Living with Scleroderma

Reflections on the Messy Complexity of Chronicity

Smell

Progress Report

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A year ago today, I was two weeks away from my second hand surgery to repair damage from severe ulcers in five fingers—damage that had exposed bone and broken two of my knuckles. My left index and right pinky were held together by steel pins, and I didn’t know if I would lose them in the next procedure. My hand surgeon felt that skin grafts were worth trying, but we didn’t know if they would heal properly. He had warned me at the outset that these were the first of many surgeries.

What a difference a year makes! I’ve been extremely fortunate. A gifted surgeon, excellent wound care and 60 dives in a hyperbaric oxygen chamber, plus effective occupational therapy sessions (and health insurance to cover it all), combined with a lot of support from family and friends enabled me to heal.

And I am cooking again. Al had picked up the slack in the kitchen for well over a year, ever since the ulcers became too painful for me to handle any utensils. He cooked up some great meals and discovered that he really enjoyed experimenting with new recipes. I was grateful for all that good and healthy food.

But a part of me missed cooking. It’s never been a major focus in my life. I don’t spend hours pouring over cookbooks and savoring the thought of new recipes. However, I do like making a good meal, especially for the holidays. It’s exhausting, but satisfying to turn out a gourmet, multi-course dinner. It gives me pleasure to prepare food that brings others enjoyment.

At some point over the summer, I began baking bread again for our Friday night Shabbat dinners. Al had gotten quite good at this, and he was deservedly proud of his delicious braided loaves, but he was happy to have me pick it up again. I also was able to help clean up after meals, which had been impossible with the ulcers and ensuing surgery.

The Jewish New Year, Rosh Hashanah, arrived just a few days after we came home from Europe last month. I knew it would be too much to have a big crowd, so we just invited a few close family members for the first night. But, to my and Al’s surprise, I was able to do most of the cooking myself. He served as sous chef, cutting vegetables. Even still, I was able to handle the chef’s knife and do a lot of prep myself. Everyone enjoyed the meal, and I felt like I had crossed the finish line.

I have been doing most of the cooking ever since, although I still have to be careful. I developed an ulcer in one of my skin grafts shortly after we returned from our trip, but I think this was actually caused by some calcinosis lurking just under the surface. It is gradually healing. Al is enjoying a well-earned reprieve, although I recruit him for help as needed.

Mostly, I’m amazed and extremely grateful that I can actually do so much with my hands again. It’s taken all this time to relearn how to use them, and I certainly have my limits. But it’s wonderful to see that, despite all the challenges, my body can truly heal.

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.

Just Breathe

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This past Friday morning, I had double-header appointments at Boston Medical, an echocardiogram followed by a routine appointment with my wonderful rheumatologist, who has been my specialist for at least two decades, now.

My last echocardiogram was done a couple of years ago, one of those tests I have to repeat occasionally to monitor signs of pulmonary arterial hypertension (PAH), a late-stage complication of scleroderma. The only symptom, so far, is extreme shortness of breath if I commence intense aerobic exercising without a serious warm-up. We’ve been watching this for years, now, and I’m on prophylactic medication that seems to be protecting me from worse complications.

Most of the time, the test doesn’t bother me. It’s non-invasive, and, depending on the tech, just mildly uncomfortable. Like I said, depending on the tech. This time, let us say, it was more challenging.

First, the easy part. You lie down on your left side, with your head on a pillow. The lights are dimmed so the tech can see the computer screen more clearly. A transducer, which looks like a short, hand-held rod with a gel-covered rolling ball on top, is pressed against your ribcage, neck and diaphragm, to send high frequency sound waves through your chest wall. It’s like an ultrasound for your heart. The sound waves bounce back to the computer, which translates them into moving pictures of your heart muscle. Occasionally, the tech will turn on the audio, and you can hear your heart beating away, kind of a squishy, pumping sound that seems to reverberate from a deep well.

Now for the hard part. You have to hold your breath during certain parts of the test, so that your diaphragm doesn’t cause your heart to move around and your lungs aren’t so full that they interfere with the heart imagery. I’ve never had an issue with this in the past, but my tech on Friday had a very specific way that he wanted me to empty my lungs, first, and then take in only a small sip of air. Then hold. And hold. And hold. While he pressed really hard with the transducer on my ribcage. I have no padding there. It hurt. And I couldn’t wave my hand or ask, “Can I breathe now?”

I really started to wonder, at a few points, if I would actually be able to hold my breath long enough. Fortunately, each time, just as I thought I wouldn’t make it, he said I could breathe again. It was also reassuring to hear my heart beating when I felt like my lungs would burst. “You’re doing great,” he said. I guess so. Test results will be available this week.

By the end of the half-hour, I was very glad to get dressed and head over to the Rheumatology Department. The sun was bright, the air crisp. As I caught up with my rheumatologist, who, like me, is in his sixties, we chatted briefly about retirement. To my relief, he has no plans of retiring anytime soon. This time, I needed no permission to breathe.

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 Credit: Eric Witsoe

Back Home

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Home from our summer travels for about a week-and-a-half, but already it seems like a long time ago that we were away. That’s the strange thing about vacations. You’re completely immersed in your environs while you’re there, but once you’re back, it’s almost as if you never left.

Which is why I keep a travel journal, and we take plenty of pictures (especially my dear husband). If a tourist walks in a city and leaves without a record, was she really there?

Yes, I was, with Al—in Prague, Bratislava, Vienna and Berlin. Sixteen days, four countries, a crash course in European history, spectacular scenery, wonderful art. This trip was also personal: the bookends of our itinerary were designed to honor the memory of my great grandparents, who were murdered in Eastern Europe during the Holocaust.

My mother’s father, a professor of engineering at the Technische Universität Berlin, saw the writing on the wall in 1935 when he lost his position because he was Jewish. In 1936, after five months of searching for work in the U.S., he was able to find a good job and make a new home for my grandmother and mother. But, despite a heroic effort, he was unable to convince his elderly parents, who loved their homeland, that they should emigrate, as well, until it was far too late for them to escape the Nazis. They were transported to what is now called Terezín, a concentration camp about an hour’s drive from Prague, in August of 1942, and died there in early winter of 1943.

No one in my family has ever gone to Terezín. So, with a private tour guide, we visited the camp and learned details of my great grandparents’ final months. We lit candles in their memory. Later, at the end of our journey, we joined friends in Berlin for the placement of two Stolpersteine, or “stumbling stones,” which are memorial cobblestones placed in the sidewalk next to the home where victims of the Shoah last lived of their own free will. These were powerful experiences for me, which I am only beginning to process and understand. It is one thing to know the history of World War II in the abstract, and quite another to confront such horrors in the lives of your own family.

We enjoyed uplifting experiences, as well: fairytale scenery in Prague, a day trip to Slovakia’s High Tatras amidst the Carpathian Mountains; a visit to a medieval silver mining town, also in Slovakia, one of several UNESCO World Heritage sites that we saw during our travels; extraordinary artwork by two of my favorite painters, Egon Schiele and Paul Klee, in Vienna and Berlin. And, oh, yes, some very delicious food. My hands held up, my feet wore out, but I’m so grateful that we were able to honor my great grandparents’ memory and have another overseas adventure, whatever the challenges—physical and emotional.

Here are a few highlights:

View of Prague Castle from the Charles Bridge
John Lennon Wall, Prague
Mucha stained glass window in St. Vitas’s Cathedral, Prague
Devin Castle ruins, Bratislava
High Tatras, Slovakia
Old Castle fortress, Banská Štiavnica, Slovakia
Belvedere Palace and Museum, Vienna
1936 Olympic champion Jesse Owens’ name carved in the wall of the Berlin Olympiastadion (top left column)
“Landschaft in Blau” (Landscape in Blue) by Paul Klee, 1917, Berggruen Museum, Berlin
The Stolpersteine honoring my great grandparents, Berlin

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.

Tin Man

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Two-and-a-half years have passed since I last had calcium removed from the bridge of my nose, an unhappy complication of my particular variant of scleroderma. So it was that I found myself Monday morning in the exam room of my ENT plastic surgeon, once again assessing what looked like a gray clump just below the skin.

According to my medical records, this is the sixth time I’ve had the procedure over the past 15 years or so (fifth time by this specialist). So I was pretty sure of what to expect.

Except my disease had decided to play a little trick. Instead of the calcium being content to attach to my septum, it had sprinkled itself into the skin, as well. This meant that he would have to remove an ovoid-shaped centimeter of skin above the clump, to excise all the calcium sprinkles as well as the main culprit.

“You’ll have a scar,” he said. I replied that I didn’t care. No worse looking than a gray bulge on my nose, and certainly easier to cover with a little foundation.

The main issue for me was to avoid lidocaine with epinephrine, the local they gave me last time that caused heart palpitations, back pain and a total sense of being out of whack for about 24 hours. He prefers it because it reduces blood flow to the excision, but I’ve had this procedure done enough times before that combo was popular, and I knew it could be done.

The team—a resident, a fellow and my doc—conceded to my request, and we went ahead. Five shots of lidocaine later, the bridge of my nose was numb. I could not feel the scalpel. But as has always been the case, I could certainly feel the grinding of the surgical tools as he scraped away the calcium. Some of the tiny pieces flipped out, one onto the corner of my closed eye, another on my neck. Within about five minutes, he’d removed it all.

Seven sutures and the incision was closed (although, as he was stitching me up, he wondered aloud if the sutures would actually pull the skin all the way back together—which, he added, was not a problem, as a bandage covering the incision would enable it to heal, but this was rather disturbing, as I imagined exposed bone on the bridge of my nose—then he remarked that it was closing up just fine—good grief).

Then came the surgical strips. First some (I believe) antibiotic ointment and one strip. Then some kind of liquid glue that smelled a bit too much like Duco Cement, then more layers of the strips. When they were done, my nose looked like the Tin Man’s from the Wizard of Oz. A little of the glue dripped into the corner of my right eye and burned like crazy.

“I said to keep your eyes closed,” he chided. Thanks a lot. Fortunately, the resident was more helpful with some sterile saline eye drops.

He was also kind enough to give me a prescription for a few Vicodin, after the specialist left the room. (The latter considered pain meds unnecessary and assured me that Tylenol and Ibuprofin would be ample, but I’ve been through this enough times to know that the first 24 hours can be quite unpredictable for pain.)

Al had accompanied me to the appointment, thank goodness, because there was no way I could drive home with a burning eye. It took dozing in the car for an hour plus a two hour nap at home to ease the inflamation. So far, as I write on Monday afternoon, I’ve been able to avoid the Vicodin, but it’s good to know I have it available for sleeping, if necessary. I also took the precaution of consulting with my infectious disease specialist ahead of time regarding taking an antibiotic prior to the procedure and for the next seven days, because I am so prone to infection.

So, now, it’s all about healing. I have to keep the steri-strips on for the better part of the week, unless they fall off by themselves. One is taped to pull up the tip of my nose a tad, to relieve stress on the incision. Eating and drinking feel a bit weird, as a result. I have to be extra careful if I have to blow my nose. But I can sit at my desk and do a little writing. The weather is quite warm, which is best for my circulation. And it’s done . . . at least for another couple of years.

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 Credit: The Tin Man. Poster for Fred R. Hamlin’s musical extravaganza, The Wizard of Oz. Poster print, lithograph, color, 105 × 70 cm. Created by “The U.S. Lithograph Co., Russell-Morgan Print, Cincinnati & New York.” Library of Congress, Prints and Photographs Division. Courtesy of Wiki Commons.

Time Out

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Sometimes I feel as if my head is going to explode from our nation’s vicious politics. So it was a great pleasure and privilege to go with Al to one of our favorite getaways on Sunday, Block Island, just off the Rhode Island coast, for a relaxing Father’s Day. The weather was perfect; the sky, azure with wisps of clouds; the water, emerald and sapphire. I stayed away from my news feeds. Best of all—no crowds. Public school is not yet out, so it was the calm before tourist season begins

I read, watched Al brave 58°F water, walked the beach, took photos and collected stones and sea glass. I got my feet wet, too, even if my toes turned purple. (Added bonus: walking barefoot on wet sand helped me to remove a nasty corn from my left foot that had re-emerged shortly after my podiatrist took it out a couple of weeks ago, a huge relief and boost in my ability to walk without pain.) After supper and some shopping, we sailed back to the coast on the ferry’s upper deck, enjoying a beautiful sunset. Just what the doctor ordered.

Here’s a taste of our visit. 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.