managing chronic disease

What Comes Next

Evelyn Herwitz · July 31, 2018 · 3 Comments

This Friday marks the one year anniversary of my hands falling apart—literally. This is not easy to think about, even as I’ve been recording my experience and its aftermath these past twelve months. It makes me cringe.

At the same time, I’ve grown quite accustomed to my “revised” hands. I was noticing this the other day when I was working on a sewing project. I had no trouble negotiating my sewing machine, handling the fabric, moving my fingers around the needle and presser foot, winding the bobbin, pinning and unpinning. I still have to be mindful of how I position my hands, but mostly it’s become second nature.

Remembering how all this started, however, is scary. I had no idea what I was in for, and it was not only painful when my very severe ulcers lifted up to expose bone, but also revolting. I don’t think I fully allowed myself to acknowledge that at the time. Some kind of internal coping mechanism, combined with my writer’s indefatigable inquisitiveness, took over. (“Oh, wow, that’s what my knuckle bones look like!”)

Fortunately, in this case, curiosity did not kill the cat but enabled her to persevere. I didn’t let my deteriorating hands stop us from taking an extraordinary trip to Iceland and Norway; in fact, as I wrote at the time, it propelled me to seek out beauty to boost my courage for whatever lay ahead. I benefited greatly from my very supportive husband, without whom that trip would have been impossible.

August is just around the corner, and we are a few weeks out from another trip abroad. I am very grateful that my hands are in relatively good shape at present, with only two bandages, including one on my right thumb that is protecting an exposed clump of gray calcium that has yet to exit the finger pad. I am debating whether to ask my hand surgeon to remove it for me or just let nature take its course. My nose is healing from surgery two weeks ago. I am praying that we will avoid any health issues or other emergencies this year.

There is just no way to know what comes next. I can only hope that my well of resilience remains deep. I hope the same for you, Dear Reader, wherever your summer travels may take 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 Credit: David Monje

Operating Instructions

Evelyn Herwitz · July 24, 2018 · 2 Comments

This one’s short.

In Anne Lamott’s Operating Instructions, a memoir of her son’s first year and her struggles as a single mother, she recalls this anecdote about writer’s block:

. . . I remembered the other day a weekend I spent with my family at our cabin in Bolinas when I was seven or eight and my older brother was nine or ten. He had this huge report on birds due in school and hadn’t even started it, but he had tons of bird books around and binder paper and everything. He was just too overwhelmed, though. And I remember my dad sitting down with him at the dining table and putting his hands sternly on my brother’s shoulders and saying quietly, patiently, “Bird by bird, buddy; just take it bird by bird.” That is maybe the best writing advice I have ever heard.

Lamott went on to write, among other books, Bird by Bird, which is, indeed, one of the best writing books out there. But her father’s advice applies to many other situations, too—when there’s too much to do, too many deadlines, too many uncertainties, too many worries, just too much stuff. Nothing big and complex and important ever gets solved or resolved in short order, be it creating a work of art, managing a chronic disease or anything and everything in-between. Bird by bird.

Image Credit: Rafael Rodrigues Machado

Tin Man

Evelyn Herwitz · July 17, 2018 · Leave a Comment

Two-and-a-half years have passed since I last had calcium removed from the bridge of my nose, an unhappy complication of my particular variant of scleroderma. So it was that I found myself Monday morning in the exam room of my ENT plastic surgeon, once again assessing what looked like a gray clump just below the skin.

According to my medical records, this is the sixth time I’ve had the procedure over the past 15 years or so (fifth time by this specialist). So I was pretty sure of what to expect.

Except my disease had decided to play a little trick. Instead of the calcium being content to attach to my septum, it had sprinkled itself into the skin, as well. This meant that he would have to remove an ovoid-shaped centimeter of skin above the clump, to excise all the calcium sprinkles as well as the main culprit.

“You’ll have a scar,” he said. I replied that I didn’t care. No worse looking than a gray bulge on my nose, and certainly easier to cover with a little foundation.

The main issue for me was to avoid lidocaine with epinephrine, the local they gave me last time that caused heart palpitations, back pain and a total sense of being out of whack for about 24 hours. He prefers it because it reduces blood flow to the excision, but I’ve had this procedure done enough times before that combo was popular, and I knew it could be done.

The team—a resident, a fellow and my doc—conceded to my request, and we went ahead. Five shots of lidocaine later, the bridge of my nose was numb. I could not feel the scalpel. But as has always been the case, I could certainly feel the grinding of the surgical tools as he scraped away the calcium. Some of the tiny pieces flipped out, one onto the corner of my closed eye, another on my neck. Within about five minutes, he’d removed it all.

Seven sutures and the incision was closed (although, as he was stitching me up, he wondered aloud if the sutures would actually pull the skin all the way back together—which, he added, was not a problem, as a bandage covering the incision would enable it to heal, but this was rather disturbing, as I imagined exposed bone on the bridge of my nose—then he remarked that it was closing up just fine—good grief).

Then came the surgical strips. First some (I believe) antibiotic ointment and one strip. Then some kind of liquid glue that smelled a bit too much like Duco Cement, then more layers of the strips. When they were done, my nose looked like the Tin Man’s from the Wizard of Oz. A little of the glue dripped into the corner of my right eye and burned like crazy.

“I said to keep your eyes closed,” he chided. Thanks a lot. Fortunately, the resident was more helpful with some sterile saline eye drops.

He was also kind enough to give me a prescription for a few Vicodin, after the specialist left the room. (The latter considered pain meds unnecessary and assured me that Tylenol and Ibuprofin would be ample, but I’ve been through this enough times to know that the first 24 hours can be quite unpredictable for pain.)

Al had accompanied me to the appointment, thank goodness, because there was no way I could drive home with a burning eye. It took dozing in the car for an hour plus a two hour nap at home to ease the inflamation. So far, as I write on Monday afternoon, I’ve been able to avoid the Vicodin, but it’s good to know I have it available for sleeping, if necessary. I also took the precaution of consulting with my infectious disease specialist ahead of time regarding taking an antibiotic prior to the procedure and for the next seven days, because I am so prone to infection.

So, now, it’s all about healing. I have to keep the steri-strips on for the better part of the week, unless they fall off by themselves. One is taped to pull up the tip of my nose a tad, to relieve stress on the incision. Eating and drinking feel a bit weird, as a result. I have to be extra careful if I have to blow my nose. But I can sit at my desk and do a little writing. The weather is quite warm, which is best for my circulation. And it’s done . . . at least for another couple of years.

Image Credit: The Tin Man. Poster for Fred R. Hamlin’s musical extravaganza, The Wizard of Oz. Poster print, lithograph, color, 105 × 70 cm. Created by “The U.S. Lithograph Co., Russell-Morgan Print, Cincinnati & New York.” Library of Congress, Prints and Photographs Division. Courtesy of Wiki Commons.

Interlopers

Evelyn Herwitz · July 10, 2018 · Leave a Comment

Mid-July, and it’s hot in Central Massachusetts. High ’90s last week, and so humid that it felt as if you were swimming, far-too-far from the beach. What a relief when thunderstorms passed through on Friday to clear the air for the weekend.

Friends have asked me if I’m enjoying the heat. They well-know my aversion to cold. But, I tell them, even I have my limits. My happy place is mid-80s with low humidity and a light breeze. So it felt very good to take a walk around the neighborhood Monday afternoon, in precisely those weather conditions.

Only a few other people were outside—a kid on a bicycle, a lawn crew, a boy shooting baskets in his driveway. Just me and the birds and the gypsy moths. The latter seem to be reveling in their last week of life, flitting around tree trunks, plastering bark with tan egg masses that will become next year’s scourge of very hungry caterpillars.

Our city’s trees have been hard-hit, especially oaks. If we get enough rain this season, we may avoid more defoliation next summer. The caterpillars’ only natural control is a fungus that has died off in recent years, due to drought. It’s making a slow comeback, and this year’s infestation is not as bad as last, but conditions have been too dry for Mother Nature to hold the insects fully in check.

As a little kid, I used to do my part. I loved to collect caterpillars and let them crawl all over my fingers (at least until whatever they secreted made my skin peel). Then I would put them in glass jars along with twigs and leaves, poke holes in the metal cap, and imagine they were my pets. They would inevitably die of suffocation.

Walking on Monday afternoon, I wondered how something so beautiful could be so destructive. There’s a marvelous felicity about these moths, how their papery wings glow golden in the sunlight. They brush your skin like a dainty feather. When they first hatched from their pupae last week, fluttering outside my office window, I mistook them for butterflies.

Well, butterflies they are not, and I am hard-pressed to understand what possible positive role they fill in the ecosystem. Same goes for mosquitos. Ditto for rare and chronic diseases, plant-borne and human.

Regardless, nature’s balance deserves—no, demands—our respect. Our lives depend on it. On Tuesday, the temperature creeps back up near 90. I hope we get some rain.

48 Hours

Evelyn Herwitz · July 3, 2018 · Leave a Comment

It’s been nearly 30 years since I visited our nation’s capital. This past weekend, Al and I packed in a slew of sightseeing in Washington, D.C., around a family celebration in Virginia. In just over 48 hours, we visited the National Gallery, Lincoln Memorial at night, Vietnam Veterans Memorial (also at night), Supreme Court, Capitol grounds, Newseum, National Gallery Sculpture Garden, National Archives, Hirshhorn Museum and National Gallery East. On Saturday morning, in sweltering heat, we participated in the Families Belong Together protest rally in Lafayette Park, next to the White House.

I walked my feet off. It was worth it. The highlight of DC, for me, was seeing the original Declaration of Independence, U.S. Constitution and Bill of Rights at the National Archives. The parchment is huge, the writing faded, the signatures inscribed by human hands. The ideals endure. I was reminded by an exhibit about women’s suffrage at the National Archives and the chiseled words of Lincoln’s second inaugural address at the Lincoln Memorial of how much struggle and acrimony is embedded in our nation’s history. I felt the power and protection of the First Amendment in Lafayette Park.

Here are some of my favorite images from our trip:

managing chronic disease

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