Medical weirdness

Back when we lived in Omaha, my primary care physician, Michael Sitorius, a wonderful doctor who was also department head for Family Medicine at the University of Nebraska College of Medicine, used to tell me that he always wished he had a student along on the days I wound up at the Family Practice clinic. I seemed to have a knack for coming in with stuff that fell into a weird category of common enough to pop up on a regular basis but not so common he could count on having examples for students to see.

None of it was ever truly serious, just annoying. Like a Bible cyst, i.e., a ganglion cyst that's pretty common in people who do tasks that involve a lot of repetitive motion, like keyboarding. A blocked salivary gland. Trochanteric bursitis, better known as a pain in the ass (it's bursitis that hits your hip). Nothing dramatic, nothing life threatening, but nonetheless stuff doctors get to deal with regularly but students often miss seeing while doing their clinical rotations.

Small digression: I got lucky in getting Dr. Sitorious as my PCP. When I called the clinic the first time to make an appointment, I was told I'd get whoever was next in line, which was fine with me. I figured that when the clinic was part of the university medical system, anyone working there had to be qualified. Turned out he was a great doctor, one of the best I've ever encountered.

Anyway, I was thinking about Dr. Sitorius this summer because I've had two things pop up fairly close together, both of which are pretty common but no one ever really talks about: BPPV and pincer toe. If they did get talked about, I probably would have heard about them before I acquired any personal experience with either.

First, BPPV = benign paroxysmal positional vertigo. It's an inner ear problem. Calcium crystals that form in the canals of the inner ear shift position and trigger vertigo. You move in a way that was never a problem before (roll over in bed, sit up, whatever), the rocks in your head migrate and things start spinning. BPPV is most common in older people but can occur at any age. It is a leading cause of falls. Based on consultations with Dr. Google, I figured out that was most likely what was troubling me.

Google was also full of links to instructions for the simple exercises a person can do to fix (at least temporarily) the problem. Being blessed with decent insurance, however, I decided to ignore the DIY methods and get a confirmed diagnosis from an ear, nose, and throat specialist. Having lost a friend last year to brain cancer influenced me, too. Her cancer caused annoying but not apparently serious systems. By the time she mentioned them to her doctor and he ordered scans, she was Stage IV. A few months later she was dead. Bottom line: if there are symptoms that might be neurological, don't procrastinate.

Anyway, turned out it was BPPV. Took one simple maneuver to reset the rocks. That was a couple weeks ago and I haven't had a dizzy spell since. I do find myself wondering how many older people have BPPV and don't realize it. They just put an increasing problem with dizziness down to getting older, assume they're stuck with it, and start restricting their activities because they're afraid of falling.

Anyway, BPPV solved. Which brings me to the toe. Awhile back I noticed one of my toe nails was starting to grow in a rather odd way. It seemed to want to form itself into a talon. It started off normal enough at the base but then the sides started migrating toward each other. It didn't hurt, but it was definitely odd looking. It got pointier and pointier. Trimming it was becoming trickier and trickier. I started wondering if I was going to have to get out the nail clippers we used on the last dog we had. You know, people aren't supposed to grow talons. We have no need to grip telephone lines or, if we felt like channeling raptors, eviscerate prey with our feet.

Once again, because I'm blessed with decent insurance, I decided to bring in an expert. I made an appointment with my podiatrist. I'm not sure just what I was expecting when I saw him, but for sure it wasn't that he was going to reach for the stainless steel pliers.

Okay, he didn't reach for the pliers as soon as he saw the toe nail. First he asked if I wanted it gone. Turns out removing funky toenails is the most common procedure he does. Apparently the number of feet that come ambling in with disgusting toenails is mind boggling. You go off to podiatry school and learn all sorts of stuff involving bones and tendons and nerves and have visions of doing really interesting medical things with feet and what pays the clinic rent? Ripping off toenails and treating plantar's warts. My podiatrist said he used to track the number of toenail removals but quit counting at 50,000 (he's been in practice for a good number of years now).

And, yes, removal does consist of literally grabbing the nail with the pliers and ripping. Fortunately, it also includes the use of a local anesthetic so you have the strange experience of seeing it yanked off without feeling a thing. It is a permanent removal. There are supposedly things you can do to correct the nail but they tend to be futile -- once it's decided it wants to be a pincer, the nail does not want to change its mind.

Anyway, he said the type of toenail I had is called a pincer nail and is remarkably common. He said sometimes people will have it happen to every toe so end up having all ten nails removed. (At this point I toyed with the idea of inserting an image, but thank me, Gentle Reader, the photos I found were all too gross even for me) That got me to thinking. Why is it so common? And why did it wait until I was older than dirt to start happening to me?

Once again, Google was my friend. Several reputable web sites (e.g., Mayo Clinic) supplied answers. There are a bunch of things that can do it, but the one that stood out for me was the correlation with certain medications like beta blockers. Guess who took a beta blocker for years? You know, I'm pretty conscientious about reading the prescribing information on drugs, all that fine print that usually concludes the list of side effects with "and death," but I don't ever recall reading that my blood pressure meds would make my toenails go weird.