Living with Scleroderma

Reflections on the Messy Complexity of Chronicity

body-mind balance

Try, Try Again

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Every morning, I try to spend a few minutes meditating. I use an app, which is helpful and instructive. My mind wanders as minds do, but I am, over time, getting more adept at slowing down and focusing on my breath.

This came in very handy on Monday, when I found myself back in my dentist’s chair, because my new crown for my fifth implant came loose last week. No so loose that it popped out, but loose enough that it needed immediate attention. Of course, this all happened on New Year’s Eve, when no one could see me for several days. (Why do these kinds of issues always happen on a Friday evening or right before a long holiday weekend?)

In any case, it took two hours of poking and prodding by my long-time dentist, Dr. K, plus several tries to remove the crown and adjust its size so it would fit properly by his partner, Dr. F (she of the smaller fingers and more delicate touch). Ultimately, that did not work. I had been concerned from the get-go a few weeks ago that the crown was too big, and apparently my instinct was correct, because it never seated properly, which is why it loosened up.

So, now I have to return in a few weeks to redo the dental impressions, and then they will order me a new crown. Why didn’t this one fit—a problem I’ve never encountered before, thankfully? It was very hard to take the digital scans, because of my tight mouth, so that might have been the culprit. (For the repeat, we’ll do it the old fashioned way.) Or, as Dr. K surmised, the manufacturer that he’s worked with for years has changed personnel, and his trusted contact who always did things perfectly is no longer there.

In any case, at least there is a solution that I don’t have to pay more for, and the implant itself (what the crown is screwed into) is still solidly in place (my biggest concern). Everyone thanked me for my patience. I was grateful that I could breathe my way through it.

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: Filip Mishevski

Self Pep Talk

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It’s only December and it feels like January here in Massachusetts. Rolling up in a ball and hibernating sounds enticing. It’s hard to get myself out of the house, let alone out of bed in the morning. When I sit too long at my computer, I stiffen and need to rouse myself.

But I know that if I don’t get up and out, I’ll feel even worse. Moving is what keeps me moving, getting blood circulating in my brain and into my fingers and toes.

So, I kept a commitment on Friday morning, even as it was only single digits outside, to go with a friend to a special awards luncheon an hour’s drive from here for a project we’d worked on for our fair city. It was uplifting and fun and just an all-around good experience. On Saturday, I made myself walk, bundled up, to synagogue, and then later spent a pleasant afternoon studying texts with two good friends.

Then on Sunday, Al and I went to Hartford, Conn., to celebrate our 41st anniversary (which is actually today). Why Hartford, you ask, when Boston, with all of its cultural attractions, is just an hour away? Because there is a wonderful art museum there, the Wadsworth Atheneum. We also took in a ballet performance of The Enchanted Toy Shop by a local conservatory and had a really nice Italian dinner after. None of which cost anywhere near what Boston costs, and the street parking on weekends is free.

And, despite 21 degrees outside as I write on Monday afternoon, I’m about to head out to Pilates and to do some errands. And I have my acting class tonight at our local conservatory.

All of this reminds me, even as my instinct is just to burrow under the covers, that I really do better when I stay active—mentally, emotionally, spiritually. Being physical is a real challenge this time of year, but the more I move and keep stimulating my brain, the more those physical challenges seem manageable. As I keep telling myself.

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: Lydia Reclining on a Divan, c. 1882, possibly by Mary Cassatt, Wadsworth Atheneum

Long Drive for a Short Appointment

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This is one of those periods when all of my many and various specialist appointments clump together. I can go for weeks without seeing any of my docs, and then, boom, lots of visits—most likely because they are on similar follow-up schedules, usually four months apart.

I definitely consider myself fortunate to have such an excellent team of specialists, both close to home and closer to or in Boston. But most of my team are at least a 45-minute to an hour-and-a-half drive from home, assuming traffic is light. Which basically kills half a day, between driving, parking, and waiting, plus the appointment itself.

Again, glad to have a great team in place. But what drives me crazy are the 15 minute appointments that require all that driving. As happened Monday, when I had my final follow-up with my excellent periodontist for my latest implant. Or this Thursday, when I need to drive into Boston for a 15-minute lung CT scan, a regular part of my protocol with my BMC pulmonologist who monitors my interstitial lung disease. Could I have this test done at a hospital near home? Yes, probably, but the communication of test results is not always great between providers. So this, in the long run, is more efficient.

Sometimes I’m able to schedule appointments in Boston all on the same day. I have such a plan in place for December when I was able to schedule check-ups with both of my pulmonologists (the other one tracks my Type Two pulmonary hypertension) plus a pulmonary function test. So, this will work so long as one of them doesn’t cancel out at the last minute. Not holding my breath.

Managing a complex disease like scleroderma takes a lot of time and scheduling. After 45 years of dealing with all of this, it’s just part of my routine. But I wish, sometimes, it wasn’t so time-consuming.

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: A n v e s h

Why Me?

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For all of the bad things that happened during the COVID pandemic, the one good thing that happened for me was reconnecting with old friends over Zoom. Five years ago, when we were hunkered down, I looked up friends from my teens and twenties and caught up online.

Some of us have continued those conversations, maybe once or twice a year. And this past Sunday, a bunch of old friends from my high school days shared our lives for a couple of hours. It was funny and poignant and an important touchstone for all of us, to recall where we came from and where we’ve ended up.

One of my friends, whom I haven’t seen in fifty years, shared that her sister had also had scleroderma. She died several years ago from a brain tumor, but lived with significant skin tightening for about 15 years. A number of years ago, I had also learned that the older sister of another classmate had died from very aggressive scleroderma. What are the odds that three women from the same small high school all got this rarest of diseases?

My friend on the call Sunday has wondered if the fact that our school was not far from a nuclear power plant might account for her sister’s illness and other rare autoimmune diseases that run in her family. I have wondered if the two years I spent in graduate school in Pittsburgh, living in a neighborhood on a hillside above the Jones & Laughlin Steel mill, which flushed its stacks every weekend, filling the air with the thick odor of rotten eggs, may have played a role in my disease trajectory.

Researchers still don’t know exactly what causes scleroderma, this formidable autoimmune disease that tricks the body into producing too much collagen that tightens and hardens skin and connective tissue. My rheumatologist at Boston Medical has told me the latest theories point to some kind of virus that triggers the disease process in people with certain genetic predispositions. It is not contagious, and very rare for direct family members to share the disease.

Stress also plays a role in disease onset. Research supports this, although other factors—genetic, hormonal, environmental, and immune system health—are all part of the mix. In my own case, I developed symptoms (puffy fingers, migrating arthralgia, gut issues, fatigue) in my late twenties after my first marriage ended in divorce. I was anxious and running on adrenaline while coming to terms with it all (not to mention the stress of the marriage itself, which was considerable). All that adrenaline flooded my body with cortisol—which at too high levels can damage the body’s immune system.

So, whatever else I was exposed to and whatever my particular genetic mix, that probably set the stage for my getting scleroderma.

If there’s one thing I’ve learned from all of this, it’s to take stress seriously and to do my best not to let it overwhelm me (not always successfully in our tumultuous times). Meditation helps. So does exercise (Pilates, walks, stretching). So does surrounding myself with nature and art and music. Loving family and friends are essential supports.

Recently I was listening to a meditation app that mentioned a Korean custom to eat only until you’re 80 percent full. The idea is to not overdo, to leave room to appreciate what you’ve enjoyed. It provides a good metaphor for living, as well—to engage fully, but not to the point that you deplete your energy (or run your health into the ground). Keep that 20 percent reserve for resting, recuperating, and recharging.

I’ve been thinking about this a lot, lately. I hope it’s a useful concept for you, as well, Dear Reader, especially right now. Take care.

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: engin akyurt

What Happened to Your Hands?

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Recently, a young boy was studying my fingers. “Why do you have so many bandages?” he asked.

“I have problems with my hands,” I answered. For a pre-schooler, that seemed the appropriate explanation.

He looked concerned, or perhaps afraid. “You don’t have fingernails,” he said.

“No, I don’t,” I said. Not exactly true. I have a few left, but they certainly don’t look normal, more like moon crescents. He seemed perplexed, but then he got distracted and that was the end of our conversation.

A friend who overheard our chat checked to see how I took it. “Kids say what everyone else is thinking,” I said. “He’s just curious.”

It really doesn’t bother me anymore when people ask, after all these decades of living with odd-looking hands and way too many digital ulcers, especially since my hand surgery eight years ago that necessitated some partial finger amputations. Most people who know me don’t pay any attention to my hands. When a stranger (often a cashier or someone else I’m handing something to) asks, Oh, what happened to you? or clucks about my bandages, I just take it as a mix of natural inquisitiveness and compassion.

My standard answer is something like, “I have chronic ulcers.” I don’t bother to go into an explanation of scleroderma, because the occasion doesn’t call for a lengthy discussion, and I’d rather keep it simple. Sometimes the person will ask a follow-up, Does it hurt? To which I say, “Sometimes.”

I realize that such inquiries can be much more challenging for those with severely tightened skin. Before my skin relaxed somewhat on my face, hands, and forearms (a miracle, truly, as it was beginning to get uncomfortable to blink in the early years, and the skin on my hands was like leather), people who knew me casually would ask with concern whether I’d lost weight. They sensed something was different, but couldn’t figure out what.

I was very self-conscious during that first decade. When I began to see wrinkles in my forehead again after several years on penicillamine (a since-discredited treatment because research samples involved too few patients to prove a positive response, but I believe it saved my life), I was thrilled. But my hands were already deformed by then.

It wasn’t until I began writing this blog in January 2012 that I started to overcome all the embarrassment that I felt about my appearance. There really is so much more to living with a chronic, deforming disease like scleroderma than your looks or your diagnosis and treatments, although I don’t in any way mean to minimize the very real physical and emotional pain and stress of literally being trapped in your own skin, when scleroderma takes its most virulent form.

What I have learned in my nearly 45 years of managing this disease is that people take their cues from you. The more accepting you are of yourself, the more accepting they are of you. It’s a journey. I’m grateful to be sharing it with you.

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: Alex Skobe