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1415174 tn?1453243103

toenail bed infection

Hi group,
I have a paronychia or toe nail bed infection. I have been soaking it and using Hibiclens as directed by my doctor plus I was on Cephalexin for 14 days but it didn't go away so they put me on Bacterim (sulfamethoxazole/trimethoprim). I have a toe nail fungas as well which he thinks caused problem because I bumped the toe and the nail pushed normal skin bacteria plus whatever else was on the toe into the wound. I have been on Bacterim for 4 days so far and 3 days on oral Lamisil. I was told that I may have to get the nail surgically removed and wondered how painful the procedure was during and after and how long until   I can go walking outside? I hope this clear up before that. If you have had this how long did it take for your toe nail bed to heal (without surgery) and what antibiotic were you on? p.s. my culture was negative but I have no pus or abscess so he couldn't get any fluid out of it.
thanks,
mkh9
Best Answer
681148 tn?1437661591
I got rid of mine with a combination of vigilance and white vinegar.  No matter which option you use, it is necessary to file down the nail bed, because the treatment has to get under the nail bed for it to kill the fungus.  So, I did this and would soak the affected foot in undiluted warmed white vinegar for half and hour to 45 minutes twice a day.  In less than one week, the fungus was gone--and it has been gone for good, too.  If you do this, do it sooner rather than later, because while the nailbed is thinned out from all that filing, you want to be able to wear open-toed sandals to allow fresh air to the foot.  The vinegar does definitely work and it does definitely dry out the skin, so be sure to have a really good skin moisturizer on hand.

I went with this method, because insurance companies view nail fungus as strictly "cosmetic" and not medical.  Well, I disagree, because you don't want the fungus to spread internally.  I had no other way to treat mine.  But, I did get rid of it, and I got rid of it permanently, too.

One good thing about the vinegar is that it has both antifungal and antibacterial properties.  This is why it works so well for natural house cleaning, too.
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681148 tn?1437661591
I'm not entirely sure, because it sounds like you still won't have any nail on the nail bed for quite a while.  I mean, I still had the essential portion of the nail, and I did this during the summer time when I had to deal with the worst of it.  So, when the fall came, I just decided to only wear shoes out of the apartment as necessary for important errands.  But, I still took them off immediately when I got home, because I knew I still needed to keep my feet from sweating and that they needed to stay clean and dry.  Even during this time I would be cautious when showering and bathing.  I made sure my feet were completely dry before even attempting to put the socks on for around the apartment.
Helpful - 0
1415174 tn?1453243103
Yes I thought it was cruel also. I didn't realize how painful it was going to be until it was too late! The area where the nail was has a regular scab now and doesn't hurt. I have cotton socks on with the big toe area cut out of them and wear a bandaid to keep from knocking the scab. It looks good so I hope a couple of weeks the scab will come off.  I don't know how long that takes. Once there is no scab and just the empty place where the nail was I should be able to wear close toe shoes right? Or should I call them to see? I think the surgeon is good at what he does but he should have offered a local anesthetic and also told me more about after care. I called the nurses the next day to ask questions and they helped but a person that is a nurse practitioner on this site helped me more than they did. Thank goodness for Medhelp.
thanks,
mkh9
Helpful - 0
681148 tn?1437661591
Ouch!  Your story makes me grateful that I was able to fix mine the way I did and mine became normal again in a relatively short time.  The way I did mine did not remove the final layer closest to the delicate skin under the nail bed where all the nerves are.  That layer was in very good shape and had no fungus.  I had to get it down to that layer in order to kill the fungus.  I mean, that's why the doctors removed your entire nail.  Uh....without pain killer seems unnecessarily cruel.  Hm, even if it means needles for local anesthesia, the needles would be a whole lot less painful than what you had to endure without the pain numbing medication.  If your home and work place are warm enough to do so, only wear cotton socks and no closed toe shoes as much as possible.  Obviously closed toe shoes would be uncomfortable anyway, but the feet need to stay as dry as possible, so you don't want to let them sweat.

At home, I have a pair of Okabashi sandals that were supposed to be sold as a men's style of sandals that have a woven pattern over the top of the foot and plenty of room for the big toe to stick out.  I wear cotton socks with them for both comfort and warmth.  I was even in the summer, too, because these shoes are plastic.  The feet will still sweat some, so what I do is take them off when I'm in my recliner chair and have my feet up.  I use these inside the apartment, because the flooring is all concrete.  There are industrial strength tiles covering up the cement/concrete.  My feet are much warmer with these shoes I use for slippers and even more comfortable in these conditions than the cushion type of slippers, which only make my feet sweat profusely.  That amount of sweating is what you want to avoid.  I have no one in the apartment to impress. and these are more comfortable on the feet and the joints.  Often, in the summer, I would sit at the computer with them initially, then slip them off and just have the cotton socks on while on the computer.  By cotton socks, I mean the ordinary socks you often buy in some sort of package that are usually all white that you can buy at a bargain price from time to time at Walgreens or Big Lots.  Recently, I found packs of three pairs at Walgreens for only $2 per package.  So, just something like that.  Your feet will be more comfortable.
Helpful - 0
1415174 tn?1453243103
Hi it has been a long time so I don't know if you will get this. I finally had to get the toenail removed and it was being pushed up by a nail that grew out over the old fungal ridden nail. The podiatrist took the nail off with no pail killer and it was extremely painful during and after. Why he did that , I don't know. Anyway, it is healing now and has a scab. I hope it grows back in normally this time.
mkh9
Helpful - 0
681148 tn?1437661591
All yogurt is good, but alone yogurt just isn't enough.  I'm glad you're looking into probiotics.  You'll be very glad you did.
Helpful - 0
1415174 tn?1453243103
Thanks so much for your advice. I will look into the various probiotics you mentined. I don't want to get Clostridium difficile.  I am eating activia yogurt which had four Bifidobacteria but probably not at the right concentration. Plus one with Lactobacillus. I have cut back on sugar. So hopefully things will be ok. So far no intestinal symptoms.
mkh9
Helpful - 0
681148 tn?1437661591
There are very good probiotics on the Swanson Vitamins website.  Information I got from a PBS special made me realize that the one I'm using from that company.  They say to have at least four or more different strains or species of the good bacteria in the supplements.  Then one should look for the ones that start with "B" and "L", as these are the most important ones.  The more species the better.

It is important to look for the highest number of active bacteria that will still be viable at the expiration date, as those are the freshest and highest potency.  With probiotics more is better.

The doctor on the PBS special also said that you would have to eat so much plain yogurt a day in order to get enough that you would be sick of yogurt.  In other words, it's still good and healthy, but it just isn't the best source for a probiotic.

What a naturopath told me before is that FloraStor is a good brand.  But, one with the same strain as that one for much less money is the Jarrow brand.  However, those only have one strain, so it is best to get at least four or more strains of the good bacteria in your probiotic supplement.

One good thing about probiotics.  It is impossible to overdose.  This doctor was talking about a case where she offered free advice to someone in a restaurant who was there often.  There was a child involved.  They were following all the recommendations and using a child's probiotic.  It was evident to this doctor that this was simply just too low a dose for the child, so she suggested to the mother to put the child on an adult dose probiotic.  The problems the child was having actually cleared up within two weeks of using the adult dosage.  So, that is pretty good evidence that one can't overdose on probiotics.  Not that you would take the whole bottle at once, as that just wouldn't be helpful, but it wouldn't harm you to take slightly more than the recommended dosage of the instructions on the bottle.

Oh, and yogurt is only fine if it's the plain kind, but to get sufficient amount, the doctor had a large bowl that looked like at least half a gallon of the stuff to show how much you would have to eat of the plain yogurt.  So yogurt is just not sufficient in of itself.  If you have intolerance to dairy at all, the side effects just aren't worth it to you if you're using it for the probiotics.  If you are including it as a healthy part of your diet, it's good, but it's just not enough.  The ones with sugary fruit are basically like eating candy and will not help.

If you can get in to see a naturopath to follow a Candidas diet for the time recommended that would be beneficial.  If you're not having symptoms of Leaky Gut (I recommend a Google search) or Candidas, it would still benefit you to at least limit your grains and avoid high glycemic vegetables (potatoes, carrots, parsnips).  During this time, you should also avoid rice, because it is also high glycemic.  And, definitely avoid ALL forms of sugar including what comes naturally in fruits.  Especially dried fruits.  People with special health problems should not ever eat dried fruits, and I don't mean just diabetics, although they should obviously be careful about dried fruit in general since dried fruit concentrates the natural sugars found in fruit.  I'm not sure about lemon even, even though they're the opposite of sweet tasting.  I've heard they still have more sugar than one thinks.  Honey is an obvious form of sugar, so it's out for a while.  

This is just until you have had enough time to rebalance the good bacteria in your gut in order to avoid things like Leaky Gut and Candidas.  It is also the natural way to treat these conditions.  The diet is definitely not easy, but very much worth it if you can avoid a lifetime of chronic conditions that are especially difficult through conventional medicine.

But, do this only through proper advice from a naturopath.  Too high of protein in one's diet is not good for the kidneys either.
Helpful - 0
1415174 tn?1453243103
Hi and thanks for all your information and help. I am eating two yogurts a day that have live bacteria. Do you have any other suggestions for probiotics?
thanks
mkh9
Helpful - 0
681148 tn?1437661591
Well, at least the Epsom salt is more comfortable than the vinegar, but at least now you have a back-up plan in case more of this happens in the future.  Now that I re-read some of the comments, I didn't have bacterial infection, just fungus, but it was the entire nailbed.  Anyway, now you know how effective the vinegar is for just the fungus alone.  It actually works well for antibacterial, too, but it is a power engine for the fungus.

I wasn't able to get the Lamisil, because of insurance saying it's cosmetic.  I know that it isn't, but they're still not interested.  So, it was the same as not having insurance for something like this.  Hopefully, the information I wrote down is helpful to the people who have no insurance at all.  Out-of-pocket cost for Lamisil is out of reach for anyone who has to pay for it themselves.  Something outrageous like $500/month.  Most people can afford a gallon jug of vinegar, which is still less than $4.00 for the whole jug.  It was definitely a lifesaver for me, since now I have a normal toenail once more and have ever since this happened to me.  

I knew that nail fungus can spread to the other nails, so I was on top of this as soon as I noticed it.  I don't think it's as cosmetic as insurance people claim it is.  

Be sure to take probiotics now that you're not on antibiotics any more.  We're supposed to be on probiotics anyway, but definitely do that now that you're off of the antibiotics to help replace the bacteria that is supposed to live in the gut.

You'll want to be especially careful for a while until the nail grows back.  Fortunately, the weather is still warm enough to wear open toed shoes.  It is okay to wear just cotton socks at home to keep the feet warm, since cotton allows the feet to breathe.
Helpful - 0
1415174 tn?1453243103
I went to the podiatrist and he said I don't have a bacterial infection (after being on antibiotics for  a month. It is a paronychia or damage to the tissue by the fungal ridden nail being jammed into the skin. He didn't have to remove the whole nail since I'm on Lamisil, and just cut off about 3/4 of two nails infected with fungus. I just have to soak it in epson salts once a day and wait for the new nail to grow back.
Thanks for your help.
mkh9
Helpful - 0
1415174 tn?1453243103
OK thanks. I have been taking the Lamisil for about 15 days now. The nail is cracking on the left side so I hope that is the start of it getting ready to fall off. I still have a nail bed infection or a perinechia (not sure of the spelling). I've finished with my second antibiotic and the doctor has sent me to a podiatrist this week. Hopefully, this thing will get resolved soon.
mkh9
Helpful - 0
Avatar universal
Hi again, sorry it took so long to get back, I wAs on vacation.  I can't give you an exact date but as the nail detatched and turned whitish, I just cut that part off.  Eventually, six months or so, most of it had been replaced by new attached nail. The bottom third never actually came off.  It's a slow process.   Good luck, suzi20071
Helpful - 0
681148 tn?1437661591
My case was different, since I thinned out the nailbed myself.  Still, it only took about two weeks to a month for the nail to return to normal again.
Helpful - 0
1415174 tn?1453243103
Hi again, I was wondering how long it will take for the old fungal ridden nail to come off or be pushed away from the nail bed. I have been on Lamisil for 11 days so far.
thanks,
mkh9
Helpful - 0
1415174 tn?1453243103
Well, my whole toe nail is infected with the fungus and when it grew back in it grew in crookedly. I will try the method you suggested next time if this comes back though. I think it is a great alternative to the Lamisil as that is very hard on the liver. I still am fighting the infection (bacterial). We'll see what happens by Thursday when I see my GP. I hope I don't have to get the nail removed surgically. But if it has to come out well, I guess better than a worse infection. I appreciate your help and will keep it in mind. Maybe my husband can use it since he doesn't have the bacterial infection as I do.
thanks again,
mkh9
Helpful - 0
681148 tn?1437661591
I actually used a file not intended for the nail, because the usual nail file one uses for nails just doesn't work on the toenail.  I used one of those cheap ones meant for the thick skin of our feet.  Then, I used the ordinary nail file to get into the grooves closer to the skin.  I was very, very careful not to file too closely.  But, I did go as far as possible without doing any actual injury.  One can feel the nerves that the nailbed is meant to protect, so as long as one is careful, this can be done.

Anyway, in my own case, it was a necessary matter of being forced to take matters into my own hands before this stuff was to get worse.  I didn't really know about the bacterial part you were talking about by the nail fungus continuing to get worse, but that does make sense.  Fortunately, the white vinegar does have both the antifungal and antibacterial properties.  I do continue to tell people about this, because it did work and it was several years ago that I did all this and the nail is still back to its normal and healthy color.  Now all I do is what I did before the nail fungus appeared, which is just the routine nail trimming that everyone has to do from time to time.  So, I do still think it is worth doing.

The nail never did fall off.  
Helpful - 0
1415174 tn?1453243103
Thanks for your help. I am still fighting a bacterial infection in addition to the fungal. So, I'm supposed to go back to the GP next Thursday then  maybe to the podiatrist if it isn't healed to remove the nail. I hope I don't have to do that. Does the fungal ridden nail fall off in a couple of months or how long does it take for that part?
thanks,
mkh9
Helpful - 0
681148 tn?1437661591
Yes, it was the entire toenail bed.  It was caused by an injury to the nailbed.
Helpful - 0
Avatar universal
Hi agAin, I know it seems like a long time but you don't stay on the oral medication for that long just one or two courses of meds.  It is just thAt it takes a year or longer for a toenail to replace itself.  A fungus is a really hard thing to get rid of too. It can always come back years down the road.  So, use topical meds and oral if the doc says you have nail fungus.

Good luck, suzi20071
Helpful - 0
1415174 tn?1453243103
Did you have a toe nail bed infection in addition to the toe nail fungus? Did your toe nail fall off or did it just penetrate the nail itself? I am taking the oral Lamisil (luckily my insurance pays for it) and so far so good (check my liver enzymes in a month). I am also taking sulfamethoxazole/trimethoprim for the anti bacterial. Yeah I know vinegar is a great cleaner and has many uses. We use it to clean our bathroom floors and even on pergo it doesn't seem to cause any damage. I am nervous about filing down the nail but it makes sense. Genereally the type of fungus that infects the nails doesn't go systemic. It only "eats" Keratin. It is caused by dermatophytes that live on hair skin and nails.  However, the nail becomes sharp and thick and pushes up the nail bed so then when you injure yourself by bumping the nail even a little, you can get bacteria injected into the skin, which can spread and go systemic if not taken care of. So, the insurance should pay for it for that reason if not anything else. I'm sick of fighting for what we pay for and don't get much out of it. I am soaking my food and using hibiclens twice a day in warm water. But if this doesn't work the doctor wants the toe nail removed. I have a back problem too and am finally making progress after 2 years and I hate to lose that progress by being layed up for a week (not to mention that it probably is painful). Did you just use a cardboard type of nail file (the disposable type)or  a metal one or drummel?
mkh9
Helpful - 0
1415174 tn?1453243103
Hi wow that is a  long time for the fungus to go away. I am taking oral lamisil but have just taken 4 days worth so far. I am on bactrim too. But my doctor said I may have to get the toe nail removed, yuck. If it wasn't for the infection I could wait for the fungus to go away. I don't know..
mkh9
Helpful - 0
Avatar universal
Hi mkh9,   I also had a fungus of the nail of one of my great toes.  I tried everything topical available but until I took oral lamisil it would not go away.  As it healed, I trimmed the dead nail back continually and put topical cleaners underneath what was left and within a years time or so it was back to looking normal. I realize you have an additional infection from bumping it so i wish you Good luck with the toe.

Suzi20071
Helpful - 0
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