Be an informed patient by avioding common mistakes and misperceptions about a visit for you first nail evaluation.
Preparing for an Appoinment
KNOW BEFORE YOU GO:
Know when to schedule an appointment. Many patients don’t schedule an appointment until they feel pain or discomfort, or until the nail itself is cosmetically unappealing. However, many of the most serious issues, including cancer, have no painful or bothersome symptoms. These are the very conditions that concern a doctor the most. Instead of waiting for the nail to hurt, schedule an appointment when you see any change in the nail, such as a discoloration or a line. Remember, nails should not be changing in appearance. Even if you go for a visit and the doctor ultimately says nothing is wrong, it’s good to have the nail evaluated and someone tell you that everything is OK.
Know who to call for the appointment. The rule of thumb is that if a nail condition is isolated to the feet, choose a podiatrist. If a nail problem develops on the fingernails, call a dermatologist. Start with your primary care doctor. He may have a strong background in nail care or he may be able to help you coordinate care. Do some research before you schedule an appointment with a dermatologist, as areas of specialty within dermatology vary widely. Try to find one who has experience with nails. You may be able to find someone local by researching online or even by calling a university, depending on where you live.
IN THE OFFICE:
The doctor may find that nothing is wrong with the nail, and you can leave with the assurance that all is well. However, he may determine that a culture of the nail is needed. If so, he will use a swab kit to take a sample and test for bacteria and fungus. Finally, the doctor may need to biopsy the nail. (See “The Biopsy Appointment” for more on what to expect.)
BEFORE YOU ARRIVE AT THE OFFICE:
Remove polish from all of your nails. Patients are often allotted only 15 minutes, and you don’t want to spend five of those minutes removing your polish, which can be done at home. Take the polish off of all 10 nails, not just the nail that is giving you trouble. The reason the doctor needs to see all 10 nails is because he needs to document “normal.” Even though only one nail may be affected, the doctor needs to see all 10 nails before he can sign off on them.
Ditto for any nail enhancements — take them off. Think of the appointment as you would a facial. All makeup would need to be removed for a facial. In the same way, any nail product, including any residual product from glue, needs to be removed.
Be prepared to answer questions. Doctors will want to know about the history of the nail. When did the problem start — has it been days, weeks, months, or years? Does the condition of the nail fluctuate, that is, does it seem to get better or worse, or does it remain stable? Does it become inflamed or itchy? Does a discoloration on the nail appear to grow or to lessen? It is very helpful when a patient has considered these questions before an appointment so she can answer them fully during the evaluation.
Be prepared to wait. Often people have the misconception that they will receive a complete evaluation from one visit to the doctor, but many times a diagnosis will take multiple office visits: the initial 15-minute visit plus at least one follow-up visit. Some conditions can be evaluated and diagnosed right in the office, of course, but many times a doctor will need to biopsy the nail, wait for lab results, and schedule a second appointment to discuss the findings. Avoid disappointment by understanding you may not have answers on the initial visit.