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post-op care after ingrown toenail removal

Discussion in 'Ask your questions here' started by jamieresearch, May 8, 2010.

  1. jamieresearch

    jamieresearch New Member

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    I came across your site and am pretty horrified by some of the things these people are posting about ingrown toenail removal. I guess I was really lucky and had a great doc!

    I had mine done (both big toes, both sides) six days ago and have had a pretty easy time of it. Put it this way - I have ZERO tolerance for pain, and I haven't taken anything since some ibuprofen the first day.

    My toenails on both sides were growing, as he said, at almost a 90-degree angle. I've been having them cut out for 15 years, and I was just tired of it so I finally had the phenol procedure done to nix the regrowth. When he cut out the nail, I was shocked and just how much there was growing into the sides. There was no infection or irritation on the ingrown, so it seems I was at advantage before I even started.

    Anyway, I'm following all of the post-op procedures to the letter to avoid infection and whatnot; I don't see the doc again for another week for followup, so I was hoping you could answer my questions in the meantime. (They've been great with any calls/questions I've had, but I just wanted to get a second opinion.)

    -The sheet he gave me said to soak BID in the epsom salt for a week; is that enough time? And just out of curiosity, what is it that the epsom salt does to help with healing?

    -Same with applying the Neosporin and bandage; he said to do it for a week, and then after that I can go without it in open-toed shoes. There are no scabs, but I do still see a little bit of what looks like rawness. Not sure how to explain it. It's doesn't have puss, it's not draining, it's not bleeding - nothing that would indicate infection. Is a week of having it covered/applying Neo enough?

    -Believe it or not, the most uncomfortable part of this is the injection sites for the numbing agent. He did four injections on each toe, and though there is no swelling or redness at the sites, they are relatively sore to the touch. I'm guessing this is normal - I often bruise after a blood test, so this doesn't really surprise me - but is there anything I can do to alleviate that?

    Thank you, and thank you for providing this forum!

  2. FootDoc

    FootDoc New Member

    No . . Nail surgery is probably the most common foot surgery performed and you just had what the vast majority experience, but few if any folks write into forums if they have had no problems.

    Nothing as far as I know. If you had a chemical destruction of the nail matrix it is the water that is important to help keep the drainage flowing.

    Neosporin is an antibiotic and is sometimes used as a prophyllactic to deter infection. A sterile dressing is employed to keep the surgical site clean and to soak up drainage.

    I instruct my patients to keep it dressed until drainage ceases and the portal heals. But that's MY protocol and every doctor has his/her own.

    "Tincture of TIME"
    Last edited: May 8, 2010
  3. jamieresearch

    jamieresearch New Member

    Yeah, I know what the Neosporin does, I just wasn't sure how long to keep it on there.

    Today has been a week since I had it done; I talked to the doc's office, who said I can stop soaking and stop covering.

    They're still kind of sore, but apparently that's normal, especially considering all he took out of my nail area. They're not red or irritated, and the drainage is still 100% clear, so I guess I'm doing the right thing.

    Everyone says about 3 weeks for them to be back to normal. That sound about right?
  4. FootDoc

    FootDoc New Member

    Some aftercare periods for this type of surgery last only a couple weeks and some go on for many, many weeks. With civility, please explain to me why so many folks would prefer to trust the blind guesses of those whom they do not know, and who don't know them or the specifics of their case rather than the doctor who does? I would be horrified if one of MY patients had to resort to Internet forums for case-specific information instead of realizing that it should would best come from me. I would consider that to be a failure on my part for not making them clearly aware of that fact or engendering that level of confidence in ME.
    Last edited: May 11, 2010
  5. jamieresearch

    jamieresearch New Member

    Wow, with all due respect, don't be so defensive. I do see some of the other posts that have people coming to you for specific advice - and being as you're not their physician, I think that's ludicrous. My doctor was great about explaining everything to me, and I'm completely comfortable with what he's told me. However, medical things can be scary for some people (I've had much worse in my life than this, so this isn't really more than mild discomfort), and they likely want to get as many opinions as possible. I agree, they should be asking their doctor for the big stuff; however, when it comes to just basic followup questions about other people's/doctors' experiences, such as mine, for which a patient doesn't want to hound the doctor's office every day, I see nothing wrong with an Internet forum and asking people who have had the procedure done.

    And I'll even throw your question back at you: Why HAVE the Internet forum if you're going to be annoyed by the things people ask you? For instance, I'm not asking you to diagnose a condition for me, I'm asking a simple question about the generics of the post-op care. And yet you pretty much bit my head off about how long the discomfort usually lasts. Had I said, "Oh, my toe is inflamed and puffy and has greenish puss coming out of it, and it's hot to the touch, what do I do?" Well, yeah, that's asinine. At that point, you call your doctor - common sense.

    If you're really as irritated as you seem to be with the questions being posed to you, my suggestion would be to shut down this forum or have another doctor take it over. You have to know that people are going to ask you just about everything in the book; obviously you can't be expected to diagnose their conditions, but if you're going to offer your expertise, you have to expect all levels of questions, from the basic (like mine, which I would have thought you would have answered graciously) to the ridiculous (such as people asking you to make diagnoses that you clearly wouldn't make).

    I hope that was answered with enough civility for you.
  6. FootDoc

    FootDoc New Member

    I would judge your reply rather passive aggressive rather than civil, and even so, supplies only an excuse rather than a reasoned answer to my question.

    First of all, I need to disspell some basic inaccuracies in your reply. This is not MY forum. I have no more to do with it than do you or any other questioner or responder. My participation here is totally voluntary and unremunerated. I respond to those question to which I wish to respond and in the manner in which I deem appropriate, and I do not solicit questions. Assuredly, I am not the only doctor who reads this forum, and the fact that so few others choose to respond here would appear to indicate that most other doctors reading the response, provided mainly by me, deem the questions adequately covered. I can assure you that doctors finding an errant answer are not shy to chime in if they have a better one. Finally, anyone who responds to as many questions as do I, though the vast, vast majority are well-received, runs into those who, for one reason or another will either take offense because their generally unreasonable expectations have not been met or they have been told something which they did not want to hear, such as that part of the responsibility for their problem lies with them and the way that they have perhaps delayed obtaining or neglected care or have dealt ineffectively with their own doctors. I have defined many times in many posts what I deem to be appropriate fodder for questions in forums such as this and have posted at the top of this forum a statement on what reasonable expectations should be.

    Apparently, you and some others infer irritation on my part when I attempt to educate them on the fact that obtaining case-specific and case-dependent information regarding their individual situations from even experienced professionals who have no intimate knowledge of their specific situations may not only be risky, but disastrous . . and particularly unnecessary when they have a source in their own doctor which should be far more specific and accurate. I deem it an opportunity to educate, rather than a matter of my irritation. In your case, I did supply the only accurate answer which I could under the circumstances, by offering you the generalities which apply when no evaluation of a specific case is not possible. But your post did beg the question, "Why, when this poster has a doctor no further away than his telephone . . a doctor who actually knew him and his case and had professional responsibility to him did he choose to search the Internet for a forum, post a question and be willing to wait an unknown amount of time for a reply from some other patient who had probably a singular experience or even an experience doctor, but one who knew nothing specific about his case and thus could not give the case-dependent answer to the question asked? A corollary to that would have to be . . "Why do you and some other deem that obtaining the desired information to satiate you rightful concerns on ANY level by asking the paid source is "hounding your doctors?" Isn't the satiation of your concerns part of what you and they are paying for? Where you came up with the comment that I was being defensive, I have no idea. What I was trying to be was accurate. "Generics of post-op care" would be how something is generally dressed or what sort of physical therapy is frequently appropriate. There is nothing "generic" about questioning, not about how long something generally takes to heal, but how long YOUR something will take to heal, and THAT is why you and everyone who wants to know the specifics about his/her case should obtain it from the "horses mouth," the doctor in attendance, and not someone on the Internet who neither knows him/her or his/her specific case. Your question simply afforded me the opportunity to teach that fact, even if it falls on your deaf ears.
    Last edited: May 11, 2010
  7. jamieresearch

    jamieresearch New Member

    Well, even if it's not YOUR forum, you choose to answer the questions. You are clearly frustrated by some of the questions you receive - and rightfully so, as I stated before - but there are some that just don't warrant your attitude.

    OK, so "generics" was a bad choice of words; I was just curious what other people's experiences (and since you're a physician yourself, you'd have more experience than anyone) had been when there have been absolutely no issues... what the average, if you will, recovery time is when there are no problems. Most people look for commonalities in medical problems, and I have several friends who have had my procedure done; it's nice to hear about other people's experiences sometimes so one doesn't feel like SHE is alone.

    I have made several calls to my doctor and the office is always accessible. Sometimes it's nice to hear from other people, though, and after a while, you feel a nuisance when you call for every tiny little question. It's like saying, "Hey, I have a headache, which is better, Advil or Tylenol?" For that kind of question, I think an Internet forum is just fine.

    Regardless, I was happy to come across someone who seemed educated and willing to answer questions, and was seriously disheartened to find someone with your poor attitude. I wasn't asking you to dx anything, simply to see what the general rule of thumb is on a few things when there are no problems present.

    I cringe when I think what your patients must experience when they come to your office; I'm guessing your bedside manner needs some work. You can still get your point across and not be nasty about it. Perhaps you SHOULD stop answering the questions on this forum; yes, other doctors must deem your answers satisfactory and thus don't post, but you clearly are so annoyed by everyone's questions, from the simple to the ridiculous, that it's amazing you're still doing this.

    This has turned into a pissing match that I won't continue. I'm sure you're very knowledgeable in your field and I have respect for that; what I don't have respect for, however, is someone who has such a nasty tone in his/her emails. It's just not necessary. You can call me passive aggressive or whatever else you choose, but I was trying to be polite and explain things from a patient's point of view; sometimes that gets lost on doctors. Consider that.
  8. FootDoc

    FootDoc New Member

    Apparently my closing statement about your "deaf ears" was right on target. I told you that I am neither frustrated, nor irritated nor annoyed about questions to which I raise the issue of their inappropriateness, but employ them as a teachable moment as I had done with yours. I am, however, annoyed at your persistence in alleging otherwise.

    You have just admitted employing a poor choice of words is a venue in which words are all that there is to go on. It is unreasonable to believe that what you were asking was the average time for healing, as you have no idea as to whether your situation is average or not and a reply on that basis would be meaningless to you. Had you REALLY wanted an answer for which you could have some basis of believe and trust, you would have not gone onto the Internet, but would have asked the only person who actually knows you and your case . . your own doctor, if, in fact, you had chosen one whom you really respect. Averages are for books and for making judgments prior to having surgery, not for case-specific facts after the fact.

    I am at the stage in my professional career where I can choose which patients and what types of cases I wish to take, and there are more who desire my services than I can or am willing to accommodate. My participation in this forum where I respond to an average of of only about 3 questions a day fits nicely into that regimen. You might be surprised to know that in my private practice I engender a personal relationship of mutual respect with my patients, rather than the god-worshiper relationship that many are use to with their doctors. My patients know that I take full responsibility for my part in their care, but that they too have responsibilities in being conscientious about following my treatment regimens and taking the time to listen and learn and understand what it is that I am attempting to am do for them and why. My patients tell us that they seek my services mainly because they have heard from my current and former patients and their own doctors that I am good at what I do, but, importantly, also because my reputation is one of actually caring about them and their concerns and being available to them when they need me. I suppose the later is in contrast to doctors such as you employ to whom you believe a call for information is tantamount to "hounding" them. I can assure you that my patients do not have the need or the desire to go onto an Internet forum as did you to ask questions about THEIR care.

    Finally, it is patently ludicrous to repeatedly insist that I am either frustrated or annoyed or irritated by questions posed here. I would not have been doing this for so many years if that were the case. I enjoy sharing my expertise, and doing so in total anonymity means that all I get from it is the personal satisfaction from knowing that the vast majority of folks have found my help useful. Again, I reiterate that the relative absence of posts from other doctors in this forum would appear to indicate that other professionals who would other know the difference seem to deem that questions here are being well taken care of.
    Last edited: May 11, 2010
  9. Unregistered

    Unregistered Guest

    How long after surgery should i return to work?


    I am having an in-grown toe nail removed on the 1st of July 2010 and wanted to know how long after surgery should i have off work to recover? (please bear in mind i have to drive to work.)

    Also is it important to keep the bandage dry and clean to stop possible infections happening?

    Many thanks

  10. FootDoc

    FootDoc New Member

    This is no way to start off your surgery and your decision to have it. You have ostensibly selected a doctor whom you believe has the experience, the skills and the qualifications to deal with your foot problem. If you really find it necessary to come to a forum to ask such basic information about your nail surgery as you have asked here instead of obtaining that information directly from the doctor who you will be trusting with your toe, then perhaps you need to rethink your choice of doctor. What others have experienced and what instructions others have received from THEIR doctors may not be appropriate for you and may be in opposition to your doctors protocol. Go ask your own doctor. That can serve as the first test of the validity and wisdom of your choice, and if you do not receive what you believe to be reasonable answers, then rethink the whole thing.
    Last edited: Jun 16, 2010
  11. Unregistered

    Unregistered Guest

    I thought it was quite a good question!!

    A podiatrist is doing my surgery and was not at all forth coming with post op advice. I think she feels worried about being mis quoted or people trying to get more time off work than they need?!!

    I am a secondary school teacher and I am estimating that I will need up to 2 weeks based on all that I have read/ been told. As I will be on my feet for more than 8 hours a day and I will be moving around a science lab so will need to get closed toe shoes on!
  12. FootDoc

    FootDoc New Member

    DISCLAIMER: THE FOLLOWING IS OFFERED GRATIS AS GENERAL INFORMATION ONLY, AND, AS SUCH, MAY NOT BE APPLICABLE TO THE SPECIFIC QUESTIONER AND/OR HIS/HER PROBLEM. IT IS CLEARLY NOT BASED ON ACTUAL KNOWLEDGE AND/OR EXAMINATION OF THE QUESTIONER OR HIS/HER MEDICAL HISTORY, AND IT CAN NOT AND SHOULD NOT BE RELIED UPON AS DEFINITIVE MEDICAL OPINION OR ADVICE. ONLY THROUGH HANDS-ON PHYSICAL CONTACT WITH THE ACTUAL PATIENT CAN ACCURATE MEDICAL DIAGNOSIS BE ESTABLISHED AND SPECIFIC ADVICE BE GIVEN. NO DOCTOR/PATIENT RELATIONSHIP IS CREATED OR ESTABLISHED OR MAY BE INFERRED. THE QUESTIONER AND/OR READER IS INSTRUCTED TO CONSULT HIS OR HER OWN DOCTOR BEFORE PROCEEDING WITH ANY SUGGESTIONS CONTAINED HEREIN, AND TO ACT ONLY UPON HIS/HER OWN DOCTOR’S ORDERS AND RECOMMENDATIONS. BY THE READING OF MY POSTING WHICH FOLLOWS, THE READER STIPULATES AND CONFIRMS THAT HE/SHE FULLY UNDERSTANDS THIS DISCLAIMER AND HOLDS HARMLESS THIS WRITER. IF THIS IS NOT FULLY AGREEABLE TO YOU, THE READER, OR YOU HAVE NOT ATTAINED THE AGE OF 18 YEARS, YOU HEREBY ARE ADMONISHED TO READ NO FURTHER. *************************************************** Wake up and smell the coffee. YOU are the employer in a doctor-patient relationship. If a doctor is not forthcoming with the answers to any and all questions regarding a planned procedure, would that not give you a clue that you may have picked the wrong doctor. Why do you feel competent in estimating how much if any time you will be off of work? The fact is that unless there are serious complications the vast, vast majority of patients having ingrown nail surgery do not require time off of work. Sure, I'll not get a bunch of comments from those few who have, but I've been doing this sort of surgery for decades and those who NEEDED time off of work are few and far between. Here's a clue . . I don't think I've ever had a SELF-EMPLOYED person in ANY field of work who took time off after the procedure.
  13. TOG Orthotics

    TOG Orthotics New Member

    It can really vary depending on the procedure and obviously on the job you do, as a teacher I wouldn't be taking any risks. My wife had an ingrown toenail that required minor surgery, she was back on her feet within a week, although the first couple of days were extremely painful. I'd politely request more information from the podiatrist.
  14. Biomech

    Biomech New Member

    Did you get the information you required?

    As far as I could read, the best bit of information was this

    from FootDoc.

    This person gives their time voluntarily to provide information and guidance. It might not be what you want to hear, but it is good guidance nevertheless.

    ps calling someone an a*sehole on a forum like this couldn't be more pointless or childish
  15. Unregistered

    Unregistered Guest

    I am pretty pleased you experienced no pain. I had my right toe done 8 days ago, and I am still in immense pain. Can't walk or drive yet and can't even touch it to change the bandages. The pain isn't really my nail, it's like the bones in my toe would be the best way to describe it, my whole toe hurts. I am questioning whether it was worth it or not because my ingrown wasn't even as painful as this, even when it was infected and bleeding. Overall I would say I didn't take the surgery well and I still am not, but when it fully heals in 8 more weeks I am sure I would jump back in surgery again for my other toe.
  16. Podwoman

    Podwoman New Member

    To unregistered,
    If you are experiencing the amout of pain that you say you are then you need to contact the person who performed the procedure.

    In 35+ years in podiatry I have only had one person who had severe pain following IGTN surgery. This patient chose to do the hoovering when she got home from the clinic while the toe was still numb and she banged it on furniture. Needless to say when the anaesthetic wore off she felt the effects of it.
  17. TOG Orthotics

    TOG Orthotics New Member

    That's an eye watering moment!
  18. Unregistered

    Unregistered Guest

    As I see it there is no call to assess "style points" here. If you want style points, go pay your own doctor to give you your answer how you like it. The answer given by the doc here seemed sound to me and it was the person who asked the question who wouldn't just accept his answer and let the issue drop. The doctor was giving free advice which I'm sure he usually gets paid pretty well for. Sometimes good advice is not what you want to hear and complaining that it wasn't sugar coated enough for you is just acting like a child. Certainly you have more pressing things in your life.
  19. Unregistered

    Unregistered Guest

    i most definitely agree with you
  20. Unregistered

    Unregistered Guest

    Footdoc...Maybe I'm missing something here... Someone comes on here for advice... and you sign in to give it but then chide them for coming on here to ask advice? If that's how you really feel about people asking for advice over the internet, I would think youd be disinclined to participate. I think that some people just like to get a second opinion. Or maybe they dont want to "bother" their dr with every little thing--like the op had said. But it is also important to remember that while patients are consumers--many do not have stellar health insurance--or any at all-- and are not free to just go to any doctor, or a better one, or one that they even have a hand in choosing. Which is why they may come here for another opinion. You dont know what a persons financial situation is--so you shouldnt berate them--if you want to give your professional opinion we'll all be more informed because of it and thankful for your time. But please don't judge, and please dont assume that because someone asks a question on this forum that their relationship with their doctor is any of your business unless the question explicitly makes it so--because you have no idea the set of circumstances that led a person here in the first place.
    Last edited: Aug 12, 2011

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