Living with Scleroderma

Reflections on the Messy Complexity of Chronicity

mindfulness

Surfacing

· · 2 Comments

At the inside crease in the first joint of my right middle finger, a charcoal gray chip of calcium is working its way to the surface. This has been going on for months. But now the tip of the chip is visible, and if I try to budge it, the sharp edges pinch.

So I need to wait it out. Kind of like a tiny submarine that isn’t quite ready to emerge. If only it contained miniaturized scientists, à la Fantastic Voyage, on a mission to repair my immune system.

I’ve discovered over decades of managing calcinosis that it’s better to let nature take its course than try to pry these odd calcium stones from my fingers. For one thing, I can’t really grasp a pair of tweezers tightly enough to dig them out. For another, it really hurts to do this. And disturbing the skin increases the risk of infection. So I use a combination of Aquafor and antibiotic ointments, dressings and bandages to soak them out, gradually.

Most of the time, this works. Once, several years ago, I had to have a clump of calcium surgically removed from my left thumb because it was too painful and wouldn’t come out on its own. Turned out it was attached to bone. But that’s been the exception.

Patience. It takes a lot of patience to let your body heal itself. For scleroderma, there are no quick fixes or easy cures. And there are many aspects of this disease that won’t heal unaided, if at all.

But one of the things that continually amazes me is how my skin, abnormal as it is, still knows how to heal itself. It just has a much longer timetable than normal.

Many of my finger ulcers take months to heal; some have taken years. Some of them form because of hidden calcium deposits that begin to surface; others, at pressure points. And yet, they do eventually heal. Sometimes the skin grows back thicker and sometimes it retains flexibility. The ulcers may reopen, but at least for a while I’ll get a respite.

This week, I was surprised and very pleased to realize that two intransigent ulcers finally closed up—in fall, of all seasons. So I’m down to three bandaged fingers from five. This is a major improvement.

Whenever a piece of calcium finally pops out, I’ll roll it around between my fingertips, just to explore it. How does my body make these strange, pointy crystals? Some can be as large as an eighth of an inch in diameter and leave a small crater in my finger.

But once I’ve cleaned out the hole with peroxide and dabbed on antibacterial ointment and clean dressing, within 24 hours, my skin has begun to repair itself and filled in. It’s really quite remarkable. For all the strangeness of this disease, my skin cells still can repair some of the damage. This is comforting.

Of course, nature can use a bit of help. I take medications to improve my skin circulation, which is critical to healing. I’m vigilant and meticulous about skin care to minimize risk of infection. I change my bandages every morning and use ointment, moisturizer and white cotton gloves at night to aide the healing process.

I also try to be mindful of how I move my hands and grasp things so I don’t bang myself. I take extra precautions, like wearing cotton work gloves when cleaning or moving cumbersome objects, to protect my bandages and skin. And I dress carefully, often in layers, to keep my hands warm.

All of this takes patience, too. After 30-plus years of living with scleroderma, I’ve adapted to the rhythm of my body’s long healing process. Some days, I’m far less patient and rant. But as long as I’m not in any significant pain, I’m able to ride out the frustration and regain my inner balance.

Today, checking the calcium chip’s long journey outward, I’m just glad it’s located in a spot that’s mostly out of the way. Maybe in a month or so, it will slip free and my skin will heal over, once again. Until the next time.

Photo Credit: Derek Lyons 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.

Coyotes of the Mind

· · 2 Comments

Friday night, as Al and I were walking home from synagogue under a brilliant full moon, a creature darted across the street ahead of us. Ghostly white, scrawny, doggish, with pointed ears and a long, thin tail, it disappeared into a neighbor’s backyard and the trees beyond.

Coyote. Had to be. Though our Central Massachusetts neighborhood is not overly forested, there are enough woods in-between lots for a coyote to lace through in search of food. And there have been occasional sitings in our area.

I shivered. Often during the past few hot summer months and on recent days when I’ve been too busy to take an afternoon break, I’ve walked our 15-year-old golden, Ginger, after dark. She loves nocturnal smells, and the stars have been stunning. No more. It’s colder, anyway, now that fall is here, and I don’t want to chance it with a coyote on the loose.

But I don’t want to give up those evening strolls, either. As long as I bundle up, I love staring up at Orion and Cygnus while Ginger pauses to snuffle each and every fallen leaf by the curb. Risks abound. If all I do is focus on the bad things that could happen, I’ll imprison myself. And her.

According to the Massachusetts Division of Fisheries and Wildlife, you should yell, blow a whistle, bang pots and pans or shine a flashlight to scare off a coyote. Not my preferred mode for a relaxing walk around the block. Maybe I’ll just wait a week or so before we venture out late again, as long as it’s not too cold.

Much as I have no desire to face down a live coyote, there’s another kind that I’m much more accustomed to confronting: those hungry coyotes of the mind—anxieties about health, money, security, family, the future.

These I fight often. Scleroderma, as any chronic illness, births a band of them, trotting across my subconscious, wily, ghostlike. They appear without warning, gobble up energy and optimism, and howl loudest on those nights when I have trouble sleeping.

What if I end up in a hospital some day and get one of those super infections in my ulcers? What if I gag on my food because my swallowing is sometimes uncoordinated and there’s no one here to help? What if I fall and mess up my hands even more? What if something happens to Al’s job and we lose our health insurance?  On and on.

But shouting at those feelings to go away, lecturing myself to silence the angst doesn’t work. It only seems to make those coyotes of the mind even stronger and more voracious.

No, especially if the anxieties have a basis in reality. Disease is disease. When your body doesn’t work right, it’s damn scary. As you gain experience coping, managing your meds and your symptoms and your docs, the anxiety dampens a bit. But the sense of vulnerability never goes away.

Better to shine a light on it, name what’s most frightening, acknowledge the storyline. Separating fiction from fact is the first step toward coming to terms with both the anxiety and the reality.

Power that light with compassion for your trembling, I try to remind myself when I find myself in the grip of wild fears. The more self-compassion, the longer you can be still and see clearly what it is you’re actually contending with—and discover the courage to be present and move beyond coping to living fully. Hard to do, but I keep trying.

Coyotes have adapted to suburban sprawl, say the wildlife experts here. Nearly all Massachusetts residents now live near them.

My inner coyotes roam at random. Lest they get too cozy, I’ll keep my flashlight handy.

Photo Credit: matt knoth 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.

Vacation State of Mind

· · 2 Comments

It was blazing hot last week here in Massachusetts—‘90s and high humidity—too hot, even for me, once again this summer. On the plus side, however, we were also on vacation, hanging out at home and doing day trips. Perfect weather for the beach.

Only one problem: I can’t swim in the ocean with ulcers on my fingers. Too much risk of infection. So we just spent one day, last Monday, a real scorcher, at the seashore. The water was wonderfully warm, and I was able to wade up to my thighs, the next best thing to swimming.

For the rest of the week, we escaped the heat and humidity by playing tourist in our own backyard and immersing ourselves in history—from dinosaur bones to the Dead Sea Scrolls, from Emily Dickinson’s reclusive world to whaling ship lore.

One evening, we watched a classic 1921 Swedish silent film, The Phantom Carriage, with live piano accompaniment. Two other nights, we enjoyed free outdoor concerts. We met Al’s infant grand-niece and took her and her parents on a Swan Boat ride in the Boston Public Garden. Later that evening, we paid respects to the site of the Boston Marathon bombing.

On our last day, Sunday, the humidity finally broke, and we headed out to Plimoth Plantation, a recreation of 17th Century life among the native Wampanoags and English settlers who arrived on the Mayflower.

Here we met Phillip, a Wampanoag descendant and interpreter, who wore his hair half-shaved, half braided, as his ancestors did, to avoid entanglement with a drawn bow. He explained all the ways the Wampanoags made use of nature’s bounty to thrive along the Massachusetts coast—building bark longhouses that provided ample heat and comfort throughout the winter, constructing summer huts from reeds that swelled with moisture to become rainproof, planting beans next to corn so the tendrils would curl up the stalks, shading the roots with squash leaves and blossoms that minimized weed growth. There were game and fish aplenty in the forests, rivers and sea. “We had everything we needed,” he said.

In the nearby English community, we chatted with interpreters who reenacted the lives of actual settlers. One young woman rocked in her dark thatched roof house, clothed in a long linen skirt and yellow vest, stitching a napkin’s hem, and told us how hard life was, how much she missed her old home in back in Surrey. The only good thing about coming here, she said, was the promise of owning land, something her husband, a cooper, could never have dreamed of back in England. When asked why they did not call themselves Pilgrims, she explained, “Pilgrims are people who travel a long way to a holy land. This is far from a holy place. It’s but a wilderness.”

Same land. Two diametrically opposed world views. I couldn’t have asked for a better example of how mind-set shapes experience.

So here I sit, typing on my laptop, inching back into my normal routine, pondering. Vacation, we discovered this year, is a state of mind. You don’t have to travel far to find it. And (I am certainly not the first to observe), how we frame our experiences defines every encounter. It’s all too easy to lapse into longing for what you lack in the midst of all the plenty you have yet to recognize. The best respite from struggle is gratitude.

The trick is to maintain that vacation awareness—that ability to step back from daily demands and clutter, to pause and truly see—in order to appreciate and make the most of what’s right here, right now.

I’ll keep trying.

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.

In Search of Earthworms

· · 2 Comments

On Sunday, in 90 degree heat, I decided it was time to weed our backyard rock garden. I haven’t done any gardening in several years, mainly because the last time I tried, I messed up my hands. But I couldn’t stand it any more.

Our yellow day lilies, just bloomed, were half-hidden by an encroaching jungle. Between the extreme temperatures and forecasts of more heat, humidity and thunderstorms for the coming week, I figured if I didn’t do something, the weeds would thrive at the lilies’ expense and choke out any hint of beauty.

Besides, weeding seemed like the perfect antidote to all the words swirling in my mind—a writer’s liability. Perhaps the physical work would negate the narration and bring some insight.

I bandaged my finger ulcers with extra care to minimize irritation, lathered on sunscreen and insect repellant, donned an old straw hat, found my lavender gardening gloves in a basket in the kitchen (their special coating keeps out the dirt but allows skin to breathe, essential for my hands), located my angle weeder in the garage (a curved, sawed-edge tool with a prong at the tip), and headed into the backyard.

It was already steamy by 10:30. I tackled a few tall weeds—at least four feet high—first. I have no idea what they were, but they pulled out of the hot, dry earth easily. Ginger, my constant shadow, sniffed around the yard a bit, then wanted to go back inside after about a half-hour. I kept working.

Wild violets had carpeted much of the rock garden. They’re pretty in the spring, but very aggressive, leaving no room for much else. They’re also tenacious. I quickly discovered that I’d have better luck digging and leveraging out the roots with my angle weeder, rather that trying to pull with my hands—more effective, less strain.

As I dug and prodded and pulled, I wondered where the earthworms were. The ground was parched from the five-day heat wave, so maybe they were hiding farther beneath the surface. But their absence surprised me. When I was growing up, I used to love to spend a hot summer afternoon weeding in the shade of my parent’s front garden, watching the earthworms crawl amidst crumbles of dirt, their soft pink bodies squeezing and stretching as they aerated the soil. Wherever they appeared, the earth felt cool and smelled rich.

Mosquitos buzzed in my face, drawn by sweat. I swatted them away, smearing my cheeks with dirt, and kept on weeding. I discovered a forgotten sapling that I’d planted a year ago in the back of the garden. Somehow, it had survived all the snow and cold of winter. Still not much bigger than a twig, it had quite a few leaves. I cleared the ground around it for more sun. Nearby, I left what looked like a wild rose that had taken root, perhaps a mistake, since they’re invasive.

Weeds near the stone steps and larger rocks in the garden proved much harder to evict.  I tried prying them out with an old trowel, but the trowel bent under pressure. So I found a long handled tool in the garage with a curved fork at one end and managed to claw out some dense root clods. I sawed off a few woody weeds that were impossible to dislodge.

As I worked, I tried to shut off the constant flow of description in my head. All the obvious gardening metaphors played through my mind—clearing away the clutter, seeing what’s really in front of you, enabling new growth/life/ideas. But the only way to achieve that through weeding, to turn it into a meditation, is to focus and stop the word flow.

I never got there. I just kept working until I’d cleared as much as I could and my heart was pounding too loudly in my ears from all the heat. It occurred to me that the best thing about weeding is the immediate gratification of making room. I found a slug, glistening on a blade of grass. I observed how some roots are like fine hairs and others, like white and purple carrots. I imagined planting basil and wildflowers.

By 1:00, with sweat flinging off my hair, I declared my weeding done. My hands felt okay, but my back and legs, weary. Grateful to discover I could still dig in a garden, I stepped back to review my handiwork. Plenty of weeds left to be pulled, but the lilies’ sunny trumpets were now easily admired.

Back inside, Ginger at my feet, I sat down at the kitchen table and drank a tall glass of seltzer. Time for a cool shower. It had been a good morning, though no great, hoped-for insights about work or my writing or something else from all that weeding. Such things don’t come when chased. They prefer to tunnel beneath the surface and emerge when ready.

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

Here, But Not

· · Leave a Comment

I’m writing Saturday night, as the parsnip-pear soup simmers on the stove for Rosh Hashanah dinner on Sunday. And when this post publishes Tuesday morning, I’ll be getting ready to go to synagogue for the second day of the Jewish New Year.

In our wired world, our words can travel to their appointed destination on schedule, no matter where we happen to be or what we happen to be doing. So even though I’ll refrain from work and not touch my computer for the length of the holiday, it will seem as though I’m online, doing business as usual.

Here, but not. The Internet, email, texting, smart phones—all create the aura of being there, regardless of whether we’re actually present.

The irony, of course, is the more we communicate through the electronic ether, the less we’re present in the world around us. Everywhere I go, I marvel (to put it politely) at how many people are constantly texting or talking on their cells, noses buried in those little screens, never noticing the sidewalk or the sunshine or the car that’s making a left-hand turn in front of them.

And I think about this often, because time takes on a different meaning when you are living with a chronic disease. Minutes, hours, days are more precious. With each passing year, I feel a greater need to experience each day fully and do something meaningful with my writing.

Staying present, really present for the people I love, appreciating whatever each day brings, even the difficult, annoying parts, takes focus and determination. I can multi-task as well as anyone, but I no longer think that’s a great way to work or live. Better to simplify and pay attention to what’s in front of me than to spread myself too thin by trying to do too much, which always leaves me worn out and aggravated and struggling to slow down my brain at night so I can sleep.

Case in point: This past Friday I planned to drive to a supermarket about 20 minutes from home because they have excellent produce and I needed a lot of fruits and vegetables for my holiday menus. I left later in the day than I’d intended, trying to finish one more thing before I quit working, and decided to take a different route that I thought would be faster in mid-afternoon traffic. But, of course, I got lost, had to ask for directions, and spent 45 minutes getting there, instead.

I was totally annoyed with myself. Then I decided to let it go. There was no point getting aggravated because I wasn’t going to get there any sooner. As I drove, just watching the road and surrounding scenery, I got an unexpected insight about work that never would have occurred to me if I had continued multi-tasking and forcing my brain to track too many details, as I had for most of the day.

I spent the next hour at the market, focused on picking the best parsnips and pears and other savory produce, weighing and labeling each bag with its price, and gave myself a pat on the back at the check-out line when I discovered I’d actually stayed within my budget.

Of course, now I’m back to multi-tasking, writing while the soup cools on the stove. But it’s filling the house with wonderful smells, and when I wrap up this post, I’m going to enjoy watching the food processor transform the chunks of cooked fruit and vegetables into a swirling, golden mass. Then I’m going to bake the challah that’s quietly rising. And then I’m going to get some sleep.

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.