Living with Scleroderma

Reflections on the Messy Complexity of Chronicity

managing chronic disease

Step-wise

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I see my podiatrist this week. It’s a good thing. Every couple of months, he rescues my feet from corns and tiny bits of calcium emerging from the tip of my right big toe. He also trims my toenails, which I can do for myself with a little difficulty, but still need help.

Scleroderma has caused the fat pads on my feet to recede significantly over the years, which makes it difficult to walk on hard surfaces. I really can’t go barefoot on our hardwood floors without discomfort. It feels like walking on bones. That lack of natural padding also makes corns more of an issue, especially when they form over joints.

Since last summer, I’ve been trying to manage a particularly annoying corn that keeps reforming over the metatarsal head of my fifth toe on the bottom of my left foot. Even with orthopedic foam inserts in my shoes—a necessity to cushion the impact of walking—I find myself rolling my left foot toward my instep, to avoid the feeling of stepping on a pebble. This places extra pressure on the metatarsal head under my big toe, which is also uncomfortable, and I end up walking with a slight limp and a rolling gate that aggravates other joints and my back.

It’s amazing how something so tiny can make it so much harder to get around. I find myself avoiding my neighborhood walks, lately, because of all this. And that means I get less aerobic exercise, and my weight starts creeping up again. If I don’t walk, I don’t sleep as well. And so on.

I’ve tried corn plasters and salicylic acid drops, which help a bit, but I can never fully extract the corn myself. Which is why I’m glad to be seeing my podiatrist this week. I’m hoping he can help me to figure out a way to keep the corn from reforming, although he’s told me recurring corns are a really common issue for his scleroderma patients.

My other possible solution is to cut away some of the foam in my left insert, essentially to make a little doughnut hole right where my corn touches it—kind of like a built-in corn cushion.

Living with scleroderma is, in some ways, a never-ending series of problems to be solved. Even after 40 years of managing this disease, it continues to surprise me. And so, my goal is to keep one step ahead, before the little stuff turns into something even more complicated and difficult to manage.

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: Christopher Burns

Say Cheese

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We could all use a reason to smile right now, and I have a good one. I finally have a full set of teeth.

Back at the end of last July, I once again had to have a tooth extracted due to root resorption from scleroderma. It’s been a long nine months without my lower front tooth, #24, waiting first for the bone graft to heal, then for the implant to heal, then for the crown to be made, and finally, on Monday, to complete the whole process and get my new tooth.

Except I actually lost another tooth along the way. When I saw my dentist last month to take the impressions for the crown for #24, I told him that my periodontist had said #23, right next to it, was already 50 percent resorbed and quite fragile. Would I be able to have a second implant next to the first? I asked.

He paused, then shook his head. Not enough room, not enough bone in my jaw to make it work.

My heart sank. Now what?

Fortunately, he had a good solution. Have #23 extracted soon, then he would order a “cantilevered” crown—essentially, a false tooth for #23 attached to the crown for #24. I’d need a temporary version for the three months it would take for my gums to fully heal from the extraction and bone graft, then a permanent crown by summer.

Not that I wanted the discomfort and expense of another extraction and bone graft so soon, but better now than later. So I went ahead and had #23 removed by my periodontist a couple of weeks ago. It went as well as could be hoped, my gums healed in a week, and I got my temporary crown on Monday afternoon.

I have to say, it’s very, very nice to be able to smile without a big gap in my lower front teeth. My tongue misses having that gap to play with (back to second-grade-missing-teeth time), and the crown takes some getting used to. But given that mask mandates are gradually easing here in Massachusetts, it is great to have a full set of teeth, once again. And I am very grateful that we have the means to afford it.

Not so for many. It really is high time for dental insurance policies to cover more than just cleanings and fillings. Healthy teeth and gums are not cosmetic luxuries. They’re essential for eating well and communicating, and play a huge role in how we’re perceived by others and feel about ourselves. Scleroderma can cause significant dental damage. Some recent research is delving into this issue, which points to a correlation between digital ulcers and so-called Multiple External Root Resorption (MERR), but it needs more attention and a search for mitigating options for those of us who must deal with this rare but particularly disfiguring and debilitating aspect of the disease.

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: hybrid

Awaiting Sunrise

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On a cold winter’s day, I’m thinking of sunflowers. Beautiful, hardy, bright sunflowers have been linked to scleroderma awareness, first in Australia, and now worldwide, symbolizing the sun’s warmth that brings so many of us comfort. At each sunflower’s center are thousands of tiny disc flowers that mature into seeds— symbolizing seeds of knowledge and the quest for a cure.

Sunflowers are also the national flower of Ukraine. Every summer, golden fields of sunflowers blossom across the country, which is the world’s largest producer and exporter of sunflower seeds and sunflower oil. The distinctive bloom is woven into wreathes for celebrations, painted on walls and furniture and folk art.

Before they fully mature and open, sunflower heads follow the path of the sun across the sky and come to rest overnight facing east, awaiting the next sunrise. Various religions have associated the sunflower with spiritual knowledge and a quest for truth and enlightenment. It is an inherently optimistic flower.

So I hold onto that as I have struggled to concentrate this past week, watching the brutal Russian invasion of a sovereign nation unfold. Great bravery and courage inspire. I pray that innocents will be spared, and that Ukraine, with the support of the world, will ultimately prevail.

And to plant more seeds for scleroderma awareness and research, I offer this: The biennial Systemic Sclerosis World Congress, a virtual gathering due to the pandemic, opens next week, on March 10, bringing together experts from around the world to share their work. There is a free Patient Congress, as well, from March 11-12, with presentations by international specialists on many aspects of living with this complex disease. Registration closes on March 7. You can find more here.

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: David Travis

February Thaw

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I was finally able to take a walk Monday afternoon around my neighborhood. The sun was bright, the sky a robin’s-egg blue, temps in the mid ’50s, and my thumb had healed enough so that I could swing both arms without the pain of gravity’s pull on a swollen finger.

All good.

The snow from a recent storm and subsequent snow showers had mostly melted, sending water trickling through storm drains. A mourning dove cooed plaintively from a nearby rooftop. As I walked, the too-tight muscles in my back began to relax. Annoying chatter in my mind quieted, and I focused on what I saw, heard, smelled . . .

Hints of green amidst bleached grass.

A watchful dog’s bark.

A power drill’s whine.

A passerby’s hello.

Tiny buds on tree branch tips.

Hockey sticks slap slap slapping.

Overhead a private plane’s purr.

Wood smoke’s tang.

Sparrows’ chatter.

Sneakers’ scrunch.

Spring can’t come too soon.

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.

In the Weeds

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Last week did not go as planned.

I’d been successfully managing two infected finger ulcers with my usual skin care regimen, plus an antibiotic that normally clears up any such issues within a few days. On Tuesday, I was on Day 10 of that medication and thinking I could probably discontinue it by Day 14. (My docs trust my judgment, given four decades of managing this disease.) But by that afternoon, the ulcer on the inside crease of my right thumb began to smart.

At first, I thought that my dressings had simply dried out and needed to be redone. But after my evening shower, I discovered that my thumb was not happy—not by a long shot. It was swollen and so painful that I ended up taking hydrocodone to try to control the cycling nerve shocks (you really have no clue how many nerves are in fingers until something like this happens). The pain woke me in the middle of the night, requiring a second pill. Even still, the pain persisted in the morning.

Now, I really hate the side effects of narcotics. They make me woozy, my mouth even drier than normal, and I just feel off. And in this case, the hydrocodone didn’t help all that much. Fortunately, by Noon I was able to reach my ID specialist, who prescribed another antibiotic that I’ve used before, which attacks a different spectrum of bacteria. Clearly, I had picked up something, somehow, that was new.

I was able to manage the pain during the day by alternating acetaminophen and ibuprofen, and took two doses of the new antibiotic by the time I went to bed. More interrupted sleep, but I was determined to not take anymore narcotics because I had to drive to Boston the  next day and see my rheumatologist for a long scheduled appointment.

During the exam, we discussed pain management, and my issues with hydrocodone and related drugs. He mentioned that a number of his patients have had good results with cannabis medications to control pain. This had never occurred to me. Armed with that new idea and a prescription for lidocaine ointment, I went home.

A small drop of the lidocaine helped block the pain when I changed my dressings that night. I had a better sleep. But by morning, the pain came roaring back. I have not experienced anything this severe since I had major ulcers several years ago. Even with the ointment, I could not stop the nerves from zapping. I was really at a loss after bandaging my thumb.

Then I remembered a jar of hemp oil ointment that Al had gotten a while back for some joint pain. I’ve used it successfully for lower back pain on occasion. So I dipped a cotton swab in the jar and painted a line of hemp oil around the base of my thumb, just below the bandage. Within minutes, the intractable pain ceased.

Really, it was a miracle. And it lasted all day.

Needless to say, I’ve been applying it the same way since Friday. Between that, the lidocaine, and my usual skin care, plus the new antibiotic at last kicking in, my thumb (knock on wood) is finally healing again. I also discovered that the hemp ointment helps with another occasional discomfort—phantom itching of my right middle finger, about an inch above what’s left of it after surgery several years ago. It’s an extremely odd and annoying sensation, because I can’t scratch it to relieve it. There’s no there, there. But a little of the hemp ointment completely eliminated the itchy feeling. Who knew?

Which is a long way of saying that I am extremely grateful for CBD therapeutics and my wonderful medical team.

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.