One of the strangest aspects of my scleroderma is calcinosis—a condition that causes small bits of calcium to form under my skin and eventually work their way out. From time to time, a calcium pit will push through, leaving a small hole, like a tiny window into my finger, that fills with new skin in a day or two.
Sometimes the piece is sharp and painful as it migrates to the surface, and other times, it’s just a nuisance, a condition I’ve long learned to recognize and manage with careful hygiene to be sure an infection doesn’t settle into the resulting ulcer. The calcium tends to form at pressure points, in whichever fingertip surface I use the most often.
Over the past decade, calcinosis has also begun to occur in the bridge of my nose, where my glasses rest. I can’t wear contacts, because my eyes are too dry from 
Sjögren’s, another scleroderma complication. I’ve switched to very lightweight Silhouette frames, which are expensive but create barely any pressure. Still, the calcium forms. These pits need to be removed surgically, or I risk ulceration in this very delicate skin that is stretched too thin by scleroderma to heal properly. Not fun.
So it was, last Monday, that I headed in to Boston Medical Center to visit my ENT plastic surgeon, for a consultation about removing yet another calcium pit from my nose. I hadn’t seen him since 2009, when he skillfully extricated the last offender from the inside, instead of having to cut through from the outside. The time before that, I’d seen another surgeon who struggled with my fragile skin when closing the external wound.
He knew me right away—I guess my nose is pretty memorable—and made a quick assessment. The pit was very close to the surface and actually sticking to the underside of my skin. He could remove it from the outside or the inside. It would only take 15 minutes. In fact, he could do it right then. His associate also took a look and concurred. Easy enough to do. How did I want to proceed?
Now, I have never, ever, made a decision to do any kind of outpatient procedure on the spot. Especially on my face. Especially without Al along for moral support and to help me get home in case I got woozy afterwards. But as I sat there, debating and discussing pros and cons with the two specialists, I made up my mind.
It didn’t make sense to extricate the calcium pit from inside my nostril, a much more uncomfortable procedure, since it was stuck and could tear the outer skin in the process. If he cut from the outside, I’d just have a couple of stitches. And if I did it right then, I’d save time.
Yup, that was the bottom line. I really didn’t want to have to come back another day, get psyched up for the procedure, and spend yet a second morning or afternoon dealing with this. Plus, it could be weeks before I’d get into their schedule again, and the pit was stretching my skin so much it could possibly break through and not heal properly in the meantime. So, I said let’s do it.
Four shots of local anaesthetic—like sitting still for a bee sting, was his sympathetic assessment as I winced and grit my teeth—a slice, some grinding against bone and tugging on the stubborn remains of the calcium, a couple of stitches, and he was done in 15 minutes. The removed deposits, which he showed me floating in a little orange bottle that would be submitted to the lab for assessment, were like grains of sand, just like the ones that come out of my fingers. At least I’m consistent.
I felt a bit shaky as I left, but victorious. It was done. And almost routine. Has it really come to this? Even the oddest experiences with this disease are now just a matter of course? Sure, why not cut into my nose while we both have the time and take out the damn piece of calcium. Might as well be practical and just get it over with.
My nose is still healing, but it only hurt for a day. The stitches continue to absorb and will come out on their own. The worst thing that happened afterwards was getting a rotten cold, probably from the ENT waiting room, that knocked me out for the second half of the week. Two calcium pits popped out of my fingers, perhaps out of sympathy for their compatriot. Otherwise, it’s been just another week.
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.
Chronic diseases do not usually rear their ugly heads till we are older. Not so in your case. But I and many of my peers and family members are now dealing with chronic illness, some easier to manage with less adverse consequences. Some can be managed with lifestyle modifications, some with meds with a variety of side effects, Nevertheless, we all seem to be dealing with our own concepts of a new normal. I realize that your blog is not a collaboration, but an expression of your own experiences, but had you asked, I think I would have titled this entry “The New Normal”
Thanks for your comment, Kathy. Actually, the more I write this, the more the themes become universal for me. In some ways, though I write about the specifics of scleroderma, the disease has become a metaphor in my mind for all the ways that our bodies break, and the struggles that ensue. So, I appreciate your thoughts and what you, friends and family are now going through.
We all start out thinking we’re immortal. Then, one way or another, we discover the truth that we aren’t. It’s a shock, no matter the particulars. And a long process of coming to terms with our physical losses.
Although I do have to admit that Outtakes is very clever.
Thanks! I considered calling it “Nose Job,” but decided against it. Too obvious.
“My nose is pretty memorable.” Great line! Of course it’s not really a desirable kind of fame . . . .
I’m kind of shocked, though you probably are not, alas, that your previous surgeon knew how to take calcium pits from a nose but not how to handle the fragile skin there. One wonders who else has such calcium pits other than people with scleroderma, so one would think that if he/she has one skill, he/she has the other. Oh well.
Calcinosis is not unique to scleroderma, but a common complication. It’s often part of a cluster of symptoms that used to be called CREST syndrome–C for calcinosis, R for Raynaud’s, E for esophageal dysmotility (all kinds of swallowing issues), S for sclerosis (skin hardening), T for telangiectasia (irregular, enlarged capillaries). Not sure if that acronym is still in vogue among scleroderma diagnosticians, but it covers a number of my issues.
I think my first surgeon didn’t quite know what he was getting into with my skin, even though he was a well-recommended dermatologist. When I had finger surgery years ago, by a top specialist at New England Baptist, he commented at the end that he hoped to never have to operate on me again, that it was like sewing up onion skin. Scleroderma is rare enough that even the best specialists may not have encountered it. The doc who did my nose the first time was able to sew me up, but left a dark scar. My current doc is a plastic surgeon, as mentioned in my post, and it makes a big difference. The man works magic. I feel very lucky to have found him.