Living with Scleroderma

Reflections on the Messy Complexity of Chronicity

body-mind balance

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

Making Progress

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As I wrote several weeks back, I’ve restarted taking Pilates. My purple pool noodle adaptation for padding the reformer’s foot-bar did not work, unfortunately (the hollow core was too narrow to fit over the bar), but my instructor found a great alternative—black foam pipe insulation. It’s about an inch thick and just the right amount of squishy protection for my sensitive feet.

So, with that issue solved, I’ve been enjoying my weekly class. The routine varies each week, and sometimes, even though this is a basic level, it is a bit of a struggle. But overall, I am feeling better, my posture is slowly improving, and I’m able to manage more spring tension on the reformer. I can walk up stairs a bit more easily, too. My lower back remains achy and stiff in the morning and when I sit too long at my computer, but it eases up with stretches and movement. My cardiologist has always told me that you can strengthen your heart and muscles at any age, and he’s right (of course).

In fact, I find myself looking forward to class, and even contemplating going more than once a week. (Although after last week’s workout, I really needed a full week’s break to let my body catch up.) The best part of the routine, aside from a sense of accomplishment, is the endorphin boost from exercise. It really does help my moods and relieve some of the mental and emotional stress that is all too present these days.

My other reward, since the studio is near a Whole Foods market, is to pick up some granola cereal and organic fruit, maybe some fresh flowers, too, after class. The first time I went to the intro session (when my shoulder developed a weird tremor), I could barely walk to my car, let alone across the large parking lot to the store. Now, even after an intense workout, I walk the distance easily.

So, progress.

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: Katelyn Perry

Tornado Warning

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On Saturday afternoon around 4:15, I was lying on our living room couch and reading (not light reading, literally and figuratively, an 850+ page history of the Thirty Years War, but that’s another story), when my cell phone alarm went off. Really loud: a National Weather Service warning of potential for a tornado in our vicinity for the next half-hour. TAKE SHELTER! it advised, with more details in all caps.

Now, it was already dark and pouring outside, and we’d experienced a bright flash and loud crack of thunder a few minutes earlier. A severe storms was definitely passing through. But tornado watches are rare in New England, let alone a tornado warning. (Years ago when I lived in Illinois, I never got used to all the watches and warnings, and tornadoes were my dream metaphors for anxiety, but all that ended when I moved back east.) Being the more cautious of the two of us, I checked with Al, who was immersed in another activity, to be sure he’d heard the alert. He shrugged and went back to what he was doing.

I went downstairs with my heavy book to read. Since our daughters moved away, our basement family room is really now a junk room for storage, but there’s still a couch and decent lighting. It’s musty and needs a good clean-up, one of my perpetual to-do’s that I mean to get to this winter (there, I’ve put it in writing). Part of Al’s old vibraphone was lying on the couch, so I rolled up the wooden tone bars, moved them to the side, then picked up the strip of metal resonator tubes, to do the same, lost my balance and fell. Fortunately, I fell on a rug (mostly), but I banged my knee on part of the vibraphone. Which was not fun.

There’s a small, high window in the room, and it was quite dark outside. I could hear the rain, but no thunder or lightening cracks. So I read and checked the time and read and finally went upstairs at 4:45. Al was still immersed. I got an ice pack out of the freezer for my knee and went back to my history book on the couch. I felt kind of silly, but so be it.

Until I learned, not long after, that a tornado had actually briefly touched down in a suburb not far from us at exactly 4:15. Known as a “spin-up” or “land spout” by meteorologists, it was relatively small and lasted only a few minutes. But the damage was significant. In that brief visit, it uprooted and destroyed numerous large trees, including some oaks, which are among the sturdiest trees in this part of the country.

Which just goes to show that you never know what’s just around the corner, and that it’s worth being cautious when the NWS sends you an all caps warning about approaching storms. Especially in this time of severe weather, I’d rather sit in our musty family room for a half-hour than risk a tree falling on our house. If I get my act together, the next time this happens, our old family room will be a much more pleasant space to wait it out.

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: Greg Johnson

A Great Way to Start the Day

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Labor Day is past, the school year has begun, and red-orange sugar maple leaves are drifting to the ground. Here in our Fair City, it is preliminary Election Day, when we have the option to narrow the field of candidates running for at-large seats on our City Council. Fourteen citizens have thrown their hats into the ring for six seats.

I doubt if many people will take advantage of the opportunity to vote. This isn’t a flashy election, with the high stakes of the upcoming Mid-Terms next year. But it’s important. Our city is in the midst of a development boom, with affordable housing options evaporating for renters. Roads need repair and repaving. Our public schools need attention. Climate change is affecting every aspect of our lives. State funding is tight, and federal funding, even tighter now. Several times over the past year, City Council meetings have been disrupted by raucous protests over international headlines. Whom we choose to guide our city through these tumultuous times matters.

So, yesterday, on Labor Day, when I took the day off to start a new sewing project, I first drove down to City Hall and deposited my mail-in ballot to the drop-box outside the back entrance. I would have mailed it, but I missed the deadline and wanted to be sure it was received by close of business today.

It took me a while to complete the ballot. I didn’t know a lot about some of the new candidates, so I read through a series of profiles on our local newspaper’s website. Honestly, it was impressive. I find it very moving, when so much seems so dark these days, that idealistic citizens still want to serve our city. The role of City Councilor is not easy. The issues are complex, people are demanding and often not forgiving of human foibles, and the hours are long, for a nominal salary. Everyone on the Council has a full-time job elsewhere.

Perhaps it would have been just as simple to vote in-person at our local polling place today. But I like the convenience of the mail-in ballot, to be able to vote on my own schedule. There is nothing complex or mysterious or fraudulent, as some claim, about the process. We use paper ballots, whether in person or mail-in. The only difference is how the ballot is collected.

Throughout election season here, yards are dotted with candidate signs. Already I’ve seen candidates standing at major traffic intersections, holding up posters and waving to passing cars. Our mailbox has been stuffed with oversized postcards, touting candidate qualifications. We’ve answered the doorbell several times to people canvassing for their person. It’s a local tradition, this old-fashioned, down-to-earth effort to gain name-recognition in the build-up to November 4.

On my way downtown, traffic was light. Street meters on Labor Day were free. The whole round trip, including parking and walking to the drop-box and back to my car, took no more than 20 minutes. And it gave me a boost—an excellent way to start the day.

Whenever I vote, whether in a local run-off or a national election, I always feel better afterwards. In our democracy, voting is both a right and a privilege that I never want to squander. Every vote counts, especially at the local level. If you have the option to participate in your own community today, please do.

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.