TB: So what we’re gonna do, we’re gonna trim both of the smaller nails first because those ones don’t have any fungus. P: Yeah. TB: Then the top big toenails that do have fungus last. Okay? TB: We’re just trimming the nail so nothing should hurt. If you feel anything that’s tight, sensitive, or sore, you let me know. Okay?P: Yeah. TB: Andagain, if you have trouble cutting your own toenails, this is something that people come in here everytwo to three months to have done and that’s what you could have done here. P: Yeah. P: Unfortunately, the toes are the furthest part from thefrom my eyesso I really can’t see what I’m doing. TB: And you got those model legs nice and long. It’s a far way for you. P: Yeah, I have to use wire cutters. For the big toes, they seem to work alright. TB: But they can be a little dangerous. P: Yeah. TB: So this side also has skin underneath the nail. P: That’s the one that looks like it would bleed, yeah. TB: So the best thing to do is you just leave it and you just cut the nail. P: Yeah. TB: You okay sir?P: Yeah. TB: But this foot, all the nails are pretty good, the smaller ones. P: Yeah, it’s just thatI was away for two weeks with these new pair of boots and Ihave to wear those safety boots because those are. . . TB: So I’ll do this foot as well. Yeah, it’s unfortunate that you cut all the little bit of skin underneath these toenails. P: Yeah. TB: But doesn’t look like there’s any infection or anything, which is good. I’m gonna file off all the dead scab and skin afterwards to make it look nice and fresh. P: A couple of years ago, I just about lost that right footdown inCosta Rica. TB: Oh no, what happened?P: One of those volcanicswimming pools,TB: Yes. P: Where the water temperature is very warmand Ihad a blister on that right foot andswimming and walking around that swimming pool, I got a real bad infection. TB: Oh my gosh!P: And it was red up to here. TB: Up to the knee. P: Up to the knee. I have a picture. TB: And just what happened? What did you do?P: I went to the hospital. Spent nine days in the real fancy hospital in Costa Rica. I don’t know how much it cost. Thank God I had the travel insurance. TB: Was it a really nice Hospital?P: Oh, yeah. Well, the would start servingsmall steaks at lunch. TB: Oh my gosh!Well, that’s why you should always travel with insurance, right?P: Oh yeah!TB: How old were you when that happened, sir?P: I was about 85. TB: 85?P: Yeah. TB: Wow!TB: So we’re gonna cut the big toenails down now. P: Alright. TB: This is the good stuff. P: Sorry. TB: So again, nothing should hurt. P: No, so far. P: Alright. TB: So I got my wire cutters, huh?P: Yeah or you really wouldn’t be able to get down. TB: We’re gonna get a lot more plus when we file the nail, it’s gonna look really good. TB: You okay, sir?P: Yeah. There we are. TB: Oh my gosh! Wow!Can I show the camera the picture?P: Sure. TB: Oh, my gosh! Look at that leg!Ouch!All from a blister and then going into the bat?P: Yeah. TB: Well, I’m happy you didn’t lose the leg. P: You know they threw me in the back of a taxi. We were staying at a fairly posh hotelso it was maybe a hundred miles from the main hospital. TB: 100 miles!P: About that. Two hours or so the back of the taxi. P: All of that dead skin in there. TB: Look at that!How am I doing?P: Fine. You’re not bothering me. TB: No pain, right?That’s good. So that the magic will be when I use that tool,the sander the filer, to get all the remaining dead stuff off. But yeah, that’s the. . . P: There’s not much of the toe left. TB: No! P: Now will that toe grow back in?TB: That toenail will always grow. So no matter how much we cut down this toenailP: Yeah. TB: It’s going to grow back. P: Okay. TB: We’re not stopping the toenail from growing. P: Okay. TB: Not at all. That’s why, what we’ll talk about quickly with the camera,you’ve been trying to treat this both of the two big toes for the nail fungus. At your age, at this amount of nail damage, the thickness of the nail the severity of the nail fungus, it’s not worth treating. It’s too hard. The best treatment for this would be for us to remove the nail surgicallybut we don’t want to cause any more injury, we don’t want to cause any sort of wound. Best thing we do is weconservatively trim the nails back as short as we can, we file the toenails as short as we can,so they look as normal as possible, and we just maintain them and that way you can stop treating it with a topical because it’sthis is very severe and we’re not gonna get it with the topical treatment. P: Yeah. TB: Okay? The best thing we do and sometimes one of the treatments is just to remove as much of the nail as possible. P: Yeah. TB: But the nail will always grow back because we’re not doing anything to prevent it. P: It seems as if there’s somethingthat grows underneath the nails and pushes the nail up. TB: That’s exactly the nail fungus. P: That’s the fungus. TB: Yes, it’s eating a nail and then it builds this debris underneath. And when sometimes with trauma, with safety boots,sometimes with nail fungus, all these things damage to the nail and cause the nail itself to grow thicker. P: Yeah. TB: And once that happens, it’s usually a permanent change. So even if you get rid of the fungus, the nail is still gonna be thick. P: Is that my phone?TB: No, that’s outside, that’s Maya. You’re doing okay?P: Yeah. TB: I try to get as much offwith a nail nipper and then we do the rest with the file. TB: You okay?P: Yeah. So how much of thetrip where youokay for before that incident happened?
How much did you get to enjoy a Costa Ricabefore the accident before that the lake flared up?P: It was a two-week period. TB: Yeah?P: That I was away for but I spent over nine daysin the hospital. I don’t know how much it costs the insurance company but I would imagine plenty. TB: I’m sure it did but the most important part you had it and saved your leg. P: Yeah, oh yeah. TB: Okay. P: Now will I still continue to put on that salve?TB: No. P: Okay. TB: It’s really not worth the effort and the energy and the money. P: Okay. TB: The best thing we do is we conservatively trim the nails as short and as thin as we can,P: Yeah. TB: And keep it that way. That way if there’s no thickened toenail,there’s really no way the fungus can grow and get bigger. P: Yeah. TB: We just kind of maintain them. Okay, we’re gonna put the feet down and then we’re gonna file the nails. You’ll feel waterbut you shouldn’t feel any heat. if you feel any heat, you let me know. We’re gonna do the smaller toes first on both feet and thenthe big bad boys. P: Okay. TB: Okay, you ready?P: Yeah. TB: So I’m gonna remove some of the dead scab that you have here, okay?P: Yeah. TB: So I don’t want to create another wound so we’re just gonna make it flat andmaybe the next time you come in, the scab will be ready to come off. P: Right. TB: But we’re going to make it a little bit smoother. You gave yourself a good cut though. P:I sure did. TB: Oh my!P: There was a fair bit of skin underneath that nail because it sure bled. TB: Well now you know the best thing to do is you just leave the skin underneath.
One more foot. P: Okay. TB: Yeah, your toenail looks pretty good after this. P: Yeah and I was just thinking the foot looks a lot better with that nail cut back, yeah. TB: It’s gonna look much better. P: Yeah. TB: You okay over here, sir?P: Yeah. TB: So you’re gonna see that it’s gonna look a lot smoother. There’s gonna be no place for any sort of fungus to hide underneath the nailand because we’re making it so thin, this is gonna last a long time. There you go. You see that, sir?All finished on that one. P: Yeah, it looks good. TB: Much better, right? Okay last toenail, okay?P: Right. TB: No pain?P: No. TB: So you can see all the debris that’s coming off; it’s raining. P: TB: No, I’m okay. Okay, look at that one too now. How does that look a lot better, huh?So best thing is do we do is we come in every probably three months,P: Alright. TB: To file down these big ones. If you need help cutting the smaller toes, we come in every two two and a half months. Okay, look at that. P: Yeah. TB: So we’ll clean up the foot, make everything nice and clean and you’re good to go, sir. P: Yeah.

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