If the Shoe Fits

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I’ve been on a quest for good walking shoes for at least a month, now. With the weather warming and travel plans ahead, I want to be sure that I have a reliable, comfortable pair that will minimize my feet issues, even as I am coming to accept that no pair exists that will make walking fully pain-free.

This is always a challenge. The biggest stumbling block is that you can’t walk outside in shoes that you’re trying out at home without committing to buying them. (I know of one clear exception, Allbirds, which gives you a 30 day trial of walking anywhere—if the shoes don’t work out, you send them back and they are donated to people who are homeless. Zappos has also accepted returned shoes I’ve lightly worn once outside, but I don’t want to take unfair advantage of that option.) So how to really know if the shoes will be comfortable on pavement or uneven terrain, which are always the big challenges?

My strategy now is to wear a pair I’ve bought around the house for a few days. Usually, if there’s a major fit issue, I’ll know right away. If there are other structural issues, I’ll know in a day. If the shoes are still comfortable after a couple of days, I’ll take the plunge and wear them outside.

But, first, they have to meet a number of criteria. The fat pads on my feet have thinned so much from scleroderma that I have to set a high bar:

  • Is there plenty of room in the toe box? No pinching?
  • Are they lightweight so as not to aggravate my joints?
  • Is the shoe made of materials that breathe, to avoid trapping perspiration and triggering Raynaud’s or causing skin breakdown?
  • Does my foot feel balanced, with pressure evenly distributed over the entire sole?
  • Does walking in the shoes adversely affect my knees, back or hips?
  • Is there sufficient arch support?
  • Is there a removable foot bed, so I can use my own orthotics or a good ready-made alternative?
  • Is there enough shock-absorbency, so the shoe doesn’t tire my feet or trigger the neuropathy in my right foot?
  • Can I walk without noticing the shoes? Do they fade into the background?

Then there is the question of style. I refuse to wear shoes that look like boats. Fortunately, now that so many of us baby boomers are aging, and many of us have buying power, there are a lot more alternatives for comfortable shoes that are at least somewhat attractive, even if heels are out of the question (and bad for your feet, anyway) and daintier styles lack necessary support. When I first began having these issues several decades ago, the choices were much slimmer. Now there are options, even for my particular taste.

If the shoes pass all of the above tests, then it’s time to risk a test drive around the block. None of this is foolproof. I’ve tested shoes outside, thought I had a winner, only to discover after repeated wear that they don’t work out in the long run. This has happened more times than I would like.

Which brings me to my latest acquisition, a pair of Abeo sneakers that I found at The Walking Company. I’m on first-name basis with the sales clerk, at this point. She knows my issues and really tries to help me find the right shoe. I landed on this pair after several rounds of other shoes that didn’t work out. Then I went back and upgraded the removable insoles. That combination seems to be on target.

My walk around the block on Monday in lovely sunshine was an A-. Pretty good, all things considered. While there is no pair that will make walking painless or tireless, these sneakers give me hope that I’ll be able to sustain longer walks—balanced with thoughtful pacing and rests. Staying active is simply too important to give in to all the obstacles that this disease throws in my path.

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.

Extraction

So, I was hoping that my resorbing molar would hang in there at least until the summer. Not to be. After a brief hiatus a few weeks ago, the tooth began acting up, with no signs of abating. Last Monday, I realized I needed to take action, because the coming weeks are busy with Passover and travel plans, not to mention my birthday later this week, which I was not about to ruin with a toothache.

Fortunately, my periodontist was able to fit me in last Wednesday. I tried not to think about it too much in advance, and there wasn’t much time to angst, anyway. A good thing, because it is such an unpleasant experience. My periodontist is very skilled and has incredible patience, both essential to extracting a big molar from the back of my jaw when I can’t fully open my mouth due to skin that remains somewhat tight. But it’s a struggle—for both of us.

The main problem, other than simply getting all the tools in my mouth and the constant tugging at my less-than-flexible lips, was that the ligament surrounding my molar had been destroyed, thanks to scleroderma. This is the membrane that enables the tooth to wiggle when loose and be easily pulled out. Instead, as had been the case the last time I had this procedure done, the roots of my very big molar had fused to my jawbone. So he had to drill them out. Not fun. I tried to calm myself by listening to the soothing classical music in the background and focusing on my breath, which definitely helped.

Because he had to drill so deeply, it took a lot of novocaine to numb my nerves. He finally used a combination of novocaine and epinephrine, which has the advantage of intensifying the local anesthetic, but the very big downside of causing my heart to race and giving me the shakes for a while after the shot. I absolutely hate the stuff, but had not realized I hadn’t told them in advance. So that detail will go into my chart for next time.

The whole process of extricating the molar, taking an X-ray to see if he’d gotten the whole root, drilling some more, then inserting the implant and stitching me up again, took about two (very long) hours. Knowing it would be hours more before the novocaine wore off (my body processes anesthesia very slowly), I drove 45 minutes back to my home pharmacy, picked up medication (and was pleased that my new Medicare Part D pharmacy card works), got home, finished up loose ends of work, and then lay down with an icepack on my jaw. (Icepacks are tricky, because they can set off my Raynaud’s, but better to put up with that than have a really swollen face.)

Five days later, my jaw continues to heal. Swelling is receding. One of the stitches already fell out on its own, as expected. It’s not comfortable, but significantly improved from the nerve pain that was only going to get worse if I waited any longer. I charged the expense to one of our travel credit cards, so at least we’ll get some points from the ordeal.

I’m glad it’s over, and that it will be mid-summer, at least, before the next step of drilling and inserting the post for the crown. I’m also glad that the gap in my teeth is not visible, so I don’t have to look like Alfred E. Newman for the next nine months. I’m very grateful that we have the resources to deal with this, and I really, really hope that it will be years more before I have to go through it again.

And, so, another tooth bites the dust.

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: Daniel Frank

Perchance to Dream

I’ve been having some trouble falling asleep, lately. I go through these bouts from time to time, when I’m trying to do too much and my mind is overstimulated, or when I’ve sat up at my computer too late, or when I watch too much news. Some of the solutions are obvious (plan in evening down time! no computer after 9 o’clock! don’t OD on the latest political crisis!). But I’ve also decided to use regular guided meditation in the morning to help me calm my thoughts.

I subscribe to Headspace, which is a great app with many guided meditation series to help with various issues. When I was dealing with my horrific ulcers the summer before last and the surgical aftermath, the series on pain management was a real boon. This time, I’m meditating my way through the sleep series, which includes both practical advice for good “sleep hygiene” as well as a mind-calming meditation to be done in the morning that helps you sleep better at night.

I was skeptical of how this would work, but lo and behold, after about ten morning sessions, I started to fall asleep more readily. I am less intimidated by the prospect of needing to fall asleep, which is the insomniac’s hamster wheel, and more able to relax. (Of course, now that I’m writing this down, who knows what will happen tonight?)

In any case, the meditation has an added benefit. Monday morning it was cold here, a drop from the mid-60s on Sunday to a wind-chilling mid-30s (welcome to New England). When I started my meditation, however, I didn’t have on any socks, because I’m ready for spring and didn’t feel like it. Of course, that meant my feet were ice cold. I wondered if meditating would improve my circulation. Sure enough, by the end of my ten minutes of visualizing a warm glow filling my body from bottom to top, my toes were actually a little pink. Not toasty, but not freezing, either.

Years ago, I had read how meditation could help Raynaud’s. I once even tried some biofeedback practice to see if it would make a difference, but didn’t have the patience to follow through consistently. Here was yet another reminder that the mind truly does influence the body. And ten minutes of calm in the morning certainly beats that nagging voice in my head urging me to start thinking-planning-doing.

I don’t expect my sleep issues to disappear, but at least it feels more manageable at present. And my toes are happier, too.

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: Cris Saur

In the Purple Zone

It’s been a yoyo week of weather, bouncing from seasonal cold to single digits to the fifties today. I’ve had Raynaud’s for so long that I barely notice the constantly changing cold sensations in my hands and feet⎯unless they go numb, of course.

But over the weekend, a friend asked me for some advice for her teenage daughter, who has developed the tell-tale signs of primary Raynaud’s (as opposed to secondary Raynaud’s, which, as the term suggests, is caused by another underlying condition such as scleroderma). When she is cold or stressed, her fingers turn purple, sometimes white and painful.

So this gave me pause as I reviewed for my friend what I’ve learned over the years. Given the crazy cold weather across the country, it’s worth repeating for those who may be new to the condition:

  • Keep your torso warm. While your first thought may be to focus on your hands, if you protect your torso from the cold, your extremities will have access to better blood circulation. Layers are key, here, and the type of fiber matters. Which brings me to . . .
  • Favor natural fibers for clothing. Cotton and wool both wick away moisture and allow skin to breathe. Polyester and other synthetics trap perspiration and can make you feel chilled. Silk is lightweight and has the dual advantage of keeping you warm in winter and cool in summer. I have a silk liner T-shirt that I’ve worn in extremely cold weather for decades; the investment pays off.
  • Get mittens. They may not fit your fashion sense, but they definitely keep your hands warmer than gloves. Avoid synthetic fur liners. Look for insulated mittens that repel moisture. Some people favor battery-heated mittens, the kind you get at hunting stores, but I have never used them.
  • Use wrist-warmers. My favorite brand is Wristies, affordable fleece warmers that come in all different colors, in various lengths, even with pockets for heat packs. I use them year-round, to keep my hands warm in winter and protect them from air conditioning in summer.
  • Wear a hat. Just as keeping your torso warm helps your extremities, so does wearing a hat on cold days. This was one of the first tips I got from my rheumatologist. Recent studies place heat loss through your head at about seven to ten percent. It’s the common sense reason behind old fashioned nightcaps (which I don’t wear) and a good excuse for buying a nice hat (which I do).
  • Wear properly fitted shoes. Pinched toes restrict circulation, which can exacerbate Raynaud’s vasoconstriction. I also look for shoes that breathe, which is why, even as I don’t eat meat, I prefer leather footwear for winter.
  • Turn up the heat. This is a mortal sin for many hardy New Englanders, but I’m fortunate to be married to a local who accepts my need for a warm house and the associated expense (even as we strive to be environmentally responsible with attic insulation and good windows). As I said to my friend about her daughter, take her complaints seriously that the house is too cold. She’s not whining. It’s real.
  • See your doctor. If your hands or feet are consistently numb and you’re experiencing persistent discomfort or pain, talk to your doctor. Protect breaks in the skin, as poor circulation can lead to ulcers that won’t heal and may get infected. There are a range of medications that can counter vasoconstriction, but you’ll need to experiment to see what works and if it’s worth it for you.

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: invisiblepower

Let It Snow . . . Sort Of

It’s chilly and damp and just plain yucky outside as I write on Monday evening. I have my legs wrapped in a blanket to ward off the cold, even with the heat on in my home office. I’m wearing sweatpants and two layers of sweaters, plus my wrist warmers. Every so often I take a break to walk around and get my circulation going.

Ah, November in New England. It was brutally cold on Thanksgiving. Fortunately, I only had a short run from the car to our cousins’ front door, and otherwise stayed inside. The weather outlook this week is alternately rainy and chilly, but at least not snowy again for a while. Famous last words.

Every year, around this time, I try to stave off my winter blahs by reading the long range winter weather forecasts. It’s kind of my own version of wondering if the groundhog will see his shadow. Knowledge is power, right? If I know how cold it’s supposed to be, then I can be prepared.

Well, so far, the predictions for the Northeast U.S. are mixed. According to the National Oceanic and Atmospheric Administration (NOAA), we’re supposed to have a warmer than average winter up here. The southern states are supposed to get more precipitation than normal. You can see the whole forecast here.

On the other hand, Boston forecasters are expecting a stormier winter season, drawing on the El Niño effect and historical data. Ugh.

I know, I know. I need to get over it. Whatever comes will come. It’s just the transition is always hard. In any case, I had my snow tires put on last week. At least my car is 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. Please view Privacy Policy here.

Image: Emil Vilsek

Wild Goose Chase

Canada geese can be a nuisance, crowding public green spaces, spackling parks with poop. But they can also be magnificent. I always love watching them fly, honking signals to form their undulating V. Strangely, I haven’t heard them yet this fall, migrating south, but I expect to, soon, as the days grow noticeably colder.

Those geese may be wild, but they are certainly organized. I cannot say the same for our local CVS pharmacies last week, as I tried to chase down a refill on a prescription to keep me warm.

Now, this medication is a vasodilator that I need to control my Raynaud’s. It’s a key part of my regimen year-round, but all the more important as temperatures drop. When I realized I had only three pills left early last week, I ordered my final refill on this particular prescription via my CVS iPhone app Sunday night. Normally, I get a confirmation text that the refill is in process (which I did), and then another text when it’s ready for pick-up within 24 hours (which I didn’t).

Hmmm. Time to follow up with a phone call. The pharmacy staff who answered the phone on Tuesday told me it was on order and would arrive later that afternoon. Fine. On Wednesday (one pill left), I received a text that a refill was ready for pick-up. So I went to the store, expecting to get my scrip and be on my way.

However, as it turned out, the refill was for a different med, one that I actually did not want refilled (it was on autopilot and I didn’t catch it in time). The medicine I needed was still on order. I inquired why. So it turns out that my local CVS did not have any of the required pills in stock, and none were available from the manufacturer (what?), and only one other CVS in the city had any. The clerk transferred the prescription to that store, so I wouldn’t lose any more time (theoretically), and I went home.

By Wednesday afternoon, still no text that the scrip had been filled. Hmmmm, again. I looked up the address of the store in question and discovered that there were two different stores on the street she had mentioned. So I called both. Had they by any chance receive my prescription? Nope. Even if they had (they could see it in the system) there was a problem. Why? Because my scrip was written for the generic version of the drug, not the brand name. And no CVS in the entire city had the generic pills in stock. I was directed to yet another CVS, on a different city street, that had the brand name showing up in the computer.

By this time, I was getting pretty annoyed. Already it had taken me more time than I had available to track this down. And it’s not an unusual drug. There was not one, not two, but three CVS stores on the newly designated street, according to my Internet search. I picked one and called. This time, I got lucky (or so I thought). The pharmacy clerk told me that they had my medication, but the problem was that my prescription had to be rewritten only for the brand name, and not the generic as an option.

Are you still with me? Aargh! I called my local rheumatologist’s office and got hold of one of the nurses who knows me. She readily took care of the new prescription and assured me she would put it under my doc’s nose as soon as he finished with a patient. Twenty minutes later, the pharmacy called back. They had the prescription, but it was still written incorrectly. There could be no mention of the generic on the scrip, only the brand name. Good grief. I called back my doc’s office, got another nurse on the line, who promised to straighten it out and get back to me when all was set, which she did by that evening.

The next day, Thursday, still no text that the scrip had been filled. I was out of pills by now. So I called the pharmacy to see what had happened. A different pharmacy clerk named Cindy answered the phone. I explained my dilemma, trying unsuccessfully not to get agitated. She calmed me down and found all the information. Apparently, they did not have the drug in-house, but she promised to order it right away from the warehouse, and expected delivery the next day. “Call me by noon to check in,” she said in a motherly voice. Thank you, Cindy, for being human.

I didn’t make the call because I got another text on Friday morning, telling me that the scrip was filled. After a client meeting downtown, I double-checked my app. Once again, it was the drug I didn’t want, still waiting for me at the original CVS (even though I had told them I didn’t need it). I called the new store to check on my quest. A different clerk answered and found out the pills were there, but my scrip was not yet filled, so she would ask the pharmacist to move it to the front of his orders.

I drove across town and found the store, a small, old CVS with a tiny parking lot, then waited at the pharmacy counter for another person to finish buying what looked like a dozen bags of pills. But when it was finally my turn, hallelujah, the scrip was filled. Not only that, but the young woman (not Cindy) who served me, who turned out to be the Wednesday clerk on the phone who had said the pills were in stock two days earlier, recognized my name and apologized for her mistake, due to an inventory error (not her fault) in their records. She was so pleasant, so committed to making my experience a positive one, that I might just leave that prescription at this out-of-the-way CVS pharmacy, despite the inconvenient location.

Wild goose chase, indeed. Any flock of Canada geese that had set out for their southern nesting grounds the day I first put in my order were probably long settled somewhere nice and warm by the time I got my pills. Thanks to some thoughtful individuals who believe in old fashioned customer service, I’m a bit warmer, now, too.

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 Credit: Jessica D. Vega

Refreshment Break

I made myself take a walk Monday afternoon. It was short, just around the block, but I got outside. It feels like fall, now, damp, chilly, and I need to get acclimated to the change in seasons. I’m back in sweaters and warm pants and thick socks, my long coat, hat. I wore mittens over the weekend.

It’s all too easy to make excuses to myself to stay inside when the weather turns. It’s too overcast. It might rain. It looks dreary. I don’t want my fingers and face to get numb.

So my short walk was a good reality check, as well as a much needed breath of fresh air. Even as it was overcast and had been pouring earlier in the day, the rain held off. The air smelled sweet with the tang of humus. My joints limbered up. My mind brightened from a jolt of oxygenated blood.

It was also good to see the neighborhood beyond my computer screen. Trees are turning late this season in Massachusetts, due to a warmer-than-normal summer and early fall. Usually we’re at peak foliage right around Columbus Day weekend, but this year green still predominates. Only the sugar maples, so far, have begun to flame and shed their leaves.

Pumpkins, plastic tombstones, skeletons and fake cobwebs decorate a few neighbor’s lawns, but the Halloween craze of a few years back seems to have ebbed. That’s fine with me. More than ghosts and goblins, there are quite a few red, white and blue signs promoting political candidates for the upcoming November election. That’s fine with me, too.

A new neighbor’s house has been repainted; that neighbor’s repairs are complete; another’s is in progress, with boards hammered over the front door. Al decorated our front steps with mums, pumpkins, gourds and cornstalks over the weekend, and I’m pleased with the result as I walk up our drive.

Back inside, I realize my fingers and lips have gone slightly numb. But it’s warm in the house, and I feel refreshed. Worth repeating.

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.

Interlopers

Mid-July, and it’s hot in Central Massachusetts. High ’90s last week, and so humid that it felt as if you were swimming, far-too-far from the beach. What a relief when thunderstorms passed through on Friday to clear the air for the weekend.

Friends have asked me if I’m enjoying the heat. They well-know my aversion to cold. But, I tell them, even I have my limits. My happy place is mid-80s with low humidity and a light breeze. So it felt very good to take a walk around the neighborhood Monday afternoon, in precisely those weather conditions.

Only a few other people were outside—a kid on a bicycle, a lawn crew, a boy shooting baskets in his driveway. Just me and the birds and the gypsy moths. The latter seem to be reveling in their last week of life, flitting around tree trunks, plastering bark with tan egg masses that will become next year’s scourge of very hungry caterpillars.

Our city’s trees have been hard-hit, especially oaks. If we get enough rain this season, we may avoid more defoliation next summer. The caterpillars’ only natural control is a fungus that has died off in recent years, due to drought. It’s making a slow comeback, and this year’s infestation is not as bad as last, but conditions have been too dry for Mother Nature to hold the insects fully in check.

As a little kid, I used to do my part. I loved to collect caterpillars and let them crawl all over my fingers (at least until whatever they secreted made my skin peel). Then I would put them in glass jars along with twigs and leaves, poke holes in the metal cap, and imagine they were my pets. They would inevitably die of suffocation.

Walking on Monday afternoon, I wondered how something so beautiful could be so destructive. There’s a marvelous felicity about these moths, how their papery wings glow golden in the sunlight. They brush your skin like a dainty feather. When they first hatched from their pupae last week, fluttering outside my office window, I mistook them for butterflies.

Well, butterflies they are not, and I am hard-pressed to understand what possible positive role they fill in the ecosystem. Same goes for mosquitos. Ditto for rare and chronic diseases, plant-borne and human.

Regardless, nature’s balance deserves—no, demands—our respect. Our lives depend on it. On Tuesday, the temperature creeps back up near 90. I hope we get some rain.

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.

Time Out

Sometimes I feel as if my head is going to explode from our nation’s vicious politics. So it was a great pleasure and privilege to go with Al to one of our favorite getaways on Sunday, Block Island, just off the Rhode Island coast, for a relaxing Father’s Day. The weather was perfect; the sky, azure with wisps of clouds; the water, emerald and sapphire. I stayed away from my news feeds. Best of all—no crowds. Public school is not yet out, so it was the calm before tourist season begins

I read, watched Al brave 58°F water, walked the beach, took photos and collected stones and sea glass. I got my feet wet, too, even if my toes turned purple. (Added bonus: walking barefoot on wet sand helped me to remove a nasty corn from my left foot that had re-emerged shortly after my podiatrist took it out a couple of weeks ago, a huge relief and boost in my ability to walk without pain.) After supper and some shopping, we sailed back to the coast on the ferry’s upper deck, enjoying a beautiful sunset. Just what the doctor ordered.

Here’s a taste of our visit. 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.

In Transition

Dare I say it? Finally, spring has arrived. “I thought it would never get here,” one of my neighbors remarked as I walked by his house Sunday afternoon. I commiserated.

Despite last week’s snow (yes, snow), a few tulips, daffodils and hyacinths adorn gardens along my route. In our own shaded rock garden, cheerful miniature daffodils greet me as I enter the back door to our kitchen. Buds on our Callery Pear are swelling, and there is a reddish mist on the maples down the street.

Best of all, I am starting to shed my warm layers. I even walked with my coat open on Sunday. Without gloves. Miraculous.

In a burst of my own creative energy, I decided to start a new sewing project. I haven’t considered anything that hand intensive for about a year, now. The project is a light-weight, unstructured coat for transitional weather. I found it online, a pattern you download and print. It took me a few hours after I returned from my walk to piece together the tiled segments, then cut out each piece and mark with sewing construction notes.

On Monday, a few fabric swatches I’d ordered arrived in the mail. They are luscious, lovely wool tweeds, but I’m not yet certain if there will be enough yardage available for the coat (end of season bolts). So I will keep looking.

What pleased me the most, so far, is that the process of assembling the pattern pieces—aligning and cutting and taping—was both manageable and fun. No hand problems or pain. I know this is going to take some time to finish. I hope it won’t be fall before I’m done. But that’s the beauty of sewing a coat for transitional seasons; even if it takes me all summer to complete, I’ll be able to wear it when I’m finished.

As with everything I do now, I have to refigure how to use my hands post-surgery. Pacing myself through a sewing project is essential. I don’t want to mess up my hands in the process. But I also don’t want to avoid one of my favorite creative hobbies for fear of hurting myself.

Spring has arrived late this year. We may still have some chilly set-backs. I can’t recall when I last pulled out my sewing machine and serger—at least a year has passed. With longer days and warmer weather, I’m ready to try again.

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.