Skin & Nail Changes (The Return of Side Eff@cks)

0:00

welcome to episode 37 of the cancer pod. In this episode, we're talking about treatment related skin and nail changes and the integrative approaches we use to address them. So stick around.

Tina 0:11

I'm Dr Tina Kaczor and as Leah likes to say I'm the science-y one

Leah 0:15

and I'm Dr Leah Sherman and on the cancer inside

Tina 0:18

And we're two naturopathic doctors who practice integrative cancer care

Leah 0:22

But we're not your doctors

Tina 0:25

This is for education entertainment and informational purposes only

Leah 0:29

do not apply any of this information without first speaking to your doctor

Tina 0:33

The views and opinions expressed on this podcast by the hosts and their guests are solely their own

Leah 0:39

Welcome to the cancer pod

Introduction

0:57

Hi, Tina. Hi Leia. We're gonna talk about skin and nails. Yeah. So the various skin side effects from treatments and also. Yeah. What happens with the nails? Mm-hmm weird stuff happens with nails. Yeah. Weird stuff can definitely happen and does happen.

Radiation induced skin changes (dermatitis)

1:17

We can just start right off. I think just starting with radiation is probably the, the big one, right? I mean, it's not the big one. They're all big ones, but radiation side effects, super common. And again, like a lot of these side effects, if they. get really bad. It can delay treatment. Mm-hmm and so that's what we don't want. Yeah. I think radiation's a good place to start, cuz it's the most straightforward too, because radiation will affect the skin. External beam radiation. We should be clear, will affect the skin wherever it is, hitting the skin to get through into the interior spaces of the body.

Leah 1:54

And it can also affect the skin where the radiation leaves the body. And so I've had patients. Say lung cancer who have radiation on their chests. And then on the exit point, they also get a little rash mm-hmm so that's kind of an interesting little, little tidbit. There is whatever you're applying to the skin on the front at the exit point. Apply something there too. And the radiation oncologist does their best to minimize this effect. So they will often have the radiation beams coming at different angles, whether it's from the side or from the front or at an angle, or there's no guesswork involved in a radiation plan. So there's physicists involved. There's the radiation oncologist that you meet with this is not left to any guesswork or to chance, and some machines even take into account your breathing pattern. So they'll. Where the beam is going, according where you are in your breath. So the precision with which that is planned can certainly inform you as to where on your skin you're gonna be exposed and you can just talk to the radiation oncologist and that person will know exactly where you're gonna be likely to have. What's called radiation dermatitis. So that's where, that's where we're starting. Um, let's just take a quick musical break and come right back. All right. So radiation dermatitis, I think where. Start as integrative naturopathic providers is with prevention

Preventing skin damage from radiation

Leah 3:28

mm-hmm So coming up with a regimen for patients to where they are protecting and healing their skin, coming up with a skincare regimen, a skincare routine that is done. Sometimes even before radiation starts all the way for a period of time after radiation ends, because radiation side effects continue to happen. The effect of radiation continues to happen even after treatment stops. So continuing with that skin regimen is really important. Yeah. So while you may not be able to escape it a hundred percent, if we think of. Akin to a sunburn where you kind of have a Reding of the skin when you first get a sunburn or you can go all the way to blistering and breakage of the skin. What we wanna do is just keep it from becoming blistered or having cracks in it. a classic example, be like under the armpit, you know, and your armpit, if you're getting radiation to the upper breast, for example, the armpit might be part of that because that's where the lymph chain goes. what you wanna do is keep it as dry as possible. Um, but without drying out the skin and you wanna keep it clean and just know that the folds of your skin, whether it's, you know, fat tissue or under the arm, or wherever we're talking about is more vulnerable because of the moisture to. cracking of the skin or damage. Yeah, the word that's used when describing the radiation skin effects, when they start to get bad is desquamation, which is just kind of like the outer layers peeling off and there's wet desquamation, and then there's dry desquamation. So this is something that if it gets really bad, there can be treatment delays. Uh, we've had patients sent to wound care to help manage the side effects. So. What what's your approach to, to prevention for a patient? Getting radiation?

Tina 5:16

I'll give you my ideal approach and then we can back off from there, cuz ideally I have people put

Herbal combination for skin

Tina 5:23

together a little combination in a spray bottle. I'll have them do Alovera gel and it's food grade. It's sterile. You have to open the bottle. Don't go using your own. You want this to be a sterile source? There is some risk of infection when you have radiation dermatitis. So I'll have, 'em do 50% of Alovera gel or juice. And then I have to make a little tea of calendula, like a good amount of CULA, and I'm not very precise about the measurements, but if I had to say, I would say a quarter cup of calendula pedals, order cup of Calla pets in. Six ounces of water, steeped like a strong tea. And then I have them put a little Rosemary if they happen to have some, I live in the Northwest and a lot of Rosemary here grows kind of like a weed. And I know that's true for a lot of the country. So you just take a little snip of your Rosemary. You put that in the water. Now the water has been boiled, so it's been sterilized and you put the calendula and the Rosemary Inn and you. Let it sit. You add that to the Allo and you spray that on daily. The Rosemary is there to keep it from going bad, but I still prefer people put it in the refrigerator. So the Rosemary's role is to preserve it a little bit. Um, and I have them make a fresh batch after a couple weeks. Because I don't want it to have any even possibility of something, not sterile in there, but, and that's why it's in a spray bottle too, so you're not touching it. So that's, that's my ideal. I like the spray bottle idea. I've recommended that for patients who have received like radiation places where, cause I. I recommend doing compresses colo compresses with Coate, T mm-hmm um, but the spray bottle's nice. If you're getting, say like vaginal radiation or, you know, somewhere where a compress might not necessarily work mm-hmm so. I do like the spray bottle.

Sitz Baths with Calendula

Tina 7:10

Yeah. I have also had people create, sits baths. Mm-hmm you know, if you're getting radiation to the pelvis, it's the most relieving thing. Like I've had people tell me that that brought them more relief from the pain of radiation than the medication What do you use? I, because I used to recommend that and I think just the farther that people have gotten from just doing sits baths in general, the harder it is to find a little tub or something that can, can hold a, a tush. Yeah. Everyone has kind of their own way of doing it. Some people like to put a tub in their bathtub and sit, you know, in there so that they can, you know, if they do splash and stuff, it doesn't matter. I've had. I don't know, I haven't seen this product, but apparently Amazon sells something that you can put on the seat of your toilet that makes life easy. So you just have to put that over the seat of your toilet and you can put your bum in that way. um, Any type of tub that you can put that you can put your bottom in and keep your feet out would work. Yeah. And just making sure you're safe if you're climbing a Nu out of a tub. Yeah. I kinda like the idea, the one that can be, you know, your toilet is actually just acting as a, somewhere to put it. you're not using it as a toilet. You're using it as just a, something you can. Put the little tub in that you're used to sitting on and you're gonna sit a little lower in that, of course. So that's probably the safer one. Oh, and you know what, I'm gonna go ahead and ask someone who has used that and I'll put it in the show notes. I'll put a link to it. Oh, okay. To the, to the Amazon, to the sits bath. Yeah. To Amazon, I suppose. Yeah. okay. Nice. Nice. Um,

Calendula cream and aquafor

Tina 8:41

yeah, cuz I do like to recommend using a callate compress or spray and then I have that area, you know, padded dry and then putting on top of that, like a combination of a calendula cream. There's remedy cream that has Deeth in it. It's nice. It's super Evolent. And so mixing that with the colo cream and applying that, and then on top of that, is where I would have somebody use Aqua for. So that kind of just seals in that moisture. it's more just holding in those creams. And then the big thing is just making sure that before you get radiation, you're not applying anything to your skin. I know some places say four hours, between putting something on your skin and getting radiation. And I just think it's safe cuz you don't wanna scrub that area. You really wanna be gentle. Um, wherever you're getting radiation, I keep gesturing to my breast, which never received radiation, but for some reason it's just what I'm doing but so yeah, just kind of having, like I said, like a regimen

9:42

I've even recommended, using a calendula goats milk soap

Tina 9:46

yeah. Calendula is probably the gest and the nicest plant to use it's anti-inflammatory whether it's a tea, a compress summon, some soap when you're doing routine care. Yeah. Callous is the go-to plant. I like the goat milk because it is like very mildly with the lactic acid. It's mildly exfoliating mm-hmm yeah, because it's goats milk. It also contains caprylic acid, which has an antifungal action. Little bonus. Yeah. Oh, and the calendula, I can think of three sources that we can mention for calendula STARWEST botanicals sells it in large amounts. Ola pedals don't weigh much. So if you get eight ounces or 12 ounces or 60 ounces, you're gonna get a pretty good size bag. Yeah. Don't go for five pounds. No, you're gonna be like selling it.

Where to buy bulk herbs

Tina 10:32

You're gonna give it away to people. So there's star west, as I mentioned, there's frontier and then there's mountain rose herbs, and all of them sell this in bulk. Yeah. And it's pretty affordable. Mm-hmm because it is sold by weight and it's a flower it's dried for flower pets. Exactly.

Cautionary tale... watch ingredients

Tina 10:47

Um, You know, this, this reminds me of a, our cancer center would be giving out a cream when. Women were getting radiation for breast cancer. And my patients would bring the cream in. And what was fascinating to me was that it was a huge dose of vitamin E in the cream. First of all, which I, I wouldn't do a huge dose of vitamin E during treatment afterwards. And after you wait a week after radiation, I would consider it, but I wouldn't. During treatment, that's me being very conservative. And the other piece was they had parabens. They had fragrances and chemicals in there to preserve it that were estrogen. And I always thought that was a little unusual. So I actually sent the evidence over to the radiation oncology team over there. And, um, you know, the nice thing is they listened because they don't wanna do their patients any harm. And. they ended up changing that. And some of them even sent them my way to, to get the spray, cuz at the time I was actually making the spray for people in my office. So that was an, just an interesting aside of like, you'd still have to be your own advocate. I mean, we like to think that the idea of estrogens in the environment is something that everyone is looking out for, but that's one of those times that, um, they would've been putting it right on the very area where you don't wanna be putting it. Soula pretty much in almost any form. I wouldn't recommend. Calendula ointment mm-hmm it has that sort of Vaseline consistency. So it probably takes a little bit more scrubbing to get it off mm-hmm and then, um, gel don't use COIA gel because it has alcohol. So that would be very dry and stingy, right?

Warning: Oil based anything directly on skin...

Tina 12:29

Yeah, that reminds me, you know, my personal observation has been that when people have sometimes despite my recommendations used. Oil based anything. It doesn't matter if it's Vaseline or if it's bees, wax and olive oil. My observation has been radiation dermatitis, which basically looks like a sunburn or worse first degree or second degree sunburn. It's worsened by the use of anything that has an oil based to it. That's been my observation personally, even though studies have refuted that and that there's no. Quote, unquote evidence that oil based products are supposed to worsen it. And I say that because there was one in particular that was supposed to be like a CBD. And SAVs are generally olive oil and bees wax or some other base mm-hmm that's similar natural ingredients. Um, I wouldn't recommend it. it's doing what mineral oil or would we use baby oil back in the seventies, baby oil shrimp, some butter on it. Yeah. put a butter on a burn. That's just it. I mean, there is, I don't care what the evidence says. I, my observation was the opposite that only had honestly, and truly, um, only so many patients. I mean, not a lot of patients have gone on to second degree burns and blisters and like actual, severe burns in my practice. so those people that did were more likely to be those kind of going off the map and using those kind of products, that ares type things. Well, what's interesting is Aqua four is very much, that was that consistency of petroleum jelly, and that's kind of what is recommended. Mm. Maybe that's explains why the evidence didn't show it. Yeah. So I think that's that, information's interesting because yeah, Aquafor is pretty standard as to what's used during radiation, but that's why I like it on top of all of those other more healing lotions, because it's used as an inclusive, it's like holding in the moisture. It's it's kind of protecting it. Mm-hmm So that, that's how I recommend using the Aquafor.

Emu oil?

Tina 14:28

oh, I've had patients who kind of go off on their own and they've used, um, emo oil before mm-hmm and they claim it, it works. So I have no idea what or how one gets oil from an emo, if it is actually emo oil. Um, but yeah, I've had patients use some pretty interesting oil. I mean, ultimately if you shower and you're able to not scrub the radiation site, mm-hmm there, maybe there isn't harm in that. You just don't want any oils on your skin prior to radiation. I completely agree with that. That's like basting a Turkey. Yeah. Yeah. It's like the same reason. I don't know, have you ever been out in the sun and for whatever reason, you know, for me, I might be grilling or something and I get oil in my hands and if I touch my leg or my arm, I tan pretty readily and I'll be like, what's with the blotch of darkness right there. And I'll realize it was oil. I'm in the sun. And I put a little blot of oil on my arm or my leg. It will tan up significantly more than what's around it. So it's kind of the same idea. That's never happened to me. Oh, you don't tan easily. is that why I can't easily? I just don't like, I think our grill are always in this shade. Oh yeah. You're probably just, I don't splash hot oil on myself. Wait a minute. I'm not even doing the grilling. What am I talking about? That's sitting back on the lounge chair. I know I'm a slack guy. Exactly. Okay.

Radiation recall

Tina 15:50

So let's move from radiation dermatitis to something that's really interesting that may happen to some people. Um, and that is radiation recall. Yeah. So someone may have received radiation a period of time prior, and then they get systemic treatment. Maybe it was a taxine, maybe it was doc Ruben or Jim citabine and the area that had been previously irradiated and healed. Suddenly that redness comes back. It's clearly the radiation field too. I mean, you can see the line of the radiation field and when people have radiation recall and you're like, it's kind of a wild effect. That the body react can react that way. Cause there's no radiation happening. It's just the chemo, right? It's just your body remembering. That's why it's called radiation recall. It's your body remembering that there was radiation and for some reason, certain drugs can trigger to come back. So yeah, that's a, that's kind of a little fascinating, mm-hmm occurrence that can happen and you can treat that topically, just like we mentioned things for radiation dermatitis, you can still treat that the same way topically.

EGFR-inhibitor drug rash (acneform)

Tina 16:54

So then moving on from radiation, um, There are these rashes, there are certain drugs, E GFR inhibitors is what they're known as, then those. Trigger a rash. And it looks a lot like acne mm-hmm and they're kind of like these different phases in the rash where it goes from just like, like a redness to PLO pu lesions, which looks like acne with a little head, do not pick it, do not do not. Um, and then that kind of crusts over, and then there's just kind of like this general redness or like we call 'em Ang. Tasia, which is like spider veiny kind of redness that happens. Mm-hmm mm-hmm so, yeah, the monoclonal antibodies cetuximab is the big one, but there are other maps as well. And then. The tyrosine kinase inhibitors, and those are the nibs. So like erlotinib, those are the ones that can result in this rash. Yeah. And those are like, you mentioned that that EEG F R inhibitors, they're targeting that. Particular receptor on the cells. And so that's what, that's a lot of colorectal cancer and lung cancer and several other cancers, breasts, head and neck, and, um, pancreatic, I think are the

Treatments for acneform rash

Tina 18:12

big ones. Yeah. So the standard of care for that treatment typically an oral antibiotic and some steroid cream. Mm-hmm I, I, I go for COA this is gonna be a really, uh, like a, a, a promotion for COA this episode. Um, but that, yeah, I, I kind. Encourage, Callia not doing anything harsh, not using products with alcohol, don't use your skin toner or anything like that. Don't use anything that you would use on acne, because it's not the same thing. It's not, um, it's not caused by a bacteria the way that acne can have the bacteria related to it. Um, it doesn't become infected unless those pests are opened and you. That's the way that they become more infecti mm-hmm Yeah. And that can happen anywhere, so it can happen on the arms. It can happen on your back. It can be anywhere it's, it's gonna be both sides of the body though. It's not gonna happen on one side and not the other, usually. So I came

Plant medicines for acneform rash

Tina 19:08

across one study, Using a specific plant that grows kind of the Mediterranean region, I guess it's a traditional plant in Turkey. Um, Pachia Terra Benes is its Latin name. I don't know it's common name. I looked on Wikipedia. That was no help. um, thanks Wikipedia for nothing, nothing. Um, so they used a soap with this plant in it, it seemed to be effective to reverse some of the symptoms of the. Acneform rash that happens with this whole E GFR inhibitor class of drugs. So I thought that was interesting, but other plants that we use traditionally just for skin health are things like. Plantain lavender, lavender, borage. Um, what else we might use topically. We do use, um, St. John's ward topically, but not internally. So this, this soap, is this something that's commercially available or is this just something that was made for a study? It was just using a study. I haven't seen a product on the market that's using. okay. So anything else for the rash? I mean, again, it's like not using anything drawing. Um, I think at one point I did recommend trying coconut oil because it does have antimicrobial properties, you know, just using a little bit. I think I recommended that for a while. I think coconut oil will act a lot differently than the other oils, cuz it won't sit on top coconut oil being a medium chain triglyceride that's a saturated fat is able to be transported through the dermis. So it doesn't just sit on top, like minimal oil. Okay. So

Hand-foot syndrome

Tina 20:46

the next big skin effect that, um, surprise, guess who experienced it? I did. Thank you. Um, hand foot syndrome. Oh, did you have hand foot syndrome too? Yeah. Thank you, Taxol. Wow. Yeah. And I actually had a go I remember Googling it to be like, does Taxol cause hand foot syndrome and yes, it does. It can. Absolutely. Mm-hmm so the one that we think of most with hand foot syndrome and that. a Reding of the palms and the souls of the feet. And it's painful if they feel SCED often. Um, and they can peel mm-hmm and one crazy side effect, which did not happen to me. is you can actually lose your fingerprints from. This phenomena, then, you know, that's a, I mean that's yeah. That, that could lead to a whole life of crime. I mean really, or being a spy. Yeah. There's a novel waiting to be written right there. Yeah, absolutely. So, um, yeah. So the big one that causes this rash is Cape citabine or Xeloda and kind of that whole like five F U family mm-hmm is, is known for that also, um, Ari micin or doc Rubin. and then it's other form docile. I've seen it more with docile. I don't think I've really seen it with, um, do Rubin and then taxter and Taxol, and then certain targeted therapies. and yeah, it could be pretty debilitating cuz it is very painful. It's it can be the souls of your feet and so anywhere where there's a lot of pressure or friction. So the bottoms of your feet, your hands it's, it's no fun. It's absolutely no fun. Yeah. Um, The big thing to prevent it or to reduce the risk I should say is avoiding heat. So really for anything that can cause a skin effect, just not doing super hot showers, being really careful with, um, if you're washing dishes, not to use hot water. And if you do wear gloves, when washing dishes make sure that they're lined. So if their rubber gloves don't have the rubber directly on your skin, cuz that's just gonna hold in the heat. So make sure they're those cotton lined gloves. Mm-hmm um, yeah, I mean, it's a good way to get outta doing dishes. that's the hard way of getting outta dishes. It, it is the hard way. but yeah, so I

Urea based cream

Tina 23:08

used a compounded cream that had. A and UIA. So UIA is what has been studied the most and UIA. Is typically found for these creams, like at a 10%, what you want is a 10%, um, Eure cream. And the studies were showing that you start using it even before the rash forms. Like just, just keep it on your hands, your feet. Okay. mm-hmm and I mean, that can be found over the counter in usin is a brand mm-hmm you know, like the there's certain like working hands, like there are all these different brands that people have used. Another product, are like creams with cides mm-hmm And so starting to. The creams, especially their UIA, even before the rash starts is important to use it as prevention, right. Or risk reduction. Right. And that's for the hand foot syndrome specifically. Mm-hmm mm-hmm,

Vitamin B6

Tina 24:08

Oh, and then there's always the studies with B6 vitamin B paridine as they call it. Yeah. So they use paridine, which is not the active form of B6, but that is what it was used in the studies. And it was generally what it was a high dose of it. 200 milligrams or 400 milligram, like really, really high doses. Mm-hmm and it's not something you wanna take forever after, because B6, if you take it indefinitely at that kind of dose. Probably give you a B6 toxicity over time. So once treatment is over and that's, those studies were done alongside five F U or Xeloda specifically, but once the treatment is over, you should stop that high dose for sure. And some people can be on those treatments for a really long time Xeloda, especially. Yeah. Yeah. So the B6 thing, I don't know, I mean, there there's studies, but it's not something that you just take will and ni. I agree. Yeah. I wonder if there's ever a topical B6 that's been used. I haven't seen anything, but we can look it up. Yeah. And I like, I'm a big fan. I don't, I, I should look it up too, but I'm a big fan of niacin topically, which is a form of niacin, um, just in general for skin. So that's something else that I would love to look up to see if that's been used for the rash, the E GFR inhibitor rash. S stuff to think about.

Skin issues on immune directed agents (checkpoint inhibitors)

Tina 25:24

Hmm. Yeah. The other class of drugs that we should touch on is the, uh, immune checkpoint inhibitors. That's that Opdivo nivolumab UVO, um, checkpoint inhibitor, drugs are being used. And this is the kind of the big, latest and greatest in the immune therapies out there. A lot of them have. Various skin manifestations. Um, so one of the things that we think about with that whole checkpoint inhibitor class of drugs is that they can cause autoimmune reactions. So sometimes if you're already prone to something like psoriasis or you're prone to scleroderma, or you're, it'll kind of be the last. Think of it as a straw that tips the scale into that direction and it can set off an actual autoimmune response. Um, so that's probably the biggest thing to be on the lookout for there's some pretty severe reactions that are less common than an autoimmune derived skin reaction. It can look like anything from blisters to eczema, but this is very real, um, and usually is treated with topical agents as far as I know. And, and as any side effects from this drug class, there's also a certain level of steroids that are used because what they do is they'll suppress the immune function. Um, so there'll be a controlled suppression to, to minimize symptoms if they get outta hand. So I just wanna mention that that's also possible that entire class of drugs. Yeah. I don't know if I've seen. But I haven't. Yeah. Yeah. I know you have, I don't think it's common. I think again, I think it's the underlying autoimmunity that sometimes is UN mass. I see that much more commonly. I mean, that's not uncommon to have some autoimmune condition arise when you're on these drugs. Um, But skin manifestations, I have not seen as commonly at all, but

Hyperpigmentation

Tina 27:09

they do happen. One thing that can happen, um, which is another really interesting side effect is that hyper pigmentation. And it's more noticeable in people with darker complexions and it can be like palms, just turning black. Like people always say like my hands just constantly look dirty. There can also be hyper pigmentation underneath the nails. Mm-hmm and those are temporary. Mostly, um, sometimes the nails, it takes longer for that to go away. But, um, typically after that particular treatment is stopped, it does resolve. Um, but it doesn't necessarily have to be on the hands. It could be elsewhere too. It's just getting these. Spots of, of darker pigment, um, five F U especially is I say guilty of that as is, um, Taxateer and then do Rubin ency. Cyclophosphamide can also cause that, yeah, I think I've seen it most with Taxateer. I mean, if I had to think about it and my patients in the past, and then nails get very tender, um, and sometimes people take to, you know, putting tape on them. They don't wanna touch anything and they don't want the nail. The nail bed raises up eventually having the nail fall off. That's the nail section, Tina. Oh, sorry. We're heading to the nail section. We're still in skin. Oh, right, right, right. That's well, we should segue over. So we still have a couple more things we wanna cover. Um, photosensitivity. That is huge. Making sure. You're always using like a sun block wearing sun protective clothing, wearing a big hat because there are treatments that will make you more prone to burning. So yeah, photo sensitivity. And then you'll have to go and use call because you have a burn. So we're bringing it full circle. Yeah. and then the last thing is just, and it is a really big, um, thing that I hear

Dry skin

Tina 29:00

from patients is just dry skin. Just everything feels dry. Mm-hmm again, using moisturizers that do not contain perfumes or alcohol mm-hmm is, is important. Um, I am a fan of using either like sweet almond oil or Sesame oil, or even coconut oil, just directly on the skin being careful that you're not. Slip in the shower or in the bathroom. Um, so don't slather it on just using a little bit of that. That's probably just more that VEIC um, way of addressing it. The creams with cides. Yeah. Not using hot water, like I said before, mm-hmm staying hydrated. Yeah. So I think that's that pretty much covers it. Skin. Yeah, I think, I mean, there are definitely are some other things that happen that are a little less common, but, um, let's take a break and then we'll come back to nails. We'll talk about all the fun stuff that happens with nails. All right. Stay tuned.

29:54

biotin is commonly found in nail and hair formulas. Did you know that it can interfere with some common lab tests, always hold biotin supplements at least three days before a lab draw and let your provider know what supplements you're taking.

Why do we have nails?

Tina 30:11

Okay. Tina, why do we even have nails? I mean, it's basically a protection. Yeah. So I actually looked it up cuz I was like, why do we have nails? So it does add strength. If you think about it, it adds strength to your fingertips and to your toes. And so if you were to touch something like your little fingertip, won't go backwards. You, you mm-hmm um, and then, you know, just like dropping things on and whatnot. So yeah. So it is protection. you know, I'm thinking about that protection thing and you're right. I sliced my thumb at I what? Go on. I sliced my thumb at Aing. Yeah. Is that why? Oh, I'm like what, what, oh yeah, no, I sliced it at home Depot on basically aluminum that was sticking out on a display. Oh, oh no. Okay. Ew. Hopefully no one's having dinner right now. And ultimately, I, I remember it just being. One going to the bathroom, but I also thought to myself, if my nail wasn't there, Ugh. Right. I mean, it is kind of an amazing piece of protection. Yeah. And it's that keratin, right. It's super, super strong. It's what hoofs are made out of. Yeah. Keratin is why rhinos have horns and horses have Hoves and so do other animals. I don't wanna leave anyone out. You don't wanna offend any animals who might be listening. I don't offend any animals by leaving them out. So just hoof animals. That's all keratin Um, and

Nail changes & what they mean

Tina 31:30

the cool thing about fingernails is that looking at them, you can actually tell if someone has nutritional deficiencies by just looking at nails and there are charts out there. We could post one in the show notes. It's such a cool thing. So just yesterday, funny, you should say that I just bought a book, an old medical book that is all about nails, how they look and when they're rich. Vertically or horizontally or nail diagnosis, nail diagnosis. What we used to use before we had high tech imaging devices and laboratory values to go by. I mean, nails were a big tell for what was going on internally. So we still use it a lot. We used nail diagnosis a lot. Yeah. And going through treatments. Those treatments themselves can change your nails. And so whether it's the nutritional deficiencies where you get the ridges or, um, there are those, uh, horizontal ridges that happen. Like you can see like, oh, at this point is where I started chemo. Yes. Or whatever systemic therapy that I'm receiving. And there's like a definite horizontal line across the nails. So nails are really, they're really, really cool. those, those horizontal lines are called Bose lines and Bo spelled as in boyfriend, B E a U, but well, it could be girlfriend too. They could be a Bo who's your Bo now is be always used with boyfriends. I don't know. I think so. I just thought it was like your, like the person you're enamored with who's your Bo don't know these things. Are you Googling it, you know, on the, on the wrong person to ask? I don't know. Okay. Then I, I don't know these things, but you can sometimes see when people are going through treatment and this will. You know, we just went through COVID. If you had a severe case of COVID, you can see a horizontal line, it, it basically just symbolizes or shows in your nail bed. it'll indent horizontal because your body's under so much stress at that time, physical stress, whether it's a severe infection or it's chemotherapy or starvation, it could be a lot of things. Right. You'll get this horizontal line. It's pretty. Pretty cool to see because you just know what the body is kind of retracting, you know, so it's kind of interesting the nail retracts, cuz I think of it that way, like conserving energy. So I had those surprise surprise. Um, and yeah, it was so interesting to watch it grow out. You know, it's like get outta my body. It took forever. My nails take forever to grow. But um, other things that can happen is the nails become very brittle and dry. They can split not only. Horizontally, but vertically mm-hmm we mentioned color changes. People develop nail fungus more easily, and then nail loss, nail loss is the big thing. Well, they're all big things, but nail loss is, you know, especially losing toenails. Yeah. That happen to me too. Yeah. And there. you lost nails? Uh, my big toes. Yeah. So my oncologist recommended that I use cryotherapy. So we did not have those fancy boots or gloves. Um, I just used biohazard bags that were filled with ice, that the nurses brought and I would alternate, you know, I wouldn't keep them on the whole time, but when I was getting taxi tear, I would kind of rotate them off and on. Not only for neuropathy, but also to preserve my nails and it worked, um, I did get discoloration of my fingernails, but, and then I lost my, both of my, my big toenails. Hmm. Was it painful? oh, well, you know, yeah. It didn't hurt. It didn't hurt. Well, you know, what's crazy is that as the, cuz they, you don't lose 'em right away. I mean the other toenail starts to come in and push it out. the new toenail and then you just have this thick area. And so shoes would hurt because I had a double thick toenail. Mm-hmm so, um, again, using good hygiene, don't go get manicures. Don't have people cutting your cuticles. Just being really gentle is important. There are different medications that you can take. If you do get nail fungus, mm-hmm there are oral medications. Those can be really hard on the liver, but there are topical prescription medications that can be painted on your nails. And those take time.

Guiness Toe soak?

Tina 35:40

I had one patient whose brother told them to soak their toes in Guinness. My goodness. And you can look on the Google. It's actually a thing you can use. Guinness, which seems like kind of an expensive beer to me. I don't know how much it costs, but it just seems like a fancy beer. Like it's not like it's PBR, it's Guinness. And apparently that works for nail fungus. All right. I got my doubts about that, but I know vinegar works and it's cheaper. I'm gonna, I'm gonna find something about Guinness and I'm gonna post it. I don't think it's this clinical trial, but well, and it must have something super special in it because when you think about it, you know, Guinness is made by a yeast and there's yeast nutrient in it. And we're talking about a toenail fungus. So kind of. We're staying in the fungi family here or fungi kingdom. So anyways, it seems odd that something that can grow one fungus is going to kill another. Well, maybe it's a, maybe it's a battle of the fungus. Maybe it is. Maybe it is maybe the, they duke it out in your nails. Sy SEIA puts out something that kills other fungus, cuz it's. Dominant, but it's something special in Guinness. Well, anyways, it's a lot cheaper by white, white distilled vinegar. by the gallon and you dilute it. Yeah, it's diluted 50, 50. Oh, I heard, uh, four to one or like four water one. Oh. Cause I saw this in a, I saw this in a continuing ed. Oh four to one and they recommended one part vinegar to four parts water. Yeah. So, you know, experiment. So at least four to one all the way up to one to one. Depends on how flush you are with It's how flush you are with, uh, your vinegar supply and how much you can stand the smell of it, because you know, it's pretty pungent. That's V that's yeah. It's vinegar. Um, so

Cryotherapy

Tina 37:23

again, with how I mentioned the cryotherapy, that is a recommendation for, you know, that you will find in kind of conventional. Resources and with the caution, not to use it with hematologic malignancies, such as leukemia and lymphoma, um, because of the risk of circulating. Cancer cells. And by putting that ice on that area, you are reducing potentially any treatment that can

Vinegar soak for toenail fungus

Tina 37:50

go to that area. So mm-hmm, I have to circle back I know how I prescribe it, but what did you hear in the lecture? How did they suggest you prescribe it for a patient? Like the duration and frequency. I don't remember. It was, it was an online CE thing. I was trying to get all my, my credits for my license at the end of the year. So I'm sure I have the notes somewhere. It was really interesting because it, there were a bunch of dermatologists talking about, oh, I should have referred to it actually for the rest of this episode, but I just remembered it with the with the vinegar when you mentioned it. But yeah, they kind of covered like the things and I thought the vinegar was really cool because it was. something that's accessible to people. Yeah. Yeah. And I. I have had people cuz toil, fungus tend to happen more frequently and I will have people get a Rubbermaid, you know, or some kind of bin. You can put your toes in at the very least comfortably. Um, do the mix, whether it's four to one or one to one of vinegar and water into the bin. And then after like have a shower at night instead of the morning and then have nice clean feet, go into the bedroom. Soak your toes. In this stuff, you don't have to soak your whole foot. You can just soak your toes. Um, but you can reuse it if you use, if you, you don't have to make it fresh every single day, you can reuse it, put the cap on it and then reuse it for that week and then freshen it up again. Cuz you know. If you feel like it's getting dirty or you're not able to shower before each time you wanna freshen up faster, but I'm saying that because you have to do it every single day for months and months and months and months, while you wait for the nails to grow out, it works. But it takes some dedication when you're doing a topical. Treatment of any kind actually, because you're waiting for the nail to keep continually grow out. That's how it is with the, um, what's it called? Penlac I think is the prescription, you know, you have to keep reapplying it and then at the end of a week you like remove it with alcohol. And then you start all over. Um, I, I was using that and I, I, I stopped after a while cause I wanted to paint my nails for something. And then mm-hmm, I'm not gonna take off that nail Polish. I mean, it just like, it just got, it, got to be a lot, but maybe the vinegar, maybe I'll try vinegar. Yes, that happened to me too. I didn't say it I thought it though. I know I'm like a poster child for side effects. Um, so things that people try biotin,

Biotin

Tina 40:07

which I don't really know what the evidence is. I did try biotin for my nails and they got really, really hard and brittle from taking it. Mm-hmm so I stopped using it cuz they were actually cracking because of the biotin. Hmm. Um, Because that was the only thing I was doing different. Mm-hmm are you hear people will

Gelatin

Tina 40:24

do collagen or even, um, Like Knox gelatin, which I think I've mentioned previously, that was a big nail thing that my mom did back in the seventies. Mm-hmm um, you know, I mean, I'm not really a big fan of, I think we talked about that. Yeah. Yeah. We probably talked about it in our collagen episode. Um, yeah, I don't think we talked about nail health in the collagen episode though. We just talked more skin skin. Yeah. But yeah, people with people have formulas people. Companies have formulas that have collagen in them. what I used during treatment was something called hoof live, which was recommended by, I don't remember who recommended it actually. Um, I would go to this feed store where I would get stuff for my chickens and they sell this product and it, you buy it in huge tubs for your horses, or you could buy them in little tiny, containers. For your own nails and it has landline in it. Mm. And you apply it. I don't know if it was a couple times a day or a couple times a week. I don't even remember at this point, but, um, yeah. I mean, it's supposed to help with your nails. Hmm. It's good enough for a horses Huff. It's good enough for me. There's that for sure. um, when

Avoiding glyphosate (Round Up)

Tina 41:31

you said hohos, it reminded me, I recommend to patients that they avoid glyphosate, which is Roundup because there is some evidence to show that the compound in Roundup or glyphosate is, disruptive to connective tissue. Skin hair, nails Hoves of horses. um, so don't apply Roundup to your nails or hair during treatment. So a lot of people use Roundup in and around their house. To control weeds and it's, it's really commonly used. So I'll ask the people just avoid the use of that too. I mean, I, I ask people, avoid it anyways, but strange as it is, sometimes you have to motivate people with what they're concerned with now, with what you are concerned with. there's a lot of reasons to avoid Roundup and strange as it may be. Nail health might be the reason someone does it. as a clinician, I'm listening to the patient and trying to, you know, help them out in every way possible. But that's something that I have done before is like, oh yeah. Cause I'm thinking to myself, I'm thinking back to some conversation I probably already had with that person where they're using this stuff or they're landscapers or something and I'll be like, oh, and by the way, if this is your concern, you're undoing some

White vinegar in the garden

Tina 42:42

of. Good stuff we're doing by using that product. You know what you can use instead of Roundup? Hmm. White vinegar. Oh, for the plants. Yeah. for killing weeds. I used to buy one of those little pump things from like ACE hardware and I fill it with white vinegar. I used it straight. I think you're supposed to dilute it and mix some soap, dish soap in there too. I just, it was the desert. Yeah. I, I used it straight and I would pump it and spray it right on the weeds. Yes. And then pull 'em out. So white vinegar. It's a defoliant yeah, this, this episode's brought to you by white vinegar. Um, and then yeah, if you do it and it's sunny, like in the Arizona sun, that'll fry 'em right up. Those weeds will go away. Yes. Yep. Yeah. I have used it that way too, as a defoliant you could get 20. Vinegar now you can even get 30% just blast them what we buy. Yeah. We just blast them. Yeah. it does work better when it's nice and concentrated. Um, I think what we buy under the counter is a lot less than that. You know, like what you put in a kitchen, like distilled vinegar. Yeah. I get the big things from Costco and just pour it in. Yeah. And I think you're supposed to use soap cuz like a little bit of dish soap. Cause that helps it kind of stick to the leaves. Is that what the point is? Yeah, I think so. That's my assumption. Yeah, but if you drown 'em anyways, this has kind of gone off topic and we're, let's talk, let's do a whole, we do a whole episode on gardening tips and the 101 uses for white vinegar. so, um, I do have a song.

The unofficial theme song

Tina 44:15

I have a song for this episode. All right. So it's originally, this episode was just skin and we were gonna do hair and nails, and then we moved nails over. So now, um, the song is more related to skin. It's. I've got you under my skin by Frank Sinatra. I will post a video. I will post a link. It'll be on Spotify, blah, blah, blah. So we are punchy. We have done a lot of work today. Mm-hmm um, if you find any of this information helpful. Then, let us know. Again, we aren't your doctors, we're not prescribing anything. We're just talking and hopefully you're listening and share this with friends. Family loved ones, total strangers. I did. I met somebody and got into a conversation with someone and it came up that there was this podcast called the cancer pod because I mentioned it. So nice. You never know. You never know. You never. on that note, I'm Dr. Lea Sherman and I'm Dr. Tina Kaser and this is the cancer pod until next time ended already.