That said, this was the best place I could think of to capture what I hope will be my sad toe turn around with my memory starting to get a little fuzzy and no abiding offline journaling habit. But heck, 10-20% of the population has the same problem as me and the number climbs to 35% for the over 65 crew. Maybe some readers will benefit from reading my lab notes. So, even if it is a bit of a compromise on privacy, here goes!
Objective/Hypothesis: 18 months from now (i.e. Thanksgiving 2027) have a left toenail that is improved to the point where I do not feel self-conscious going barefoot without polish cover with the support of a new podiatrist and ChatGPT.
Background: contracted Trichophyton rubrum in the intense training that lead up to completing an Ironman in Arizona in the fall of 2017. When OTC topical stuff did nothing, I sought treatment from a podiatrist (2019-2020ish?) which included an oral antifungal (probably terbinafine) with the understanding I would need to get follow up bloodwork to refill the prescription. Also with the understanding that reinfection was highly likely due to difficulty completely disinfecting the environment. Oral seemed to be working, but the doctor declined writing a second Rx and insisted on a second appointment (not discussed at intake). At this point, we had pandemic controls, I had an infant and not great childcare coverage. I had vivid memories of waiting a long time for the first appointment listening to the doctor quarrel over the phone next door about not having been invited or something to a conference while I stressed that the clock was running down on my sitter coverage at home. Now I was stressing I had toxified my liver and no one was willing to discuss it with me over the phone in the worst case and this being some sort of second co-pay grift situation in the more likely scenario. I declined making a second appointment and settled into a routine of my hubby shellacking the offending nail with a heavy coat of my favorite nail polish. I briefly consulted a few years later with my general physician and got a similarly bleak prognosis and an Rx for a topical nail paint which we applied haphazardly and is now 2 years expired.
Intervention/Experiment:
5/15-5/25: Prep. Based on suggestions from ChatGPT.
- Remove nail polish
- Begin treatment with Lamasil AT (topical terbinafine) assuming comorbidity with Athlete's foot. While package claims 2 weeks sufficient, will probably need to continue longer due to reservoir in nailbed. I have a pretty good anchor habit of 2x/day face washing so I will stack this application with that.
- Begin overnight treatment with 40% urea lotion to soften nails and allow better topical treatment penetration.
- Begin weekly treatment with disposable emery board to debride build up on nail and allow products to penetrate more effectively. I am finding this might work better with a full soak rather than a shower. Perhaps in a future week I will try to stack it with a Friday heat the spa and hang with MacGyver day because I think he misses our now on hiatus pedicure catch ups.
- Prioritize barefoot policy at home to maximize dryness/airflow. I am finding this works a bit at cross-purposes to covering my feet with Lamasil cream in the morning and then slip-sliding around the house. However I am finding it is pretty agreeable to my attempt to keep the house cleaner projects (though the other 2 inhabitants wear their shoes all over and then complain when they can't find pairs to wear at the back door, so...)
- Douse shoes with lysol and situate outside during the day to do some amount of UV disinfection in sunny socal. I thought I could store them outside indefinitely and then remembered we have a feral cat situation and the spray of those is even more objectionable that the smells coming out of the depths of my climbing shoes. Considered plug-in UV shoe disinfectors but they are expensive, reviews of their efficacy are mixed, and it would be a big departure from our current dump shoes at the back door routine to use them consistently.
- Disinfect all toe clippers with rubbing alcohol. Discover just keeping an open tiny container for disinfecting is unsafe, so will stick with keeping it capped at all times except during a 10 min dip after tools are used.
- Take baseline toe nail photos (below)
- Research + purchase 2 new sandal models at REI to wear once I have podiatrist go-ahead during the full treatment process to maximize sanitation and allow rotation to fully dry (Keen Newport-- machine washable, toe cap affords some privacy if self-conscious in social settings. Bedrock Cairn EVO-- minimalist sandals that should be easy to disinfect for everyday use). I am in a clothes low-buy phase, but this spree seemed ordained with notices from REI I had member benefits to spend and both shoes being available at the local shop for 25% off and an opportune sushi-rolling class for the kid enabling MacGyver and I to swing by for a date night. Retire Minnetonka moccasins.
- Request appointment with different podiatrist who advertises several fungal treatment modalities on 5/25...
Current concerns: 1. my climbing shoes are really hard to fully disinfect and I wear them barefoot for about 2 sessions per week but I am not ready to replace them, especially while I feel I still have an active not-fully treated infection. I can try wearing with socks, storing outside of the bag, and spraying liberally with Lysol after use until I am ready to replace them. 2. general concerns the new podiatrist won't get back to me, won't be flexible enough to work around my childcare logistics (like the last guy), will have a grim prognosis, or that I actually have the liver toxicity situation.
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