Total Pageviews



Sunday, February 3, 2013

Toe Nail Fungus: Email Advice

Hi Richard,

Thanks a lot for today, specially for noticing me standing out there and taking a few minutes to sort out my other concern.  I was just about to leave when I saw you in the main office.  Quite fortuitous.  ONe of the secretaries had just told me that you had just begun an hour appointment. 

So I took Lamisil orally for four months and got rid of a fair amount of fungus on two big toes and three or four smaller ones. Since the treatment I have been applying Desenex powder on my toes almost daily. Nevertheless, a sliver of fungus showed up n my right toe just as the last part of it was growing out on the top.  So now the sliver is about i/8 of an inch by 3/8 lying perpendicular to my left big toe. 

I have a metal file that is about 1/8 wide which was perfect for filing a 1/16 by 3/8 inch section across the toe and about 1/16 inch deep.  I have filed rather  easily, and applied the vinegar patch with your little cover.

Here are my questions:

1. The vinegar seems to burn a little.  Any concern about overdoing this treatment?
Dr Blake's comment: Vinegar is 5% acid so you do have to watch how your skin reacts.

2. Is there any danger in filing deeper and even getting down trying to make a little hole in the nail just above the skin.  Possibility of infection? or pain?  The reason I ask is that I want the vinegar, if that is the best treatment, to be able to soak in as best I can.
Dr Blake's comment: The nail bed is under the cuticle, and under the nail, firmly attaching itself. You do not want go through the nail since you risk damaging the bed. 

3. How often should I apply the vinegar and for how long.  For the soaks in vinegar, you recommend 2-3 times a week for 30 minutes each time.  Is that the same for the vinegar patch? Dr Blake's comment: The vinegar patches I recommend 3 hours max. If your skin does well, you can try longer. You can do the vinegar patch daily, but probably go to rest the skin every 4th day. Continue to monitor the skin for excess dryness with cracking.

4.  Since Lamisil is clearly a very effective killer of the fungus.  Why would I not use Lamisil ointment to penetrate and kill the new fungus rather than vinegar?  Perhaps because the ointment does not permeate the nail.  All the more reason for trying t create a hole in the nail.  Perhaps cutting through the nail is something that would be better to leave to you.  Do you do such things in a case like mine? Dr Blake's comment: Answered above, but Vinegar is 100% anti-fungal and Lamisil is not 100% active ingridient. Fungus loves moisture, so when medications do not kill fungus well, they can actually make the situation worse by keeping the area too moist. 

5.  I understand that fungi do not do well when exposed to oxygen.  Again, a hole would bring more exposure. Dr Blake's comment: Toenails breathe, they are alive not dead, polished toenails stop oxygen from penetrating the nail bed allowing toenail fungus to thrive after a pedicure. 

6.  What about supplementing the vinegar with Vick's vapor rub and/or tea tree oil?  Is a combination more effective than just the vinegar?Dr Blake's comment: See my blog post below. 

7. Is it better to apply powder directly on my toes or better in my shoes and between my orthotic and shoe, or both? Dr Blake's comment: Powder it all. 

8. Finally a question about balancing on one toe.  What do you think about shifting my arms and one leg in different directions to challenge my balance and to increase my ability to balance on one foot? Dr Blake's comment: That is a great idea as you do the Single Leg Balancing Exercise. It is important to continue to make it harder over the next year as you get stronger and stronger. 

Thank you for your excellent in office treatment and for your willing (so far) electronic bedside care!!!!!

No comments:

Post a Comment

Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.