Living with Scleroderma

Reflections on the Messy Complexity of Chronicity

finger ulcers

Miraculous

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As of today, I have five dives left. My progress has been striking. I am touch-typing this post with five fingers between my two hands. Grafts on my right pinky and left middle finger have fully healed, as has the flap on my right middle finger. My left index graft is close to healed, though it’s taking longer because of a probable infection that is now under control. My right thumb is closing up, even as a second ulcer with calcium deposits opened in the tip last week.

Hyperbaric oxygen therapy notwithstanding, calcinosis remains one of my biggest challenges. My fingers are loaded with the little gray pits, and one is rising to the surface of my right index finger at just the wrong pressure point. But there is no cure for this, only patience and constant tending. Meanwhile, the worst of this marathon is behind me, thank goodness.

A friend asked me what I would do with all the time freed up in the morning, after the HBO ends next Thursday. Well, for one thing, I hope to get a little more sleep! It will be a pleasure not to have to head out to the hospital on a cold wintry morning at 7 o’clock. My goal is to use the regained three hours for my fiction writing. I’ve had to put this aside for the duration—filling the gap by listening to fine fiction via audio books while lying in the HBO chamber. Good to get back to my own creative writing, especially now that I can type again.

It will take some time to fully adjust to my “revised” hands. I’m still figuring out how much pressure I can exert on the two fingers that now have fused bones where knuckles used to be. I have next to no feeling in the grafts, so I have to learn how to interpret sensations deeper in these fingers—and avoid damaging what I don’t immediately notice.

The finger with the flap presents its own unique challenge: since the skin that was once the side of the finger is now wrapped over the top of the amputated tip, the nerves send confusing signals to my brain. The finger is also notably shorter and stubbier, which requires some readjustment to reach. I’m not quite sure what/where I’m feeling. So, practice, practice, practice, and my brain, I trust, will rewire.

But I remain amazed to have come through this eight month ordeal with functioning hands and ten fingers. This evening is the eighth night of Hanukkah. For me and my family, it is a most fitting way to mark my miraculous recovery.

I will be traveling over the weekend and taking a break next week from blogging. To you, Dear Reader, best wishes for a wonderful holiday season filled with joy, love, health and healing.

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.

Image Credit: Element5 Digital

Tradeoffs

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After two dozen dives, my hands continue to heal, thank goodness. I’m typing this post with a few fingers on each hand, instead of poking away with a stylus.

But I am also beginning to experience one of the side-effects of HBO therapy—blurred vision. For more than a week, I’ve noticed that road signs look a bit fuzzy when I’ve driven home from the hospital. Then, last week, I realized that my computer glasses no longer were the right correction. Instead, I needed to wear my regular bifocals and sit a bit farther back from the screen.

Over the weekend, to my dismay, things got more blurred. I can certainly see, but when we went to the movies Saturday night, the screen was a bit fuzzy. I did some long distance driving on Sunday to be sure I could still handle it, and I could—but needed Al’s help to read signs.

Fortunately, I still have my most recent pair of glasses, which have a stronger correction for nearsightedness. As I’ve discovered over the past few annual check-ups at the optometrist, aging can improve vision of distant objects. So using my old prescription has compensated for the worst of the problem—for the time being.

I’m told it could continue to get worse, in which case I’ll need to get a new prescription and a pair of cheap glasses to tide me over until I finish my dives. Based on my discussion with the team last Thursday, we’ve agreed to apply for insurance coverage for 10 more sessions, to be sure my grafts heal fully. That will take me into the last week of December.

The vision issues, like my hearing issues that have required temporary ear tubes, should resolve within six to eight weeks after I finish diving. I’m hoping it doesn’t get worse. But it could.

Even still, I’d rather stick with the treatment. Too much is at stake for healing my hands, especially as the weather gets colder. If I have to get driving glasses for a few months, so be it. Fortunately, I had a previously scheduled eye dilation appointment with my optometrist last week, and everything else is fine. As for my farsighted correction, I’m better off with my current prescription. I guess I’ll be switching back and forth.

Miraculous as the HBO therapy has been for me, nothing is ever that easy.

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.

Image Credit: Clem Onojeghuo

Baking Bread

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As of today, I am two-thirds of the way through my HBO treatments: 20 dives down, 10 to go. Last week’s mishegas about another potential infection was doused effectively with medical grade bleach soaks for the recalcitrant graft and a visit to Dr. S, who reassured me that the finger looked fine. Thank goodness!

Meanwhile, I continue to make more progress. Each day, the edges of the grafts pull a little farther away from surrounding skin, which is what they are supposed to do as new skin forms beneath. My fingers feel more able, despite missing tips and odd shapes.

I didn’t cook Thanksgiving dinner (Al’s department—and very good it was, too), but I did make the stuffing that we baked separately in the oven (main course was pecan-crusted salmon). This is one of the first times in about six months that I could tolerate stirring contents of a hot pan. Previously, the rising heat and steam were very painful to my exposed, over-sensitive wounds. Not to mention, I couldn’t hold the spoon.

My biggest accomplishment in the kitchen, however, was finally being able to bake bread again. It has been my practice for years to bake fresh challah for our Friday night Shabbat meal. I have a great recipe from a cookbook that my sister gave me nearly 30 years ago, and I’ve been making it since Mindi was a toddler who relished punching down the risen dough each week.

It’s the highlight of our Shabbat dinner, as well as a source of pleasure and pride for me to provide my family and friends with delicious homemade bread. But my hand debacle has made this favorite, meditative task an impossibility since summer. Al took over baking after my surgery and has become quite adept. Still, I missed doing it myself.

So this post-Thanksgiving Friday, as I was hanging out in the kitchen with my two visiting daughters, I decided to see if I could once again slip my fingers into a pair of de rigueur disposable rubber gloves, essential for any handling of raw ingredients—and, voila, to my amazement, they fit over my bandages without any discomfort! I proceeded to proof the yeast, pour flour, sugar, salt, oil and eggs, plus the yeast and warm water, into our old Cuisinart, mix the dough and pull it out onto the floured bread board.

And, as my daughters gave approval and encouragement, I kneaded the dough by hand. This is my favorite part of baking bread. There is something so magical and satisfying about feeling the dough transform from a sticky mass to a smooth, soft, elastic whole. My hands had not lost too much strength or touch. Into the oiled bowl the dough went, covered with a clean towel, to rise.

I punched it down for the first rising, but Mindi was getting organized to drive back to Boston by the time the dough had doubled in size a second time. “Do you want to punch it down?” I asked. “It was a little hard for me because my fingers don’t bend quite right.” She smiled, then proceeded to expertly punch all the air out of the dough. Still a special moment to share.

Later, when the challah came out of the oven, I sent her a text with a photo.

“Ta-da!” I wrote.

“Very nice!” she responded.

Yes, very nice, indeed.

P.S. This post is my 300th entry in this blog, When I began writing in January 2012, I had no idea where what has become an online journal of my life with scleroderma—and just life, which is really the point—would take me. More than 200,000 words later, I’m still discovering. Thank you, Dear Reader, for sharing the journey, and for your encouraging and thoughtful comments along the way, which keep me going.

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.

Fingers Crossed

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So, now things get a little more complicated. Last Thursday, when the Wound Center team checked my progress, the vascular surgeon thought that my left middle finger tip was colonized by an opportunistic bacteria common in wounds called pseudomonas. What I had taken to be some incidental spots had turned a pale green, which she said was a tell-tale sign. No pain or other issues, so I did my dressings and then checked it again that evening. It seemed to have spread more across the upper layer of the graft, which is dead skin.

Next day, I told the team, but no ID specialist was available to look. So, they scheduled a visit with the covering doc (mine is, of course, away for the week of Thanksgiving) for Monday morning. Meanwhile they recommended soaking the tip in a medical grade bleach. After just a minute, I was able to remove all of the green growth with a cotton swab. Powerful stuff.

They gave me some to take home and use again on Sunday. This time, nothing came off, and I couldn’t really tell if the discoloration was white or something else. Monday morning, I came in a little later for my HBO therapy, as planned, to give the ID doc time to look at the finger before my dive.

However . . . due to some miscommunication, when paged he said he’d never seen me before and didn’t know why he was being asked to consult, and went ahead with regular appointments. Aargh! More calls back and forth with the nurse who’d set up the appointment for me, and she got him to come later, after my dive. Of course, the wait took an extra hour.

He was apologetic when he came, very nice, thoughtful, accompanied by two students. However, he could not give me any firm answer about what may or may not be discoloring my graft. Only way to really know, he said, would be to debride the finger and do a deep tissue culture—which, of course, would mean removing the graft. And antibiotic treatment at this point could involve IVs, which I really don’t want. Not going there, not now, we agreed. Better to stick with the bleach and keep close watch. So long as I don’t have pain, any redness from cellulitis, swelling or fever, there’s no reason to do more.

After he left, the nurse suggested checking if I could see my hand surgeon before the holiday, to get his input. Fortunately, since they know me well in his office, his medical assistant squeezed me in for Tuesday afternoon, the only day he’s in this week. Good relationships really count.

I was not in a great mood Monday afternoon. But then I took a step back. After all, a surface culture on my opposite middle finger, the one that was actually weeping goo a couple of weeks ago, had tested positive for pseudomonas, and nothing came of it. The antibiotic I’ve been on, true to my ID specialist’s prediction, took care of the infection.

Plus, my open wounds were growing all sorts of stuff prior to my first surgery, as demonstrated by cultures done at that time. None made any difference in my outcome. Best to keep vigilant and monitor symptoms rather than fret over what-ifs, or do unnecessary procedures that would make matters worse.

I’m just grateful that I’m being monitored so closely by experts and not dealing with this all on my own. I’m also grateful that I continue to make more progress—this past week, I was able to fill my car with gas, lift a mattress to make a hospital corner, stir onions in a pan on a hot stove, and begin to write by hand again. That’s what I’ll be focused on this Thanksgiving.

And so, Dear Reader, I hope you have much to celebrate this holiday, as well. And for all of us, here’s to good healing and good health.

P.S. I’m happy to report from my Tuesday appointment that Dr. S thought my finger was fine. He said that grafts are “biological dressings” that protect new skin growing beneath. Not surprising that something could grow on the surface, as well. Given no worrisome symptoms of an infection, I should just keep doing what I’m doing. Other fingers continue to look good, in his opinion. Thank goodness—and it pays to remember that specialists know their specialties but can misinterpret what falls under another’s specialty! Seventeen dives and counting.

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.

Image Credit: Nathan Anderson

Maiden Voyage

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Hallelujah! I can drive again long distance on my own. Last weekend’s hour-plus experiment with Al as my backup gave me the confidence to try going it alone this week. So on Friday, after finishing up my morning HBO therapy, doing all of my bandages and putting on my makeup (not allowed inside the chamber), I drove an hour into Boston to see my favorite hairstylist for a good cut.

Now, to some it may seem silly to drive that far just to get a haircut. However, this stylist has been doing my hair for more than 15 years, beginning when I was commuting to work near Boston. She is very gifted, precise and understands exactly how to make me look my best. Given the way that scleroderma has changed my face over the years, having a great haircut is much more than an indulgence. It is one of the few ways that I have control over my appearance. I always walk out of the salon feeling wonderful.

The last time I had seen her was 10 weeks ago, more than twice the amount of time that I usually allow to lapse between visits. That trip was courtesy of my younger daughter, who was in town for a visit and drove me in for my appointment, four days after my first surgery. I wasn’t even sure until the night before that I would be able to make it, but was very glad I did.

Now, more than two months later, my hair was flopping, unruly and difficult to manage. Whenever I looked in the mirror, I felt that I looked old and weary. The hand ordeal was taking its toll.

Thank goodness for the HBO therapy. After 10 dives, not only are my grafts healing, but also my energy level has improved significantly, to the point where I felt confident enough to make an appointment. Originally, I had planned to take the train to Boston—time consuming and pricey, but still a good option. Then, when I realized last Sunday that I could actually handle the car on the highway again, I was determined to drive into the city.

Complicating my plan was a cold snap. We’ve been enjoying unseasonably warm weather here in Central Massachusetts, but late fall returned with a vengeance at the end of the week with a freeze overnight and 30°F temperatures, plus stiff winds during the day. I didn’t care. I added extra layers and figured out where to park that would enable me to take a break from the weather on the way to the salon by eating lunch at a favorite restaurant.

My visit did not disappoint. My stylist, who is one of the only women I’ve ever met who looks fantastic with magenta hair, gave me a hug and set to work, skillfully trimming at least an inch, reshaping my graying mop. As she snipped, we caught up on health, family and life in general. When she finished putting the last hair in place, I was grinning. What a relief! I felt like myself again.

The 10 minute walk back to the car was bitter cold, but I was glad that I had driven and not taken the train, which would have required waiting on a very cold platform. The drive home in rush hour on Friday afternoon was long and tedious, and I was happy to walk into our warm house, where Al was preparing Shabbat dinner. I had to lie down for a half-hour, because I was very tired, and my hands were a bit uncomfortable from all the driving in stop-and-go traffic.

But it was well worth it. I no longer feel that I look like a patient. I no longer feel confined.

On Sunday, I drove into Boston again, this time for brunch and a movie date with my eldest daughter. We had a great time together, and when I came home, I still had plenty of energy to sit down at my computer and write this blog post. On Monday afternoon, I will get in my car once again after my HBO therapy and drive into Boston to see my rheumatologist at Boston Medical Center for the first time since my second surgery. The last time I saw him, after my first surgery, Al had to take off from work to bring me. Now, I can do it myself.

Despite all this progress, I know I can’t overdo. Three round trips in four days is plenty for the next week. Driving after the hyperbaric chamber is more tiring than driving on the weekend when I’m rested. Still . . . it feels really, really good.

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.

Image Credit: Alex Iby