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Reflections on the Messy Complexity of Chronicity

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Royal Flush

Evelyn Herwitz · September 16, 2014 · 7 Comments

As the late Joan Rivers would say, “Can we talk?”

I’m referring to bathroom hygiene.

5360420829_c2d1617f3b_bNow, before you say, “E-w-w-w-w-w-w-w,” I raise this because it’s one of those topics that no one wants to discuss in public, but that presents some very real challenges for those of us with scleroderma.

To wit, what do you do when your hands don’t work right—because you have digital ulcers, like me, and/or you have flexion contractures that freeze your fingers at right angles, and/or your wrists aren’t flexible and your skin is too tight and your fingers are sore or just not that strong anymore—and you have to clean your bum after taking a dump?

It’s not easy, and it can be downright frustrating.

I’ve discussed this with occupational therapists over the years and gotten a few helpful suggestions.

Here’s what I’ve found to be most effective. There are three essentials:

  1. Soft, strong toilet paper. Forget the one-ply stuff that supposedly saves money but disintegrates as soon as you tear it off the roll. You just need three times as much to do the job.
  2. Flushable toddler wipes. My favorites include aloe. You can buy these at any drugstore or Target, they’re inexpensive, and they make the whole process of cleaning yourself up much quicker and easier, especially if your fingers are weak or sore. Just be sure to check that the package says safe for sewers and septic systems. You don’t want to clog up your plumbing.
  3. Antibacterial hand sanitizer. These products have gotten a bad name, lately, because of worries that we use so much antibacterial soap and cleanser that we’re encouraging resistant strains of bacteria. But I’ve checked with my infectious disease doc, because I cannot use soap and water on my ulcer bandages without risking more damage to my skin beneath the dressings, and he assures me it’s fine. Hand sanitizer that I rub on and let air dry is a major part of my hygiene routine and a reliable defense against ulcer infections. Again, I favor products with aloe that don’t dry out my skin.

And here’s my method: Make a wad of toilet paper, large enough that you have a good grasp without exposing your fingers. This essentially provides padding for fingertips. Top it with a wipe. This gives you additional protection plus a gentle moisturizer for efficient clean-up. Swipe and flush. Repeat as needed. Then clean your hands with the sanitizer.

Sometimes, if you’re dealing with a bigger job, it helps to have some disposable vinyl gloves on hand, to be sure you keep your fingers clean.

If you have trouble pulling the wipes out of their plastic packaging, try cutting the package apart and placing the stack of wipes into a ziplock bag, the kind with a plastic slider at the top edge (I find these easier to open and close). This is also a good way to carry some wipes with you, in a purse or carryall, when you are out of the house.

If anyone out there has some additional tips, please share. I’m a fanatic about hand hygiene, because I’ve had far too many infections over the years. We all have to use the john, and those of us with scleroderma—or any other medical challenge that limits manual dexterity—have to be creative when it comes to bathroom habits. It’s not just a matter of staying healthy—it’s a matter of staying independent.

Photo Credit: KimCarpenter NJ via Compfight cc

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

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Filed Under: Body, Mind, Touch Tagged With: Bathroom hygiene, finger ulcers, flexion contracture, hands, managing chronic disease

Enter Autumn

Evelyn Herwitz · September 2, 2014 · 2 Comments

The other day, as I was walking Ginger around the block, I heard a flock of Canada Geese honking overhead. I never saw them, but I envisioned them flying in V-formation, heading south.

August is over. I’m writing on the first day of September. Even though summer doesn’t officially end until later this month, Labor Day is always my turning point from the comfort of warm, long days of sunlight into the prospect of cooler, darker, busy fall.

Black-eyed Susans 9-1-14Sugar maple leaves are the first harbinger, speckling the sides of our street for the past few weeks with splashes of gold and tangerine. As the days grow shorter, the trees begin their annual rite of passage, hardening for winter. Today seems odd—it’s muggy, hot and very sunny. But the trees know better, what’s coming.

As I write, Emily and Al are packing a friend’s truck for the drive out to her new apartment. Grad school starts this week, both for her, as a first year master’s student, and for Mindi, entering her second and final year of her professional degree program. Closer to home, public schools began last week. Time, once again, to remember to avoid leaving the house mid-afternoon when school buses from nearby schools travel their routes.

I’ve spent much of my Labor Day weekend sewing. I’m nearly done with a new dress. But, of course, it’s a summery dress, not a fall outfit. For some reason, I am never able to sew ahead of the season. I bought the pattern in July. I’ve had the fabric, a beautiful fuchsia knit, for at least five years, purchased another summer with a different dress in mind.

Two weekends ago, I finally altered the pattern and cut out the pieces. I started sewing in the evenings, until our house was full with family, and I had to clear off the dining room table. So I dug in again yesterday, because I finally had time, and because I didn’t want the dress to wait another full year. I may still get some use out of it before the weather consistently cools off.

I am a slow sewer. I have to pace myself because of my hands, and I can’t manage the fabric as well as I once could, which is why I don’t sew often. Picking out seams when I mess up, which is more often than I’d like, is tricky and tedious. I’m more willing to live with mistakes that no one else will notice, given my limitations. The end result is still good enough, albeit not the perfection I’d prefer.

I would like to sew more. My favorite sewing magazine is full of luscious fall fabrics in autumnal hues. The dress pattern I’m using comes from a designer who creates lovely, easy-to-construct clothes. I hate shopping for ready-to-wear, and sewing is the perfect antidote—not only a way to create unique clothes that actually fit, but also a great meditation. Nonetheless, I have to respect my hands. And my energy. And the number of hours in the day.

Ahead lies a solid lineup of work and creative projects to take me well into the fall. Much as I love the summer months, it’s easier to concentrate as the weather cools and everyone else is back to work or school. The trees may shed their leaves and the geese fly south, the weather will inevitably make me long for warmer days and fewer layers, but I’m looking forward to the crisp crackle of new beginnings.

I just need to sew up that wonderful warm fabric I wove last winter into a jacket, before the days grow long again.

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.

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Filed Under: Body, Hearing, Mind, Sight, Touch Tagged With: hands, mindfulness, sewing

One More Thing

Evelyn Herwitz · August 5, 2014 · Leave a Comment

As my family well knows, I have a bad habit of trying to squeeze in as many items on my to-do list as possible before I head out the door. I get a lot done, but all too often I run late—not horribly late, and I manage to make most appointments on time, but when the deadline is less rigid, I can slide five, ten minutes behind.

The problem is that everything usually works out fine, anyway, which just reinforces my obsession with getting that One More Thing done.

Except for Monday morning, when I had to catch a train to Boston to catch the bus to Logan for a flight to Kansas City on business. (Fortunately, this has a happy ending, but this once again reinforces my bad habit, as you’ll see.)

I was well organized for my trip when I got up, relatively on time (mornings are always hard, as my body is sluggish). My bag was 99 percent packed. Did my exercises. So far, so good. Stopped myself from catching up on news and Facebook, so I wouldn’t waste precious minutes.

Then came the fateful decision to do One More Thing. I had a family project I wanted to finish before leaving the house, which I needed to complete online from our secure network, that I felt couldn’t wait until my return from my business trip later this week. It took about 15 minutes. I had just barely enough time to eat breakfast, finish packing, get dressed and race out the door with Al to get to the train station.

Challenging under even the best of circumstances. But I was also upset with myself, because in the midst of finishing my One More Thing project, I thought I’d messed up the online form because I was rushing and couldn’t backtrack. As I finished shoving the last few items into my suitcase, my hands started shaking. This always happens when I hurry and get stressed. Totally involuntary and very frustrating—my coordination just gets worse.

So I ranted to Al all the way to the train. Fortunately, he is very calm when I freak out. As we drove up to the station, I could see the train waiting at the platform. I jumped out of the car, Al grabbed my bag from the trunk, we said a quick goodbye, and I ran as best I could toward the platform . . . only to watch the train pull away. As one of the conductors, standing on a coach staircase, slid by me, he shook his head and shrugged. Just another late, would-be passenger.

At this point, I started crying. There are many things in this world worth crying about, and this wasn’t one of them, but I was just so frustrated with myself. Al to the rescue (fortunately, he had waited to be sure I got on) with a big hug. Rather than go home and come back in two hours to catch the next train, which would have risked a tight rush to the airport, he drove me in to Logan.

Now, here’s where my One More Thing habit gets reinforced. The ride into town had the advantage of saving my hands from dragging my carry-on from train through South Station to bus to airport. We said a real good-bye when Al dropped me off. I made it through security in 10 minutes, bought a bagel and found a table where I could write before every space was taken later in the morning. And, to top it off, I found out through an email exchange about my One More Thing project that I’d completed the online form correctly, after all. No problem!

Next time I miss a train because I’m trying to do too much, I still hope my loving husband will take pity on me once again and save the day. But I honestly don’t want to cut it so close to the wire, for myself (too much stress) or for him. (Hear that, Al? Thanks again! Love you!)

It’s comforting to know that life usually works out, even when you think you’ve messed up. But it’s also good to remember that One More Thing can usually wait. (Hear that, me?)

Photo Credit: Éole via Compfight cc

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.

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Filed Under: Body, Mind, Sight, Touch Tagged With: hands, life style, managing chronic disease, mindfulness, time management, travel

Logistics

Evelyn Herwitz · May 6, 2014 · Leave a Comment

12:15, Thursday morning. I should be asleep by now. I have to rise at 5:10 to get ready and leave the house by 7:00, to drive to New Haven in time to catch the 9:28, so I can arrive in Manhattan in time for an afternoon of meetings, starting at Noon.

This is an experiment. I want to see if I can manage a one-day trip to NYC on business without wearing myself out. But, of course, I can’t sleep, too preoccupied with whether I’ve selected the right outfit for the predicted mix of rain and possible thunderstorms and 70-degree temperatures. If I dress too warmly to ward off dampness, I’ll end up sweating and getting chilled. And if I wear something too lightweight, I’ll freeze, especially if the office has turned on the AC.

When I wake after a meager four hours of sleep, I review the fiber content of the outfit I’ve chosen—a white sweater top that is a mix of silk and cotton, an ivory crocheted cotton cardigan and black wool crepe pants—okay, I’m good. Comfortable and professional, made from natural fibers that won’t trap perspiration, with loose layers to allow plenty of air circulation.

Next step, hands. The night before, I cut all my bandages and dressings to be sure I could take care of my finger ulcers in five minutes instead of the usual twenty. It’s absolutely essential to cover every possible skin crack when I travel, but if I feel pressured by time, I can get sloppy and have to redo the dressings. With everything ready, I relax and neatly prepare my fingers for the long day ahead.

As I do my stretching exercises and get dressed, I rethink my plan for my laptop and decide to shift it from a carrying case to the center zipped compartment of my large purse. The laptop is lightweight, and I don’t want to fumble with extra stuff to carry when I make purchases. I test the arrangement. The purse is roomy enough for easy wallet retrieval, even with the laptop, and remains securely over my shoulder. Check.

After a breakfast of scrambled eggs and toast—need to be sure I have enough protein in my system to stay awake for the two-hour drive ahead—I head out the door. Only 10 minutes behind schedule. Okay so far.

That is, until it starts raining. Not just raining, pouring. And there’s fog, too. I pull over at a rest stop on the Mass Pike to check traffic around Hartford on my cell phone. I have to drive around the city during rush hour on my way to New Haven. There are two ways to go, and I select the one with the least congestion.

This plan works until I get closer to Hartford and find myself crawling at 11 mph on Route 84. Should have left earlier, but no use getting upset now. Nothing to do but sit out the traffic jam. I decide to catch the next train, if need be, and let my clients know I’ll be a half-hour late. I am not going to run through the station and risk getting winded from what my physicians think is exercise-induced pulmonary hypertension. I had a recent, unnerving episode, and I don’t want to push it.

Once the traffic eases and I get onto 91S, I drive as fast as I can without exceeding the speed limit by too wide a margin. More traffic back-up on the exit ramp to New Haven’s Union Station, but, miraculously, I find a space in the parking garage just one level up. There’s a covered walkway to the station, and the restroom is right down the hall, conveniently located for a quick pit stop. Time, 9:12.

Okay, now I just have to buy my ticket and find the train. Only a few people in line at the counter. Ticket in wallet, I walk briskly to the gate, up a long flight of stairs. The train is waiting. Plenty of seats, still. I settle down, take off my raincoat and catch my breath. Made it! Seven minutes later, we pull away from the station.

By the time we reach Grand Central, all traces of rain are gone. I switch to sunglasses as I climb out of the Union Square subway station. People stroll and hustle in shirtsleeves, shorts, flip-flops. Pink crabapples abound. Somewhere, someone is making a loud May Day speech about workers’ rights. Delivery trucks battle for curbside parking. A siren wails down another block. The air smells of car exhaust and felafel and fresh doughnuts. I unzip my raincoat, slip my collapsable umbrella into my purse and head toward West 17th Street. It’s going to be a good day.

Photo Credit: JefferyTurner via Compfight cc

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.

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Filed Under: Body, Hearing, Mind, Sight, Smell, Touch Tagged With: finger ulcers, hands, Raynaud's, resilience, travel

Skirmishes

Evelyn Herwitz · April 15, 2014 · 2 Comments

Dear people, do you know of the battle of the vegetables?
All is put before you.
The tomato rises up from the center:
“My food is famous, better than the eggplant!”

The eggplant responds:
“Be quiet, tomato.
You are not worth a penny.
Two days in the basket,
you are ready for the garbage!” . . . 

—from Si Savesh La Buena Djente (Dear People, Do You Know of the Battle of the Vegetables?)

A lot of vegetables will be clamoring for attention at our seder this Tuesday night. We host the second night of Passover, and there will be both tomatoes and eggplants featured—but not in the same dish, so no fighting at the table.

On Sunday afternoon, I set out to buy the freshest vegetables (and fruit, too) that I could find before the holiday. The weather was warming, the air pleasant. I backed out of the garage. Ca-chunk!  Not sure what that was about, I tested my brakes. All seemed fine, and on I drove.

That is, until the tire pressure gauge lit up about a mile down the road. I pulled over. Sure enough, I had a very flat tire. I drove carefully into a nearby parking lot, called AAA, then called home.

There was a time, long ago, when I might have tried to change it myself. In grad school, I once spent a very cold afternoon in a garage with one of my classmates, who taught me how to tune up my old Chevelle. It was fun. My hands froze, but this was long before I knew I had any medical issues.

Much as I wished I could have saved time, there was no way I would now attempt to change the tire with my hands so damaged by scleroderma. Instead, Al came to the rescue, traded cars with me and waited for AAA to arrive, while I headed off to the market.

Already behind schedule, I got there about 1:30. Never go shopping for vegetables at a Wegman’s on a Sunday afternoon, especially before a holiday week. The produce section was mobbed. Mesmerized shoppers wandered amidst rainbow mounds of fresh vegetables and fruits, sniffing and squeezing, checking for ripeness and price, with many near misses between shopping carts. “Pick me, pick me!” cried the delectable produce from their artful displays—all except the organic strawberries, on special, which had been snatched up long before I arrived.

Fortunately, the eggplants were piled at one end of the produce section and the tomatoes, at the other. I assume the produce staff are well aware of their rivalry and keep them separate.

I resolutely stuck to my list—except for picking up a bag of lovely, multicolored fingerling potatoes. One more easy side dish of roasted veggies certainly won’t be a hassle, right?

On my way to check-out, a seductive display of fresh plum tomatoes nearly broke my resolve. But I reminded myself that it would be so much more hand work to peel and seed them for the Prassa Yahnisi (Turkish Braised Leeks and Tomatoes), rather than use the Kosher for Passover canned variety that Al had already bought for me. Plus, I didn’t trust them to be sweet enough this time of year, no matter where their place of origin.

Yes, yes, I know. Sorry tomatoes, I’m afraid the fresh eggplants won this round. Maybe next year.

But . . . did you have anything to do with that flat tire?

Note: You can read the entire translated Ladino poem, Si Savesh La Buena Djente—and find wonderful vegetarian recipes for Passover and year-round—in Olive Trees and Honey: A Treasury of Vegetarian Recipes from Jewish Communities Around the World, by Gil Marks (Wiley Publishing: 2005).

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

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Filed Under: Body, Hearing, Mind, Sight, Smell, Taste, Touch Tagged With: cooking, hands, vegetarian

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About the Writer

When not writing about living fully with chronic health challenges, Evelyn Herwitz helps her marketing clients tell great stories about their good works. She would love to win a MacArthur grant and write fiction all day. Read More…

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I am not a doctor . . .

. . . and don’t play one on TV. While I strive for accuracy based on my 40-plus years of living with scleroderma, none of what I write should be taken as medical advice for your specific condition.

Scleroderma manifests uniquely in each individual. Please seek expert medical care. You’ll find websites with links to medical professionals in Resources.

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