Living with Scleroderma

Reflections on the Messy Complexity of Chronicity

mindfulness

Vaccine Powerball

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Have you received the Covid vaccine, yet? That’s the Big Question in all my conversations with family and friends, now that we have a new president and science is once again taken seriously.

So far, the biggest winner of the vaccine lottery in my family is my sister, who bravely volunteered for the Moderna vaccine trials last fall and won the jackpot when she learned last week that she got the real thing. Thanks to her and thousands of other willing guinea pigs, we’re all going to be safer in coming months.

Next is my eldest daughter, who received her first Moderna shot on Friday, and Al, who is scheduled for his first Moderna dose on Tuesday afternoon. Both are social workers involved with home care, which put them in Phase 1 here in Massachusetts. Twenty-eight days from their first appointments, they will get the second dose. Then it’s a two week wait for the vaccine to be fully effective.

On Monday I learned that Phase II here begins February 1 for persons 75 and older. Those of us 65-plus, also those with co-morbidities (two check marks for me) are next up, with appointments coming online in mid-February. Counting the days . . .

While our daughter was able to get her shot through her employer, Al was on his own. We learned on Thursday night that he was now eligible (as opposed to original estimate of early February), so on Friday morning he contacted his boss, who had also just received the news from state officials, and Al got the link for the state attestation form that documents his status as a home care worker. Then began the hunt for an appointment.

I had already downloaded the contact information from the state website for vaccination sites in our area. But the first site, a Walgreens, (a) had an appointment page that lacked an option for the Covid vaccine and (b) was out of doses through this week. Another site was closed on Friday and not answering their phone. The third site had no appointments available for weeks.

There is a huge drive-through site at Gillette Stadium, home of the New England Patriots, but that’s a 90 minute drive from here. Nonetheless, I began checking for appointments, but found nothing. Then, in the midst of this increasingly frantic search, our rabbi happened to call me, and when I told her our predicament, she mentioned another site, maimmunizations.org. This website had one universal form to complete and more vaccination locations listed, so I began flipping through them to see if I could find anything for Al.

At first, it seemed like every available time slot was taken. I clicked on one rare opening, only to have it snapped up a split second before me. I was almost about to give up when another appointment at a local site suddenly appeared (nothing was open when I had checked that same date and site a few minutes earlier). So I grabbed it. Felt like a game of wack-a-mole.

I hope, by the time appointments open for my cohort, there will be more sites, more vaccine, and a more effective appointment interface. Meanwhile, I’m laying low, avoiding in-person shopping as much as possible. Al is out and about because of his work for his clients, but he’s agreed to double-masking when shopping, as an extra precaution.

Such a strange, strange time. At least the days are getting noticeably longer. Stay safe, Dear Reader. Stay safe.

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: dylan nolte

Liminality

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For a few minutes on Monday afternoon, clumps of snowflakes swirled in the air, large as silver dollars. I was scrolling through my Twitter feed while eating lunch, checking for news of violence in D.C. or state capitals. There wasn’t any, thank goodness. The snow was brief, and did not stick.

I feel as if I am spinning like those snowflakes, neither here nor there, caught in liminal time and space, somewhere on the invisible threshold between states of being.

I go about my work and meetings on ephemeral Zoom, catch up on correspondence with friends and family, tell Al to “be safe” when he goes out to see his clients and do their grocery shopping.

I recheck our state’s Covid website to see if there are any new announcements about vaccine availability. There are none. I check the time and count the hours until Wednesday’s noontime Inauguration.

I look at surreal images of our nation’s capital, thick with masked men and women in camouflage, carrying arms—this time, in service of our country—and am both relieved and so very sad that it has come to this.

I remember to meditate before breakfast, but forget to walk after lunch. Daylight wanes as another 24-hour cycle wheels past or through or into memory.

My memory isn’t as sharp as it once was, so I write, so I know that I really was here, in this strange time and place that will someday be the subject of countless doctoral theses and historical treatises. I imagine colloquia and documentaries and debates, far into the future, about the forces that shaped our present, when people will wonder how we let it happen. They will have the advantage of knowing how it all turned out. But we must remain, here, and wait, and wait.

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: Darius Cotoi

Heartfelt

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Years ago, early in my life with scleroderma, I developed an arrhythmia. For decades now, my heart occasionally feels like it’s skipping a beat. Actually, however, as my cardiologist has explained to me, I’m having an extra contraction. It gets worse when I’m stressed and is my orange alert to slow down, examine what’s going on, and make some adjustments in my life. It always improves with regular exercise, especially walking.

Recently, in the weeks after the November election, my arrhythmia has been more active. No surprises, I guess, because I have been very stressed about both the divisive politics plaguing our nation and the pandemic surge. But its frustrating and annoying, to say the least.

So, when I spoke with my cardiologist recently, he recommended doing a heart monitor study for up to 30 days. (Hopefully I won’t need to wear the monitor that long.) It’s probably been 35 years since I wore a Holter monitor, and I think it was maybe for only a week. Back then, the monitor was this big clunky device, the size of an old Motorola cell phone, that you wore around your neck or on a belt, connected to a bunch of wire leads attached to your body. Basically, it was a portable 24/7 EKG. You had to make notes in a notebook if you felt any symptoms, with date and time. All that information was compiled after you turned in the monitor and notes. Not fun.

Fortunately, technology has significantly advanced over the past three-plus decades. No appointment necessary to activate the device. It arrived via UPS on Friday, in a small box with the equipment and how-to instructions. Instead of a big, clunky monitor, there are two small, rechargeable monitors about 1.5 x 2.0 inches and maybe a half-inch high. You charge one while you wear the other, and the charge lasts about 12 hours. The monitor snaps into an oval foam base. On the back of the base are two snaps for removable electrode patches. So basically, you plug in the monitor, attach the electrodes, and then peel off the sticky backing from the patches and adhere to your skin. The correct positions (two alternatives) are illustrated in the guide book.

Readings collected by the monitor then feed via wireless tech to a Samsung phone that is solely for collecting the data. This, in turn, sends reports periodically to the tech company that is running the study. If you experience a symptom, you press the button on the monitor, and then the phone displays some choices to describe the symptom. You tap the appropriate description and go back to whatever you were doing. You just have to keep the phone within 10 feet; if you go out of range, the data will download when you’re close again.

Pretty amazing. And relatively easy to manage. You can’t get it wet, so you have to pause the study and remove the monitor when taking a shower or bath. I also find that my skin needs a break every 24 hours from the electrode patches, which cause a mild rash, even as I asked for the extra-sensitive skin version. So I wait about a half hour after my evening shower before reattaching everything. In the morning, I just switch out the monitors.

My cardiologist said that if I experience enough symptoms over the first week or so, I can call him and see if he can get an early version of the report, so that we can end the study. I’m hoping that will be the case. I’ve certainly recorded symptoms at least a dozen times so far. From what he tells me, it’s probably nothing serious, just an annoyance that I continue to live with. But I’m glad that we’ll have an updated baseline, at the very least.

Ironically, he also predicted that my symptoms might vanish, or at least lessen, once I have the monitor on. That was certainly true for the first 24 hours or so. How odd to have the presence of the monitor be somehow a placebo or, at least, a reassurance that I’m going to get some answers. The disconcerting experience of the extra beats, especially when they go in runs, is worse when I don’t know what it means.

Meanwhile, I’m trying to get in some walks, despite a lot of snow here in recent days and much colder temperatures. That, and trying to better manage my news diet. The winter solstice is one day past. Let there be light.

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: Jude Beck

A Tale of Two Visits

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I had two visits with my Boston Medical Center physicians last week—one, in person with my new rheumatologist, and a second, via video chat, with my cardiologist. Both had been scheduled months ago, but it afforded me an interesting opportunity to compare the two modes of doctor’s appointments.

My in-person visit went well. I was very glad to see my doc and have a good long conversation with him. He gave me plenty of time to discuss my health and any concerns, and was able to answer all my questions. It was more of a schmooze than a strict, all-business visit, and I think being there helped to make that possible. Having that time—we spoke for about an hour, with only a brief interruption—made the commute worth it.

The downside was just the stress of being there, with all the Covid concerns. First off, I had forgotten that the parking garage requires you to touch a button to get your parking ticket. I did this with gloves on, but how many people don’t? It’s a virus magnet.

There was the inevitable challenge of door handles, elevator buttons, and using a public restroom. I got past all those hurdles with extra vigilance and disposable gloves, which I kept on until I went into the exam room. I used plenty of hand sanitizer, with and without gloves. The medical center checked temps and symptoms upon entry, handed out masks with a pair of forceps, and limited occupancy of elevators and waiting rooms. It simply was not as crowded as usual. And the big test, one week out, I have no Covid symptoms, thank goodness. So, that’s a huge relief.

On Friday, I spent a half-hour on a video chat with my cardiologist, whom I’ve been seeing for decades. The only drawback was a slight hiccup in the video signal that almost kicked us off to a phone call, but fortunately, the signal stabilized. We had a very thorough conversation, which was as good as if I had seen him in person. And no stress of driving or dealing with the public space.

So, given the choice—seeing as I’ve now had a good personal visit with my new rheumatologist and made a real connection with him—I think I’d prefer sticking with telehealth until I’ve had the vaccine and am in the safe zone. The stress of Covid vigilance is intense for me. My blood pressure at BMC was much higher than normal, and that’s probably the reason (back to normal at home).

And it sure beats traffic.

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: Jason Dent

Calculated Risk

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This Tuesday I have my first in-person visit to Boston Medical Center in about a year. All my appointments since last winter have been via telemedicine or phone. My new rheumatologist told me when we spoke over the summer that he’s now trying to alternate virtual and face-to-face meetings with patients unless circumstances make an in-person visit too risky. Given the pandemic’s surge, I was expecting this one to be telemed once again, but not so.

Instead, I’ve received a series of texts and emails with a Covid questionnaire (all my answers to risk and exposure were ‘no’), instructions about coming alone (unless I was accompanying a child or a disabled or elderly patient), and to remember my insurance cards (of course).

What I don’t know is this:

Will they give me a new mask and require hand sanitizer when I arrive? I assume so. This is standard at every other medical practice that I visit. I hope they won’t prevent me from wearing my protective gloves.

Will there be a limit on number of people in the elevator? The Rheumatology Department is on the seventh floor, and the elevators in the medical building were always crowded in the Before Times.

How many people are scheduled for the waiting room at a time? Appointments often run late. There’s a big open corridor outside the office with large glass windows overlooking the BMC complex. The waiting room is shared with another department. Can I wait in the corridor instead of the waiting room? Will someone come to get me?

I will bring some cleaning supplies along in case I have to use the public restroom. At least on the 7th floor, the restroom doesn’t get too much traffic, but BMC is still a busy place, and I can’t take any chances.

Is it worth it to go in person? I could have requested a virtual appointment. But I actually want to see my rheumatologist again. We only met once, when my long-time physician, Dr. Robert Simms, was transitioning to retirement. It’s time to have a real visit. I really like and respect my new doc, and we need to get to know each other better.

So, I will take the calculated risk. Life is full of such decisions these days. Maybe, by the next appointment, I’ll have been vaccinated already. God willing.

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: Aziz Acharki