Living with Scleroderma

Reflections on the Messy Complexity of Chronicity

finger ulcers

‘Tis the Season

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April showers (and we’ve had plenty) certainly bring May flowers in my neighborhood. White-blossomed cherry trees and cream-colored callery pears, fuchsia magnolias and pink weeping cherries, along with maples unfurling pale green and purple leaves, grace sidewalks and lawns. White and violet violets speckle lawns that grow lusher by the day. The air smells delightful. With all the rain of late, pollen is subdued, and I haven’t started sneezing, yet.

In keeping with the season, another sign of spring has emerged: I have an infected ulcer in my left thumb. This spiked suddenly last Monday. Fortunately, it’s responding to antibiotics, which seem to be a perennial part of my world at this time of year. A good thing, because I’m traveling this week to New York for a mix of business and pleasure.

As my thumb became irritated, I wondered if I’d aggravated it by typing. Then I realized that I never use it to type. I’ve adapted to so many finger injuries over the decades that I automatically compensate for fingers that can’t comfortably or effectively strike the keys. Which made me wonder: How many fingers am I actually using to touch-type?

This is a bit like asking a centipede how it walks. I really have to stop and notice what I’m doing automatically, which can lead to more typos. But the answer is this: I use my pinky and ring fingers on my left hand, and my thumb, ring finger and pinky on my right. And I can still type quickly enough so that my thoughts translate almost immediately to the computer screen. It helps, significantly, to use an Apple “chiclet” keyboard, which has nearly flat keys with an easy touch, and a minimal rise so it’s easy on my wrists.

When my hands fell apart with severe ulcers two years ago (also in the spring), I learned to use Dragon dictation software to write. It was certainly a big help and enabled me to keep writing. But dictation taps a different part of the brain than writing brain-to-hands, and I will keep typing, even with only five fingers, as long as I can, because it is simply faster and more intuitive.

And so, I am dashing off this entry before I leave on my travels. Looking forward to fresh adventures—and to seeing how the flowers have grow when I come home.

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.

High Wind Warning

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Monday morning. I awake to wind, rushing and subsiding, like an angry tide. A quick check of the weather forecast on my phone reveals high wind warnings all day, with gusts over 50 miles per hour throughout the afternoon. I have to drive into Boston for an evening class. I imagine a tiring commute, fighting the wind, but am determined to go, despite plummeting temperatures.

As I make the bed and bandage my chronic thumb ulcers, I listen to the The Daily podcast by the New York Times. Today’s topic: whoever controls the incipient 5G network, which will integrate all things hooked to the Internet—self-driving cars, smart TVs, home security systems, communications networks, the power grid, artificial intelligence, our brains—will basically control the world. This is the new Cold War. The wind howls outside. I sit cross-legged on the floor, try to quiet my mind and meditate.

While cooking oatmeal and boiling hot water for tea, I call the lab that has sent me two invoices for recent bloodwork stating that we owe $150 because the claims were rejected by our insurance. This happened while our COBRA administrator had not yet told our insurance company that we had renewed our policy back in January, so I have to get the lab to resubmit.

I work my way through their phone tree until I reach the customer service line, which promptly puts me on hold. I put the call on speaker and stir the oatmeal. Winds rush through trees and around corners. I sit down at the kitchen table, sip my tea and begin to eat my comfort food. Peppy music crackles through the phone, interrupted momentarily by a male voice: We apologize for the delay. A customer representative will be with you soon. Your call will be taken in the order it was received.

Over the cycling music, another male voice cheerfully ticks off all the possible lab tests I could consider: prenatal screening with a non-invasive blood test that could inform expectant parents of any chromosomal abnormalities at ten weeks, an eight year risk analysis for diabetes, a comprehensive heart health profile. I wonder about lab test results in a world of 5G interconnectivity. Who will have access to what about me in the future? Who does already?

Eight minutes in, a woman takes my call. She asks for the invoice number, my name, address, insurance policy ID, group ID (name, rank, serial number). I answer. She goes silent. The wind rushes outside the kitchen windows. She tells me to disregard the invoices and that the claims will be resubmitted. I hang up, finish what’s left of my oatmeal, rip the invoices in half and text Al the good news.

I think about the bits of data shooting from my fingers through the Internet to his phone. I think about the digital footprint of this blog, drifting forever in cyberspace. I think about a video clip of three horses galloping away from a swirling wind turbine, seconds before it disintegrates in a powerful storm. As I type, the evergreen boughs of the yew beyond my office window chop and sway in the rushing wind.

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: Benny Jackson

Excuses, Excuses

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My desk is a mess. So is my office. Stuff is being fruitful and multiplying when I’m not looking. Honest.

I blame this cluttered state of affairs on my hands. It’s hard to pick up piles of paper and sort and file, because I’ll inevitably bang my fingers. There’s not enough room to properly store my books. I need to have that stack here and this stack there for easy reference. Right.

Then again, I like having lots of interesting stuff around me when I work. There are my little turtle statues to play with. And a bronze T-Rex that I got when I was maybe five years old at the Museum of Natural History in New York. And a cube that I can rearrange to show various paintings by Edward Hopper, depending on my mood.

Of course, I must have at least two pens nearby and a red marker and yellow highlighter and pencils to keep track of my work progress in my handy Bullet Journal. (Yes, I’m addicted.)

And how can I NOT have that pile of reference books on the side of my desk? Or those mail solicitations that I need to remember to follow up? Or those really cool beads that I bought on sale last week to string into a necklace?

Then again, it would be nice to have a clear space in front of me and to get rid of those papers I really, really need to shred, already. And move that stack of old files to the cabinet in the basement. And make some decisions about what stuff is truly necessary.

Al has offered his hands to help anytime. Maybe when I can no longer move in here, I’ll take him up on 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.

Snap Judgment

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Even as I’ve adapted to my “revised” hands a year post-surgery, sometimes they still spring a surprise on me. I was working on a sewing project on Sunday, feeling quite pleased with myself that I could manipulate the fabric, stitch with great accuracy on my sewing machine, serge precisely to finish raw edges, iron and steam as I went along to get the right finish.

Then I noticed some red stuff on the handle of my iron. At first I thought it was just some shmutz from the fabric, which is a reddish brown and tends to shed. Then I looked at my right hand. Sure enough, without realizing it, I had cut the tip on my right ring finger.

Now, this can happen to anyone, I suppose, but for me the issue was that I didn’t feel the cut at all. This is one of my fingers that was partially amputated last fall due to ulcers gone wild, and the nerves at the tip are no longer as sensitive as they once were. Fortunately, the cut was only superficial, and I hadn’t dripped any blood on my project, which would have been a mess. But it was disturbing.

How could I have missed it? As I cleaned and bandaged the finger, I reviewed what I’d been doing in the past hour or so. Then it dawned on me: I have a lot of trouble manipulating pins for this project, because some of the fabric is densely woven and my fingers are now too short to leverage even a long, glass-head pin through all the layers. So I had tried using small binder clips, instead, to hold the pieces together. But I couldn’t pry them open far enough (again, an issue of finger strength), so I used a pair of pliers—and the clip snapped away from the pliers and nipped my finger. Ouch. It smarted, but eased up, so I didn’t think I’d really hurt myself. Apparently, however, that’s what did the damage.

I was able to keep sewing after I took care of the cut (and wiped the blood off the iron handle). I’m very happy with my slow but steady progress. But I realized that I have to be more vigilant when I’m using sharp tools. I may have learned how to use my hands again, but they are simply more fragile than they used to be, and I must pay closer attention to any pain sensations, even muted. Nerves are a first line of defense, to warn us when we’re endangering ourselves—but the sentinels in my fingertips are no longer operating at full strength. Time to call in the reserves.

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.

Wild Goose Chase

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Canada geese can be a nuisance, crowding public green spaces, spackling parks with poop. But they can also be magnificent. I always love watching them fly, honking signals to form their undulating V. Strangely, I haven’t heard them yet this fall, migrating south, but I expect to, soon, as the days grow noticeably colder.

Those geese may be wild, but they are certainly organized. I cannot say the same for our local CVS pharmacies last week, as I tried to chase down a refill on a prescription to keep me warm.

Now, this medication is a vasodilator that I need to control my Raynaud’s. It’s a key part of my regimen year-round, but all the more important as temperatures drop. When I realized I had only three pills left early last week, I ordered my final refill on this particular prescription via my CVS iPhone app Sunday night. Normally, I get a confirmation text that the refill is in process (which I did), and then another text when it’s ready for pick-up within 24 hours (which I didn’t).

Hmmm. Time to follow up with a phone call. The pharmacy staff who answered the phone on Tuesday told me it was on order and would arrive later that afternoon. Fine. On Wednesday (one pill left), I received a text that a refill was ready for pick-up. So I went to the store, expecting to get my scrip and be on my way.

However, as it turned out, the refill was for a different med, one that I actually did not want refilled (it was on autopilot and I didn’t catch it in time). The medicine I needed was still on order. I inquired why. So it turns out that my local CVS did not have any of the required pills in stock, and none were available from the manufacturer (what?), and only one other CVS in the city had any. The clerk transferred the prescription to that store, so I wouldn’t lose any more time (theoretically), and I went home.

By Wednesday afternoon, still no text that the scrip had been filled. Hmmmm, again. I looked up the address of the store in question and discovered that there were two different stores on the street she had mentioned. So I called both. Had they by any chance receive my prescription? Nope. Even if they had (they could see it in the system) there was a problem. Why? Because my scrip was written for the generic version of the drug, not the brand name. And no CVS in the entire city had the generic pills in stock. I was directed to yet another CVS, on a different city street, that had the brand name showing up in the computer.

By this time, I was getting pretty annoyed. Already it had taken me more time than I had available to track this down. And it’s not an unusual drug. There was not one, not two, but three CVS stores on the newly designated street, according to my Internet search. I picked one and called. This time, I got lucky (or so I thought). The pharmacy clerk told me that they had my medication, but the problem was that my prescription had to be rewritten only for the brand name, and not the generic as an option.

Are you still with me? Aargh! I called my local rheumatologist’s office and got hold of one of the nurses who knows me. She readily took care of the new prescription and assured me she would put it under my doc’s nose as soon as he finished with a patient. Twenty minutes later, the pharmacy called back. They had the prescription, but it was still written incorrectly. There could be no mention of the generic on the scrip, only the brand name. Good grief. I called back my doc’s office, got another nurse on the line, who promised to straighten it out and get back to me when all was set, which she did by that evening.

The next day, Thursday, still no text that the scrip had been filled. I was out of pills by now. So I called the pharmacy to see what had happened. A different pharmacy clerk named Cindy answered the phone. I explained my dilemma, trying unsuccessfully not to get agitated. She calmed me down and found all the information. Apparently, they did not have the drug in-house, but she promised to order it right away from the warehouse, and expected delivery the next day. “Call me by noon to check in,” she said in a motherly voice. Thank you, Cindy, for being human.

I didn’t make the call because I got another text on Friday morning, telling me that the scrip was filled. After a client meeting downtown, I double-checked my app. Once again, it was the drug I didn’t want, still waiting for me at the original CVS (even though I had told them I didn’t need it). I called the new store to check on my quest. A different clerk answered and found out the pills were there, but my scrip was not yet filled, so she would ask the pharmacist to move it to the front of his orders.

I drove across town and found the store, a small, old CVS with a tiny parking lot, then waited at the pharmacy counter for another person to finish buying what looked like a dozen bags of pills. But when it was finally my turn, hallelujah, the scrip was filled. Not only that, but the young woman (not Cindy) who served me, who turned out to be the Wednesday clerk on the phone who had said the pills were in stock two days earlier, recognized my name and apologized for her mistake, due to an inventory error (not her fault) in their records. She was so pleasant, so committed to making my experience a positive one, that I might just leave that prescription at this out-of-the-way CVS pharmacy, despite the inconvenient location.

Wild goose chase, indeed. Any flock of Canada geese that had set out for their southern nesting grounds the day I first put in my order were probably long settled somewhere nice and warm by the time I got my pills. Thanks to some thoughtful individuals who believe in old fashioned customer service, I’m a bit warmer, now, too.

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 Credit: Jessica D. Vega