TB: If not, you come here. See, see all this?
Daughter: Yeah. Wow! Holy cow!
TB: It's just dead skin.
(music)
TB: There we go. So like I said, we trim all the nails and the fun one is that last one.
D: Sure.
TB: But his nails are normal so when you go back, when he sees the foot care nurse at the home,
she can take care of this.
D: Sure. Just a regular check up?
TB: Yes, but every couple months we come in for the big thick toenail.
D: Sure. Yeah.
TB: Okay.
D: It's funny, they just assumed it was fungus. There was never like...
TB: Again, it could be some fungus in there, but the real problem is the thickness of the toenail;
that's what's causing pain
and unfortunately once the toenail gets thick, it's always gonna be thick.
D: That (medication?) was very expensive.
TB: It's very expensive.
D: But I thought we would try it for a year just to see if it makes a difference.
They say you have to use it a minimum of one year.
TB: Yes and again,
if there's true fungus, it might help with the fungus, but it's not going to make the nail thinner;
D: Right.
TB: That's a permanent change.
You okay, sir?
P: Yeah.
D: He's a pretty tough cookie! He doesn't complain about much.
That's why, when he finally complained about his toe, I went, "Oh, no" because that was the first time
he complained about his toe.
TB: Okay. You okay?
P: Yeah.
TB: So let him know if something hurts to tell me.
(D speaks in a foreign language to her father.)
P: I know, I know.
TB: So is he seeing the the foot care nurse at his place?
D: We haven't. We were going to start, but there's some miscommunication and then
she never saw him and then it would be another month and I thought,
"No! I'm not waiting!"
TB: No, no and
they they usually don't have the file or the the tools that I have
to take care of that big one so it's gonna be
better for me to do the first one and then they can take over.
So you can see that this big toenail is a little bit thicker as well...
D: Yeah.
TB: And that's because the big toes always receive more trauma;
D: Oh, I see. That makes sense.
TB: They always get bumped or tighter in the shoes, and that's why the big toes normally grow thicker as we get older.
The good thing is this one hasn't been as traumatized as the other one.
So these feet these, this foot, no real big problem.
TB: So let's get out some of the dead skin that's in there, okay, and we'll do that other one now.
Now this is the one that's gonna make him famous! This is the star of the show! (laughter)
D: Yeah!
And these are the co-actors! We'll get them out of the way. They'll do their role quick and then on to the star.
Have you been trimming his nails?
D: I have been, yeah. I'm trying.
TB: Oh, you are good!
You're a good girl.
D: I'm the "it girl", you know?
TB: You're a good girl. Oh my gosh!
D: He used to do it by himself for the longest time
until we realized that big toe wasn't looking too good.
We were not sure what it was because he nicked it when he was trying to cut it.
TB: But it's been like this for many years.
D: Oh, okay.
TB: Yeah. And what happens with more pressure, now that the toe is thicker, it puts more pressure in the shoe,
and now it gets even harder to cut, and it's just a vicious cycle.
So like I said, there might be fungus in here,
but the real problem is the thickness of the nail and that thickness is not going to go away,
even if you get rid of the fungus.
So today, we're gonna do the conservative treatment. To remove as much of this thick nail as possible.
D: That one was impossible to cut, yeah, even when I did his other nails, that one was like humm?
TB: You gotta have the right tools.
D: Right. Exactly. Oh my, look at how thick it is; see?
TB: You, okay, sir?
P: Very good.
TB: Very good.
P: Very good!
TB: OOHHH! Very good. You have the glasses on? You're watching?
D: He's very happy. He's watching you.
TB: Yeah, he's watching. That's awesome!
TB: So what happens the nail bed is usually what becomes damaged and thickened
or scarred so the nail doesn't attach like it used to so now
it's growing on top of all the dead skin on top of the nail bed.
D: And that's probably what's wobbly.
TB: Yeah, so it's not really attached properly.
D: Wow, wow! Look at how thick that is! Holy cow!
TB: Well you're getting front-row seat to the show as well, uh?
D: No kidding!
I've done his toes before but I never noticed it that bad
but on Monday, I couldn't get very far when I was trying to trim this toes. I'm sorry.
TB: And again, people don't know what's nail what's skin.
D: That's true.
TB: You okay, sir?
P: Yeah.
TB: Hurt? Pain?
P: No pain.
TB: No pain?
P: Yeah.
TB: Okay.
D: He's got some neuropathy so I don't know that he feels that much pain.
TB: But what happens, people still feel a little bit of the tugging.
D: Yeah. (She talks to patient using a different language.)
D: I said, "Do you see how thick it is?" and he says, "Yes."
TB: So all that's underneath is dead skin.
See all this?
D: Mm-hmm.
TB: That's all dead skin; the nail bed. The nails only on top
D: Right. Holy cow!
TB: Look at that; this is the good stuff.
D: Mm-hmm.
TB: See all that?
TB: Yummy yummy!
(laughter)
D: So that's nail bed? Like all of that?
TB: All of this is nail bed
and it's damaged
and what happens, as you know, we get
callus, right, from too much pressure like on another foot. The nail bed almost becomes like a callus and it becomes thicker.
D: Interesting.
TB:And then the nail isn't growing flat anymore; It's growing on top of this callus.
D: He says it doesn't hurt.
TB: Doesn't hurt.
I know it's always tricky to find out
if it's sensitive or not.
(D and P speaking together.)
TB: There. Look at that one.
D: So the nurse was just asking too if there was any recommendations?
P: Thank you!
TB: You're welcome!
The nurses at the nursing home were saying if there's any recommendations for them?
TB: No, no medicine.
D: No? There's no medicine?
TB: No medicine, nothing. Nothing's gonna fix this.
D: Just trim his nails?
TB: All of the other nails trim normally and we have this trimmed down
every couple of months.
But even the foot care nurse, depending on what tools she might have, she might she might be able to file this down.
If not, you come here.
See? You see all this?
D: Yeah. Wow. Holy Cow.
TB: It's just dead skin.
So we've got a little bit of fluid under here but it's not a true
injury. It's kind of like a buildup that just happens.
A little bit of fluid, you can see that.
That's why we had some black and blue or sort of black spots red spots and that's the pressure underneath the nail bed.
TB: Any pain?
P: No.
TB: So right under there is the flesh. So we've got a little bit more we can do.
and then what I
will be doing after this is filing down all the nails and that's what's gonna make this look much, much better.
D: Mmm hmm.
TB: So you can see how deep the corners are.
D: Yeah.
TB: This one's not as bad.
So think of it almost like a blister that was happening underneath because the nail was pressing so hard on the tissue underneath.
Once that fluid comes out, it's almost like a pocket.
D: I've done his toenails before but I don't remember them being that bad; it's definitely much worse.
TB: Much worse now?
D: Yeah.
TB: Okay. So I'm going to file this down and we're all done. Okay? I'm gonna file this one first
and then we do the rest.
TB: If we can get this to focus...there we go. Okay. So let him know, if he feels any heat, to let me know.
D: Any heat?
TB: Any heat, heat.
(Daughter and Father speaking)
TB: Okay?
P: Okay.
TB: What he might feel is just cold water.
TB: So as you can see, the nail is all
clear. You see that? That's not fungus.
D: Okay.
TB: It was just to build up a dead skin that was making it look a lot worse than it was.
TB: Yeah, this is the...
P: Very good! (laughter)
TB: Yeah, this is a moneymaker right here; this tool.
So, this is just a pocket.
TB: Due to all the pressure from the thickened toenail.
Think of it like a blister or small, little abscess.
What I'll tell the nurses to do is just to put an ointment
with a band-aid
for around a week just so we don't get any sort of infection anything like that.
But it's not a true wound; it was just a pocket of fluid.
Okay, I'll do the other nails and...
D: He's getting a pedicure!
TB: He's getting a real pedicure! He's in a spa!
We'll do the other one. This spot over here.
So we're getting rid of the extra flesh.
Like I said, that's the build-up of all the pressure on the tissue; it can actually damage it.
Sometimes this happens on the bottom of the foot and we call it an ulcer or wound.
D: Oh, okay, okay.
TB: And the same thing can happen with the nail; where there's too much pressure from the tissue above that it creates a wound underneath.
D: Dad is a diabetic so he has to be careful.
TB: Mm-hmm, but again, this is not a true wound. This, when we put the
ointment, will just heal up,
you'll dry out, and then the nail just has to be maintained.
Okay. So let's wipe this one down. I'll put a little dressing on the toe.
This is something called iodine and
all it needs to be done is twice a day morning afternoon or evening this gets put on
just like that.
Okay? With a bandaid. One week, and that should really calm down everything, okay?
(D & F speak together)
TB: There you go! New man, new toe and what I would suggest...
(D & F talking)
TB: What I would suggest,
in probably around four months,
we come back and take a look to see how it's doing. As long as he's getting the nails cut at the nursing home,
D: Yeah.
TB: He can be, he'll be good here for four months.
D: Okay.
TB: If he's not getting that care there,
then every two months we come in just to keep everything up. Okay?
D: Okay, great. Thank you.
TB: You're welcome.