TB: You’ve been to many places. P: Yeah, yeah. I’ve been to many places, everywhere that has nails and this and that and they said no. TB: No one said they can cut it? P: No. They don’t want to. TB: Okay, and that’s why I kept growing and growing growing. P: Yeah. TB: So both of your big toenails are very thick like this. Somehow, they have been damaged. Whether it’s tight shoes, you drop something on your toe, something has damaged the toenail and that has caused the toenail to grow thick. P: Oh. TB: Once a toenail grows thick, it will always grow thick. Always. That’s why the other toenails are also getting a little bit thick sometimes with pressure or trauma, the nail changes and once that happens, it’s a permanent change. P: It will not… TB: Never again gonna be flat and normal. Okay? You understand? The thicker the nail, the harder to cut. No one can cut it so the nail grows even thicker and bigger and bigger. Now it’s hurting you in your shoes? P: Yes. I cannot wear my shoes. TB: No, no. So we’re gonna help you very easily today with this. Today we’re going to trim all the nails. I’m gonna cut this nail nice and short. This whole top of the nail is dead and lifted. That’s why it’s dark It’s growing different. Yes. I’m going to trim it short, and then I’m gonna file the nail thin. It’s gonna look much, much better. P: Thank you so much, TB: You’re welcome. But the problem is we’re not stopping the nail from growing. So the nail will continue to grow and in the future, it’s going to grow just like this all over again. So people come in every two to four months to have the nails cut and file. P: Me too! I will come to you. TB: Oh, that’s sweet of you. So we can do that. The other option that sometimes we do, if you get tired of this thicken damaged toenail, I sometimes remove the toenail permanently. It’s a very quick procedure. I give you a needle on either side of your toe. The toe is completely numb. I remove the toenail and then I apply an acid to stop the toenail from ever grow again. P: Oh. TB: And this is a permanent procedure. So this is something that some people do if they don’t want to deal with a big thickened toenail again. You understand? P: Yeah. TB: So today, we’re going to do the conservative treatment, We’re gonna cut and file, make it nice and thin, and we keep doing this every couple months. If you get tired of doing that, P: Then I will think about… TB: Then you think about doing the big one exactly. Just like that, okay? P: Alright. TB: So you just relax. We’ll cut all the toenails. So the the walk-in clinic downstairs told you to come here? P: Yeah. TB: Very good and just like that you’re here. P: Yeah. (laughs) TB: Very nice, so… P: I showed them, the doctor… TB: Yes. P: He said, “I’ll tell you where to go.” There was no charge for that. TB: He did a very good job. So what we’re gonna do is we’re going to cut the smaller nails first, and then cut the big ones last, okay? P: Alright. TB: So you just relax. First we cut and then we file. So if anything gets sore, you let me know. So cutting is one thing but I’m gonna use a file to make the nails nice and smooth and thin. That’s what’s gonna make this one look much better. P: Yes, of course. TB: Poor you! You’ve been walking around with this long toe nail for how long now? It must be around what… P: About four-five years. TB: Four or five years! P: Once, not that long ago, the lady in Walmart she said she couldn’t cut it at one time, slowly, slowly, slowly. TB: And it was better. P: Yeah, it was better. TB: But then it grew thick again. P: I don’t think…because I was going to Pakistan, my country. I have to wear something chicer. TB: Okay. So we do this one as well okay, and then we cut the big toenails. P: Alright. TB: And like you said you’re a foot model today. (laughter) P: Yeah, I’m a model! TB: You’re a model today. P: Yeah. TB: So do you speak Urdu? Do you speak Urdu? What language do you speak? What language do you speak? P: What? TB: What language? P: What language? Urdu. TB: Urdu! So you can talk to Maya she knows Urdu. P: Usually I am Urdu speaking. TB: Ah. P: (I speak) English is because I am living here and I talk to everyone. TB: Very good! P: That’s why I Iearned. TB: So my roommate in university, he was born and raised in Karachi. P: Is your mom from Karachi? TB: Okay, so yeah my I grew I lived with him for almost four years. So we were good friends and yeah (he was) from Karachi. From Pakistan so I learned a lot about the culture and P: Yeah. TB: the food and P: It’s good. TB: It’s good. Karachi is a big city. P: What are you eating? (What did you eat there?) TB: All the good stuff! P: Many good stuff. TB: Okay. Now the big one. So if anything hurts, you let me know. This is all just thickened, dead nail. So what we do P: This is thick also. TB: This is my workout for the day. I don’t need to go to the gym anymore TB: You okay? P: Yeah. TB: So I’m going nice and slow so nothing hurts, okay? P: You specialize in nails? TB: Nails. Yes. P: How much time is your degree? (How long does it take?) TB: It’s three years… P: Three years! TB: after university. P: After university. What did you do in university? TB: I did biomedical sciences… P: Biomedical sciences. TB: At Waterloo. P: In? TB: At University of Waterloo. P: Waterloo? TB: Yes. P: And then you did this further for four years. TB: Three years. P: Three years. From Karachi? TB: No, all in Ontario. P: All in Ontario. TB: In Ontario, yes. P: Why were you there, in Karachi? TB: No, my roommate was from Karachi. My roommate. P: Roommate was. TB: My roomate. P: You’ve been to visit? TB: No, I never visited. P: Oh. TB: You okay? P: Yes I am. TB: See, you’re a tough girl. P: I am very tough. TB: (laughs) Yeah, I know you’re tough! You know. You know why I know you’re tough? Because you got tough nails; tough nails for a tough woman. P: Because I am already old and still I am doing everything for myself. I’m doing it myself. TB: Wow! P: Living by myself, I’m going everywhere. TB: That’s amazing. That’s amazing. So… P: Now I discovered this (place) because of someone who worked here. TB: Now you know. P: Now I know, I will start looking to you every three months four months when I need. TB: When you need it, yeah. P: Yeah. TB: Oh my gosh, this is a slippery toenail! P: It is very hard. TB: No, I just don’t want to cause you any discomfort, so I’m trying to grab it very gently. You okay? P: Yes. TB: Does it hurt? P: Umm? TB: No, a little bit? Okay, I’m sorry. I’m sorry. So what I’m gonna, do is try to file it down as much as I can. P: Because it is very thick. TB: It is. So I trim it first and then I file it and then like we said, if you get tired of dealing with this thickened nail, we can remove it permanently. P: If I want (to do that), then what happens? TB: So what happens, the cuticle closes, heals shut and then just skin. P: It won’t come out no more? TB: Then, nope, no more; just smooth skin. P: I will think about it. TB: Yeah, you just, no need to rush for that for you because you’re gonna see after we take care of this, it’s gonna look much better. Sorry, sorry, sorry! Okay that one’s a little sensitive for you there. Do you remember if you banged your toes or sorry, sorry, sorry! Do you remember if you banged your toe or… P: Yes. I don’t remember. TB: That’s really sensitive, ah? Is that really sensitive? P: Umm. TB: Okay. P: Sometimes I bang (the toes) and I don’t care it bangs. (laughs) TB: (laughs) I better watch out then; you might just bang me then! You might just kick me! (patient starts sniffling) TB: Do you need a tissue or anything? You’re okay? P: Yes. No, no. TB: No? You’re okay? P: I don’t want it. TB: Okay. Because the more I trim down now, the more I can file. There we go. So all this that’s underneath, that’s all dead skin. P: Alright. TB: The nail bed is damaged and that’s why the nail is not going flat anymore. Here’s a big piece; look at that! P: Oh, my G_d! TB: Oh my. This is an instant diet! You’re gonna lose ten pounds after this. You’re gonna be super light after this. P: Hmm? TB: All this extra weight is gonna be gone. You okay? P: Yeah. TB: It’s like we’re giving it a haircut; a buzz cut – we’re cutting everything off the top. Oh, you’re nice and close now; you see that? P: Yeah. TB: Okay, so we’re gonna put the foot down and we’re gonna file, we can put this one down, we’re gonna file the toenails. That’s what’s gonna make it look really nice, okay? I do the normal toenails first and then we do the two big toenails last. This shouldn’t hurt. There’s gonna be a little bit of water the water’s gonna keep the toes nice and cool. If you feel any heat, you let me know. Okay? P: Hm. TB: Okay, let’s do the baby toes here first. You just relax, okay? So I’m just waiting for the water, there’s the water. P: Yeah, I see. P: That one is pretty. TB: It looks good, huh? P: Yeah. TB: See, you’re a real foot model today. P: Yeah P: You just cleaning it also? TB: Sorry ? P: You just clean also? TB: It’s cleaning it, yeah. Yes. So the thicker the nail the more yellow the nail looks. A lot of people will look at your two big toenails and say you have fungus, but to me, it’s more of just a damaged toenail. That’s why it look so yellow and dark. It’s because we have dead skin underneath. Okay? P: Okay. TB: Let’s do this one. Okay so again, if you feel any heat you let me know. Look how nice they look now, ah? P: Um hum. Any pain? P: No. TB: Okay. Now this one. Okay. So again, if you feel any heat, you let me know. You give me a bump. You give me a good bang. TB: Are you okay? P: I am. TB: No pain? P: I’m more than okay. TB: You’re more than okay? (laughter) P: I am happy they are clean and looking normal. TB: So again look at that! Once I start filing the dead stuff, you can see the underneath and nail looks quite healthy. It’s just thick and that’s why it looked that way. So I’m gonna try to do it as much as I can, okay? So if you feel the nail… is it’s hurting? P: Yeah, it is hurting. TB: Sensitive? P: Yes. TB: Okay. I’m trying to remove as much of the dead skin from the side, but if it’s too sensitive, we leave it, okay? I do as much as possible. That way this lasts a long time. P: Yes. TB: Any heat? P: Yes. TB: A little heat there? P: Yes. TB: Okay, so unfortunately we can’t go too much thinner than this. Okay one done. How’s that one look? Looks pretty good? Okay. One more. You okay? P: Yes. TB: I know it’s a little sensitive. So the tip of your nail is dead. That’s why the nail cannot attach over there, and that’s why it grows straight up in the air; because the nail bed is damaged. TB: Are you okay? P: Yeah. TB: Look at that! P: This black thing is not going away? TB: No. This is dry blood. That was there from before. Is it a little sensitive? P: Yes. TB: Yeah, so we leave it. It’s just dry blood. So you had too much pressure, and that’s what caused some bleeding underneath the nail. So we come back in four months and do the same thing again. TB: Okay? P: Okay. I will try, if I am here. TB: Four months might be a little bit too long, but usually two to four months, whatever works for you. P: It is too long; I know. TB: So yeah, so we can try to come back maybe in I would say three months. P: Three months or four months. TB: Yes, okay How do you feel P: I feel really good. TB: That’s good. P: I’m happy too. (laughter) TB: That makes me happy. Okay. You take care, okay? P: Thank you so much.