Dr. Sam Christian, MD.

Dr. Sam Christian

(Foreword: Dominica’s medical community joins the nation in mourning the tragic loss of the dear son of our distinguished leader, Dr. David Johnson. May you, Sir, and your family be comforted, even as you have comforted others.)

Ingrown toenail


Those words didn’t quite come out your mouth, because you’re just not that type of person. But admit it – you just managed to choke back the expletives erupting from the tip of you tongue. Somebody stepped on your toe and they didn’t even say sorry. Really? The fact is it just got bumped in the shuffle, but it felt like being pounded with a mortar pestle.

Hello! You’ve got an ingrown toenail!

The book of Samuel declares, “Man looks at the outward appearance, but God looks at the heart.” And being a man, of course I do. And what I see is not just a little Cutex daintily dabbed on the down there like in the old days. Toenail adornment is a booming industry in Dominica as in any other part of the world. Pedicures are as common as a glass of fresh water in the land of many rivers. The designs are like a living canvas, esthetics embracing art, revealing just how much a woman really feels about herself.

By the same token, most men couldn’t care less – about their own toenails.  Men are manual. Toenails are too far away. Those little piggies are often neglected like they reside in some distant land.  I have had successful businessmen come in for executive physicals only to discover toenails like claws cutting through their socks. Have you not heard a woman complain how her man mauled and scraped her legs with these weapons at night?

A construction worker once came to me with a chief complaint of a tumor in his right groin. Indeed, a lemon-sized lump was clearly visible. It was red, hot and quite tender to touch – classic signs of infection. Immediately, I’m thinking: the groin is lymphatic drainage for the leg below; where is the infection coming from? I don’t see any wounds, ulcers, lymphangitis or red streaks up his leg. How about your toes?

“Nothing there,” he says.

“Go ahead. Take off those boots.”

As he peeled off his thick socks, I was knocked back by an assault of noxious odors emanating from a red, puffed-up inner edge of the right big toenail. The whole toe was gorflay! He jerked his foot away in pain as I examined it. Yellow pus was dripping out like drops of honey. How could he not have known? Well, in this case, someone stepping on it could not cause inordinate pain because this hard-working man literally lived in his industry-mandated, steel-toe, protective boots.

So there you have it: infected ingrown toenail. Treatment: removal of the portion of nail digging into the flesh. (Ouch! He did not like me one bit when I numbed it). Antibiotics. Wound care instructions. Recheck in two weeks. That lump in the groin was gone. Poof! Just like that. It was all a mirage, a reaction to that savage infection down there.

Even before using our own Cadet boots for jump-up, we teenage brothers were privileged to use our father’s Fire Brigade boots to mash it up in the streets of Roseau. Uniformed officers, farmers, factory and construction workers are particularly prone to developing ingrown toenails. The culprit? Ill-fitting boots as would be the case from time to time in growing boys. But women are not immune to ingrown toenails either. Trying to squeeze into shoes sizes too small for them? Guilty! Just ask Cinderella’s sisters.

My own ingrown toenail caught up with me while I was a surgical resident. I finally made time to see the foot doctor, fully resigned to undergo this not-so-nice operation. As it turned out, he told me it was not that bad after all. Forget scissors. He recommended getting a proper toenail clipper, not like the fingernail kind that you press down, but like pliers that you squeeze. He demonstrated using the sharp pointed tip to firmly pry at an angle under the leading edge of that offending nail. That’s all? I kid you not! This kind of clipper is more expensive than a simple bigger version of the fingernail-type clipper, but more than worth it its weight in gold.

Like Syrian general Naaman initially refusing to dip in the Jordan River (2 Kings 5:1-19), the masochistic side of me was a bit offended I did not get to wallow in the sympathy of a real operation. However, at the end of the day, I was delighted that the technique spared me the ordeal – and many of my patients ever since.

An infected ingrown toenail is not fun. It can make you utter bad words not normally in your vocabulary. However, that can easily be avoided by a little preventive maintenance. Properly trim those toenails at least once a month – best done after a shower, when the nails are softer. Filing afterwards prevents stockings from being ripped.

Let’s face it; the intention is not for men to display attractive toes in open shoes. It is just part of living in the civilized world. Someone is going to really appreciate your foot care and even offer to help you – especially if they do not have little daughters to play with. How cute! But a man however, has to draw the line somewhere. You are under no obligation to buff and polish, pedicure-style – although I understand that nowadays that an increasing number pamper themselves that way. Whatever floats your boat!

Seriously though, please note that toenails that become thick and chalky with age (onychomycosis) could be a sign of diabetes or poor circulation. And trimming the nails for the elderly is one of the kindest deeds you can do for those who have become unsteady or can no longer reach all that way down.  Toenail status is as good a barometer as any, of how well a person is cared for. And it doesn’t have to be intimate. Friends do that for friends. If it needs to be done, let’s get it on. If they feel bashful, just tell them Dr. Sam said so. Furthermore, if inspired for additional ideas on nail care, consider starting at http://www.wikihow.com/Care-for-Your-Feet-and-Toenails (biased toward females, but you get to understand what it entails).

Come on guys! It may not be exactly macho to pay attention to your toenails, but trust me, if they get out of hand; you’re not going to have a good day. And even though you may not be into worldly vanity, whenever you come across presentable toenails, a little compliment doesn’t hurt. A lot of loving attention went into that.

Dr. Sam Christian is a general surgeon and general practitioner opening Dominica’s first Urgent Care at 137 Bath Road, Roseau. The blessing will take place this Wednesday, September 4th at 4:30 PM. He can be reached at 440-9133 / 613 8345 or at urgentcare.da@gmail.com.