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10/13/2021    Robert D. Teitelbaum, DPM

Recommendations for Nail Drill with Vacuum (Peter A. Ternus, DPM)

Peter Ternus' response to the belittling post from
Estelle Albright concerning the "use of
woodworking tools" in the treatment of fungus
nails was excellent. I would like to concentrate
on the "be the physician that you are" aspect of
that post. I prescribe Terbenafine for
onychomycosis in the following manner: I ask the
patient if 1) he/she has ever had any form of
hepatitis, or jaundice, 2) takes more than two
pharmaceuticals everyday for any condition, 3) has
ever been told by a physician that there were
unusual liver enzyme tests on a routine blood
work-up. If they pass this test, I prescribe the
drug. I also like to prescribe it if the patient
is 35 years old or younger. I have never had a
problem with it, not to say that it could not
happen.

What is strange is that much of the public somehow
knows that Lamisil is a dangerous drug because of
this liver toxicity. Just today, I had a new 67
year old, very healthy female patient who takes no
medicines for any condition--but she doesn't want
to take Lamisil "because it's dangerous". She
said "I researched it". I performed my usual
magic with various sizes and grits of sanding
discs and rendered her nails about 75% better than
when she arrived. I also dispensed Clear Nails
Pro (I also have Formula Three and Clarus,
depending on my whim). I was encouraged when she
said that if this plan did not work out, she would
consider a prescription for Lamisil. "Being the
physician you are" is not easy in these times.

Some notes about the "tools" I use: I have
serious micromotor drills, made in Germany,
relatively heavy because of the decent magnets
inside, and rated at 35,000 rpm, with a
transformer that produces at least 25 and
preferably 32 volts. These are not easy to come by
and when they are inspected in the photographs of
all sides of the transformer it is hard to
visualize the voltage of the unit, but it can be
done.

I graduated in 1976, so you can guess my age.
Twice daily I'm asked by patients "You're not
going to retire now are you?" I say no, and they
day "Thank God". Sometimes I pull numbers out of
the air, but I'm good at it, and I feel that 25%
of this profession needs to figure out why these
patients are saying "Thank God".

Robert D. Teitelbaum, DPM, Naples, FL

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