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Post by chifhpod on Dec 5, 2008 13:25:06 GMT
Hi everyone, My apologies for posting in the wrong place. I too was disappointed that the momentum seemed to be lost as page two seemed not to exist! I want to thank David Smith for the references - I can learn too, and I intend to look them up and read. As for the value of the debate, I would not wish to see any dumbing down for the sake of FHPs. They are not fools and I am sure they can follow, at least so deep as we have gone at this point. What I hope will happen is that they will discover that there is more to know - and do something about it. It's me age, you know! I have not had the depth of education of a 3 year degree (although I do have a good education and now have a degree (Podiatric Medicine)). I was taught in a previous age where doing something and carefully observing its effects was regarded as best clinical practice of its day. And yes, the world does move on. I know this better than anyone here, but I don't intend to just let go and let it happen without making an effort to update and keep swimming! To return to the debate...It has been said that silver nitrate is an astringent, not a caustic. I believe until I learn more that it acts upon any/all epidermal layers in formation of the eshar. I know (because I have treated hundreds of cases over hundreds of years) that the eshar will fall off in 7-10 days bringing 0.5 mm of HPV infected tissue with it. This 95% application can (with no observed problems, scarring, argyria, etc), be applied 7 days about for as long as it takes. And it works! Thanks, Bel, for 'keratolysis'. This exactly sums up the effect that I have observed where the full depth of the epidermis can be removed without dermal invasion. 'Scoop out infected tissue is exactly what I have been doing. The HPV tissue actually turns brown/purple so that you can see it as different to the white macerated uninfected skin. Without intending to be political in any way whatsoever, I do grow concerned at the depth of no - knowledge expressed by some FHPs from some outlets. I know there are good students and those that will never get it, but there are also schools barely worthy of the name. I hope I can say that without censorship. I believe that no true forum can decently exist without trying to rationally debate these important issues. Just calls for strong moderation! ?
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Post by robertisaacs on Dec 5, 2008 13:26:10 GMT
Gosh has'nt this one moved on since i last checked in! I would echo what others have said. I think to "dumb down" input to threads because they might be viewed by FHPs would be an error most egregious. Whatever level somebody trained at they should strive towards best practice and that is the same for all! I know more than one FHP whose knowledge of biomechanics knowledge has exceeded the level taught at degree. What a loss if they were denied access to the information which can take them further! Agree 100% And the best way to enable our FHP colleauges to act with due caution is to furnish them with the facts and information around the treatments which may be used. These are not children to be denied useful information because it is too difficult for them. As i said, i do not believe best practice to be dependant on where one trained, certainly not in this instance. Caution is always appreciated. But i do feel that our FHP colleagues deserve a little credit for their common sense. Sal acid is available OTC to patients up to 50%. As such patients will use it themselves, undirected and unguided to this concentration. Can we then say that it is appropriate for use with no guidance at all but NOT for use with guidance from an FHP? And finally this. The OP concerns the treatment of VPs. A few posts (mine included) seem in danger of turning it into a debate on "context of the locality". That is another topic and one which should be discussed in another thread or referred to Admin. To which end... Quite! This seems a bit much to me even for a directed and monitored treatment (much less a home package!). Anyone else? Regards Robert
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Post by chifhpod on Dec 5, 2008 14:50:43 GMT
So, if 60% sal acid is a keratolytic it produces keratolysis of the epidermis. Keratolysis is breakdown of keratin (and other similar proteins, do you think?) (keratohyalin - s.granulosum?) If you agree, that's three out of five layers.
Does tissue that is broken down (dead?) produce prostaglandins/inflammation mediators/create inflammation? and can that inflammation if it happens ever be enough to bring on resolution of our VPs? Is it even worth trying for as a VP removal strategy?
After 7-10 days exposure 60% sal acid macerates the epidermal skin to the extent that much of the HPV infected tissue volume can be pared away to a depth of up to a depth of 0.5 cm. That's a great deal better than sitting about waiting for an inflammation that I have not observed - despite looking!
The application can be repeated 7 days about until total eradication is acheived. And it works! Obviously it would be applied with discretion and would not be applied to uncontrolled diabetics/ PAD sufferers.
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Post by blinda on Dec 5, 2008 19:49:02 GMT
There is always more for everyone to know, learning is never over. I`m no spring chicken myself, and can appreciate the benefit of first hand/long term experience. Certainly, experience is the foundation of reflective practice, how else can we evaluate what does/does not work and deduce a future action/treatment plan? The world does indeed move on and sometimes we do have to make the effort to swim to avoid drowning in the sea of complacency. Pleasure. Why the concern? My advice: Don`t concern yourself with matters that don`t directly concern you. Are you privy to the extent of knowledge every FHP has? The private training schools vary greatly in their education and as such the scope of practice of each FHP varies. So long as each practitioner has the training and insurance and works within those parameters, knowing where and when to refer on, what is there to be concerned about? Yup, I`ve met such ones too during practice and my undergrad research project. Speaking as a practitioner formerly known as unregulated, I am jolly glad that I was not denied such access. …..and a little less patronizing. and OK, see you there. Good evening. Tonight on 'It's the Mind', we examine the phenomenon of déjà vu. That strange feeling we sometimes get that we've lived through something before, that what is happening now has already happened. Tonight on 'It's the Mind' we examine the phenomenon of déjà vu, that strange feeling we sometimes get that we've, Oh, haven't I seen you somewhere before? No, doctor, no. Something very funny's happening to me. Ah, come in. Now what seems to be the matter? I have this terrible feeling of déjà vu. (sorry, couldn`t help myself ) Martin very eloquently explained that; Inflammation of any sort IS an immune response …inflammatory response occurs immediately after trauma (ie, after application of a trauma inducing caustic). Do you genuinely believe that when you apply 60% sal acid you are not creating a wound which can only heal with inflammation, proliferation, and remodeling? How else can the wound that you have inflicted heal? Bel
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10feet
Junior Member
Posts: 68
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Post by 10feet on Dec 5, 2008 20:05:04 GMT
Probably.
Indeed. Discussions are taking place with the appropriate lawyers.
Martin, I seem to have upset you. Not my intention at all.
Pete
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Post by Martin Harvey on Dec 5, 2008 21:09:36 GMT
- rest easy Pete, the last time someone tried to upset me was in 1973 with a 9mm. Have not been noticeably upset since.
Anyway, nice to get back on track. To return to the debate...
Perhaps it may contribute to the debate to discuss a little about silver nitrate. Its physical and chemical properties are as follows: Appearance: Transparent, colorless crystals. Odour: Odourless. Solubility: 219g/100g water @ 20C (68F). Specific Gravity: 4.352 pH: ca. 6 (neutral to litmus) % Volatiles by volume @ 21C (70F): 0 Boiling Point: 444C (831F) Decomposes. Melting Point: 212C (414F) Vapor Density (Air=1): 4.4
To start to examine its use in footcare it may be of value to initially consult Runting, Le Rossignol and Holiday as three of the progenitors of scientific method in Chiropody in the 1920’s and 1930’s. They variously refer to it as Argenti Nitras, Silver Nitrate or Lunar Caustic(suggesting the reason for the latter synonym as the supposed crescent moon shaped crystals)
It is recounted by these worthy's as being prepared by dissolving silver in hot concentrated nitric acid, evaporating to dryness and re-crystallising from an aqueous solution. They state that it is very soluble in water, has a somewhat bitter taste (I take that on trust and have not tried it myself) and decomposes on exposure to light.
To specifically quote Le Rossignol & Holiday in their 1937 ‘Pharmacopoeia for Chiropodists’ they offer that; “Argenti Nitras is used for many purposes in Chiropody as it is a powerful antiseptic, astringent, caustic, irritant and styptic” they further point out that it can be neutralised by a saturated solution of common salt and that when applied to an area in conjunction with either iodine or ferric chloride it forms silver iodide and silver chloride respectively which “may be beneficial” They describe its “caustic properties as due to its affinity for albumin in the tissues which it coagulates, causing a hyperaemia which is usually stimulating and beneficial” and suggest that inflammation caused by AGNo3 can be relieved by applying a compress saturated with aluminium acetate solution. They advocate its use for diagnosing ‘suspect verrucae’ by showing up papillary tufts and state that it is “not usually strong enough by itself to destroy verrucae” further uses suggested are ; “dropping a 50 or 25% solution into the enucleated cavity of a corn to simplify the removal of its sheath lining after a few days”, plus “treatment of heel fissures, relaxed nail sulcii and interdigital fissures (used as a 5% solution)”.
Moving on to Peter J Read’s ‘Therapeutics for chiropodist’s’ published variously from 1957 through to 1991, the monograph on AgNo3 in the 1991 edition does not differ markedly from Le Rossignol and Holiday’s in 1937 and recounts similar uses. Read also refers to it as an ”Auxiliary form of treatment” for warts which should not be used for more than two consecutive treatments “otherwise the treatment of the wart may be prolonged”
By the time we reach the fourth edition of ‘Neal’s common foot disorders’ in 1993 AgNo3 is sidelined in favour of salicylic acid, monochloroacetic acid and pyrogallic acid. It is briefly mentioned however, and it is suggested, in contrast to all the other works previously quoted that it may be used as a sole treatment but no suggestion of its mechanism of action is made.
In its fifth incarnation in 1998, Neal’s appears to have abandoned AgNo3 entirely, preferring to concentrate on salicylic, monochloroacetic, pyrogallic, nitric and trichlorocetic acids together with potassium hydroxide as its advocated chemical agents.
Coming forward to Cochrane’s latest review in 2008, AgNo3 does not figure at all in its examination of “thirteen trials of salicylic acid and other topical treatments” and one of the reports conclusions is “There is a dearth of sound evidence to govern the rational use of treatments for common warts. Simple topical treatments containing salicylic acid appear to be both effective and safe. There is no clear evidence that any of the other treatments have a particular advantage in terms of higher cure rates and/or fewer adverse effects”
So, where does that leave our use of Silver Nitrate? Does it have a place, is it effective? Has it passed from modern literature because it is unromantic, no profit in it for drug companies?
What say you?
Cheers,
Martin
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leon
New Member
Posts: 11
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Post by leon on Dec 5, 2008 21:34:03 GMT
Hello, I have found this information on a website
'Verrucae are caused by a papilomavirus, which is also responsible for warts on other parts of the body. The virus is contagious and seems to thrive in damp conditions - such as swimming pools, showers and bathrooms. It can only be caught by direct contact with one of the types of virus responsible (there 78 known types), by walking on, for example, wet surfaces or by using infected towels. Cuts and foot injuries can increase the risk of picking up a verruca. Here at the surgery we will assess you condition and provide an honest opinion on the prognosis and ensure that all treatment plans are made with not only the latest effective treatments but at minimal costs to the patient in this sometimes-recalcitrant painful condition.'
I would like to know please how the prognosis can be judged and what are the effective treatments talked about as silver nitrate I understand is not agreed on? Also what are 78 types of virus I did not learn about this? Thank you. Leon
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Post by Martin Harvey on Dec 5, 2008 21:55:35 GMT
Leon,
In fact 80 types of human papilloma virus have now been identified and several others reported anecdotally so the website perhaps needs updating. HPV are DNA viruses, which infect epithelial cells (cells that form the outer layer of the skin or the lining of body cavities). Viral replication only takes place in fully differentiated epithelium and the subsequent proliferation results in a clinically evident warty papule or plaque. The clinical appearance of warts is variable and depends to some extent on the type of HPV involved and the anatomical site. HPV can also remain dormant within epithelial cells without visible disease. Any epithelial surface can be affected and different types of HPV tend to favour particular anatomical sites. The most common infections are with HPV type 2 on the hands and feet. HPV types 1, 4, 27 and 57 are also frequently found in common warts. Plane or flat warts which are clinically distinct from common warts and usually occur on the distal limbs and face are caused by HPV types 3 or 10. Genital warts, which are probably not recommended to be treated by Podiatrists, are caused by a different group of HPV types (6,16,18,31,32,42-44 and 51-55) and are reported to be very common by current literature.
For a very brief discussion of treatments see my previous post.
Hope this clarifies the situation.
Cheers,
M
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Post by dtt on Dec 5, 2008 22:06:25 GMT
Hi Leon Thank you for your quote from an obviously well informed web site (if perhaps in need of a small update Thank you Martin) You must remember that web sites are designed to give general information to the public as to the services the practitioner provides, not detailed aspects of conditions and or treatments. "Some" also give IP addresses from requests generated from the web site, so the poster CAN be traced should the need arise Now perhaps you can answer the request that has been made to you please ...
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leon
New Member
Posts: 11
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Post by leon on Dec 6, 2008 6:21:31 GMT
Good morning Mr DTT, I am doing investigation of VP and I look at websites but many to put here. This is how I learn. Why are you not pleased I use yours it is good knowledge, yes? I do not ask you where you train so please, it does not matter where I train but not at SMAE. I am personal trainer at gym and want other occupation so I do foot care course. I think you are very cross man and best we not talk any more. Mr Harvey he is helpful, thank you. Leon.
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10feet
Junior Member
Posts: 68
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Post by 10feet on Dec 6, 2008 7:37:06 GMT
Guys, I have finally seen the light.
This is a vigilante exercise.
My apologies for not realising sooner.
Under your terms we have no authority controlling the foot care market, so the aim of this now identified cohort of OP vigilants is to educate, to your standards, those that have failed to embrace the University route.
With dawning realisation an OP vigilant cannot accept a more technical approach to foot care, preferring to take forward the foot health practitioner into the realms of complex terms, evidence and research based rationale.
However, I may appear to applaud your noble sentiments but I am not an exponent of vigilante behaviour, preferring to work with authority to change the system.
So at this point I will bid farewell from this thread and wish you well with your venture.
Kind regards
Pete
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Post by Admin on Dec 6, 2008 8:39:05 GMT
Guys, I have finally seen the light. This is a vigilante exercise. Pete, This is not a vigilante exercise. It is a genuine desire by a number of like-minded people (who have no political hidden agendas) to carry out electronic and other CPD. The FHP Board is there primarily to post on FHP matters/concerns/queries. Re-reading your last post I think one or two of us may have seen the light too . Everyone is very welcome to join in on this forum as long as they are polite, don't spam, and don't make postings of an adult nature.
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leon
New Member
Posts: 11
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Post by leon on Dec 6, 2008 9:14:56 GMT
Mr David, Yes, you say these welcome things, but your Mr DTT say he take my ISP number and track me because I do not tell him where I learn. Is he Policzia ? This is what I think of him. On jest smutnym czowiekiem i odpadów kosmicznych. If I was rude person I would say dupek. I go now Leon
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Post by robertisaacs on Dec 6, 2008 9:22:09 GMT
A fair and reasonable gesture. Whilst i'm not sure vigilante is the right word it is true that information picked up here, by FHP or pod, is over and above that learned at uni / training school. We call it CPD, you call it viglantism, it is what it is regardless of what it is called
. However i do applaud any effort you make to work within the system to improve training levels for pods and fhps and i likewise wish you well in YOUR efforts which are, at end of day, in fundamentally the same direction. That of improved standards of knowledge and understanding to those who work in the footcare industry.
Shalom.
Robert
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Post by Martin Harvey on Dec 6, 2008 9:22:58 GMT
It was interesting to watch the ongoing trolling develop through this thread and now that the current chapter has concluded it may possibly be of interest to pick out a few salient points.
Troll psychology is a relatively shallow science because it can often only be based on the projected persona. In most instances, unless you are dealing with a professional troll, this is a hastily constructed sham persona which does not, by its very lack of substance lead itself to detailed analysis – you may as well try to analyse the shape of a cloud of coloured gas exposed to random molecular Brownian motion.
Thus it is a pretty pointless exercise to attempt to apply analysis to the public projection because it will always change in response to any analytical questions (a little like the discussions that Rob Isaacs and I have had on “is the cat alive or dead – or both at the same time?”)
The give-aways are always the same however, ‘the Devil is in the detail’ as they say. The anonymity of course is a basic give – away, no information is deliberately revealed which allows identification of the troller. The longer a thread becomes, the harder it is for a troll to maintain anonymity before giving away basic information on their identity.
Also, of course, the usual reasons given for anonymity such as “it gives me freedom of expression” etc, etc etc are pretty indefensible in a profession which is supposed to be science based and therefore peopled by individuals who have been exposed to the phenomenon of academic debate, which can be disputative in the extreme before everyone calls it a day and goes for a drink in the university bar.
Interestingly, the choice of pseudonyms can sometimes be an immediate give-away in that it sometimes combines letters and numbers in a subconscious acknowledgement to the repeated injunction we receive to include both in online passwords. Thus the desire of the troll to hide their identity is easily revealed.
The syntax adopted by the troll can also reveal them, in much the same way that the GCHQ listeners learned to ‘read’ the morse signatures of individual wireless operators by the unconscious gaps and breaks in operating a morse key.
Then of course the spelling is another easy to read sign. Most spelling mistakes are unconscious and in an effort to blur this tell-tale the troll will sometimes seek to put in deliberate mistakes, however, this does not cover the non-deliberate ones and is again fairly weasy to spot ;-)
Perhaps, most importantly, on a site such as this one which is aimed at a relatively small professional group it is also hard for trolling to continue for extended periods because the classic troll ‘fronts’ of eager to please learner asking vapid questions can only last so long before it becomes starkly obvious that one is dealing with a troll. Also, because we deal with science-based technical knowledge that is easy to reference the troll technique of dispute of information can only be sustained for a short while before they are obliged to flame and reveal their true agenda.
On a troll visual analogue scale I would award the current one only about 2/10.
Have a good weekend,
M
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