REMEMBERING DR. ANOOP WAHAL AND HIS CLASS ON INGROWING TOE NAIL AND PARONYCHIA

 

Dr. Anoop Wahal was a lecturer in the Department of Surgery when we were introduced to the subject of General Surgery during our 4^th Semester. He was one of the first teachers of Surgery and his afternoon lectures were held in the majestic Anatomy lecture theatre. He was young and stylish, recently back from his Commonwealth Fellowship in the U.K, and still had that English accent left in him. Needless to say, we were mighty impressed! He was also an avid sports enthusiast and would play Cricket and Tennis with us in the evening, and that only increased his popularity amongst us.

 

During my surgical residency he was a lecturer in Prof. P.C. Dubey’s unit. He had recently returned from the U.K after completing his training in Minimal Invasive G.I. Surgery and we, the younger generation, were naturally attracted towards him. For the first time in our life we were watching laparoscopic cholecystectomy and appendicectomy and we were mesmerized! He took time to demonstrate how the intra-abdominal structures looked through the laparocope and as this would take time he was often hustled by almost everyone from anaesthetiests to theatre sisters to the waiting surgeons. This however never bothered him and our education continued uninterrupted. I can't tell you how many amongst us took up Minimal Invasive Surgery to be cool like him!

 

Besides being a great teacher, much later in life he became a friend and confidant to many of his juniors. He was a very meticulous thesis guide to the lucky ones who managed to have him as their guide. As there were no dearth of patient details and photographs writing a thesis or a paper was not difficult with him.

 

Sir was very fond of Cricket and would regularly play with us. I remember the evening I met the great Don Bradman in Bowral, NSW in 1991 just before Christmas, I rang up Sir to share my excitement. I had heard so many stories of watching Cricket at Lords and Tennis in Wimbledon that these two were high in my ‘to do list’ and I can assure you his descriptions were no exaggeration.

 

Prof. Wahal led a very active life, which I remember was once interrupted by a cardiac event but he soon recovered and started working with his usual enthusiasm, zeal and zest, because there was no other way he could function. His wife, Prof. Rita Wahal is an anaesthetiest and would regularly assist him in private. His father Prof. K.M. Wahal was our teacher in Pathology and an illustrious researcher.

While going through my old lecture notes of Surgery a very interesting lecture delivered by him, on a very common problem of ‘Ingrowing toe nail and Paronychia’ came in front of me, and suddenly I started recollecting that winter afternoon in Anatomy lecture theatre most vividly. After finishing with our attendance and cracking a joke or two he started: 

If you ever experienced the pain of an ingrown toenail, you know that what begins as a nuisance, can quickly become a painful infection that can require medical treatment. More than 5% of the population suffers from ingrown toenails, yet people hold many misconceived notions about treating the condition.

What is an ingrown toenail?

An ingrown toenail is a condition where the edges of the toenail are bent and grow into the skin of the toe. The result is pressure, itching, swelling and pain. In many cases, the nail breaks the skin, which usually leads to an infection called Paronechoea, and in extreme cases it may require surgical intervention.  

The main causes of ingrown toenails are:

·        Heredity: Ingrown toenails have been shown to be a trait that is passed down.

·        Improper trimming: Cutting your toenail too short may cause the skin to grow over it.

·        Improperly sized footwear: Tight shoes can push the toenail down and into the skin.

·        Trauma to the toe: Suffering a trauma to the toe can cause the nail to start growing into the skin.

·        The condition of the toenail: Fungal infections can lead to ingrown toenails.

 

Myths & Facts:

Myth: Getting a pedicure every 2-4 weeks will effectively treat an ingrown toenail.

Fact: Only a doctor is licensed to treat the pathology of an ingrown toenail.

 

Myth: Cutting your nails short enough will stop toenails from ingrowing.

Fact: Cutting toenails too short can lead to ingrowing. It’s better to cut them straight across.

 

Myth: “Bathroom Surgery” is an effective way to stop ingrown toenails.

Fact: Many cases of infected toenails are a result of “Bathroom Surgery”. They may also lead to Paronechoea

 

Myth: Getting a doctor to treat the ingrown is painful.

Fact: Doctors use a local anesthesia and the procedures are painless.  

 

Non Surgical / Conservative treatment:

1. Soak your foot in warm water for 15 minutes, twice a day. Be sure to dry your foot completely after the soak.

2. Only wear shoes that don’t put pressure on your toes. The pressure will push the nail into the toe, exacerbating the situation.

3. If your toes are swollen and painful, try pulling the skin gently away from the toe. This may release some pus – if so, wash the area, apply disinfectant and use a cotton swab to apply antibiotic cream.

4. In a case of an infected toenail, see a doctor as soon as possible.

Paronychia

Paronychia (pahr-uh-NIK-ee-uh) is an infection of the skin around a fingernail or toenail. It usually results from bacteria. Bacteria get into the skin through cuts in the cuticle and the nail fold (the skin around the nail). Most nail infections get better with antibiotics. Paronychia doesn’t usually cause serious health problems. In some cases, the infection lasts a long time or comes back after treatment. The infected area can become swollen, red, and painful, and a pus-filled blister (abscess) may form. Most of the time, paronychia is not serious and can be treated at home by:

·        Oral antibiotics

·        Betadine – luke warm water lavage

·        Anti-inflammatory drugs

The infection will probably heal in a few days. If paronychia doesn't get better after a week or so, call your doctor. You'll want to call a doctor right away if you have an abscess (a pus-filled area in the skin or under the nail) or if it looks like the infection has spread beyond the area of the nail. An abscess will require proper drainage and perhaps excision of the ingrowing part of the nail.

If you have diabetes, there's a risk that paronychia could spread to deeper tissues and bones, or into the bloodstream and other parts of the body. In extreme cases of deep infection, paronychia can result in the loss of fingers, toes, or limbs. So for a diabetic with paronychia there is no scope of home treatment and amateur adventure.

Prof. Anoop Wahal retired as the Head of the Department of G.I. Surgery from King George's Medical College, Lucknow and started practicing in private, but his journey was cruelly cut short by cancer. A gem from the batch of 1966, Prof. Wahal was a true blue blood Georgian, a great teacher, a daring surgeon and a wonderful human being. We all miss him so much!