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Nail Fungus or Onychomycosis refers to a fungal infection of the nail, nail bed, or nail plate. The  procedure for treating nail fungus may require one to five treatment (persistent cases may take more).
The laser wavelength is absorbed though the nail, and kills the underlying fungus by exposing it to heat and light. Although considered safe for most people, laser treatment is contraindicated in pregnancy, in disorders that cause loss of sensation in extremities (neuropathy), sunburned skin, scleroderma, those people with previous skin cancers on the feet or hands, people who have used accutane in the last 12 months, anyone who has had a major skin disease or anyone who has experienced problems with previous laser treatments. Nail polish MUST be removed prior to treatment, but may be reapplied immediately following laser treatment. No, laser nail treatment is considered an aesthetic treatment and therefore health insurance does not cover this procedure.
If the bugs are hard to kill, the battle rages on for a while and because the area is very tiny, the pressure becomes high and it becomes extremely painful.
There are lots of technical descriptions of root canal treatment on the internet (for a list of websites, scroll to the bottom of this page).
Since so many people seem to recoil in horror when they hear some friend or other is having (or has had) a root canal treatment on their tooth, I thought I’d share my own root canal experiences. I had cold sensitivity develop in a molar tooth which had previously been filled twice by different dentists, in the 1970s and in the 2000s. The first appointment involved opening the tooth up, taking out the nerve to stop the toothache, cleaning out, finding and disinfecting all the canals; and placing a medicated temporary dressing. After waiting a while longer, he then tested gently with the explorer and asked if anything felt sharp. You may also be given the option of using a ‘soft bite block’ if you find it comfortable and easier on your jaw joint but it is not compulsory. Next up was probably the most nerve-wracking moment for a modern RCT virgin… but I already trusted this guy from previous treatment, so I generously gave the benefit of the doubt, when he informed me that he was now going to open up the tooth (by drilling into it with the handpiece in case you were still wondering!). Before doing so, he reiterated that it was not supposed to hurt at all and if I felt anything untoward, I must signal at once by raising my arm. For the next 90 minutes he stayed totally calm and apparently happily absorbed in intricately working on my tooth. Because I was wearing safety goggles with quite a thick rim and because I was tipped back, I couldn’t really see very much at all of what was going on, unless I made a real effort to watch.
Some of the time, it was noisy with the canals being explored using longish L-shaped pointed attachments to the handpiece. But most of the time, it was quiet with the assistant handing various tiny files to the dentist (he kept asking for particular numbers) which he then either attached to the root canal system handpiece or more often than not used by hand to carefully navigate the canals, gently rotating them to feel his way to the apex. Some people (and I now agree despite having initially been sceptical) have reported that it is a more relaxing experience than a conventional filling, despite taking longer. At various stages (probably no more than 3 times per appointment) a digital x-ray was taken to confirm progress.
At frequent intervals I glimpsed a syringe-like nozzle (no needle) which was simply used to squirt the bleach down the canals. The time had passed surprisingly quickly and I felt a bit euphoric knowing that the toothache had finally been banished. I went away having been assured that the second appointment would be very similar with more shaping and a substance called gutta percha being placed as the final filling material, topped off with composite and that it would eventually be wise to get the tooth crowned, once we were sure the treatment had been a success. At the second appointment, despite the nerve having already been removed, I was automatically numbed up. The main difference was that the ‘plugger’ was used a lot more, since this was the stage where the gutta percha cones (pieces) were gently pushed down to the bottom of the canals – the goal was to have no gaps. Towards the end, I could sense some heat coming off something inserted in my tooth – I think this was probably serving to melt the gutta percha?
I was advised to take nurofen for the jaw-joint as soon as I got home and I did so but I felt no need to take a second dose. I subsequently had an old root canal (done in the early 1990s by a general dentist) re-treated at an endodontist. I was told the only real downside of treatment were if a file broke off in the lower portion of a tooth root, it might be hard or impossible to retrieve. I was also aware of the endodontist measuring the canals from time to time – he wore a special ring on his finger with a ruler scale on it. You may have heard people say that root canal treatment is very painful, or you may have had such an experience yourself.
Done competently by someone who cares for the quality of the patient experience, root canal treatment should be a pain-free procedure with just local anaesthetic.
Bear in mind that advanced numbing techniques for ‘hot’ (infected) teeth may be more likely to be known by specialist endodontists. It is your right to be numbed for the second appointment even though the nerve is likely already gone. Pain upon biting down and dull pain is common and a recognised side effect of root treatment.
It should be manageable with maybe a little bit of an anti-inflammatory drug like ibuprofen or similar. Ask if they will wear loupes (to obtain some kind of magnification benefit over the naked eye). Endodontists have special equipment (such as a really good microscope – see photo) and advanced training in root canal treatment. This is not to say that general dentists cannot competently carry out root canal treatment.
Here comes the question we’ve all been waiting for: under which circumstances would a dentist choose an endodontist? Tell me About… Root Canal Treatment (British Dental Health Foundation) Easy-to-read information in a question and answer format. Patient Information (British Endodontic Society) Common questions and answers about root canal treatment. The Dental Anxiety Network is Dental Fear Central's sister website for dental professionals and dental students.
Membership of the International Society of Dental Anxiety Management (ISDAM) is now available to healthcare professionals who have a registered qualification and a regulatory body. Definition: Canine Atopic dermatitis is a genetically predisposed inflammatory and pruritic allergic skin disease with characteristic clinical features.
Diagnosis: The diagnosis of CAD begins with attaining a good history and recognizing the primary clinical signs, performing a dermatologic examination to characterize lesions and distribution, creating a differential list to work from, and performing some basic diagnostic tests to refine the differential list. History and Clinical signs: The most important aspect of evaluating a pruritic dog is obtaining a comprehensive history. Dogs with CAD are pruritic (itchy), and pruritus is usually the initial and most salient feature of the presenting problem. Parasites: The dermatologist will treat and control for all ectoparasites that are pruritic, and rule out demodecosis if there are compatible lesions. Diagnostic tests: The tests performed on patients presented for pruritus will be dependent upon the history and lesions identified during a complete dermatology examination.
Differential list: The differential list will be dependent on all information gathered after history is obtained, the exam is performed and results of some basic diagnostic tests are available.
Components of therapy used in the management of CAD: As there is no one cause or trigger for CAD, there is not one treatment approach that will satisfy the needs of all patients. In order to prescribe ASIT, allergens to which a dog is hypersensitive need to be identified through allergy testing.
When considering which type of test (intradermal or serum) should be performed, consider that neither modality is perfect.  Both intradermal and serum testing have their place in dermatology practice.
Intradermal allergy testing (IDT) detects the presence of tissue-bound IgE and the ability of the antibody to bind allergen and cause mast cell degranulation to form an erythematous wheal. In clinical practice, I expect that 70% of well characterized dogs with CAD will have a 50% reduction in pruritus. The Wastewater Treatment has a complete back-up power generator system in case of a loss of power. The proper operation and maintenance of the sewage plant facility must be performed and supervised by certified operators with the manager holding at least a Class III certificate issued by the State of West Virginia.

During after hours, holidays, and weekends, please call 304-348-8111 for sewer problem assistance. Bring a separate new, clean pair of socks to change into after your laser nail treatment appointment.
Print and complete New Patient Laser Nail Treatment Medical History Form and read Office Policies Form prior to visit or arrive 15 minutes prior to appointment to complete.
Once the fungus is destroyed in both the nail and nail bed, the tissue is revitalized to encourage new, clear, and healthy nail growth. A mild warming sensation or rubber band snapping sensation may be experienced during the laser nail treatment. This includes treatment, consultation with physician and instructions for post treatment care to prevent future re-infection.
Full regrowth of the big toenail may take 12 to 18 months Smaller toenails may take 9 to 12 months.
At Oregon Natural Medicine we are committed to providing this service at a reasonable cost to our patients.
Studies have shown that even when only one nail appears infected most nails have some fungal growth present. Most Heath Savings Accounts (HSAs) or Flexible Spending Accounts (FSA) may be used for this treatment. Any passing bacteria find this a source of nourishment and proceed to munch on the dead nerve and have lots of babies ?? . X-rays, cold air-spray, the probe and tooth sleuth (a plastic thing you bite down on each cusp individually to see if the tooth is cracked) all proved inconclusive. Well it took a few days but eventually I realised the weird pressure build-up sensations and spontaneous twinges in my tooth probably fell into the category of ‘getting worse’.
He explained that the nerve was in the process of dying and the best thing to do would be a root canal treatment to save my tooth. It also had the benefit for me whilst lying there that I could ‘swallow’ easily when I needed to and that I was in no danger of accidentally gulping down the treatment debris including old filling material and the bleach later used to disinfect the canals. I was offered a soft bite block but it didn’t fit well so I shook my head and he immediately removed it and I did just fine without. Some anxious patients might prefer more of a ‘running commentary’ (just ask if you do) but I was happy to let him give most attention to the tooth. This means if you don’t want to see, you can just relax and close your eyes, or as per my preference, alternate between staring at the boring ceiling and peeking at the proceedings.
Occasionally I was asked to adjust my head position slightly… just like at the hairdresser’s.
The difference is I think, the extensive above-mentioned periods of quiet concentrated work. My jaw felt a bit stiff understandably and the local lasted ages longer before it wore off which was fine by me. This was done very thinly in lots of separate layers and the usual curing light was used multiple times. Teeth that have had root canal treatment are more brittle and a crown provides extra support and strength to the tooth, especially if it is a back tooth. However this was quickly followed up by an assurance that it had been years since he had had such an incident so I probably shouldn’t lose any sleep over this remote possibility. The most common reason for painful root treatment is that the dentist finds it difficult to make your tooth numb because of an acute abscess.
If profound anaesthesia cannot be achieved for whatever reason, it is time to rethink all options including sedation. They are also more likely to always have in stock the stronger and longer-lasting local anaesthetic types which may be ideally suited to root canal treatments. It makes work on the surrounding tissue much more comfortable regardless and gives longer-lasting relief from any discomfort afterwards.
This is especially true for back teeth – these are usually much more difficult than front teeth. It will not only protect you from tasting nasty substances – it will make it much more likely that the treatment works! Especially for more complex root canal treatments and for re-treatments where a root canal has failed, their chances of success are higher (in some cases much, much higher) than those of general dentists. There are many who do enjoy it and who have done additional training in endodontic therapy since qualifying. Because endodontists have had to invest in additional equipment and training, they tend to charge more than a general dentist. Ask your dentist about this option, or make a consultation appointment with an endodontist if you are in any doubt. Join to receive free newsletters and keep up-to-date with what is happening in the world of dental anxiety management! Members will receive newsletters, have access to a discussion and support forum, and have access to live and online training courses.
If itch precedes the appearance of any rash, I am almost certain I am dealing with allergic skin disease (if parasites are already controlled for) as the primary problem.
They will review clinical signs, lesions and treatment for demodecosis and sarcoptic mange.
Avoidance: Complete avoidance of offending allergens is typically not practical and is difficult to sustain.
Control of Secondary Infections: Antimicrobial therapy is used for active infections and may have a purpose in prophylactic therapy in some situations.
Immunotherapy: Immunotherapy, is the practice of administering increasing quantities of an allergen extract to an allergic subject to ameliorate symptoms associated with subsequent exposure to the causative allergen. Essentially, the pet is “desensitized” to specific allergens to which it has demonstrated hypersensitivity, and immune tolerance is induced. None of the commercially available serum tests has been proven to be more accurate than another in reviewed publications.
Antihistamines: The appeal of antihistamines is that they are nonsteroidal and relatively safe, yet they are not approved by the FDA for the use in CAD. Essential Fatty acids: Fatty acids improve the skin and hair coat and enhance the epidermal barrier.
Topicals:  Shampoos, conditioners, sprays, rinses, and leave-on conditioners are available and may remove allergens from the skin surface. Corticosteroids: Corticosteroids are anti-inflammatory agents used in 65-80% of atopic dogs. Cyclosporine: There is strong evidence for the use of oral cyclosporine in the management of CAD. It is well tolerated by most dogs for long term therapy.  The most common side effects reported include gingival hyperplasia, papillomatosis, vomiting, diarrhea, bacterial infections. It was designed to treat a dry weather flow of 2,230,000 gallons per day with a wet weather capacity of 5,600,000 gallons of flow per day.
The plant is monitored and tested with oversight by the State and Federal governments through the National Pollutant Discharge Elimination System and Water Pollution Control Permit regulations. The Dunbar Wastewater Treatment Plant is controlled by four operators and overseen by the General Manager. No discomfort has been reported following treatment and there is no down time following treatment. Often moderate to severe cases, where the nail has changed color and thickened, may require multiple treatments. We charge $399 for the treatment of one foot or hand and $499 for the treatment of both feet or hands. Anyway, to sort this mess out, the dentist has two choices, extract the tooth and remove the bugs that way or do a root treatment.
If appropriate they may quickly clean the tooth in question before gently anchoring a special clamp with a frame around your tooth and then stretching a piece of rubber over the frame which they then adjust, usually so that only the tooth to be treated is visible in the dentist’s work area. The only real difference between him and my dentist was the use of the endodontic microscope at the first appointment and a general air of confidence as to likely success. In regions where fleas are not a problem, CAD is the most common canine allergic skin disease.

It is characterized by chronicity, pruritus, typical lesion distribution and a familial history.
Food trials are also essential prior to confirming CAD in a dog with non-seasonal pruritus.
Empiric treatment for sarcoptic mange can be considered a diagnostic test, and is always appropriate to prescribe.
If a dog has seasonal disease, flea allergy dermatitis and insect bite hypersensitivity are differentials. No evidence that avoidance alone is 100% successful, but certain avoidance measures can be helpful and make the pet feel better. Shampoos, sprays, and topically applied medications with barrier enhancement properties are available. Allergen specific immunotherapy (ASIT) should be recommended in all cases of CAD, unless clinical signs are very mild and controlled easily with nonsteroidal therapy. A positive allergy test indicates the presence of excessive amounts of IgE, and a positive result may be associated with clinical allergy or subclinical hypersensitivity. There are several tests available and each uses a slightly different method to detect the serum IgE levels.
They are used in 30-50% of CAD patients, but only 10-15% of dogs have a sustained reduction in pruritus. In addition, restoration or enhancement of the compromised epidermal barrier may reduce allergen penetration, microbe penetration, and irritant exposure to the skin immune system.
They are appealing because of their rapid time to effect, but side effects occur with chronic usage.
The plant operation begins as the wastewater enters the plant at a self-cleaning bar screen with compactor combined with a grit chamber with grit washer to remove trash. Like any other treatment, laser works very well for some people and is not as effective with others.
So it’s best to agree up-front (even with an experienced dentist) that if any unforeseen problems are encountered, you would like to be referred on to an endodontist. The involved allergens are dust mites, pollens, mold spores, danders, insects, and other miscellaneous allergens. Ultimately, the diagnosis of CAD is made based upon signalment, typical history, presentation of compatible clinical signs, and the systematic exclusion of all other pruritic skin diseases.
Empiric therapy for sarcoptic mange is often indicated early in the plan for pruritic dogs. If pruritus is non-seasonal, without exacerbations, cutaneous adverse food reaction, sarcoptic mange, and contact hypersensitivity are differentials.
The dermatologist will ensure that there is adequate control of secondary infections as they proceed through diagnostic steps and design the management plan.
I recommend ASIT be incorporated early in the course of disease as a core component of the management plan.
The significance of a positive result can only be ascertained once all other causes for the dermatitis have been ruled out. In the tests, the specificity of the IgE detection reagent is critically important to minimize false positives. Both omega 3 and omega 6 have been recommended; omega 3 for pruritus and omega 6 for the restoration of the cutaneous barrier. The wastewater will enter three vertical loop reactor tanks, nine disc aerators, and three supplemental blowers to begin the cleaning process.
This starts an abscess, the body reacts to the invasion by pouring in defensive cells, which kill most of the bugs in the area, but still can’t get to the source of the problem, which is in the tooth. Several breeds are over represented including the Boston terrier, Boxer, Cairn terrier, West Highland White terrier, Scottish Terrier, Fox terrier, Yorkshire terrier, Chinese shar-pei, Cocker spaniel, English bulldog, English and Irish setter, Labrador and Golden retrievers, Pug, and German Shepherd, and miniature schnauzer.
It may appear seasonally in the early years, but develops into a non-seasonal disease in most dogs. Also, we prescribe very strict flea control for all pets in a household with an atopic dog. Alopecia in CAD is the result of pruritic behaviors of licking, biting, scratching, chewing, rubbing, etc. Secondary infections with bacteria and yeast should always be treated and controlled, as they are an important contributor to the severity of pruritus in many cases. In addition to possible barrier enhancement, one benefit of topical therapy is mechanical removal of allergens from skin and hair coat.
A 50% reduction in pruritus should be considered favorable, as it may permit elimination of corticosteroids or other adjunctive medications. Also, a positive result should be for an allergen present in high quantities at the time of year that the individual patient has exacerbations of skin disease. Negative IDT reactivity was demonstrated in 20% of dogs in a population of dogs with clinical signs of atopy. The main mechanism is to block H1 receptors in the skin and prevent or reduce the release of histamine. All the other elements of our management plans are aimed at eliminating the need for corticosteroids all together. Metabolism is inhibited in cases of liver dysfunction or when drugs that suppress the cytochrome p450 system are given. Reevaluation after 4 -8 weeks while the dog is still receiving treatment is essential to establish a response to therapy.
Successful management requires a basic understanding of the complexity of the disease, an accurate diagnosis, control of secondary problems, institution of a comprehensive management plan, and frequent reassessment. Fleas are a trigger factor for CAD, and flea bite hypersensitivity is often present in combination with CAD. Light coated breeds may also have salivary staining at body sites that are licked and chewed.
To avoid pollens, avoid outdoor environment when pollen counts are high, keep grass cut short, bathe dog frequently, use air conditioners and change filters often, and wipe the pet down with a wet cloth after outdoor activity.
This likely decreases quantity of allergen in contact with skin and likely decreases the amount of percutaneous exposure of allergen through the defective cutaneous barrier.
Thus, the dermatologist will review patient history prior to selection of allergens for immunotherapy. A small percentage of dogs with CAD never have positive allergy tests, and this is considered to be equivalent to human intrinsic atopic dermatitis. They modulate leukotriene and prostaglandin synthesis, restore the normal composition of lipids in the skin, and modulate lymphocyte functions. If corticosteroids are part of the plan initially or for flares, they are used strategically and carefully.
The water on the top of the clarifiers travels to the chlorination tanks for disinfections, then to the de-chlorination tanks before it is discharged into the Kanawha River.
Some dogs will not have any lesions, and pruritus is the only problem.  The distribution of lesions and pruritus in CAD is characteristic. They decrease pruritus and inflammation by altering the potency and quantity of mediators formed during inflammation.
Many failures are attributed to the owner decreasing the frequency of administered when there has not yet been a response to therapy. The solids are transferred into a sludge thickener before the final process in the aerobic digester. Common sources include cold water marine oil, evening primrose, borage, and black currant oil. Monitoring for side effects must be scheduled and planned.  At least q 6 months serum biochemistry, CBC, and urine culture are recommended in my practice. When restarting, I have the owner administer the capsule with a small amount of food until it is tolerated for a few days. The sludge from the digester is transferred to the belt press, a post line stabilization facility, where additional liquids are removed.

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