Living with Scleroderma

Reflections on the Messy Complexity of Chronicity

managing chronic disease

Parallel Universe

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About thirty years ago, when we had our first dog and no children, in our first home, we were robbed.

We didn’t actually know it until a police officer came to the door that evening. Earlier in the day, the thief had shown up at our bank with a forged check he’d snitched from the middle of our checkbook. Unfortunately for him, but fortunately for us, an off-duty cop was at the bank when he pulled his stunt—and recognized him.

We were shocked. Sukki, our lab-springer-golden mix, had apparently welcomed him with a friendly wag of her black-and-white tail as he went through our desk drawers and my jewelry box. Not only did he steal the check; he also fenced some of my jewelry, a pearl necklace from Al and a gold charm bracelet that my grandmother had given me. But at least he didn’t steal our bank balance.

Maybe a year later, we went to the county courthouse as witnesses in his trial. Let’s call him M. We met a few other victims. To the best of my recollection, one of them told us that M had stolen a TV set and then called a cab to take him home. Needless to say the guy had bad judgment. He was a crack addict. We waited around for hours, only to learn that the case had been plea-bargained, and M would soon be sentenced.

Since that time, every so often, we receive letters under the Commonwealth’s witness protection program about M’s whereabouts in the correctional system. He would move from minimum security to medium security and back again, fail to achieve parole over and over. For three decades. About a month ago, M came up for parole and actually made the cut. I have to admit, I was both astonished and a bit glad for him. Thirty years is a long, long time to be in prison. But I was not optimistic. (I am not in the least concerned that he would reappear at our door since we moved so many years ago.)

Sure enough, on Monday I got another letter from the Massachusetts Executive Office of Public Safety and Security. M was back in temporary custody “due to a possible violation of the conditions of parole.” I’m guessing that he must have sabotaged himself. Think of all that has changed in the past three decades. How would any of us be able to adjust to the outside world after spending all that time in the structured, restricted, but in-its-own-way-predictable prison system?

In some ways, I measure my life against M’s. Since he’s been behind bars, I’ve lived with my own sentence of scleroderma, which emerged a few years before the robbery. But I’ve been fortunate—with excellent medical care, a supportive family and a lot of luck, I’m living a fairly healthy life, all things considered. I’ve raised two daughters, built a successful career, pushed the envelope on discovering what I can still do despite medical constraints.

M remains mired in a dismal life. Some of that is surely his own doing. I wonder, however, what real support he’s had in trying to turn himself around. I think he was about my age when he went to prison. He’d be in his 60s now.

I don’t have an easy conclusion for this one. It would be too facile to say that we each make choices in how we meet life’s challenges. I know nothing of M, other than the occasional progress reports (or lack thereof) that we receive in the mail. We never saw him at the courthouse all those years ago. Suffice it to say that incarceration is as much a state of mind as a prison is a fortress of cement and stone and barbed wire.

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.

Image Credit: Christian Bardenhorst

In 3-2-1

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I stay up way too late most nights watching late night comedians. Since we live on the East Coast, this means I’m getting to bed around midnight. My evening routine is prolonged by tending to all the bandages on my fingers—up to six ulcers at present, plus one on my left ankle—so my excuse is that the shows keep me company while I’m taking care of my hands. But in all honesty, I rely on satire to keep my sanity.

My favorite is Stephen Colbert. Al’s, too. So when Al suggested that we mark our anniversary this year by a trip to NYC to see a live taping of The Late Show, I readily agreed. We were married in December 32 years ago, but due to scheduling conflicts, our first opportunity to go was last week.

And go, we did. We decided to make a mini vacation of it, booking a four star hotel on Park Avenue at a January discount, scoring half-price tickets to a Sunday afternoon off-Broadway show, enjoying great food and wonderful art museums on Monday and Tuesday. But the highlight of the trip was our pilgrimage to the Ed Sullivan Theatre for Colbert on Monday afternoon.

Now, as children of the ’60s, it was exciting enough to be at the very spot where the Beatles made their American debut. The theatre features architectural filagree that gives it a period flare. It’s located on Broadway between West 53rd and 54th Streets–the latter also designated as Señor Wences Way, a throwback to that wonderful, corny feature act on the Ed Sullivan Show that we loved as kids.

But it was also fun just to be with other Colbert fans as we waited outside, joking and speculating about the program as we stamped our feet and huddled against the cold. The priority ticket line formed at 3:00 p.m. We arrived shortly after and quickly made our way through the check-in, staffed by friendly red-jacketed twenty-somethings armed with iPads and headphones, who made occasional announcements about what to do and where to go. A nice couple offered to take our picture in front of the marquee, and we returned the favor.

By 3:45, rehearsal was over and we were finally allowed to enter the warm theatre lobby. More waiting and waiting in a long, snaking line beneath large TV monitors playing excerpts from previous shows, though the sound was muted. From time to time, one of the staff would fill us in on next steps and rules: turn off all cell phones, no food allowed in the studio theatre, and—around 4:30—now’s the time to use the bathroom, because once you’re seated, there are no bathroom breaks.

Wait, what? I’d figured that, if I had to go, I’d be able to do so during a commercial. But, no, only if it was an emergency—and no guarantee you could be reseated. Now, this was potentially a major issue for me. I can no longer go long stretches without a trip to the bathroom. My bladder just doesn’t empty efficiently. So I joined a line of other women, waiting for a stall in the Ladies’ Room, and hoped I could squeeze out the last drop. Fortunately, we’d eaten lunch about two hours earlier, and I hadn’t had much to drink.

Back in line, I distracted myself by chatting with some of our neighbors, flexing my ankles and feeling grateful that I was wearing compression knee socks, so that my feet wouldn’t swell from all the standing around. Finally, shortly after 5:00, it was time to be seated. The red jackets were very experienced at crowd control, and we efficiently filed into the main floor. Lo and behold, the center section was full, so Al and I found ourselves guided toward the third row of the right-hand section, directly in front of Jon Batiste’s Steinway concert grand piano. Al was in heaven.

Here we were, with a great view of the Late Show set, so familiar from our TV at home. We gawked and chatted with our seat mates (mine was a Lutheran pastor from Saskatchewan, here with friends for her first visit to NYC), listened to more instructions about our role as audience (enthusiasm and energy are essential for the performers as well as the 2.5 million folks watching later tonight), practiced standing and cheering, warmed up to the warm-up comic, clapped and bopped to the outstanding jazz of Jon Batiste and Stay Human, and then, finally, screamed our heads off, just like those Beatles fans fifty years ago, when Stephen Colbert ran out on stage to greet us.

He was genuinely warm in person, very down-to-earth, as he fielded a few questions from the audience with his quick, dry wit. Then it was time for the taping to begin. We could watch the cold open on the video monitors, then Colbert ran out on stage again, this time as part of the show. The boom camera swept the audience, and we were off to the races.

Time zipped by. There was a surreal quality to the experience, watching Colbert perform for the four cameras that surrounded him in his opening monologue, even as he fed off our energy. There was a pause for him to switch from his suit jacket to a Dad sweater for a skit with guest Leslie Mann, another pause because one of the lights wasn’t working properly, casting a shadow on the couch where they were to sit. “The Russians must have hacked our set,” he quipped.

The band played on during commercial breaks (how I wish that were the case when you watch on television–they are such amazing talents). Lewis Black and Dan Levy rounded out the program. We stood and cheered on cue (when the stage manager waved his rolled-up script in the air). Colbert’s wife made a surprise appearance to roars of approval.

And then it was over. I’d been so absorbed, I’d forgotten all about any bathroom jitters. Al and I looked at each other. We didn’t want it to end. Despite the cold, we walked all the way from Times Square back to a little Italian restaurant near our hotel, where we enjoyed a fine dinner and live piano music. Later, we watched the show again in our hotel room, to see how it was edited and, of course, to see if we made it onto the tape. And there we stood, cheering in the crowd after one of the early commercial breaks! I finished bandaging my fingers, and we went soundly to sleep.

All in all, it was a wonderful anniversary celebration—a great break, a much-needed chance to recharge, a gift of resilience. And, oh, did I mention? The Colbert tickets were free.

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.

Oasis

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I’m finding it difficult to write about anything other than the chaos in the world, in our country, in my heart. So what I’m sharing today may seem odd. But we chose to immerse ourselves in art and floral arrangements at the Worcester Art Museum’s annual Flora in Winter exhibit this weekend. I’m grateful that I have the opportunity to do so. It is, indeed, a privilege.

Inspiration, courage, solutions, just finding the next step can become clearer when you give yourself the chance to find beauty in the world. I share these with you, Dear Reader, in hopes that you will find inspiration, too.

“The Blue Bowl” by Roger Fry

Hand-drawn mock-ups of Ed Emberley’s “Drawing Book of Animals”

“Selma to Montgomery March, 1965” by James Karales

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.

Existing Conditions

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With the presidential inauguration only a few days away and the Republican-controlled Congress on a fast track to repeal the Affordable Care Act, it’s essential for all of us who live with chronic diseases to understand what’s happening to health insurance coverage. Much is still in flux. I have been staying up far too late recently, reading the most reliable sources I can find to follow the pace and direction of “repeal and replace” of Obamacare.

I do not intend to turn this blog into a political forum on the issue. However, I will confess that I am deeply alarmed by what’s happening in Washington and what I perceive as the significant risks of repealing a flawed but beneficial law with no clear plan to replace it. The drafting of the ACA involved many participants in the health care system. Its replacement deserves similar, deep discussion and debate, and enough time to consider all the implications—especially for the millions of Americans who may now lose health insurance without the means to purchase needed coverage, if insurance subsidies provided under the ACA are eliminated.

The procedural rules that Republicans are using to push through reform are complex. The process of ACA repeal began last week with a special budget process called reconciliation, which requires only a simple 51-49 majority in the Senate and precludes filibuster by opponents. In accordance, both Houses passed a blueprint for repealing Obamacare. There is a long way yet to go. Here is a January 13, 2017 article by Margot Sanger-Katz from the New York Times that explains all the steps: Obamacare Repeal is Moving Forward. When Will Changes Affect Consumers?  As she notes, it’s highly unlikely that those currently covered by the ACA will feel the effects this year of a potential repeal.

I have been very fortunate to have excellent health insurance through my husband’s employer. Since I work for myself, buying private insurance, even in Massachusetts, which created the prototype for Obamacare, is expensive. But I know I can get it if I need to, even though I’ve had scleroderma for more than three decades.

At stake for so many out there with serious health issues is the pre-existing condition protection provided by the ACA. So far, the president-elect has expressed an interest in preserving this aspect of the law. But, it’s complicated. Here is an excerpt from another piece by Sanger-Katz, explaining what’s at stake. You can read the full article here: The Biggest Changes Obamacare Made, and Those That May Disappear

One of the law’s signature features prevents insurance companies from denying coverage or charging a higher price to someone with a pre-existing health problem. The law included a host of other protections for all health plans: a ban on setting a lifetime limit on how much an insurer has to pay to cover someone; a requirement that insurers offer a minimum package of benefits; a guarantee that preventive health services be covered without a co-payment; a cap on insurance company profits; and limits on how much more insurers can charge older people than younger people. The law also required insurance plans to allow adult children to stay on their parents’ policies until age 26.

What would happen? These rules can’t be changed using the special budget process, so they would stay in place for now. But eliminating some of the other provisions, like the subsidies, and leaving the insurance rules could create turmoil in the insurance markets, since sick customers would have a much stronger incentive to stay covered when premiums rise.

What might replace it? Mr. Trump has said that he’d like to keep the law’s policies on pre-existing conditions and family coverage for young adults, but Senate Republicans recently voted against nonbinding resolutions to preserve those measures, suggesting they may be less committed. Some of the other provisions would probably be on the table if there were new legislation. Republicans in Congress would probably eliminate rules that require a minimum package of benefits for all insurance plans and allow states to determine what insurers would have to include. Mr. Trump has said he’d like to encourage the sale of insurance across state lines, a policy likely to make coverage more skimpy but less expensive for many customers. Republicans would also like to expand tax incentives for people to save money for health expenses.

Many of the Republican proposals would also establish so-called high-risk pools, which would provide subsidized insurance options for people with chronic health problems who wouldn’t be able to buy insurance without rules forcing insurers to sell them coverage.

The debate is far from over. We each have an opportunity to express our views to our congressional representatives. Whatever your opinion on this subject, please read beyond tweets and headlines, be informed and willing to listen to other points of view, and make your voice heard.

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.

Image Credit: Pablo Garcia Saldaña

Think Warm Thoughts

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It’s really cold out. My hands are not happy. Six ulcers on my fingers and a tenacious one on my left ankle tingle and smart. The good news: even though we’re in the teens today, by Wednesday, it’s supposed to go up to the 50s. Welcome to New England.

As I await the warming trend, it’s nice to remember our long New Year’s weekend in St. Petersburg, Florida. Were we really at the beach one week ago? I have the pictures to prove it. So, I share with you, Dear Reader, some highlights of our trip. I hope these bring a little warmth into your day. Enjoy. . . .

At the Dali Museum, which features the works of Spanish surrealist painter Salvador Dali, a special exhibit explored the life and paintings of Frida Kahlo, a 20th century Mexican artist who broke new ground for women painters. I found her life’s story especially moving: she suffered a serious accident at 18 that caused her great pain and many surgeries over her lifetime, but her art enabled her to find meaning in her struggles and to express herself in a universal language.

While Dali’s paintings of melting clocks and dreamscapes are his best known works, I preferred these two examples of his early paintings.

Outside the Dali Museum, visitors tie their entrance wristbands to a bedecked tree. The strips of colored tags luff in the breeze.

The Morean Arts Center includes a collection of glass sculptures by Dale Chihuly. His exuberant use of color and form creates a mesmerizing, whimsical kaleidoscope.

Around the corner, the Center includes a glass blowing workshop. We enjoyed the demonstration, which resulted in a free form glass bowl.

We met ibises in the afternoon . . .

. . . and pelicans at sunset.

St. Pete Beach offered a chance to relax and pretend that winter didn’t exist.

Back home, there is snow on the ground and ice on the sidewalks. It will all be gone by week’s end. I know there’s more on the way. I just need to remember . . . think warm thoughts.

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.