Tuesday, April 22, 2008

The Agony of De-feet

Well, either you are throwing virtual tomatoes at me for choosing this post's title, or you are wondering, WHAT agony? Turns out, yours truly has (or had) an ingrown toenail on my left big toe. (I suppose I could have titled the post "The Agony of Da-Foot" but it doesn't have the same ring to it.) I got it removed yesterday, by a professional (are you listening, Dariush?) although fortunately, he just had to remove the right edge.

This isn't the first time my toes have gone "under the knife," so to speak. Way back in the late 80's, I had several incidents with ingrown toenails on my right big toe...and it was removed a total of I think three times, ultimately growing back rather thick and ugly-looking. I always said if it happened again I'd just get the whole nail removed, but so far I haven't had to do that.

This time, it was my left foot's big toe that was the problem. It was actually acting up on me before my trip to Amsterdam, so in order to be able to walk around while I was there, I trimmed it REALLY short on that side. Not a medically wise thing to do, I know, but I wanted to be able to ambulate without pain while I was there.

I went to my regular doc's office after I got back from my European adventure. I had caught some kind of cold or bronchial infection while I was on my trip, and wanted to get it checked out. My primary doc also looked at my toe once I mentioned it to him, prescribed some antibiotics, and referred me straightaway to a podiatrist, which is where I went yesterday (and where the minor surgery occurred.)

My toe wasn't that inflamed when I went to the podiatrist's office yesterday (probably due to the aforementioned antibiotics) but he felt removal was the best option, which I had no problem with. He also wanted to prescribe more antibiotics, and some kind of ointment. Unfortunately, when I got to the pharmacy, I was told the total for those two items was going to be about $80 ($50 just for the ointment) and that there were no generic equivalents available.

Now, I do not skimp on my health, let me make that clear. If I have to get something done, I have no problem going to see a doctor or get the medicine they recommend. But in this case, the after-insurance price of the drugs made me take pause...especially since I didn't think my toe was all that infected. And no, I'm not a doctor, but I have had severely inflamed ingrown toenails in the past, and this one wasn't like that at all. Also in the past, doctors have said that plain old over-the-counter Neosporin works fine as an ointment, post-removal. I opted to not get the prescriptions filled yesterday and called the doc's office to leave a message asking about them. Of course, nobody had returned my call by this afternoon.

I finally called back and got the doctor's nurse. I asked to speak with the doctor and got the reply of, "Is there something I could help you with?" I swear, getting a doctor to talk to you directly on the phone is like pulling teeth sometimes...but I went ahead and explained the situation to her. "Well, that's what Dr. Nag likes to use with his patients," she replied. "There's no generic available. You haven't gotten it yet? Hold on, I'll talk to him."

She came back a couple of minutes later. "Dr. Nag says he prefers the mega-overpriced foot goop but says you can use Neosporin if you insist." (OK, she didn't really say the mega-overpriced part.) "He said you don't have to take the antibiotics either, if you don't want to, but to soak your foot in warm water with some vinegar twice a day for a week." I never did speak to Dr. Nag (not his real name, if you hadn't guessed) directly today, but if I can avoid spending money on overpriced foot goop, I'm all for it.

My question is, do doctors ALWAYS choose the most expensive option in determining how to treat patients? If I didn't really need an antibiotic, why did he prescribe one anyway? Oh well. I guess I'm fortunate that I don't have any kind of chronic condition or ongoing prescriptions I have to get all the time...my mother does, and I know how much those can add up to be. All the same, I wonder if many doctors here might do better not to blindly prescribe expensive medicine if it isn't really necessary.


Suldog said...

MY WIFE had an ingrown nail on her big toe almost totally removed in her teens. She now has a little nail that covers about 1/4 the area of the one on her other foot. I call it her wonky foot (lovingly, of course.)

It freaks out the Asian ladies she goes to for a pedicure occasionally.

Anonymous said...

First of all, soak those tootsies in epsom salts and the warmest water you can stand - twice a day is best, but at least once a day for at least 15 minutes. The epsom salts will help draw out (and dry up) any infection that might be left. Pat dry, and then try to go barefoot whenever you can until it's completely healed up.

If you start to get another ingrown, you can always take the bit of cotton from the end of a q-tip and (gently) push it under the toenail. Don't overdo it, but pack enough under there to raise up the corner and get some relief, then soak in the epsom salts as above. Catch it early enough and it often is easily fixed.

And now to your question: Why do doctors prescribe the most expensive thing? First of all, most doctors don't know how much a medication costs. They know what the pharmco rep tells them. Second of all, the doctor wants you to get well, so they tend to prescribe what will (should) work most effectively. Again, cost isn't much of a factor there for the doctor...

Trust me, if doctors had to pay for the prescription out of their fee, we would have $1 generics faster than you could say "Jack Robinson".

Merujo said...

I had an infection of an actual toenail about five years ago. The doctor gave me an Rx for a polish to put on it. I went to pick up the medication only to find out it cost $120 for the tiny bottle. I just about passed out when I heard. I was stupid enough to go ahead and buy it. When I next saw the doc, he said, "So, how did that drug work?" When I told him how much it had cost me (and created great hardship for me for a month) his face went all white. He had no idea of the cost, and he was embarrassed -- turns out it just worked a bit faster than another drug he could have prescribed - one that cost $15. He was absolutely silent through the rest of the appointment. That was when I started asking hard questions every single time I got a new Rx...

Chuck said...

Suldog - I've never had a pedicure, but I hear they're enjoyable. My big toes would definitely present a challenge to the pedicurist.

Thimbelle - Soaking did help. And I have been wearing flip flops as much as possible. Toe is about all healed.

Merujo - Yeah, I had some similarly expensive crap prescribed once...now when I get presented with a whopper of a bill, I ask questions.