Articles, Blog


September 6, 2019

(upbeat music) – Hey everybody, it’s
Dr. Nicole Freels again. We are here with a gentleman who’s been suffering with toenail fungus. You can kind of take a peek right here. It’s quite thick, You had an injury to
this, how many years ago? – [Man] It’s been years. – [Dr. Freels] Long time.
– [Man] Yeah, a long time. – [Dr. Freels] And so
it kind of grew back. What’d you say, almost?
– [Woman] Almost nine or 10. – Nine or 10 years. So I’m assuming you have a
lot of pain and discomfort, especially if it gets a
little too long with shoes, especially in the winter. So not only did it grow in fungal, it grew in like it’s almost
wanting to head directly upward. So what we’re going to do, we discussed a couple options
of Lamisil versus laser. So he has opted to do the laser, which is three treatments, one a month for three months after this completely heals. So we’re going to start with this toenail, and then we’ve got a bigger
one over on the other foot that we’re going to take care of. So first let’s just check to
make sure you’re nice and numb. Do you have any questions about how to take care
of this once we are done? – [Man] I think the
girl before explained– – [Dr. Freels] Okay, perfect. Again, let me know if you feel any pain, you know a little pressure, I expect, and I’ll hide it, unless
you want to watch it. – No.
– No, okay. So let’s check around, make sure it’s nice and numb. Alright, and some of these nails can be a little more attached
to the nail bed underneath, so if you’re thinking of
doing the oral medicine, which is the Lamisil, it has to penetrate
through this thick nail. And so basically, it treats the root, and it’s pushing off the big nail. And so, you know, a lot of
times it’s not successful. Lamisil itself is only
about 80% or so successful. It’s hard to get ahold of this guy today. So you can see, it’s really thick. So even if we were
lasering through this nail, it’s a thicker nail to penetrate. Okay, one down, one to go. Let me get wrapped up here. So essentially, once this fills in, we are going to start doing the laser. So I am anticipating in three weeks it’ll be fully healed after using the wound care powder that we
were talking about, the Helix, and then keeping it covered, of course. Okay, so you can see that took, I don’t even know, 15 seconds
to remove that toenail, I mean, it’s no time at all. Okay. Alright, one down, one to go. Let’s do it again. Good? Perfect. You can imagine, I mean, look at under here. That would be hard for laser and Lamisil, anything like that to push that off. The good news is, it’s only two toenails. So free everything back up at the base for all the students
and residents watching. Release everything back here, and you almost like a little give to it. ‘Cause if you do not get it all, that nail is going to come right back. And if you don’t free it
up the first time around, you’re going to kind of be
wrestling with the toenail itself. Is this too much information for you? (laughing) So go in here, just kind of wiggle it, make sure those attachments release. And it doesn’t have to be traumatic, some of these I see on YouTube, it’s just so barbaric looking. As long as you know your anatomy, what you’re doing, then it
should come out pretty easy, even though this is a thicker nail. Okay, let me see if I can
get ahold of this guy. And I know, everybody,
I have white pants on, don’t even comment. There we go. But as long as you use proper technique, you don’t have to worry
about getting it on you. There you go. You okay? (laughs) You don’t have to watch. So for everybody at home, you can see all of that is fungal and how thick that is. So basically, it was going this way here. So you can see the Lamisil
would’ve had to treat this part and push all of this this way, but it’s also having to
work underneath here. I mean this thing is probably
about 3 millimeters thick. Alright, my friend, the torture is over. Let’s get you cleaned up and wrapped up and out of here. Not too bad. Now these guys like to bleed, so we want to make sure there’s no bleeding through
the bandage before you leave. And it’s just because they’re vascular. You know whenever you stub your toe or your finger, anything like that, underneath the nail
there’s lots of nerves, and lots of blood flow, so we expect that. A little more tension on
the Coban wrap itself, just to make sure that we’re
kind of controlling that. But not too tight, ’cause, ah-ha did it this time. Yay. Alright, this is for you guys, you can reuse that. See right there, I’ll do
another couple, gause please, just a small ones are fine. Perfect. A little more pressure, let me take a look at this guy over here. He’s even been dangling
down, he’s going to be fine. Thank you. Oh, wow, you’re a good assistant. (laughs) A little more pressure. So your toes going to be nice
and numb for about eight hours, and then tomorrow, of course,
you’ll take the bandage off. Any concerns for any, you
know, signs of infection, you know, odor, drainage, outside of what we expect drainage, you know, nothing yellow
or anything like that, increase in pain, redness, please give us a call, we’ll
want to know right away. Thank you, ma’am. – [Woman] And she said
that he’ll need to wear open toed sandals for a while, so he can probably wear those to work. – Yeah, that would be fine.
– Can he get like, a note or something– – Absolutely. Sure, no problem at all, yeah. Any pressure, of course, with a closed toe, too, on there is going to make it more uncomfortable, so honestly, you could probably wear that opened toed shoes
as long as you want to, as long as it’s comfortable for you. And you can transition into
activity at your comfort level. So I’ll let you be the decider of that. Now, obviously, not today, back off, they’re going to be numb, so you feel like you can go do anything, but you can’t. – [Man] Can I go to the gym next week? – Next week, oh, absolutely. And then we’ll do cardio. I would recommend like
doing a lot of weights. – [Man] Yeah, that’s what I do– – Something like that. – Okay.
– Okay. And maybe you can try cardio maybe about 10 minutes. – Alright.
– But, when you’re running around, if you
feel like, ooh, that hurts, don’t do it. Just wait, you know. Alright everybody, we’re finished with another nail evulsion. We’re getting ready for fungal
treatment with the laser. So if you have any questions, comments, please drop them below. Happy to answer anything you’ve got going. Don’t forget, sign up for our channel, ring the bell, and I’ll see you soon.

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