TB: Okay.
So, what's gonna happen,
let me just make sure everything is set.
On the count of three,
you're going to feel a pinch
and a sting.
If you feel like moving your foot, don't;
just push your heel
just down, straight down like that, ok?
So I'm going to wipe down the toe and see how tough you are
Patient: Alright
TB: Are you going to show Brian this?
Patient: Yeah for sure
he was like "you better live stream it"
and I'm like "Ahh I don't know about that"
TB: I'm just wiping the toe.
Pinch on three, not too bad, ok?
P: Ok
TB: So here we go
On 3
One
two
three
That's the pinch
and a sting.
You ok?
P: I didn't feel it
I'm just kidding
TB: It's not too bad
So here we're going to
bottom part of the toe, you ok?
P: Yep!
TB: A little sore here?
You ok?
P: Yep!
TB: Little sore huh?
P: Ooo that's a tough– that's hurting now
TB: Yeah.
You got a wide toe, man
P: Thank you.
TB: You ok here?
P: Yep!
TB: Gone down the pain?
P: Yep.
TB: How about now, any pain?
P: Nope
TB: Yeah, it was a wide toe, the bone was much wider than I thought
but you're ok, you made it.
P: Cool.
TB: What's up, Brian?
Any pain right now?
P: No
TB: It wasn't too bad, right?
P: No it was alright
Except when...two seconds there I was like ahh.
TB: So actually when you go slow it's better.
P: Yeah? TB: Yeah.
TB: Because is there any pain right now?
P: No TB: No
It's just that initial pinch and a sting.
So I'm just really making sure this side is going to be numb.
So that was the harder side to be honest.
So one more side and the whole toe will be numb, ok?
So another pinch on three.
One
two
three
You ok?
P: Mhm
TB: This side should be a little bit easier for you.
You ok?
P: Yep
TB: Yeah man, you're a tough guy!
I do this everyday; you're doing very well.
P: Thank you.
P: You're very caring, I like that, checking in with me.
TB: You have to.
Any pain right now?
P: Nope
Do you usually get a lot of people that squirm?
TB: Mhm
But it's just the initial pinch like you said.
P: Yeah.
TB: So that's why I have to hold on to the toe
for dear life
because if they flex and they move
and if you're not holding on to the toe, the needle will go right through the toe.
P: Oh, okay.
TB: That was it; that was the hardest part,
P: That's it, ay?
TB: Yeah.
P: Oh, man!
TB: So what's gonna happen,
I'm gonna set up, bring in a tray, set everything up,
P: Yeah.
TB: And we test the freezing to make sure the toe is completely numb.
P: Yeah.
TB: And then once we know the toe is numb, off we go.
P: Awesome!
TB: Okay, so what we're going to do, John, we're just to test the freezing to make sure it is completely numb.
P: Okay.
TB: So I'm going to use a little bit of a toothpick, something sharp...
P: Sure.
TB: I'm going to touch the top of your foot, to see if you can feel how sharp it is, then we'll touch the toe.
Pressure is normal but you shouldn't feel anything sharp.
P: Okay.
TB: So if you look, I'm just touching my hand; something sharp.
P: Yeah .
TB: I'm going to touch the top that foot over here.
P: Ooh!
TB: Sharp?
P: That's sharp!
TB: Okay. Do you feel anything sharp here?
P: No.
TB: Pressure is normal...
P: Yeah.
TB: But nothing sharp. Anything sharp here?
P: No.
TB: Here?
P: Nothing. No nothing, man.
That's awesome!
TB: Here?
P: No. No.
TB: Nothing sharp?
P: No.
TB: How about here?
P: No, I'm good, man.
TB: Nothing sharp? P: Nothing.
TB: Nothing?
P: No.
TB: Can you feel this?
P: Yeah! (laughter)
TB: Okay, you're numb.
P: That's crazy!
TB: That was the hard part. So we'll put the foot here. We're good.
P: Okay.
TB: You keep filming. I'll set mine up,
I'll put on the good gloves, then off we go.
TB: Yeah, that was the hardest part; just the freezing.
just the freezing.
P: It was a piece of cake.
TB: A piece of cake.
P: You just watch for all that blood splatter, though.
TB: That's right! (laughter)
P: I'll just keep it shut!
TB: No, but that's why a lot of people come in and I'm used to doing this last minute procedure.
P: Yeah.
TB: I'll get calls late nights, weekends and we get people in within like 24 to 48 hours at the clinic.
P: Really?
TB: Yeah.
P: That's a quick turnaround!
TB: Yeah, we sneak people in right away so.
I don't double book but I put people in between
and I make sure people get in and out. yeah
P: Yeah. How long does this usually take per patient?
TB: From start to finish, maybe 20 minutes for a new patient 25 minutes.
P: Okay.
TB: How long have you been in here? Not even that long, right?
P: Yeah, about 10 minutes.
TB: Yeah. So we already did the freezing. I set everything up. So what we're doing, we're putting on the
tourniquet. This is a rubber band and
it's pushing out the blood so there's very
little to no blood during the procedure and the reason we're doing that is to
stop first of all blood flow, so I can see everything clearly, and number two
that acid that we're using to stop the nail from growing back you need to be in a bloodless
field. If there's too much blood, it will actually dilute the acid.
P: Okay.
TB: So that's why if you see, if you ever YouTube other surgeries and its really bloody, no good.
The acid won't work and then the nail might grow back and then they might have a
new ingrown all over again.
P: Okay.
TB: So, pressure is normal. You shouldn't
feel anything sharp.
P: Okay.
TB: So you let me know if you feel something that doesn't
feel right.
P: Will do.
TB: So this is betadine. It's an antibacterial ointment just to clean the
area up. I'm gonna write you a prescription for a cream for the first
week, and then after the week, you're gonna use this brown liquid.
P: Okay.
TB: Okay. So we're gonna do a little test first.
Do you feel anything sharp?
P: No.
TB: Here? Anything sharp?
P: No
TB: How about here? Anything sharp?
P: No, sir.
TB: Down here?
P: No. You're ready to get in there too! (laughter)
TB: Yeah, I'm right in there.
TB: No pain?
P: No.
P: OMG! Oh my! No way!
TB: So we separated the nail from the nail
bed and I'm actually just trimming that nail that's a little bit curved.
TB: Good?
P: Yeah.
TB: Not grossed out yet?
P:That's pretty ____ to watch!
TB: So you see the piece of nail is
only the width of that front hemostat?
P: Yeah.
TB: That tool?
P: Oh man! Wow!
TB: You see that? So see how wide that piece is?
P: And that's the ingrown nail.
TB: But look at how wide the nail is.
P: Yeah.
TB: So it was really ingrown!
P: I had no idea!
TB: Here, let me just to see so everyone can see, look at that! See the hole? And look at the nail.
P: Oh man!
TB: You never knew that, uh?
P: No! I did not even realize that one bit.
TB: So I'm just checking to make sure all the nails is gone.
So this is a straight edge, good. making sure nothing's left behind.
So, that's just dead skin we'll clean up.
TB: Huge piece of the nail!
P: That's massive!
TB: Yep.
And there's really no blood.
P: Perfect procedure, doctor.
TB: Just call me "Jonathan", no "doctor".
P: Okay, Jonathan.
TB: I hope I pushed record on that thing! Do you know I mean times like I've started I was like oh shoot!
I'm not recording. So, no blood at all.
P: Oh man!
TB: Now the fun part!
We apply the acid a few times.
That's gonna stop the nail from ever back.
There you go: shish kabbabed toe. (laughter)
For the long weekend!
P: Great!
TB: So anytime you have barbecue, you can think about your toe!
P: Perfect!
TB: That is a huge piece!
P: Yeah, that is something I never thought I would see in there!
How long do you think that's been growing in there?
TB: A long time.
P: Yeah?
TB: Yeah. You can take a closer...I'll get it.
P: Holy cow!
TB: Huge!
P: Yeah!
TB: Good?
P: I'm good.
TB: No pain, right?
P: No. I didn't feel anything.
TB: So I do this every day.
P: Everyday?
TB: Everyday.
My record is seven in one day.
P: Really?
TB: Yeah, it's pretty interesting and you know,
P: That's crazy, man!
That is crazy!
P: The life of The Toe Bro! (laughter)
TB: That's why you haven't been seeing me in the gym! I've been cutting too many damn thick ass nails.
TB: I didn't see you last week I was going and you weren't there.
P: I didn't go at all last week, man, we switched.
TB: That's right, you're going this week and I said I don't want to look so tiny
next to this big ass guy so I mean it's gonna wait till he's takes a week off.
Just a little bit some dead skin.
We give it one more round and that's it.
P: Okay!
TB: That's like the whole procedure.
P: Wow, man. That was actually way better.
TB: Better than what you thought. And you see how wide
the nail is?
P: Yeah.
TB: That's how wide your nail is gonna be for the rest of your
life. I'll show you once I just push this in the skin in you'll see how it's gonna
look when it closes up. There's gonna be not too much of a difference.
P: Okay, cool.
TB: So I'm going away for a week, Sunday. Normally we do a one week follow-up,
P: Okay.
TB: So I'll get you to send me a picture to my email so I'll tell you how everything
is doing if it's looking good or not.
P: Okay.
TB: I'll write you a prescription for
an oral antibiotic just in case you need to take it but you should be good with
the cream antibiotic that I gave you, okay? So if you look here, this is what
the it'll look like afterwards.
P: That's pretty normal.
TB: Yeah, really no different. So I'm using alcohol now to just neutralize that acid
that I used so the reaction stops. You can see it's pretty damn clean.
P: Thanks.
TB: That's one clean-looking toe.
So you're just gonna put this cream just like that, okay?
P: Okay.
TB: So the first couple
days, what I would suggest you do is you use two or three pieces of gauze,
P: Yeah.
TB: With the cream just like this and then you use this wrap and you're just gonna
wrap it once or twice around.
P: Okay.
TB: I'm gonna put it on a little bit more today
just to reduce any sort of swelling or bleeding,
P: Okay.
TB: But for you three pieces
of gauze. Wrap it once or twice around and you're good to go.
P: Perfect.
TB: Thank you for the help, monkey toes!
I think you're pretty shocked right now.
P: I don't even know what to say, man.
TB: Yeah, you look pretty shocked.
P: That was pretty epic though. That was crazy!
TB: There you go. That's it.
P: That was cool, that was awesome! Thank you!
TB: That was everything. So freezing is gonna last 10 to 12 hours.
P: Okay.
TB: You should be good for tonight. Once we're done with the video, I'll give you all the
instructions, I'll give you a printout too. I'll give you a little take home baggy
with everything you need to dress the toe. The only thing you need to get is
the antibiotic cream tonight, okay?
P: Perfect! Thank you!
TB: All done.
P: Man! You're awesome!
TB: Thanks!