Living with Scleroderma

Reflections on the Messy Complexity of Chronicity

mindfulness

False Alarm

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I had a routine mammogram a couple of weeks ago. Not my favorite “non-invasive” test, as any woman knows. As the tech was arranging me for the inevitable squash grip of the mammography mammoth, I asked her why she had chosen this particular technical specialty. Her answer: “Because it saves lives.”

Fair enough. Fifteen minutes later, I was glad to be done with it for another year and on my way home.

Or so I thought. A week ago Sunday, I received an email about a new message for me in MyChart, my online portal for medical records and communication with my teams here at home and at Boston Medical. I took a look. No problems in the right breast. Here’s what it said about the left: “Indeterminate calcifications in the upper outer quadrant require additional views. Diagnostic mammogram is recommended for further evaluation.”

Calcium deposits in breast tissue (I learned, from a quick internet search) can be a precurser to breast cancer. A letter in my file indicated that I should set up an appointment for another series of X-rays, adding this supposedly reassuring sentence: “Most such findings are benign (not cancer).” Probably just a nuisance, I concluded. But I wondered, with so much calcinosis in my fingers, could this actually have something to do with my scleroderma? And what would that mean?

As luck would have it, I had a routine appointment with my Boston Medical rheumatologist the next day, so I filled him in and asked what he thought. Was it possible to have calcinosis from scleroderma in breast tissue?  Sure enough, yes, it’s possible. Indeed, it’s possible for calcinosis to show up in all kinds of strange places. He shared a research study with X-rays of some pretty dense (and very uncomfortable-looking) calcification of breast tissue. We talked at length about how to proceed, how to avoid unnecessary diagnostics, and more, and concluded that he would send a referral to Boston Medical’s breast health clinic, which is one of their top specialty clinics, to get me into their queue, just in case.

I went home in a terrible mood. Before I had thought this was probably nothing, but after that conversation, it felt like something more serious. I called the radiology clinic at home and was able to get an appointment for first thing the next morning to do the additional mammograms. I was told that I would get results at the appointment, which I appreciated.

When I got to radiology last Tuesday morning, I told the tech that I have calcinosis from scleroderama. She did not think that would be a likely factor in the results, but I asked her, nonetheless, to tell the radiologist. After three very squished close-up scans of my left breast, I waited in the exam room for the outcome. The radiologist came in and said the words I was hoping to hear: not related to breast cancer. I have “calcification of some small vessels” from scleroderma. Nothing to worry about.

What a relief! When I got home, I wrote my rheumatologist about the results and asked what that meant. Would some calcified small blood vessels lead to eventual tissue death? Was there anything more to understand about this? His answer: “Calcinosis unfortunately remains a mystery.” I can live with that. No sense speculating about it. I’ll find out in due time if it matters or not, and meanwhile, there’s nothing to be done.

So, there you have it. This very strange disease continues to throw some very wild curve balls. But at least this episode wasn’t as scary as it seemed. I write this post for you, Dear Reader. Mammograms do save lives. They can also create uncertainty and may require clarification. In case you get a similar worrisome result from a mammogram, be sure to advocate for yourself and explain your full medical situation. It matters.

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: John Cafazza

Soundscape

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As I was lying on an exam bed Monday morning, during a routine echocardiogram, I was thinking about sounds. Not just the sounds as the tech pressed the ultrasound probe to my chest and took photos—beep—typed—clackety-clunk-clackety-clackety-clunk—and played audio of my heart beat—woah-wacka-woah-wacka-woah. That alone was quite the medley.

I was also listening to the sounds of the Boston Medical office building—the whoosh of air through metal ducts in the ceiling, the padding and occasional squeak of rubber-soled shoes along the corridor, someone’s cell-phone ringing, muted conversations among the medical staff.

Medical offices have a very distinctive soundscape. Especially offices that are tied to hospitals. There is a certain muffled white noise that permeates the space, some combination of the type of linoleum and carpeting, sound-absorbing tiles on high ceilings, the cushioned shoes, the air ducts. Conversations ebb and flow around corners and through walls of exam room warrens. You can hear personal details that you shouldn’t. You can sense the tension in sotto voce murmurs.

In waiting rooms, I’ve decided there are basically two kinds of people: those who respect the presence of others and keep their voices down, and those who think they’re in their own living rooms and yell on their phones or play loud videos or music without wearing earphones. Some waiting rooms post signs that cell phones are not allowed. Some places enforce those rules. Others don’t. I have yet to determine a pattern of which kinds of doctor’s waiting rooms are more likely to be quiet or noisy. It would be an interesting subject for research.

All I know is if you dropped me blindfolded into a medical office building, I would know where I was immediately, just by the sounds. Which also means I’ve spent way too much time in medical office buildings.

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: Pawel Czerwinski

On Getting Older

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In just over a month, I will turn 70. That number doesn’t feel so old to me anymore. In fact, it feels about right.

There’s an old saying that you’re as young as you feel. Can’t say I feel young—at least, not physically. My body has been aging prematurely since I developed scleroderma in my late twenties. In some ways, I don’t really know what it’s like to be thirty or forty, or even fifty, since I was always ahead of the aging curve. I’ve been living for decades with aches and stiffness and body parts that don’t work and a sense of physical vulnerability that normally wouldn’t arise until late middle age. I used to envy friends who were healthy and energetic when I couldn’t be. I wondered what that would feel like.

Not anymore. Everyone’s caught up. Meanwhile, my decades of experience with premature aging have made the onset of the normal range of physical limitation that come with this time of life just another blip. Aches and pains when I wake up or rise after sitting for a while. Check. Need to manage my energy. Check. Lots of specialists appointments. Check. Need to manage multiple meds. Check. Harder to walk than before. Check. Eyes too dry and tire more easily. Check. Hands giving me problems, hips, feet, knees. Check, check, check, check.

It adds up, and I certainly understand how distressing it is when all this starts to happen, whatever your age. But I never expected scleroderma to give me an advantage. It has forced me to learn how to pay attention to what ails me, problem solve, adapt, get proper medical attention, manage my health care, and most importantly, focus on what I can do rather than on what I can’t. After forty-plus years of living with it all, turning 70 doesn’t really seem like a big deal.

In fact, it feels like an accomplishment. And I’m looking forward to it.

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: Volodymyr Hryshchenko

 

This Bud’s for You

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Spring teased on Monday, with temperatures hovering in the mid-50s, a great break from more frigid weather last week. It never ceases to amaze me how our trees and shrubs withstand all this winter yo-yoing, made all the more intense as climate patterns shift in response to global warming. Too cold? Too warm? They adapt. At least, so far. Certainly better than I do.

I took a break from client projects Monday afternoon to take a few photos of the stalwart buds on our new cherry tree out front and more buds on the overgrown azaleas—or are they rhododendrons?—by our back door, and to admire tiny plants peeking out of the moss in our rock garden. Their resilience always gives me hope.

Daylight Savings Time starts this weekend. Spring is but a few weeks away. Here’s a little taste of seasonal rejuvenation to savor during this first week of March in the Northern Hemisphere. Enjoy.

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.

Dancing Ants

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As I write on Monday afternoon, my Pandora feed is playing Brahms’s Hungarian Dance Number 5. It’s short, energetic, and an old favorite, a good mid-afternoon pick-me-up.

Whenever I hear this particular piece, it reminds me of a game I used to play with my sister. Somehow, in my childhood imagination, I invented a character named Clancy the Ant. I would jump out of the closet in our bedroom and sing nonsense syllables to Hungarian Dance Number 5, cross my arms and kick my legs like a Russian folk dancer, then voice Clancy’s enthusiastic chants of hey-hey-hey to the music, going on and on long after the piece had supposedly ended. While it loses something in the telling, this performance would inevitably cause my sister to laugh, which was the whole point.

Why an ant? I have no idea. Why Clancy? No clue, either, about that or the Russian folk dancing. As for why Brahms, I can only say that classical music was always playing in our home. Our dad had a huge collection of vinyl records, and our parents had also gifted the two of us a small, electronic turntable in a little red carrying case. We had our own set of yellow vinyl 45s of short classical pieces for children. I don’t recall if the Hungarian Dance Number 5 was one of them. I do recall listening to Debussy’s Golliwogs Cakewalk on one of those yellow records—a wonderful, playful piece. My love of classical music was undoubtedly inspired by immersion in that milieu of beautiful sound.

Perhaps that was also the beginning of my desire to act. Tonight in my acting class, we have to present a monologue. Fortunately, we don’t need to memorize it—my one big worry, another hurdle to overcome. Performing in front of the group is not an issue, however. Last week I did a cold read of a monologue provided by our teacher and was amazed that I wasn’t scared at all. This time, I’m planning to perform a monologue from my yet-to-be-published World War I novel. As I wrote a few weeks ago, my goal in taking this class is to learn how to sink more deeply into my characters. So, here I go, and maybe, just maybe, I’ll stir the universe enough to attract an agent or even a publisher, at long last.

No ants, but certainly upping the ante.

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: Mike Haupt