm. The Royal Flying Doctor Service is a great organisation.

Don Scott
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Old 19th March 2009, 01:46 PM
Deborah Ferguson Deborah Ferguson is offline
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Default Re: Standard of care for verruca

Hi
Has anyone experience of using electrosurgery to treat VP. I have searched Science Direct and Pub Med with limited results. One study in 1955 and another in 1996 but little else. Had a patient recently who had previously had this treatment in Harley street, London with seemingly good results.
Thanks in advance
Deborah
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Old 19th March 2009, 01:49 PM
Deborah Ferguson Deborah Ferguson is offline
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Default Re: Standard of care for verruca

Hi
Does anyone have any experience using electrosurgery to treat VP. I have searched Science Direct and Pub Med with limited results. One study in 1955 and one in 1996 but little else. Had a patient recently who had had this treatment in Harley Street, London with seemingly good results.
Thanks in advance
Deborah
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Old 19th March 2009, 02:01 PM
joseph Paterson joseph Paterson is offline
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Default Re: Standard of care for verruca

Quote:
Originally Posted by dmf View Post
Hi
Does anyone have any experience using electrosurgery to treat VP. I have searched Science Direct and Pub Med with limited results. One study in 1955 and one in 1996 but little else. Had a patient recently who had had this treatment in Harley Street, London with seemingly good results.
Thanks in advance
Deborah
I use electrosurgery in clinic very often but what you need to remember is that there is no cure for a virus. Two methods I use is one to burn the vp if they are only on top of the skin, seconded is to cut the vp out with a little extra skin to atempt to remove any remaining vp cells.

I find it quicker for the patient and less painfull than cryosurgery, it is another worth while option.


Joseph
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Old 19th March 2009, 02:11 PM
Deborah Ferguson Deborah Ferguson is offline
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Default Re: Standard of care for verruca

Ihave never seen the equipment advertised and never seen it used. What is the success rate?
Thanks
Deborah
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Old 19th March 2009, 02:19 PM
joseph Paterson joseph Paterson is offline
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Default Re: Standard of care for verruca

It is hard I think to say that a certain percentage you have success with but I believe that it is dependant on the patient as whether they are prone to vp's.

I do prefer to use it instead of cryosurgery.

Joseph
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Old 19th March 2009, 02:21 PM
joseph Paterson joseph Paterson is offline
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Default Re: Standard of care for verruca

It is hard I think to say that a certain percentage you have success with but I believe that it is dependant on the patient as whether they are prone to vp's.

I do prefer to use it instead of cryosurgery. I use for Electrosurgery. Aaron Bovie 950.

Joseph
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