Living with Scleroderma

Reflections on the Messy Complexity of Chronicity

hands

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The other night, I dreamed I had normal fingers and had to choose the right color nail polish. Nothing garish. Maybe a pearl pink or cream, my old favorites.

Of course, when I woke up, there were my fingers in their night-old bandages. The only real surprise was that I had that dream at all. It’s been almost 30 years, nearly half my life now, that my fingers have been damaged by scleroderma.

The bones in my fingers are resorbed, so the tips look stubby and my nails, like moon slivers. With rare exceptions (two summers ago I managed to go bandage-free for a couple of weeks), at least half my fingers are protected by bandages to cushion chronic ulcers that take months and even years to heal.

Oddly, although my fingertips are extremely sensitive to the pain of ulcer infections, they are dulled receivers of everyday stimuli. I feel the world through a scrim of damaged nerve receptors, fleeting numbness, ointment, dressings and bandages.

So I drop knives and forks. Or think I’ve removed an errant strand of hair from my face when I haven’t. Or whack my fingertips when I misjudge the grasp of a faucet or doorknob.

I wear disposable rubber gloves, the kind you find in the drugstore first aid aisle, whenever I cook, so I test, poke and knead through a thin rubber barrier. It used to bother me to lose that tactile sensation of food, but now it’s just second nature—I assume doctors and dentists make a similar adjustment to examining gloves.

Sometimes, it’s incredibly frustrating. I always loved to explore with my hands, and now I just have to be extremely careful. I can sense more through the skin on my inner arms, so that’s a back-up strategy for choosing which fabric to sew or ensuring the right water temperature for proofing yeast. I can make general distinctions by touch, but need to extrapolate for finer gradations of texture.

Even as I wish my fingertip nerves weren’t so damaged, however, there are some advantages to my ever-present adhesive barrier. When I sew, I can use my bandaged thumb like a thimble, as long as I’m careful not to accidentally stitch or pin my wrapped fingers to the fabric. I rarely cut myself, because my fingers are so protected. The rubber gloves save me extra hand washing.

And my bandaged, odd fingers have proven useful in another way. Several years ago, when I managed a marketing department and had to make hiring decisions, I would always note how interview candidates looked at my hands. If they stared at my bandages and didn’t make eye contact, they didn’t make the cut.

Conversely, if they just glanced at my hands but spoke directly to me for most of our conversation, I’d give them more consideration. Arbitrary, perhaps, but I always sensed that people who related to me on a personal level and didn’t get sidetracked by my strange hands were more likely to be good people to work with. Most of the time, I was right.

I still envy other women’s beautiful fingers—at least sometimes. I wish I could actually get a great manicure and have stunning, shiny oval nails, or even flaunt those miniature hand-drawn flowers or intricate patterns with tiny glass beads for special occasions.

But this is not to be. So I do my best to keep my fingers clean and safe, reach carefully, and paint my toenails, instead.

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.

Grand Old Lady

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Ginger is getting old. She turned 14 about a month ago, which means she’s 98 in dog years—or people years, I can never keep it straight, seeing as she’s lived 14 years as a dog but is the equivalent of a centenarian.

She’s been with us since she was two, a skinny, flea-bitten dog that Al rescued from owners who sold her for the price of their overdue electric bill. From the day he surprised our girls after school, waiting with her to walk them home, Ginger has been our beloved companion—silly, rambunctious, cuddly, trusting, faithful—the Golden Retriever Mindi had begged us for, for years after our other dog died.

My constant companion who hangs out under my desk while I write and follows me all over the house, often positioning herself where I’ll trip over her if I’m not careful, she’s doing really well for a Golden. Our vets are always impressed and tell me she’s way out on the tail of the big dog survivor bell curve, still friendly as a puppy and a total love bug, even as she’s white in the face and struggling with arthritis.

But it’s hard to watch her age, especially as she has more trouble getting around. She often trips over her front paws when I walk her, because, as the vet explained, she has less range of motion in her hips and has shifted weight-bearing onto her front legs. And she can’t climb stairs—or, at least, she’s afraid to—which we learned recently when she made her way down into the basement family room twice in one week and had to be carried back up both times. (We’ve since blocked the door.)

So, here we are, both with our ailments. But unlike me, she has no way of understanding what’s happening to her body, and she’s completely dependent on us to help her.

We’ve tried a few different arthritis medications. The first irritated her stomach so much she stopped eating after a week, and the second made her throw up after two days. Now we’re in day five of trying that same med plus an antacid pill twice a day, and so far, so good.

My challenge has been trying to figure out how to get the medicine into her. The first option was a chewable tablet, so that seemed like the perfect solution until she stopped eating. Her current medication is a liquid, which I’ve been mixing into low fat ricotta cheese—for Ginger, a huge treat.

The problem has been the antacid pills. I can’t open her jaws with my fingers. I can’t hold the pill. Al leaves too early in the morning to give it to her, because Ginger, grand old lady that she is, doesn’t rouse until after 9 o’clock most days. Our former dog would snap at pills. So, for a few weeks after Ginger threw up, even after I discussed the problem with our vet and he suggested the antacids, I procrastinated. I just stopped giving her meds. I was afraid to try.

But then I took her for a walk last week and she was tripping so much I decided I really had to get over myself and figure this out. A smidge of butter on the pill, delivered on a teaspoon, did the trick. After only a few days, Ginger now perks up her ears when it’s pill time, trots over to the fridge while I prepare the spoon and swallows her pill patiently. She’ll even allow a second try if I miss my aim and the pill falls off the spoon. A good thing, because my hands won’t cooperate easily.

Ginger’s big treat, also part of the mix to be sure her stomach doesn’t get irritated, is a piece of challah after she’s taken all her meds. This is her favorite food in the whole world. She grabs it from her bowl and runs under the kitchen table to eat in her bed.

Yesterday when we walked, she was perkier, sniffing every leaf and blade of grass, curious, not lagging behind me as much when we went up a slight hill on the way back home. She got up from her bed with less trouble this morning and took a leisurely downward-dog stretch. She’s eating normally. So I have my fingers crossed.

Tonight Mindi comes home from a year in Israel. She’ll be with us for a month, then going back to Tel Aviv for another year. She’s asked after Ginger often when we’ve Skyped, and we’ve tried to get Ginger on screen for a woof or tail wag, but without much success. I’ve had my worries this year, watching her age more rapidly, if she’d hold on until Mindi’s return. She has, and so have we. And I’m grateful, very grateful.

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.

Heat Wave

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In India, “cold weather” is merely a conventional phrase and has come into use through the necessity of having some way to distinguish between weather which will melt a brass door-knob and weather which will only make it mushy.
—Mark Twain, Following the Equator

It’s been extraordinarily hot in India in recent days, and here in Massachusetts, as well—not hot enough to melt brass door-knobs, but close. Temperatures in Delhi neared 109 degrees Fahrenheit over the weekend. We weren’t that far behind. I was in Cambridge on Thursday, and my Prius recorded 99 degrees outside around 7:00 p.m.

Normally, I enjoy hot weather. Summer is my time of year. My Raynaud’s quiets down, and my hands are comfortable most of the day. My ulcers heal. But last week’s record-breaking heat wave was too much, even for me. I hardly ever break into a sweat, but I was perspiring rivers.

We New Englanders are fond of saying if you don’t like the weather here, just wait a few minutes. Not so last week, when the heat wave locked in for nearly three solid days. I was grateful to be in air conditioning, which I usually can’t stand.

I used to work in an office that was so cold in the summer, those of us with slighter builds would walk around in heavy sweaters and, sometimes, coats. What amazed me (to put it mildly) was that we had to put up with it. Some of my co-workers had heftier physiques and thrived in the cold. Some were men, who just seem to burn hotter than women (and who always, especially the heftier variety, seemed to be in charge of the computer program that ran the heating and cooling system). Some had normal internal thermostats, unlike myself. Whatever the reason, the majority didn’t want it any warmer. Some complained it wasn’t cold enough. This, despite the need to conserve energy and finances. The shivering ones among us were told to put on sweaters and deal. Infuriating. One of the many reasons I’m glad to be working for myself, now.

When you have severe Raynaud’s and finger ulcers, air conditioning isn’t just a nuisance. It hurts. More than winter’s chill, because you can’t escape the cold in the space where you need to do your work, keep your appointments or shop for food. Your blood vessels contract and your ulcers smart like crazy.

I always carry layers with me in the summer—a sweater and my Wristies, which are great fleece hand-warmers. This usually does the trick. But it’s a constant balancing act, because my hands can turn blue even if it’s in the ’80s and a breeze starts blowing. Summertime is all about managing relative temperature changes, more than absolute temperature. Except above 90 degrees.

At home, we have no air conditioning, just ceiling fans and window screens. Al is fine with it, concerned for my health and glad to save money on our electric bill. Our daughters both grew up with no AC and understand my issues with staying warm. For most of the summer, this works well—except on days like the end of last week.

It was so hot (how hot was it?) that I went to the grocery store without a sweater to protect me from the freezer section. I never do this. I hate grocery shopping because the stores are so cold, they make me feel sick from numbness. It was so hot that I had to put my Aquafor ointment in the refrigerator so it wouldn’t turn to soup when I squeezed it onto my finger ulcers. It was so hot that I blasted the AC in my car at 68 degrees and directed the vents onto my face and neck to clear my logy brain.

Today, we’re back to normal, whatever that means with global warming on the rise—another rainy June day, thunderstorms, temperatures in the ‘70s. Later in the week, it’s supposed to creep up to 90 again. It’s going to be an interesting summer.

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.

Zen and the Art of Saori Weaving

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Back and forth, back and forth, I slide the shuttle that holds the bobbin that’s wound with the thread that creates the weft that fills the warp that blends into fabric I weave by hand, to make up my scarf as I go.

Tonight is my fourth Saori weaving lesson. So far, I’ve learned how to wind my warp (the long, vertical threads that define the width and lengthwise pattern for my scarf), thread one end of the warp through the reed (the metal comb that holds each thread in place, in the order I define), thread the warp tails through the heddle (two rows of wire guides that divide the warp, so one set of alternating threads moves up while the other moves down), wind a bobbin with weft fiber, and pass the weft shuttle horizontally through the warp, shifting the heddle with foot peddles and beating the weft into place. I’ve also learned how to change weft bobbins, how to pick up a second weft color freestyle and how to add “treasures”—slubs of fiber inserted at random for color accents.

It sounds complicated, but it’s actually quite intuitive, once you get the feel of it. And feeling is what Saori weaving is all about.

This modern Japanese weaving method, created by Misao Jo in the late ‘60s, nurtures individual expression and creativity. Saori looms are simpler to thread and manipulate than traditional looms, and they have adaptive attachments to facilitate weavers with disabilities.

Last week, my instructor, Mihoko, added a narrow shelf to my loom so that I could slide my wooden shuttle back and forth without having to hold it—an advantage when my hands get tired. I use a small pair of tweezers that I always carry to manipulate threads in-between the warp. Mihoko helps with knot-tying and other tasks that I find too difficult. The loom is easy to understand, and the parts take little pressure to maneuver. Nothing hurts.

But what I like the most about this new-found art form is the way you can do just about anything with the fibers, within the constraints of interlocking threads. You can leave gaps in the warp or the weft to create an airy pattern. You can interlace new colors and tufts of fiber or cloth or whatever other kind of material you want, so long as the warp is strong enough. You can break a warp thread—by accident or intent—and weave knotted tails of your repaired warp right into the piece.

Mistakes, imperfections—these are what make the fabric personal, unique and fascinating. Accepting and encouraging exploration and individual vision is the art form’s core philosophy. In Saori weaving, flaws don’t exist.

It’s a welcome break from my daily worries about how I’m going to balance my writing and health and all the necessary hard work of building a consulting practice. And a great reminder of the value of taking risks, making mistakes, and staying clear and focused about what’s important.

Tonight, when I pick up where I left off last week, I’m going to shift the weft from dusty roses to slate blues. I’m going to play more with free-style design and whatever else occurs to me in the moment. When I weave, I’m totally focused on what’s right in front of me, figuring it out as I pass the shuttle and shift the heddle. I can only understand the pattern as I make it happen. And I’m doing it with my own two hands.

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.

What Did You Do to Your Hands?

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Scene One:
I’m buying a slice of pizza at a luncheonette across from Boston Medical Center before I drive back home from an appointment. As I fumble with my wallet, the middle-aged man behind the counter notices my five bandaged fingers.

“What did you do to yourself?” he asks.

“Oh, I get ulcers,” I say, giving my standard explanation.

“Does that hurt?”

“Sometimes, if they get infected.”

He nods and hands me my change.

 


Scene Two:
I’m taking my first Saori class to learn this fascinating Japanese weaving method that encourages free-form creativity and uses looms that accommodate people with disabilities. The young son of one of my new classmates comes up to greet me. He loves to run around and say a loud Hi to everyone when he’s not weaving wonderful fabric. I shake his hand, and he pulls back. Later, I offer him my hand again. My Raynaud’s has kicked in, and my palm is a mix of indigo and fuchsia from haphazard blood flow. He stares and says No, frowning and shaking his head as he steps away. I believe I’ve frightened him.

*   *   *

June is national Scleroderma Awareness Month. It’s the month for walkathons to raise money for research, ramped-up efforts to publicize scleroderma’s devastating impact and continued lobbying for NIH funding of scleroderma research to find a cure.

All of this is important, focused work. But I wonder. How do you really get anyone to care about one more way that our bodies fail us, unless they have a vested interest? This time of year, there’s a race or walkathon or bike-athon for some disease every weekend, every cause has its own colored ribbon symbol or rubbery message bracelet, and Congress is still gridlocked over cuts in domestic spending. Not to mention that nobody pays attention to anything in front of them any more, just the alternate reality of their smartphone universe.

As part of its awareness campaign this year, the Scleroderma Foundation has developed a social media strategy to encourage patients to share personal stories about scleroderma and to create a video story collage that they plan to send to Washington lawmakers in the fall. I hope it works. For me, the art of storytelling remains the most viable means of building awareness, a primal way we connect as humans. But it requires a willingness to speak up and a willingness to listen. Neither are easy to come by for a disease like scleroderma.

Before I started writing this blog in January, I had a very hard time talking about my disease. In fact, I’ve been silent about it, for the most part, except when sharing with very close friends and family, for the better part of three decades.

When asked that all-too-common question by curious cashiers (the people most likely to ask, it seems)—What did you do to your hands?—or its variants—Did you cut yourself while cooking? Did you prick your fingers with a sewing needle? Did you stick your hand in a lawnmower?—I used to demure and just say I have sores. Now I say I have ulcers, and if I think the person is genuinely interested, I’ll explain I have scleroderma.

Responses range from compassionate concern to flickering interest in freakishness—the latter, I think, veiling the true reaction so powerfully expressed by the young boy I met in my weaving class: my hands look really strange and scary.

This is the hard truth of scleroderma. It’s rare, it defies easy explanations and it’s disfiguring in a way that others find threatening to their own body image and sense of well being.

It’s hard to talk about. It’s hard to draw attention to yourself, or more attention to yourself, and say, hey, I have this weird disease that makes my hands look like claws and my face like a mask and has screwed up my lungs and digestion and God knows what else.

Honestly, I just want to be known for who I am, not for this disease I live with.

But what I’ve come to understand and am coming to embrace is that scleroderma is a part of who I am. There’s no getting around it. I have this fucking disease, and I’m stuck with it for life. Which is why I’ve begun, finally, to write about it, tell my stories and try to make some sense of it all.

I have no awareness agenda. I am aware, however, that it’s important to get past the shame and embarrassment of living with a disfiguring chronic illness and share this journey with others who want to understand. This blog is my medium for that message. And maybe the next time a stranger asks what I did to my hands, I’ll tell them my real story.

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.