If you don’t know about the amazing Kate Bowler… you’re welcome! Her take on the “secret of life” (yup, for real) is one of the best I’ve ever heard. (Click on the image to hear it)
“Tiny plastic pellets called nurdles – each about the size of a lentil – are washing up on Texas beaches in alarming quantities. These pre-production plastics are the raw material used to make everyday items like bags and bottles. But when they spill during manufacturing or transport, they escape into the environment, becoming one of the most widespread sources of microplastic pollution.”
This is a scary situation I knew nothing about. These little pieces of plastic “act like tiny sponges, absorbing toxic chemicals such as pesticides and heavy metals”. So it’s not just that we take in microplastics by eating fish that have confused these objects with food, we also consume the poisons the nurdles have absorbed.
A reminder that forest bathing is wonderful (and so easy)
I spent some time yesterday in a park near my home and, while there, decided to try the Japanese practice of shinrin yoku, known in English as “forest bathing.” (Which is therapeutically known as sylvotherapy!)
It’s a practice that involves all five senses, one by one, intentionally…
Listening to sounds, birds, insects, wind in the leaves
Touching the ground, the trees, and the leaves.
Smelling flowers, plants, the dirt
Seeing plants, birds, animals, clouds..
Tasting by breathing through your mouth
If you work in a hospital or another building, a small green area or a single tree will suffice.
We have powerful tools on our digital phones, particularly in medicine. But the relationship with our phones is complicated…and not always beneficial.
The first time I ever came across the word alexithymia was in this New York Times opinion piece about digital phones by Steven Barrie-Anthony. As a physician, I love learning new clinical words with Greek roots – in this case “a” for not, “lexis” for words, and “thymos” which means “feeling” or “spiritedness”. Alexithymia (a word invented in 1970 by psychotherapists), is also known as “emotional blindness”, and means not being able to recognize your emotions.
Dr. Barrie-Anthony noted that the “vast majority” of his patients were experiencing an “alexithymic fog” due to the “gravitational pull” from their phones and social media, a condition that affected “the most important aspects of who they are, their relationships with others and how they move through the world.”
Do we really have agency when we get pulled in by the gravitational force of our phones? For our non-work related time, we pick the app…but then we fall into the dopamine feedback loop of whatever game we’re playing, or algorithms that are foundational to social media.
I think it matters more that I’ve realized, and not for the reasons I thought:
Being used by the tools of the digital world is different from using them as tools because it separates us from our authentic emotions.
“One constant I’ve found is how technology brings a kind of alexithymic fog — alexithymia being the condition of having difficulty identifying or being able to express one’s emotions. This isn’t universal, and the emotions we’re pushing away aren’t always the same. But it happens in a startlingly consistent way.”
To tackle the problems of technology we have to return to our emotional lives for their own sake, and not always leap to doing or changing or fixing. This is the only viable pathway if we are to remain in touch with our humanness and to preserve love, empathy, emotional and spiritual richness, and the capacity to create art and music that reflect our inner lives.
I have yet to experience awe in the digital world.
“When medieval Christians gathered in cathedrals, the soaring architecture and stained glass were designed to lift their thoughts toward the divine. The shared narrative included an image of the good life that directed one to love their neighbor as oneself. Today’s digital architectures are designed with a different purpose – to keep our attention firmly earthbound, focused on consuming content and generating data. The “infinite scroll” isn’t just a design feature; it’s a spiritual technology that trains us to value quantity over quality, novelty over depth, reaction over reflection.”
Burn-out is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions:
feelings of energy depletion or exhaustion;
increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and
It took a very ill 10 year old child with perforated appendicitis and Systemic Inflammatory Response Syndrome (SIRS) to make me think about this differently.
As I often do, after my initial visit to the Emergency Room and while waiting for the operating room to get ready, I pulled up UpToDate and PubMed to make sure there wasn’t anything new that might help me take care of this child. As I read, a light bulb went off…
“SIRS is considered a clinical syndrome that is a form of dysregulated inflammation. It was previously defined as two or more abnormalities in temperature, heart rate, respiration, or white blood cell count [29]. SIRS may occur in several conditions related, or not, to infection. Noninfectious conditions classically associated with SIRS include autoimmune disorders, pancreatitis, vasculitis, thromboembolism, burns, or surgery.”(UpToDate, Sepsis syndromes in adults: Epidemiology, definitions, clinical presentation, diagnosis, and prognosis, accessed 7/4/2024)
Which led to an important question….
1. What if burnout is more like SIRS?
If burnout were like SIRS, it could be caused by a variety of etiologies…
SIRS is most often caused by a serious infection. But it can also be caused by trauma (gunshot wounds, car accidents, burns), pancreatitis, burns, inhalation injuries, the “trauma” of major surgery of any kind, transfusion reactions…
What if the same were true for burnout?
What if there were multiple possibilities that could start the cascade from stress to distress?
…and should be understood as the end-stage presentation of a progressive process.
In the case of SIRS from untreated infection, patients who present with seemingly mild symptoms like fever and tachycardia can rapidly progress to sepsis to septic shock to organ failure, and even death.
What if thinking about burnout in the same way could help us understand the progression healers experience from distress to suffering to burnout?
2. The treatment would start with resuscitation (and rapid diagnosis).
Patients with SIRS are hospitalized and aggressively treated with oxygen, fluids, appropriate medications to stabilize blood pressure and antibiotics to treat possible infections. All of this takes place while appropriate exams are being done to find the source of the problem.
What if we approached burnout in a similar fashion? What if, when we first noticed the symptoms ,we provided appropriate “resuscitation” and started looking for specific etiologies?
3. The definitive treatment would be “source control”.
For a patient with SIRS, once we make a diagnosis, we seek to eliminate the source of the SIRS. For appendicitis, we take out the appendix. For pneumonia, we prescribe appropriate antibiotics, and use supplemental oxygen and chest PT as needed.
“Source control” for burnout would be no different. Specific treatments would depend on identifying the specific issue(s) that started the cascade of distress and suffering.
4. Full recovery would require supportive care.
Source control starts the process of healing, but healing is not something we do for or to a patient. In clinical medicine, we facilitate the patient’s ability to heal … and then we support them while they heal.
Burnout should be no different.
I mentioned the need for a good “differential diagnosis” in order to identify the source of SIRS
Which leads to the next important question.
What’s the differential diagnosis for the causes of this syndrome?
I’m sure there are others, but the major categories of insult and injury that I believe should be included in the differential diagnosis of healer distress and/or burnout include:
Failure to recover from injury (physical, emotional, and spiritual). For example, pronouncing a child dead in the ER and then having to run to clinic because you are now late and patients there are getting angry.
Moral distress, injury, and outrage. Moral injury occurs when we know the right thing to do, but can’t do it. For example, not being able to perform an important elective surgery or prescribe a needed medication because it is denied by the patient’s insurance.
Trivializing the sacred nature of healing. For example, the hours spent typing trivial information (for billing) into the EMR.
Secondary trauma from chronic exposure to suffering or specific traumatic events (like the death of a long-time patient or being sued)
The structural violence experienced by being marginalized at work and/or in society (racism, misogyny, homophobia, etc)
You’ll notice lack of self-care and insufficient resilience aren’t on this list.
I believe that insufficient self-care is most often a symptom and never the cause of burnout. That being said, I don’t mean to imply that self-care isn’t important. (You can probably tell I think it’s important just by scanning through the other entries on this blog!)
I’ve come to understand that insufficient self-care should be seen as a “comorbidity” for those in the grip of distress, suffering and burnout…similar to how having diabetes makes it harder to recover from physical illness or injury.
As for resilience… There are no human beings more resilient than those who choose to heal. The idea that insufficient resilience causes burnout is just not true. But itis true that this idea has been weaponized by the institutions who employ us to deflect from the real issue; We work in systems that create moral suffering for those who care for the ill and injured.
What should we call this model?
As I began to think more about using SIRS as a way to think about burnout, I realized I needed a name for this concept. I started with “PDS” for Physician Distress Syndrome, which I loved because PDS is my favorite suture. But a good friend, who works as a nurse practitioner, pointed out to me that this wasn’t just about physicians. Good point. She also said, “But you don’t have to change the acronym! You can call it “Provider Distress Syndrome”.
But I never use the word provider.
Everyone who works in healthcare in the United States (and to a lesser extent in the rest of the world) is affected by these issues. It’s too burdensome to list everyone when we are talking about this – but we need a word that describes all of us.
“Provider” is out.
“Clinician” works, but it is too narrow (and too cold).
The only word I’ve come up with so far that works is “Healer”. So for now, I’m using “Healer Distress Syndrome” to describe this model.
By the way, if you recognize yourself as being somewhere on the continuum from distress to suffering to burnout, you are not alone. Every healer I know is currently or has been there.
You matter.
Your work is sacred work.
We need you.
If you are suffering, please reach out to someone and/or seek professional help.
It is hard to eat well when you are a med student, resident or busy doc (also true for busy people not in medicine!). The key to eating well if you are busy is to have a strategy. You/ve developed strategies for studying to get where you are… so you have this skill set already! (Trust me, if you can learn how to take out a gallbladder or diagnose a complicated infection, you can learn to do this, too.)
As I’ve written before, here are the basic steps that you need to follow to eat well if you are “too busy to cook”:
Find recipes that sound good (but take less than 30 minutes to prepare)
Fill in a calendar with the plan for your meals (at work, on call, at home)
For the last 6 years, I have used an app that make this process incredibly easy. Paprika is not free, but it’s money well spent. I recommend downloading both the phone app (which right now is $4.99) and the app for your computer ($24.99). Try the phone app first if you aren’t sure, but I think you’ll find the laptop version is more than worth the money.
The reason I think this app is perfect for healers, healers in training, and anyone who is super busy is because it takes the four steps listed above and puts them all into one place. It not only makes it easy to choose recipes, plan your week and shop, it almost makes it fun. Here’s how:
Find recipes that sound good (but take less than 30 minutes to prepare)
Click on the browser tab to find new recipes and download the ones that work for you. As you save recipes in the app, it becomes your own personal “cookbook” which is searchable by category, name, or ingredients.
Fill in a calendar with the plan for your meals (at work, on call, at home)
This was the first moment I knew this was a great app. All you do is drag and drop the recipes you want into the appropriate day. Wow.
Make a shopping list and go shopping.
This is when I was completely sold. When you pull up the recipes you’ve chosen, there is a little “hat” icon at the top:
When you click this icon EVERYTHING IN THE RECIPE appears in a shopping list. Click what you need and repeat for the week’s recipes and voilà – your shopping list.
Because this app is on your computer and your phone, just take your phone with you to the grocery store. As you pick up each item, click the box next to it to take it off the list. If you are sharing the app with your significant other or roommates, anyone can add to the grocery list or unclick things they have bought.
Ryder Carroll suggests that goals should be lighthouses, not rules. Instead of the usual New Year’s resolutions, this year set your goals as destinations… as “lighthouses” in the distance. Write them down and revisit them often (every journey needs a map).
“When goals are lighthouses, success is defined by simply showing up, by daily progress no matter how big or small…” Ryder Carroll
At least once a day think about how to move in the direction of your goal(s). If you veer off course, that’s part of the journey…. look up, find your lighthouse, and correct your course.
Potential New Year “Lighthouse” goals
Learn more about compassion and practice it
Be a better friend
Write genuine thank you notes to people who have helped you
Become stronger, faster, more fit
Eat real food for as many meals a week as possible
Find out more about who you are through meditation
Keep a “stop doing” list
Be better at your work through deliberate practice (practicing and learning the things you don’t like and aren’t good at)
Read things that bring you joy
Keep a journal, even if it’s just 3 things you are grateful for every day
Learn the names of as many people at work as you can
Rituals have great power, but some more than others. For me, going to the Farmers Market has become a ritual that is almost as important as the food I buy there. So I spent some time this morning pondering why…
It’s outside. Sun, clouds, breeze. Sometimes a little cool, sometimes too hot… but always the season that matches the fruits and vegetables being sold that day.
There is music. And dancing… people dancing with children, children dancing alone, folks dancing in their wheelchairs.
Everyone is happy. Seriously. Not a dour face anywhere!
There is delight in the colors, odors, and tastes.. It’s beautiful… and that sensual beauty evokes all kinds of good emotions – delight, joy, and even awe.
It anchors you to the season. We don’t have peaches in January at the farmer’s market. So when they show up in May it’s a day of celebration! Eating what is being grown in the season keeps you somehow anchored to life around you and, according to some traditions, is better for your body. It’s certainly better for the planet, since this is food grown within miles of where it’s sold… not half way across the world.
You develop relationships with the people that grow your food. Lisa’s new tortoise gets a spectacular salad every day, so we chat about his salads and her goats. I get to practice my French with the Congolese farmers who grow their produce on an inner city farm developed to provide new refugees a place to farm. Some of the vendors know my name, most of them know and recognize me with a smile (even if they don’t know my name), and all of them are happy to share how to prepare their food and what’s happening on the farm.
And then there is the food. There is no question it’s often (but not universally!) more expensive to buy your food at the farmer’s market, but for the reasons above it’s worth it. But there is one other reason … which is probably the most important reason of all.
One of the very first times I went to a farmer’s market, I bought potatoes. I remember distinctly thinking that it would not be worth the extra money because “it’s just a potato”… but I did it anyway. Every potato I had ever bought in a store tasted the same as every other potato … so I didn’t expect these to be any different. Wow… I was SO wrong. A potato that has been pulled out of the ground the day before you cook it is absolutely amazing. A light went on. Fresh food raised in smaller quantities by people who are devoted to doing it tastes better. It just does.
There is most likely a farmer’s market near you if you live in a city, but if there isn’t you have a other options (The USDA Local Foods Directory is a wonderful way to find farmers markets, gardens, and local farms near you if you need help. )
CSAs (Community Supported Agriculture). Google “CSA’s near me” to find farms that make up boxes with small portions of anything they are harvesting that week to distribute to people who have signed up with them.
Community Gardens. If you love to garden (and you can spare a few hours every once in a while) you might want to actively participate – it’s also pretty soul soothing to dig in the dirt and grow your own tomatoes. But it’s also worth asking if you can buy any produce that isn’t otherwise promised.
A local farmer or neighbor who has a big garden. You don’t know unless you ask. Offering to buy some of their produce might end up being a win-win. They may have too much produce, need a little extra income, or both. And you end up with fresh produce and a relationship with the person who grows it!
It has been said that the Inuit people have a hundred words for snow. When you live in a dangerous environment, it’s important to learn the variations of snow to survive. But, when you look into the origin of the “hundred words for snow”, it turns out it’s not exactly true – Inuits don’t have more words for snow than other languages…Their detailed understanding of snow is a lived, not spoken vocabulary.
The same is true for those who spend nights awake working in a hospital. We, too, have a lived vocabulary that includes hundreds of subtle variations of fatigue, even though we don’t have words to describe them. (The closest I’ve come to being able to describe this fatigue is in “sleep equivalents”, specific events or things that makes you feel like you have had more sleep than you actually did. For example, a shower after being up all night can give you the equivalent of anywhere from 20 to 60 minutes of sleep depending on how tired you are. Brushing your teeth after a hard night of call is usually 5-10 minute sleep equivalent. A good strong cup of coffee can be as much as 45 minutes of sleep equivalent – although it’s important to titrate it so you don’t end up with anxious jitters instead of just being awake.)
Knowing how to manage this level of fatigue it is part of medical training. (Don’t get me wrong… I’m not advocating that trainees must get tired on a regular basis to “learn how to manage it”) Learning to successfully manage the fatigue of long days and nights on call hinges on two things and both have to do with deliberate choices.
Learning not to trust your first instinct if you are sleep deprived is the first important lesson. Even if it’s a drug you know well, or the chest x-ray looks ok, stop and be deliberate. Consciously review the data, look at the options and, for really important decisions, ask someone to look at the situation with you.
The second lesson in managing fatigue is maybe even more important. The bone deep fatigue of medical training is not solely the result of sleep deprivation. When you stay up all night you also lose the liminal spaces of waking and falling asleep, the threshold between night and day. In scientific terms, this means there is a major disruption of your circadian rhythms. But it’s more than just physiology. The drowsy moments between sleep and being awake take place in the liminal spaces of dawn and dusk. We lose more than orientation to daylight when we lose this liminal space. The Irish poet and priest John O’Donoghue, teaches that liminal spaces are moments and places where the spiritual touches the finite. By losing the profoundly important rhythm of rest – including these liminal spaces – we end up physiologically, psychologically, and spiritually unmoored.
You have to be deliberate here, too. By trial-and-error work to find the things that ground you, the things that help you recover in a deeper way than just catching up on the sleep. Make lists of anything and everything that helps you recover from call for the times you are too tired to remember or choose. Look at those lists before you leave for your call day and choose something to do for yourself when you leave the hospital the next day. It might be going to the gym for a light workout, having a great cup of coffee in a cafe, a slow, grateful walk outside, playing with a pet, a hug from a loved one…or finding a way to “play” outside.
May the sacrifice of time and sleep you make for others come back to you as joy … and may you find deep rest in knowing you make a difference in so many lives.
All of us have a list of things we know we should do every day… and usually don’t. They shouldn’t be that difficult to fit into our day, but we somehow end the day holding our intentions and the struggle rather than the completed task. I’m not talking about the things other people need from you, or the requirements of jobs or school. I’m talking about the things that bring you joy (whether immediate or delayed), things that are really important to you.
Why don’t we do the things that bring us joy? The first step to conquer this paradox is to make a master list of the things that bring you immediate joy (e.g.prayer/meditation, reading, journaling, playing music, calling or writing to a friend you haven’t seen in a while, walking in nature, checking in with older relatives if it’s been more than a couple of days, learning something new, cooking for your family and/or friends) …and things that might be hard at the moment but will bring you joy in the long run (e.g. working out, organizing and cleaning your living spaces, working on a big writing project)
Once you’ve made this master list, acknowledge there is no way you are going to be able to do all these things in a day. It’s important to name these things, to make this list and revise it as new things are recognized… but it’s equally important to acknowledge that you are going to have to make some choices. Pick what you currently think are the two or three most important things on this list and make a covenant with yourself that you will do them “every” day. The “every” is in quotes because let’s be real… life happens. Promise yourself that you will do these things every day, but give yourself grace for the occasional day when it’s just not possible.
Next, pick a way to remind yourself and keep track of your progress:
Schedule them on your calendar. This is probably the best way to do this for most people, but you have to build in a “what if” plan. If for some reason you don’t accomplish it at the time you scheduled it, it doesn’t break the promise you made to yourself. Move it on the calendar, commit to doing it later, but don’t blow it off.
Keep a “routine checklist”. This is separate from any other to-do list you create. This is for you. Not the things you have to do for other people, but the things you are doing for yourself, the things that add goodness to your days.
Morning is best (if you can). There is an adage in finance that you should pay yourself first. In other words, the first thing you do with your paycheck is to put money aside for investment in your future. Time is no different. Doing the important things first, the things that are just for you, is an investment in the day and your future.
The power of streaks. Put an X on a calendar every day, like Jerry Seinfeld or get the app that lets you put the Xs on a digital calendar. (There are other streak tracking apps, too.) Alternatively, create your own visual record of a streak with Excel or a Word document. The power of a streak is that you become more and more invested in not breaking the streak as time goes on.
Final thought. We are all busy, and we are all tired. This era, more than most, is one of being pushed and pulled in so many directions and in so many ways. Take the time to identify the things that bring you joy. If that’s all you do, it will be a good start, because just making that list will make it more likely you will add joy to your days. When you are ready, make a real covenant with yourself, a promise that you will do the one, two or maybe three (no more that three!) things at the top of that list every day. And then, do your best. Give yourself grace when you stumble… and start over.
We’ve all been there (yes, all of us). Something happens and we can’t stop thinking about it. It can be a complication, a misdiagnosis, something that happened in a toxic work environment, a failed exam, a harsh word. Not being able to let go of these thoughts means you are a normal person who cares… but it is not comfortable.
It will stop. At the time you are caught in the spiral of rumination, it seems unending. But it can’t and won’t last forever.
You are not your thoughts. There are your thoughts (and this annoying thought in particular) and then there is “you”. Hold that thought (then see below).
Don’t make it worseby yelling. It’s human nature to try to push an uncomfortable thought or image out of your mind. But it doesn’t work. Yelling at yourself (in your mind) because you are not able to move past the thought/event makes it even worse.
Get curious. Berating yourself makes it worse, but there is a way to disarm the thought and even make it go away:
When the thought arises, just notice it.
Wait….if “you” are noticing it, then the thought isn’t “you”.
Exactly.
Every single time the thought arises, say to yourself “I’m thinking about it again.” But – and this is the most important thing – when you notice that the painful thought is back, you have to notice it without judgment. Not… “I can’t believe I can’t let go of this thought.”…or “Something must be wrong with me.”… Just “There it is again.”
Image from multiple internet sties
Mindfulness. The practice of noticing without judgment is called mindfulness. There are good data that an informal practice of mindfulness helps when we find ourselves with a thought that won’t let go. A daily practice helps even more. Set aside just 10 minutes and sit still. Just notice everything that comes up, acknowledge it, and don’t judge. Ditto for the next thought, and the next, and the next…
Here are some links if you’d like to learn more about mindfulness:
Working as a surgeon for as long as I have, trust me, I have learned the agony and ecstasy of foot care. After a long case or after 24 hours on my feet it’s the agony. But I’ve learned how to make my feet happy… and I’ve learned that it’s not that hard.
The ideal hospital shoe has a wide toe box, is flat, laced (I’ll get to clogs in a minute), lightweight, slip-resistant, fluid resistant, and can be thrown into the washing machine. You can expect to spend around $100 for these shoes. Don’t get cheap shoes – spend the money!
Although many running shoes meet these criteria, my current favorite shoe is from Merrell, which has been a go to company for me for years. The other major contender right now for favorite hospital shoe among medical students and residents is All-Birds.
Even though I wear lace up Merrells most days at work, I love clogs when I operate. They let me back my feet out of them and lower my heels to stretch my calves. I can kick them off and stand barefoot for a while if I need to change the pressure points on my feet. I had Dansko clogs for years, which are almost a tradition for surgeons, and then changed to Merrell clogs (which are pictured above) Although they are great for standing, the problem with clogs is that your toes have to grip the shoe when you walk (or run to a code), which means they aren’t the best shoes for the rest of your day.
Here are some other options beside running shoes, Merrells, and All-Birds to consider. If you have tried these or have other shoes I should add to the list, please let me know!
Atoms – Great reviews and an amazing story about the owner of the company
Bala Shoes – designed by nurses with consideration for structural differences in women’s feet
There is practically nothing worse for your feet than wearing high heels. (Sorry if you love them). If you wear them, please wear them only for special occasions and keep the heels as low as you can. If you are wearing heels in the hospital because it hurts to not wear heels, that’s a huge red flag and you need to really work on it.
Compression socks have the potential to change your life. Ok, maybe that’s an exaggeration, but this is one thing I wish I had started earlier in my career. It’s not clear that they do anything to prevent the occupational hazard of varicose veins, but boy do they make your legs feel better at the end of a long day.
Make sure you throw an extra pair of socks in your call bag. There is nothing that feels better than taking your shoes and socks off after 10-12 hours, massaging and stretching your feet (if you have time) and putting on new socks before the second half of a 24 hour call. BTW, the same is true for shoes. Swapping out shoes (if you have two good pairs) is also really nice for your feet during a 24-hour call.
A friend recently lent me this book which is written by Katy Bowman, with the help of 4 “goldeners” (all older than 70) about what they wish they’d known about caring for their physical wellbeing. Feet are literally the foundation of our musculoskeletal “chain” and unhealthy feet not only hurt, they can affect the function of your kness, hips, and back. Here is the routine recommended in the book to care for your feet. It only takes about 10 minutes and is something you will look forward to doing at the end of the day since it feels so good.
Dorsal foot stretch. Put the top of your foot on the floor and stretch your toes and ankle. Hold it at least 30 seconds and repeat it at least three times. If you get bad cramps (which is normal if it’s tight) it just means you need to keep doing it. Let the cramp subside and start again.
Sole of the foot stretch. Buy this foot massager (or one like it) right now! Stand on it to to stretch and massage every single square centimeter of the sole of your foot. You’re welcome.
Toe circles. Grab each toe separately, pull on it a little and then move it in a circle (both ways) for several rotations.
Toe stretches. Pull each toe away from each other (medial to lateral) then put your fingers between the toes and leave them there to continue the stretch
Toe lifts. Lift your big toe first and work your way up to lifting the other toes as individually and as high as they let you.
As an alternative, if you want a guided yoga practice for your feet, check out this video from the amazing Adrienne Mishler.
Every time you take a shower, look at your feet with intention. If you have calluses use a pumice stone to take off the layers of dead skin. Don’t let your toenails get out past the end of your toes and never cut them in a curve like you do your fingernails. If you start to get an ingrown toenail, soak your feet twice a day, dry them well, and then wiggle dental floss under the corners of the nail. Leave the dental floss in place until the next time you soak and then put another piece under the corner of the nail. Continue doing this until the nail grows out enough to be cut straight across. Since toenails grow about one millimeter a month, plan on it taking at least a month.
By the way, if you’ve never had a professional pedicure, ask around to find a good place and try it. It’s not just for women, so if you are a man who has never tried this, step out of your comfort zone (no pun intended) and try it at least once!
