Mother of patient: You finished all of your school here? TB: Yeah. Only one school in Canada for this program; The Michener Health Institute in Toronto. It’s the same school my dad went to 30 years ago. M: Is that (right)? Oh. TB: Yeah, so I want you to sit back. I’m just gonna wipe down the toe to clean it up. So I’m gonna give you one side a pinch then we do that other. Like I said, on the count of three if you feel something that’s tight or a little bit uncomfortable and you want to move your foot don’t; just push your heel straight like. P: Like that? TB: Yes. P: Okay. TB: Okay. So on three little pinch. It’s a very small thin needle. So here we go one, two, three, very good. You okay? P: Uh huh. Ahh! TB: What? Bad or not that bad? P: Not bad. TB: Well for you because you’re a tough guy. How about now; any pain? P: No. TB: Very good. The whole toe has become much enlarged, even on the whole downside here. But we’re not gonna be touching that.
We’re just gonna be removing this top portion, okay? Any pain? P: No. TB: Okay. One more side, okay? P: Okay. TB: That wasn’t bad, right? P: No. TB: Okay, here we go on three another pinch one, two, three. This side is a little bit harder. You okay, Igor? P: Uh hum. M: (speaking Serbian) TB: I know; it’s a little tough this side. P: I think it’s bone. TB: It’s a tight fit. How about now? P: It’s okay. TB: No more pain? Just pressure? P: Yeah. TB: This side is much tighter because there’s not as much room. Like you said, it’s right beside the bone. TB: Any pain right now? P: No. TB: Okay, very good. You feeling okay? M: You’re just okay? P: Uh hum. TB: Okay. All done. Okay, so what we’re putting on is just a tourniquet, okay? It’s a rubber band… P: Okay. TB: And this rubber band is gonna push out any of the bad blood or blood that’s just sitting in a toe. P: Oh. I see. TB: The reason for that, the acid that we’re using to stop the nail from growing, it needs to work in an area where there’s no blood. If there’s too much blood, it will dilute the acid and then it won’t kill the nail. P: So basically like you you’re burning this. TB: Burning the nail. P: Okay. TB: Yeah, with a chemical. P: So how does this chemical not enter the blood. TB: So we’re just applying it to a certain area… P: Oh, I see. TB: In a controlled environment. TB: So we’re just cleaning up the toe. M & TB: (?) in Spanish, yeah and in other languages yeah, it’s amazing, M: Yeah (?) that’s the Latin name. TB: It is? (?) P: You’re Spanish? TB: No, but I can speak a little Spanish. P: Oh, okay. M: Nice. TB: So we’re gonna do a little check of the area. P: Okay. TB: Anything sharp here? P: No TB: Here? P: No. TB: How about here? Anything sharp? P: No. No. TB: Nothing? P: Nothing. TB: Pressure? Not even pressure? P: No pressure. TB: Okay. We numbed you very good. P: Yeah, you did. TB: And how about this side; anything sharp here? P: No. TB: Anything sharp here? P: No. I just feel like someone’s scratching something. TB: But no pain? P: No. M: Nice. TB: Anything sharp here? P: No. TB: Okay. So we’re gonna trim the bad nail out. Any pain? P: No. I’m just feeling it’s numb. TB: Okay. We’re removing the ingrown now. P: Okay. Good. TB: You see that? That’s one. M: See how it is growing inside? That’s (what’s making the pain). TB: Big! P: Why this happening? Like so many people complaining like they have this (ingrown nail). TB: There are many reasons. Sometimes it’s the way the nails just they grow, sometimes it’s genetic, sometimes it’s because of pointy or narrow shoes that push the skin over the nail, or sometimes it’s the way we cut our nail. Sometimes we cut it bad and it changes the way the nail grows. P: I have a friend with three brothers. TB: Yeah. P: All three of them have a problem like that. TB: So to me, that sounds like they were born with it the way the nail grows. P: Probably. TB: Some people are just born with very curved nail. M: Si (yes). TB: So just making sure there’s nothing left behind. TB: Okay. TB: But you didn’t feel anything, uh? P: No. TB: The other thing is sometimes trauma, dropping something on the toe, can really change the way the toenail grows as well. P: Seriously? Wow! TB: Yeah, and once that happens, it grows like that forever. P: Could it be like even if you hit the toe like somewhere? TB: Yep. P: Wow! TB: You didn’t say you’re taking any blood thinners; are you? P: Huh? TB: You’re not taking any blood thinners are you? P: No, no. TB: No, uh? There’s a lot of bleeding. A lot of bleeding. Okay. So nothing wrong with that. M: Why lots of bleeding? TB: Why? Just because of all the bad tissue, I think. M: Uh hum. TB: So what we’re gonna do, I’m just gonna put on that elastic band a little bit tighter. That’s all it means, okay? P: Okay. TB: Because what’s gonna happen, when we cut that tissue, that’s where it’s gonna bleed a lot. That’s normal but I just removed the ingrown nail and it’s bleeding a little bit too much; more than it should. P: It’s because of that blood that’s in that? TB: I think it’s just a bad, all that bad tissue. P: Yeah, probably. TB: Yeah, like we discussed the hyper granulation tissue. P: Yeah, yeah. TB: Okay. Let’s see how it’s doing now. So what’s gonna happen, normally we’re going to use the acid first… P: Okay. TB: And then we’ll trim that bad part of the skin last. P: Okay. No problem. TB: See how it’s doing now. Because I don’t want to trim that bad skin first, because it’s going to bleed too much, and then the acid won’t work properly. P: Okay. TB: So first, we’re going to do that acid, stop those two sides from growing, then we can trim the all bad skin. Okay? P: No problem. The most important thing is that’ I don’t feel the pain so that’s it. TB: And you’re not feeling any pain now are you? P: No. M: That’s acid. You burn with acid? TB: Yes. M: Kiselina? TB: That acid is phenol. M: Yeah, yeah, I know. TB: And no pain? P: No. TB: So we’re doing okay? P: Yes. No, I was looking that that’s why I like it happened (it hurt). TB: Yeah, that’s the only reason why you felt that way. P: Yeah. TB: Now it’s not really bleeding so that’s good. And then afterwards, when we’re done, I’ll give you all the instructions how to dress this toe okay? P: Okay. P: How long do I need to put a bandage on? TB: For a week, P: Oh, for a week? TB: And then we come back, we take a look how its healing… P: Ah ha. TB: Then I give you a new set of instructions depending on how it looks. P: Okay. TB: Big. Didn’t you see, you saw that, Mom, right? M: These things make infection? TB: Yes. M: That grows inside you skin or not. TB: Yes. Knowing the kind of Serbian mom you are, I’m sure you would have gotten in there, you said it yourself, you would have jumped right in there! P: But you know this pedicure I went to, she also got a piece, but she probably didn’t get everything. TB: Yes and plus, it’s very hard, especially if it’s painful. If it’s bleeding, you can’t see properly, and again if the nail is very wide, it’s very hard to get to the very end of the nail. P: Yeah, you know like when she was cutting that like. there wasn’t so much bleeding. She just cut a piece and pull it out but see, obviously there were some more. TB: So as you can see, Mom, no bleeding, huh? How does that look? It looks good because I removed the bad skin. M: Bad skin. Yeah, of course. P: So is there going to be a bump? TB: Is there gonna be a bump? P: Yeah? TB: Not as big of a bump. P: Okay, that’s good. But at least it won’t be red, so it’s okay. TB: Yes. P: That’s good, and there’s not gonna be that bad tissue? TB: No. P: Good. M: You know my pedicure also cut around my nails, so like you know. (?) TB: So this one… TB: We’re gonna remove as much of this bad skin TB: So, see that bump? M: I know. P: So tomorrow, probably , I don’t need to walk as much as I was supposed to? TB: No, you’re gonna take it easy tomorrow. P: Okay. M: Maybe Sunday also. (Patient and mom have a conversation) TB: So when it heals, it will be smooth. M: Yeah. (patient and mom have a conversation) TB: So, you can see, this…gone. TB: Big, uh? M: That’s really big. TB: Yeah. M: That’s after it will grow up new skin, everything? TB: Smooth. TB: So, this thing is going to bleed; that’s normal. Okay? M: Yeah? TB: Yeah, because remember that tissue, is all just blood vessels. So normally I get people to leave this on for 24 hours before they change it. We’re gonna change it a little bit sooner so the back so the bandages don’t get stuck to the side of the toe, okay? P: Uh-huh TB: You’re still on your antibiotic, right? P: Yes. TB: Okay. How many more days do you have? P: I am not really sure how much I have. Maybe a few more days. TB: Yeah, I gave you just for seven days. P: Yes. TB: So should be almost there (finished). P: I had one today like three, three-thirty like I’m gonna have one tonight. P: 9: 30. So when do you want me to change this bandage? TB: Tomorrow morning. P: Tomorrow morning. TB: Yeah, so when I take off this tourniquet, When I get some, some… M: At my house, I don’t have this bandage. TB: I’m gonna give you this; don’t worry, Mom. O: Okay. TB: I’m gonna give you everything, Okay? O: Okay. TB: So that’s why you don’t have to worry about it today. O: Maybe he will come in for checking? TB: He’s gonna come in one week. P: Okay. M: Next Friday. P: So maybe next Friday, uh? TB: Yeah. TB: Okay. TB: That’s one big toe! TB: All finished! P: Okay, good. M: Thank you!