When it comes to living with CAD, no good deed goes unpunished

Ignoring a toe injury proves to be the wrong decision

by Mary Lott | June 12, 2023

“Ouch! Consarnit! Dagnabbit! Wrassin-frassin-muchi-fuchi!”

I grabbed my foot and hopped around the room one-legged, expressing lots of adjectives about the pain I was feeling. “Man, that hurt!” I yelled, listening as my expressions echoed through the empty house.

I was doing a favor for a friend and had just started covering the new shelves in the kitchen with sticky paper. To help things go faster, I had removed the shelf from the cabinet and balanced it on the framework of the unfinished countertop. Well, no good deed goes unpunished. I had not properly balanced the board, and as soon as I turned to measure the shelf paper, the board clattered down the cabinet and smacked onto my bare toe. This was not a life-changing accident. It had even happened before and I lived to tell the tale. Although painful, there are much worse things in life.

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My knees turn to jelly

I must confess, I am a wuss. I do not like invasive procedures. I’ve had subungual hematomas before, which are basically a bruise beneath a nail, and I knew the treatment was to drill a hole through my toenail to relieve the pressure. My knees turn to jelly and my stomach churns at the phrase “drill a hole” when it pertains to my body. So I decided not to go to an urgent care clinic right away. That was a mistake. A week later, it was obvious: Infection had set in, and I made myself make the dreaded appointment.

Minor incidents like this can become a major problem for those of us with cold agglutinin disease, or CAD. Part of the problem of being chronically anemic, which is a characteristic of CAD, is that not enough oxygen and nutrients reach the site of injury. Therefore, we are prone to infections and it takes longer for infections to be cured. For this reason, infections need careful monitoring and need to be addressed immediately.

The physician at the urgent care clinic I patronized explained, “You have plenty of white blood cells. They are just not able to work as well as they should.” He immediately brought out a type of electric wand and burned a hole through my toenail. Yes, it did hurt when the tool reached the flesh beneath the nail. There was a burning odor and I jerked my foot backward, away from this added pain.

The procedure had the desired effect. Tissue debris issued out of the hole and the nurse cleaned up the mess. The doctor prescribed an antibiotic and a tetanus shot. With orders to keep my foot clean and to wear sturdier shoes, he sent me on my way.

The aftermath

The rest of the story proceeds without any incidents. Although the doctor opined a strong possibility of not losing my nail, after three months, it was obvious the nail was history. The new toenail grew under the old, slowly pushing it out and loosening the grip of the old nail on the sides of my toe. The antibiotics aided my damaged white blood cells and anemic red blood cells, and together, they won the war over the infection that had developed.

The pain subsided within a day of treatment. The swelling and redness disappeared. It took about a year for the new toenail to completely regrow. Overall, I learned that I had to be more careful with wound care due to my CAD.

Changes in lifestyle

I have made a few changes since that injury. I pay closer attention to bug bites, cuts, and injuries to see if an infection is developing. At the first sign of sickness with fever, I call my primary care physician, who is aware of my CAD, to discuss the need for an antibiotic to clear things up. My husband and I are diligent in making sure our first-aid kit is stocked with proper bandages, antiseptic soap, and an over-the-counter triple antibiotic ointment.

In the past, I have been known to “suck it up and carry on.” Now, I try to remain within calling distance of my husband, who knows to come help me when I request it.

On the other hand, though, I still go barefoot in the grass.

Note: Cold Agglutinin Disease News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Cold Agglutinin Disease News or its parent company, Bionews, and are intended to spark discussion about issues pertaining to cold agglutinin disease.

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About the Author

Mary Lott is a southern girl from Auburn, AL, living in Sentani, Papua, Indonesia, where she and her husband have worked for almost 30 years. She has taught sixth grade to missionary kids. Now, she designs websites, gardens, SCUBA dives as often as possible, and uses a motorcycle as her primary mode of transport. Their three kids have grown, but this gap is filled by two Papuan boys from one of the island’s interior villages. Mary is a surrogate “mom” while the boys attend a private school in town. Since her diagnosis at age 63, Mary juggles life and living at her home, “Ivy Manor East.”

When it comes to living with CAD, no good deed goes unpunished