Living with Scleroderma

Reflections on the Messy Complexity of Chronicity

scleroderma research

If I Had a Billion Dollars

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Al and I were sitting at the dinner table Sunday night, finishing our meal of salad plus macaroni-cheese-and-tomato-sauce casserole. “The Power Ball is worth over a billion dollars,” he said ($1.4 billion, to be exact—but who’s counting).

rainbow-1393626-639x391“Really?” I said. “What would you do with a billion dollars? I mean, whatever was left after taxes?” (Even if it was less than half, that would still be a whole lot of money.)

We agreed that our first priority would be to pay off all debts—our mortgage, the equity line, the girls’ college and grad school loans. We’d make sure their futures were financially secure. And we agreed that our second priority would be to set up a charitable foundation.

“Who would you give the money to?” Al asked.

I began enumerating—certainly I’d donate to scleroderma research, also our favorite charities and our synagogue. I’d give a lot of money to climate change research, like how to desalinate sea water, alternative methods of farming during droughts, better ways to control coastal flooding. I’d fund interfaith dialogue and Middle East peace initiatives. Grants to fledgling artists and writers. For starters.

“What else?” he asked.

“Well, I’d fix up the house, do all the projects we’ve put off. Maybe I’d want to sell it and downsize.”

“Downsize? With all that money?”

“Sure. Then we could buy vacation places around the world. Except they’d be a lot of upkeep.” (So much for downsizing.)

“It wouldn’t matter,” said Al, caught up in the game. “We’d have enough to pay for a home on Block Island.”

“Okay, then we could also have an apartment in Tel Aviv and a place on the French Riviera. And I’d want to travel. First class. Go to Antarctica.” (I could certainly afford to buy whatever gear I needed to stay warm, there or here, for that matter.)

Al smiled. He began to clear the dishes.

I imagined buying custom-made shoes for my hard-to-please feet and any clothes I wanted.

“You could get a personal trainer,” he said, picking up my empty dinner plate.

“Yeah,” I said, “and I’d want to put aside enough money so we’d be able to afford in-home care, 24/7, for when we get older, so we’d never have to live in a nursing home.” (Might as well be a little practical about the future with all that imaginary money. Certainly no more worries about medical expenses!)

What about work? We agreed we’d have our hands full managing our foundation, even if we hired staff to run it for us. We’d also be busy traveling. The rest of the time, I’d want to write my novel.

“Better buy some tickets,” I told him. (I can dream, can’t I?)

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.

Image Credit: Yarik Mishin

Imagine

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Passover this past weekend was extra special. A few hours before we were scheduled to begin our seder on Friday night, we learned that one of our cousins received the all-clear on her lymphoma, following six months of chemotherapy. There were big hugs all around when she and her family arrived for dinner.

A central theme of the seder is retelling the story of the Israelites’ Exodus from Egypt, as if you, personally, were escaping from slavery to freedom. The word in Hebrew for Egypt is Mitzrayim, which means “a narrow place.” So the metaphor had exceptional resonance at our table that evening, and again Saturday night, when we repeated the seder at our cousins’.

Then, on Sunday, I learned that the beloved husband of a childhood friend had died the day before of ALS. They were married only a few short years. The words of comfort I shared with her seemed so shallow compared to her loss.

Our bodies can betray us in so many ways.

There are never any guarantees that a treatment will work for a particular disease for any given individual. I am profoundly grateful that our cousin has responded so well to chemo and is on the path to full recovery from cancer.

My friend’s husband, however, had no such options. ALS has no cure, although research is progressing to identify the genetic underpinnings of the disease and treatments that may slow the deterioration of nerve cells.

According to the ALS Association, about 30,000 Americans may have the disease at any point in time. By contrast, figures from the American Cancer Society project more than 1.6 million Americans will be diagnosed with one of the four major forms of cancer this year—colon/rectal, lung, breast and prostate. And that’s not counting the myriad of other ways cancer can attack our bodies. No wonder a preponderance of research dollars go to finding a cure for “the emperor of all maladies.”

Scleroderma research for a cure faces similar hurdles as ALS research. With Congress deadlocked over basic federal spending issues, let alone medical research for rare diseases, the need to find other resources to support this important work has never been greater.

Where could it come from?

Here are some mind-blowing figures:

It’s not that we as a nation don’t have enough money to support medical research for rare diseases. It’s just a matter of priorities and the need to make a commitment, as a society, to be responsible for each other’s well being and not only for ourselves.

Imagine, for a moment, what it would be like to live in a country where we spent more on finding a cure for scleroderma or ALS or any number of horrible, painful, debilitating diseases than we do on all those half-eaten snacks that get tossed in the garbage.

Imagine.

Then please consider donating to the Scleroderma Research Foundation or the Scleroderma Foundation—or to the ALS Association.

Thanks for listening.

Photo Credit: a.s.ya 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

Ray of Hope

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Nothing like starting the new year with some good news about scleroderma research. In my email box last week, I found this item in the Scleroderma Research Foundation’s monthly eNewsletter (12-30-13):

Researchers Prevent and Reverse Mice Fibrosis in a Mouse Model of Stiff Skin Syndrome; Study Shows Promise for Scleroderma

I read on, heart quickening:

Dr. Hal Dietz and his team at The Johns Hopkins University have made a key discovery that may have broad implications for future scleroderma therapy. In a report in the November 7, 2013, print issue of the premier scientific journal, Nature, the researchers demonstrated that integrin-modulating agents (integrins are molecular receptors that mediate the attachment between a cell and its surroundings) can stop fibrosis in a genetic mouse model of scleroderma-like skin and, more strikingly, that established fibrosis can actually be reversed by the same agents. The Scleroderma Research Foundation has supported the work for the past six years.

In other words, it may be possible, some day in the future, to reverse skin stiffening that is the cursed hallmark of scleroderma.

Here’s a bit more explanation from the same piece:

In the SSS mouse model and, seemingly, in scleroderma, there is a fundamental process that goes awry: cells in the skin lose the ability to attach to the extracellular matrix and to sense their surroundings. Those cells then become activated and stimulate an immune response that causes the surrounding cells to produce excessive amounts of collagen, resulting in fibrotic skin. What’s most exciting is that the Dietz lab discovered a strategy to suppress the abnormal activation of the immune cells. In doing so, they also found that they could not only prevent, but also reverse established skin fibrosis.

You can read the full news release here.

There is so much we still do not know about the causes of scleroderma and potential cures. But the Johns Hopkins study gives real hope that somehow, someday, this disease will have a cure. Maybe not in my lifetime, but, then, who knows?

Both the Scleroderma Research Foundation in San Francisco and the Scleroderma Foundation in Danvers, Massachusetts, raise and distribute millions to find a cure. But they need help. There is just not enough funding through the National Institutes of Health for the research that remains to be done. Scleroderma is simply not up there on the top ten list of diseases-that-affect-enough-people-to-get-more-funding.

So, it’s up to all of us who are affected by this mysterious and disabling disease, friends and loved ones, to help out. Please, even though it’s past December 31, consider making a contribution.

Thank you, and profound thanks to everyone at both Foundations for all you do to help those of us who continue to fight our daily battles, living with scleroderma.

Photo Credit: Kuzeytac (Hopefully Back) 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.

Miracle Quest

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Twenty-six years ago this fall, I got on an airplane and flew to Pittsburgh to see Dr. Virginia Steen, one of the pioneering rheumatologists in the field of scleroderma research. She was kind, thoughtful and clear: I had systemic sclerosis, I was on a risky path, and I needed to start taking d-penicillamine (not to be confused with penicillin), an immunosuppressive medication that was, at the time, one of the main treatment modalities.

The drug was not without its risks and critics, and it has since been discredited in some of the medical literature as ineffective in treating scleroderma.

But you will never convince me of that. Six months after I started taking it, the wrinkles in my forehead began to reappear. Within a couple of years, the darkened, tight skin on my forearms had receded and my veins once again contoured the backs of my hands.

Most notably, I felt better—as if someone had switched on the light inside my brain that had been dimmed since my symptoms first emerged five years earlier. So much better, in fact, that I travelled back to the University of Pittsburgh and got Dr. Steen’s clearance to taper off the penicillamine, and, if I did okay without it, to try to get pregnant. I did, and I did, and our younger daughter is now 21.

Everyone’s course with this complex, debilitating disease is different. Better treatments have emerged. But I consider myself very lucky. When I saw Dr. Steen the second time, she told me she had believed when we first met that I was headed for a very difficult course. Had I not responded so well to the medication, I imagine I would be living, if still living, with severe disfigurement and many more complications.

I was recently thinking of Dr. Steen (now at Georgetown University Hospital in D.C.) after skimming through an online scleroderma forum. Someone had posted a question about her. I added my two cents’ worth. Many had shared similar, glowing anecdotes. A couple told angry, critical stories of their visits.

So much of dealing with this or any other complicated, chronic illness, depends on finding medical specialists you can trust. I’m fortunate to have had the resources to see Dr. Steen years ago and to live an hour’s drive from Boston Medical Center, with access to some of the best scleroderma specialists in the world. I’ve learned volumes from them and from my local rheumatologist, a man who has been treating me since 1985 and who understands the disease very well, but who also knows and admits the limitations of his own expertise.

In the scleroderma forum discussions, there is a lot of anguish, fear, pain. There are some very knowledgeable people who share good advice about managing the disease and all the information you need to track in order to manage your care. There are also many seeking miracles, people who distrust their physicians and look to fellow travelers for tried-and-true solutions.

Unfortunately, for some, that distrust is well-founded. Scleroderma is rare enough that there are still far too many internists and rheumatologists who aren’t well versed in its many symptoms and ramifications. Some patients get really bad advice and struggle to get an accurate diagnosis and appropriate treatment. Who else to trust but those who are also going through the same thing?

While some homegrown advice is useful, however, some of it is misguided. When you’re scared, without a solid understanding of the disease, it’s difficult to sort it all out.

As one who has benefited profoundly from expert medical care, I believe it’s essential to get help from knowledgable medical professionals who specialize in scleroderma. This is a select group, but they are worth the time, travel and expense to see. Both the Scleroderma Foundation and the Scleroderma Research Foundation in the U.S. provide resources to find local and regional scleroderma specialists.

There is no miracle cure for scleroderma—not yet. Both foundations are working hard to support research that will eventually lead to that cure. In the meantime, the real miracles, for me, are that I found a team of physicians who have helped me stay as well as I am able, that I have the loving support of my family and friends, and, above all, that my body, for all its malfunctioning, still works as well as it does.

That, and a good night’s sleep, are a lot to be grateful for.

Photo Credit: gnackgnackgnack 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.

Enough, Already

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On Monday afternoon, I took Ginger to the vet. This was her semi-annual check-up, time for renewing all her shots. For a nearly 15-year-old Golden, she’s doing great, though getting a bit slow on the up-take, between arthritis, some hearing loss and what I suspect is a touch of senility, as well as the inevitable lumps and bumps so common to her breed.

Bringing her takes some preparation. She needs a walk, first, around the block, to loosen her joints and be sure she empties her bladder somewhere other than the exam room floor. Of course, the skies chose to open right before we needed to leave, so I took an umbrella and she got soaked, though didn’t seem to mind. Then she scrambled into the car with none of the usual coaxing, probably to get out of the rain.

At the vet, though, anxiety set in. She panted and panted, sounding like a choo-choo train, as she lay on the waiting room’s linoleum floor. When her name was called, she tried to pull me out the door. In the exam room, she paced back and forth, attempting to hide behind my skirt. It took our vet, her aide and me to lay calming hands on her in order to complete the exam and all the shots. We were both glad to get her back into the car and drive home.

I know how she feels. I am tired of doctor’s appointments. In recent weeks, I have seen my local rheumatologist, my Boston rheumatologist, my cardiologist, my uro-gynecologist, my dentist and my podiatrist. I’ve had my feet x-rayed. I need to make an appointment for my bi-annual pulmonary function test.

I don’t mean to whine. I’m grateful for all of these gifted medical specialists. Some people with scleroderma have to travel a half-day or longer to get the equivalent treatment. I only have to travel between 10 minutes and an hour-and-a-half to receive some of the best care in the world.

But I’m still tired of it. I wish I could take a summer vacation from it all.

This past Saturday, June 29, was World Scleroderma Day. Organizations in the U.S., Europe, Canada and Australia rallied to publicize the search for a cure. Someday, I hope, if enough people pay attention, and enough of us contribute, and Congress finally passes the Scleroderma Research and Awareness Act (reintroduced, once again, this legislative session, as HR1429), then maybe, just maybe, researchers will have enough funding to find that cure and future patients will be able to find lasting relief from this complex and devastating disease.

In the U.S., you can contribute here:

Scleroderma Foundation
Scleroderma Research Foundation

And write your representatives here:

Scleroderma Research and Awareness Act – HR 1429 – Scleroderma Foundation

Thanks for listening.

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.