Living with Scleroderma

Reflections on the Messy Complexity of Chronicity

managing chronic disease

Knee Deep

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It’s been a little over three months, now, since I fell and whacked my right knee. No visible signs of any injury or X-ray evidence of internal damage. Still, from time to time, it can still get achy.

I had mentioned this to my Boston rheumatologist back in early January, and he thought I may have bruised the inside of my kneecap. If the issue persisted another month, he suggested getting an MRI to determine if there might be a stress fracture. So, when I saw my local rheumatologist last week, I mentioned the residual soreness and asked him what he thought.

His advice: give it more time. He agreed with the bruised kneecap theory. But he also raised a really important point. If the MRI found a stress fracture, what would I do differently? Give that I have no trouble (thankfully) walking, standing, or sitting, there is no way I would want any knee surgery. The risks are significant (particularly regarding infection) and benefits in my case, questionable. I would just have a clearer idea of what was going on inside my knee, but—so what? Why undergo an expensive diagnostic, even if it were covered, or mostly covered, by my insurance? What’s the value-added to my ability to take care of my health?

Of the many lessons I’ve learned over 35-plus years of living with scleroderma, this was a really good reminder that not all diagnostics are worthwhile, especially when they might lead to more tests and complexity that doesn’t necessarily add up to better health.

So, I’ll just keep listening to my body and allowing my knee to heal. Going to the gym is helping or, at least, not slowing down the healing process. I’m up to a mile-and-a-quarter on the stationary bike, plus my mile walk on the indoor track. Climbing stairs is a bit easier, and I feel more energized, overall.

Obviously, if the pain were to worsen, I’d need to reevaluate next steps. But for now, it’s one less thing to worry about. And that’s the best health boost of all.

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: Ricardo Velarde

Viral

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Most weeks, I write this blog on a Monday, and this week is no different. I often don’t know what I’m going to write about until I get up that morning. Last Monday, however, it was good that I’d planned ahead with a photo essay, because I was just barely recovering from a really nasty stomach bug that had dogged me since Saturday evening.

This happened, of course, on a weekend when Al was out of town. For a good 24 hours, I could barely tolerate liquids. Monday morning, after a rough night, I did a little internet research and found a homemade electrolyte recipe for a mix of hot water, honey, lemon juice and salt. This helped enough that I no longer felt woozy, and I was gradually able to munch on rice cakes with a little date spread, to boost my energy with a slow metabolizing sugar. By mid afternoon, I had bounced back enough to return to my normal schedule.

It took a few more days for my system to fully right itself, but my point is, one week later, I’m feeling fine, thank you.

Our bodies, even when they don’t work perfectly, do have an amazing capacity for self-healing. Common sense, being attuned to symptoms when they first arise and responding accordingly, patience—all go a long way toward recovery. Obviously, this includes getting appropriate medical attention and treatments when warranted.

I’ve been thinking about all of this while watching the news about the spread of the coronavirus throughout the world. As of Monday morning, there were nearly 17,500 people who had contracted the flu-like disease in a few short weeks, mostly in China, and 11 in the U.S., including one here in Massachusetts. At least 362 people have died and 530 have recovered. The World Health Organization (WHO) has declared the virus a global health emergency, travel restrictions on flights to and from China are in effect, analysts warn of market instability, and surgical masks are sold out everywhere. Sadly, predictably, anti-Chinese xenophobia is also on the rise.

The prospect of a deadly worldwide pandemic is certainly terrifying—but the reality is that this virus is not nearly as deadly as this year’s version of the flu, an annual occurrence that we take for granted. Plenty of people don’t even bother to get a flu vaccine, even though it’s covered by most insurance policies. According to the Centers for Disease Control, there have been more than 107,000 confirmed cases of the flu in the U.S. since last September, and the virus is prevalent throughout much of the country. It has affected as many as 26 million Americans and is responsible for at least 10,000 and possibly 25,000 deaths.

That’s in four months. So why are we all so fixated on the coronavirus? According to the WHO, 2019-nCoV can cause mild, cold-like symptoms, like runny nose, fever, and cough. More severe cases can cause shortness of breath, which can lead to breathing difficulty or pneumonia, and, in rare cases, death. People with compromised immune systems are at greater risk (but that’s basically true for any disease). That said, this year’s influenza strains certainly pose a much greater health risk, at least, as far as we know.

Bascially, it all comes down to this: We’re used to the flu season. It arrives around October and ends around April. We know what to do (even if we don’t all do it). The coronavirus is spreading exponentially with an unknown trajectory, which feels threatening, and there’s no vaccine, because it’s a novel virus. Any vaccine would take a year to develop and produce in large enough quantities. And people have died.

There is every good reason to treat this virus as a serious public health emergency to contain its spread. But panic isn’t going to help anyone. If we can take the flu in stride (perhaps more than we should—it would be great, for example, if employees had incentives to stay home when sick instead of having to trade off health with cost of lost income), then we should be able to use commonsense hygiene and treat others with common courtesy when our coughs and sneezes are clearly putting them at risk.

The fact that flu seasons end every year, even when about half the country doesn’t get vaccinated, means that many people are able to heal and build up immunities, despite what truly is a deadly virus. I want to be clear that I am absolutely not arguing against vaccination, especially for those of us with chronic autoimmune diseases. I’m just saying that freaking out about the coronavirus is a waste of time and energy.

Better to stock up on soap and sanitizer, get medical attention when you need it, and treat others when you’re sick as you wish they’d treat you.

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: Dominik Martin

Sugarplums

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As I write on Monday morning, snow melts off the roof of my home office, tap-tapping on the sill below. The droplets catch the sun, like streaks of liquid gold. Yew boughs glitter and sway in the light breeze.

Still, it’s quite cold outside, with highs today only in the low ’20s. I’m glad for my renewed gym membership, knowing I can walk and ride the bike despite the frigid air. (And, yes, I hit my goal last week of three workouts!)

Memories come in odd flashes. As I was getting dressed, trying to figure out how many layers I needed, I suddenly recalled a particularly cold day in the second grade. Back then, freezing temps would not have stopped our teachers from sending us outside for recess. As long as the sun was shining, we were on the playground, tossing rocks for hop-scotch, twirling jump ropes, climbing the jungle gym, swinging on swings, playing dodge ball.

But on this particularly cold day, a few friends and I were complaining to the recess monitor, a woman with a dark-brown, Jackie-Kennedy-style coif, scarlet lipstick, and a kind disposition, about the fact that we didn’t want to be outside. She was our favorite monitor, possibly one of the moms, though I don’t recall. “You’re just a bunch of sugarplums,” she teased. “It’s a beautiful, sunny day!”

Our seven-year-old response was to link arms and march around, chanting, “It’s cold, it’s freezing, it’s terrible! It’s cold, it’s freezing, it’s terrible!” She laughed, and we did, too. At some point that seemed like forever (probably after a mere 20 minutes), the bell rang and we gratefully retreated to the warmth of our classroom.

I am, still, indeed, hypersensitive to the cold—though not due to any (implied) weakness of strength or character. Remembering that day, I have to smile, but I’m glad that, in our own childish way, we stood up for ourselves. (Back then, girls had to wear skirts and dresses to school, so our legs were pretty darn cold.)

At the same time, our recess monitor made an important point. Focusing on the negative wasn’t going to help us one bit to stay warm. Running around would have been a better idea, soaking up the sun and generating our own heat. Linking arms, our improvised solution, helped, too.

Some 59 years later, those lessons still shimmer in my mind. Focusing on the negative, overwhelming as the challenges may seem, won’t get us anywhere. Standing up for our truths matters. Linking arms helps.

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: Nine Köpfer

Cycling

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I hit my low energy point every day around 2:30 in the afternoon. I’ve been this way since graduate school. My brain gets fuzzy and my body wants to take a nap. Usually I can push through it.

Twelve hours later, it’s a different story. If I’m unfortunate enough to wake at 2:30 in the morning, chances are I won’t be able to sleep again for another couple of hours. My brain is wide awake, and there’s no use trying to pretend to sleep. Better to just get up and read for a bit, to short-circuit my mental hamster wheel.

Exercise interrupts both circadian cycles. And, now that it’s a new year, I’m back to the gym. I’ve been experimenting with different types of exercise for the past several years. Each has its advantages and drawbacks. Pilates is still the best overall exercise, but the classes I prefer are either first thing or mid-morning on a Wednesday, which is just not optimal timing, since I’m just not an early morning person, and I hate losing the rest of the morning to driving 20 minutes, going to class, and driving home.

Recently, I found another alternative—a Sunday morning barre class at an adult dance studio. But the pace, at present, is a bit too fast for me, and ever since I fell and whacked my knees at the end of October, I need to be careful of putting too much pressure on them. So, I’m hoping to get back to that, and, if the studio schedule shifts, a dance class, too, but I need to build myself up, first.

That is why, last week, after a three-year hiatus, I renewed my membership at a nearby college gym. Al is an alum, which gives me spouse privileges, and this gym has an indoor track. My favorite exercise is walking, but in winter, not so much. The elevated track, which encircles the gym, provides a great alternative. There are also stationary bikes. These, I’m not so crazy about, but I need to just do it, for aerobic exercise and to strengthen my legs.

Armed with my new ID card, I headed over to the gym on Monday afternoon around 2:30. To make the experience more enticing, I brought along a new, inexpensive set of over-the-ear wireless headphones, which I paired with one of my favorite travel podcasts. Off I went on my old routine of a half-mile steady walk around the track, a mile on the stationary bike, followed by another half-mile on the track.

It felt really good. When I got home, the bonus: my brain was clearer, despite the mid-afternoon witching hour.

If I can stick to this three times a week, I’ll be meeting a reasonable goal. More often, so much the better. And since I’m writing it here, I’m holding myself publicly accountable. Stay tuned for progress reports.

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: Tyler Lastovich

Chopper Talk

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It is most delightful to have my molar back. As in my back right lower jaw, which has been missing that tooth since last April, when a painful, resorbing root sent me to my periodontist for an extraction. No fun, that. Nor has it been a treat to eat with a large gap in my teeth in the grinding department. I’ve had to be extra careful for months to thoroughly chew my food, mostly on the left side, to be sure I can actually swallow safely.

Ah, the joys of scleroderma dental problems. And esophageal dysmotility.

But my new post and crown, inserted on Monday, fits perfectly. It’s an odd feeling. What is that thing in my mouth? Oh, it’s a molar! No longer can my tongue wander into the gap for a little exercise. No longer must I consider whether to mush food with my lower gum on the right or chew on the left. No longer does my right cheek sink in ever-so-slightly over my missing tooth.

Fitting the crown and inserting it proved to be the usual challenge in my tight mouth. A month ago, I had to help the dentist and his assistant insert the molds for my upper and lower jaw, because it was easier for me to figure out the right angle than for them to try without stretching my lips to intolerable tension. Yesterday, it took more lip contortions and some deep breathing on my part as my dentist screwed in the post for the crown—not easy for either of us. But it’s done, and it feels amazing.

Turns out, my dentist told me, he had just needed an extraction himself of one of his front teeth. He has a partial, temporary bridge, so you can’t tell, while he traverses the long process of implants and replacement. I found this encouraging, not only because he uses the same periodontist that he’s sent me to (definitely a good referral), but also because one of the next teeth I may lose due to scleroderma resorption is also a near-front tooth. We’ve been monitoring it for years.

Hopefully, it will continue to take its time. But it’s reassuring to know that, whenever the inevitable comes, I won’t have to look like Alfred E. Newman for months until the procedure is complete. Meanwhile, I will enjoy having a full set of choppers. Carpe diem—or should I say, carpe dente? Maybe not. I don’t want anyone seizing any more of my teeth for as long as I possibly can.

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: Stefan Steinbauer