Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Latest Posts

A Family Doctor’s “Footnotes”

Regular readers have heard me rant about the fragmentation of medical care in this country. Each body part not only has its own medical specialist, but in some cases its own allied health profession. Such is the case with the feet.

Doctors of podiatric medicine have to complete a four-year course of study after college, followed by a three-year podiatry residency. At the end of all that, I grant, they are expert in the care and management of complex disorders and conditions of the foot, ankle, and lower leg. I refer to them regularly, especially for stubborn ingrown toenails. (I did indeed learn how to remove offending portions of nail bed, but over the years I’ve gotten away from it.) They fail, though, when they try to extend their reach beyond their grasp, which is the case of the podiatrist above the knees. Read more »

*This blog post was originally published at Musings of a Dinosaur*

Medical Treatment Of Ingrown Toenails: 1908 And 2009

Flipping through the 1908 textbook, A Text-Book of Minor Surgery by Edward Milton Foote, MD I found at an antique store last month, I came across the section on ingrown toenails. The causes of ingrown toenails were much the same as one hundred years.

This is a condition in which the edge of the nail, usually of the great toe, by its too close contact with the flesh beneath causes irritation, ulceration, or suppuration. There has been much discussion as to whether the nail or the flesh is the more at fault. This discussion is without profit. It is much better to study the normal conditions, and see what can be done to restore them. Read more »

*This blog post was originally published at Suture for a Living*

Guest Post At GruntDoc’s Blog: Plantar Warts

While I was “homeless” my blogging friends kindly invited me to guest post at their websites. Allen Roberts (aka GruntDoc) posted this for me:

As many of my close followers know, I’m “in between blogs” at the moment. My new website has not launched yet, so I’ve asked a few close friends if I could guest-blog at their sites until further notice. Dear Grunt Doc actually offered me a password and authority to post directly to his blog. Now that’s trusting! I mean, I could fill up his site with LOLcats posts if I wanted.

A few blog-hijacking fantasies later, I decided to ask myself – “What sort of content would be appropriate to contribute to an Emergency Medicine blog?” The answer, of course, is “real photos of anything gross.”

And as luck would have it, I do have a nice photo of something gross (albeit mildly so). Even better, it’s my own grossness so there’s no HIPAA violation looming. What is it? Well, it’s the sadistic work of a dermatologist. (By the way, dermatologists have the best photo galleries of really gory conditions).

Let me explain…

Click here to read the rest of the post.

"Doctor Fish" Give Great Pedicures?

Thanks to my friend Jen for highlighting this unusual “health story.” Apparently a type of fish (called “doctor fish” – not sure how I feel about that) found in Turkish hot springs thrive on dead human skin. They’ve been used in the past to treat psoriasis, a condition that produces skin cell overgrowth. And now, an enterprising salon has imported these fish to nibble off dead skin found on pedicure seekers’ feet.

Images of the movie “Piranha” came to mind for me until I read the fine print – these fish have no teeth, but use a kind of suction action to feed. Also, the silvery creatures are the size of minnows.

Some clients say that the process tickles, and it feels as if their feet are being “kissed” by hundreds of fishies. The salon owners claim that the fish have doubled in size since they were first unleashed on American spa-goers.

I suppose this is an “organic” way to live in a symbiotic relationship with nature’s creatures - but as a physician, I can only imagine all the potential fungus and wart viruses thriving in the warm fishy waters. [Shudder]

I’m going to stick with my pumice stone.


You may also like: “Flip Flop Foot” and “Conversations at the SpaThis post originally appeared on Dr. Val’s blog at

The Dangers of Flip Flops?

I wrote about an interesting podiatric phenomenon last summer: “flip flop foot.” Some people experience cramping between their toes after walking around in flip flops for significant periods of time.

Flip flops seem comfortable and easy to wear (I like them because they don’t pinch wide feet) but they actually create more work for your foot and leg muscles than regular shoes.  You may not realize it, but when you wear flip flops your toes must grip them extra firmly to keep them from sliding off or sideways.  So you actually contract many extra toe muscles (like the adductor hallucis and the flexor hallucis brevis) with each step you take.  Wearing flip flops for long hours can give you actual cramps in these muscles and others.

But here’s another potential danger associated with flip flops: skin cancer! Dr. Benabio over at The Derm Blog rightly points out that we often forget to put sunscreen on our feet (that may not have seen the light of day since last summer). This puts the skin of our feet at risk for blistering sunburns, and in the long term, skin cancer.

So as you enjoy the warmer weather, take good care of your feet. Walking a mile in your own shoes might be better than doing so in your flip flops.This post originally appeared on Dr. Val’s blog at

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

Read more »

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

See all book reviews »