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CTLAWYER, well said!
I think you guys are scaring LU too much. Sounds to me like she stubbed her toe, and it is purple because of bleeding under the skin (you know, a black-and-blue mark, just this time it is purple), and swollen because of the injury. I don’t think she needs to go to the ER for that. From personal experience, I suggest getting a nurse to put on a splint-like thing to keep the toe from moving. If you were on the kupa, I would say go to the clinic, get a Dr to look at it and write out instructions for nurse, and nurse will take care of it. There are private nurses who may do this for you without having to see a Dr (can also judge is there is more going on here).
Disclaimer: Do not take this as medical advice. This was given as friendly help from a non-professional who has experience with stubbed toes.
Swollen toe – see a shrink.
As for why G-d created podiatrists: Podiatry school teaches the same basic medicine as medical and dental schools, in the first 2 years. They then focus on clinical treatment of feet, whereas medical school in the last 2 years focuses on clinical treatment of everything above the feet, and dental school in the last 2 years focus on teeth, gums and the bones they are anchored in.
Orthopedists treat bones and muscles, but podiatrists treat foot ailments that include infections, skin diseases, neurological problems and other stuff I know nothing about.
They actually go to medical school and then specialize in podiatry (residency, interenship) if they so choose
Thats not true.
Orthopedists treat bones and muscles, but podiatrists treat foot ailments that include infections, skin diseases, neurological problems and other stuff I know nothing about.
So go to an orthopedist for bone problems, dermatologist for skin problems and a neurologist for neurological problems. That’s what people do for the rest of the body. What’s so special about feet?
CTLawyer raises some interesting questions so I asked my pharmacist is licensed in both NY and another state. This is his responses:
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About diagnosing an illness: you think of a podiatrist as a doctor specializing in the foot, think of a pharmacist as specializing in medication. They recommend, they do not diagnose. If I were to say “you have the flu, take medication x”, CTLawyer is correct. What I should and do say is “You sound like you have the flu, I would try X.” The latter is not a diagnosis, it is a recommendation – well within my licensure.
Similarly, I cannot diagnosis a swollen toe. I review what you’ve told me and recommend therapy. We are extensively trained in red flags that preclude self-treatment. (to Health – you do make a good point. However, we are aware that a purple toe could be many things – gangerene, warfarin-induced, an extensive bruise among others. We take a history and make a recommendation – which could very well be “See a physician – I will not recommend anything over the counter.”) If I am certain that the disease state is something that can be treated by an over the counter medication, I will make a recommendation; if not, I will refer you to your physician – even if it means I lose a sale.
Pill-dispenser? I must say this is an offensive misconception. I refer you to the American College of Emergency Medicine, the American College of Cardiology and others who all have released policy statements to the effect of pharmacists have a unique base of knowledge and are an extremely valuable resource. The law permits us to vaccine and we are held in responsible for the clinical appropriateness for every prescription (ie. if an overdose leaves the pharmacy on my watch, I must be to justify why I felt it appropriate to dispense and how I mitigated the risk to the patient)
Mod-29: I have made recommendations to prescribers since I was student and have had them followed exactly. Sometimes prescribers do turn to us for medication selection. You are correct in that we do not diagnose. Also, we train extensively to give medical/lifestyle/pharmaceutical advice – we have semester-long classes on this kind of thing.
Which is what I thought I had said, correct? I believe they probably know better than some docs what would work, but they are still at the mercy of the prescriber.
CTLawyer – A. Why Corporate chooses to have a 24 hour store in the area has nothing to do with the profession. That is a corporate decision. B. That being said, it may be that American trained pharmacist are not willing to practice in CT because of the extremely loose narcotic laws in CT and knowledge of some very lawsuit-happy law firms not too far south in NYC. C. In order to get licensed in NY, you actually need to demonstrate that you know how to make capsules, liquids, creams and IVs. You would be hard pressed to find someone who will make tablets for you as that requires a good amount of physics and chemistry not traditionally taught in school.
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I’ll be happy to pass anything along to him. Just post.
Bk613 -“What’s so special about feet?”
The profession was separated from regular medicine from Time Immorial.
From Wikipedia:
“The professional care of feet was in existence in ancient Egypt…
WtP -“Disclaimer: Do not take this as medical advice. This was given as friendly help from a non-professional who has experience with stubbed toes”
Because it’s not! You see there was a reason I wrote to see a podiatrist. She doesn’t need to pay money to see a doctor or a nurse, just for immobilization. She could tape it herself!
Now back to my point – you need a x-ray, because sometimes rarely, you need an Orthopedic surgeon or a Podiatrist to do “internal fixation”!
You just proved – why you can’t take advice from the internet!
Some Common Sense -“(to Health – you do make a good point. However, we are aware that a purple toe could be many things – gangerene, warfarin-induced, an extensive bruise among others. We take a history and make a recommendation – which could very well be “See a physician – I will not recommend anything over the counter.”
My post wasn’t in anyway against Pharmacists, but the trend nowadays to use you guys as PCP’S.
I’m not sure why this phenomenon is occurring!
Perhaps it’s lack of money or insurance, or perhaps it’s laziness or something else (which I can’t think of)!
Some Common Sense: Thanks for the research 🙂
Health you said: “but the trend nowadays to use you guys as PCP’S.
I’m not sure why this phenomenon is occurring!
Perhaps it’s lack of money or insurance, or perhaps it’s laziness or something else (which I can’t think of)! “
Hypotheses of why this is so:
-Making an appt w/a PCP can takes days or weeks from the day of need/call. Pharmacists are right there the same day.
-Going to a PCP means taking off work, or changing one’s schedule and missing important things. Pharmacists are there until 9, or even 24 hours a day.
-Pharmacists are in grocery stores or in convenient locations. One can ask while doing regular things like buying food or take a moment to go next door to ask.
-Pharmacists are very helpful and willing to answer questions. PCP’s in my experience are very busy, and moving from my room to the next and then back. I start asking one question and sometimes it’s interrupted. ______Though if it’s a busy pharmacy and busy hour, then they really don’t have time to talk because they’re dealing with a bunch of people waiting in line and juggling people in drive-throughs too.
-Yes because of money and free access, at least for customers who have a rapport with the pharmacist already it’s nice.
-No shame (lol). Sometimes I feel more comfortable asking ridiculous-sounding but honest vulnerable questions. Another cool thing was when a pharmacist said “Me too.” Made me feel like a regular human.
Mod 29
Based on stories he’s told me before: yes, the doctor has to prescribe the medication and he can only fill what he’s told to fill. However, he does have the right to overrule the doctor and say that he will not fill the medication. It has to be for a good reason (overdose, patient is abusing medication, drug interaction) and is done infrequently but he does have that power. It’s a two way street. The prescriber is, in some ways, at mercy of the pharmacist too.
Health
He and I have talked about this before – when one fellow asked him if he has eye drops for pink eye (he sent him to urgent care and told him not to use Visine). It comes from the fact that doctors are busy and some patients have high copay or aren’t insured at all. Pharmacists are known as the most accessible healthcare providers and people come to them with medical questions – many of which they can answer. When you add low health literacy to the mix combine with people don’t understand what we are and are not allowed to do is when you have people coming in asking for a diagnosis and a medications which for the most part we cannot provide (exceptions: Narcan [state dependent], human insulin, contraceptives [state dependent]).
Some Common Sense: One thing that frustrates me is that CVS no longer sells cigarettes (Yay that’s wonderful) and the problem is that at the pharmacy, they had a nurse that prescribed a friend of mine an anti-depressant.
She met her once. Wrote a prescription to help her deal with smoking cravings. The friend got it filled at the pharmacy right then and there.
Hello! That’s really really dangerous in my humble opinion. Even a psychiatrist, whose job it is to make those determinations, takes time to assess the person and one’s needs with more time and background.
I don’t know if all podiatrists are created equal, but I would prefer, as suggested above, to see an orthopedic surgeon who specializes in feet. Yes, they do exist. I used to work for one. He’s an excellent doctor.
LU – Just FYI, you never said what happened to your foot at the beginning. You simply said that your toe was swollen. Then you said it was purple. That could be a multitude of things – a sign of infection, lack of blood flow, etc.
When you give the details that you banged your toe, it sounds to me like you have what they call in Hebrew a “shetef dam”. What I think that means is that you have some internal bleeding (bruise) going on there. The bang you gave to your toe broke some small blood vessels and they bled, creating the purple color and the swelling. I would say that if your toe is very painful (like you can’t walk on it or sleep at night) or crooked, then I would go to Terem and have them take an x-ray (they would figure out from your story that it was not an infection or ingrown toe nail but possibly a fracture). If it is neither extremely painful nor crooked, then I would wear some comfortable shoes, keep your foot elevated when you can and take an anti-inflammatory, like Advil or Neurofen to help reduce the swelling and pain. If you do this for two or three days and the pain gets worse or does not improve, then I would go to Terem and have them take an x-ray.
How’s your toe LU?
Yay glad that it’s healing thank G-d 🙂
….I kind of don’t want to talk about it please. I’m kind of embarrassed because I intentionally avoided at least one important-looking person that I really wanted to introduce myself to at the event. Instead I think I lingered awkwardly without engaging in the conversation so I wouldn’t have to deal with the handshake thingy.
Thankfully after the event was over and people were mingling, my hands were busy cleaning and packing up the stuff.
-That said. It’s a start. And b’esrat Hashem I will feel more assertive and confident in this respect.
Thank you btw! Talking about it helped me get it out. And… I’m really really glad that I talked to my manager about it because it turned out that it’s totally okay and we’ll practice how to go about it when we have time so I am better prepared.
I guess the good thing here is that I survived and went, and I opened a dialogue to learn how to better handle the situation so I can actually talk to clients instead of avoiding them.
Also… all this talk about asking a sheilah made me realize that this is something that I want to ask my LOR, and hopefully also LORebbetzin too 🙂
Thanks LU. That means a lot.
Nechomah – “I don’t know if all podiatrists are created equal, but I would prefer, as suggested above, to see an orthopedic surgeon who specializes in feet. Yes, they do exist. I used to work for one. He’s an excellent doctor.”
I don’t know if all orthopedic surgeons are created equal, but I would prefer to see a podiatrist!
“When you give the details that you banged your toe, it sounds to me like you have what they call in Hebrew a “shetef dam”. What I think that means is that you have some internal bleeding (bruise) going on there. The bang you gave to your toe broke some small blood vessels and they bled, creating the purple color and the swelling. I would say that if your toe is very painful (like you can’t walk on it or sleep at night) or crooked, then I would go to Terem and have them take an x-ray (they would figure out from your story that it was not an infection or ingrown toe nail but possibly a fracture). If it is neither extremely painful nor crooked, then I would wear some comfortable shoes, keep your foot elevated when you can and take an anti-inflammatory, like Advil or Neurofen to help reduce the swelling and pain. If you do this for two or three days and the pain gets worse or does not improve, then I would go to Terem and have them take an x-ray.”
Thanks for your non-medical opinion (even though you worked for a surgeon), but it can be a fracture without a lot of pain!
Yes, Health, but a fracture of a toe that is not very painful and she could walk on the foot would not likely need more than a supportive comfortable shoe (not that she would be wearing flip-flops in the winter) and a pain reliever. What else would a podiatrist or orthopedic surgeon do for it?
Being that you are a trained medical professional and I gave my lowly non-medical opinion, what would you recommend that she do? People without insurance cannot run to the doctor for every little bump or bruise. She did not say in the beginning what had happened, thus the multitude of recommendations.
BTW, nobody asked whether you preferred a podiatrist to an orthopedic surgeon, that is your opinion. They are not so prevalent here in EY (I know that is where LU is located) and they certainly do not have access to an x-ray machine. The most logical thing for her to do would be to go to Terem, which we have both referred to) and have an x-ray to make sure it is not a fracture. If her toe was not hot or painful, then possibility of infection is low. I do not feel that I gave her bad advice in the least.
Nechomah -“Yes, Health, but a fracture of a toe that is not very painful and she could walk on the foot would not likely need more than a supportive comfortable shoe (not that she would be wearing flip-flops in the winter) and a pain reliever. What else would a podiatrist or orthopedic surgeon do for it?”
You meant well, but the way a medical professional looks at the situation – is not what it probably is, but to look at all probabilities. And to determine that – you must do a x-ray!
Because of that, there is the slight possibility of the need for internal fixation.
And as a side topic, it seems that she doesn’t have insurance.
I haven’t been there in a long time, but what I remember is that Kupat Cholim is pretty cheap. Not having money is not an excuse for not seeking medical care!
Health did you see the bruised leg thread please?
How can a leg still be blue after four months?
It’s still tender feeling when I poke it (and the other leg is okay) but not painful when I walk.
Sorry Health, Kupat Cholim is not cheap unless you have Bituach Leumi, which you have to have properly arranged. I do not know if you can even arrange for kupat cholim without Bituach Leumi. It’s a bit of a complicated system. I have no idea why she has no insurance, as it is pretty basic over here and the law is that anyone who is here for over a year straight, with or without making aliyah, you can have Bituach Leumi and then kupat cholim.
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