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[nenjin]

You continue to be very helpful. Thank you.

This thing got infected, but the good news is my GP prescribed me oral antibiotics and it seems to have cleared up.
I have no idea how that happened. I have been soaking it every day, using antibiotic cream, and I haven't worn shoes since the operation/procedure.
I mean I also keep it covered with a bandage too, so I don't get how it happened. At least it seems better now.
It does not throb anymore on antibiotics and Tylenol but it used to do that all the time.

Tomorrow is a follow up with the podiatrist. Hoping for good results and I mean it still has a scab on it and no more infection that I can see. So that's good.

As I said, not giving it time to air out daily can lead to an infection. Unsure how much of that you did. And there's levels of infection. I mean.....I basically took the entire surface of the last digit of my right middle finger in an accident. (Pinched in a fork lift.) That thing took months to heal and it looked SO incredibly fugly I would have thought it was infected. And yet it wasn't and I didn't take antibiotics. Feet are just gross, I guess, and nearest to everything that can introduce bacteria. Consider that your carpets are loaded with foreign particles. Anyways, glad to hear it's not super infected and that you got stuff for it.

Thank you. Yeah the swelling was just nuts whenever I wasn't on antibiotics. Weird thing was sometimes it helped to elevate it and sometimes it didn't. I mean it helped at first to elevate it but then if I kept it up there elevated for a while it started to hurt again. Then, weirdly, it just sorta started feeling better once I put it back down after elevating the foot for a long time. I'm not brilliant but I don't get that one.

That's just blood pressure at play. Elevated and most of the blood has run out of it? Contraction. Pulls on the wound. Pain. Not elevated? Loaded with blood due to gravity, it swells pushing out on the wound. Pain.

[Robot Parade Leader]

I would air it out for a few hours I guess and always did sandals so it never touched the ground. I'm sorry you had to go through that with your finger and hope you are ok now.

That is the best explanation I've gotten. I asked the podiatrist and he did not seem to know. He said that problem pain when elevated sometimes happens with peripheral vascular disease, but that I am healing this pretty well so not that.

So more follow up I guess.

Also, they charged me exactly what T said they would plus the procedure visit and stuff. The permanent procedure was like $2000 with everything including 2 follow ups, phone consult things, and the prescription exam. Insurance covered all but like $273. They did have to be argued with though.... I mean, it isn't cheap but seeing a foot doctor 4 times and having a nurse for phone calls isn't bad. Plus something went wrong with the infection, and it is permanent so no recurrence "unless I missed some but I did not. I never have but talk to me if I ever do."

I'm just hoping it heals well over the next few months and looks normal/no more infections.

[Radsoc]

A bit late to the party, but glad that you got your issue treated and that it won't recur. In the general case, if you have an inflamed toe (and it isn't e.g. gout), I would consider a chlorhexidine or aluminium acetotartrate drenched bandage (refilled every 3h). If there is an abscess (i.e. pus filled) I would puncture it. Antibiotics are usually not needed (unless you develop a fever or the inflamed area spreads), and should be avoided on a population level, but individual cases may be different. There are a number of non-surgical treatments for ingrown toe nails, but if a patient is healthy in other respects, a permanent surgical procedure could take 30 mins (same precautions afterwards to avoid new problems). Most GPs do that here at no cost, but I guess salaries are a third of US ones, and a sixth after taxes.

[Robot Parade Leader]

The US healthcare system is a nightmare. Everything costs a lot. The healthcare workers don't get paid well and are too stressed. Try to mention socialized medicine and there is a good chance someone will get absolutely pissed at you, because people have been told it is evil for basically forever. Well, I'm still here so that's good.



I've been on antibiotics for most of the past 3 weeks, because it got infected. Getting off those and I really hope that goes well.
I'm letting it breath. I found a good trick is to basically have the bandage with a flap that can close over the area and stick around to the other side of the toe or just remain open. Much easier to apply and open/close.

I haven't really worn shoes since (I mean a little bit for actually a couple of hours at a time at most). I stopped soaking it because the doctor told me that was to draw out fluid and he didn't think I needed it anymore.

It is still weird to feel throbbing in the toe sometimes. I guess it is what nenjin said about blood pressure at play putting more or less pressure on it depending on if it is elevated. Weirdly if I sit still (which has to happen) it can be worse for a bit but I can take a couple of steps and that temporarily helps? OR there might be other issues but the throbbing lessens? I guess I never thought about it like that. That and it's kind of weird it's been 3 weeks and this is still happening. Most of it hasn't been that bad because of antibiotics though. That seems to have been the key.

I'm a little worried about going off antibiotics. Hopefully won't matter after this long.

[nenjin]

Follow your doctor's instructions. The worst thing you can do is be inconsistent with antibiotics. Either use them or don't, but don't half ass it or you get resistant bacteria. And you don't want to stay on antibiotics for eternity either.

Depending on your age, the healing process can take longer. I too would figure you're past the "throbbing" part of the recovery process but everyone is different. Just keep checking in with your doctor's office. If it gets reinfected when they take you off the anitbiotic, they'll put you back on it.

[Djohaal]

One thing people don't realize is healthy tissue healing can look infected at a glance to the untrained eyes (or those uninitiated to healthcare-fu).
For a relatively large and frayed surgical site like a nail, you'll usually have a fibrin layer like a bed forming on top of the wound, and then skin slowly growing from around the borders. Fibrin at a glance can look a lot like pus, its whitish yellow and gooey, so it might look infected when it isn't.

[ChairmanPoo]

Look, he should contact his local mob enforcer about it and get an opinion

[Robot Parade Leader]

Hi there. Update. 2 months.

Things are overall better without anymore infections, and it still kinda hurts more with shoes/socks etc, but there is one odd thing. I think he may have ultimately taken more than the 2 mm of total nail he said he would. I don't ... know if it is only cosmetic or what. I don't think it's immediately life threatening or anything but I have no clue about things and am not qualified to say anything like I don't know if it will lead to difficulties down the road like more lost nail or eventual healing/sensitivity while the slowly newly exposed nail bed/base heals.

I think he may have used that acid on a part of my toenail he may not have directly meant to that is right next to the part he was supposed to cut out.
So, from the very beginning, I noticed there was a straight "crack" and discoloration on the nail bed (the part that grows the nail at the very base of the nail, next to the part where he took out 2 mm of nail_. That crack was about 90 degrees from the clean cut the doctor made. I told myself I was just imagining it (got pictures though) and besides I know I'm stupid and wouldn't know what "normal" would look like after this anyhow. Could've been completely normal for all I would know. Now two months later, the part where that "crack" is, is not growing new nail. Instead there is a little "hole" that is maybe 4 mm wide judging by the ruler I used. It seems to be pulling away from the base. That same "crack," is now forming a straight line behind which no new nail grows. I know 2mm of the nail wasn't supposed to grow anymore nail but this is now total of more like 6 mm.

So bottom line I'm slightly worried I might end up slow motion "losing" another 4 mm of whole nail in addition to the 2 mm the podiatrist cut/burned out with acid. This means as the nail has grown over the past 2 months, the area behind the "crack" has not grown. I kind of worry this trend may continue, because if the nail continues to grow and "push out" from the base (otherwise growing like toenails do), and this portion of the base does not grow any new nail, .... This means that "hole" or missing portion of nail where it is wider than the 2 mm part that should have been is going to slowly grow until it will eventually be like he took 6 mm of toenail instead of 2 mm.....

I don't know if this will result in maintaining that clean surgical edge to that side of the nail or not. I also don't know if this will lead to slowly exposed nail bed that will have to slowly heal and be a bit of a pain when wearing shoes.

The good news is I have pictures of everything on a near daily basis so show everything I am talking about to this doctor. I can look at the pictures and see this slow motion happening over the days. I just don't want anymore toe/foot issues or to be that stupid patient who screws up something. I went to a professional at a hospital podiatry department so nothing like this would happen. I only noticed this particular part of the issue when a scab came off and it kind of looks like a bit of the tissue is still on the nail part. There's also a black area inside the toe part where the nail was and I'm hoping that's just a scab protecting the area.

I hope I'm just worried over nothing. I know I know nothing though. Also I mean, if he ended up taking 3 times more than he said he would 2 mm verses 6 mm total with acid, I don't want anyone else do deal with that either. Nothing like more acid burns on your toe than necessary and only take what you need..... I have no idea and acid burns do not feel great.

I don't wanna be a problem but at the same time, there's like ... a hole in my nail and the lost part may end up being bigger than I thought....Hopefully not deeper than I thought? No idea.

[Truean]

Please do not quote

You ok? I'm assuming so and not an emergency if you're posting here rather than going right to a doctor.... Primary concern is always everyone's safety/health. Secondary concern is having insurance pay for it. Standard disclaimer: if emergency get help.... No one here can treat you. VERY IMPORTANT: As I'm sure you've been asked before, are you diabetic? Tell your doctor (he or she can help, we can't) if you are, because diabetic foot wounds can be very serious.

1.) "The good news is I have pictures of everything on a near daily basis so show everything I am talking about to this doctor," is what is going to help you explain all this to your doctor and insurance company.

The hospital may have a "Mychart" or other software patient portal you can upload photos onto for your doctor's team.

Bottom line:
Call the hospital/a medical professional and ask what your next steps should be/where you should seek treatment.
Describe it to the nurse or medical professional answering the phone. Do as the medical professional says.
Have a medical professional look at it.

You show the picture of that beginning "crack" or whatever circumstance to your doctor/a nurse and then you show a picture that it got bigger over time. Ruler showing scale helps. Also, if your insurance company gives you flack about why they need to pay for another follow up visit/treatment, "Look at this Ins company." If Insurance $ claim denial: appeal process. Their physician medical director can see it as it happened, that you're not making it up, and didn't cause it/something else didn't cause it. I've had to fight like hell with [insurance company redacted] to get six figures of medical bills paid after surgeries/rehab PT/OT and show I met coverage criteria. I am incredibly glad I had photos of surgical incision healing to show the insurance company's medical director why I needed wound care services along with the nursing notes from the provider and physician's orders. The insurance company actually tried to cut off treatment sooner than my doctor wanted. I hope it's nothing like that for you. I don't think it will be, but taking a picture is a small thing that can help.

2.) "There's also a black area inside the toe part where the nail was and I'm hoping that's just a scab protecting the area. " Have the doctor look at this to make sure.

Always try to be a helpful patient to the (usually over stressed) physician and medical staff to make it easier to treat you. Even in the event a physician screwed up (which I don't know if that's the case here) being unprofessional never helps and is harder to treat.

3.) If your boss asks why you need to take time off work for sick leave, you shouldn't have to show him a photo but practically, that and a doctor's note can be the difference between your supervisor giving you crap about it or supporting you. Depends on the supervisor.

Please do not quote

[Robot Parade Leader]

Ok. I took pictures and sent them to the podiatrist over the hospital's computer system showing the first crack thing and the current gap.

One of his staff replied back and said they showed the doctor and they said he said,

"At times, more nail is removed from underneath the skin during procedure then can be evaluated at follow up. Usually nail growth corrects this, but that takes six to nine months sometimes. If you have any concerns in office eval would be best. Home monitoring is ok if there is no drainage, pain or redness."

I don't understand this.
What does she mean he said there can be more nail removed underneath skin?
I thought they were just supposed to take what they were supposed to take and not more.

What does she mean "usually nail growth corrects this?"
He used acid so it wouldn't grow back so how is there going to be nail growth?

What does she mean 6 to 9 months?
This whole thing was supposed to be healed up in 3 to 4 months. It's been 2 months.

Redness? There's some red in there but I don't know if that's normal and it is shown in the picture I sent her. There's another blackish area I think is a scab inside it but I don't know.

Pain? Yeah it doesn't feel good.

As for what I'm supposed to do about it. Wearing socks irritates it but I need to do that for work, and 6 to 9 months of issues?

I think I might need to actually go in and see this doctor again, but that's just awkward if he screwed up and took more of my toenail and more recovery time than he said he would by twice as long/much. As far as I knew I was supposed to be halfway done with this and I did everything I was supposed to. I made sure to. Now, I wouldn't even be upset with him if he did screw up if he could fix it. Plus I don't know if there will be more care required and more to pay for. I keep getting told things are going to be "simple," and not to worry about it. Then stuff gets like this and I'm just kinda stuck?

[ChairmanPoo]

I dont know jack about nail surgery specifically, but on one hand it doesnt sound unlikely that bigger areas than might be obvious at first might need to be removed during surgery.

(On the other... if you're being offered surgery for a relatively minor problem, think it through before going forward and ponder the risks/benefits from a 'worst likely outcome' POV. Doubly so in for-profit systems. It's never *that* simple

[Radsoc]

I don't think there can be any illegitimate concerns. You're always right to raise your worries. Seemingly trivial feet problems can be serious enough to affect quality of life negatively in major ways. Maybe here some additional tissue got affected/damaged, but they expect it to regrow or heal eventually while the 2 mm-area that was treated surgically is not expected to. They are likely not worried about this judging from the response, but it's impossible to say, best is to visit a/the doctor like they say.

[nenjin]

Could always get a 2nd opinion too. Doctors tend to stand by their diagnosis, so if mistakes were made and they're obvious, a 2nd doctor isn't under the same pressure as the one that treated you. It's a pain in the ass but if it will bring you peace of mind it's probably worth it.

[Robot Parade Leader]

Thank you guys.

I scheduled an appointment to see what's going on.
In the meantime, the toe gets irritated if it is in a shoe/sock for ... 3 or 4 hours.... Kind of difficult situation with work and all. Not sure how to make it not irritated, etc. 

I dont know jack about nail surgery specifically, but on one hand it doesnt sound unlikely that bigger areas than might be obvious at first might need to be removed during surgery.

(On the other... if you're being offered surgery for a relatively minor problem, think it through before going forward and ponder the risks/benefits from a 'worst likely outcome' POV. Doubly so in for-profit systems. It's never *that* simple

I can certainly respect that from a person I know is much smarter than me. Thing is, if they did need to remove more, then wouldn't they have said something at some point? Cause he didn't.

*****

I think I kind of want to see what he says about the little ... pit ... because I don't know what else to call it. Also a small 1mm part of the scab is dark red/black. The part of the nail on the shelf (with nothing behind it except that pit/missing nail part, is turning the color of the part of the nail you trim. So the nail grows from the base, then it has a like pinkish color until it gets to the part at the end where you trim your nails. Yeah, It's starting to turn that color by the area where it was removed and with that missing bit behind it. Weird.

[Robot Parade Leader]

Three doctors came into my first appointment since this. The first was the doctor who did the procedure and he's like 40ish. The second was much older and did most of the talking. The third was introduced to me as a wound care specialist physician.

From what I was told:
I would have blood tests done to make sure I did not have diabetes.
I would be seeing the wound care specialist physician every week and using "silver algenate" bandages as a precaution.
I would also see the first doctor with the second doctor reviewing everything.
I was asked to give them copies of the daily pictures I took of my toe and keep doing that.
I was told this would cost me nothing and would not be billed to my insurance even.
I told them I was not signing anything and the doctors didn't seem to care or mind that part at all.
They did ask permission to show the pictures to the Utilization Review Committee in their hospital and I said they could see the pictures
They said I would be fine and they would handle it.

So now I have regular recurring appointments for the next 3 weeks and maybe longer. It seems to be doing a little better since I started this.