Living with Scleroderma

Reflections on the Messy Complexity of Chronicity

And Then This Happened

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I have spent far too much time with medical professionals of late. Last Thursday, my blood pressure suddenly spiked. I don’t typically measure it. When it goes too high, I just know. My heart, normally gently beating in the background, pounds in my ears and makes my chest vibrate. Usually this subsides. But on Thursday, I was on a wild roller coaster ride with my circulatory system.

By mid-afternoon, I tried to reach my cardiologist at Boston Medical Center, but couldn’t get through. So I called my local geriatrics team and asked for help. They tried to reach him, too, without success. Given my BP readings (I had finally taken some measurements, which were inching much higher than I had even expected and not helping my angst level), they sent me to the local hospital ED.

I absolutely hate going to the ED. Fortunately, it was not too crowded in the waiting room, and I got a bed pretty quickly. While I was lying there, waiting for someone to come and talk to me, I messaged my BMC cardiologist through MyChart. Within a minute, I got a call from the covering cardiologist, which was a godsend, because the ED doc was then able to consult with her. Scleroderma is so complicated, it really is important to have a team of specialist who know the disease when faced with an emergency.

Long story short—they did a chest X-ray, EKG, and blood work, and the final assessment was that my BP spiked because I had taken an OTC decongestant that morning. I was skeptical, because I’ve used that same decongestant many times without this reaction. But my BP was coming down, so they let me go home after a remarkably short three hours, with instructions to start metoprolol, a beta-blocker go-to med for hypertension.

Fortunately, just as we got home, I got another call from the BMC covering cardiologist, who had finally been able to speak to my guy, who had been covering the ICU that day (hence, hard to reach). He nixed the metoprolol, because it causes vasoconstriction and would aggravate my Raynaud’s. Instead, he recommended losartan. This, he prescribed after we were able to talk on the phone Friday. Like I said, it’s really important to have a specialist who knows this disease.

I wish I could say that’s the happy ending. But my BP is still giving me trouble. It takes time for the losartan to build up in your system. On Monday, after a rough night, I ended up speaking at length with my Boston Medical rheumatologist about where things stood and got more blood work done that afternoon. He was quite reassuring, and we have a plan. But he took me seriously, because hypertension in scleroderma is nothing to fool with.

I definitely felt more at ease after sorting that all out with trusted medical professionals, including the nurses and patient care folks who helped me get through the maze of voicemails, messages, MyChart missives, and phone calls to get the answers and action I needed. This will take more time and patience and care, but if there’s one thing I’ve learned from this disease, it’s that you must be your own best advocate.

Looking forward to a few days by the ocean, with my dear Al, to write and just be.

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: Олег Мороз

Delayed Reaction

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A week ago Friday, I checked an item off my health care to-do list when I got my pneumonia vaccination. For older adults, mine was Pfizer’s Prevnar 20, which stands for Pneumococcal 20-valent conjugate vaccine, in case you’re wondering. Basically, it covers a slew of bacterial strains, and as of current practice standards, I won’t need another pneumonia vax, ever.

It barely hurt, and I only had minor aches in my left shoulder for maybe 48 hours. No big deal.

Meanwhile, I’m still nursing nasty multiple ulcers in my left ring finger that have cost me a nail and considerable discomfort for at least six weeks, now, even as it slowly heals.

Thursday evening, after my shower, I noticed an odd, blotchy rash on my upper left arm. At first, I thought it could be hives, which I occasionally get from taking a shower. But the rash did not clear. In fact, it seemed to be spreading a bit.

Now, I have a history of cellulitis when I get infections in digital ulcers. Haven’t had an episode in quite a while, but this was my immediate concern. If you’ve ever dealt with this kind of superficial skin infection, then you know that it can get very dangerous if left unattended, with the potential, if it gets into the bloodstream, of causing sepsis.

Typically, when I’ve developed cellulitis, it spreads in a thick, red line from the ulcer up my forearm. I once had the experience of watching it spread at a rate of about an inch an hour. That landed me at the infusion clinic of my hospital, getting IV antibiotics.

So, even as this rash was in no way connected to my ulcer, I was still worried—indeed, worried enough to have trouble falling asleep, and rising to check if it was spreading several times. That is, until about 2:30 in the morning. I had traced the outline with an eyeliner pencil about an hour earlier and the rash hadn’t really moved. So I took a minocycline pill, which I always have on hand, and convinced myself to get some sleep. No way I was going to the ER to deal with it unless it seemed aggressive.

When I woke up Friday morning, there was no change in size, though the rash had filled in and was definitely warm. It suddenly occurred to me that this might be a reaction to the pneumonia vaccine. During Covid, I had twice developed a rash in my injected arm from the Moderna vax, though never from Pfizer. But this was a totally different shot. Sure enough, I found a few research articles online about delayed reactions to the Prevnar shots, though it’s quite rare (of course—I always get rare complications).

At 8:00 I called our geriatric practice and explained my concern, that I needed someone to determine if it was cellulitis or the vax reaction. I was prepared to spend half a day at Urgent Care, if necessary. So, here’s why I love our geriatric providers: they make house calls. And, it turns out, that even as our NP was not available, they could send a mobile urgent care team to our home. Which they did.

The team was great, and they confirmed my second hypothesis, that I was reacting to the shot, even as the rash was several inches below the injection site. The solution? Zyrtec. Which I started that day, and the rash is subsiding.

To say I’m grateful is an understatement. Fortunately, after four-plus decades of living with scleroderma, I know enough to know what to watch out for and how to get help. And I’m lucky to live where excellent help is available, right in my own home.

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: Louis Reed

A Break from the News

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This weekend, my dear husband persuaded me to get out of the house on a bitter cold Sunday afternoon for a visit to our art museum’s wonderful annual Flora in Winter exhibit. It’s always fun to see how area florists interpret artworks, and given the flood of horrid headlines here in the U.S. of late, the exhibit was all the more refreshing. Seeking out beauty is essential these days, to remind myself what matters.

Here are some of my favorites. Enjoy!

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.

No Easy Fix

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So, here’s what I learned at my optometrist last week, with a thanks to all who expressed concern and good wishes:

My blurry vision is due to the fact that my eyes simply don’t make enough tears, the result of Sjögren’s Syndrome that I’ve had for decades. The relief I’ve gotten from using EvoTears, which form a moisture-trapping film over my eyes, is real, but not enough to keep my corneas truly healthy. So, especially in my right eye, which is more blurred, my vision is effectively analogous to looking through a dirty car windshield. This isn’t cataracts. It’s Sjögren’s. And there’s no point in updating my eyeglasses prescription until my corneas heal, because I can’t get an accurate assessment of any vision changes right now.

The other important fact I learned: The Restasis drops (standard treatment for dry eyes) that I use before the EvoTears are in a castor oil suspension. I need to wait a half-hour between the two eye drops, or I’m effectively trapping the castor oil in my eyes. This explains some of the irritation I’ve been experiencing. So, that’s an easy fix.

My optometrist gave me samples of a varenicline solution nasal spray, which I’ve used before, that stimulates tears, to see if this in combination with both eye drops will help. There are two issues with this approach: First, the spray helps, not not markedly, so far. Second, the nasal spray is outrageously expensive, available only by prescription, and not covered by my insurance.

So, I’m back to finding a way to tolerate the scleral lenses. He checked both lenses for me, and there are no scratches, so however I injured my eye a few months ago was some kind of fluke in the way I inserted the left one. I will need to keep the lenses in at least four hours a day, four to five days a week, to really heal my corneas and maintain them.

With six fingers in bandages right now, including that left ring finger still healing from a lost nail and an infection, that’s a challenge. So, I’ll just need to tough it out with the medications I have until I have better dexterity again. (As a side note, I’m typing with just my left pinky on the left hand right now, and somehow I’ve learned to type by touch and don’t have to look at the keyboard. So, that’s some progress!)

If there is any advantage from dealing with scleroderma and its sidekick diseases for more than 40 years, it’s this: I know my body does eventually heal from assaults like this. It just takes time and a lot of patience and vigilance. As the weather warms and my hands improve in their seasonal cycle, I should be able to master the lenses again and find the right balance. I’m grateful that I have access to excellent care and medications and the scleral lenses, even if they are difficult to deal with. The alternative is much, much worse.

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: Unsplash+

All a Blur

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It’s a good thing I’m seeing my eye doctor this week for my very dry eyes. For several months, I’ve been struggling with blurred vision, and it is getting worse—to the point where it’s affecting my ability to read easily and see the computer screen clearly. This could be due to one or a combination of factors:

  • My eyeglasses need a new prescription. Definitely a part of the mix.
  • My Sjogrens is getting worse. Also possible.
  • The house is very dry, which is not helping. And no, we don’t use a humidifier, because we still have old fashioned radiators and baseboard heat and heat pumps, all of which are drying for my eyes. Plus, a room humidifier is a pain to keep clean and not that effective. But I need a warm house to manage my Raynauds, especially in recent weeks when it has been extremely cold here.
  • I’m having a reaction to my EvoTears eye drops, which up to this point have been nothing short of a miracle. They form a protective film on my eyes that retains moisture. However, blurred vision can be a side effect. Really hoping this is not the issue.
  • I have some kind of underlying allergy or infection in my eyes that is causing them to get goopy and blurry.

I am as meticulous with eye care as I am with my hands. I use gentle eye drops to clear them in the morning, then wash around my eyelids with warm water and a dot of baby shampoos to clear the tear ducts, then use Restasis for dry eyes, then the EvoTears. At night, I do another drop of Restasis and then use an overnight eye gel. This has worked well for a long time. But something has shifted. My vision is fine when I complete my morning routine but soon blurs, as if my eyes are making another filmy substance that interferes with my sight.

My eye doctor, who runs the dry eye clinic at a local college that teaches state-of-the-art optometry, has been a genius at diagnosing my symptoms and helping me find solutions, including the EvoTears, which I order from Europe, because they require an expensive prescription here but are sold OTC there.

My appointment is tomorrow. It can’t come a day too soon. Will report back when I have some answers.

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: Nigel Hoare