Soaring prescription prices… Why is this?
No one likes spending a lot of money on prescriptions. It seems like when something is really neededto treat a condition you have, you should not be prevented from taking thatmedication due to inability to afford it. At the same time, quite often it is the lure of those very same highprofits that encourage pharmaceutical companies to produce many of the amazing,and quite often, life-saving drugs that we all depend on. Eliminating the reward would, in my opinion,lead us to where fewer and fewer new drugs would be developed.
There is one drug, however, that has been around for years…indeed thousands of years. It is called colchicine. It is a powerful anti-inflammatory medication that is most often used in the treatment of gout. Gout is a condition related to anincrease in uric acid in the body. This can lead to severe pain and inflammation in the joints. Quite often, the joints of the foot are involved. A patient with gout will typically come to my office stating that the pain, redness, and swelling in their foot came on quite suddenly and is excruciating. Colchicine treats acute gout very effectively, relieving symptoms quite often in a matter of hours. So, you can imagine the surprise of patients(and doctors) when it was discovered that generic colchicine was no longer available! Instead, the drug wasavailable only in the form of a non-generic called Colcrys. Same drug. Same benefits. Not the same price. How much has the price gone up? According to as CBS Evening Newsreport, a 23 day supply has gone from $6.72 up to $185.53! Why is this happening? Watch this news report from CBS Evening newsthat aired last night:
http://www.cbsnews.com/stories/2011/10/10/eveningnews/main20118283.shtml#comments
To make a long story short, there are many drugs which pre-date the FDA – one of which is colchicine. The FDA was concerned because there was a lack of modern research on the medication. Now, no drug company will ever do research on inexpensive generic drugs. To get around this, the FDA has taken the generic version of the medication off the market to allow URL Pharma, the company that makes Colcrys, to help recoup money it had spent to study the drug. Now, my patients spend A LOT more on their prescription for colchicine. Is this right? It may not be as clear cut as it would seem. As a result of the studies done by URLPharma, it was determined that a lower dosing of colchicine would be just aseffective as the traditional dosing, making it safer to use. So, you tell me: If it were you paying out of your pocket for this medication, would that information be worth the extra $$$ knowing know that the medication was safer for you to take? As is the case with many medical questions, the answers can be hard to come by.
Tuesday, October 11, 2011
Monday, October 3, 2011
What Toning Shoes Can't Do For You
In the last few years, many manufacturers of shoes have developed and marketed “toning shoes”. The claims that the manufacturers make are very appealing – that by walking in these special shoes, the muscles in your feet and legs will be forced to work harder, and thereby allow you to achieve better outcomes with less effort on your part. In one advertisement, fit woman was used to describe how the shoes worked – and that by walking in the shoes you would strengthen your hamstring and calf muscles up to 11% more than with normal shoes, and that the buttocks would be toned an up to 28% more! Magic! Well, not so fast…
This past week, one manufacturer, Reebock, was forced to pay $25 million in a settlement for deceptive advertising. It turns out that their claims had no substance, and there was no real proof that the benefits they were touting would be seen by the public who were using the shoes. The link here goes into more detail regarding this settlement: http://www.ftc.gov/opa/2011/09/reebok.shtm
From my perspective, I have a few thoughts to share. First, I am always amazed at how easily people will fall for such claims. As the saying goes, if it seems too good to be true, it likely is. If you want to tone your calves, hamstrings and buttocks 11 – 28% more, there is a real simple, tried and true method to do so. Work 11 – 28% harder!
I have patients come into my office with these shoes from time to time. Some love them, some do not. Most will put more pressure on your forefoot and midfoot, which in the case that I tried, was painful. I could not tolerate the pair I was given by one manufacturer to try. However, if you like them, I feel that there is no problem with the shoes. Just don’t buy them with the expectation that in a matter of weeks you’ll look like the woman selling them on tv
This past week, one manufacturer, Reebock, was forced to pay $25 million in a settlement for deceptive advertising. It turns out that their claims had no substance, and there was no real proof that the benefits they were touting would be seen by the public who were using the shoes. The link here goes into more detail regarding this settlement: http://www.ftc.gov/opa/2011/09/reebok.shtm
From my perspective, I have a few thoughts to share. First, I am always amazed at how easily people will fall for such claims. As the saying goes, if it seems too good to be true, it likely is. If you want to tone your calves, hamstrings and buttocks 11 – 28% more, there is a real simple, tried and true method to do so. Work 11 – 28% harder!
I have patients come into my office with these shoes from time to time. Some love them, some do not. Most will put more pressure on your forefoot and midfoot, which in the case that I tried, was painful. I could not tolerate the pair I was given by one manufacturer to try. However, if you like them, I feel that there is no problem with the shoes. Just don’t buy them with the expectation that in a matter of weeks you’ll look like the woman selling them on tv
Wednesday, September 28, 2011
Seven Questions To Ask Your Podiatrist BEFORE Foot Surgery
You’ve made the big decision to have surgery on your foot. You will likely have an appointment with your podiatrist shortly before surgery to discuss the surgery, and you will also in most cases be asked to sign a consent form. Instead of just listening to your podiatrist tell you about the upcoming surgery, here are some questions you can him/her to make sure you understand all aspects of what will be happening before, during and after surgery.
Question #1: Is this surgery necessary? The follow up question to that is what would happen if the surgery was not performed. In most cases, foot surgery is elective. What I mean by elective is that while there may be good reasons to do the surgery, such as relieving pain, it is not mandatory that the surgery be performed. An example of a surgery that is not elective would be surgery to remove a ruptured appendix. So in the case of your bunion, for example, it may be important to perform the surgery to allow walking and wearing shoes without pain, but people can and do live with bunions. In the bunion example, perhaps your podiatrist will say that not performing the surgery will likely lead to progression of the bunion which will lead to more pain, and a more complicated surgery down the road to correct.
Question #2: What type of anesthesia will be used? For anesthesia, there are a few choices which you may want to discuss so that the experience of foot surgery is as comfortable as possible.
The first choice is local anesthesia, which means the area to have surgery is made numb by given an injection of a local anesthetic. This works very well for simple procedures, and in some instances, may be the preferred method for even more involved cases. It is very safe, and although the injection is uncomfortable, once the area is numb, you will feel no pain the remainder of the surgery. You will be able to hear what is going on, which can be disconcerting to some patients.
The second choice is called monitored anesthesia care. This is the type of anesthesia I usually use for most of my surgeries performed in a hospital or surgery center setting. Medication is given through an IV by an anesthesiologist to put the patient in a light sleep. Once the patient is asleep, the part of the foot that will be operated on is numbed by a local anesthetic. Then, during the procedure, the patient usually remains in a very light sleep. No breathing tube is used – the patient is able to breathe by him/herself. Typically, the patient is unaware of what is going on, hears no sounds, and when the procedure is done, wakes up to a numb foot feeling well-rested.
The third choice of anesthesia is general anesthesia. In this case, the patient is put totally asleep by the anesthesiologist. A breathing tube is put down the throat, and the procedure is done with no chance of the patient ever being aware of what is going on. Recovery following general anesthesia is a little longer, but this too is usually very well tolerated by patients. A sore throat afterwards is not uncommon. If I perform a surgery using general anesthesia, I will generally numb the foot at the end of the surgery so that the patient will have no pain for several hours afterwards.
What anesthesia is best for you? Talk over the choices with your doctor, and the two of you will come up with a plan for what will be best for your particular surgery.
Question #3: What restrictions will there be after surgery? Will you be able to walk on your foot? How much? Will you be able to get the foot wet? Will you have to wear any special shoes or perhaps a cast? If you cannot walk on your foot, what method of keeping weight off your foot will be used? (crutches, wheelchair, etc?)
If you will be using crutches, ask your doctor or his assistant to show you how to use them, particularly going up and down stairs.
Question #4: How long will I be off of work? This question will depend in large part on both the type of surgery performed, and the type of work you do. Someone who sits a desk for work all day will be able to return to work much sooner than someone who does extensive standing or walking as a part of their job. When your doctor gives you an estimate on when you’ll be able to return to work, please understand that it is just an estimate. Perhaps things will go very well, and you’ll be back to work sooner, or perhaps you will take a little longer. The period of time given will usually be an estimate on what most patients experience.
Question #5: How long will it be before I can return to my regular shoes and my normal activities? Again the answer to this question will depend on the surgery performed, the shoes you would like to wear, and the activities you plan on participating in.
Question #6: How will post-operative pain be managed? With any surgery, there will be discomfort in the period afterwards. Pain medication will help to decrease the pain, but will rarely make it go away completely. Ask what you can do to help control pain. This might include icing your foot, keeping it elevated, etc.
Question #7: Under what circumstances should you contact the doctor after surgery? From my perspective, I want patients to call me if there is bleeding that is excessive (coming through the bandage), the level of pain is unbearable, they injure the surgery site, or they get dressings wet that were supposed to be kept dry. However, you should feel free to contact your doctor whenever you have a serious concern.
Surgery is a partnership between the patient and the doctor, and best results are obtained when the patient fully understands the process and is committed to doing his or her part.
Question #1: Is this surgery necessary? The follow up question to that is what would happen if the surgery was not performed. In most cases, foot surgery is elective. What I mean by elective is that while there may be good reasons to do the surgery, such as relieving pain, it is not mandatory that the surgery be performed. An example of a surgery that is not elective would be surgery to remove a ruptured appendix. So in the case of your bunion, for example, it may be important to perform the surgery to allow walking and wearing shoes without pain, but people can and do live with bunions. In the bunion example, perhaps your podiatrist will say that not performing the surgery will likely lead to progression of the bunion which will lead to more pain, and a more complicated surgery down the road to correct.
Question #2: What type of anesthesia will be used? For anesthesia, there are a few choices which you may want to discuss so that the experience of foot surgery is as comfortable as possible.
The first choice is local anesthesia, which means the area to have surgery is made numb by given an injection of a local anesthetic. This works very well for simple procedures, and in some instances, may be the preferred method for even more involved cases. It is very safe, and although the injection is uncomfortable, once the area is numb, you will feel no pain the remainder of the surgery. You will be able to hear what is going on, which can be disconcerting to some patients.
The second choice is called monitored anesthesia care. This is the type of anesthesia I usually use for most of my surgeries performed in a hospital or surgery center setting. Medication is given through an IV by an anesthesiologist to put the patient in a light sleep. Once the patient is asleep, the part of the foot that will be operated on is numbed by a local anesthetic. Then, during the procedure, the patient usually remains in a very light sleep. No breathing tube is used – the patient is able to breathe by him/herself. Typically, the patient is unaware of what is going on, hears no sounds, and when the procedure is done, wakes up to a numb foot feeling well-rested.
The third choice of anesthesia is general anesthesia. In this case, the patient is put totally asleep by the anesthesiologist. A breathing tube is put down the throat, and the procedure is done with no chance of the patient ever being aware of what is going on. Recovery following general anesthesia is a little longer, but this too is usually very well tolerated by patients. A sore throat afterwards is not uncommon. If I perform a surgery using general anesthesia, I will generally numb the foot at the end of the surgery so that the patient will have no pain for several hours afterwards.
What anesthesia is best for you? Talk over the choices with your doctor, and the two of you will come up with a plan for what will be best for your particular surgery.
Question #3: What restrictions will there be after surgery? Will you be able to walk on your foot? How much? Will you be able to get the foot wet? Will you have to wear any special shoes or perhaps a cast? If you cannot walk on your foot, what method of keeping weight off your foot will be used? (crutches, wheelchair, etc?)
If you will be using crutches, ask your doctor or his assistant to show you how to use them, particularly going up and down stairs.
Question #4: How long will I be off of work? This question will depend in large part on both the type of surgery performed, and the type of work you do. Someone who sits a desk for work all day will be able to return to work much sooner than someone who does extensive standing or walking as a part of their job. When your doctor gives you an estimate on when you’ll be able to return to work, please understand that it is just an estimate. Perhaps things will go very well, and you’ll be back to work sooner, or perhaps you will take a little longer. The period of time given will usually be an estimate on what most patients experience.
Question #5: How long will it be before I can return to my regular shoes and my normal activities? Again the answer to this question will depend on the surgery performed, the shoes you would like to wear, and the activities you plan on participating in.
Question #6: How will post-operative pain be managed? With any surgery, there will be discomfort in the period afterwards. Pain medication will help to decrease the pain, but will rarely make it go away completely. Ask what you can do to help control pain. This might include icing your foot, keeping it elevated, etc.
Question #7: Under what circumstances should you contact the doctor after surgery? From my perspective, I want patients to call me if there is bleeding that is excessive (coming through the bandage), the level of pain is unbearable, they injure the surgery site, or they get dressings wet that were supposed to be kept dry. However, you should feel free to contact your doctor whenever you have a serious concern.
Surgery is a partnership between the patient and the doctor, and best results are obtained when the patient fully understands the process and is committed to doing his or her part.
Tuesday, July 13, 2010
What's New in Podiatry?
Tomorrow, I will be leaving for Seattle to attend a podiatry conference - which I do at least yearly. In talking to a friend this past week and telling him of my trip, he said that he empathized with me having to travel. Since I don't travel that much, I really enjoy these trips. It got me to thinking how much I have learned AFTER finishing podiatry school in 1989. When I compare how I practiced medicine then compared to now, so much has changed. Certainly, many things are the same, but it's the constant changing requiring me to learn new things that makes podiatry exciting and challenging to me. I thought I would discuss a few of the many things that are new to podiatry in the last 21 years that I feel make me and other podiatrists better at treating our patients.
In no particular order...
1. Diagnostic ultrasound. This technology has been around for years, but its use in podiatry has really come into the mainstream in the last 10 years. X-rays do a fine job of showing problems with bone. However, if the soft tissue around bone is abnormal, x-rays can't always help pinpoint what the problem is. Diagnostic ultrasound allows me to see pathology in tendon, ligaments, joints, muscles, nerves, etc. It allows excellent visualization of cysts. What's more, it gives immediate feedback. Certainly, all these structures in the foot can be seen using an MRI, but the cost for an MRI is substantially more, and the results are not immediate. With ultrasound, I know right as the patient is sitting there what is going on.
2. Lamisil. Everyone remembers the commercial that was aired in years past with "Digger the Dermatophyte." Patients would tell me that the thought of Digger in their toenails made them shiver. Well, Digger had been in toenails before, but there was little that could be done to really rid toenails of fungus so that they could grow out normally again. Now, patient's have real options that are effective. I have treated successfully literally hundreds and hundreds of patients with this medication. It does not work all the time, but in the vast majority, significant improvement is seen, and quite often, total clearing of the toenails.
3. Wound care. The options for wound care have multiplied exponentially in the last two decades. Certainly, the basics of controlling infection, cutting away dead tissue, taking pressure off the ulcerated portion of the foot are still used and of utmost importance. However, the dressings and medications available now are far superior to what we had available to us in 1989. This gives us a much better chance not only to heal wounds, but to get them healed more quickly. Another huge improvement is the ability of vascular surgeons to improve circulation to the feet. Without adequate blood flow, ulcers will not heal.
4. E-prescribing. While this is not an advancement in medicine per se, I have found it to be a huge help when it comes to prescribing medications to my patients. Just last week, I had a patient who was in need of a prescription. She had listed her medications, and I had checked to make sure that none of her medications would interact with what I was prescribing. Everything seemed to be okay. However, when I went to process the prescription on the computer, her records through the pharmacy (which gave a COMPLETE listing of her medications) revealed that she was indeed taking a medication that was not compatible with what I wanted to prescribe. She had just forgotten to tell me about that particular prescription. So, because of e-prescribing, I was able to change her prescription to something that worked better for her.
5. Vascular testing. Newer technology makes it much easier to test my patients for poor circulation in their feet and legs. Not only easier, but I find it to be more reliable as well. This helps me identify patients who are at higher risk for ulceration and limb loss early, so that measures can be taken to improve circulation before problems develop.
This is just a short list of the improvements and advancements that I have seen over the last two decades of practicing podiatric medicine. And as I get ready to hop on my flight tomorrow, I fully expect that there will be more that I will learn to better help me treat my patients. I encourage other podiatrists to add to my list of what's new in podiatric medicine that has helped to make them better doctors.
In no particular order...
1. Diagnostic ultrasound. This technology has been around for years, but its use in podiatry has really come into the mainstream in the last 10 years. X-rays do a fine job of showing problems with bone. However, if the soft tissue around bone is abnormal, x-rays can't always help pinpoint what the problem is. Diagnostic ultrasound allows me to see pathology in tendon, ligaments, joints, muscles, nerves, etc. It allows excellent visualization of cysts. What's more, it gives immediate feedback. Certainly, all these structures in the foot can be seen using an MRI, but the cost for an MRI is substantially more, and the results are not immediate. With ultrasound, I know right as the patient is sitting there what is going on.
2. Lamisil. Everyone remembers the commercial that was aired in years past with "Digger the Dermatophyte." Patients would tell me that the thought of Digger in their toenails made them shiver. Well, Digger had been in toenails before, but there was little that could be done to really rid toenails of fungus so that they could grow out normally again. Now, patient's have real options that are effective. I have treated successfully literally hundreds and hundreds of patients with this medication. It does not work all the time, but in the vast majority, significant improvement is seen, and quite often, total clearing of the toenails.
3. Wound care. The options for wound care have multiplied exponentially in the last two decades. Certainly, the basics of controlling infection, cutting away dead tissue, taking pressure off the ulcerated portion of the foot are still used and of utmost importance. However, the dressings and medications available now are far superior to what we had available to us in 1989. This gives us a much better chance not only to heal wounds, but to get them healed more quickly. Another huge improvement is the ability of vascular surgeons to improve circulation to the feet. Without adequate blood flow, ulcers will not heal.
4. E-prescribing. While this is not an advancement in medicine per se, I have found it to be a huge help when it comes to prescribing medications to my patients. Just last week, I had a patient who was in need of a prescription. She had listed her medications, and I had checked to make sure that none of her medications would interact with what I was prescribing. Everything seemed to be okay. However, when I went to process the prescription on the computer, her records through the pharmacy (which gave a COMPLETE listing of her medications) revealed that she was indeed taking a medication that was not compatible with what I wanted to prescribe. She had just forgotten to tell me about that particular prescription. So, because of e-prescribing, I was able to change her prescription to something that worked better for her.
5. Vascular testing. Newer technology makes it much easier to test my patients for poor circulation in their feet and legs. Not only easier, but I find it to be more reliable as well. This helps me identify patients who are at higher risk for ulceration and limb loss early, so that measures can be taken to improve circulation before problems develop.
This is just a short list of the improvements and advancements that I have seen over the last two decades of practicing podiatric medicine. And as I get ready to hop on my flight tomorrow, I fully expect that there will be more that I will learn to better help me treat my patients. I encourage other podiatrists to add to my list of what's new in podiatric medicine that has helped to make them better doctors.
Thursday, February 11, 2010
Are your toenails ready for summer?
One of the joys of spring is that the weather permits people to shed their heavy shoes and wear sandals. However, if you suffer from a fungal infection in your toenail(s), exposing your toenails to the public is probably the last thing in the world you’re interested in doing.
If you have a toenail fungus, you know what it looks like, and you don’t like it. Toenails that are infected become dark, thick and crumbly. Quite often, the toenails can reach a point where they are thicker than long. There are other causes of toenail discoloration and thickening, and your doctor may perform tests to confirm a diagnosis of onychomycosis (the medical term for fungal infected toenails).
Fortunately, there are ways to correct and cure the problem, but you need to start the process now. I am aware of no treatment for onychomycosis that will solve the problem overnight. The underlying problems in treating this disease are that first, the fungus that causes the infection is not conveniently located on the surface of the toenail – it is imbedded deep within the toenail. This makes it difficult for topical treatments and home remedies to effectively kill the fungus when they are applied to the surface of the toenail in all but the mildest cases. Second, once the fungus is killed, the toenail does not miraculously return to normal. What has to happen is that the toenail must be replaced by new nail growing out from its base. And since toenails grow slowly (when compared with fingernails), it can take many months for the new, clear, non-infected toenail to replace the infected portion of the toenail.
So, what is the best treatment available? What works? I have found that terbinafine (Lamisil) to be quite effective. It is a pill that is taken once daily for three months. As the medication is taken, it gradually becomes deposited into the toenails and fingernails. There, it can begin eliminating the fungus. What the patient sees is gradually clearing of the nail from the base as new toenail begins to grow. Certainly, any medication taken orally has the potential for side effects, but I have found side effects with terbinafine to be quite infrequent, and they go away when the medication is discontinued. For patients with a history of liver disease, this is not the medication for you. Perhaps the most limiting side effect in the past was the cost. A three month course of treatment used to be upwards of $1200. A few years ago, the medication became available in a generic form. In our area, we have found three pharmacies that offer terbinafine for just $10 for the three month course of treatment!
So, if you are not happy with the appearance of your toenails, or if they are causing discomfort, see your podiatrist. Most likely, there are treatments available that can greatly improve your condition!
Tuesday, January 19, 2010
Ingrown Toenails
One of the more common problems that causes patients to come see me is for the treatment of ingrown toenails. They are painful, persistent, and can really make life miserable. For some reason, I see a lot of fear on my patients when it comes to the treatment of this problem. I would like to explain what causes ingrown toenails, and what the preferred treatment is for most of my patients.
Ingrown toenails can affect people of all ages. I have seen infants with ingrown toenails, elderly patients, and everyone in between. What causes them to occur? Sometimes it is just the inherited shape of the toenail that predisposes people to develop ingrown toenails. Other times, it can be caused by wearing shoes that are too tight, or an injury to the toe that drives the nail into the surrounding skin. Fungal toenails, because they are often thicker, can also be a factor. Finally, if toenails are cut too short, especially long the sides of the toenail, they can become ingrown as they start to grow back out. Once the problem starts, the surrounding skin will often become infected and inflamed, As it does so, it will cause the entire area around the toenail to be painful.
Treatments at home can and probably should be tried first in mild cases. This includes putting a little bit of cotton under the nail, foot soaks, and avoiding wearing tight shoes. However, if you don’t see results after a week or so, it’s time to let your podiatrist take over. The treatments he can offer range from controlling the infection, to permanently correcting the problem so it does not happen again.
As mentioned above, the toe often becomes infected when the toenail is ingrown. The right antibiotic can treat the infection and greatly reduce the pain. But if that is all that’s done, your relief may be short-lived. Antibiotics do nothing to treat the underlying cause of the problem, namely, the toenail digging into the toe. Under local anesthesia (yes, that does mean a shot!), a portion of the toenail can be removed. Once this is done, the pain is dramatically reduced in most cases, and it also helps to clear the infection. I have found that when just a portion of the nail is removed (as little as 1/8”), the toe heals up within a week or so following the procedure. The one problem with this method is that while the pain is gone, the part of the toenail that was removed will grow back, and often will grow back ingrown.
So what do I do? I have found that for most of my patients, the best alternative is to remove the ingrown portion of the toenail permanently. Not the entire toenail, just the tiny portion along the side that is causing all the problems. Essentially, the same procedure is done as was described above, but I also use a medication to kill the root of the portion of the toenail that was removed. When done correctly, this will prevent the portion of the nail removed from growing back, thus solving the problem for good.
One of the first questions that people ask me is “how much does it hurt to have my ingrown toenail fixed?” Since I believe that it’s best to be straight with patients, I will admit that when the toe is made numb during the injection, there is discomfort. However, that does not last very long, and the rest of the procedure is painless. Afterwards, the biggest surprise most have is how little pain there is once the numbness wears off. Certainly, there is some tenderness, but by far the vast majority of patients tell me when they come back to see me one week later for their follow up appointment that they are happy, they feel much better, and they wish they had taken care of the problem sooner.
Once the toe is healed up completely, the toenail will be a little narrower. Other than the patient herself though, very few will be able to tell that anything had ever been done.
So, my advice is that if you have trouble with a painful ingrown toenail, decide to get it fixed and fixed for good. You’ll be glad you did!
Ingrown toenails can affect people of all ages. I have seen infants with ingrown toenails, elderly patients, and everyone in between. What causes them to occur? Sometimes it is just the inherited shape of the toenail that predisposes people to develop ingrown toenails. Other times, it can be caused by wearing shoes that are too tight, or an injury to the toe that drives the nail into the surrounding skin. Fungal toenails, because they are often thicker, can also be a factor. Finally, if toenails are cut too short, especially long the sides of the toenail, they can become ingrown as they start to grow back out. Once the problem starts, the surrounding skin will often become infected and inflamed, As it does so, it will cause the entire area around the toenail to be painful.
Treatments at home can and probably should be tried first in mild cases. This includes putting a little bit of cotton under the nail, foot soaks, and avoiding wearing tight shoes. However, if you don’t see results after a week or so, it’s time to let your podiatrist take over. The treatments he can offer range from controlling the infection, to permanently correcting the problem so it does not happen again.
As mentioned above, the toe often becomes infected when the toenail is ingrown. The right antibiotic can treat the infection and greatly reduce the pain. But if that is all that’s done, your relief may be short-lived. Antibiotics do nothing to treat the underlying cause of the problem, namely, the toenail digging into the toe. Under local anesthesia (yes, that does mean a shot!), a portion of the toenail can be removed. Once this is done, the pain is dramatically reduced in most cases, and it also helps to clear the infection. I have found that when just a portion of the nail is removed (as little as 1/8”), the toe heals up within a week or so following the procedure. The one problem with this method is that while the pain is gone, the part of the toenail that was removed will grow back, and often will grow back ingrown.
So what do I do? I have found that for most of my patients, the best alternative is to remove the ingrown portion of the toenail permanently. Not the entire toenail, just the tiny portion along the side that is causing all the problems. Essentially, the same procedure is done as was described above, but I also use a medication to kill the root of the portion of the toenail that was removed. When done correctly, this will prevent the portion of the nail removed from growing back, thus solving the problem for good.
One of the first questions that people ask me is “how much does it hurt to have my ingrown toenail fixed?” Since I believe that it’s best to be straight with patients, I will admit that when the toe is made numb during the injection, there is discomfort. However, that does not last very long, and the rest of the procedure is painless. Afterwards, the biggest surprise most have is how little pain there is once the numbness wears off. Certainly, there is some tenderness, but by far the vast majority of patients tell me when they come back to see me one week later for their follow up appointment that they are happy, they feel much better, and they wish they had taken care of the problem sooner.
Once the toe is healed up completely, the toenail will be a little narrower. Other than the patient herself though, very few will be able to tell that anything had ever been done.
So, my advice is that if you have trouble with a painful ingrown toenail, decide to get it fixed and fixed for good. You’ll be glad you did!
Wednesday, January 13, 2010
What is a Podiatrist?
What is a Podiatrist?
As a practicing podiatrist for the last 20 years, this is a question that I am frequently asked - What is a podiatrist? Along with that question is the ever-popular "how can you stand looking at feet all day?" To answer these questions, let me start by explaining what it takes to become a podiatrist.
For a person coming out of high school with dreams of becoming a podiatrist, the first step is to go to college. Your major in college is not nearly as important as some might think. You will need to take several required classes regardless of your major though, with a heavy emphasis in the sciences (chemistry, physics, and the biological sciences). Once you near the end of your undergraduate career, it's time to start the application process to one of the 8 podiatry schools. Podiatry school is a 4-year curriculum, which when examined, closely resembles that of a typical medical school. This is especially true for the first two years. It is rigorous, and will test even the brightest of students. The further along students get into podiatry school, the more emphasis is placed on clinical training - as in actually seeing and treating patients. It would be a mistake, though, to think that today's podiatrist only learns about feet. To the contrary, the training is quite broad. In real life, it is impossible to treat foot problems without knowledge of what is going on with the rest of the body. For example, if a patient comes into my office with sudden onset of pain in his foot at the base of the big toe, I would include in my list of possible causes of the pain the diagnosis gout (see http://www.concordfootdr.com/library/1860/Gout.html). Treatment for this systemic disease that presents itself in the foot usually requires oral medication. Medication cannot be prescribed without knowledge of what other medication the patient is taking and how they all interact. Because of this, podiatrists have become experts in treating diseases, injuries and abnormalities of the foot and ankle, but are also able to tailor treatment plans that take the whole patient's situation into consideration.
Following the completion of podiatry school, the training is not yet complete. Podiatrists today must complete residency training that lasts up to 3 years. During this time, further training is received in the many areas podiatrists see in daily practice, including surgery, wound care, biomechanics, podiatric medicine, etc.
On a typical day in my office, I may see and treat any number of following conditions:
Ingrown toenails
Diabetic ulcers
Heel pain
Flat feet
Bunions
Hammertoes
Arthritis
Neuromas
Fungal toenails
Sprains
Fractures
Athlete's foot
Gout
Poor circulation
Neuropathy
Corns and calluses
And the list goes on and on.
So, the next time you think of your podiatrist, be grateful that such trained individuals are there to take care of all your foot care needs.
Oh, and as to the second question, how can I stand looking at feet all day? I look at it this way. If I can have a person come into my office with pain, and leave painfree, there is nothing I would rather do. I brings a great deal of satisfaction to get people back to normal activities... back to being able to walk, run, and work. In short, healthy feet go a long ways to making lives more fulfilling and productive. It's great to be play a part in improving the lives of my patients!
As a practicing podiatrist for the last 20 years, this is a question that I am frequently asked - What is a podiatrist? Along with that question is the ever-popular "how can you stand looking at feet all day?" To answer these questions, let me start by explaining what it takes to become a podiatrist.
For a person coming out of high school with dreams of becoming a podiatrist, the first step is to go to college. Your major in college is not nearly as important as some might think. You will need to take several required classes regardless of your major though, with a heavy emphasis in the sciences (chemistry, physics, and the biological sciences). Once you near the end of your undergraduate career, it's time to start the application process to one of the 8 podiatry schools. Podiatry school is a 4-year curriculum, which when examined, closely resembles that of a typical medical school. This is especially true for the first two years. It is rigorous, and will test even the brightest of students. The further along students get into podiatry school, the more emphasis is placed on clinical training - as in actually seeing and treating patients. It would be a mistake, though, to think that today's podiatrist only learns about feet. To the contrary, the training is quite broad. In real life, it is impossible to treat foot problems without knowledge of what is going on with the rest of the body. For example, if a patient comes into my office with sudden onset of pain in his foot at the base of the big toe, I would include in my list of possible causes of the pain the diagnosis gout (see http://www.concordfootdr.com/library/1860/Gout.html). Treatment for this systemic disease that presents itself in the foot usually requires oral medication. Medication cannot be prescribed without knowledge of what other medication the patient is taking and how they all interact. Because of this, podiatrists have become experts in treating diseases, injuries and abnormalities of the foot and ankle, but are also able to tailor treatment plans that take the whole patient's situation into consideration.
Following the completion of podiatry school, the training is not yet complete. Podiatrists today must complete residency training that lasts up to 3 years. During this time, further training is received in the many areas podiatrists see in daily practice, including surgery, wound care, biomechanics, podiatric medicine, etc.
On a typical day in my office, I may see and treat any number of following conditions:
Ingrown toenails
Diabetic ulcers
Heel pain
Flat feet
Bunions
Hammertoes
Arthritis
Neuromas
Fungal toenails
Sprains
Fractures
Athlete's foot
Gout
Poor circulation
Neuropathy
Corns and calluses
And the list goes on and on.
So, the next time you think of your podiatrist, be grateful that such trained individuals are there to take care of all your foot care needs.
Oh, and as to the second question, how can I stand looking at feet all day? I look at it this way. If I can have a person come into my office with pain, and leave painfree, there is nothing I would rather do. I brings a great deal of satisfaction to get people back to normal activities... back to being able to walk, run, and work. In short, healthy feet go a long ways to making lives more fulfilling and productive. It's great to be play a part in improving the lives of my patients!
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