There are two types of diseases that affect the nail. One is medical disease like diabetes , kidney disease or lung disease, that show up differently. And then there are surgical diseases of the nail such as cancer and benign tumors. Also common are benign bony overgrowths that can be taken care of by, for example, a podiatrist or an orthopedic surgeon. Just taking out the jutting spur of bone resolves the problem with the abnormal nail.
A full nail in a young person grows around three months and in an older person about six months. That means six months of nail is essentially one's complete medical history- in an entire nail. You can see the progression of the disease and also if it's growing out and not getting worse, it's not going to be a cancer.
But thanks to modern medical imaging machines, there is a way to find out the problem before waiting three to six months. We use a regular ultrasound machine to show the thickness of the nail, which is important since antifungal creams will not penetrate through a nail plate deeper than 1.8 mm. Then we use the blood flow to see if there are any abnormal vessel flows in the nail and what it means. For example, when you have psoriasis, which is a common dermatologic problem, it not only thickens the nail but it's associated with arthritis in about one third of people and increased risk of cardiovascular disease. So one third of people with fingernail psoriasis with perceptible blood vessels on Doppler imaging will develop arthritis and other ailments which is something we're currently learning more about.
There are over 29 different abnormalities of the nail that can predict problems or tell you what the history of the body has been in terms of health. For example, clubbing of the nails is very common in pulmonary disease like chronic obstructive disease, the smoking lung. In anemia, the nail gets a spoon shape. Generally arthritis causes light vertical deformities while melanoma will produces vertical dark stripes.
To distinguish if it was an injury or if it's actually a health issue, we can first ask for a history of injury but you could immediately examine the Doppler blood flow, which will show you what's going on. When you have pitting of the nails and psoriasis, the next step is to put on the Doppler to see how many abnormal blood vessels are present. A lot more blood vessels means the psoriasis will be more aggressive and it'll mean the chances of getting arthritis are much higher.
People should look at their nails more often for any indication of something that's worse going on in the body. They may be able to catch it early enough by looking at their nails. Digital diagnostics can predict what's going on and also the likely outcome.
We are all familiar with Fungus - but parathyroid adenomas are benign tumors behind the thyroid in what's called the parathyroid gland. It's a very common problem with brittle nails and weak bones because the abnormal calcium metabolism from the parathyroid gland reduces the bone growth and it causes all sorts of other problems. The excess hormone from the parathyroid destroys the nail, makes brittle skin, makes hair fall out, and the point of bringing this up is that 99% of patients with a parathyroid adenoma are misdiagnosed for the first year or two.
They are most often misdiagnosed as a psychiatric disease. They're told it's in your head; because it's hair falling out or you're getting older. It's missed a lot and so many symptoms are associated with it that you go to a GI doctor for it and they don't look at the parathyroid. You go to the cosmetic person for your hair and they don't check that. But we can check it with the Doppler machine.
This article is based on the transcript of the interview by Carol Alt's A Healthy You (Fox News)- with guest Dr. Robert Bard.
Robert L. Bard, MD, PC, DABR, FASLMS is internationally known and recognized as a leader in the field of 21st Century 3-D ULTRASONOGRAPHIC VOLUMETRIC DOPPLER IMAGING. Dr. Bard specializes in advanced 3-D sonography to detect cancers in numerous organs including the breast, prostate, skin, thyroid, melanoma and other areas. Dr. Bard’s images are used to accurately guide biopsies, target therapy and provide focused follow-up after treatment.
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