Q: Could you please tell me how to get rid of toenail fungus? — T.D., Wilkes Barre, Pa.
A: Toenail fungus is a very stubborn problem. Fungi enter the nail either through the cuticle or under the tip of the nail. They easily attack the nail, thriving off “keratin,” the nail’s protein substance.
When the tiny organisms take hold, the nail may become thickened, yellow-brown in color and foul smelling.
To get rid of toenail fungus, the best treatment is a three- to four-month course of an antifungal pill like Sporanox or Lamisil. Over-the-counter antifungal sprays and creams just don’t work. Antifungal nail paints like Penlac are not very effective but may be of additional benefit when combined with antifungal pills.
Aggressive debridement of nail fungus by a podiatrist followed by antifungal pills seems to provide additional benefit over antifungal pills alone.
The PinPointe laser system is a new option in treating nails refractory to standard treatments.
There are all sorts of home remedies, ranging from bleach to Vick’s Vaporub. I can’t recommend them because the safety and effectiveness isn’t proved. Creams, sprays and soaks don’t work on toenail fungus because they can’t reach organisms that are deep within the nailbed.
In some stubborn cases, much as it pains me to say it, the only way to get rid of toenail fungus is to remove the nail. By doing that, a topical antifungal cream along with pills can have a good shot at getting rid of the fungus.
Q: I recently read about a study that showed that most people who have had knee replacement surgery gain weight rather than losing weight afterward. Why do you think that is so? — P.O., New York, N.Y.
A: You would think that overweight people with severe osteoarthritis in their knees would, if given the opportunity to walk and exercise again, lose some of the additional weight that resulted from limited mobility. But according to a recent study conducted at the University of Delaware (Jan. 15 issue of Osteoarthritis and Cartilage), most folks after knee replacement surgery dropped weight while receiving post-op physical therapy but gained an extra 14 pounds over the next two years. What appears to be the case is that the sedentary lifestyle that folks have because of their degenerative knees is a tough habit to break — even when given a second chance — and the excess calorie consumption and poor dietary habits that caused them to become obese in the first place still remain.
An important reason gaining weight after a total knee replacement is a cause for concern is that it will greatly increase the chance that the other knee will soon need replacement.
An important conclusion from this study is that weight gain after surgery needs to be treated as a separate concern and integrated into the usual post-op care through nutritional counseling and retraining patients to encourage a more active lifestyle.
Dr. Mitchell Hecht is a physician specializing in internal medicine. Send questions to him at: “Ask Dr. H,” P.O. Box 767787, Roswell, GA 30076. Because of the large volume of mail received, personal replies are not possible.