Living with Scleroderma

Reflections on the Messy Complexity of Chronicity

Why Me?

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For all of the bad things that happened during the COVID pandemic, the one good thing that happened for me was reconnecting with old friends over Zoom. Five years ago, when we were hunkered down, I looked up friends from my teens and twenties and caught up online.

Some of us have continued those conversations, maybe once or twice a year. And this past Sunday, a bunch of old friends from my high school days shared our lives for a couple of hours. It was funny and poignant and an important touchstone for all of us, to recall where we came from and where we’ve ended up.

One of my friends, whom I haven’t seen in fifty years, shared that her sister had also had scleroderma. She died several years ago from a brain tumor, but lived with significant skin tightening for about 15 years. A number of years ago, I had also learned that the older sister of another classmate had died from very aggressive scleroderma. What are the odds that three women from the same small high school all got this rarest of diseases?

My friend on the call Sunday has wondered if the fact that our school was not far from a nuclear power plant might account for her sister’s illness and other rare autoimmune diseases that run in her family. I have wondered if the two years I spent in graduate school in Pittsburgh, living in a neighborhood on a hillside above the Jones & Laughlin Steel mill, which flushed its stacks every weekend, filling the air with the thick odor of rotten eggs, may have played a role in my disease trajectory.

Researchers still don’t know exactly what causes scleroderma, this formidable autoimmune disease that tricks the body into producing too much collagen that tightens and hardens skin and connective tissue. My rheumatologist at Boston Medical has told me the latest theories point to some kind of virus that triggers the disease process in people with certain genetic predispositions. It is not contagious, and very rare for direct family members to share the disease.

Stress also plays a role in disease onset. Research supports this, although other factors—genetic, hormonal, environmental, and immune system health—are all part of the mix. In my own case, I developed symptoms (puffy fingers, migrating arthralgia, gut issues, fatigue) in my late twenties after my first marriage ended in divorce. I was anxious and running on adrenaline while coming to terms with it all (not to mention the stress of the marriage itself, which was considerable). All that adrenaline flooded my body with cortisol—which at too high levels can damage the body’s immune system.

So, whatever else I was exposed to and whatever my particular genetic mix, that probably set the stage for my getting scleroderma.

If there’s one thing I’ve learned from all of this, it’s to take stress seriously and to do my best not to let it overwhelm me (not always successfully in our tumultuous times). Meditation helps. So does exercise (Pilates, walks, stretching). So does surrounding myself with nature and art and music. Loving family and friends are essential supports.

Recently I was listening to a meditation app that mentioned a Korean custom to eat only until you’re 80 percent full. The idea is to not overdo, to leave room to appreciate what you’ve enjoyed. It provides a good metaphor for living, as well—to engage fully, but not to the point that you deplete your energy (or run your health into the ground). Keep that 20 percent reserve for resting, recuperating, and recharging.

I’ve been thinking about this a lot, lately. I hope it’s a useful concept for you, as well, Dear Reader, especially right now. Take care.

Evelyn Herwitz blogs weekly about living fully with chronic disease, the inside of baseballs, turtles and frogs, J.S. Bach, the meaning of life and whatever else she happens to be thinking about at livingwithscleroderma.com. Please view Privacy Policy here.

Image: engin akyurt

Open Air Cathedral

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Beautiful, crisp fall weather this weekend beckoned for a walk. Our trees here in Central Massachusetts have carpeted lawns and streets with leaves, but there is still much beautiful foliage to enjoy. So I set out on Saturday afternoon to stroll through a historic cemetery in our fair city.

Why a cemetery, you ask? Because this one, Rural Cemetery, was first created in the 1830’s during the eponymous 19th century movement to create “open air cathedrals” for burying the dead, as opposed to cramped burial sites that dominated urban centers. Aside from the aesthetics, these park-like cemeteries limited the risk of ground-water contamination from decaying bodies. And so, our Rural Cemetery is an arboretum with some very old and magnificent trees.

The cemetery is also the resting place from some famous local citizens, whose names define many streets and landmarks here. Being a local history nerd, I find it fascinating to discover them, as well as to observe the art of gravestones from earlier times and how it reflects social attitudes and values about that most mysterious aspect of life—what comes next.

I hope you enjoy this stroll with me. . . .

Evelyn Herwitz blogs weekly about living fully with chronic disease, the inside of baseballs, turtles and frogs, J.S. Bach, the meaning of life and whatever else she happens to be thinking about at livingwithscleroderma.com. Please view Privacy Policy here.

Gutsy

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My gut has not been happy, of late. I simply don’t process food easily, and I often have to go to the bathroom a lot during the day. Last week, this had gotten to the point that, despite multiple trips to the john that morning and yards of toilet paper,  I left the house only to have to run back inside for one more bout of diarrhea before I could get on the road to Boston for an appointment with my rheumatologist, Dr T.

This is a common issue with scleroderma. As Dr T explained (once again, because this is not a new conversation), over time the vascular supply to my small intestine has decreased, which slows the peristalsis (muscle contractions) that move digested food through my system. As a result, good bacteria that normally resides in the gut overgrows, and that’s what causes all the runs to the bathroom.

Ironically, the solution is antibiotics. Normally, antibiotics can cause diarrhea because they destroy the good gut bacteria along with whatever bad bacteria they’re aimed at. But with bacterial overgrowth, certain antibiotics can bring the issue under control.

I’ve actually noticed this whenever I end up taking antibiotics to manage an ulcer infection, or, most recently, when I had a dental implant and took Cipro to mitigate against infection. Sure enough, my gut issues improved.

Turns out Cipro is one of the antibiotics that helps with gut bacterial overgrowth. So Dr T wrote me a prescription for 10 days. Literally within hours of taking the first pill, my gut began to calm down. What a relief.

I also asked Dr T for a referral to a GI specialist. I haven’t had one in years. I think the last one retired or moved and I wasn’t as concerned as I am now to have that end covered. Fortunately, BMC has gained a new GI doc who knows scleroderma, too, which is what I was hoping for. Now it’s just a question of how long I’ll need to wait to get an appointment. This problem isn’t going away, but at least I have a stop-gap treatment in the meantime.

Evelyn Herwitz blogs weekly about living fully with chronic disease, the inside of baseballs, turtles and frogs, J.S. Bach, the meaning of life and whatever else she happens to be thinking about at livingwithscleroderma.com. Please view Privacy Policy here.

Image: Janelle Hiroshige

What Happened to Your Hands?

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Recently, a young boy was studying my fingers. “Why do you have so many bandages?” he asked.

“I have problems with my hands,” I answered. For a pre-schooler, that seemed the appropriate explanation.

He looked concerned, or perhaps afraid. “You don’t have fingernails,” he said.

“No, I don’t,” I said. Not exactly true. I have a few left, but they certainly don’t look normal, more like moon crescents. He seemed perplexed, but then he got distracted and that was the end of our conversation.

A friend who overheard our chat checked to see how I took it. “Kids say what everyone else is thinking,” I said. “He’s just curious.”

It really doesn’t bother me anymore when people ask, after all these decades of living with odd-looking hands and way too many digital ulcers, especially since my hand surgery eight years ago that necessitated some partial finger amputations. Most people who know me don’t pay any attention to my hands. When a stranger (often a cashier or someone else I’m handing something to) asks, Oh, what happened to you? or clucks about my bandages, I just take it as a mix of natural inquisitiveness and compassion.

My standard answer is something like, “I have chronic ulcers.” I don’t bother to go into an explanation of scleroderma, because the occasion doesn’t call for a lengthy discussion, and I’d rather keep it simple. Sometimes the person will ask a follow-up, Does it hurt? To which I say, “Sometimes.”

I realize that such inquiries can be much more challenging for those with severely tightened skin. Before my skin relaxed somewhat on my face, hands, and forearms (a miracle, truly, as it was beginning to get uncomfortable to blink in the early years, and the skin on my hands was like leather), people who knew me casually would ask with concern whether I’d lost weight. They sensed something was different, but couldn’t figure out what.

I was very self-conscious during that first decade. When I began to see wrinkles in my forehead again after several years on penicillamine (a since-discredited treatment because research samples involved too few patients to prove a positive response, but I believe it saved my life), I was thrilled. But my hands were already deformed by then.

It wasn’t until I began writing this blog in January 2012 that I started to overcome all the embarrassment that I felt about my appearance. There really is so much more to living with a chronic, deforming disease like scleroderma than your looks or your diagnosis and treatments, although I don’t in any way mean to minimize the very real physical and emotional pain and stress of literally being trapped in your own skin, when scleroderma takes its most virulent form.

What I have learned in my nearly 45 years of managing this disease is that people take their cues from you. The more accepting you are of yourself, the more accepting they are of you. It’s a journey. I’m grateful to be sharing it with you.

Evelyn Herwitz blogs weekly about living fully with chronic disease, the inside of baseballs, turtles and frogs, J.S. Bach, the meaning of life and whatever else she happens to be thinking about at livingwithscleroderma.com. Please view Privacy Policy here.

Image: Alex Skobe

Drips and Drops

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It’s been raining here for about the past 24 hours, much needed after a long dry spell. According to our official state website that tracks such matters, we are in a “significant drought.” You can tell that we haven’t had enough rain this summer because the fall foliage is muted. Trees need moisture to flame out.

So, I’m glad for the rain, even as it’s chilly and I’m putting on more sweaters. I turn on the heat in my office for the first time this fall and watch the rain dripping off the mountain laurel outside my office window. The drops cling to the leaves like glowing orbs until their surface tension breaks and they’re plucked by gravity’s pull.

My steroid eye drops arrived over the weekend. I think they are helping, though it’s too soon to be sure. I tried to follow the directions for application (pull your lower lid down to make a pouch for the drop, then hold it closed for a minute or so to be sure it doesn’t spill out of your eye), but I found it nearly impossible. My eyelids are (a) swollen and (b) not that flexible. So I just drop them in while looking up and do my best to not waste too much. My vision is still blurry, but my eyes don’t seem quite as sensitive. So far.

The gray sky helps. Bright light has been painful.

My German teacher tells me that the word for eye drops is Augentropfen. Somehow, this seems to capture the sensation of putting them in—the explosive pf feels like the fluid that always spills over.

I like it when words encapsulate sensations.

Like the word encapsulate. which sounds to my ear like a thought being snapped up.

drip

drip

drop

Evelyn Herwitz blogs weekly about living fully with chronic disease, the inside of baseballs, turtles and frogs, J.S. Bach, the meaning of life and whatever else she happens to be thinking about at livingwithscleroderma.com. Please view Privacy Policy here.

Image: Iuliia Naumova