P: Oh, look at the poor little thing.
TB: Oh, now you're feeling bad for this thing? See how sweet you are? You're feeling bad? (laughter)
P: It's so nailless!
(music)
Patient: No, it's because it lifted it got worse.
I guess it was kind of like redamaged.
TB: Okay.
P: It looked different.
TB: Yeah.
P: And it turned. When it was going straight,
I could kind of manage around it. I could cut it.
TB: Your doctor actually gave you the referral to see was it a plastic surgeon or dermatologist?
For this nail?
P: A general surgeon.
TB: A general surgeon, okay.
P: So then I started worried about that.
TB: Yes.
P: How would a general surgeon do that?
TB: I'm not too sure
P: Not often.
TB: I'm not too sure. So that's why, like I said, two simple options:
we trim the nail back on a regular basis. Today would be the hardest time. Once we get it short and thin,
maintenance is easy. Nothing to be worried about just a little quick buff every couple months.
It's only because no one was able to cut it that that's why it grew so long.
So we just do routine treatment or like we discussed earlier
we remove the toenail permanently, which is also something that a general surgeon will probably suggest.
P: Yes.
TB: Okay, but like I said, no antifungal medicine, no oral medication, no nail polish is going to fix this toenail ever again.
It's been damaged and this damage is a permanent change.
P: Right.
TB: Okay?
P: Yep.
TB: So the fun part.
P: Oohhh.
TB: The easy part nothing to be nervous about.
P: Really?
TB: So all I'm doing...
P: I can't even have a pedicure. How can I survive?
TB: No, it's nothing bad so,
little by little, if something's a little sensitive, you let me know but we just basically trim the nail back and file it down.
It's dead nail so we're gonna trim as much of this lifted nail as possible.
P: Okay. I think the only part that hurts is when it lifts off the...
TB: Okay. Oh, you are exactly right when it lifts.
So that's why we got the right clippers and tools to trim this baby down.
P: That looks like something you would use on a horse's hoof.
Which is pretty much what this is now.
TB: No, no, no!
P: That's what the doctor said that looks like bone or a horn!
That's what she said! It is like a horn.
TB: Well, do you know what we used to call this? A ram's horn.
P: Ah, well that is what it looks like.
TB: It looks very similar, doesn't it?
So we go nice and slow piece by piece, okay?
P: Yeah.
TB: So your doctor did refer other patients for this exact same thing. It's very common and...
P: A friend of mine dropped a whole bunch of pans on her toe
and she's very vain about her toes like she wants them beautiful all the time,
which doesn't matter to me, but anyway
she was told that what you told me that the nail wouldn't grow back if it was removed
and so she's been going to her pedicurist to have it
fixed and actually she's done a very good job with it
which is astounding but it's what you say it's a maintenance thing.
TB: It's a maintenance thing. It's a maintenance thing.
So a lot of people
always say in my videos that I should be filing this first before trimming it but the truth is the file would take too long
and it's just
P: Because it's so thick.
TB: Yes, so the best thing is for me to trim this as much as I can, get down as much as a thickness on top,
and then the file to finish it off.
P: Right.
TB: Plus this is my workout for the day! I need to get some exercise.
P: Yeah, it's good you're strong!
That's the other thing. I have rheumatoid arthritis and I can't get a good grip!
TB: And you know it, feet aren't close at all.
P: No.
TB: So that makes it...
P: That's the other thing they're easy to ignore because they're far away.
TB: So sorry if it gets a little sensitive. You're okay?
P: Yeah, I'm good.
TB: So the nail is lifted because it's completely dead underneath. It's not attached only attached here and
that's why as you say when the nail gets lifted, it pulls on the nail bed. That's what hurts.
P: I know. Do you think that makes it easier to remove?
TB: Yes.
The truth is when you're numb,
you don't feel anything and since we would be permanently removing it we can just pull the nail right out.
P: Is this something, you wouldn't be going through all this if you were removing it though, right?
TB: No, we wouldn't go through this. If you were numb and I wanted to remove it, we just numb the toe and pull the toenail.
P: uuhhh!
TB: Sounds like fun, doesn't it?
P: It sounds terrible!
That's the other reason I put this off because Dr. Mathers told me pretty much what would be done.
What?!
TB: I know it sounds a lot scarier than it really is.
P: Yes and I have a phobia about my feet, I don't know why.
TB: You got great feet! You just have this like we said bad nail, one bad nail to spoil the whole world, huh
P: One bad apple.
It's going to be wonderful not having that growing in my toe.
TB: Yes, that poor second toe was taking a beating.
P: Yeah it was. I've been wearing bandaids on it to try to protect it.
TB: And again if it gets a little sore, you let me know.
P: That hurt a bit.
TB: Okay, I'm so sorry there. Little by little, okay?
P: Yeah.
TB: We'll just take a smaller piece and
the problem is because it's lifted, it it's moving so much.
That's why I'm trying to hold the nail still while I
P: Right.
TB: Trim this baby.
P: I could not do your job! I hate feet!
TB: Yeah, a lot of people do but this is something I grew up watching my dad do, look at that nice piece!
P: Ohhh!
TB: You know my dad did this for 30 years?
P: Oh did he?
TB: And my job as a little baby kid was to take off their shoes and socks for the patients.
P: Ah!
TB: And look at that! I told you I hated it
because I was like you feet are gross!
P: But you learn to put up with them.
TB: Yes.
P: Oh my word! Look at that poor sucker!
TB: You begin to
see how much people need the help and how helpful this service can be so it's really rewarding.
P: Well, that's true. That is true.
TB: Like I'm excited for you to see you walk out of here. You're gonna be a new woman!
P: Well that's the other thing. A surgeon wouldn't go this...they wouldn't know how to do this. They wouldn't have the stuff.
Oh, look at the poor little thing!
TB: Oh, now you're feeling bad for this thing?
See how sweet you are? You're feeling bad for him!
P: It's so nailless!
TB: See.
P: It looks like a little baby!
TB: See how sweet you are?
P: Holy! So now
do I need to put some protection on that since...
TB: No, usually no, no.
P: It's already toughened up underneath there?
TB: That is exactly it.
Are you doing okay?
P: Yeah.
You're pretty good at this.
TB: I try. Thank you, that's sweet of you to say. Well, I try. I'm just cutting a toenail.
It's not my first toenail, it's not my last, so.
P: Well that's the other thing. My cousin said don't go to a surgeon,
go to a chiropodist
because she had her
what do you call it?
TB: Bunions?
P: No that other thing.
TB: Hammertoes?
P: Yeah hammer toes done and her sister had hers done at the same time.
Her sister went to a surgeon and she went to a chiropodist and paid a lot of money to have it done.
But she walked out and was fine and my cousin other cousin is still having trouble with it years later.
So she convinced me to come here.
TB: You okay?
P: Yeah
TB: So the reason why it was little reddish in the corner was dry blood.
There were so much pressure the nail might have lifted in the past that we probably got some...
P: I know it lifted one night.
because I was crawling into bed and got it caught in the sheet and that's when it turned.
TB: You okay?
P: Yeah.
I shouldn't watch but I can't help myself. (TB laughs)
TB: You just can't help it, uh?
P: I know I can't watch. I was at the dentist yesterday. I'm having a torturous week.
I couldn't watch that.
TB: Well, I'm getting
near to the end and I've made it relatively flat.
P: Yeah.
TB: And we'll have the nice finish here with the file.
This is all dead skin in this corner.
P: Poor toe!
TB: I think you're feeling bad for him now.
P: Well it just looks so bare.
TB: See, he's on a diet! He's just on a diet. We're making him nice and thin today.
P: Does your dad still work or is he...
TB: No, he's off, he's left all the fun for me.
P: Yeah.
TB: Yeah.
P: Did you take over his practice?
TB: Mm-hmm.
P: Oh, that's nice.
TB: So when I finish, I'll put the foot down for a second, when I finished school, five and a half years ago,
he said okay, have fun.
P: It's yours now.
TB: So I've been on my own, since I started school.
P: Wow. How nice.
TB: Yeah, it was it was good.
P: He must be very proud.
TB: I think he's a little old school, where you know, they just say, okay good job, and they just let you be they don't say too much.
P: Yeah.
TB: So this is the fun part.
P: Oh, you said that about the other part and it wasn't fun.
TB: I think everything is fun for me then and for you.
So what we do is we're just gonna file the nail nice and thin.
Okay?
P: Yes.
TB: There should be no pain. There should be no heat.
If you feel something that is a little hot or sensitive, you let me know but really you shouldn't feel anything.
Okay, here we go. So you just relax your foot. There's gonna be a little bit of water to keep the toe nice and cool.
Look at those big eyes!
P: You scared me but I'm alright I'm alright.
TB: Look you did the hardest hardest part was cutting.
P: Yeah.
TB: Yeah, this is the easier part. Okay ready?
P: Yeah.
TB: Okay.
TB: When the surgeon sees your toenail, he's gonna think what what are you coming in for? There's nothing bad.
P: Yeah well you know it's not something...(?)
TB: So today I'm gonna try to file down as much as I can and this is going to give you
relief for as long as possible.
P: Right.
TB: You okay?
P: Yes.
TB: No pain?
P: A little bit.
TB: Sensitive would you say? Is it the vibration?
P: I guess.
TB: Okay, if something hurts, you let me know.
P: Yeah.
TB: All we're doing is just filing down the toenail.
You okay still?
P: Yeah.
TB: Well, you're doing very well; we're almost there.
TB: I know, I know this side is sensitive for you, okay? I'll just go nice and easy.
I think it's sensitive because that's where we had the nail lift with the dry blood. So...
P: I don't mean to jump but it's so...
TB: That's okay, that's okay. Again, if something's too sensitive then that's all we can do.
P: Ooh, it hurts a lot.
TB: It hurts on this corner?
P: Yeah.
TB: Okay. So I'm gonna leave that corner alone.
What I have a feeling is now that it's free, when we come back in the next couple months, it won't be so sensitive, okay?
P: Yeah, it will grow back better.
TB: Yeah, it just feels a little sensitive on that side so we'll leave it.
P: Right. When did you say? In a few months?
TB: In a few months, we should be coming back
like I said every couple months, every few months, to have this done over and over so the nail never gets long again.
P: Right.
TB: You okay?
P: Yeah.
TB: Okay, okay you survived.
P: I did.
TB: You survived so
you can see there's still some old nail left behind here, but you see there's a line of red?
P: Yeah.
TB: That's dry blood. So that's probably where you had that injury where the nail got lifted.
The nail is really thick but that's all that's attached. You see this front part?
P: Yeah.
TB: There's no nail at all.
The nail bed is completely scarred and hard and that's why the nail can't reattach.
That's why once it gets over that part, it starts to do funky things. It starts to turn and starts to get very thick.
P: It has nowhere to go.
TB: No, so what would happen if we were to do the surgery, I give you two small needles on either side of the toe.
The toe is completely numb. We remove this remaining piece of nail,
I apply an acid underneath the cuticle, and that would stop any nail from completely coming back. Okay?
So now, this is the shortest we can get it because it's getting a little sensitive for you.
We just come in every couple months to maintain it this length.
P: Yes, okay.
TB: The moment you let the nail grow too long, it's going to grow lifted, detached, and thick.
P: So what do I do? Nothing?
TB: Nothing. Okay?
P: That can just remain open?
TB: Like that.
TB: Yes, there is, let me wipe the foot, there is no cut, there is no blood, there is no open sore.
P: As you said, it's hardened up under there.
TB: Yep, that's the shortest we're going to get because it's getting a little sensitive for you.
So, that's the nail now.
P: Oh my gosh. That looks so much better. You know it looks weird!
TB: It might look weird but it looks better.
It looks better because at least now we don't have a thickened toenail like before.
Okay, so that's the best that we can do.
P: So that's not sensitive now? I don't have to wear open-toed shoes?
TB: No, you can do it you can wear anything you want, okay?
P: Okay! Yeah! Oh!
TB: You made it!
Congratulations, there you go.
P: I'm so happy! I didn't think I would be happy! I thought I would be miserable.
TB: There we go.
P: It looks good!
TB: I'm happy.