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Post by blinda on Jul 21, 2009 15:43:55 GMT
Hi All, I know some of you have been following the `needling` thread on PodA with much interest. Unfortunatley, Craig has advised that the thread has "gone missing temporarily", so I thought I would post some before and after pics of this treatment on here. Ian Linane and I spent a CPD afternoon with Steve Wells, practicing LA techniques and Steve needled this pt who has a hx of painful mosaic VPs. He only needled the VP prox to the 1st MPJ, under a post tib block, on his Left foot. Here are the before, during and six weeks later pics (Consent was given by pt for pics to be used for educational purposes);    Also of interest is the VPs on his right foot have all but disappeared, even though they weren`t needled. Guess that ol` immune response kicked in!   Has anyone else had success with this method? Cheers, Bel |
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Post by robertisaacs on Jul 21, 2009 16:19:41 GMT
Yep! ;D
Did it with a patient who had a history of extremely recalcitrant VPS. Previously had no success on ANY lesion with anything short of electrodessication (which left some nasty scarring).
Did the needling and got rid first time! Patient highly delighted although the person observing me did describe the process as "brutal".
There will be blood.
There's some really encouraging anecdotal stuff flying around, it desparatly needs a study carried out. I wonder if we could agree a protocol and do a multi center trial and collate some of this stuff into meaningful data.
Regards
Robert
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Post by fronny1 on Jul 21, 2009 19:29:28 GMT
Is this the needle plus bleomycin that I've read about or another proceedure?
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Post by robertisaacs on Jul 21, 2009 19:45:29 GMT
This is the dry needling multiple puncture technique.
Whats bleomycin?
Regards
Robert
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Post by blinda on Jul 21, 2009 20:50:04 GMT
As Robert said, this is a `dry needling’ technique, which involves anesthetizing the area and then, using the same needle puncture the VP until it turns to mush. It is bloody, but the recent posts on PodA have indicated that discomfort for the patient is limited only to the initial application of anaesthetic to numb the area. There is also no need for a dressing once a scab has formed, usually within a few days and the patient can shower/bath as normal.
Kevin Kirby described the mode of action for this as;
The needling method can treat multiple/mosaic VPs on the same foot by only treating one lesion and has been seen to have an effect on the contralateral foot.
This method does not involve the use of Bleomycin, which is a (Glycopeptide) antibiotic that inhibits the synthesis of call walls, often used in tx of cancer. The Cochrane review did suggest that it does warrent further studies into the tx of VPs.
I would love to, but will have to wait until after November, there are only so many projects that one can juggle at the same time!
Cheers,
Bel
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Post by samrandall on Jul 22, 2009 0:07:28 GMT
Ooh.. ok.. I have some stubborn VP's on my right foot.. quite a few in fact.. I'll do a case study on myself if you guys would be interested.. I'd be happy to get rid of the buggers. Can anyone send me a detailed description of the procedure? Also, is there any good evidence out yet? Or only case study type stuff?
Regards,
Sam
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Post by twirly on Jul 22, 2009 5:36:37 GMT
Hi all, Unfortunately (like Bel' stated) the mosaic v/p needling thread on Pod' A is one of the threads which vanished. Craig is looking into it but unsure if the thread (& others) can be retrieved. Sam, If you do 'needle' your v/ps any chance of pre & post- photos? Many thanks, Mand' PS. Bel' your photo's are brill'  |
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Post by robertisaacs on Jul 22, 2009 7:05:52 GMT
Hey Sam. I'll do one better. We can arrange a time and you can video call me on skype and I'll talk you through it. Unless you're back in the country at any point and feel like popping by. We can video it for you to show your friends! Regards Robert |
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Post by samrandall on Jul 22, 2009 7:39:25 GMT
Of course,
Happily share photo's, Will post things as and when they come up.. Infact, I'm thinking of writing it up for Pod Now (if they want it?!). What exact technique should I use on the VP?
Thinking of getting in touch with the dermatology dept here and seeing if we can get a study going with the Doctors here too..
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Post by samrandall on Jul 22, 2009 7:40:13 GMT
awesome.. sorry last post was sitting on my browser for a while.. will email you and maybe do something over the weekend??? Cheers mate :-D
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Post by billliggins on Jul 22, 2009 15:53:53 GMT
I'm interested in a multi-centre trial too.
All the best
Bill
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Post by ianl on Jul 22, 2009 17:59:20 GMT
Certainly interested in the multi-centre trial
Ian
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Post by blinda on Jul 24, 2009 13:34:20 GMT
Hi Twirls,
Alas, i cannot claim credit for the pics. I no longer posses a camera since mine was stolen during a break in at the surgery a couple of months ago. These are the handiwork of the fantastic Mr Wells, although he did let me hold the camera briefly! It was an interesting afternoon, discovering the most painful part to infiltrate LA was ID, although i did have a problem walking after so hubby had to drive me home.
I did save some of Steve Arbes photos before the thread went AWOL on Pod A. I`ll see if i can locate them and repost them on here. He did give permission for us to use them for educational purposes.
Cheers,
Bel
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Post by blinda on Jul 24, 2009 14:46:30 GMT
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Post by blinda on Jul 25, 2009 12:41:42 GMT
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Beautiful people are inside out.
