Living with Scleroderma

Reflections on the Messy Complexity of Chronicity

Mind

Touch Type

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As I was writing just now, I realized that I am typing with only my pinkies these days, with my thumbs handling the space bar. (Using an Apple keyboard makes this possible, because it requires only a very light touch.) Usually I also use my right ring finger, but it’s been out of commission for a few weeks due to another ulcer, which, of course, formed on a pressure point, as in where I touch the keys.

What’s so interesting about this is that I don’t actually notice, most of the time, how I’m typing. My hands have learned to adjust to various fingers being unavailable for so long that they “know” the distance between keys without my having to look (for the most part). Kinesthetic memory is a powerful sensory skill.

Many decades ago, when I could still play the violin, I could hear a piece of music and sense in my fingers how to play it—where each fingertip would land on the strings, which direction to ply the bow. I certainly can’t play Mendelssohn anymore, but sometimes I can still almost know, intuitively, how.

So, I guess I haven’t lost that skill. It’s just emerged in a different way. Pretty neat.

Our brains and bodies are quite amazing, even when they don’t work perfectly anymore.

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: Wayne Hollman

Open Wider, Please

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So, on Monday I made another long drive for a not-so-short appointment, this time to my dentist for the next step in my latest tooth saga, measuring my mouth for the crown for my implant. While I’m grateful that there is a way to keep saving my teeth as I keep losing them to scleroderma-induced root resorption, the process is long, uncomfortable, and not covered by insurance, so it’s no fun and incredibly expensive.

This visit was to make an impression of my teeth, so that the crown can fit properly. I believe the last time I had this done, a few years ago, they were still using that icky goop in a metal tray that they stuck in my mouth (no easy feat). I had to bite down and hold for a few minutes to create a mold. The process always reminded me of my childhood orthodontist’s office, with its shelves of plaster dentures from all of his clients’ mouths, eerily grinning.

Now, however, they can make a digital image of your teeth with a probe. No goop. But the probe is not small and my mouth opening, due to scleroderma, is not big. And as one tech, and then another, did her best to scan my teeth, each had to stretch my lips and cheeks to get the full impression, a definitely-no-fun experience. Finally that first set of images was completed, and I was able to rest my mouth.

Then came my dentist, who had to remove the small metal screw-in cap from the implant and then screw in some kind of post that determined the angle of the new crown. But he was having trouble unscrewing the cap and screwing in the post, because his finger are large and my mouth opening is small. Again, no fun, and he was stressed because he knew I was uncomfortable and didn’t want to hurt me. Finally that stage was finished, and I rested my mouth again.

But the next step was to scan the post with the probe, and first one tech, and then the next, could not get the full image that was required, despite a lot of lip and cheek stretching. They were discussing the possibility of falling back to the goop mold (after all that?!) when my dentist’s partner, a women with small, steady hands, a great sense of humor, and a boatload of patience, came to the rescue. Turns out the post was turned the wrong way, so that’s why the image wasn’t registering. She deftly repositioned it, redid the scan, took out the post, and replaced the cap in a fraction of the time the whole procedure had taken up to this point. “You’re a trooper!” she said, at the end.

If memory serves, she had to come in as the closer last time around, too. Sigh.

Before I left, I set up a payment plan and my next appointment. I’ll have my new tooth before New Year’s, and it will be paid for by my birthday in April. Al and I could have traveled around the world with all the money I’ve had to spend on implants in the past decade-plus. Here’s hoping everything fits, and that I can avoid this whole mishegas for another few years, until the inevitable next tooth bites the dust.

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: Jonathan Borba

Long Drive for a Short Appointment

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This is one of those periods when all of my many and various specialist appointments clump together. I can go for weeks without seeing any of my docs, and then, boom, lots of visits—most likely because they are on similar follow-up schedules, usually four months apart.

I definitely consider myself fortunate to have such an excellent team of specialists, both close to home and closer to or in Boston. But most of my team are at least a 45-minute to an hour-and-a-half drive from home, assuming traffic is light. Which basically kills half a day, between driving, parking, and waiting, plus the appointment itself.

Again, glad to have a great team in place. But what drives me crazy are the 15 minute appointments that require all that driving. As happened Monday, when I had my final follow-up with my excellent periodontist for my latest implant. Or this Thursday, when I need to drive into Boston for a 15-minute lung CT scan, a regular part of my protocol with my BMC pulmonologist who monitors my interstitial lung disease. Could I have this test done at a hospital near home? Yes, probably, but the communication of test results is not always great between providers. So this, in the long run, is more efficient.

Sometimes I’m able to schedule appointments in Boston all on the same day. I have such a plan in place for December when I was able to schedule check-ups with both of my pulmonologists (the other one tracks my Type Two pulmonary hypertension) plus a pulmonary function test. So, this will work so long as one of them doesn’t cancel out at the last minute. Not holding my breath.

Managing a complex disease like scleroderma takes a lot of time and scheduling. After 45 years of dealing with all of this, it’s just part of my routine. But I wish, sometimes, it wasn’t so time-consuming.

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: A n v e s h

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.