Here is the 2nd part of an interview with Ramona where we talk about different topics regarding foot care.

  • How to choose a specialist
  • How to make an appointment
  • Why you shouldn’t be embarrassed about your feet
  • Treatments for ingrown toenails, warts and heel pain
To your health,
Dr. Donald Pelto

(For those that like to read I included the transcript below)

Ramona:  So tell us about where you work.
Donald Pelto:  I work on Lincoln Street, about two buildings over from the old Hahnemann Hospital, now it’s the Hahnemann Surgery Center, right across from the Nordgren Funeral home. Everyone sees it and you’ll see a little sign, there are a couple of other doctors that are there. In their office we have a number of wonderful staff, we have about eight or nine staff there. We have three doctors, it’s myself, Dr. Neil Feldman, a lot of you here that are watching this a lot of people in the city, if you’re runners or triathletes, pretty much he’s the go‑to guy for the athletes and triathletes. They all see him because he’s done a number of Iron Man’s and he’s amazing, just amazing. We also have Dr. Lucius, he just started with us, and he’s there as well.
There are three of us in the office and we have just a wonderful staff and we’re open pretty much every weekday to treat people with foot problems. People come in normally with a referral from their doctor. Something a lot of people don’t know, in this day and age, you can see a specialist, and we can help you with the referral. If you think you need to come see someone, just give us a call and we’ll help you out with that referral.
Ramona:  Well that’s a comfort too, because sometimes, you know your own body, and you may be saying I think I need to do this. They could contact you and give you the skinny of what’s happening and you could do some of the leg work for them. That’s a comfort in itself.
Donald:  It’s good, especially in this day and age, because many people, like it or not, they delay. They have their foot problem, they tend to delay it. A lot of people they come in and they say its’ urgent, and I ask them, how urgent is it? How long has it been there? They say, well it’s been there for two months. Well if it’s been there for two months, a lot of times you don’t want to go to your primary care doctor first and then they send you to a specialist anyway. To save a trip, you could just come to the specialist, that’s what a lot of people are doing, especially if it’s regarding a foot problem.
Ramona:  What are the most common things, for instance, in someone who’s a little bit older in age? What are the most common things that you find that you see and that you treat? And how do you treat it?
Donald:  One of the most common things that people come in for are they have kind of a yellowing or a thickening of their toenails. And they’re usually embarrassed about it. And they’ve usually had it for a number of years and they think it’ll just go away by itself. Just so you know, when you get older, not everyone has thickened toenails. You don’t have to have thickened toenails just because you’re older. But there’s a problem that can happen. There’s a type of a fungus that can invade the toenail and it can make it thickened, yellow, discolored, sometimes there’s even an odor to it.
And it usually doesn’t, you don’t just wake up with it. It’s not, you don’t just wake up and oh, my toenails are thickened. It usually starts on a little edge of the toenail and then it creeps over and then affects the other ones and eventually you wake up and all your toenails are thickened.
Ramona:  That’s pretty scary, actually, if you think about it.
Donald:  It is, it is. In a lot of the older people, they think it’s just normal. Usually the ones I see are the younger ones that come in, and the women, especially, they’re just distraught. “What can I do? I’ve tried all these different chemicals, nothing’s worked. I don’t know what to do.”
Ramona:  Yeah, “Went to the over the counter stuff and tried different things and tried this ointment and that ointment. Saw that commercial, this commercial. What do I do?” We were talking about that earlier off camera. You know, what is that actually diagnosed as? What is it called?
Donald:  So, the technical term usually is onychomycosis, or it’s just a fungal infection in the toenail. But you know what? Not everyone with thickened toenails has a fungus. So, you have to do something, you have to actually take a nail sample and send it off to a lab where they try to grow it in a petri dish to see if it’s a fungus or not. How can you treat your fungal toenail if you don’t really know if it’s a fungus?
Ramona:  Well that’s true then you’ll be buying all that stuff for nothing, because it wouldn’t be doing anything
Donald:  How many people do that? How many people they go to one of the pharmacists?
Ramona:  That’s true, because you don’t really think about your feet.
Donald:  They go to the pharmacy and they buy all this stuff. Whereas if they come and see a specialist they can save a lot of the hassle, and the hassle isn’t so much the 20 or 30 dollars you’re paying for it. It’s every single day putting it on, being frustrated, being embarrassed when you go to the beach, being embarrassed when you’re wearing flip flops.
Ramona:  Even that, but not understanding the course of how you would get rid of it and how long it takes. Because from what I’ve heard it doesn’t just go away, it’s a process that has to be done. Could you just quickly explain what someone might go through? They would have to get a cream, they could take a pill, and you could have new technology with lasers. How does that work?
Donald:  Exactly, no matter how you treat it, it’s going to take about nine months for it to get better. If you use any of these three methods I’ve been talking about, there’s no quick way to treat it. You can hide it with nail polish, but there’s no quick way of treating it…
Ramona:  So if you can hide it with nail polish why are you treating it?
Donald:  Well, with two of the types…
Ramona:  OK.
Donald:  OK, so the first one is by using a topical medication. Now there are a lot of people that say they use Vic’s, they use tea tree oil, there are a lot of these magic potions you can find online. I always say, if you look online and there are hundreds of treatments for it, it’s because none of them really work. None of them really work, if there was one I would carry that in my office, and that one would work. If you’re going to use a topical treatment the only thing I would ask is get one that is a money back guarantee. Because if it’s good it’s going to have a money back guarantee, and if it doesn’t work you can get your money back. That’s all I’d say with the topical. The only bad thing I can say with the topical is you can’t paint your toenails while you’re treating it. If it’s the summertime you can’t put on the topical and the nail polish because you’re putting it on every single day. There are certain nail polishes that have anti‑fungal medication in it. The anti‑fungal topical medication work about 20 percent of the time.
Ramona:  OK.
Donald:  The other two work about 80 percent of the time. They’re either a pill that you take, it’s called Terbinafine is the generic name. It used to be called Lamasil, it used to cost 600 dollars, but now it’s generic it only cost 10 dollars. Very, very inexpensive I’ll go through some reasons people may not want to do that, and then the latest and greatest is this fungal laser. The two other treatments, you can paint your nails, you can do whatever you want with them, and it still takes six to nine months with either of these. The oral pills you take one pill a day for three months. The only drawback you might want to talk to your primary care doctor, because this medication like all medications, are usually processed by the liver, or by the kidney. This one is processed by the liver. So, you have to do a blood test prior to make sure your liver is working OK. If it’s not, or if you have concerns, you probably don’t want to do that treatment.
A lot of the younger patients, put them on it, I put it on people pretty much every day or every week for that oral medicine. Really easy to do.
If you can’t do that, then the other treatment is the laser. The laser works the same way as when you have a cold, for example. If you get a virus, a cold, what happens to your body? You start shivering and shaking, it heats up the body to a certain temperature, and then it kills the virus in your body. The same thing with the laser. The laser itself doesn’t kill it. It’s the heat that kills it.
Ramona:  So, it burns it off, and then the new toenail starts to grow. So, that also takes time for that to happen.
Donald:  Six to nine months. So, you take the nail, you heat it up to over 100 degrees, that heat kills the fungus, and then, as it grows out, it’ll grow out normal.
Ramona:  Oh, that’s great. And that is Central Massachusetts?
Donald:  Podiatry.
Ramona:  Podiatry.
Donald:  At 299 Lincoln Street.
Ramona:  In Worcester. And again, you said there were three doctors that work there.
Donald:  Dr. Neil Feldman, Dr. Damien Lucius, and myself. If any of your listeners have questions, they can certainly email me and I’ll leave my email for them. They can just shoot a question over. That’s the nice thing nowadays, is you don’t, if you’re too busy, if you can’t make it in, or if you’re wondering, well, should I go see someone? Just send me an email, I’d be happy to answer it.
Ramona:  Which is nice, I mean, because a lot of people check, they Google things or they check maybe WebMD or other things, which can be good sources, depending on where you go. But here, they can actually talk to someone that’s local, and I always support local, and get some answers to their questions directly.
Donald:  Exactly.
Ramona:  From someone who’s working in that field, and I think that that makes a difference.
Donald:  Yes.
Ramona:  All right, thank you so much for coming on.
Donald:  Thank you, Ramona.

Ramona:  I’m Ramona, and you’ve been watching Ramona interviews. Have a wonderful week.