Dr. B's Finest Kind Medical clinic and Fish Market

Now I am having healthy young people coming into my office insisting that they get an expensive new medicine for their discoloured toenails...

You see, there have been all these frightening commercials on TV, and they think they have a new, unusual, deadly disease.

The dirty little secret is that this disease is common, stubborn, and that the "new" medicines cost about $100 a week, take six months to work, and even if you give "pulse" therapy (i.e. one week a month) is expensive. And usually, it comes back the next year.

Now there is a population that could use this: The elderly and the diabetics. Infected toenails lead to local infections and foot loss.

But the medications are not used, because of side effects. Instead, we use podiatry and strict foot care, including trimming and even removing the infected nails.

So you have a remedy but those who need it the most can't use it...so you advertise to those who don't really need it...

And then you have yuppies complaining that medicine is too expensive. (I have no problem with prescription health care for the elderly. I do object to treating neurotic women with expensive anti depressants, or having young, healthy patients insist on Celebrex when advil will work. Alas, these patients will come into my office for a common ache or pain, and when I ask what they have taken for it, say nothing: hello. Take two advil and call me in the morning...ah, but no. They want a doctor to say it's only a sore muscle-- and give them Celebrex, or maybe Lortabs...ah but that's another story).

The only ones I routinely prescribed the medication is in the "hot shots" who fought forest fires, who had some of the worst onchomycosis that I ever saw.

No, I take that back. The worst toenail fungus that I have ever seen was way back when I worked in the North woods, and spent one day a week in a small clinic for Native Americans.

Now, Native Americans who are traditional are shy of those they don't know. But once they get to know you and trust you, they will open up and show you what is really bothering them.

So after about a year, the old ladies would shyly say: Can you fix my feet. And I would find toenails a half inch thick to be trimmed. A moist climate, only one pair of shoes, and often those shoes were plastic, led to the worst cases of toenail fungus that I ever saw... so I would put on our masks, take out my dromel motor tool, and carve.

Thank the Lord (and the US Government) that most IHS clinics now offer free shoes to their diabetic patients as part of a program to prevent amputations.

http://www.ihs.gov/MedicalPrograms/Diabetes/index.asp

So cheers to the devoted IHS doctors who work in the middle of no where, and prevent disease, death and amputations, while the NYTimes is busy debating if rich yuppies should let their teenagers have boob jobs (paid for by their health insurance, of course)

http://www.nytimes.com/2004/09/28/health/28cons.html

and let your health insurance pay for diet pills (aka uppies) and stomach stapling so you can continue to eat twinkies...

http://www.nytimes.com/2004/09/30/business/30obese.html

http://www.nytimes.com/2004/09/28/nyregion/28nyc.html

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