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Reflections on the Messy Complexity of Chronicity

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Taste

Tale of the Tooth

Evelyn Herwitz · September 9, 2014 · 2 Comments

I hate going to the dentist.

It’s not that I don’t like the professionals who take care of my teeth. They are all wonderful, dedicated people. It’s just that there is no easy way for anyone with adult-sized fingers to maneuver around my teeth and gums without painfully stretching my mouth. The skin around my lips is simply too tight for me to open wide.

So, this past week, I was not looking forward to the visit to my periodontist for an implant—the second step of three to replace a molar lost this past spring to root resorption, a rare and very frustrating, painful complication of scleroderma.

This is the second time I’ve had to have a tooth replaced because the root resorbed. The last episode occurred maybe five years ago, and the tooth came out easily because most of the root had dissolved. But drilling to create room for the post was awful—I apparently have a dense jaw, a good thing. However, it took what felt like an hour to drill deeply and widely enough to accommodate the post. Even my periodontist remembered the ordeal.

I prepared for the appointment by shoving it out of my mind. Extracting the tooth back in the spring was no fun at all. It took more than an hour of drilling, breaking the molar into segments to get it out, long roots and all (the root had resorbed sideways into the nerve, rather than lengthwise).

Tuesday arrived, and I was even a few minutes early for my appointment. But construction work in my periodontist’s office building over the Labor Day weekend (so much for Labor Day) had left the practice with no running water when they arrived in the morning, and resolving that issue delayed all appointments. So I buried my nose in a fashion magazine as a distraction.

An hour later, it was finally my turn. Time to lie back, with my head lower than my feet, stare at the ceiling and await Novocaine. Always at this point in any dentist visit, when I know they have to stick needles in my gums, I have to focus on my breathing to manage my panic impulse.

Fortunately, they used a topical anaesthetic, first, which reminded me of Smith Brother’s cherry cough drops (used to love those as a kid, but no more). It dripped into the back of my throat, giving me the icky sensation of not quite being able to swallow, but it successfully numbed my gums enough to reduce the bee-sting pain of the Novocaine shots. Soon the slicing and drilling began.

This is where things got dicey. My periodontist is a real pro, and he understands the constraints of my mouth, but there is just no way to avoid pulling at the corners. Between the tools and the drill and the suction and probing fingers, I was stretched to the max, with no give. It hurt, even with Vasoline on my lips to ease the strain.

Mercifully, this time the drilling went more easily, and the whole procedure, from shots to stitches, took about an hour. I drove myself home, my mouth still very numb, walked in the door, got changed into comfortable clothes, swallowed a Vicodin, got an icepack for my jaw (even with Raynaud’s, this felt good, surprisingly), and lay down on the couch for the rest of the afternoon.

By the next day, I was able to manage the pain with just Tylenol and Ibuprofin. A week later, the swelling is virtually gone, most of my stitches have dissolved, and the gum is healing well. The tears at the corners of my mouth have healed, and I feel almost back to normal.

So, I’m grateful. The procedure is costing a small fortune, because our dental insurance barely approaches the total, but I’d rather have a molar than a gap in my jaw. I’m glad I can have an implant and a crown (that step will wait another three to four months for total healing) rather than dentures, which would be a nightmare with Sjogren’s dry mouth.

A few other teeth are resorbing, but I hope they will take their own sweet time. Meanwhile, much as I hate going to the dentist, I’m sure glad I went.

Photo Credit: purplemattfish 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.

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Filed Under: Body, Mind, Sight, Taste, Touch Tagged With: dental implants, tooth resorption

State of Mind

Evelyn Herwitz · July 22, 2014 · Leave a Comment

It’s finally here, a week when Al and I kick back and take advantage of all that New England has to offer in the summer, beautiful and fascinating places that other people travel miles and miles to visit, but just happen to be within a few hours’ drive of our home.

We got into summer day-tripping a few years ago to economize, and now it’s become a highlight of the year. We started off on Sunday with an afternoon in Boston’s South End, browsing stores and artist lofts and outdoor booths filled with all kinds of crafts, a massive indoor vintage market (read, upscale term for flea market), plus a farmer’s market.

Strawberry Banke 7-21-14On Monday, we drove up to Portsmouth, N.H., to Strawbery Banke, a living history museum covering four centuries of life in one of that city’s oldest communities. Period homes are surrounded by heritage gardens, including one with a children’s tea party set amidst fanciful fairy houses.

I wouldn’t mind living there for a while. In the fairy garden, I mean.

Even as I’m enjoying the break from routine, the glorious weather so far and discovering regional treasures, I’m having some trouble separating out from what else is going on in the world. When you leave your home for a period of days or weeks, it’s easier to take a complete mental break. This is essential to recharging and relaxing, so critical to maintaining health and well-being.

But I can’t seem to tear myself away from following news in the Middle East. Trying to set a limit, but I feel compelled to keep up, even as I find the developments so stressful. Too much is at stake.

So I was grateful to find an oasis of peace right here in our hometown Sunday night. A few years ago, Al and I decided to initiate an interfaith dialogue between our synagogue and a local mosque. Since that time, members of both our communities have studied texts together, broken bread and come to understand how much our faith traditions have in common.

Weeks before the most recent hostilities broke out between Israel and Hamas, our friends at the mosque had invited us to join them for a Ramadan break-fast. And so, this past Sunday evening, a group of our congregants and our rabbi went to the mosque and shared in a study session about the meaning of the Ramadan fast. We explained fasting in our Jewish tradition. We asked questions. And we learned, once again, how much we have in common.

What made the deepest impression on me, as I listened, was how both Ramadan and Yom Kippur are intended for introspection, self-improvement, mending relationships, bringing goodness into the world and drawing closer to God. Both faith traditions are deeply committed to peace.

I will carry that awareness with me as I follow the news and pray that the best in both sides will prevail. And I’ll try to create my own inner space of peace, appreciating what is good and beautiful all around me, as I take a break from headlines, deadlines and most of my responsibilities for a week. The alternative is to wear myself out, and that won’t do anyone any good, especially me.

After all, vacation, no matter where you are or how you do it, is really only a state of mind.

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.

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Filed Under: Body, Hearing, Mind, Sight, Taste Tagged With: body-mind balance, mindfulness, resilience, vacation

And I Didn’t Get Sick

Evelyn Herwitz · July 15, 2014 · 2 Comments

Sitting in St. Louis’s Lambert Airport on Monday morning as I type on my laptop, watching fellow passengers gather at my gate. Surprisingly, some people are actually sitting and talking with their neighbors, rather than burying their noses in cell phones or tablets. One woman is reading a book. As in, the kind made out of paper.

photo-1But plenty of others are typing on laptops, like me, or talking business on smartphones (loudly—don’t they know others are listening?) or texting or checking emails or playing games on tablets. There are comfy armchairs next to electrical outlets to accommodate all our gizmos. I have managed to get everything into my carry-on and purse, so no worries ahead about losing luggage. I’m getting better at air travel since my trip here last year, when my return flight connected through JFK and my checked bag disappeared for 24 hours.

Despite Midwest heat and humidity, the sky is robin’s egg blue with puffy cumulous clouds. A pleasant end to a lovely weekend with my older sister and family, including a visit to the exquisite St.Louis Art Museum, great meals featuring my brother-in-law’s home-grown vegetables, an al fresco Italian dinner, Shabbat services at a local congregation that felt just like home, sharing the Cardinal’s ups and downs against the Pirates and the Brewers, a Sunday brunch with friends, the World Cup finale, and a drizzly performance of Gershwin’s Porgy and Bess at the outdoor Muny Opera (one hour rain delay halfway through Act 1, and the show was cancelled before the last three songs due to approaching thunderstorms, but even so, the music and acting were terrific).

The highlight of our weekend together was hearing my sister, a talented flutist, perform wonderful music with her woodwind quintet at a local bistro. That, and sharing old family stories. “Are you making that up?” she asked me, laughing, since I can always remember more about the past than she, even as we’re both getting a bit fuzzy about recent events. Ah, the power of longterm memory.

Travel remains a challenge—inevitably, the bandages on my finger ulcers get messy and loose, and I need to manage my energy and joints. Getting through security is exhausting, with all the lifting and sorting, organizing purse, shoes, laptop in gray rectangular buckets and then reorganizing everything quickly so as not hold up the person behind me. But fellow travelers have been very helpful, especially with hoisting my bag into the overhead storage bin and retrieving it. And so far, no one’s been too pushy or impatient.

I also decided to pay extra to fly direct this time, to save wear and tear on my body. Definitely the way to go, when possible. So much less stressful, all around.

Best of all (though perhaps I’m tempting fate, here), I have not gotten sick on this trip as on previous ventures in the recent past. No infected ulcers. No cellulitis. No cold virus. No eye infection. No rotten tooth. My worst physical ailment has been reduced hearing and stuffy ears for about 12 hours after landing. All good, and encouraging.

Travel doesn’t always have to mean setting myself back. It can just mean having a great visit with my Big Sis.

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.

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Filed Under: Body, Hearing, Mind, Sight, Taste, Touch Tagged With: travel, vacation

#19

Evelyn Herwitz · May 13, 2014 · Leave a Comment

Friday afternoon, Greenwich Village. Al and I squeeze into two remaining back row seats of a tiny, darkened theatre at the IFC Center just as the previews end. The acclaimed documentary is Manakamana, a mesmerizing character study of pilgrims traveling to and from a Hindu temple in Nepal via cable car. This is first on my list of things to do on our big weekend celebration of my 60th birthday and Mother’s Day. I’ve been looking forward to this trip for weeks. And I have a toothache.

Central Park Bass 5-11-14I have a rare complication of scleroderma: The roots of some of my teeth are resorbing. So far, I’ve had a couple of back molars extracted and a front molar replaced with an implant. My dentist and periodontist have been monitoring the relentless deterioration of several other molars, since. The worst one, lower left, has been hanging on for five years, occasionally oversensitive to cold, but manageable. If it had a name, it would be Grumpy. But it only has a number, 19.

A few days before our trip, 19 was acting up. I assumed it would calm down with careful tending, per usual. But as we drove closer to NYC Friday afternoon, the twinges were becoming more persistent. I tried to ignore it.

A couple sits shoulder to shoulder in the cable car. He wears a traditional peaked cap, shirt and vest, and carries a live rooster. She wears a red blouse and necklace of green beads. Her face is shriveled. She leans with her arm over the back of the seat, exhausted. He checks his watch. As the car rides higher and higher above terraced corn fields and sal forests, she brightens. It’s fun to go to the temple, she says. It’s good to go out when you can.

As we leave the theatre, I realize that not only is 19 aching, but the pain is also traveling into my left ear. I can’t believe this is happening. I’ve come prepared with my pharmacopia of meds, but I don’t want to deal with a rotten tooth on my birthday weekend. It’s drizzling. We sit on a bench outside a bakery to sort out options. I don’t want to ruin everything we have planned, and I certainly don’t want to waste time in an ER or try to find a dentist who may not take our insurance. So we agree that I’ll try to manage the pain with my meds, wait and see.

Later that night, after a great meal (despite 19) of wine and risotto, enhanced by Al’s magical ability to find interesting people (across from the cafe, at an artist’s opening in a church gallery, we shared Shabbat candle lighting and kiddush), I lay awake, unable to sleep in strange surroundings. My mind travels back to the film.

Three young long-haired men, all dressed in black, joke and fiddle with their digital cameras and cellphones as the cable car travels up to the temple. It feels like we’re going up steps, says the one in the middle. My ears keep popping. They pose for each other’s selfies and play with a scrawny kitten. People ski on hills like this in other countries, says another. What if the cable broke and we fell, laughs the third. 

Despite a fitful night, I get just enough sleep to go ahead with our plans for the day. So far, 19 is achey but manageable. It’s warm and the sun is shining. We attend Shabbat services at B’nai Jeshurun on the Upper West Side, then take a long stroll through Central Park, watch turtles sunning by a pond and wander through the Shakespeare Garden. I lie down on a bench while Al explores. People row on the lake, others play softball. Horse-drawn carriages clop along the road. The skies open up and we take refuge in the Museum of Modern Art–Al’s first-ever visit. I’m weary but elated to view these stunning works once again and watch Al’s enthusiastic response.

It’s still raining when MoMA closes, but we find a great restaurant right next to the Broadway theatre that is our final stop for the evening. I’m revived by the meal and we finish just in time to pick up our tickets for After Midnight, a revue of Cotton Club jazz from the ‘30s, starring Vanessa Williams. The music, singing, tap dancing, costumes are spectacular. Even from the very last row of the rear mezzanine, we can see everything perfectly. Exhausted, I sleep through the night, grateful that 19 has not gained the upper hand.

Three women sit in the cable car, dressed in bright colors and beads, their hair white, their faces gnarled like the bark of ancient trees. They talk about how their husband couldn’t come because he twisted his ankle while carrying a bucket of water he had drawn. They nod and look out the glass windows of the cable car, admiring the view. Life is so much easier than it used to be, one says. We had to struggle to survive.

Sunday is warm, beautiful. We enjoy a hearty breakfast in a little cafe, a stroll to the East River, and then head to the Brooklyn Botanical Garden for a glorious walk beneath blossoming cherry trees. Next door, at the Brooklyn Museum, we immerse in the works of dissident Chinese artist Ai Weiwei and so much more. I make sure to take my pain meds on time, to keep 19 in check. We reluctantly depart for home when the Museum closes its doors at six.

On Monday, I call my dentist and get a late afternoon appointment. The x-ray tells the story: There is a round gray shadow over the molar’s left-branching nerve. The resorption has exposed it. Nineteen has to go. It will take six to nine months after the extraction to complete the implant. Not surprised, I accept the bad news reluctantly, rub my achey jaw and drive home. At least the procedure will get split between this year’s remaining dental insurance and the next.

Two men sit in the cable car, each holding a stringed instrument and a bow. The older one looks out the window and recalls walking over the hills below to get to the temple, before there were even paths. We should tune up, he says to his younger companion. As the cable car descends, they watch treetops pass while playing a rhythmic folk melody, round and round and round.

 

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.

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Filed Under: Body, Hearing, Mind, Sight, Taste Tagged With: body-mind balance, managing chronic disease, resilience, tooth resorption

Six-Oh!

Evelyn Herwitz · April 22, 2014 · 2 Comments

It’s official. I’m now in my seventh decade. Last Friday was my birthday, the big 6-0.

hydrangeasI’ve actually been looking forward to this milestone. First of all, 60 doesn’t seem nearly as old as it once did. Funny how that works—when you finally get here, the view is longer, deeper, more nuanced, not the caricature of feebleness that I envisioned when I was young. (Of course, my twenty-something daughters have had a field day, teasing me about senior moments. Mostly, I’ve laughed.)

Second of all, 60 feels like an accomplishment. I’ve been living with scleroderma for more than half my years, now. It is certainly wearing, exhausting and painful at times, frustrating, angering to feel gradually more limited in how much I can do with my hands or accomplish in a day. Each year brings new medical challenges.

But I’ve beat the odds on longevity and developed strong coping skills and plenty of resilience. I may have achieved this, anyway, with age, but I believe this complex disease has also taught me a lot about patience and persistence that I might not have learned otherwise. For a 60-year-old with scleroderma, I’m doing damn well, thank you very much, and I intend to do my best to keep it that way, whatever this disease throws my way.

So, I was looking forward to a celebratory day off on Friday, devoted to art—my own fiction writing and a trip to the Worcester Art Museum.

My body, however, had other ideas. Thursday afternoon, on my way home from a routine check-up with my Boston Medical rheumatologist, my joints began aching and I was flashing hot and cold in the car. My stomach had been irritated all day, from, I assumed, too much matzo for Passover.

I ascribed the joint pain to skipping my Ibuprofen due to the irritated stomach. After a light meal, I felt a bit better. That is, until evening, when I was dozing on the couch and suddenly felt like I was going to pass out. Thankfully, Al was home to help.

And that is why I spent my birthday flat on my back, sipping only water, trying to let my GI tract heal from what was by then, obviously, a virus. This was not the day I had planned.

I was determined, however, not to let a most unwelcome stomach virus ruin everything. So I wrote on my laptop and finished revising a short story that had been languishing for more than a year. That, plus greetings and gifts from family and friends, two beautiful hydrangeas that Al had brought home the night before and a cuddly stuffed turtle that he gave me that evening (nothing like being babied when you’re feeling crummy) helped to salvage the day.

I’m writing on Sunday, sitting at my desk again, able to eat very bland foods, looking forward to joining a group of good friends for dinner tonight as we begin the last two days of the Passover holiday. The art museum is closed for Easter Sunday, so I’ll postpone that visit a bit longer, keep it as something to look forward to. In May, Al and I will celebrate my birthday with a weekend in Manhattan.

Much as I wish it had all gone differently, somehow, it seems, this is what 60 is all about—taking the imperfections in stride, making the most of each day, whatever your state of health, appreciating the love of family and friends. And, for me, making art. Time to get over the fear-of-rejection hurdle and start sending out those short stories for publication.

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.

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Filed Under: Body, Mind, Taste Tagged With: body-mind balance, managing chronic disease, resilience

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About the Writer

When not writing about living fully with chronic health challenges, Evelyn Herwitz helps her marketing clients tell great stories about their good works. She would love to win a MacArthur grant and write fiction all day. Read More…

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I am not a doctor . . .

. . . and don’t play one on TV. While I strive for accuracy based on my 40-plus years of living with scleroderma, none of what I write should be taken as medical advice for your specific condition.

Scleroderma manifests uniquely in each individual. Please seek expert medical care. You’ll find websites with links to medical professionals in Resources.

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