Revolutionary New Treatment for Fungus
Nails - No drugs, lab tests, anesthesia or pain - all in one visit
By: Michael Zapf, DPM, MPH, FACFAOM, FACFAS
Are you ready for the most revolutionary new way to treat
fungus nails. Yes, our office was the first office in
Ventura County and the Conejo Valley to offer
LASER TREATMENT OF FUNGAL NAILS
for treating Fungus Nails.
See the video on Fox New York --> (
www.foxnews.com/video-search/m/21918137/video_laser_for_fungus.htm )
See the ABC Good Morning America segment here -->(
http://abcnews.go.com/Health/OnCall/story?id=7113863&page=1 )
We offer the opportunity for a
free consultation with me or any of the doctors in
my office to see if this technique is right for you. Call 805-497-6979 or
818-707-3668 to set up
your free consultation appointment.
The CUTERA FUNGUS LASER is approved for use in
podiatric medicine and has been patented to treat and kill the fungus that
causes fungal nails. It has been in use since mid-2008 and has
been shown to provide clinical improvement (Medical speak for happy patients)
a high percentage of the time. This is in contrast to the oral Lamisil medication which shows
improvement only 65-70% of the time. Best of all, the Laser has absolutely no
side effects. There are no pills to take and no laboratory tests to be
performed. .
The top nail picture was done at 9 months and the rest of
the nail grew out cleanly at 12 months. The bottom nail is still a bit thick
after the procedure but still quite an improvement.
Here are some question and answers about this new
revolutionary technique for treating fungus nails.
Does it work?
The laser was first introduced to the world in mid 2008. Since that time it has been used on many thousands of patients and the
improvement noted is in the ranges of 80-85%. Topical medicines work about 11%
of the time. Lamisil works about 75% of the time. The laser works about 88% of
the time because there is no real resistance to the laser light. Failures from
this treatment are usually because the underlying damage to the nail that was
caused by the fungi or that led to fungal involvement was so severe that killing
the fungus did not make an appreciable improvement in the appearance of the nail
plate. A fungus can be no more resistant to the laser light than can you be
resistant to a flame.
Is it safe?
There are virtually no side effects from this procedure.
In the thousands of treatments there has been no damage to the skin around the
nail and no increase damage to the nail plate. The wavelength of the light
chosen for this laser passed about 5mm into the skin and the nail rupturing the
cell walls of the fungi and leaving the skin and nails virtually untouched.
Topical medicines like Penlac, Lamisil, Lotrimin, Micatin,
Tea Tree oil,. Vicks Vapo-rub. bleach and white vinegar have all been tried on
fungus nails. They need to be used at least twice a day. Even the best of these
medications, and even when used properly, have a success rate in the single
digits to the low teens. In our office we recommend a topical medicine called
Fungal Free Nails-Rx (
www.fungalfreenails.com ) which we think is the best of the topicals but
even then it is time consuming, messy and works only some of the time even when
used twice a day for a year like the package insert recommends. Topicals are
quite safe but every foot doctor has seen patients that have been allergic to
one or more of these substances and have developed a local allergic reaction to
the medicine that caused quite a bit of discomfort for a time. I, personally,
have never seen any lasting damage to the toe, skin or nails from a topical
medicine.
The most commonly prescribed oral medication is Lamisil or
its generic siblings called terbinafine. It consists of a pill that you take
once a day for three months. It has a low but quite definite risk of liver
damage (and even rare liver failure), a risk of damage to your white blood
cells, taste disturbances and even drug induced Lupus (
www.drugtalk.com/lamisil/index.htm?p=2 ). The following sentence can be
found on www.drugs.com: "Some people
taking Lamisil have developed severe liver damage leading to
liver transplant or death. It is not clear
whether Lamisil actually caused the liver damage in these patients. In most
cases, the patient had a serious medical condition before taking Lamisil."
For this reason Lamisil therapy needs to be monitored carefully with liver
function and white blood cell tests. In my practice I have seen several patients
discontinue the medicine because of headaches, stomach distress and allergic
reactions. I have found the incidence of problems greater with the generic
versions than with genuine Lamisil. I always test the liver and the blood before
starting Lamisil and, again, a month or two later. I have seen some increases in
liver function enzyme levels that have caused me to discontinue the medicine but
I know of no one who was permanently damaged. But, in all good conscience, I
must say that I have no idea what the long term consequences of taking Lamisil
might be. I assume it is safe but there are no guarantees. I am personally very
happy that I now have a laser alternative to taking a potentially dangerous oral
medication.
How is the treatment done?
Normally we will make a 40 minute appointment for the
Laser treatment. If you already have a diagnosis of fungal nails and we have
established that you are a good candidate for this therapy we will do it during
that 40 minute session. If you are new to the office we will meet with you at
the start of the 40 minute session and make sure you are a good candidate
and tell you if we think the Laser will help.
The treatment will usually be done in our Agoura Hills
office. Please come without any nail polish or ornamentation. Please do not use
any creams or ointments on the nails for several days before the laser
treatment. For the procedure
no anesthesia or sedation is ever needed. You will be seated in an exam chair
and protective goggles will be placed over your eyes. We will take pre-treatment
photographs of your feet. If necessary the nails will be thinned with an electric
hand-held grinder (we call this debriding). The only sound you will hear is that
of a vacuum that collects any particles from the grinding or the lasering. After
nail preparation we will start the lasering. We will go from toe to toe
streaking the laser light across, then down and then across again. You will feel
either nothing, slight warmth or the occasional tiny prick that is not really
painful - just a little startling for a millisecond. Because we are so close to
your toes, we will wear a mask to keep us from breathing any particles that
might come off of the nails. After 40 minutes of this treatment the
lasering is done. We will apply a topical anti-fungal lotion to your nails and
toes. This cream is not to treat the fungus (we just did that) but to give a
little protective barrier against future infection. We will then give you some
ways to keep the infection from ever recurring. More about this later.
What is the cost?
Laser treatments are as little as $500 for one infected
toe nail. For each additional nail that needs the laser we charge an additional
$100. We cap the whole treatment at $1000 for all 10 nails. This includes the
grinding of the nail before the laser treatment,
This includes the initial visit, the nail debridement, pictures, exam, the laser
treatment and follow-up visits at 4 months, 8 months and 12 months. (Just be glad
you are not in New York - they are charging $1200 for the same procedure as you
will see on the Good Morning America segment aired on April 9, 2009 --> go to
www.abcnews.com and use key words: laser
fungus nails. )
Will my insurance cover it?
Unfortunately we have not found an insurance company that
will cover the laser treatment of fungal nails. They call it both experimental
(it isn't) and cosmetic (which I believe it is not - how can a fungus plant
growing in your nails, on your body, be considered cosmetic? I guess I do not
think like an insurance company). You can pay for your treatment with cash,
check or credit card (Visa, MasterCard and American Express). You can also use
you flexible spending account or HSA.
Who will do it?
In our office your procedure will be performed by one of
the doctors or a registered nurse who are all trained in the procedure. Here is
my certificate and everyone who does this procedure
needs to have a similar certificate. Double click to see it in all its glory.
Is it guaranteed?
For nails that are only partially involved one laser
treatment usually works quite well. For very thick and long-standing infections,
a series of treatments will be needed. As tine goes on the fungus is likely to
start growing back on nail and a "booster dose" will, again, be needed. Because
we now have a new powerful laser the treatments are much faster than the with
the original PinPointe laser and we can offer the retreatment sessions at a very
affordable fee.
Consent Form
The consent form you will be asked to sign a consent form
that states in part "I understand that the fungus may not be completely
destroyed, that the nail may become reinfected, or there may be other types of
infection present. The nail may continue to be discolored or not attached to the
nail bed. This treatment will not change the shape, width or other deformity of
the nail plate(s). It may be necessary to perform additional treatment to obtain
optimal results."
Post Treatment Care
For the first two weeks after the procedure we want you to
massage into your nails, toes, toe web spaces and bottoms of the feet a thin
layer of anti-fungal cream (Lamisil, Lotrimin, Mycelex,
Miconazole, etc) that you can purchase at a drug store or from our office. After
the first two weeks we recommend that you apply this medicine once
a week or so.
Every day, after wearing your shoes, either spray the
inside of the shoes with an anti-fungal foot spray (not just dusting with
powder).
<-- As an alternative you can substitute the
use of a SteriShoe ultraviolet shoe light shoe tree (we sell this item if you
want or you can buy it at
http://www.sterishoe.com/ ) This ultraviolet light in this shoe tree kills
all knows fungus, bacteria and viruses.
Never wear the same pair of shoes two days in a row -
instead give them a chance to dry out (it is estimated that your feet can
perspire as much as a 1/8 cup of water on a warm day
that gets absorbed by your socks and shoes.) If your shoes do not dry out they
can become good harbors for fungus and other meanies.
A Steri-Shoe UV shoe sterilizer
