Living with Scleroderma

Reflections on the Messy Complexity of Chronicity

Touch

Best Vacation Ever

· · 2 Comments

As a child, I used to watch a public TV program about Japanese brush painting, and I learned how to paint the images that the artist demonstrated. It has been a dream for decades to travel to Japan. And so, for two weeks in June, Al and I made that dream come true. Back home since Thursday night, after a phenomenal trip—strenuous, but worth every minute.

We flew from Boston to Montreal, stayed overnight, then made the 12-hour flight to Tokyo, where we stayed for a couple of nights in a ryokan, a traditional Japanese inn with tatami mats as flooring and a futon bed on the floor. Then it was on to Kyoto by the Shinkansen bullet train. Our accommodation there was a rented home in a family neighborhood, lovingly preserved and decorated. The bedrooms were up a narrow staircase hidden behind a sliding bookcase.

We spent five days in Kyoto, which included a day trip to Nara, the ancient capital of Japan where deer are sacred and roam free. Then we took a Shinkansen to Hiroshima, where we stayed in another traditionally decorated apartment in a residential neighborhood. Our time there included a powerful visit to the Hiroshima Peace Memorial Museum, which commemorates the victims of the atomic bomb attack on August 6, 1945. We also took a day trip to the nearby island of Miyajima, home to UNESCO World Heritage temples and shrines. Then we moved on by train and ferry to spend three days on the island of Naoshima, known for its art museums and galleries. On our way back to Tokyo, we caught a glimpse of Mount Fuji.

Yes, it was another of my super-charged itineraries. We saw exquisite gardens, ancient temples and shrines, museums, shops, street life, and navigated the food scene. Google Translate was a huge help, both for speaking with people and translating signs and other text.

I will be thinking about this trip for years to come. It was inspiring, transformative, and, yes, challenged my physical endurance. But I am so, so glad we went, as is Al. Here are some pictures. 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.

Yes, You Can Get TSA PreCheck Without a Full Set of Fingerprints

· · Leave a Comment

Memorial Day weekend is over, so that means unofficial summer has arrived (even if it doesn’t feel that way on a chilly afternoon). Al and I will be traveling again soon, and I am looking forward to getting away.

In preparation, I was at AAA recently and noticed a sign for TSA PreCheck®. Unbeknownst to me, our local AAA can do those applications. I had always thought that I had to go into Boston’s Logan International Airport to apply, a major disincentive.

The main reason I had never applied, however, was that you need to be fingerprinted. With all my bandages and skin grafts on my fingers, I thought that was impossible, so why bother?

So I asked about it. And it turns out that the process can accommodate people with hand disabilities. Which had never occurred to me, but is both obvious and appropriate. I made appointments for both of us, and last Monday we went to AAA to apply.

To do the fingerprints, they use a huge tablet. You need to press your fingers onto the screen, and as long as enough of an image is captured, you’re all set. Even if your fingerprints don’t work, or you are missing the primary fingers they want to use (thumbs and index fingers), they can enter an explanation that by-passes the requirement.

In my case, thumbs were out (bandages), as was my right index finger (bandage), and the left index finger is too bent to lie flat on the tablet. But they were able to capture prints from my ring fingers and pinkies on both hands.

A few days later, we received emails that our applications had been accepted. Now we have our TSA PreCheck ID numbers, which I just have to enter on our airlines reservations. Who knew it would be this easy?

I’ll be taking a break over the next few weeks and will have lots to report later in June. In the meantime, be well, Dear Reader.

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: Arthur Mazi

Gut Feeling

· · 4 Comments

For months, now, my gut has been unhappy. Al and I both got the flu over the winter, and ever since, I’ve been having diarrhea most days, often several times a day. This is not a new issue, and I’ve discussed it at length with my Boston Medical rheumatologist, who has explained how scleroderma affects the intestine, slowing it down so that you get bacterial overgrowth. I have gained relief for decent stretches of time from antibiotics, particularly Cipro, which seems to solve the problem.

However, I recently saw my new GI specialist at Boston Medical—an appointment that took months to get—who ordered a battery of tests to get to the bottom of it all (no pun intended). He is very reluctant to prescribe Cipro, because he doesn’t want me to develop resistance to it. He prescribed a different antibiotic that is specifically for bacterial overgrowth in the intestine, but even with my insurance, it cost several thousand dollars for a few weeks’ treatment. I couldn’t afford it, and so I didn’t fill the prescription, and told him so. He understood.

Now I have to go through all the tests and get results before our next appointment. So far, a blood test ruled out Celiac. I have a breath test for bacterial overgrowth later this summer, which I was supposed to do in April, but I had to take antibiotics for an infected ulcer a couple of weeks before the appointment, and that violated the 30-day period prior to the test of no antibiotics. In August, I have an upper endoscopy. And last week, I did a barium swallow, a test I haven’t done in decades.

I figured that there might be some changes in the process or equipment since the last time, and there were. The barium drink wasn’t delicious, but it wasn’t as vile as I remembered. Which made drinking three-and-a-half cups of it tolerable. The most interesting part of the test was that I could actually see the progress of the barium through my digestive tract on the black-and-white fluoroscope and discuss it with the radiologist in real time.

To everyone’s surprise but mine, my first sip of barium got stuck in my esophagus, hanging there on the screen like a black, sagging water balloon. It matched the familiar sensation of swallowing bread and having it just sit there. I always drink a lot of fluids when I eat, and, of course, drinking water finally helped the barium to begin to trickle into my stomach.

The team began discussing various strategies to finish the test, because the plan was to see how barium traveled through my intestines, as well. Given my slow start, they were anticipating many hours. But fortunately, once I drank more barium (three cups!), everything started to move. When they checked the fluoroscope a half-hour later, the solution had moved well into my stomach and intestines. I was free to go home.

The test results were pretty positive. Apart from my sluggish esophagus, a known scleroderma issue for decades, everything else was fine. And once the barium passed out of my system (it took about two days), my gut settled a little. But not a lot.

I’ve lost about eight pounds since I had the flu—one way to get rid of some age-related weight gain that I’d just as soon as do without. But I don’t recommend this way of losing it. I’m hoping things will stabilize sooner than later. And that the rest of these diagnostics go well and provide some direction.

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: Mika Baumeister

A Day in the Life

· · Leave a Comment

I’m heading into one of those periods when I have at least one and often two or more medical appointments each week for several weeks. Last week I met with our PCP to evaluate my sore back. Turns out it’s not a pulled muscle; it’s sciatica. Ugh. Treatment remains the same—lidocaine patches, OTC pain meds, heat or cold as needed, gentle stretching, no heavy lifting, rest, rest, rest. I’m slowly improving, able to sit and write at my computer again and drive longer distances, take walks. Sleeping soundly. All that is good, but I wish it would just go away.

My resilience was put to the test the next day, when I had to get up very early to drive in rush hour traffic to Boston for a 9:00 a.m. echocardiogram to assess my pulmonary hypertension, followed by a later morning appointment with my cardiologist. I did okay on the long drive, knowing from experience that I could lie down and doze during the echo, depending on how the tech handled the ultrasonic probe. Fortunately, he had an excellent, light touch, and I was able to rest for most of the half-hour procedure.

I found a cafe not far from the clinic and roused myself some more with an excellent breakfast. Then, after getting my sense of direction mixed up and walking a few blocks the wrong way (more tired than I thought), I realized my mistake and walked back to the clinic with 10 minutes to spare for my next appointment.

I was led to an exam room right on time for an ECG. But my cardiologist was backed up, so I was sent back to the waiting room for a while. Maybe a half-hour later, I was ushered into an exam room again, only to sit and wait for another half hour or so. This is when my iPhone is a necessary companion. I kill a lot of time in waiting rooms doing The New York Times crossword and other puzzles.

At last my wonderful cardiologist arrived, apologizing for the delay. Turns out there was a crunch of patients who showed up all at the same time. In any case, we reviewed my echo preliminary results, which were stable. Always reassuring. Pulmonary pressures were good. He noted, as he has previously, that I have some fluid around my heart, a bit more than is normal, which he attributed to some stiffening of the heart muscle due to scleroderma, which apparently impedes normal fluid absorption. Nothing to worry about, but important to track. He ordered some blood work to rule out any inflamation. We compared notes on sciatica. He’s lived with numbness in his left leg for years.

Then it was down to the lab for a blood draw. I had some other tests for my new GI specialist from a previous appointment that I could not complete at the time, so I took care of all that. The phlebotomist’s name was also Evelyn, so we bonded and chatted about our different nicknames (she goes by Eva and I, by Evie). I informed her that I have small, rolling veins, which can be an issue for getting stuck easily, and she used a butterfly needle, a good thing, because there were six vials to draw.

That accomplished, I drove home, which only took an hour, given no traffic midday, then stopped at the pharmacy to pick up a refill. By the time I got home, seven hours had elapsed since I’d left. I plugged in my heating pad and took a much needed nap, which enabled me to get some work done at my computer later that afternoon.

I’m always grateful for all of the excellent medical care. I’m also grateful when I can have some days off from all those appointments. Sleep is essential. Pacing is everything.

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: Jackman Chiu

Aging Grace

· · Leave a Comment

I turned 72 on Saturday. It was a birthday when I felt my age more than I would have liked. A couple of weeks ago, I aggravated an old lower back injury, trying to do more than I should have. Thought it was resolving, just a bit sore. Then on Wednesday afternoon, after I got back from driving once again into Boston environs to take care of my loose crown (yes, it’s finally tight and stable!), after I sat at my computer for several hours, when I tried to get up, I could hardly stand.

What the . . .  ?

It was really quite astonishing. I couldn’t get up easily or sit without pain, couldn’t walk without pain, couldn’t bend over. Called our PCP’s office and spoke with one of the nurses, asked what to do and if I needed a PT referral. She promised to get back to me, but for whatever reason, I did not hear anything, so I called the coverage after hours. That nurse, who, from background noise, appeared to be working from home and a bit distracted, nonetheless read me the notes I hadn’t received: warm compress, lidocaine patches, heating pad, rest, gentle stretching, OTC pain relief. I knew all that already, for the most part, having been through this a few years ago. But followed her suggestions.

Spent the next few days mostly on my back with a heating pad. I was able to visit with friends on the afternoon of my birthday, a very welcome break, and then go out to dinner with Al that evening, but scrapped our plan to see a play matinee on Sunday because my back felt worse again. We’ll make up for it another time.

By Sunday evening, I realized that part of the problem could be the memory foam topper on the bed, which I hadn’t flipped in months—necessary to keep it from getting too squishy, because soft bedding is not good for my back. So Al helped me remake the bed, and Monday morning I was feeling a bit better again. As I write this at my desk, I have the heating pad on my back.

Our geriatrics team called me late last week to follow up and set an appointment with our NP to make a home visit on Wednesday. So that will be my opportunity to review progress and figure out the PT question. I’m glad she can come here, one less drive and office waiting room to sit through. I’m feeling more confident that this, too, shall pass, as my mom used to say (an aphorism that used to drive me crazy, but bears remembering).

Above all, I realized that this birthday’s lesson was all about patience and being realistic about my limits. The older I get, the more relevant it becomes to remember that I need to set some boundaries for myself, even as I do my best to stay healthy and strong. My body is aging, all the more so with scleroderma, and that is just how it is.

At moments like these, I hear T.S. Eliot in my head, from The Love Song of J. Alfred Prufrock:

I grow old . . . I grow old . . .
I shall wear the bottoms of my trousers rolled. 

Here’s to another year. May we all age as gracefully as we can.

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: Julien Tromeur