This September marks both the beginnings of both school and "health care
reform." Since my thoughts on reform couldn't possibly be limited to just one column
I will spend my time musing about the former. Suffice it to say that I wish President
Clinton the best of luck in reform. Great ideas can often result in unworkable programs
after they are dissected and reassembled by the legislature. I am sure that when it was
first proposed, the Medi-Cal program seemed like a great idea. Now the overwhelming
paperwork, lack of coverage for needed tests and procedures and unrealistically low fees
make it a program most doctors want to avoid. I pray that this new program is successful.
Now to the kids.
I see many high school age patients. Almost 90 per cent of the time they come to my
office with three problems: ingrown nails, plantar warts and overuse injuries.
Ingrown nails come in two varieties: acute and chronic. Adults get the chronic kind
where the toe looks, at worst, a little red. A chronic nail hurts with pressure of a show
on the side of the toe. A sure sign of a chronic ingrown nail is the "sheet
test." This is a name I coined to describe a condition where a toe hurts in bed with
just the pressure of a bed sheet. A chronic ingrown nail can hurt just a little for years
at a time but it never gets red, swollen and infected like an acute ingrown nail. A
chronic ingrown nail needs treatment when you either are tired of the pain or when it
"passes the sheet test."
For some unknown reason, teenagers usually have an acute ingrown nail for quite
sometime before they bring it to their parents attention. By then they have tried a
variety of "bathroom surgery" techniques to cure their problem. Sometimes
parents notice the evidence on an acute ingrown nail on the child's socks at laundry time.
In any event, an acute ingrown nail can be infected and almost always needs professional
treatment.
In the office an acute ingrown nail is quickly and nearly painlessly treated. After
anesthesia of the toe, the edge of the nail is delicately trimmed away and the toe is
allowed to heal. Regular activities can begin immediately in most cases including, to the
dismay of many kids, P.E.
Plantar warts are caused by a virus that gets into the crack in the skin and invades a
deep layer of the skin. It reproduces in a skin cell. When the cell bursts the virus
invades surrounding cells. This continues until there is a little lump on the bottom of
the foot. If the wart is on a weight bearing surface it can cause a stinging, burning
pain.
Treating a wart is easy. Getting it to go away and stay away is the hard part. Plantar
warts can be very resistant and are prone to recur. In my office I, like most doctors, use
more than one treatment method to treat warts. They vary from removing the wart on the
first visit to using topical acids that take several to many weeks to eliminate the wart.
I base the treatment I use on the number and location of the warts, the pain tolerance of
the patient and the activities in which the child is involved. The main ingredient in
treating warts is patients.
Over use injuries happen when too much stress is placed on the body in too short a
time. This is common during the first weeks of practice in a sport or activity the child
has not played either ever of for a long time. Muscles, tendons and even bones can fail
when placed under this stress. The key to over use injuries is prevention. Activity levels
should be increased no more than 10 per cent a week. If a sport begins with a "hell
week" where the coaches demand 100 per cent from day one, then preparation for this
sport needs to begin weeks earlier. Without that preparation injuries are sure to follow.
