Toe Bro: Okay, go back-- yeah, let's see that piece again.
Yep,
woo.
Patient: That was the main piece that he pulled out and you can see how much it's bleeding - I got a blood pad
and that was right after and, by the time I was leaving, it was, like, three times that diameter.
TB: That-- that's a huge piece they got out.
P: Hm-mhm.
TB: But I’m really curious why it would come back so fast if--
if they got everything; that's what I’m really curious.
P: Well, they didn't do-- they didn't cauterize anything; they just ripped up the nail.
He pulled out all the little bits and then just--
TB: Because, this is the thing - even if you remove that much of the nail, if it's truly all gone, it should take
six months to a year for that whole space to fill up with a new nail so the fact that happened almost immediately;
I’m very curious to see what is inside.
P: Yeah.
"P: [winces in pain]
[winces in pain]
Some people just have a natural resistance to, uh, numbing?
Specialist: No, it's just that it's really hard to penetrate over here because of all of that stuff that's there.
P: Okay. S: So it's harder.
P: [winces in pain] Oh, there's a lot of shards of it.
[winces in pain]
I certainly felt that.
S: Yeah, it all came out. It's just stuff that will eventually kind of settle down on its own
if you just soak it in a lot of salt water baths.
P: Yeah.
S: They bleed a lot, unfortunately. P: Yeah, I know.
I ended up using vodka this morning to finally get it to stop bleeding because I ran out of rubbing alcohol.
S: [laughs] Can you do me a huge favor? I'm gonna take the [inaudible]
So, could you put a lot of pressure here, if you can? Just hold it tight and then I'll get my nurse to put a dressing on that, okay?
P: Okay."
TB: We gotta numb the toe, obviously. Is this side bothering you at all?
P: Nope. TB: Ever bothered you?
Because this is the one thing-- P: I'm not sure if it has, no.
TB: Because in the picture, I know both sides look pretty inflamed. The fact that your toe is going to be numb--
P: Yeah. TB: We normally charge $100 more to do extra and, like we said, we're going to worry about that another day.
If you ever want to do both sides now, you never have a chance to get an ingrown but if you feel
you do have problems because it is a little bit low and tight in there--
P: That's the thing - it hasn't grown-- that side of my nail hasn't grown in probably six months.
TB: Okay. So, if you feel comfortable and you've never had problems, we don't have to touch it; just this one.
P: Yeah. TB: So, to get this toe completely numb, we gotta do one injection on either side.
When you feel the pinching sting, don't pull away. What you can do is push your foot right into the chair if it hurts.
P: Flex my knee and just push down.
TB: Do you want me to tilt you further back or are you okay like this?
P: I'm okay like this.
TB: Okay, we do one side then we do the next, okay?
I’ve already wiped down the toe so we're ready to go for that little pinch.
P: Hm-mhm.
TB: And just a quick little pinch and then the sting and then goes away really quick, okay?
P: Okay.
TB: So here we go with our first little pinch.
Very good; and just breathe, just breathe.
Very good.
P: Oh... TB: You okay?
P: Yep, it's just that tight feeling. TB: Yeah, it's not a fun feeling but--
P: No, cause I-- when I took the really bad chunk out, I'd say about a month ago on my own--
TB: Yeah.
P: I actually did it using a nerve block and some morphine that I had--
TB: What?! P: -- in the emergency medical.
TB: I got you to start working here and helping me out.
P: [laughs] TB: [laughs]
P: Yeah, I have-- TB: Any pain right now?
P: Nope, just a very tight sensation. TB: That pressure.
P: Though, as I should point out, it also never hurts right now unless something bumps it which is why I’ve been able to work on it.
TB: But how's the injection? Not bothering you right now, right?
P: No, a little, like, sharp but not-- I wouldn't say painful.
TB: Very good.
Okay, we got one more side, okay?
So, one last pinch - here we go - this side's gonna be a little crappy.
P: Oh... TB: Oh, I know, I know. I’m sorry.
It'll go down pretty quick. You okay?
P: Yep.
TB: Very good. Just breathe through it--
P: I'm no stranger to needles; I gotta get blood drawns done once every two months
and they take twelve vials of blood, so-- TB: Oh.
P: So, I’m obviously no stranger to needles and for ever--
TB: You're feeding all the vampires here in Mississauga.
P: [laughs]
TB: Any pain here?
P: Nope. TB: It's already gone down, right?
P: Yeah.
TB: Okay.
So, how was this injection versus the hospital? Any different?
P: Ugh, f-ck, way better.
TB: [laughs] What was the difference? P: He missed twice the first time.
TB: Well, the toes are jumpy, they like to jump on ya. How's that? Pretty good? Easy?
P: Yeah. TB: Not bad at all, right?
P: No. TB: So, I’m going to set up a tray. Before we start, we'll test the whole toe to make sure it's completely numb.
P: Yeah. TB: Once we know the toe is numb, then we start because you shouldn't feel anything.
P: I shouldn't be screaming-- TB: No, you shouldn't be screaming.
P: --like I'm getting my teeth ripped out. TB: Like I said, you can still swear at me if you like it but you shouldn't be--
P: I should be fine. TB: --screaming out of pain, yeah. Just because you don't like me, that's all.
[laughs] P: [laughs]
TB: I’m just gonna wipe down the toe and the first thing we're gonna do is we're gonna put on that rubber band
and the tourniquet so that there's very little to no bleeding so I can see everything clearly.
P: Yeah, I love how the other guy put a tourniquet on it and my toe bled like crazy.
TB: Well, he did the, like, a little-- a thin little one, right?
Did he wrap up the toe or just put it right at the base from the beginning?
Patient's Companion: Yeah, did he, like, roll it up? P: I don't think--- I don't know, I think he just did it at the base and just went, like, one-two times.
C: Like a rubber band? TB: Yeah.
P: Yeah.
I mean, like, start to finish, the whole thing he was done in ten minutes-15 minutes.
So, like, he just stuck the needle in, froze the toe and didn't do anything to, like, make sure it was frozen really. He literally just went--
C: I guess the freezing took longer because he, like, went through your toe and all that other stuff, so--
TB: So, we're gonna do one last little check.
Anything sharp here?
P: No.
TB: Anything sharp here? P: No.
TB: Anything-- let me get it under. Here?
P: No.
TB: Okay.
And you know what? That is ridiculous-- so, you-- I saw the video; there's a huge piece he took out
but this nail is still so wide-- I know how you're so close. You see the edge of this nail?
P: It was-- C: Oh, oh, oh. TB: Oh, try not to touch it, yeah, I know.
P: It was-- uhm,
can you see the-- the groove in it? The vertical line?
TB: No, so, see, the-- the nail's been cut back-- I'll find the edge of the nail for us.
No, look--
P: Holy sh-t. Oh my God.
TB: I don't know what he-- I don't know what's in that video.
P: He cut it back, uhm-- TB: [laughs]
C: When was this done?
P: Three months ago. C: Oh, okay.
TB: It's not fast enough for a nail to grow all that way.
P: And here's the thing though -
I’m gonna-- see-- okay, see where the little red bit on the tip of my toe is?
TB: Yeah.
P: That-- yeah, that little bit you just wiped; draw a line straight back to the root from that line - that's what he actually removed.
TB: That were-- P: Yeah.
TB: I’m gonna take a little bit more just to be safer and give you more space.
P: Like, it grew back super, super fast to the point where I was like, "how is this normal?"
TB: Well, you said you wanted to come here because you saw me do one in normal conversation
- now we're doing the same thing. [laughs] P: I’m not feeling anything and he-- at this point, I was screaming.
TB: Okay, so, you can see the edge of my tool is against the edge of the skin so whatever you're left of it, is what's still in the nail.
So,
still a wide amount but I think the problem is
just the amount of hypergranulation tissue. The wound, without antibiotics, it just trapped the nail all over again.
P: Yeah, and, like I said, like, the chunk that grew out-- that he pulled out originally was a bit wider than that.
He cut it about where you did; I want to say not quite as far in, right?
But it grew back way faster than I expected.
Like, it grew back so fast, I was like-- but, then again, I heal from wounds-- like, my appendectomy--
C: Yeah.
P: --they originally told me it was gonna be six to ten weeks before I could, like, bend down, touch my toes, etc., without a lot of pain.
It was, like, three weeks.
TB: So, basically, you are wolverine.
P: I have really rapid-- yeah. TB: [laughs]
P: My dad's the same, my mom's the same.
TB: Okay, let's take a good look at this.
So, the nail was going all the way this wide before so you can see the gash here.
P: Yeah.
TB: And that's how deep the nail was going before; all the way down here.
C: My God.
P: There's a little white chunk there. TB: So, this is that
damaged tissue in the past that was trying to heal.
P: Okay.
TB: It's not nail, it's just damaged. But, so, I think what happened with the last procedure - there's probably a lot of damage to the nail bed itself.
P: Well, like, he's-- like, he was ripping little bits out like that
and pulled probably 30 little chunks out of my nail. Like-- like, he had to cut it, like, four or five times.
C: Right. P: So, I think he ended up chopping the nail into little bits and then stabbing it into my-- into the nail bed.
TB: So, that will fill up with completely normal tissue
and no more nail in that corner.
P: Delightful. TB: Just like that.
That's the only thing that they have to do afterwards.
P: Yeah.
TB: But, again, a new nail-- a new nail, from start to finish, we always say one year
but for a healthy person - it's six months. C: Yeah.
TB: So, you've only been two to three months; there's no way, if they trimmed
that huge piece, that it grew back to the top. So, I’m just curious, like-- and I saw the piece in the video, it's-- it's huge.
I-- I don't-- it's crazy. I don't know what the heck happened.
C: I wanna see it.
P: Well, how long does-- how long does, like, something, like, say, your thumbnail take to grow back?
TB: From bottom to top? Maybe three months.
C: Fingers is faster.
P: Okay, because I lost my thumbnail about a year and a half ago and it was, like, to here
and I want to say, like, three-four weeks.
C: Oh, wow.
That's fast.
TB: Female wolverine. C: [laughs]
P: Yet my hair, of course, knowing my luck, the one thing I do want to grow out, it grows, like, half a centimetre.
TB: Oh, you-- you preach-- you preach to me, that's right, you tell me. I feel ya. C: [laughs]
P: It was devastating. [inaudible]-- and then I went to the salon to get it faded from purple into black--
C: Yeah, yeah. P: --and it knocked off, like, eight inches of my hair.
It's been three years, I’ve only regained three inches.
C: What is your natural hair color? The brownish?
P: Yeah, like-- C: Yeah, yeah, yeah.
P: So, yeah, it melted off, like, eight-- eight to nine inches in my hair.
TB: Hey, hey, ladies, we're-- we're talking about toes today.
C: [laughs] P: [laughs] TB: Today's toe talk, not hair talk. You're making me jealous.
So-- [laughs] C: [laughs]
TB: You see-- C: So many questions.
TB: You see the difference?
P: Yeah. TB: Different procedure, right?
And no pain? P: None. Oh, this is great.
TB: [laughs]
At least I don't have to bleep out all your swear words at me during this, it'll be good; just earlier. [laughs]
So, we're just going to do this one extra time to be really sure but this acid basically floods this area, stops these nail cells from coming back.
That whole pocket will fill up with fresh granulation tissue--
P: But no pain. TB: --and it'll stop, yeah, it'll stop.
It won't become this hyper granulation tissue which fills in the spot.
The difference - I am going to give you a course of antibiotics orally because when I went-- when I went in, there was a little bit of some pus
so it's better for us to just really hit it hard with an oral antibiotic and we're still going to
give you a prescription for a topical antibiotic and this will really shrink that side of the tissue.
P: All right.
TB: And that's it, okay? So, you're going to be dressing this morning and night with an antibiotic cream.
P: Okay. TB: For one week and then the second week we switch to that brown liquid - iodine.
P: How-- how much wrapping do I have to put on it?
TB: Whatever you feel comfortable. Because you're working in a-- in a shop or loca-- you might want to put
a couple pieces of gauze on top to give you a little bit more protection.
P: Yeah, but I’m thinking if I can keep it to, like, the thickness of one of those gauze pads as a wrap
or, like, do one gauze pad on it and then medical tape;
that's enough that I can still fit it into the same shoes that I wore here today
because these are the only shoes that I’ve been able to wear that don't make my feet hurt.
C: Yeah, that should be so.
TB: There you go.
So, for the camera's sake, in your own video, we'll take one last look. P: [laughs]
TB: When did you first find the Toe Bro videos?
P: I don't know. I want to say probably back-- just before I went to the hospital, it was when I first found it but I first, like, really started looking at the videos
after he botched it and after I was going through so much pain, I’m just like, "I thought this was supposed to be painless."
TB: Oof. C: Nice.
P: That's a nice chunk.
TB: Yeah, it's-- and I still can't believe the video of what they did take out. So,
this is what you're gonna do - so, you're gonna take the antibiotic,
you're gonna plop it on
and I’m gonna put a little bit more.
Now, because of the big pocket, if it bleeds and it bleeds through - not a problem. Just
take everything off and put a new dressing on. I normally do four pieces of gauze
but you might want to try the two or three, just like you said, make it feel a little bit more comfortable.
P: Yeah. Yeah, cause I-- I have to stand, like, I'd say, on average, I only really work six-hours a day
because of fibromyalgia and back problems but, in general, when I’m actually
working with stuff, I'd say I spent probably an hour and a half-two and a half hours a day, like, crouched down
working on, like, the bottom of the bumper or something, so, like, I’m bent down on my toes.
TB: Okay. So, I know it's a little bit big but we'll leave this for tonight.
Tomorrow morning, what you can do - you can shower with this on, take everything off and redo the dressing.
I’m gonna give you a little print out of all the instructions so you know how to dress it yourself, okay?
P: Sounds good. TB: But there it is - that was the whole thing.
P: Awesome.
TB: Any last words?
With a-- for anyone else with ingrown toenails?
P: Oh, the lack of pain makes every dollar that this is going to cost worth it.
TB: [laughs] That's right.
P: After you go through that much pain the first time, you'll spend anything.
TB: Yeah, I-- that was way too much, that was way too much.