Living with Scleroderma

Reflections on the Messy Complexity of Chronicity

managing chronic disease

Courier Service

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A few weeks ago, I had a series of pulmonary function tests—a routine, annual procedure, just tracking my lungs’ status. I’ve been doing these tests at a local hospital for decades, now, so I continue to do the procedure there to keep a comprehensive record.

Only one problem: the hospital’s electronic medical records do not speak to my providers’ electronic medical records, either here at home or at Boston Medical. So, I have to track down my test results each time, get a printout, and bring them to my Boston Medical pulmonologist for our next appointment.

Now, you might wonder, why not have the tests done at Boston Medical? Their EMR speaks to my local providers’ EMR, and vice versa. And the answer is: I don’t want to have to make yet another trip to Boston for yet another test.

HIPAA regulations do not make this process any easier. As of this PFT appointment, the respiratory tech could not give me any printouts. I signed a bunch of forms to be sure the results got to my local rheumatologist, who had ordered the series for me. I also signed forms to send them to my Boston Medical rheumatologist. But, having learned to be a skeptic about the efficiency of medical systems sharing information with one another, I decided to get a hard copy to bring with me, just in case.

Where to start? Seems like the obvious place would be the hospital’s medical records department. I looked up the number online and placed a call, only to get a message that the number was no longer in service. No info about whom to call or how to get any help. Not encouraging. I contemplated going to the hospital in person, but reconsidered. I was not in the mood to beat my head against the wall.

I knew the results were available, because I had received a message in MyChart to that effect. But when I went to look in my electronic medical record, all I found was a blank page. Aargh.

So I called my local rheumatologist’s office and asked if they could get me a hard copy. Fortunately, I spoke with a very helpful nurse who could see the actual results online (only viewable by the provider, not the patient, for some dumb reason). She put in a request to my rheumatologist to get me a printout.

Lo and behold, a day later, I got a message that the results were waiting for me. All I had to do was drive over to their office and pick them up. I could have had the printout mailed, but I wasn’t sure I’d receive them before my Thursday appointment. And so, on a sunny Monday afternoon, I took time out of a busy day to get my test results, which were, as promised, waiting for me in an envelope with my name on it.

Dealing with a chronic illness requires a lot of managing—not only your own health, but also coordinating all your specialists and keeping track of a ton of information. I’ve been at this for many years, and I take it mostly in stride. But I always wonder: Why does it have to be this complicated? And why can’t I see any test result that is my own when I want to? And why must EMRs from different systems be unable to share my information, even if I authorize it? In 2024?

Sometimes, it feels like yelling into a rain barrel.

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: Lobby Card from the 1925 film “The Pony Express” via Wiki Commons

Spring at Last

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On Sunday, I walked outside without a coat for the first time this year. What a blessing, especially after feeling so cooped up 10 days ago with Covid. It’s been spring on the calendar for more than a month, but this was the first day that really felt springy.

As far as I can tell, I’m done with the virus. Whatever lingering sinus congestion (mild) is now attributable to allergies (the downside of spring). When I went for a routine pulmonary function test on Friday, at first the respiratory tech was not sure if she could administer it to me, given my recent Covid experience. But fortunately she was able to check with the hospital’s chief of infectious diseases, who agreed with my expectation that, given revised CDC protocols, I was free and clear.

(In case you’re not aware, the new guidance basically says that after 24 hours free of fever without OTC meds and no symptoms, you can go out masked. After five days of masking, you no longer need the mask, which is where I was on Friday, eight days from no symptoms, thanks to Paxlovid.)

I completed the test, which is never easy at this point, but the good news was that my diffusion rate (not stellar) had not really changed—which has been the case for several years now. So that was encouraging.

And a relief after my other health debacle last week—skillfully scratching my cornea in my right eye on Thursday when I was putting in my scleral lenses. I wasn’t sure, at first, why my eye was bothering me with the lens in place, because it bathes my eye in saline. But once I removed it, my eye continued to smart, and going outside in bright sunshine was truly uncomfortable.

Don’t try driving with a scratched cornea. I did okay, but my eye was tearing and I could barely keep it open. Bad idea. Very bad idea. Back home, after flushing my eye with drops, I used some eye gel and covered my eye with gauze and paper tape for several hours, which made it tolerable.

Fortunately, on Friday, before the PFT, I saw a specialist at the local college eye clinic, who assessed it and thought I was on the mend, though he was prepared to do an emergency debridement if need be. Thank goodness that wasn’t necessary. And I was fine by the weekend.

So, all the more reason to be glad to walk outside without a coat or a jacket or even a sweater on Sunday. No more Covid. No more eye pain. Just sun and flowers and blooming buds on our new cherry tree. A good way to begin a new week.

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.

Best Laid Plans Department

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And so, despite my best efforts, I did get Covid last week, after all. In fact, I tested positive on Tuesday afternoon. At first, I thought it was just allergies. All the trees have finally bloomed here, and pollen is in the air.

Just to be sure, though, I took a test. When I first looked at the results, I thought I was still okay, but there was the faintest positive stripe. So I repeated it. Same thing. And by evening, I didn’t really need to doubt it. I was starting to get chills, and my throat was swelling.

By morning, I felt truly rotten. No fever, but all the symptoms I get with a virus, especially severe Raynaud’s and joint aches and headache and sinus congestion. My hands felt like blocks of ice, and it took at least a half hour of huddling under blankets and meditative breathing to regain feeling. I called our primary care nurse practitioner’s office, and by midday I’d gotten the go-ahead to start Paxlovid.

This is the second time I’ve caught Covid. Last time was two summers ago, right before we were supposed to go on vacation, causing a total reorganization of travel plans.

This time, it hit right before my 70th birthday and Passover, which begins tonight. So all plans for both had to be scuttled and rethought.

Thanks to my wonderful daughters and husband, my birthday turned out to be a lovely celebration, despite being sick. The Paxlovid kicked in enough for me to feel somewhat better when I woke on Thursday—and discovered in my email a gift certificate from the family, orchestrated by my daughters, for an Air BnB writing retreat, good for anytime I want to go. In addition, my younger daughter had created a fantastic 70th birthday video with greetings from family and friends, including some people I had lost touch with over the years. It gave me a great boost and is a wonderful keepsake.

Al brought home flowers, and later, he picked up a nice dinner from one of our favorite restaurants to eat at home. So, I felt fully celebrated and grateful—and resilient. Take that, Covid!

We’ve had to upend our Passover plans, because we are just barely clearing the hurdle of having to mask in public (five days after you feel better, have no fever and no symptoms). So we are doing a Zoom seder with our immediate family for the first night, and just me and Al, the second. It’s a small and quiet holiday this year. Given my energy level post Covid, that’s just fine. Cooking for just the two of us on Sunday wiped me out.

The one bright side of this, as my Boston Medical rheumatologist said to me weeks ago when we were discussing pros and cons of a spring Covid booster shot, now that I’ve had the latest variant, most likely JN.1, I’ve gained some protection against it. At least, I sure hope so. This virus is not to be messed with, especially for those of us with compromised immune systems.

And so, Dear Reader, I hope you stay well and avoid Covid. But if it nabs you, be sure to ask for Paxlovid. It significantly reduces risks of the virus and really made a huge difference for me. The most recent research says chances of rebound are slim. It makes your mouth taste bitter, but that’s a small price to pay.

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.

And So It Goes

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I was planning to write an upbeat post today, in anticipation of my 70th birthday on Thursday. But life has a way of throwing curve balls. On Sunday, we discovered that Al has Covid. So far, he seems to be doing okay, and we expect a green light for him to start a course of Paxlovid. The last time he had Covid, nearly two years ago, it worked well for him. But he still has to lay low. So our dinner plans for Thursday night are postponed.

So far, I’m doing fine, no symptoms and testing negative. I sincerely hope that I don’t get Covid for my birthday. I also hope we are both are in the clear for hosting family for next week’s Passover seders.

I was texting with our older daughter on Sunday, who was very sympathetic about the bad timing of all this, and I remarked that turning 70 is all about taking this kind of downturn in stride—even as I was pretty frustrated when I saw Al’s positive test result that morning. As she rightly noted, a birthday is just one day, but “you can be celebrated all the days!” Very true.

For weeks I had been debating whether to get the recommended spring Covid booster. I had discussed this with both of my rheumatologists, at home and at Boston Medical, as well as with our geriatrics nurse practitioner. All had been ambivalent. The issue is that the spring booster is the same vaccine as last fall’s, although the prevalent Covid strains have evolved. While it’s possible that the booster could help dampen the impact of those new strains, it’s not conclusive that it would make a difference.

Had I gotten the booster, would I be at less risk for getting Covid for my birthday? I’ll never know. However, given my exposure, whether I catch the virus or not, I will build up some more immunity from the current strain. So I guess that’s a plus. But one I could do without.

Fortunately, even before Al got sick, we had decided to schedule an overnight trip to New York City to celebrate my birthday in early May. My original idea, to go this week, would have been too much, too near to Passover, which involves a lot of cleaning and preparation. Now it would have been impossible.

And so, all I can do is wait and see. Getting upset won’t change anything. I’ll make the best of my 70th birthday, regardless, and we’ll celebrate together when we’re both well. Lessons learned from seven decades.

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: Simon Hurry

Something Completely Different

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The sun is bright overhead as I write on Monday afternoon, a few hours before the solar eclipse is set to begin here in Central Massachusetts. We’re expecting that the moon will block about 90 percent of the sun at 3:28 p.m. I have my two pieces of cardboard to create a camera obscura, a pinhole in one piece through which I can project the eclipse’s image onto the other, so as not to fry my retinas.

On a day of a rare celestial phenomenon, it seems all the more appropriate to break from my routine here and share some good news that has nothing to do with scleroderma. I’ve occasionally menioned on this blog about writing my yet-to-be-published work of historical fiction, Line of Flight, set during the First World War. It’s the story of a mother’s journey to find her estranged daughter, who has run off to France with her beau to volunteer for the French ambulance corps. The good news: within the past few weeks, two excerpts from Line of Flight have published on two separate online literary journals.

And so, in an act of shameless self-promotion—and if you’d like to read something that will take your mind off this nasty disease and related medical concerns, or any other stress in your life—I share a few links:

  • The opening of Line of Flight appears in the April 2024 edition of Embark, which presents openings of ten unpublished novels, twice a year. This happens to be their 20th issue, and I’m in good company. You can read my novel’s opening here.
  • A chapter called “The Sinking” is in the spring 2024 edition of The Writing Disorder, an aptly named literary journal for those of us afflicted by this form of art. The action takes place on the fated last voyage of the Lusitania on May 7, 1915. Read it here.
  • I’ve started a Substack newsletter, History Making, that digs into lessons learned from researching and writing historical fiction, as well as other works of historical fiction that I admire, the long and winding road to publication, and related topics. I’m publishing a post twice a month, and subscriptions are free. So, if you’re curious about the writer’s life and this genre of fiction, you can find it all here.

I said none of this has anything to do with my scleroderma—but that’s actually not quite true. When I was growing up, my hands were extremely dexterous. I could make any kind of art or craft, and I played numerous musical instruments. Once, when I was perhaps ten years old, I recall lying in bed and thinking about what it would be like to lose one of my senses. I decided I would never want to lose the touch of my gifted hands.

That was not to be. But I have realized over the decades of dealing with this disease that writing is my art form, my way of creating images and making music. It took me eight years and twelve drafts to get my manuscript to the point where I feel ready to seek publication. And I’ve been seeking an agent and/or publisher for the past two. That involves a lot of patience and persistence and a refusal to give up—all skills I’ve honed through living with scleroderma.

So, getting this far with my novel is a major milestone, indirectly inspired by managing a complex and chronic disease. And, with any luck, my manuscript will get into an enthusiastic publisher’s hands sooner than the next total eclipse of the sun.

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: Jongsun Lee