Living with Scleroderma

Reflections on the Messy Complexity of Chronicity

Mind

Priceless

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This January marked 30 years since I first met my rheumatologist. Al and I had just married a few weeks earlier. My internist had set up the appointment because my fingers had swollen so much, for no apparent reason, after we ordered our wedding rings, that my ring was too tight when we picked it up at the jeweler’s.

Blood work revealed a positive ANA. I didn’t really know what that meant—that my immune system was attacking healthy tissue—and I almost cancelled the appointment because it seemed like a waste of time.

But that January day, my new rheumatologist explained to me with compassion, patience and insight, chances were that I had either rheumatoid arthritis, lupus or scleroderma. I was in total shock, completely unprepared for such a serious set of options. He answered all my questions, took all the time needed to help me absorb the frightening news. I went home very shaken, but I trusted him.

We were both in our thirties, then. He’s still my go-to guy here at home, complementing my rheumatologist at Boston Medical Center—another wonderful doc who is also now in his sixties. I trust him implicitly, too.

Both of them have followed me for decades, listened to all of my anxieties about this very complex and scary disease, given me excellent advice, understood my aversion to new medications, my fears of hand surgery, my many worries about what’s next. They have encouraged me, cheered my forays into dance classes and Pilates, empathized with my pain from infected ulcers and praised me for my meticulous hand care.

They’ve also given me hard advice that I’ve needed to hear—like the reality check after I gave birth to Emily that it would be far too risky, despite my postpartum delusions about how great it would be to have more babies, to go through it again. “You were really sick,” my hometown rheumatologist told me, straight out. Of course, he was right. I had developed pre-eclampsia at 34 ½ weeks, and by the time I was in labor, my kidneys had shut down and my blood had nearly stopped clotting.

My BMC rheumatologist was the one who pushed me to take exercise seriously in order to stay strong and retain as much range of motion as possible. “Find something you love to do,” was his wise counsel. “That way, you’ll stick with it.”

At a recent visit in Boston, the two of us were joking about the indignities of being mistaken for seniors—but still wanting the senior discount. It will only be a few years until we’ll both be legitimately eligible.

So, in the back of my mind is a new worry: What will I do when these two wonderful physicians, who have been so much a part of my life in coping with this awful disease, finally decide to retire?

It’s no small concern. I know there are other excellent rheumatologists around who are younger, well educated, experienced and will provide fine care. But it won’t be the same.

These two men don’t simply know my diagnosis, blood work, X-rays, pulmonary function tests, echocardiograms, medications, allergies, long history of infections, difficulties with infusions and all the other data points that make up my megabites of digital medical records. They know me. And they genuinely care about me—and I, them.

At some point, I will have to make a transition to a new dynamic duo. I must trust that each of them will hand off to another rheumatologist who will provide a comparable level of excellent care. I’ve been very fortunate to have found them both. I hope my luck will hold, because my scleroderma shows no signs of retiring at 65.

In the meantime, I hope each stays in good health and decides, despite all the frustrations of practicing medicine these days, to stay with it, and with me, for a long time to come. In a health care system where so much is measured by dollars saved, a trusting friendship with your physician who’s helped you manage a long-term, chronic illness for decades is nothing short of priceless.   

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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.

Thawing

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Winter’s grip is at long last loosening. The icy ruts on our street mostly melted as temperatures rose into the 40s on Monday. The sun shone all day. Snow drifts are slowly, slowly shrinking. Buds are visible on the Callery pear in our front yard.

And somewhere under all that snow, I’m sure there are crocuses waiting for the sun to warm the frozen earth just enough for their tender leaves to push up and free.

Hard as it is for my internal clock to adjust to that first Sunday when we jump forward to Daylight Savings Time, it’s a delight to have the days feel longer again (even as I know it’s just an artificial shift in how we perceive when the day begins and ends).

March can be a deceptive month here in New England, promising spring and then dashing hopes with a late snow storm. But I’m feeling optimistic. According to the weather reports, the Jet Stream has finally moved farther north, which means we’re in for an easier, sunnier spell.

We’re certainly due after all that record-breaking snow and cold. My hands have taken a beating this winter. I’m finally weaning myself off a long round of antibiotics to clear up two infected ulcers, and I have five fingers swaddled in bandages as intransigent ulcers gradually heal. Spring can actually be my toughest season, though, so I’m hoping these will continue to improve.

Even still, there’s just something about seeing the promise of new leaves on the trees and watching water bubbles slide beneath the icy crusts along the street that I find reassuring. No matter how bitter the winter we’ve endured, the snow will melt, the temperatures will warm and the world will turn green once again.

I’m looking forward to wearing something other than the same sweaters, in varying combinations, and foregoing multiple layers—leg warmers, wrist warmers, two or three tops, wool pants, neck scarf, down coat, outer scarf, wool hat, insulated gloves, boots (have I forgotten anything?)—every time I go out the door. As it is, two of my good cashmere v-necks, which I’ve had for years, finally wore out with holes at the elbows. Maybe I’ll figure out a way to shorten the sleeves.

Most of all, I’m looking forward to walking outside with my coat open and a warm breeze on my neck and the sun warming my face.

Spring officially arrives a week from Friday. Oh, yes, I’m ready.

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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.

Sleepless in Massachusetts

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My grandmother used to say that her mother used to say she was lucky if she slept every other night. Sometimes I wonder if I’ve inherited her genes.

8669222331_3133314c7eOf course, I know there are good sleep habits and bad ones, and lately I’ve been slipping into the bad column—going to bed too late, working on my iMac’s large screen until 10:00 or 11:00 at night so I’m exposing myself to too much light before I should be getting ready for bed (this is actually a huge factor), trying to do too much in the evening so my brain can’t unwind.

Recently I’ve been turning to Turner Classic Movies to relax as I finally get ready for bed, because they’ve been showing a lot of wonderful Oscar-winning films, and there are no blasting commercial interruptions. But then, it’s really hard to stop watching Jack Nicholson in One Flew Over the Cuckoo’s Nest. Or Robert Redford and Dustin Hoffman in All the President’s Men.

So Sunday night, after Chicago ended and I was finishing up bandaging my fingers for the night, I was amused to watch an old black-and-white short film featuring the droll essayist Robert Benchley talking about—what else?—insomnia.

Understand that my sister and I used to take turns when we were young reading Benchley’s essays to each other (and James Thurber, too). Benchley was also born in my home town of Worcester. So I was obliged to watch (at 12:15 a.m.).

The film, How to Sleep, released by MGM in 1935, features Benchley explaining all the ways we do everything but go to sleep—transitioning from a mug of warm milk to a feast of leftovers; getting up for that glass of water to quench our thirst, and another, and another; swatting at mosquitos; and fixing the flapping blinds only to trip on the way back to bed. He failed to mention all the journeys to the bathroom, but then again, it was 1935 and such things weren’t discussed in polite company.

Benchley also demonstrates all the contortions that the sleeper goes through during the night—parodying a study by the Mellon Institute about sleep patterns that was commissioned by the Simmons Mattress Company. This, apparently, was the inspiration for the film, which won an Academy Award and is Benchley’s most famous short feature. Simmons Mattress, however, was not amused.

I shut off the TV and went to bed, feeling lighthearted. But, of course, all it takes is a comedy shtick on insomnia to make me more self-conscious of how I wasn’t falling asleep. I tossed. I turned. I couldn’t shut off my brain. Al was snoring. I shoved him. He stopped and then snored some more.

Finally, around 2:00 a.m., as snow plows once again rumbled down our street, I went downstairs to read. I picked up an art book and was transported to 17th century Spain. A different part of my brain, the visual rather than word-intensive side, took over. By the time I went back to bed, I had finally enabled my busy mind to unclench, and I went to sleep.

Five hours isn’t really enough for a very full day, but I made it. And the one good thing about a bad night’s sleep—odds are much better that I’ll sleep soundly the next. As long as TCM isn’t showing another good flick that will keep me up way past my bedtime.

Photo Credit: DG Jones via Compfight cc

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.

A Little Night Music

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It’s really cold here, nine degrees on Monday night. Our street is a sheet of ice following a relatively warm day on Sunday—above freezing, WOW—when the snow that fell overnight melted and then refroze as temperatures dropped.

photoBut Saturday night, despite more snow, Al and I made it to a concert of Latin chamber music at Clark University performed by the Worcester Chamber Music Society, featuring Argentine guest soloist JP Jofre, a world class artist on the bandoneón, a type of concertina.

There is no better antidote to yet more snow than hearing the tango on the bandoneón.

When we got home, I decided to take a walk around the block. It was snowing gently, and the temperatures were just below freezing, so it felt relatively mild, even for me. The fresh snow coated all the dirty drifts that have narrowed our roads to nearly one way and freshened the landscape, transforming tree boughs to white lace.

I had the street all to myself. It was quiet and peaceful. Ginger would have loved it.

This winter will eventually come to an end. A week from Sunday, March 8, we switch to Daylight Savings Time and it will be lighter in the evening. The snow will melt (maybe by June).

So, to nudge things along and give you a little break from your own winter doldrums, here’s a video of Jofre performing Ástor Piazzolla’s Escualo with the JP Jofre Hard Tango Chamber Band at NYC’s Le Poisson Rouge in September, 2012. Tango, anyone?

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.

A Dog’s Life

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Last week, on Friday the 13th, we lost our wonderful Ginger. At 16 ½, she had outlived the average Golden Retriever by almost five years. But still, her end came too soon.

It all started when Mindi wrote a grade school report about Goldens. After our first dog died in 1998, she was adamant that if we ever got another, it had to be this breed. About a year later, we began our search, and in October of 2000, we learned of a family that was looking to sell a two-year old, pedigreed Golden.

As Al arrived at the owners’ home, he noticed an electric company truck in their drive. It turned out that the family was behind in their utility payments and about to have their power shut off. So he went to the bank, withdrew $200 to pay their bill and got Ginger in exchange. She jumped in his car and never looked back. That afternoon, Al greeted Mindi and Emily after school with Ginger in tow. At first, they thought he was just holding her for another parent. Needless to say, they were ecstatic to learn she was our new pet.

Neglected by her owners, ten pounds underweight, loaded with fleas (we soon discovered), never spayed, she needed a lot of love and attention. She took refuge under the kitchen table, and that’s where we placed her new bed. But she often liked to sleep on the hardwood floor, perhaps because that’s all she knew before coming to us.

At first, Ginger didn’t have quite enough energy to walk all the way around the block. But as she put on weight and gained strength, she gleamed and grinned. And, despite the former owners’ claim that she would swipe the baby’s meal, she never stole food.

In fact, she never stole anything that I can recall. She never climbed on the dining room table to snarf up a pound cake, like my childhood beagle, Snoopy, nor snatched socks and tissues, like our first dog, Sukki. She never snapped at us, only at dogs that got in her space. She only ran away once, chasing after a skunk on a frigid January night. When Al found her and brought her home, she reeked as she galloped around the house. I don’t recall how many baths it took to remove the scent.

Simply put, Ginger was just a love bug. Hugs and ear-scratches and snuggles were her ambrosia. She adored company and was totally oblivious to social cues from anyone who was skittish around dogs. Any resistance to her sweet face just encouraged her to persist until she got a pat on the head.

The squirrels always got away (thank goodness she never brought dead animals to our door), but she loved the woods. She would race back and forth between Al and me as we hiked, making sure we were both there, then wander a ways to sniff and explore. Her fur, such a beautiful russet, always blended with the fall foliage.

For the past five years, after I was laid off and began my consultancy at home, she was my constant companion. By this time in her life, she had mellowed considerably and was content to sleep, curled up under my desk or next to me in my office as I worked. But come 2:30 in the afternoon, somehow her internal clock would always go off and she would rise to nudge me for a walk, often nosing my hands off the keyboard to get me going. A good thing, for both of us. Those walks always cleared my head and gave us quality time together. I even finally taught her how to heel and not chase other dogs that passed us. Who says you can’t teach an old dog new tricks?

Most of all, she was a loving, comforting presence. We had our own way of communicating. She would let me know what she needed by pacing to and from the desired object—her water bowl, the back door, the kitchen to remind me it was time for pills (in ricotta cheese, of course), the back door again. Whenever I came home, she would always be there to greet me. And whenever I offered a walk, she was ready to go. On Shabbat afternoons, she would curl up nearby while I napped on the couch, and, sometimes, she could still climb up to cuddle next to me.

A hardy girl, she was beloved by her vet, who called Ginger her favorite Golden and always remarked on how she still had such “pep in her step.” But by last year, she was finally beginning to show her age. Arthritis, thyroid issues, weakened sight, loss of hearing in her right ear, lessened smell, confusion—all took their toll. Two weeks ago, she began to have trouble keeping down any food, and after a blood panel, we learned that her liver was failing. I thought she was rallying with medication and new bland food that she loved, but that was wishful thinking.

On Friday, I was writing at the kitchen table before going to the vet for some more anti-nausea meds. I got up to put on my coat and began telling her I’d be back soon, thinking I had let her back inside from her morning rituals, only to realize she wasn’t there. I called for her and looked all over the house, upstairs, the basement, out back, out front, in a total panic. It was as if she had vanished. Finally I clambered through the deep snow in the back yard, following the path she’d carved for herself in the drifts, and found her, collapsed. She was hemorrhaging. Blood stained the snow by her muzzle.

I stumbled back through the snow to get her a blanket, then called Al in hysterics. Thank goodness he could come home from work, because there was no way I could lift her and my fingers were going painfully numb in the frigid weather. He carried her to the car and we took her to the vet, but we knew it was over. She died, peacefully, in loving hands.

Of all the things I learned from Ginger, here’s what I will remember most: Live each moment fully. Be sure to take a nice, long stretch when you wake up. Ask for what you need. Find the good in everyone. And remember that whatever is troubling you, love is the strongest force in the Universe.

Rest in peace, Ginger. You are forever in our hearts.

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.