Can Fungal Nail Infections Be Cured?

Lynn A. Drake, M.D.

It may start slowly, with a nail that begins to peel, crust, become brittle, and separate from the toe or finger. Or the first sign of trouble might be a nail that seems dirty and unkempt and turns unnaturally white, yellow, or black and blue. It’s not a problem that a manicurist can solve, although that may be the first place people turn for advice.

While nail problems can masquerade as cosmetic difficulties, many are caused by a fungal infection called onychomycosis. Unlike many infections, this one rarely goes away by itself. If left untreated, it can cause numbness, tingling, or pain; the nail may gradually separate from the finger or toe; and eventually, the nail could be permanently destroyed.

Causes and Consequences

Onychomycosis accounts for about half of all nail diseases. It affects nearly 11 million Americans, or one in 25 people. An estimated 20 percent of the population between the ages of 40 and 60 are affected. It is most common in men and among middle-aged and older people. Although both fingernails and toenails can be infected, onychomycosis occurs about four times more frequently in toenails. The fungi that cause it thrive in moist, warm environments, like the inside of a shoe. Fungal infections may be linked to walking barefoot around public showers or swimming pools, health clubs, and even hotel rooms. Wearing airtight shoes for activities such as hiking, biking or other sports may predispose one to infection. It is well known that people with medical problems, such as diabetes, poor circulation, trauma or deficiencies of the immune system have higher incidence of fungal nail infections. There is a genetic susceptibility to develop fungal infections in general, so the condition can be lifelong with frequent recurrences. Vulnerable people need to be extra vigilant.

The fungi can enter the nail either through the cuticle from the lateral nail fold or under the tip of the nail where it separates from the underlying nail bed. Onychomycosis causes nails to become thick, brittle, hard, distorted, and discolored. As the infection progresses, the nail plate may begin to separate from the nail bed and ultimately may be destroyed.

Although changes in the color, texture, and structure of the nails are the most visible signs of infection, onychomycosis affects more than appearance. It can have physical, emotional, psychological, and social consequences as well.

Individuals with onychomycosis may experience foot discomfort in the form of pain and abnormal sensations because their shoes no longer fit properly. They may also find it difficult to walk or stand for long periods of time, and they may be unable to exercise or participate in sports and other recreational activities. Infection of the fingernails can interfere with manual dexterity, making it difficult to pick up small objects, and with such activities as knitting, typing, and playing a musical instrument. It may even interfere with their ability to get a job or keep a job.

Onychomycosis can also result in a poor self-image, low self-esteem, and feelings of inadequacy. Embarrassment may make people hesitant to expose their infected nails, leading to social withdrawal and isolation, thereby affecting relationships with family members, friends, coworkers, and employers.

Diagnosis

With proper diagnosis and treatment, nail fungal infections can be cured. Before starting treatment, the physician should confirm the diagnosis and rule out other possible causes, such as psoriasis, minor trauma, alopecia, and certain types of dermatitis. In one quick, simple test, called a KOH preparation, nail scrapings or clippings are added to the chemical potassium hydroxide (KOH). If a fungal infection is present, elements of the fungal structure will be visible under a microscope. KOH preparations, however, cannot identify the specific fungus responsible for the infection. Cultures of the nail samples are required in order to obtain this information.

Treatment

Fungal infections are notoriously persistent and can be difficult to cure. Approaches to treating onychomycosis include topical therapy and oral antifungal medications. Topical lacquers and creams that are applied directly on the nails are of limited value, however, especially with toenail infections, because most of them do not penetrate thick, dystrophic nails. These agents may be more useful in very early stages of infection or in conjunction with oral antifungal agents.

Surgical or chemical removal of part or all of the nail plate is another approach, but it does not eliminate the fungi causing the infection, and the result is unsightly and uncomfortable. Therefore, because of the successful results of the newer oral agents, nail removal is seldom performed by dermatologists as a treatment for onychomycosis.

Oral Medications

A number of prescription oral medications are available. Griseofulvin was the first oral medication to be approved for treating onychomycosis. Because this drug remains in the nail plate for only a very short time, however, it must be taken three to four times each day and continued until the infected nail grows out—up to six months for fingernails and 12 to 18 months for toenails. Ketoconazole offers an alternative to griseofulvin for the oral treatment of onychomycosis. This drug is taken only once daily but, like griseofulvin, has to be taken until the infected nail has been completely replaced. There is also a slight risk of liver damage with the use of ketoconazole.

Fortunately, newer, highly effective oral antifungal medications with once-daily dosing schedules and much shorter treatment periods have been developed. Two of these, itraconazole and terbinafine, are currently available in the United States. Another, fluconozole, has yet to be approved for use in the United States but is used in some European countries. These drugs penetrate well into the nail plate and remain there for an extended period of time, even after treatment stops. Because of this good penetration, the required duration of treatment is reduced to only three to four months. There is a new convenient treatment for fingernail onychomycosis—the Sporanox PulsePak. The medication is taken twice a day for a week, then no medication is taken for 3 weeks, then the PulsePak treatment is repeated. Although itraconazole is eliminated from the plasma by two weeks post treatment, this shorter treatment regimen reduces toxicity even further. Sporanox should not be taken with astemizole, terfenadine, cisapride, triazolam, lovastatin or simvastatin.

Preventing Reinfection

During treatment and after the fungal infection has cleared up, individuals must take the necessary steps to prevent reinfection. It is particularly important to avoid situations that may have led to the initial infection. Specific measures to prevent reinfection include:

• Do keep nails clean.
• Don’t walk barefoot in public areas, especially hotel rooms and public showers.
• Do select shoes made of material that allows the feet to “breathe,” such as leather.
• Do make sure shoes fit properly. Those that are too tight can cause sores that lead to infection.
• Don’t wear someone else’s shoes.
• Do contact a doctor at the first sign of reinfection.

Regular Maintenance of an Aquarium.

Fish Aquarium

Aquarium is beautiful only when it is regularly cared for. Despite the widespread view of the complexity of care, in fact it is much easier than to keep the house, for example, a canary. Canary to feed, drink, brush tray in the cage, thank you for a walk even though it is not necessary. And all this day, just try to leave the poor bird in the hot summer season at the weekend without water and food! Most likely your return, it will not wait. But running properly you can easily keep an aquarium at least for the whole vacation, or anything with him or with the fishes will not happen. Hard to believe, is not it? Yet it is true.

If starting a new aquarium you will comply with all the steps – first bought an aquarium, filled ground, planted the plants, water filled and, most importantly, they gave him to stand at least a week before buying the fish, then at an early stage any problems should arise. Well, maybe if you decide to generously feed the fish right half of the contents of the jars available feed, and this at once spoiled water. But the days pass, and at such a neat sand begins to appear first dirt on the glass to appear on a distinguished film and micro-organisms, and so neat when you buy a bush plant suddenly starts to go out of the water. What to do? What’s wrong? And in fact, all right, and do not need to be afraid, just the time has come for the first time to clean the aquarium.

Aquarium as well as any home needs regular cleaning. While cleaning her apartment, usually immediately and ventilated. The aquarium in the process of cleaning you will substitute some of the water. And in this procedure is no big deal, especially since it is sufficient to carry out only once a week, and if the fish a little, then enough for two times per month. Compare this with the daily cleaning of the canary!

To care for the aquarium, we need a bucket, a regular or special hose with a nozzle-siphon (hose of the best to use a transparent fillms, ordinary rubber may produce undesirable components in the water, and the rubber is aging rapidly, and becomes unfit for use), a special scraper for glass and possible pair of scissors. Scissors will be needed in case of need to trim excessively overgrown plants, although many aquarists simply break off his hands. But the main tool is still a hose and bucket.

We begin with a clean glass. The fact that the glass is always picking up the lower algae and various microorganisms inhabit, thereby impairing visibility. If a strong light and bright areas are actively breeding green algae, they look like green fuzz on the rocks, leaves, plants and windows. Brown patina on the glass and leaves of plants indicates a lack of lighting and the colonies called diatoms. The easiest way to remove algae from glass is to use a special comb. Scrapers are magnetic; these consist of two parts one of which is placed in water, while the other pulls it through the glass outside. As a result, you can safely, even without wetting the hands of just driving on the glass, and part of being in an aquarium will be with scrape plaque from the walls.

Another pig is a sponge on a wooden handle. They are also quite convenient to clean glass aquarium, but for deeper tanks, he will not do. But a sponge can be cleaned aquariums made of plastic, magnetic scraper is easy to scratch their walls. However, there are magnetic scrapers specifically for plastic glasses, but they rarely occur in the sale. If the scraper is not at all, then you can either use a new clean sponge for dishes, or a razor blade (be careful, the blade can scratch the glass, even ordinary, not to mention organic) or use an old nylon stocking. Please note, all methods of removing algae with a sponge or a stocking require great physical effort, as it does not look, but the magnetic scraper is preferable.

But the scraper can clean just the glass, but what about the leaves of plants or rocks, driftwood and other decorative elements? There may come to the aid of fish feed on algae. The most popular algae – Ancistrus. Even a Ancistrus able to shine clean the aquarium for 50 liters, more importantly keep it on a starvation diet. This is connected with the fact that if you get a lot of Ancistrus feed, then they stop nibbling algae from glass, preferring to watch “manna from heaven” at the trough. I think this one can understand – why do all day puff on the glass scraping thin plenochkoy algae. If the food and so drops you right on the head? It is also very nice to clean the tank of algae – especially guppies and mollienezii. Try not to feed them a couple of days and they all instantly algal overgrowth, leading aquarium in the sparkling look! There are other fish in the aquarium contained specifically to clean the glass, but I will tell about them another time.

But on the snails in this important matter should not be relied. They often give birth to this very purpose, but in fact they eat algae and a little uneven, leaving just the glass of the intricate patterns in algae tracks.

The next step after cleaning the glass will be cleaning the filter. In the most common internal filters filter material consists of special water-resistant foam. The filter is switched off, carefully pulled out (some filters be disconnected without turning off the filter compartment), and rushes to the bathroom or the kitchen for washing. Usually, simply rinse the sponge under running warm water, then put back into the filter and return it to the aquarium. But about once every two months is useful to completely disassemble the filter mechanism, remove it from the rotor and remove him from the accumulated mucus and dirt, and clean the nozzle of the filter. Very easy to use for that old toothbrush unnecessary.

As you can see, there is nothing difficult to clean the aquarium there. Glass is easy to clean, you can even throw this honorable duty on the fish. However the bathroom to wash the filter in the fish until you know how, but this minute operation is unlikely to cause someone trouble. Thus, we can safely go to the most important – the substitution of water in the tank. Water is the habitat of fish and plants, and regular replacement of its very beneficial effect on the state aquarium inhabitants. With fresh water in the tank are made necessary for the development of plants doses of trace elements, and an old water tank is removed from the waste products of the fish. It remains only to explain exactly how it’s done.

Probably all seen as drivers with a hose is drained from the fuel tank? It’s very simple – the hose pushes the tank (in this case to the aquarium), the other end is taken into the mouth and the liquid (water or gasoline) to gently sucked. After a little practice, it turns out quite easily and happily murmuring water rushes from the tank to the outstretched pot. Of course, the bucket must be below the water level in the tank, otherwise it will not work. You can do another thing – the whole tube is heated in the tank, completely filled with water, then gently clamped ends of the hose, one end is transferred to the bucket and there released. Even if the hose will be a small amount of air bubbles – this is not scary. They will make the water flow. Also on sale are all sorts of devices to facilitate this process – hose with a rubber bulb (it is built overlooking the water valve in one direction only), or even special electrical traps on batteries. But for simplicity and low cost of conventional hose it’s best! One note, do not try to take the hose is too large diameter for a thorough cleaning of the aquarium would be the best pipe diameter 10-15mm, max. Thicker tubes are useful only when the substitution of large quantities of water immediately, using them to clean the inconvenient – until the end of the hose a handful of dirt on the bottom, the bucket is already time to be filled.

So, water is poured into the bucket, what do you do next? Again, nothing complicated – you bring the other end deep into the tank (it is better to stick his hand into the water, otherwise the hose is too difficult to send in the right places) and start to drive them in places where dirt or remains of half-eaten food. Just a word of caution – the current of water gives a very strong and can begin to suck sand from the bottom, and careless or too curious fish may also tighten. To loosen a bit during the end of the hose often wear a funnel. This greatly simplifies the process of cleaning, and the sand remains in the tank, but not all migrate into the bucket.

In pet stores often sell special tools – a kind worn by the cylinder hose to clean the aquarium. This arrangement is called a siphon, and although it’s all just kind of in the hopper, but it gives the aquarist another great opportunity – siphon primer. Let me explain what this means. The fact that the soil is constantly fail micro particles are not eaten by fish feed and feces that have accumulated there in large numbers may begin to rot. Of course, part of the accumulated in the soil is used as fertilizer plants, but all is good in moderation! The fact that participating in the process of putrefaction bacteria produce hydrogen sulfide, which is a poisonous gas in the tank, and it is not the place. In such cases, aquarists say that the soil “sour” is defined by it’s very easy – just cranking out his hand and sniffed the ground had risen to the surface of bubbles. If the bubble does not exist or they do not smell, it’s all right. But if they smell like rotten eggs – hence an urgent need to siphon the ground.

The process itself soil is different from the normal water changes, just use the hose only planted on his end of the cylinder is found not only on the ground and stuck to it. Stuck, raised a storm of sand and pebbles are pulled over, and with them, and all the accumulated dirt in the sand. But the heavy stones, they rise up to half of the cylinder and falls back down, and the lighter particles of dirt carries a current of water. Once the water in the cylinder becomes transparent – it stuck in the neighboring area of ??the soil. And so on until the bucket is full. At first the water flow will be obtained is too large, such as brushed and nothing at all, a piece in a couple of palm size, and the bucket is already full. But with practice efficiency will increase, and there is no need to wait long to sand absolutely everything in it. Just a few seconds without having to wait until the first portion of the elongated leaves and ground haze through the hose into the bucket is already possible to stick a siphon into the adjacent area. You can remember on which part you left off and continue to siphon it into next week. It will be preferable to just replace the tank too much water.

Speaking of the substitution. The aquarium will NEVER have to change all the water! Those who have to clean the tank drag the whole thing a bath, the fish are planted in a pot and wash it up to boiling of ground – comes completely wrong. The norm in the aquarium water changes from 10 to 25% of the total in a week. Suppose you have an aquarium of 100 liters. Then it means that you can just pour out of him and a half or two buckets of water (the usual bucket has a capacity of 10-12 liters), and pour fresh water to the desired level. That’s it!. The second error – they say the water for substitution must necessarily be a distance not less than one day. Not at all! Years of experience and hundreds of thousands of experienced hobbyists shows that the water can without any problem pouring straight from the tap. And the cold water tank at a temperature of 25 degrees, even the Gulf of two buckets of cold water from ordinary tap water you get a drop in temperature on the strength of 1 degree. And then turned on the heater (all modern heaters have built-in thermostat) quickly align the temperature to be necessary. You may ask – why must the cold, because you can mix it with hot water to the desired temperature? But this, precisely, do not be! The fact that the heating plant and the boiler formed to fight the scum inside the hot pipes, using various chemical additives, which can be deadly to your pets. In this aquarists use only cold water, in extreme cases can pour tea into a bucket of hot water to raise the temperature. And it makes sense to protect the water only at very strong chlorination of the water when a strong smell of chlorine. By the way, “whitish” water, which is often mistaken for a strong chlorine, nothing to do with chlorine does not, it is only whipped high pressure air microbubbles. They instantly evaporate from the dishes, enough to give the water stand for a couple of minutes. But to remove the chlorine from the water need much more time, not less than one day. But I repeat once again – to defend the water makes sense only if clearly expressed a strong smell of chlorine in all other cases it can be safely substitutes just like that. If you are still afraid to pour into the aquarium water does not defend, and defend it and have no place in what, in pet stores sell many kinds of air conditioners for the aquarium water. They not only remove chlorine to it, but also bind and neutralize a variety of harmful heavy metals and nitrogen compounds.

It’s all about what I wanted to tell at this time. As you can see in the regular care of the aquarium there is nothing complicated, just enough to half an hour once a week to fish will be healthy ( without fish antibiotics) and plants feel good, and the tank remains clean and beautiful. Agree – this is not so much, for half an hour a week?

Miss a Dog Alone?

What a joy it was to the family when we bought a puppy. We have long been preparing for this event. It is very difficult, it turned out, we select the appropriate breed by nature, because each has its own inherent qualities. With someone needs a lot of walking with someone engaged in the performance of training, someone must take on the hunting or combing several times a day.

Having defined the breed, we picked up a nursery, where, in our opinion, were the best representatives. We had to wait 3 months.
During this time, we bought a couple of things: a rug, bowls for food and water, all sorts of colorful toys, tweeters, vitamins and mineral supplements on the advice of breeders and much more.

We had a lot of information about what to feed the puppy, when to vaccinate, how to care for his hair, how to monitor the change of teeth and so on. But we did not know what to do, that our pet is pleased us with his behavior.

As time passed, he grew up, and our house has become a “battlefield.” The floor is broken claws and in some places dug up the concrete, wallpaper on the bottom of the wall is now missing scratched doors. When we come home from work, we met a lot of foul-smelling, and almost a flood in the kitchen. This is despite the fact that we honestly walk with the dog in the morning and evening for almost an hour.

All these details would be for us to tolerate, if not for the neighbors who complain about the constant howling and barking in our absence. Now we face a choice, or somehow fix everything that creates our dog, or we simply evicted.

During that time, until the dog with us we are so accustomed to it, love, and give it to the “good hands” is not acceptable, let alone put to sleep, like insisting bellicose neighbor.
This is one of the stories of those dog owners who are faced with the problem of fear of loneliness. Many believe that this behavior is caused by just the presence of boredom, which is trying to get rid of the dog described above.

But this opinion, we believe is absolutely wrong. If you try to understand what boredom is just an association with drowsiness, yawning and sleeping. Thus boredom dog for us is just an extremely desirable. During the absence of the hosts they are just sleeping. This is normal behavior alone.

What is the cause of abnormal behavior, which we have called above the fear of loneliness?

Usually – it’s dominance. What is it?

Any dog, regardless of its size and species, has characteristic of the behavior of the wolf. A dog that lives in the family believes it to his flock. In the pack there is a hierarchy, where a representative of other more important, in other words, he – leader of the pack. The higher the position of the animal in the hierarchy, the more he has the rights and benefits.

Usually, the leader sets the rules and demands of their performance (dominant). He always comes first, forcing the others to follow. The leader eats first. It can take food from other pack members. He is the initiator of all actions of the pack, whether it be playing or hunting. He sleeps on the hills. As is well acquainted with all the animated film about Mowgli, the leader Akella is always lying on a high rock.

Anyone who has faced the problem of destructive dog behavior at home during the absence of the hosts, allowed her to behave this way. Our experience shows that none of these people just had no idea that their dog feels the principal in relation to them. Such behavior is inherent in these dogs from birth, it determines how viable they will flock in the wild. The desire to lead the pack and become a leader is in each dog.

Therefore, in order to reduce the dominance of a dog, she cannot afford to behave like a leader. You need to behave themselves, that is:

– Always enter and exit the first in any door. That is, before the door, gate or gate, you have to stop, go first and then allow the dog to do it. The leader should always be first.
– Also, you must first climb up and down the stairs. The dog, thus, must go side by side or slightly behind.
– Completely ignore the dog when it requested a meal when you eat. During your meal, it can not be with you. After you eat, take a bowl in one hand and show her. In the other hand, take any piece of human food (cookies, candy, fruit or vegetables) and eat it in her eyes. Then give her a bowl. This way you will show your dog that you eat first, and defraud her of her food, as does this leader of the pack.
– Ignore the dog if it sticks to you with a desire to play or wants you to caress her. Tell her strictly “Fu” or “not” and do not pay attention to it. If you want to own it to play or cuddle it, Call it 1-2 a minute, praise her, play and cuddle. The leader is the initiator of all actions of the pack.
– Be sure to decline to lie on beds, chairs, etc. At higher elevations is the leader and the dog tries to push you, “his office”

If you are faced with the fact that the dog finds a home, you must also begin to engage with it in training of a novice with an experienced instructor individually or on a training club in the group with other dogs.
The problem of dominance can not be corrected to include the radio or TV during the absence of the hosts. Nothing happens if you leave a toy with a record of your voice. The dog will demand your return as you its slave, and she is, roughly speaking, your boss. Often, even the presence in the room other animals or people she does not think the members of his flock, cannot prevent the dog’s excitement, her howling, barking, jumping on the door, etc. And if you close it in one of the rooms, donating it to the pogrom that can protect your neighbors from noise published?

To correct the fear of loneliness must do the following exercise.

Close the dog in the room or on the balcony and wait for one, without going to it.
If she whines, scratches or shows any other concern, it should be ignored.

After 3 minutes, if it has not ceased to behave this way, go into the room, but as if you do not have a dog. Let her out of the room should not be. Walk around the room without even looking at her. If the dog jumps, not repel it, leave the room.
Wait a bit. If the dog stopped, it is necessary to enter and praise her, give a treat, and leave again. If you still whines, then go back, go, completely ignoring. Again leave until then the dog stops whining. It usually takes between 5 and repeat 12 times.

As soon as the stop whining, come and praise. Each time, increase the time that she was sitting quietly. That is, the first time, when the dog stops whining, just come in and praise, for the second time in 10-15 seconds, then after a minute, etc.

It is necessary that the first time you perform this exercise; it is not whined at least 3-4 times in a row. This may take 2-3 hours. If the dog begins to whine and did not stop, come in and ignore.

This exercise is designed to reduce the pleasure of a dog howling and anxiety, as we cease to praise her for it. On the contrary, we praise her for her calm demeanor. Eventually, the dog realizes that solitude is fine, but when the owner comes home compliments and wishes for her that she is calm and does not notice her if she “hooligans”. For dogs, what they fail to notice and ignore the far more vexing any other punishment (shouting, swearing, beating, etc.).

In addition to dominance, fear, loneliness can be caused by the fact that the dog is not accustomed to a stay at home. This happens when people take a puppy with small children and always sits with him at home, never leaving him alone. Then circumstances change, and the dog is no one to stay. Such abrupt changes cannot afford to move many of the dogs, regardless of their breed.

When you buy a puppy, it must be left alone. Then you can leave the apartment a short time, gradually increasing the period of absence.

As a result, we believe that any breed of dog can safely tolerate the absence of hosts, if, after purchase the puppy, leave them alone and they are engaged in the above-described methods. That is, there are no excess breeds of dogs, which is completely absent fear of loneliness. Experience shows that such a seemingly bedroom of breed of dogs, an English bulldog, Yorkshire terrier, toy terrier, Labrador may have a fear of loneliness. Rather, it is the result of improper handling of a dog-and-error in the education, not racial characteristic.

Dogs who do not fear loneliness, you can leave with friends and relatives. They are easy to move it. In other words, they are simply bored to sleep.

It is believed that there are breeds of dogs, house breaking content that they mind. This is misleading. There are breeds of dogs are active. They usually have a lot of walking. Therefore, many feel that these dogs can not be kept in the apartment. We think that if you provide dog walking sufficient to meet its activity, the breed does not matter. Psyche can spoil rather than flats content, and mishandling the dog and the mistakes in the upbringing.