Living with Scleroderma

Reflections on the Messy Complexity of Chronicity

Reassurance

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On Monday afternoon, I finally saw my cardiologist at Boston Medical. This was no small feat. I was supposed to see him back in December, six months after our June 2024 visit, per usual. But that appointment got cancelled, and I was told the next available appointment was not until early May. I reluctantly accepted, though it made no sense to have to go to the end of the line. Then, a few weeks ago, I got a call that the May appointment had been cancelled, and next available was the end of July. I took the date to get into his calendar, but I was not happy.

So, instead of just accepting the situation, I called my cardiologist’s assistant and asked if she could find out if he could slot me in. Apparently enough patients had also called that he added more clinic days to his schedule, and I saw him yesterday.

Given all the mishegas last month with my trip to the ED for spiking blood pressure—even as we had spoken by phone a few days later—I just needed to see him in person. He knows me really well, and he has a wonderful, calming demeanor. He also understands the role scleroderma can play in heart disease. My rheumatologist had ruled out kidney involvement for the high BP, at my insistence, even as it would have been a really remote possibility. But I needed to know: Could the spike be due to thickening of heart tissue?

While it is possible to run a diagnostic to investigate that question, he said the resulting data would not be definitive. But given that my BP has now stabilized on Losartin, he said that thickened heart tissue would not be the issue. If it were, then my BP would not have come down to a normal range.

While there is some stiffening of my heart, causing Type II Pulmonary Hypertension, it does not appear to be the causal factor for the BP spike. Most likely, he said, it was the OTC decongestant I took that day, which contained pseudoephidrine, which is a vasoconstrictor. Even if it never affected me before, he said I could have built up an intolerance.

Then there was the other big fear: With all the weird heart stuff, was I at risk of just keeling over from a heart attack? No, he said. You have no evidence of any electrical issues with your heart. From my echocardiograms, he added, your heart is actually quite strong. He’s told me this before, but I just needed to hear it again.

We joked a bit, and he told me if I ever need to see him, just call his assistant and she’ll fit me in. That, and his steady hand on my back as I said goodbye, was the best medicine of all.

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: Cathal Mac an Bheatha

And Just Like That . . .

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For weeks now, my bonsai, a Brazilian rain tree that I have been cultivating for nearly four years, now, has been shedding leaves. While some of this is to be expected—it’s a deciduous tree, after all—it just seemed out of the ordinary. Nearly every morning, I’d discover more yellow amidst the emerald green.

Was I watering it too little? Too much? Was my bonsai upset with the cold weather? The heat pump? Had I lost my touch? I had made sure to give it a little fertilizer to help it through the dark days of winter. A mistake?

Then, last Tuesday, all of a sudden . . . tiny new leaves! A Brazilian rain tree is characterized by multiple, symmetrical leaves that fold up like books at night. These newbies appeared as if a little green library was sprouting. And each day, since, the new leaves have grown larger, opening up to sunlight. It seems my bonsai was communing with all the plants outside that have begun to sprout their own new leaves, in synchrony.

Every spring’s rebirth is a miracle—and a reminder of Nature’s intense imperative to replenish and grow, despite the odds. It’s such a great gift, and a welcomed assurance that even when our world is so chaotic, life rebounds.

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.

The Scam I Almost Fell For

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Bad actors are everywhere these days. Last week, I finally was able, with some tech support, to reinstall my computer virus scanner, run a sweep, and reassure myself that I did not download a virus a few weeks ago when I accidentally opened one of those fake alert screens that scream at you that you absolutely must save your computer by calling or clicking their blinking red link. (I immediately turned off my computer).

This weekend, the scammer came by phone. I saw a call from my credit card company on my cellphone and answered it. A man’s voice inquired if I had recently made a $1,300 charge on Amazon, which I had not. It was supposedly made by someone in Dallas. He needed me to confirm my full credit card number (he listed the first six digits) to cancel the charge and give the last four digits of my Social Security number.

As I was getting my card from my wallet, a little voice in my head piped up. Why would he need my credit card number, let alone part of my SSN? I’ve dealt with my credit card company’s fraud unit before, and they don’t work this way. Also, on the few occasions when there has been a fraudulent charge on my account, they first contact me by text, and all it takes is a confirmation of the error to deny it. Plus, when I have had to call them to cancel a lost card, there is always noise in the background, as if the person works in an open office space. No background voices on this call. Then there was the phone number I was speaking to, a Boston area code, rather than an 800 number.

So, I asked the guy on the phone, “How do I know you work for [my credit card company]?” He got irritated, then downright mad. He claimed that the person in Dallas had actually used my cell phone number to call and try to get the charge approved. This made absolutely no sense. He said if I didn’t act now to give him what he requested to cancel the charge, I’d have to wait until Monday to reverse it. This also made no sense, since my credit card company’s fraud unit is available 24/7. I told him I would not give my credit card number over the phone and was going to end the call. His ultimate retort? “I’m going to hang up in your face!”

So, there!

After this weird exchange, I blocked the number on my phone and checked my credit card transactions online to see if there was any pending $1,300 charge. There was not. Then I called the company’s fraud unit to double-check, to let them know about the scammer, and to give them the phone number that had shown up on my cellphone. The woman I spoke with was professional, polite, and appreciative. And there were other folks in the background.

Why didn’t I hang up right away? I had been trying to take a nap when my phone rang and was not all there. The caller ID said the name of my credit card company. And he did suck me in with his claim about the $1,300 charge. Thank goodness I woke up enough to realize what was going on.

So, once again, I share this adventure as a public service. Bad actors are everywhere these days. Be prepared.

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: Gratisography

Adventures with Antibiotics

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Now that my blood pressure seems to be, thankfully, calming down, the next frontier is healing the infection in my left ring finger. As I’ve written recently, this has been going on for a couple of months, now. Two multi-week courses of Minocyline perhaps helped, but not enough to really clear the infection.

So, last Monday, I met with an infectious disease specialist to get some help. Finding a broad spectrum antibiotic for me is complicated, because I am allergic to a variety of treatments. This physician is a colleague of the ID doc I had switched to a couple of years ago, after my longtime specialist retired. The new doc was away, so I was scheduled to meet her. A good thing, as it turned out, because she is very empathetic and understood immediately what the problem was. She put me on a ten-day course of levoquin, which I had successfully used a couple of years ago for a severe digital ulcer infection.

Levoquin has a number of potential side effects. The most serious involve tendon inflammation and risk of tearing or rupture, especially the Achilles tendon. So far, thank goodness, that hasn’t happened. But, the evening I took the first dose, I discovered another side effect—insomnia. I simply could not fall asleep until after 4:30 a.m. While tossing and turning and looking up the drug’s impact on sleep (sure enough, I was not losing my mind), I also learned that you should not take ibuprofen with levoquin, because it can increase risk of seizures. I take ibuprofen daily to manage join pain.

So, the next morning, I wrote to my new ID specialist, told her what had happened, and asked about ibuprofen. While she was surprised about my sleep disruption (I always have rare side effects), she double checked and concurred that I should stop the ibuprofen while on this antibiotic and switch to acetaminophen to manage pain. Now, acetaminophen is fine for pain relief, but it does not treat inflammations.

This became readily apparent that night. I began to experience nerve pain in my infected ring finger and the middle finger next to it, which apparently had picked up some of the infection. Again, I struggled to sleep, and I could barely concentrate the next day. Finally, I gave up, contacted my geriatrics team which serves as my PCP, and my NP gave me a scrip for gabapentin to control the nerve pain.

I have not had to take this drug since 2017, when my hands fell apart and I needed hand surgery. It is strong. It makes me loopy and groggy. It exacerbates my blurred vision from Sjogrens. The side effects ease as my body adjusts, but it packs a punch. It also, thank goodness, brought my nerve pain under control. Would this have been unnecessary had I taken an antibiotic that wasn’t contraindicated with ibuprofen? I have no idea.

At least the gabapentin is helping me sleep. And keeping the nerve pain at bay. The levoquin appears to be helping, but I’ll be glad to complete this course and get back on ibuprofen. I have an appointment next week at the Wound Clinic at our hospital to find out how to heal the skin and grow back the nail on my finger—and, I hope, some new ways to prevent this from happening again.

Managing scleroderma is complicated. I’ve learned enough over the years that when I meet a new medical professional, I’m often asked if I am one myself. I’m grateful that I have access to excellent care and that, at least for now, my Medicare still covers it all (another topic for another time). I also am grateful that I can adv0cate for myself effectively. But it is exhausting. Doctors are overworked and miss stuff. You have to pay attention and do your research and speak up. There is no other option.

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: Stefano Pollio

Blue Mind

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Last week, after all the mishegas with my roller-coaster blood pressure was mostly resolved (no, thank goodness, I was not experiencing scleroderma renal crisis, which would be a rare but very serious development at this stage of my disease), Al and I went to Cape Cod for a few days.

I had planned this trip for several months as a writing retreat on my own, to dig into Novel 2. Given that I was/am still adjusting to my new BP med, however, I did not feel comfortable making the long drive and staying alone. The cottage I had rented was a small. renovated barn next to the home of two artists in Truro, which is way up on the Outer Cape, a short drive west to the Bay and east to the Cape Cod National Seashore.

And so, once settled in, we visited a beach each morning, where Al then stayed to walk the shore all afternoon, while I went back to the cottage to write. It was the perfect getaway. He reveled in nature, and I cleared my head, felt the healing moisture of sea air on my too dry eyes, and made some real progress on my novel.

I also discovered that Apple’s Pages software, which I’m using for this draft, includes a dictation feature that comes in very handy for transcribing my handwritten scenes into my document, as well as mining material from my first draft. My left ring finger remains a problem (requiring yet another doc visit, this time to an ID specialist), so this feature was really a hand-saver.

There is nothing like the ocean to calm my nerves, lower my blood pressure, heal my eyes, clear my lungs, and just enable me to recenter myself. And there is nothing like the Cape off-season, with hardly any people or cars around, just the waves pounding and receding, to give me the clarity I need to write fiction.

Here are a few pictures from the beach and environs. Be well, Dear Reader.

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.