Living with Scleroderma

Reflections on the Messy Complexity of Chronicity

Body

Heat Wave

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In India, “cold weather” is merely a conventional phrase and has come into use through the necessity of having some way to distinguish between weather which will melt a brass door-knob and weather which will only make it mushy.
—Mark Twain, Following the Equator

It’s been extraordinarily hot in India in recent days, and here in Massachusetts, as well—not hot enough to melt brass door-knobs, but close. Temperatures in Delhi neared 109 degrees Fahrenheit over the weekend. We weren’t that far behind. I was in Cambridge on Thursday, and my Prius recorded 99 degrees outside around 7:00 p.m.

Normally, I enjoy hot weather. Summer is my time of year. My Raynaud’s quiets down, and my hands are comfortable most of the day. My ulcers heal. But last week’s record-breaking heat wave was too much, even for me. I hardly ever break into a sweat, but I was perspiring rivers.

We New Englanders are fond of saying if you don’t like the weather here, just wait a few minutes. Not so last week, when the heat wave locked in for nearly three solid days. I was grateful to be in air conditioning, which I usually can’t stand.

I used to work in an office that was so cold in the summer, those of us with slighter builds would walk around in heavy sweaters and, sometimes, coats. What amazed me (to put it mildly) was that we had to put up with it. Some of my co-workers had heftier physiques and thrived in the cold. Some were men, who just seem to burn hotter than women (and who always, especially the heftier variety, seemed to be in charge of the computer program that ran the heating and cooling system). Some had normal internal thermostats, unlike myself. Whatever the reason, the majority didn’t want it any warmer. Some complained it wasn’t cold enough. This, despite the need to conserve energy and finances. The shivering ones among us were told to put on sweaters and deal. Infuriating. One of the many reasons I’m glad to be working for myself, now.

When you have severe Raynaud’s and finger ulcers, air conditioning isn’t just a nuisance. It hurts. More than winter’s chill, because you can’t escape the cold in the space where you need to do your work, keep your appointments or shop for food. Your blood vessels contract and your ulcers smart like crazy.

I always carry layers with me in the summer—a sweater and my Wristies, which are great fleece hand-warmers. This usually does the trick. But it’s a constant balancing act, because my hands can turn blue even if it’s in the ’80s and a breeze starts blowing. Summertime is all about managing relative temperature changes, more than absolute temperature. Except above 90 degrees.

At home, we have no air conditioning, just ceiling fans and window screens. Al is fine with it, concerned for my health and glad to save money on our electric bill. Our daughters both grew up with no AC and understand my issues with staying warm. For most of the summer, this works well—except on days like the end of last week.

It was so hot (how hot was it?) that I went to the grocery store without a sweater to protect me from the freezer section. I never do this. I hate grocery shopping because the stores are so cold, they make me feel sick from numbness. It was so hot that I had to put my Aquafor ointment in the refrigerator so it wouldn’t turn to soup when I squeezed it onto my finger ulcers. It was so hot that I blasted the AC in my car at 68 degrees and directed the vents onto my face and neck to clear my logy brain.

Today, we’re back to normal, whatever that means with global warming on the rise—another rainy June day, thunderstorms, temperatures in the ‘70s. Later in the week, it’s supposed to creep up to 90 again. It’s going to be an interesting summer.

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.

Until Next Time

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I’ve had a lot of doctor’s appointments, lately. This seems to happen every couple of months. They come in clusters of scheduled follow-up appointments, with an occasional diagnostic test or blood work or acute care visit thrown into the mix.

In a period of about two weeks, I’ve met with or will soon meet with my cardiologist, uro-gynecologist, rheumatologist and podiatrist—all regular, periodic check-ups. In addition, I met last week with an infectious disease specialist to get a better handle on how to deal with my all-too-frequent digital ulcer infections. This was on top of a couple of phone consults to discuss a nasty infection in my left thumb that has, fortunately, healed after two weeks of oral antibiotics.

It’s gotten to the point that I bought a notebook to keep track of all the information I learn with each visit. I used to be able to keep it all in my head, but no more. It’s simply too much detail, and my brain just doesn’t work that way post-menopause. Plus, sometimes my docs read test results differently, and their assessments need to be squared with each other. And I ask a lot of questions.

In addition to the notebook, I always bring something to read. And I never arrive the prescribed 15 minutes early, because I’ve learned that chances of any doctor running on time is next to zero, and I don’t want to add time to the wait. So I aim for arriving right on the dot. Then I usually wait at least a half-hour to be seen. I’ve taken to bringing my Kindle, so I can flip around from one book to another, depending on my mood. Sometimes I bring work, as well. Having something interesting and worthwhile to do helps minimize the frustration of losing control of my time.

My only other rules for doctor’s appointments are to dress in layers to deal with overly air-conditioned exam rooms, and to dress well. There’s something about walking into the doctor’s office and looking my best that helps me cope with being there in the first place. So much of our conversations are about what part of my body may not be working right, that if I make myself look good, I feel better about myself and not owned by my scleroderma.

At least, until I leave the appointment and start to absorb the latest assessment. I have wonderful, supportive physicians who are great about taking the time to answer all of my many detailed questions. But the news is usually mixed, and the list of potential complications keeps growing. I often find that it takes the rest of the day to put everything in perspective and keep anxiety about the future in check.

By morning I regain my equilibrium, refocus on my writing and family and project work, and let my scleroderma concerns drift into the background of my days. Until my next acute episode or my next doctor’s appointment.

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.

Breakthrough

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Last Wednesday, the Scleroderma Foundation announced a research breakthrough in the search for a scleroderma cure. A team of University of Pittsburgh Medical School researchers, including the Foundation’s board vice chair Dr. Carol Feghali-Bostwick, has discovered a peptide that blocks skin and lung fibrosis.

The so-called E4 peptide was discovered serendipitously when the team was investigating agents that promote fibrosis—thickening of connective tissue. This particular peptide (a chain of amino acids that make up part of a protein) blocks fibrosis in mice. Testing the discovery further, the investigators found that E4 also reduces fibrosis in human skin samples maintained in the lab.

Exciting news, since lung fibrosis is the leading cause of death in patients with scleroderma, and excessive skin thickening is at the core of the disease process. The discovery of E4 is not a cure, but an important step forward in that quest.

I’ve been thinking about this announcement all week and wondering: Is it really possible that a cure for this disease could be found in my lifetime?

It’s an idea that I have not let myself entertain, for decades. Scleroderma is disease that affects about 300,000 people in the U.S., just under one percent of our nation’s population. It seems like a lot of people to me, but not enough to attract significant research dollars, compared to a killer like cancer.

According to language in the Scleroderma Research and Awareness Bill (HR2408 and  S1545), which has been pending in Congress since 2009, NIH funding of scleroderma research was then about $20 million annually. The Scleroderma Foundation and Scleroderma Research Foundation each raise and distribute a little more than $1 million for research each year. So, that’s around $22 million, give or take. Just about the same as Red Sox first baseman Adrian Gonzalez will earn this year.

Would that our nation made health as high a priority as sports franchises. But I digress.

For my own part, I’ve tried to help the search for a scleroderma cure by participating in studies ever since I was diagnosed 25 years ago by Dr. Virginia Steen, a leading researcher in the field, then at the University of Pittsburgh, now at Georgetown University.

Data about my blood samples are in research databases around the country. I contributed a tissue sample from my placenta when I gave birth to Emily. I’ve helped to test new drugs for Raynaud’s (I think I had the placebo) and have allowed images of my hands, pre- and post-surgery, to be published in medical journals.

I’ve also explained my case history to numerous rheumatology fellows at Boston Medical Center over the years, and I’ve talked to classes of second-year BMC med students, helping them to learn how to diagnose scleroderma.

I don’t often fit the criteria for research trials at this point, because I’ve had the disease for so long. And I don’t participate in any research that involves procedures that sound painful or too risky. I’ll leave those to someone braver. But I’m glad to help when I can. It’s the least I can do to try to find a cure and improve the chances that some new patient suffering from the disease will be diagnosed sooner, with better odds of survival.

As for the E4 peptide discovery, all I can do is hope that the progress of my disease continues slowly enough, and that the research proceeds apace, so that maybe, just maybe, as my health gets worse, there will be better treatment options available when I need them.

And when I finish this post, I’m going to make a donation to both the Scleroderma Foundation and the Scleroderma Research Foundation. I don’t really care who claims credit for the next breakthrough. I just want us to get there, already.

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.

What Did You Do to Your Hands?

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Scene One:
I’m buying a slice of pizza at a luncheonette across from Boston Medical Center before I drive back home from an appointment. As I fumble with my wallet, the middle-aged man behind the counter notices my five bandaged fingers.

“What did you do to yourself?” he asks.

“Oh, I get ulcers,” I say, giving my standard explanation.

“Does that hurt?”

“Sometimes, if they get infected.”

He nods and hands me my change.

 


Scene Two:
I’m taking my first Saori class to learn this fascinating Japanese weaving method that encourages free-form creativity and uses looms that accommodate people with disabilities. The young son of one of my new classmates comes up to greet me. He loves to run around and say a loud Hi to everyone when he’s not weaving wonderful fabric. I shake his hand, and he pulls back. Later, I offer him my hand again. My Raynaud’s has kicked in, and my palm is a mix of indigo and fuchsia from haphazard blood flow. He stares and says No, frowning and shaking his head as he steps away. I believe I’ve frightened him.

*   *   *

June is national Scleroderma Awareness Month. It’s the month for walkathons to raise money for research, ramped-up efforts to publicize scleroderma’s devastating impact and continued lobbying for NIH funding of scleroderma research to find a cure.

All of this is important, focused work. But I wonder. How do you really get anyone to care about one more way that our bodies fail us, unless they have a vested interest? This time of year, there’s a race or walkathon or bike-athon for some disease every weekend, every cause has its own colored ribbon symbol or rubbery message bracelet, and Congress is still gridlocked over cuts in domestic spending. Not to mention that nobody pays attention to anything in front of them any more, just the alternate reality of their smartphone universe.

As part of its awareness campaign this year, the Scleroderma Foundation has developed a social media strategy to encourage patients to share personal stories about scleroderma and to create a video story collage that they plan to send to Washington lawmakers in the fall. I hope it works. For me, the art of storytelling remains the most viable means of building awareness, a primal way we connect as humans. But it requires a willingness to speak up and a willingness to listen. Neither are easy to come by for a disease like scleroderma.

Before I started writing this blog in January, I had a very hard time talking about my disease. In fact, I’ve been silent about it, for the most part, except when sharing with very close friends and family, for the better part of three decades.

When asked that all-too-common question by curious cashiers (the people most likely to ask, it seems)—What did you do to your hands?—or its variants—Did you cut yourself while cooking? Did you prick your fingers with a sewing needle? Did you stick your hand in a lawnmower?—I used to demure and just say I have sores. Now I say I have ulcers, and if I think the person is genuinely interested, I’ll explain I have scleroderma.

Responses range from compassionate concern to flickering interest in freakishness—the latter, I think, veiling the true reaction so powerfully expressed by the young boy I met in my weaving class: my hands look really strange and scary.

This is the hard truth of scleroderma. It’s rare, it defies easy explanations and it’s disfiguring in a way that others find threatening to their own body image and sense of well being.

It’s hard to talk about. It’s hard to draw attention to yourself, or more attention to yourself, and say, hey, I have this weird disease that makes my hands look like claws and my face like a mask and has screwed up my lungs and digestion and God knows what else.

Honestly, I just want to be known for who I am, not for this disease I live with.

But what I’ve come to understand and am coming to embrace is that scleroderma is a part of who I am. There’s no getting around it. I have this fucking disease, and I’m stuck with it for life. Which is why I’ve begun, finally, to write about it, tell my stories and try to make some sense of it all.

I have no awareness agenda. I am aware, however, that it’s important to get past the shame and embarrassment of living with a disfiguring chronic illness and share this journey with others who want to understand. This blog is my medium for that message. And maybe the next time a stranger asks what I did to my hands, I’ll tell them my real story.

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.

Waking Up Is Hard to Do

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It takes me a long time to get going each morning. No matter when my cell alarm vibrates, I press snooze at least three times before I can fully gain consciousness and know for certain that I am here, in my bed, not hugging a newly planted tree to protect it from a group of strangers who want to rip it out of the soil.

A relief to know I’m not stuck in those early morning dreams. But then there’s the matter of getting up. My body is always stiff, my hands often a bit swollen and my mind is sluggish. In winter, as steam heat slowly rises in our radiators, all I want to do is lie there under the blankets and stay warm.

The first step is, literally, always the hardest. I know my joints will feel better once I start moving, so I roll myself up to sit on the side of the bed, let my normally low blood pressure adjust, then push up onto my feet. This entire process, from first alarm to standing upright, takes about a half-hour. I just have to plan it into my schedule.

Some of this morning sluggishness is due to my scleroderma—unless there’s some kind of emergency and my adrenaline blasts me out of bed, I simply cannot accelerate quickly from zero to even 30 mph.

Some of it also has to do with not getting quite enough sleep. I know I should get to bed earlier, but I’m hooked on the Daily Show and Colbert Report to have a good laugh before turning in. If I were wiser, I’d watch the night’s episode online the following evening. But it’s not the same, and, besides, I prefer bandaging my finger ulcers, a 20-minute process, while watching. It’s become my evening ritual.

Even when both shows are in reruns for yet another vacation hiatus, I’ll find a different reason to stay up too late, like finishing the Sunday Times crossword or watching episodes from the first season of Mad Men.

But mostly, my slow morning trajectory just is. When I used to commute every day to Boston, often an hour-and-a-half drive in morning rush hour, it was extraordinarily hard to get up early enough to beat the traffic.

Now, working for myself and being able to set my own schedule, I have more flexibility. It’s a mixed blessing—the feast-or-famine stress cycle of finding clients for my marketing consulting is offset by the freedom of knowing I can get a few more minutes’ rest in the morning if my body just isn’t ready to move. I set appointments for late morning and early afternoon to maximize my attention and alertness, and work after dinner, as needed, to put in a very full day.

Which is why I stay up until midnight to let my brain unwind, and why I have trouble getting up in the morning. Recently I read an essay by William Zinsser, one of my writing heroes, describing how he used to get to his office at the New York Herald Tribune around 10 o’clock each morning. It made me feel better. At least I’m in good company.

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.