So, remember this photo?
And then this one? Definitely NOT how we left the podiatrist's office.
I will preface this whole post with one sentiment -- it's only a toe & there are a lot (and I mean A LOT) of worse things that we could be dealing with. But when surgery is discussed, it's still a very serious problem within my little motherly world. My mama-bear limits were severely tested during that appointment.
As you can see in the photo, Fish was sleeping when we got into the exam room. I took him out of his winter suit and took his socks off. And then... The doctor came in. I fully understand that he needed to see his toe and I fully understand that he probably isn't used to seeing too many babes Fish's age. But man, was that doctor rough with his poor little toe. And man, did Fish scream. The wails that were coming out of that room were enough to wake the dead.
So let me explain exactly what Fish's toe looks like, as the original photo isn't too descriptive... Behold, my amazing Photoshop diagram.
It might be beneficial to compare the diagram with the original photo to completely understand.
Fish has a full sized nail on his toe. But his skin on the tip of his toe has raised up and is covering the "growing" edge of his nail. The yellow triangle on the upper right is actually a combination of dead skin and toe nail, which the doctor peeled off in the office. If his nail continues to grow "as is", it would grow directly into the underside of the overhanging skin (the black line).
What Dr. Toe tried to do in the office was shove a small piece of cotton underneath his nail with a tweezers so that the nail would grow OVER the skin curling over the nail. In order to do this, he had to push the skin that is curling over his nail bed back down and try to shove a teeny bit of cotton under his nail with these sharp tweezers. Because Fish is so young, his nails have not yet hardened and the doctor ended up peeling back half of the poor boy's nail! I still cringe when I think about it. Fish screamed and screamed and screamed (obviously).
After wreaking havoc on the poor guy's toe, the doctor told me that we wouldn't be able to do this under his nail has actually grown out enough to hold the cotton in place. So I'm assuming that some cotton will be underneath his nail tip and some will be shoved underneath his nailbed. And he told me that I was going to have to re-do this three times a day. Ha. Ha ha. I have a follow-up appointment with Dr. Toe in four weeks to reassess his nail. Dr. Toe hopes that it will have grown enough and strengthened enough to place cotton underneath it.
If we are unable to place the cotton to get the nail to grow over the skin (which given his circumstances and placement of the skin, I don't think that we are going to be able to get the toe to grow over it), then he will have to have surgery to remove the skin tip. With most adults, this is done simply with some local anesthetic, but with a newborn who squirms and kicks, he has to be knocked completely out (which could be quite dangerous on someone so young).
The only instructions Dr. Toe left me with was to wash it daily and watch for infection. I asked him what I was supposed to do if the nail grew too much during the four weeks and began to cut into his skin. He said if that happens, it WILL become infected and we would need to do immediate surgery to remove the skin.
We have his 8 week appointment with his regular pediatrician on Monday. I'm going to have her assess the situation and ask her some questions and hopefully she will be able to relieve some of my anxiety about Toe Watch 2014.