Living with Scleroderma

Reflections on the Messy Complexity of Chronicity

Mind

Merrily (NOT) We Enroll Along

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For those of us in the U.S. who are 65 and older, these weeks leading up to December 7 are our annual opportunity to choose a new Medicare plan. It’s called open enrollment season, but it’s not a season to be jolly. No, it’s a season to either stick with what works or bang your head against a wall.

I’ve used Blue Cross/Blue Shield here in Massachusetts for my Medicare supplement plan for the past four years, and it is not cheap, but it covers my many specialists at home and in Boston. On Monday, Al was reviewing his own coverage and spoke with a trusted insurance broker who recommended switching to another Medicare supplement program that would save about $45 a month over BC/BS. When Al encouraged me to speak with him, I declined.

Maybe it would be helpful, but I am totally risk averse on this topic. I know all my docs accept my insurance. The coverage is quite comprehensive. There is no copay.

Note that this is a Medicare supplement (Part F), not a Medicare Advantage Plan (Part C) that I’m talking about. I have avoided Medicare Advantage like the plague, because those plans are based on a narrow provider network, and I need broad access to specialists. Fine for seniors with minimal health issues. That’s not me.

A client who is very knowledgeable about how health insurance does and doesn’t work in this country has warned me that, eventually, Medicare supplements (Medigap) will be phased out and only Medicare Advantage will be available. I believe her, but so far, I’m still able to get the coverage I need. Not so for anyone enrolling new to the system. There are already limitations on who can get Medigap.

Ultimately, the glaring question is this: Why does this have to be so fraught and complicated? Given the current mess in Congress, chances of rational, comprehensive national health insurance in the U.S. is a distant dream. Even improving Medicare is a slog. A new law, part of the federal Inflation Reducation Act (IRA) that will cap out-of-pocket costs for prescriptions at $2,000 annually, won’t go into effect until January 2025. Efforts to include coverage for hearing aides in the IRA—an item needed by so many seniors that is a budget buster for custom hearing aides—failed for lack of political support.

I could go on and on, but I’ll spare you, Dear Reader. Let’s just say I find the whole topic infuriating. Health care in the richest country in the world should be a right and a common sense priority for public investment. End of rant.

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: Courtesy of Gratisography

Fall Back

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For the first time since I can remember, setting back the clocks this weekend didn’t bother me. Usually, the shift to earlier sunrise and the quickening of darkness at day’s end leave me feeling a bit claustrophobic until my circadian cycle readjusts. But not this fall. Oddly, the changeover feels like it fits.

There’s been a lot of debate about whether we should change the clocks at all. The U.S. Senate unanimously passed the so-called Sunshine Protection Act last year, but then the bill stalled in the House of Representatives. Given the current chaos in Congress, I doubt if it will go anywhere soon, but the goal is to make Daylight Savings Time permanent, nationwide. Why? The main arguments involve, in part, the notion that more daylight hours for evening activities will provide an economic boost for restaurants and entertainment venues.

Compare that to a push by the American Association of Sleep Medicine (AASM), which advocates for sticking with standard time year-round. Here the rationale is that standard time better aligns with our bodies’ natural rhythms. More sunlight earlier in the day helps our brains to shut down production of the sleep hormone melatonin and switch over to wakefulness.

I had read about this debate last year, and when we switched to DST last March, I felt very off-kilter. Now I feel back in synch. Coincidence, or the power of suggestion? I have no clue.

In any case, everyone seems to agree that switching back and forth twice a year is not good for anyone. According to the AASM, this time toggling actually increases risk of heart attack and strokes, mood disturbances and even suicides.

I’m curious to see how I feel as darkness settles sooner over the next few weeks. Not having to drive back from a doctor’s appointment in Boston in late afternoon or run errands at the end of the day definitely helps me to adjust. So does focusing on the stark light of November, when trees are bare and the shadows sharp, a time of transition that I find particularly striking.

And so does the knowledge that in just over six weeks, our days here in the Northern Hemisphere will gradually lengthen, once again. For all the turmoil in our troubled world, Nature’s rhythms soothe.

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: Jack Hunter

Small Miracles

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For months, at least since March and maybe longer, I’ve had a charcoal-gray pit of calcium sticking in my left thumb. I have not been able to budge it or tease it out with tweezers. It has been lodged there, staring at me as I change my bandages morning and night. Sometimes it hurts, other times not. Sometimes it gets infected. Mostly it just serves as a reminder to handle things with care so I don’t bang it.

That is, until this weekend. I was doing my evening routine of cleaning my ulcers and re-bandaging them when I suddenly realized that the calcium pit was gone. No bigger than a poppy seed, it lay there on a piece of tissue. Really? I wondered, rolling it between thumb and forefinger, you were that small all this time?

More calcium hides beneath the surface in both of my thumbs. In x-rays, they look like long white chains from thumb tip to below the joint connecting thumb to palm. Slowly but inevitably, the pits work their way out of the skin. There’s nothing I can do to get rid of them but wait until they are ready to emerge, then wait until each one dislodges.

There is an obvious lesson about patience, here. I’ve learned to play along, not to aggravate the skin and nerves by jiggling the pit in a vain attempt at extraction. As long as I’m careful with how I cushion it with dressings and use Aquafor ointment to keep it moist (but not too moist) eventually, the calcium will exit on its own.

But there’s something else that fascinates. And that is how my body continually surprises me with its ability to heal, scleroderma or no scleroderma. It doesn’t always happen the way I want it to, or on a convenient timeline, but it does happen. That a calcium pit the size and color of a poppy seed can cause so much discomfort and then, one random evening, bid adieu, is one of the mysteries of this disease and the miracles of the healing process.

And so, until the next one appears, I will tend the hole in my thumb as it fills and be grateful for the reprieve.

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: Victoria Tronina

Healing Stories

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One of the most complicated aspects of scleroderma is how it changes our relationship with our bodies. Hands that were once dexterous now are cramped, facial skin no longer flexes. It can become very hard to pick up objects, bend over, reach. In its most virulent form, this debilitating disease literally traps you in your own skin. It’s painful, exhausting, achey. Not to mention internal organ damage to heart, lungs, kidneys, gut.

As I’ve written before, I’ve been graced with a reversal of some of the worst aspects of scleroderma during my first decade of the four that I’ve been living with this chronic disease. I credit the use of d-penicillamine early on, a treatment that was never fully embraced by the medical profession due to inconclusive research. But it worked for me, loosening tight skin in my hands, forearms, and face. I still have abnormal skin that limits my dexterity and ability to open my mouth, but nothing like before, when it was becoming uncomfortable to blink.

Grateful as I am with that gift, I also still wrestle with how scleroderma has affected my face and damaged my hands. Scleroderma ages you prematurely. I’ve learned to make the best of what I have, but it can still be discouraging to look in the mirror.

So, I deeply appreciated an interview that I heard over the weekend with Krista Tipppet of the On Being Project, and Matthew Sanford, about “The Body’s Grace.” Sanford, now in his 40s, survived a car crash when he was 13 that took the lives of his father and sister, and left him paralyzed from the waist down. He speaks of a deepened relationship with his body, a knowing derived from inner silence, a reconnecting with those parts that no longer feel and work as they once did.

Sanford likens this awareness to “walking from a well-lighted room into a dark one. At first, you can’t see anything. But if you sit, and you pause, and you listen, usually there’s enough light to get across the room. It’s not going to be like turning the light back on, but in fact, the world gets this other kind of texture that makes it beautiful. It also makes it scary in the dark; it goes either way.”

Coming to terms with a life-altering accident or disease is a lifelong process that Sanford calls a “healing story.” And, as he and Tippett discuss, all too often, in our youth-obsessed culture, the healing stories we tell ourselves are ones of overcoming physical and emotional adversity. With enough willpower, we, too, can be the 80-year-old who runs a marathon or skydives; we, too, can “power through” anxiety or depression.

Though willpower is an important skill for confronting physical weakening or loss or just plain aging, Sanford suggest that it shouldn’t be the sole or primary skill. Finding your own, unique path of mind-body integration when the connections are weakened or severed is a journey toward a deeper relationship with your physicality and your body’s miraculous striving toward healing, even when damaged. It is also a journey toward deeper appreciation of your connections with others and the world.

We are always so much more than our medical diagnoses. We are so much more than our physical limitations. Each of us writes our own healing story as we learn how to see in the dark.

Here’s a link to the On Being podcast interview with Matthew Sanford as well as a transcript.

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: Spenser Sembrat

The View from Black Mountain

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Eighty years ago, my mother graduated from Black Mountain College in North Carolina. She was one of the few students in this small, experimental college to actually graduate, though the fact that the institution was never accredited caused some issues when she began to apply for work beyond the home in the 1970s.

No matter. BMC was a unique, character-shaping environment that left a deep impression on all who studied and worked at its bucolic campus, beneath the beauty of the Blue Ridge Mountains, near Asheville. The college, which existed from 1933 to 1957, placed the arts at the core of its curriculum, with a particular focus on how a specific material or medium—paint, clay, fiber, paper, wood, concrete, photography, dance, music, poetry, and more—defines and informs the act of creating. The place was a hive of interdisciplinary cross-fertilization and produced a generation of extraordinary talents, taught by some of the most influential artists and thinkers of the 21st century.

My Mom, however, was not an artist. She was a psychology major. But she also helped to build BMC’s Lake Eden campus, its second home, as part of the school’s work collective. Collaboration was key to the BMC ethos, perfected in the work program. So was democratic governance by students and faculty. Among Mom’s fondest recollections of her three years at Black Mountain was learning carpentry, pipe-fitting, masonry, and electrical wiring to help build the Studies Building and the college’s farm buildings.

I was immersed in this inspring environment over the past weekend at a conference about Black Mountain, which I shared with our younger daughter. It was a fascinating deep dive into scholarship about BMC, its students and faculty and staff, its unique educational philosophy. We met some truly wonderful people who welcomed us into their circle with open arms. It was also a needed respite from the chaos gripping the world, even as grim headlines tap-tap-tapped on my mind throughout our stay.

Somehow, despite all its many financial struggles, BMC managed to flourish through the Great Depression and World War II as an avant-garde island in the Jim Crow South. The McCarthy era of Red-baiting, as well as changes in GI education funding, eventually spelled its demise. But the cultural and intellectual contributions, as well as the mythology of Black Mountain, live on. I will be processing what I’ve learned for a long time. Already, though, I feel the gravitational pull toward a BMC way of thinking and doing. All good.

Here are some images of our visit to Asheville, the weaving exhibition at the heart of the conference, the former campus, and the stunning Blue Ridge Mountains. Enjoy, y’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.