Living with Scleroderma

Reflections on the Messy Complexity of Chronicity

Sympatico

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It definitely feels like fall this week in Massachusetts. A few days ago, it felt like summer. But now the trees are really starting to change colors as the days grow shorter and temperatures hover in the 50s.

I find myself feeling more tired, which always surprises me when cooler temperatures finally settle in. It’s like my body senses the approach of winter and wants to prepare for hybernation. My hands start turning blue more often, and I just want a nap.

My bonsai is responding to the seasonal shift, as well. When I set it out on Sunday to catch the sun, its leaves soon drooped in response to wind and chillier air. A Brazilian Rain Tree, it prefers tropical weather and humidity, but can still flourish in the Northeast, just not when temps drop below 45°F.  I’ve been bringing it inside at night, but now it seems to be imploring me to keep it in the kitchen when temps drops below about 60°F.

We are definitely sympatico.

I brought its little table inside, too, so it can enjoy the midday sunshine through the south-facing sliding glass door off our back deck. Now I just need to get a tray and fill it with gravel and a little water, to place underneath its pot. Evaporating water will help to keep it humidified when we turn on the heat.

I know it may lose all its beautiful foliage at some point this fall. So far, however, it remains emerald green and continues to form new leaves and stalks. Though I’ve cut back on watering it daily, it keeps growing.

Even as my fingers turn blue, I guess I may have a green thumb, after 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.

Flipper

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It’s been nearly three months since I had #24 extracted from my lower jaw, due to resorption caused by scleroderma. The bone graft is well-healed, and in a couple of weeks I will get the post implanted for my new tooth. Then it’s another three to four months to wait until I get the crown to complete the process.

So, meanwhile, I had a “flipper” made, which is a false tooth on a pink base that snaps in place beneath my tongue. I use it occasionally when I’m on a Zoom call with clients or people I don’t know well, because the gap in my lower jaw looks pretty ridiculous. But thanks to masks for Covid, I don’t really need it when I’m out and about. And when I’m with family or friends, it doesn’t matter.

The question is . . . was it worth it? I had to have it adjusted by my dentist a couple of weeks ago, because it was too loose. She was able to tighten the fit, but she also took another scan of my lower jaw and sent it to a different lab to see if they could improve on the current version (at no cost to me). The flipper makes it a bit harder to speak clearly, but perhaps the new version will be less of an impediment.

Bottom line, though, is that I’ve gotten used to the gap, and I’m not nearly as self-conscious about it as I was, at first. My tongue definitely likes to twist and turn in that open space when I’m thinking. I can eat without any trouble.

On the other hand, February is a long ways away, still, and I have a presentation coming up at the end of this month, on Zoom, of course, that I’d prefer to do without a missing front tooth. The screen view really amplifies the gap. I’ll just have to practice speaking with the flipper in place.

These are trivial problems, of course, in the grand scheme of life. There are many places here in the U.S. and around the world where people cannot afford to keep their teeth as they age, for lack of resources, poor nutrition, and/or limited access to dental services. I know that I’m very fortunate, if I must deal with this chronic issue of resorbing teeth roots, that we have the means to pay for this very expensive process.

(Which is why I sincerely hope that Congress is able to pass popular and long overdue legislation that would add dental benefits to Medicare, despite opposition by the American Dental Association, but I digress.)

And so, like a kid in grammar school, I play with the gap between my teeth, and wait.

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.

Ulcer Fiends

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It has been pouring, a chilly rain, all day Monday. Fall is definitely here. What amazes me, though, is that I only have one digital ulcer—on my left thumb—that requires a bandage. At this time of year, that’s a minor miracle.

As I’ve written elsewhere, spring is always my worst season for ulcers on my fingers. This summer, however, was a challenge, as well. In the past six months, I have been on antibiotics at least three times, for about a month each time. That’s how long it takes the infection to clear. May was the most challenging month, with multiple fingers competing for attention.

Fortunately, I caught the infections before they became intolerable. One set required two different antibiotics to clear up completely. Perhaps it’s because I just finished the last round of antibiotics only a few weeks ago that my fingers are in better shape right now. Or maybe because I’ve been using medical grade honey to treat them, which both has natural antibiotic properties and also gently debrides dead skin. I was getting concerned about my left thumb, because it appeared that bits of calcium were buried in the ulcer and popping out, impeding its ability to heal. That situation has finally resolved, for now.

Writing about my sole bandaged thumb certainly risks tempting the Ulcer Fiends. They will be back to stage another sneak attack, as is their way. But I hope they’ll give me a break for a few months, at least. Maybe give me time off for meticulous hand care? A pass for layering up with sweaters and hand warmers? A chance to enjoy a little freedom from bandage adhesive? I promise to always use hand sanitizer when I’m out and about and a good skin moisturizer every night.

Are you listening, Ulcer Fiends? Probably not. Until we meet again . . .

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: K. Mitch Hodge

Hardening Off

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On Monday morning, steam clunked through our radiators. The sugar maples on our street are beginning to tinge yellow and orange and shed a few leaves. The days grow shorter. Fall is officially here.

My bonsai has been flourishing all summer, but as temperatures begin to drop, I need to learn how to prepare it for fall and winter. I’ve found some instructions online. Not surprisingly, you begin to limit food and water, still ensuring that it never dries out, but restricting intake. Like all trees, it has to harden off for the colder, darker months of the year here in the Northern Hemisphere. Time to reduce stress from cooling temps and allow it to acclimate.

I feel the approaching cold, too. Still wearing sandals for as long as I can, but starting to acclimate my feet to enclosed shoes again. I’m going through my sweaters, adding more layers as needed. I do not look forward to winter coats and boots and gloves and scarves and hats, but I will make the most of it. I ordered some beautiful Italian wool to sew, and I’m contemplating projects.

Soon the brilliant New England fall foliage will entice, as trees shut down photosynthesis, shed their leaves, and transfer sap to their roots, saving energy for the cold months to come. That, at least, is a gorgeous way to transition to weather that triggers my Raynauds.

And I will adjust, too, as I always do. Carpe diem.

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.

Inhale Exhale

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It’s been three years since I’ve had a complete series of pulmonary function tests. Last year, my new rheumatologist here at home ordered a PFT, but when I had the test done, I quickly realized that this was not the full series I was used to.

So on Monday, in order to have comparable data, I redid the test with the full set: spirometry, which measures how much air you can breath in and quickly exhale; diffusion, which determines how well the oxygen in the air you inhale moves from your lungs into your blood; and body plethysmography, which tests how much air is in your lungs after you inhale deeply, and how much is left after you exhale as much as you can.

These tests are never easy. They have gotten more challenging over four decades, which is to be expected. But my results are not normal. Though I don’t, fortunately, have interstitial lung disease that can result from scleroderma, I do have enough scarring to reduce my lung capacity. Which is why it’s so important to keep track of any changes.

Covid has complicated PFTs. First of all, you need a negative PCR test to even do the exam (can’t risk exhaling Covid droplets and spreading the virus). In addition, appointments are harder to get because of protocols that require test rooms to be vacated for 30 minutes between patients.

When I arrived at the hospital, I was first taken to a room without the plexiglass box (kind of like a phone booth that you sit in) that is required for the plethysmography. I told the respiratory therapist about the lack of a complete series last time, that I needed to be in the box. Fortunately, they were able to switch rooms to the right one after waiting a few more minutes for it to be deemed safe. (This was also helped by the fact that the scheduled patient didn’t show up.)

A second respiratory therapist handled my full set of PFTs. Before we began, she had to don a full blue plastic gown, gloves, two masks, and goggles. Definitely a riskier occupation these days. Then we started. I had to repeat the spirometry quite a few times, because I couldn’t do it without coughing. After several aborted attempts, she had me inhale a dose of Albuterol, which ultimately helped me to complete the test, but gave me the jitters.

The other two tests also required several tries until I could produce consistent results. All told, it took about 45 minutes. And, not surprisingly, my lung capacity over the past three years has declined a few points, down to 82 percent. Some of this is due to aging, but I can also tell, from how much trouble I have completing the tests, that it’s just getting harder with time.

At least it’s done. And I worked most of the Albuterol jitters out of my system by afternoon, though the breathing benefits persisted. Which was a nice side benefit. So it’s done for at least another year, maybe two. My lungs are far from perfect, but also far from limiting me, as long as I stay active and exercise. Still a lot to be grateful for.

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: Kind and Curious