Living with Scleroderma

Reflections on the Messy Complexity of Chronicity

managing chronic disease

Healing Stories

· · 2 Comments

One of the most complicated aspects of scleroderma is how it changes our relationship with our bodies. Hands that were once dexterous now are cramped, facial skin no longer flexes. It can become very hard to pick up objects, bend over, reach. In its most virulent form, this debilitating disease literally traps you in your own skin. It’s painful, exhausting, achey. Not to mention internal organ damage to heart, lungs, kidneys, gut.

As I’ve written before, I’ve been graced with a reversal of some of the worst aspects of scleroderma during my first decade of the four that I’ve been living with this chronic disease. I credit the use of d-penicillamine early on, a treatment that was never fully embraced by the medical profession due to inconclusive research. But it worked for me, loosening tight skin in my hands, forearms, and face. I still have abnormal skin that limits my dexterity and ability to open my mouth, but nothing like before, when it was becoming uncomfortable to blink.

Grateful as I am with that gift, I also still wrestle with how scleroderma has affected my face and damaged my hands. Scleroderma ages you prematurely. I’ve learned to make the best of what I have, but it can still be discouraging to look in the mirror.

So, I deeply appreciated an interview that I heard over the weekend with Krista Tipppet of the On Being Project, and Matthew Sanford, about “The Body’s Grace.” Sanford, now in his 40s, survived a car crash when he was 13 that took the lives of his father and sister, and left him paralyzed from the waist down. He speaks of a deepened relationship with his body, a knowing derived from inner silence, a reconnecting with those parts that no longer feel and work as they once did.

Sanford likens this awareness to “walking from a well-lighted room into a dark one. At first, you can’t see anything. But if you sit, and you pause, and you listen, usually there’s enough light to get across the room. It’s not going to be like turning the light back on, but in fact, the world gets this other kind of texture that makes it beautiful. It also makes it scary in the dark; it goes either way.”

Coming to terms with a life-altering accident or disease is a lifelong process that Sanford calls a “healing story.” And, as he and Tippett discuss, all too often, in our youth-obsessed culture, the healing stories we tell ourselves are ones of overcoming physical and emotional adversity. With enough willpower, we, too, can be the 80-year-old who runs a marathon or skydives; we, too, can “power through” anxiety or depression.

Though willpower is an important skill for confronting physical weakening or loss or just plain aging, Sanford suggest that it shouldn’t be the sole or primary skill. Finding your own, unique path of mind-body integration when the connections are weakened or severed is a journey toward a deeper relationship with your physicality and your body’s miraculous striving toward healing, even when damaged. It is also a journey toward deeper appreciation of your connections with others and the world.

We are always so much more than our medical diagnoses. We are so much more than our physical limitations. Each of us writes our own healing story as we learn how to see in the dark.

Here’s a link to the On Being podcast interview with Matthew Sanford as well as a transcript.

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: Spenser Sembrat

In Stitches

· · 2 Comments

It’s been five years since I last had calcium deposits removed from the bridge of my nose, the fifth time I’ve endured this procedure. Usually, I take care of this annoying issue about every three years, but the pandemic put that on hold this time around—which ultimately meant that the calcinosis got worse.

Originally, I thought the problem was caused by the weight of my glasses. I get calcinosis in my fingers at pressure points, so it made sense. But I switched from wire frames to very lightweight Silhouettes years ago, and it has not solved the problem.

No one really knows why scleroderma can cause this build-up of calcium in unwanted places. My theory is that, regardless of how thoroughly my ENT plastic surgeons have tried to remove the calcium growths from my nasal bone, a seed remains that grows more calcium crystals over several years. They always biopsy what they remove, and it always (thank goodness) is benign. In any case, once it gets big enough, it becomes unsightly and increasing uncomfortable, stretching skin that is no longer very elastic.

This spring I met my new surgeon, Dr. E., who is chief of Otolaryngology at Boston Medical (his predecessor had done the last three extractions). I liked him and his team immediately. He is thoughtful and conservative about performing a procedure that is either unnecessary or has low potential for success. In fact, he was at first reluctant to take me on, given how fragile the skin on my nose has become, but we came to a meeting of the minds, with a plan to do a skin graft if necessary to close the wound.

And that is what he and his resident did last Wednesday. I’d had to postpone the procedure twice over the summer, given unexpected schedule conflicts. During that delay the calcium had pushed through the skin, so I was managing an open wound and doing my best to avoid infection until we could finally take care of it.

Nonetheless, I was not looking forward to the procedure. Getting Lidocaine shots in your face is no picnic, and neither is having the bridge of your nose cut open and calcium deposits scraped out of bone. Then there was the added complication of the skin graft, which they took from below my left ear. And sewing me back together.

I’ve learned from past experience that I do not do well with Lidocaine mixed with epinephrine, which is a preferred concoction because it limits bleeding. So, instead, with plain Lidocaine they had to use a cauterizer, which, even with local anesthesia, feels like pins and needles, and sometimes like tiny darts. And it smells like burnt roast, which is, of course, essentially what’s happening.

This all took over an hour. I did my best to keep breathing evenly through the process. Some music from the High Holidays was a welcome ear worm. In addition to suturing the graft, they stitched a rectangular piece of gauze, called a “bumper,” on top of the graft to hold it in place for a week. That comes off, I sincerely hope, tomorrow. Between the stitches under my left ear and the bumper, I looked a bit like Frankenstein’s monster when they let me see my face in a mirror.

“Can I have something to cover it?” I asked.

“What did you have in mind?” asked the resident.

“A bandage?” It seemed rather obvious. His concern was that it not pull at the bumper to dislodge it in any way, but there was no way I was going to walk around with a piece of bloody gauze stitched to my nose for a week. So he found a light blue bandage, which I later replaced with one of my good cloth bandages, and I have been carefully tending it since. I also started antibiotics the day of the procedure to avoid infection. Pain has been easily managed with OTC meds.

So, this has been the every-few-years routine. Except, Dr. E told me when he finished, there’s not a lot of bone left where the calcinosis has repeatedly invaded. He was clear that this is the last time he would do such an extraction. If it grows back, which it most likely will, then we’re talking rhinoplasty. “Well,” I quipped, “at least I have a lot of nose to work with.”

And that is where I find myself after Extraction #5. It’s a lot to process. If the calcinosis re-emerges in a year or so, I may not wait until it begins to form a noticeable bump to undertake the inevitable. I’ll be 70 next April, and if I need major nose surgery, it’s better to do it sooner than later. In the meantime, I’m glad this round is done. And the immediate benefit: I can breathe better.

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: Anne Nygård

First in Line

· · Leave a Comment

I got my new Covid shot a week ago, as soon as it was available. Glad to have that out of the way. It seems that the wily virus is popping up everywhere, once again disrupting lives, albeit with less serious risks for most, thanks to progress with vaccines and a build-up of natural immunity.

Just one way Covid has caused disruptions, of late: I sing in a quintet at my synagogue for the Jewish High Holy Days. Just before Rosh Hashanah the weekend before last, the wife of one of our tenors tested positive, so he could not sing with us out of an abundance of caution and consideration for others. Then this past week another member, who also sings tenor and was covering for the first tenor, was exposed to Covid while traveling, so we were scrambling to figure out who could sing which solos and harmony.

Fortunately, our game of musical chairs resolved over the weekend. The first tenor’s wife is better and he never tested positive, and the other tenor remains negative and symptom free. So both could join us in song for Yom Kippur, although the second tenor wore a mask to be extra safe.

So it goes in this post-pandemic time, when we all wish Covid was behind us, but it still lurks. I got the Pfizer vaccine, since I’ve had rashes and aches from Moderna. While my arm was a little sore for a couple of days and I felt very tired by day’s end, that was it for side effects. A small price to pay for protection.

Next up, getting a flu shot in early October, and then I’ll get the RSV vaccine. I take them one at a time, to avoid a pile-on of side effects. Not so for Al, who got his Covid, flu, and second shingles vax all on one day last week and never felt the worse for wear. I admit, I’m jealous.

However you go about it, Dear Reader, I hope you take heed and get your Covid vax as soon as possible, if your medical condition allows—for your own well-being, and for that of those around you. While the worst Covid outcomes are limited by antiviral medications like Paxlovid, the risks of long Covid remain real and serious, and increase with repeated infections and lack of vaccination. Be well.

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: Tim Mossholder

Enter Fall

· · Leave a Comment

It is rainy and chilly and dreary as I write on Monday afternoon. Here in Central Massachusetts, we were fortunate to avoid the worst of Hurricane Lee over the weekend, and the rest of the week looks sunny. But I’m feeling the chill in my hands today, knowing that fall officially begins this Saturday.

Already, the days are notably shorter, the transition even more striking since we came back from the Baltics, where the sun sets later because it’s farther north.

And so, it’s time to make my annual adjustment, mentally and physically, to inevitable colder weather. I should be used to it by now, but I always hate to bid summer adieu. Time for lined leggings and sweaters and wrist-warmers, heavier coats and gloves and hats, more effort to get dressed and out the door.

Sigh.

At least there is fall foliage to look forward to. That, and crisp air, and fewer mosquitoes, and the way that autumn light etches shadows. Even as leaves begin to drop and trees harden off for winter, new buds are forming. My hands will adjust as I remind myself: Only three more months until the pendulum swings and the days grow longer, once 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. Please view Privacy Policy here.

Rhapsody in Teal

· · 8 Comments

I haven’t sewn a garment for myself in quite a while, not since December 2021, to be precise. That project was an alpaca wool jacket, which came out fine, but I haven’t worn it too often because the fabric is a bit itchy. Oh, well. One of the challenges of making your own clothes is learning to pick the right fabric for the right project.

I have a lot of fabric in my stash, accumulated over decades. This is a common challenge for people who enjoy sewing—inspiration and purchase, followed by lack of time, energy, or whatever excuse to actually sew the garment. Call me guilty, as charged. But recently, I decided that if I wasn’t going to sew something or make use of all those fabric scraps from prior projects, I should at least find a way to responsibly recycle them.

Turns out our composting service will recycle textiles for a minimal fee. So I dug through my fabric stash to see what to eliminate. Not easy. I have a lot of nice textiles. Still, it was time to be realistic. After filling a bag for recycling with scraps that I will never use, I examined several yards of beautiful teal rayon. I must have purchased it not long after Al and I married, so it’s nearly 40 years old. But still in excellent condition.

Then I dug through old patterns, many of which I will never sew because I no longer like the styles, and bagged a bunch to recycle. But I found one, a simple caftan, that held promise for that gorgeous fabric.

Rayon is a tricky fiber. It drapes beautifully, but ravels easily and is slippery to sew. With two thumbs in bandages at present and limited dexterity, I knew it would be a challenge. That’s probably why I’ve avoided it all these years.

I read up on sewing techniques for rayon and set to. First I zigzagged the ends to prevent raveling, washed the rayon on delicate to pre-shrink, then air-dried it and pressed it on low (no steam). After testing the pattern with left-over muslin for the front and gingham for the back (more leftovers), I made some adjustments. Then I went to the fabric store and bought a better rotary blade cutter than my old ones, which I could no longer hold properly, some rayon thread, and some extra sharp needles for my sewing machine (recommended for rayon).

The rotary cutter was worth it, because I was able to cut out the pattern quickly and neatly, without hurting my hand. Theoretically, you’re not supposed to use pins other than those intended for silk, or they’ll leave permanent holes in rayon. I tried mini binder clips to hold the seams when I stitched, but they were too clunky and hard to open and place properly. Turns out, fortunately, that this fabric was fine with pins.

I took my time. I experimented with seam binding, but that didn’t work. I couldn’t serge the seams, because the serger destroyed the delicate fabric. So I stitched the seams on my trusty old Huskvarna, trimming them and zig-zagging the edges. For the neckline binding, I had enough fabric to cut bias strips, found some stretchy iron-0n interfacing in my stash, and made custom bias tape, which worked great.

Finishing the sleeves and hem was the hardest part of the project, because the pattern called for pressing under a quarter-inch of the edge, then folding it again and stitching down. Like I said, the fabric is slippery and I don’t have the ability to nudge a narrow, raw edge with my fingertips, which no longer exist. Stitching a quarter inch from the fabric’s raw edge gave me a guide for the first fold, which I pressed. Then I made the second fold, pinned and lightly pressed. But the big aha was realizing I could top-stitch the hem from the wrong side, thus easily controlling the narrow folded edge, and no-one would know the difference.

The finished dress earned a “Wow!” from Al, the desired response. I’m really pleased with it. It’s cool and comfy and fun to wear. All these years later, I finally found the right project for that beautiful teal rayon. I can still sew. And there is so much left in my stash. . . .

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.