John what happened to your toe? Well I abused it... I abused it...So a few hours at
a climbing gym in a very tight climbing shoe...
I think that it was, it was sore after that, but a few hours after that at home
I jammed it hard against a cabinet and that's... after the climbing... yeah that
wasn't enough abuse you had to... yeah so then I got home and took my regular shoe off
and my sock was all bloody and I've been changing out the bandages since then... And what we see is that
the nail is actually elevated by the blood that was underneath it there was
enough blood to separate the nail from its bed and so you're going to lose that
nail. The question is: is it going to be sooner or later? Well if we don't do anything
it's going to be catching on things... No I've been through that before and I just assume to get it done now
put your foot down and I'm going to spray some numbing spray. It kind of gets
both sides of the toe where the nerves come through
Here's a shot, sorry, in a sensitive place by the way. I don't feel anything like sharp pain...
Ok, you might hear as I get this... Still not hurting you huh?
And then I need to get a couple other nerves and we're going to use the 27
which is still a small needle but this one is longer allowing me to numb up the
nerves on the bottom side of the toe but accessing it from up here because it
hurts to get shot in the bottom. He's already numb up here so let's go
through where it's already numb. And I'm sorry I went a little bit too in. There we go
so i'm going to go
you're probably going to feel it again yeah
and it is sensitive down there, sorry
ok so with that I'm going to test for sensation
Can you feel a poke here or here?
What? No? It was like a tickle there but... Did you feel a poke here... I feel pressure... Pressure but it
wasn't sharp? No
What about here? Pressure. Am I hurting you?
No, just pressure
I'm going to separate the nail on the skin over the nail and that will allow us
some freedom of the nail
I'm not hurting you? Now it's a little more sensitive
I feel the tugging.Feel the tugging? Yeah, there's a lot of traction being applied
here. That's more sensitive?
How bad? Tolerable
ok
That hurts. That hurts? Yeah
This is the supplemental anesthetic locally
I'm giving you lots of anaesthetic. Now too much anesthetic puts people at risk for
seizures and heart arrhythmias. We're not using that much though, we're ok. We're
like half of the limit
When he starts stinging or seizing give him the rope that we talked...
The master and commander rope we talked about earlier. We probably won't put this
online... The seizure part... yeah. Can we edit the seizure out?
yeah. Ok now we're back
So let's look underneath here. All right John we got something for your
doggie bag here. So this will continue to heal and there will be a little bit of
oozing or bleeding
Keep an eye out for signs of infection if there's increasing redness or
swelling, red streaks up the leg, puss-discharge, fever or anything like
that, call me, but apart from that we'll just keep a loose dressing on it to
collect any drainage there is. It should be very little. Now you
you could also have a fracture of the very end of the toe, of the bone in there
but there's no different treatment for that other
than pain control, the recommendation for hard-soled shoe and you can take
over-the-counter pain medicines for that
Alright. So until next time this is John and Dr. Mark Vaughan telling you to stay
good health and don't smash your toe.