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Reflections on the Messy Complexity of Chronicity

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resilience

Spilled Coins

Evelyn Herwitz · June 11, 2013 · Leave a Comment

Quarter past ten. Why does it always take almost as much time to drive 50 miles from my home into Boston as it does to maneuver through local traffic and park for my rheumatology appointment?

I’ve driven round and round the garage, finally located a space on the sixth level. Heading toward the stairs, I notice the elevator has just arrived and decide to shave a few minutes. For some reason, I have it in my head that I’m late, when I’m actually, amazingly, early for a change.

A curly haired woman in capris steps into the elevator ahead of me. As the doors begin to close, another woman with a rolling briefcase runs, calling for us to wait. The first woman reaches her forearm to hold the door. “I’m not very good at this,” she apologizes. “But you did it!” says the third passenger.

When the curly haired woman steps toward the back of the elevator to make room, I notice her hands. They are frozen into fists, with scabs from ulcers on the back of each knuckle. Her face is smooth and tight, lips pulled into a grin. She carries her paper coffee cup in a pink rubbery sleeve with two handles that she can hook with each hand.

As familiar as I am with scleroderma, I’m startled. I don’t often meet a fellow traveller. I feel badly for her. Her hands seem so much worse than mine. I wonder if I should say something. But casually commenting, “So, I see you have scleroderma, too,” feels awkward. There’s no hiding this disease. We all want our privacy.

We both walk quickly across the street and into the medical center. She pauses to study the floor directory. I signal the elevator and am the first one in, this time. We exit at the same floor, with me a few steps ahead. We sign in for our appointments simultaneously. I overhear her saying that she is seeing the same rheumatologist. Her appointment is the one before mine.

As I open my wallet, a dozen coins spill onto the carpeting. Great. This is the price of leaving the coin compartment unzipped to save my fingers. The curly haired woman is the first on her knees to help me. She scoops up some quarters and dimes with her fists and places them on the counter before I can flip a few into my palm. “I often find using a piece of paper helps,” she says. I thank her, marveling at her speed.

We sit on opposite sides of the waiting room. She scrolls on her pink-encased smart phone. I type on my laptop. Our doctor is running late, as usual. I think how grateful I am that I can still type. I notice how adept she is at maneuvering objects with her two fists. I keep track of her turn, since mine will be next. She disappears into the warren of exam rooms.

When I finally see my doctor, an hour later than scheduled, we go over all my latest symptoms and difficulties. My ulcers have been particularly troublesome for the past few weeks, due, no doubt, to the odd extreme temperature changes of late. It’s frustrating, I tell him. They’re sore all the time. But, I add, there was this woman in the waiting room who had the appointment before me. Her hands were so much worse. What do I have to complain about?

It’s only a few days later, when I recall her comment about how a sheet of paper helps her to scoop up coins, that I realize she may well have thought the same of me and all my bandages.

This is a jarring disease. It disfigures and contorts the body. But it doesn’t straightjacket creativity, so essential for coping. My curly-haired counterpart has figured out how to scoop up coins with her fists. I have found the lightest touch keyboard so I can still write with my bandaged fingers. I wouldn’t trade my frustrating but familiar problems for hers, and I expect she would say the same of me. Maybe we’ll talk about it, next time our appointments coincide.

Photo Credit: uhuru1701 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: adaptive tools, body image, finger ulcers, flexion contracture, hands, managing chronic disease, resilience

What a Blast

Evelyn Herwitz · June 4, 2013 · 3 Comments

When I was little, one of my prized possessions was a Japanese fan, the kind you could snap closed with a flick of your wrist and spread open with your fingers, gently, so the paper wouldn’t tear. It was pale gray with hand-painted, pink-and-white blossomed cherry trees and gilt edging. I don’t know what ever became of it, but I could have used it this past week.

It was really, really hot here in Massachusetts.

So hot (’90s-muggy-record-breaking-air-quality-alert-hot) that our neighbor’s three dogs were outside, barking, at 12:30 in the morning because it had finally cooled down enough for them to do their business, and I’m sure she assumed that everyone else had their windows closed and air conditioning on and wouldn’t be disturbed.

So hot that our lawn must have grown three inches, one for each day of the heat wave, not unlike the corn that grew so rapidly on hot, humid days near my home in Central Illinois years ago that you could actually hear the stalks squeaking as they reached for the sun.

So hot that I, perpetually cold, broke into a sweat just sitting at my computer in my converted-porch home office, finally tried out our new heat pumps on their dehumidify cycle—and was grateful, so grateful for the instant relief.

One weekend ago, everyone was shivering and complaining that their heat was turned off and sweaters packed away. Five days and 50 additional degrees later, it felt like deep summer, already.

Climate change, anyone?

I love heat. It makes my hands and feet very happy. But there’s heat, and then there’s heat. My perfect weather is sunny, mid-’80s, low humidity, with a light breeze. High ’90s, with air so thick it clings to your lungs, is too much, even for me.

My annual summer dilemma usually surfaces mid-July, when we get a stretch of this kind of stifling weather and I can no longer make due with just open windows and ceiling fans. Air conditioning, which we have studiously avoided for years because of my Raynaud’s, then becomes a necessary evil—too cold to tolerate for more than about a half hour, but impossible for me to concentrate, without.

Our new heat pumps provide a miraculous compromise. I can set the kitchen on dehumidify, and it refreshes the entire first floor during the hottest part of the day. Or just flip on the pump in my office for a half-hour and then shut it off again as I enjoy the residual coolness. If it gets really bad outside, there’s an AC setting, too, but I haven’t broken down to try it, yet. We’ll be paying off the interest-free loan for the next seven years, but well worth the investment to have year-round, personalized, energy-efficient climate options in every room of the house.

Not so when I leave home, though. Whenever I enter and exit a commercial building in the summer, it’s as if I’m going between this past week’s two weather extremes—from the equator to the arctic, and back again. I always carry a sweater and my wrist warmers wherever I go, so I can quickly adjust layers to the interior climate change.

This makes dressing for special summer events a major challenge. This past Saturday, we had a family bar mitzvah to attend. What to wear? I remembered the temple from the last time we were there, a few years ago for the older sister’s bat mitzvah, as icy cold. But it was in the mid-‘90s, for crying out loud! Just once, just once, I wanted to wear a summer dresses without a bulky cover-up.

I decided on a sleeveless rayon knit—lightweight, but warm—with a cotton crocheted sweater. I brought along a rayon shawl and a pair of my fleece wrist warmers, just in case. Sure enough, as we entered the lobby, I could feel my fingers chilling. On with the wrist warmers, but, fortunately, no need for the shawl. As the AC cycled throughout the service, I countered by slipping my wrist warmers on and off, as needed.

I was expecting a similar experience at the reception, held at another location. But to my astonishment, the event space was—heaven forbid—comfortable.

So comfortable that I could actually take off my sweater and wrist warmers and enjoy the next few hours with family and friends in a sleeveless dress. I cannot remember the last time this happened. It must have been back in the 1960’s when central air was still a luxury.

Maybe this phenomenon occurred because businesses are finally starting to realize that you save money if you don’t crank the AC down to 65, which most people in their right minds and bodies can’t tolerate, anyway, for more than about 15 minutes.

Or maybe it was because their central air was malfunctioning.

Anyway, I was happy. Who knows? As the world gets hotter and we finally learn, the hard way, that we can’t suck all the fossil fuels out of our planet and pump CO2 into the atmosphere without dire consequences of extreme weather patterns, we’re all going to have to adjust, one way or another.

For my own part, I’d much rather wear a sleeveless dress and carry a beautiful Japanese paper fan to a summer celebration—because everyone finally agrees to keep the AC at 78 or even turn it off and open some windows if there’s a breeze—than tote a sweater, a shawl and a pair of fleece wrist warmers in a 90-degree heat wave.

Photo Credit: sakura_chihaya+ 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, Touch Tagged With: air conditioning, heat wave, managing chronic disease, Raynaud's, resilience

In the Belly of the Beast

Evelyn Herwitz · May 21, 2013 · 4 Comments

There’s no such thing as a non-invasive test. Some are just more invasive than others.

Last week I found myself inside a clanging, banging, buzzing, bleeping MRI machine, undergoing a 25-minute diagnostic that was probably unnecessary, one of those just-in-case procedures you occasionally have to endure because one of your specialists needs to validate a hypothesis and define a baseline.

I’d had an MRI once before, at Boston Medical, lying on my back with a pair of headphones, listening to Ray Charles. The procedure was longer, but the music was good enough to distract me from the machine’s clanging, so the time passed relatively quickly.

Not so last week at an outpatient facility near home. First of all, the position was uncomfortable. I had to lie on my stomach, head in a padded masseuse-like cushion, arms forward, another pad pressed against my abdomen, ankles draped over some kind of wedge, like a swimmer frozen in a dead man’s float. Secondly, the music was lousy—a choice between two stations I dislike (pop rock versus easy listening) on headphones with poor reception. So equipped, unable to see around me, with an IV in my arm and a rubber squeeze ball to grasp in case of emergency, I slid backwards into the MRI’s gullet.

Buzzing soon commenced. Through the headphones, I could hear the tech’s voice alerting me that this first scan would take five minutes. BEEEEP. BANG-BANG-BANG-BANG. I could barely hear the music because of all the static in the headphones, let alone all that banging and clanging, and the song wasn’t anything I really wanted to listen to in the first place, but I hung onto the notes so as not to start feeling claustrophobic.

CLANG-CLANG-CLANG-CLANG. The music ended and the announcer started jabbering, followed by a lot of commercials that sounded like gibberish. I tried to figure out how many more of the five minutes were left by counting the number of ads. Finally, a moment of silence inside the machine.

BUZZ-BUZZ-BUZZ-BUZZ-BUZZ. Another series of scans. I did my best to keep breathing without moving anything I wasn’t supposed to move. This was not easy, especially with the pad compressing my diaphragm. I practiced Pilates breathing, expanding the sides of my rib cage. I wondered if either of the techs had ever gone through this procedure. I decided this should be part of every MRI tech’s training.

The tech’s voice in my headphones informed me that she was now going to insert the contrast dye through the IV. I might feel a cool tingling, but if I took a few deep breaths, the sensation would pass. BEEEEEEEEEEP. BANG-BANG-BANG-BANG. Somewhere in the background, I could hear Billy Joel’s “Just the Way You Are.”

I tried to monitor the progression of the slightly cool dye through my veins. I have an allergy to certain contrast dyes, but I had been assured this was very safe. BUZZ-BUZZ-BUZZ-BUZZ-BUZZ. So far, so good. I tried to focus on the barely audible lyrics as the machine moved through a series of five scans, grateful for the brief silences between each cacophonous set.

More commercials. Next up, “I’m Never Gonna Dance Again.” Yuck. The voice in the headphones said this was going to be the last set, a two minute scan. Thank goodness. BLEEP-BLEEP-BLEEP-BLEEP-BLEEP.

All of a sudden, I felt flushed and unable to get a full breath. I tried to calm myself, but my breathing was too shallow. I squeezed the rubber ball several times. The tech and her assistant were both in my headphones, slightly annoyed. This was the final scan, just two minutes left, what was wrong? “I feel like I’m going to faint,” I said, twice. The machine stopped. A door opened. I moved forward. Someone took my hand, probably the assistant. The tech reassured me it couldn’t be a reaction to the dye, I’d had it seven minutes ago and been fine, it was like aspirin, it would just pass through my system. The weird sensation lifted, and I was able to breathe fully again. Back into the belly of the monster.

BLEEP-BLEEP-BLEEP-BLEEP-BLEEP-BLEEP-BLEEP. Not a procedure for anyone with a propensity for migraines. I told myself it would be over soon and marveled at how anyone in their right mind could think all these decibels should be tolerated for the sake of more medical data points.

At last, blessed peace. The awful radio music ended, too. I could feel myself moving out into the open air of the room. As the tech removed the IV catheter, she noticed my bandaged fingers.

“Are you a nail biter?”

“No, I have scleroderma.”

“Oh.” Silence. She had no clue what I was talking about.

I sat up, slowly, feeling groggy. The assistant brought me a bottle of apple juice. I took a few sips and wondered aloud why the machine was so noisy. The tech explained that it had to do with the various levels of magnetic resonance. Then she added, “A man made it. That’s why it doesn’t work right.”

I was still a little woozy getting dressed, but relieved to slip my wedding ring back in place. Fresh air felt wonderful. I took another sip of juice as I relaxed into my car seat, Symphony Hall playing on my satellite radio, then realized I’d forgotten to ask when the test results would be available. But I didn’t really care. I’d hear soon enough.

Down the street was a car wash. No one was in line. As my Prius drifted gently into the dark, automated cavern, I lay back, listening to Brahms, drinking my juice, and watched the clear, fine spray wash the last traces of late winter’s grime from my windshield.

Photo Credit: digital cat  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, Hearing, Mind, Sight, Touch Tagged With: body-mind balance, invasive procedures, managing chronic disease, medication side effects, MRI, non-invasive procedures, resilience

Take Me Out to the Ball Game

Evelyn Herwitz · May 14, 2013 · 4 Comments

Some people have a knack for winning raffles. Al is one. So when he told me a few weeks ago that he’d won a raffle at work for two Red Sox tickets, I wasn’t really surprised, but I was glad to go. I enjoy a good game of baseball, and I hadn’t been to Fenway Park in far too long.

Fenway_5-8-13Our tickets were for last Wednesday night, Red Sox versus the Minnesota Twins. Tuesday, I checked the forecast: rain, maybe even a thunderstorm. I started fretting. I had spiked yet another infection over the weekend in an ulcer in my left thumb. What if it got too cold and damp for me to sit outside?

Al checked the location of our tickets, and our luck held—we were in the grandstand, under the second deck. Okay, game on! Even if rain caused a delay, I’d have my layers. I put two coats to choose from in the back of the car, brought along my gloves and leg warmers, just in case, and we set out for Boston.

Despite a downpour on the Mass Pike, heavy traffic and a search for ridiculously expensive parking, we made it with about 10 minutes to spare before game time. The sky had lifted, and everyone was in a good mood as we walked past the food and souvenir barkers, through security (a sign of the times, especially after recent events in Boston), and into the ball park.

Our seats, way in the back of the grandstand, were high and dry, and we had a great view along the first base line. Call me corny, but there’s something about that first glimpse of the ballpark—the emerald green outfield, neatly trimmed in a criss-cross plaid; the perfectly groomed clay-red infield; the players in their bright uniforms, warming up; the good-old red neon Coca Cola sign; the inevitable baseball trivia opening award ceremony (it was the 40th anniversary of the American League’s designated hitter rule)—that just made me grin and get a little lump in my throat.

We were both smiling by the end of the first inning. After the Sox pitcher gave up far too many walks, loading the bases for the Twins and enabling them to drive in four runs, our boys redeemed themselves in the bottom half with a run and a grand slam that put us up by one.

But it was all downhill from there. The Twins scored seven more runs in the second inning, and we never caught up. Final score, 15-8, a total rout.

Al was not pleased. But I didn’t really care that much, even though I would have preferred a better contest. I was having too much fun watching the people show—the guys in yellow vee-neck tees and ball caps, climbing up and down the stadium, carrying trays on their heads loaded with nuts, lemonade, hot dogs, water bottles and chowda-chowda-he’ah; the spectators bopping to the music, laughing at themselves on the big screen, trying to start a wave around the stadium, cheering as the ball flew high into the night sky and sighing as it was caught only a few feet from the Green Monster; the between-innings standing ovation for a dozen Rhode Island state troopers in their dress olive green uniforms and Smokey hats, honored for their help after the Marathon bombing; the seventh inning stretch, singing along with the crowd and organ to Take Me Out to the Ball Game.

No one around us got too drunk. People were chatting and texting and just relaxing, despite the lousy game. We had plenty of room and were able to move down to the front section as discouraged fans left early. People danced and pumped their fists to the team’s informal theme song, Neil Diamond’s Sweet Caroline.

Even in the bottom of the ninth, when we were so far behind, die-hard fans (maybe a quarter of the stadium, at this point) were still chanting a sing-song let’s-go-RED-Sox! It started sprinkling just as the game was ending, and the deluge and lightening held off until we were well on our way home.

Hope springs eternal at Fenway. Despite the fact that we lost, despite the threat of rain and my lousy infection, despite the fact that if Al hadn’t won the tickets we wouldn’t have been able to afford to go, despite doping scandals and the commercialization of professional sports and outrageous players’ salaries, there is just something so sweet about a Wednesday night baseball game at an old fashioned ball park that makes everything seem possible again. So good, so good, so good.

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, Hearing, Mind, Sight, Touch Tagged With: body-mind balance, finger ulcers, hands, how to stay warm, managing chronic disease, Raynaud's, resilience

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

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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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