Nodules

My foot a few days after surgery

I am extremely lucky to be in the chosen few. The select few that get special perks. I’m in the 1% of the population that has RA. Within that one percent, I’m in the 20% for whom methotrexate doesn’t work, and in the 5% that have their hair ruined by the medication. I’m in the 15% who develop rheumatoid nodules, and in the 1% who get them in their feet. I should buy a lottery ticket. With everything disease related there are certain rules, certain statistical facts of the disease and how it acts. And it seems I am always the exception. I am the one who is in all the smaller percentages of “less common” cases, which basically means I’ve got a lot more trying to hold me back. Well, to all the life-wrecking, joy-sucking healing-preventing improvement-slowing problems: good luck.

“Oh my gosh what is that!” That’s usually how people respond the first time they see it. They act like I have some bizarre-looking abnormal growth on my elbow that is grossing them out. OH WAIT, that’s because I do. But it’s not some weird wart—it’s called a rheumatoid nodule. They grow under the skin, not on top of it, and can’t be spread or removed the same way as warts. A rheumatoid nodule is a lump of hard tissue that usually grows on a prominent joint of the body (like fingers or elbows). They are benign and typically do not cause any problems. They can be as a small as a lentil, or as large as an orange. The ones I have range between pea and blueberry size. On my elbow they are smaller like a pea, but I have two or three of them clustered on my left elbow. That’s why my left elbow gets such strange reactions when someone first sees it. Yes, they are relatively small, but they still look weird since they stick out so much being on the point of my elbow. For some reason my right elbow doesn’t have them, so it’s just the left that is peculiar. Elbow nodules are the more common of the rheumatoid nodules, but they are purely cosmetic. I could get them removed if I wanted to, but right now a funny looking elbow is the least of my worries.

I was more worried about the ones that grew on my feet. When your body is already experiencing widespread pain, you do as much as you can to eliminate any additional cause of physical pain. Nodules on the feet, suck. Not only did my feet hurt at the joints where my toes connect to the rest of the foot, but also on each foot I had two nodules in the ball. So every time I took a step it was like I had two pebbles stuck in my shoe—but I could never take them out. No amount of removal, cleaning, or shaking would get the darned rocks to leave, because they were inside of my foot. After a month or so of developing the lumps, I went in to a podiatrist. I could tell they were growing, and didn’t want them to become a bigger nuisance than they already were. Eventually, we decided to surgically remove the two from my left foot.

February 1^st, 2012 they operated on my left foot. It was only an hour-long procedure, but there was a month long recovery period. One incision was on the outside, but the other was down the pad beneath my big toe. Of course, this placement meant that I was unable to walk. At all. Even a little bit of pressure could make the bottom incision open up, thus thwarting the healing and potentially leaving nasty, hard scar tissue in replacement of the nodule. Essentially the scar tissue could defeat the purpose of the surgery itself. And so, it was bed rest for a week, followed by three weeks of crutches. Doesn’t sound too bad right? Wrong. It you have arthritis issues, crutches are the opposite of friendly. The pain in my wrists prevented me from being able to support myself on crutches for more than a few meters, so my only independent way of moving was blocked. Don’t forget that it’s February—I still have high school to attend. And so, for a couple weeks I got to have a wheelchair at school. It wouldn’t have been so bad, but people didn’t really get why I couldn’t use crutches. All I had was an inconspicuous little black surgical shoe, so people probably just thought I was lazy. It wasn’t exactly fun to have a wheelchair at school, but my amazing friends are really why it was bearable instead of humiliating. Since they are all familiar with my disease, they were completely understanding and supportive of the whole thing. They fought over getting to push me, opened all the doors, made me paths where needed, and defended me if someone tried to come down on me. I am thankful that they were all there for me post-surgery.

The second time was much easier. It was June, so I didn’t have school to attend. Plus, both incisions were on the sides of my right foot so recovery time was much faster. It was still challenging to figure out showering with one foot, still annoying that I was unable to play in the water or soak my foot while all my friends were having fun, and still frustrating that I was completely dependent on other people (since I couldn’t walk). It was good though, getting things taken care of before they get worse. All too often I feel like I’m trying to catch up to my disease by tackling the symptoms. But with the nodules, I was able to get all four of them removed from my feet before they could really cause any problems. I feel proactive with my pain, and that gives me just a little bit of confidence in handling my disease. Now about that elbow…