It’s getting to be the winter doldrums here in NYC, cold enough for the toes to hibernate for the season, thus leaving the owner of said toes without a trace of a reminder of the fungus that may lurk deeply within those nails. But whether your nails are as green as the tree in the living room or yellow as the lights of the menorah, it’s time to start thinking about some treatment, because nails treated in the dead of winter are ready to be paraded proudly at the beach.

We have had this discussion before in these hallowed halls, and it bears repeating. Nail fungus is a very common condition that affects many of us, and perhaps almost all if we are lucky to live long enough. And it’s not just a matter of hygiene – there is clearly a hereditary component to the infection and one has to be both susceptible and exposed to the fungus in order to contract a fungal toenail infection, so once again, blame your parents, and they in turn can blame theirs. And since it is essentially a genetic disease, no matter how effectively it is treated, and even with the most judicious and diligent measures of prevention, it is likely to recur at some point years down the road.

Fungus likes warm, wet places and feeds on the protein which comprises nail tissue. Once a nail is infested with fungus, it can be difficult to eradicate; fortunately your local NYC podiatrist has more than a few tricks. The gold standard is still the oral medication, which works well because it attacks the fungus from within, systemically. And yes, I know kids, you don’t want to take it because somewhere out in the blogosphere there is someone on the transplant list waiting for a new liver to replace the one that was utterly destroyed by nail fungus treatment. However, the incidence of liver damage is exceedingly low, and kept that way through careful monitoring of liver function via blood tests both before and during treatment. As I have told patients many times, I would not hesitate to give the medicine to my mother in law (ha!). But seriously folks, I’ll be here all week, tip your waitress. No really, seriously, I wouldn’t have a problem taking the medicine myself, although I fully understand and work with patients who feel the medicine is not worth any risk. Especially since this is certainly not a life or limb threatening infection. Generally the oral medicine is very well tolerated, and when taken properly boasts a very high cure rate.

There are two more accepted treatments which we have not yet discussed that are also effective and less invasive than the oral medication, but it seems we’ve run out of time. Going to leave the other two treatments for the next fun filled and thrilling blog. Nice to have a cliffhanger at the end of the year. To be continued…

See you in the office.

Ernest Isaacson