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Living with Scleroderma

Reflections on the Messy Complexity of Chronicity

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managing chronic disease

Going for a Walk

Evelyn Herwitz · May 7, 2013 · 4 Comments

This past Sunday, on a blue-sky spring day, my husband joined more than 300 people whose lives or loved ones have been affected by scleroderma, on a three mile walk to raise awareness and funds for a cure. Sponsored by the New England chapter of the Scleroderma Foundation, this was one of hundreds of walks around the country that are organized each year in communities large and small, providing an important revenue stream for medical research grants.

Paul Klee, "Cat and Bird," 1928, at MoMA
Paul Klee, “Cat and Bird,” 1928, at MoMA

There is, as yet, no known cure for scleroderma, and both the Scleroderma Foundation here in Massachusetts and the Scleroderma Research Foundation in California depend on armies of volunteers nationwide, through events like awareness walks, to help garner support for their fundraising efforts. Each foundation distributes about a million dollars annually for promising research—grants needed more than ever during this time of sequesters and congressional gridlock over federal spending.

Al is much better than I am at this kind of event. I’m always uncomfortable asking for donations. My forte is raising awareness through words. Al, however, is a great fundraiser. Last week he sent out an email to family and friends asking for sponsors, and by Sunday he had collected more than $200. A record number of participants joined the walk, and I was proud of him for being one of them.

While Al was striding for a cure Sunday afternoon, I was trekking through the crowded corridors of Penn Station, on my way to a two-day business meeting. We wrapped up early on Monday afternoon, giving me just enough time for my own private scleroderma pilgrimage. I set out into the crisp spring sunshine, pulling my rolling suitcase down Manhattan sidewalks, through subway stations, across 5th Avenue, along 53rd Street to the Museum of Modern Art, to finally see, in person, the works of Paul Klee.

Paul Klee, "Letter Ghost," 1937
Paul Klee, “Letter Ghost,” 1937

A member of the German Expressionist Blaue Reiter Group a century ago, a distinguished faculty member of the Bauhaus school of art in the 1920’s, Klee created a lyrical mix of abstract forms and hieroglyphics, a “visual vocabulary” inspired by music, nature and poetry in his intricate drawings and paintings. Luminous, whimsical, haunting, his art is a journey into dreamscapes. He once described the act of drawing as “a line going for a walk.” But when the Nazis rose to power, they targeted Klee’s work as degenerate art, and in 1935, he was exiled from Germany to his native Switzerland.

Isolated from his intellectual circle of artists, who included his close friend Wassily Kandinsky, alone with only his wife for emotional support, stonewalled in his efforts to regain his Swiss citizenship, Klee became ill. A strange rash and long bout with pneumonia left him severely weakened. Other symptoms eventually surfaced. The skin on his face began to tighten. He developed difficulties swallowing and digesting. In a meticulously researched account, Paul Klee and His Illness, physician-author Hans Suter deconstructs Klee’s health struggles and concludes that the artist was suffering from diffuse systemic sclerosis.

Miraculously, Klee’s hands were not affected by the disease, and he was determined to continue drawing and painting. Despite fatigue, painfully tightened skin and ongoing problems with his digestion, lungs and heart, he created thousands of works in the five years he battled scleroderma and suffered through the treatments of the day—including, according to Suter, an infusion of olive oil and turpentine, believed to be a beneficial stimulant that would shock the immune system back to normalcy.

Paul Klee, "Intoxication," 1939, at MoMA
Paul Klee, “Intoxication,” 1939, at MoMA

Nothing worked. Klee was focused and courageous in the face of his disease, but he also eventually came to understand and accept that he was dying. His later works are full of dark lines, wistful angels, pain and loneliness, infused with irony and deep, rich color. He died in 1940, at 50 years old, a few days before the local canton government finally took up his citizenship application.

Medical research has come a long way since Paul Klee’s battle with scleroderma. No one believes in olive oil and turpentine infusions anymore, thank goodness. But we still have many steps to walk before a cure is found. As I stood before Klee’s subtly complex paintings, marveling at his detail and textures and many-hued washes, I wondered what more beauty he might have created, had he had the benefit of today’s medicine. I hoped to be as courageous in my own art. And I thought how wonderful it would have been to have walked together.

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.

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Filed Under: Body, Mind, Sight, Touch Tagged With: diffuse systemic sclerosis, hands, Hans Suter, managing chronic disease, Paul Klee, resilience

The Random Factor

Evelyn Herwitz · April 30, 2013 · 2 Comments

Every morning, once I’ve worked the kinks out of my joints, made the bed and done some stretching, I wash my hands and sit down with manicure scissors, clippers, nail file, tweezers, ointment, bandages, wound dressing and moisturizer to tend my fingers. I pick and nip any shreds of dead skin, clip nails that have split or splintered at the corners, file away rough skin patches and inspect for signs of inflammation. Then I treat and bandage any open ulcers and slather on moisturizer, rubbing and wringing my hands over and over until the skin no longer feels sticky.

This is how I try to protect myself from the world—all the inevitable bumps, bangs, cuts and bruises, as well as all the nasty germs that could invade my body through cracks in my skin, inflicting pain and havoc.

It takes time, this daily ritual, sometimes five minutes, sometimes a half-hour, depending on what I did with my hands the day before, how well they have healed in moisturizer and white cotton gloves overnight, and the random factor.

In statistics, random factor analysis is used to determine whether an unusual observation—a data outlier—is caused by random events or some underlying trend.

Each morning, as I clip and nip, I perform my own informal random factor analysis: Did I get this ding when I banged my finger on the kitchen chair? Is this soreness on my pinky from tapping too often on my iPhone? Does this nail-bed inflammation stem from forgetting to wash my hands when I got home after running errands and using the germ-covered keypad at CVS without my gloves? (All random events.) Or is the increased number of recent ulcers due to the extremely cold and fluctuating temperatures these past few weeks? (An underlying trend.)

Trends, such as weather patterns, are a bit easier to cope with, once identified. I just need to dress with greater attention to the forecast. More layers. Don’t mothball the down coat or sweaters quite yet. Keep those scarves and wrist-warmers handy.

Random events are the most challenging because, by definition, they’re random. I have no idea that I misjudged the distance between my finger and the back of the kitchen chair as I reach to pick my wallet off the table until I feel the pain. I can’t anticipate an ulcer on my iPhone pinky when for months the finger has been fine and I haven’t changed my frequency of tapping and texting. I don’t always get an infection every time I use a check-out keypad bare-handed, though I’m beginning to douse my hands in antibacterial hand cleaner as soon as I get back in my car, just to be safe.

You could say that I’m constantly adjusting and adapting my protective behavior as I continue to gather more data points.

But random is as random does. You just can’t anticipate all the bad stuff you’re going to run into every day. Or, to be fair, all the good stuff, either.

So my morning ritual is as much a meditation on my state of being as it is a random factor analysis. Here is where my fingers are today. This is how the rough patch of skin feels before and after I file it down. That is an incipient hangnail in need of trimming before it gets worse. Here is how much dead skin I can cut away to sense more through my thumb. That ulcer still needs a bandage. This one looks like it could go without, finally.

Rub, wring, rub, wring. The moisturizer absorbs into my pores, a silky, invisible film to keep my skin flexible and ready for whatever the day may bring. This is how I try to protect myself. This is how I face the world each morning.

Photo Credit: topher76 via Compfight cc

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.

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Filed Under: Body, Mind, Sight, Touch Tagged With: body-mind balance, finger ulcers, hands, managing chronic disease, resilience, wound care management

Aftershocks

Evelyn Herwitz · April 23, 2013 · Leave a Comment

The tension has lifted here in Massachusetts. The sun is shining, the sky is blue, the trees are leafing, the forsythias are in bloom. Friends and family in Greater Boston who were locked in their homes all day Friday as FBI and police tracked down the fugitive Marathon bombing suspect have enjoyed a beautiful weekend of freedom. Neil Diamond flew to Boston on his own dime to sing “Sweet Caroline” with cheering Red Sox fans on Saturday afternoon, and our boys beat the Kansas City Royals, 4-3.

b_strong_blueAll weekend we’ve been sharing stories of near misses: friends who spent three hours at the Marathon finish line, right where the first bomb was planted, only to leave five minutes before it detonated to catch the T; friends whose apartment overlooks Boylston Street and felt the blasts; another who discovered his home is a few short blocks from the suspects’ Cambridge apartment pipe-bomb stash; a friend who chose not to run this year, who probably would have been crossing the finish line right at the deadly moment.

Surreal is the only word that describes this past week. It feels like we’ve all been living in a Hollywood disaster movie—except it actually happened. There is a collective sense of relief that it’s over, shared grief for the victims and their families, and pride in how Boston rose to meet this horrible tragedy.

But there is also a heightened sense of vulnerability—so many innocents struck by a random, senseless act of violence. And so many tiny decisions that led one person to be in the wrong place at the wrong time, and another, equally innocent, to stay clear of harm’s way.

The reality, however, is that we’re always vulnerable. Life is full of risks, all the time. The chance of being struck down by a terrorist’s homemade pressure cooker bomb is significantly lower than the chance of being struck by a drunk driver or the chance of being stricken by a debilitating, chronic disease.

We compartmentalize our awareness of most risks, because we live with them every day. As long as we don’t ignore risks completely, but take reasonable precautions, we’re undoubtedly better off, because to focus on what-if’s all the time is to become paranoid and paralyzed.

But living with a chronic illness, whether it’s scleroderma or one of a thousand other diseases, brings a sharper, lingering awareness of vulnerability, because it forces you to face your own mortality sooner than you might otherwise.

If you’re managing your disease well enough, that awareness is more like white noise in the background unless you have a flare-up. When something like this past week’s horrific event occurs, the sense of threat intensifies. It’s not only the fear, What if it had been me? It’s also the fear, How would my chances of survival or escape have been further compromised by my illness?

This is not to minimize, in any way, the real losses suffered by the victims of the blasts and their loved ones. It’s just the nature of aftershocks. If I were stronger and healthier, I probably wouldn’t have been quite as frightened, and I probably would have gotten more sleep this past week.

I have no answers to all the what-if’s. I have no idea what I would have done if I had been there. I’m profoundly grateful that I wasn’t. My thoughts and prayers go to all those who lost lives and limbs, and my thanks, to those who saved so many. I hope it never happens again. I fear that it will.

We live in a dangerous world. All we can do, the only thing we can really control, is our focus—to appreciate fully every moment that we have, and never take our lives, however complicated and challenging, or those we love and who love us, for granted.

Image Credit: Boston Red Sox

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.

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Filed Under: Body, Mind Tagged With: awareness, Boston Marathon bombings, managing chronic disease, resilience

Busy-ness

Evelyn Herwitz · April 2, 2013 · 2 Comments

When did being busy become the equivalent of being virtuous?

Nearly every day, I find myself in some kind of conversation about how busy we are—working, caring for family, solving one kind of problem or another. Especially among women, how well you can multi-task, juggling a job, childcare, other family duties, care for aging parents, errands, entertaining, housework, you-name-it, has become the way we promote ourselves and size each other up. The busier you are, the more ably you handle more stuff, the better. You can complain about being too busy, but there is always pride beneath the gripe. Of course, if you do all of this while managing your own health challenges, you score extra points in the Superwoman contest.

It drives me crazy.

Even as I let myself get sucked into it.

I can multi-task with the best. I run my own consulting business and our home. For years I did extensive volunteer work on top of commuting more than an hour each way to a full-time job. I raised two daughters while running a college marketing department, taking on community leadership roles and managing my parents’ needs for help as their health deteriorated. I’m the go-to mom when my adult daughters ask for advice or support with decisions big and small. All while doing my best to keep myself as healthy and fit as possible with scleroderma.

There. See? I’m busy, too.

But I want to slow down. In fact, I believe my long-term health depends on it. Working for myself these past three years, setting my own agenda, ditching that exhausting commute, working with clients that I enjoy—all of this helps. I no longer do evening meetings and now use my afterwork hours for exercise or creative hobbies that recharge my batteries. I choose volunteer commitments selectively, focusing on work that’s uplifting, rather than spreading myself too thin over projects with stressful politics.

Even still, I feel out of balance. There’s that voice in my head, urging me to be productive, to not waste time. Idle hands are the devil’s playthings and all that. Our culture’s Calvinist undercurrent runs deep.

And there’s another piece. When I’m still, when I’m not busy doing, making, fixing, there are other thoughts that bubble up—worries about my health, all the what-ifs. What if my scleroderma gets a lot worse? What if something happens to Al? What if he loses his job and our health insurance? On and on.

Healthy or not, we all have these worries. But chronic disease brings an added sense of vulnerability. Easy to avoid it if you keep so busy that the disturbing thoughts can’t surface.

One answer is meditating. Mindfulness practice forces you to sit still, let all those thoughts float past as you continually bring your attention to the present moment—which, 99.9 percent of the time, is actually safe, peaceful and just, well, there.

I try to do this every morning. I try to sit still and breathe. I’m not terribly good at it, because I want to get going with the day. If I can sit for five minutes, I’m doing well.

Occasionally I join a drop-in group on Monday afternoons, led by a gifted friend who is a seasoned mindfulness teacher, and manage to meditate for a half-hour. Afterward, I usually feel refreshed and reminded of the tremendous value of just being in the present moment. And tell myself I need to refocus my day on what really matters, rather than all those to-do lists.

On my desk, next to my iMac, I keep a small pink sticky note with a quote by Marlene Dietrich, paraphrasing her longtime love, Ernest Hemingway:

“Don’t do what you sincerely don’t want to do. Never confuse movement with action.”

Indeed.

Photo Credit: Tie Guy II via Compfight cc

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.

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Filed Under: Body, Mind Tagged With: managing chronic disease, meditation and disease management, resilience

Murmuration Liberation

Evelyn Herwitz · March 26, 2013 · 2 Comments


“All religious rituals, perhaps like all art, are attempts to gesture toward what cannot be spoken, to invoke it and make it palpable, a sense of the world too immense to be summed up in words without sounding like prattling children.”

Jonathan Safran Foer
New American Haggadah

Passover comes early this year, the evening of March 25. As I write, Al is working on the kitchen, doing the final cleaning and kashering and countertop covering before we switch all our dishes over to the kosher-for-Passover cookware and red-and-green glass settings that were once his mother’s. It’s a lot of work, if you observe all the stringent Jewish laws around Passover food preparation—and the source of much good-humored communal kvetching: If this is the Feast of Freedom, then why do we feel like slaves in the kitchen?

This annual cleaning ritual is just one step in the process of prodding yourself to focus on retelling the story of the Israelite’s Exodus from Egypt. Upending your kitchen, removing all traces of leavening from the home to recall how our ancestors left in such haste that they couldn’t wait for bread to rise, causes you to stop and examine not only your surroundings, but your intentions:

How do you enslave yourself? What weighs you down in your life? What holds you back? What obstacles do you throw in your own path? What burdens can you lay down, freeing yourself to live a more fulfilling life of generosity, gratitude, grace and compassion?

Everyone who participates in the Passover seder is asked to imagine what it would feel like to emerge from slavery to freedom. There are so many ways we imprison ourselves. The ritual presents a formidable challenge, if you take it seriously.

Chronic health issues, of course, create their own form of imprisonment. Scleroderma, at its most virulent, feels like being trapped in your own skin. Other diseases bring their distinctive, cruel pains and restrictions. Our bodies, so complex and miraculous, can fail us in as many ways as we take them for granted.

But the feelings of constraint, the constant struggle against pain and physical limitations imposed by chronic illness, are only the first barriers to overcome—the barbed-wire-topped prison walls. The harder, interior cell to penetrate is the one the mind constructs.

I fight this all the time—that murmuring voice of angst, the one that worries, with each recalcitrant ulcer, whether I’ll get another infection that could land me on IV antibiotics; with each staircase that leaves me short-winded, how much harder it will be to get around in five years; with each additional minute it takes me to work around my clumsiness, how much longer I’ll be able to manage for myself.

I know this doesn’t help. I know I need to focus on the present and all I have to be grateful for. I know that catastrophizing is self-defeating. But the voice still murmurs.

Paradoxically,  the key to unlocking this particular, insidious form of self-imprisonment isn’t to silence that voice, either through self-lectures on the impropriety of self-pity or sheer force of will. The more I try to suppress it, the more the murmuring seeps into my consciousness.

No. The only way to soothe the fears is to acknowledge them. Loss, and fear of more loss, is as understandable and human as it can be emotionally crippling. Chronic disease, whatever its form, brings losses. Giving yourself the gift to grieve what you’ve lost and feel self-compassion for what you’re going through is essential to coping, healing and moving forward.

After all the cooking and dishwashing and hosting and cleaning, after we’ve joined at the seder table with our cousins to retell the Passover story once again, that’s the release I’ll be seeking this year. And the one after that. And the one after that.

Image Credit: Illustration from Vaught’s Practical Character Reader, a book on phrenology by L.A. Vaught, 1902, Library of Congress Internet Archive, courtesy Public Domain Review.

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.

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Filed Under: Body, Mind Tagged With: body-mind balance, finger ulcers, managing chronic disease, Passover, resilience

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About the Writer

When not writing about living fully with chronic health challenges, Evelyn Herwitz helps her marketing clients tell great stories about their good works. She would love to win a MacArthur grant and write fiction all day. Read More…

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I am not a doctor . . .

. . . and don’t play one on TV. While I strive for accuracy based on my 40-plus years of living with scleroderma, none of what I write should be taken as medical advice for your specific condition.

Scleroderma manifests uniquely in each individual. Please seek expert medical care. You’ll find websites with links to medical professionals in Resources.

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