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03/14/2014 Wm. Barry Turner, BSN, DPM
Using Nitropaste to Increase Blood Flow (Robert Bijak, DPM)
In response to Dr Bijak's "slam" on my nitroglycerin paste protocol, I am familiar with his rude responses and judgmental behavior that is so typical for him. I will try not to take it personal. I am fairly certain in my description of my protocol using nitroglycerin paste, that I presented both sides of the discussion using this particular modality. I mentioned that the medication had a dangerous potential and cited my experience of using it on a 90-year old patient, with low body weight.
I had a similar event of hypovolemia while treating a patient when I was a cardiac nurse. That incidence dosing was a full inch, applied directly over the heart. That time was under the direction of a cardiologist while I was working in a Cardiac Cath Lab. The time I used it on that "little old lady" in my office was in an attempt to save her foot. She died shortly after the amputation. That was over twenty years ago and yes I learned from the incident. I have saved literally hundreds of limbs using that technique since then. Not one person has died.
I believe that I mentioned that I had tried to do a study, but could not find any sponsors, so I recorded my experience and presented it just as that, "my experiences","my protocol".
I believe that I commented on hearing about a study, but was unable to verify it.
This medication in your hands might very well cause an MI or hypovolemic shock, but not by anyone that uses the protocol I described. I used a cardiologist to help me develop that protocol. I doubt your cardiac vascular knowledge and experience are in any way equal to mine. That is why I put together a protocol.
As far as scope of practice, I practice in Georgia. Dr. Bijak is correct what is legal in Georgia may not necessarily be legal where you practice. Regarding my practicing outside my scope of practice, I am not. Did I mention I served a decade on the Georgia State Podiatric Board? How long did Dr. Bijak serve on his state board? His statement regarding that the prescription of nitroglycerin possibly being outside the scope of practice of a podiatric physician supports my doubts regarding his knowledge of his own state's scope of practice act. I am very aware of my state's practice act. Did I mention I was the first podiatrist in Georgia to be allowed to supervise and bill for full body hyperbaric oxygen therapy when treating lower limb pathology.
My critical care experience as a RN and my over all medical background are extensive, starting with my combat medic training during the Vietnam War. I spent over five years working as a "hot shot" agency nurse in South Florida. While I was attending podiatry school, I worked in almost every ICU/MICU/SICU/CCU in the Miami/Ft. Lauderdale area. Using my knowledge to enhance my podiatric training, is just that, enhancing my ability to treat my patients within my scope of training and my state delegated restrictions.
I do not remember telling anyone to practice outside their scope of practice. Did your residency teach you how to do ankle surgery, or fix tibial-fibula fractures? Are you allowed to perform those procedures in your state? Did having the knowledge hurt you, even if you can not perform these procedures in your practice?
I understand the need for verifiable studies. I am a firm believer that testimonies are refutable and need to be verified by studies.
How many lawsuits have you had? Hmm. I have never been sued and I have practiced for over 24 years. I have people come from all over for my wound care, as I get some pretty impress results.
Do I sometimes push the envelope? Never without doing due diligence; contacting various specialist, review of literature and incorporating knowledge with common sense.
I am unsure why your ego made you feel that you needed to attack me in a less than professional manner, but I have followed your writings in the past and I am neither surprised or impressed.
Sir, when you are ready to give all to your patients, you may some day become a physician for your patients. I am willing to look outside the "box" in my attempts to heal my patients. No subterfuge. I am up front and tell them their options. I encourage second opinions.
One final word, if I might provide Dr. Bijak with a lesson in professionalism. When you disagree with other professionals, it would be more proper to contact them at their provided email address, instead of being pompous and acting like you are the moral authority of our profession. Dr. Bijak's behavior is embarrassing for our profession, or any profession for that matter.
Wm. Barry Turner, BSN, DPM, Royston, GA, claret32853@ymail.com
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