Recently, I met my newborn niece for the first time and attended my brother-in-law's wedding. The only thing I'm missing to remind me about my mortality is a funeral. Seeing all the potential in a seven-pound human and the chapter of someone's life begin reignited mixed emotions in me that I didn't expect after having already come to terms with my diagnosis. That's the thing about receiving a diagnosis with no hint of a prognosis and no idea how a disease will affect me over the years or when it will kill me—I have no idea what to expect at each juncture.
I used to be the jar opener in the house. Whenever someone couldn't open a jar or container, including my husband, I somehow had the strength to see it through despite having very little upper body strength. It's like my body was preemptively compensating for the second half of my life in which I would never be able to open a jar again. These are the miniscule and mundane things I'm now realizing will be defining factors in how I move forward and handle these setbacks.
Everything I do with my fingers is painful now. I can't sew my husband's button back on to his suit 10 minutes before he officiates his brother's wedding. I can't dice potatoes without placing my hand in a compromising position that could end in a little skin slice. I can't put my eyeliner on without extreme focus and moving my hand at a snail's pace. I can't clasp my dead mother's necklace that I just placed around my daughter's neck for the first time without risking it falling to the floor. I can't paint my toenails with my daughter on her bedroom floor the way I always envisioned I would. I can't press down my son's flyaway hairs after he has dressed in semiformal wear for the first time. I can't pluck all the little black hairs on my chin and upper lip that I've been fighting my whole adult life. I can't even open my fucking pill bottles to take the medication that is attempting to save my life without paying for it each time. I mean, I can do most of those things, but it hurts like hell.
What I can do is type because it doesn't require a pincer grasp. Those of you who know me well know I've always wanted to be a writer. I playfully wrote what we'll call "poetry" in my youth, occasionally wrote nonfiction pieces here and there throughout my early adulthood, and I started a gratitude email chain when my children were younger and life was very difficult for me—just so I had an excuse to write and share my experiences with close friends and family. After conducting extensive research on my family's ancestry over the past decade, I decided that I would write a book about transgenerational trauma in the maternal side of my family. I stumbled upon my Aunt Patsy's 20-page autobiographical account of her early life, which included my mother's childhood, and realized I had a story to tell that was bigger than my own. But when would I write it? When would I find time to travel to Johnstown, PA, to research the Great Flood of 1889 in which a few of my ancestors died, jumpstarting a generational cascade of trauma and poverty? Is my trauma really trauma?
My Disease Origin Story
In October 2021, I was standing at the sink in the kitchen—washing dishes and listening to music, completely content and happy that I had thus far survived the COVID-19 pandemic and hadn't caught the virus. I was grateful. I was relaxed. But I felt a warm feeling come over my whole body, and parts of my arms and legs were going numb. I had difficulty breathing and thought I might pass out. I had no idea what was happening, but all signs pointed to a heart attack, which wouldn't be a surprise given my family history. I called out to my husband, and after waiting a few minutes, we decided to go to the emergency room. In the middle of the pandemic. At night. We waited hours, during which I sat and struggled to breathe, panicking that I was sitting in an overcrowded waiting room with people who likely had COVID-19—some who would probably end up dying from it weeks or months later. My first EKG was normal, and eventually I was called back to have blood tests and an x-ray of my heart. My heart was fine, and my blood test results showed no signs of a heart attack. I went home with a diagnosis of dyspnea (labored breathing)...and that's it.
I felt better over the next few days but was exhausted. When I received the x-ray report days later, I noticed it said, "Mild interstitial prominence bilaterally. Linear atelectasis at the left lung base." Additional info suggested follow-up regarding the lung observations. However, no one in the emergency room mentioned this. They didn't tell me anything was wrong with my lungs. I saw my primary care doctor, who recommended I schedule a visit with a pulmonologist. This jumpstarted my journey.
A local pulmonologist sent me for a CT scan of my lungs and a pulmonary function test (PFT). We received the results quickly, and he diagnosed me with interstitial lung disease (ILD). During my long, slow walk down the hallway to the exit, I realized everything would change. When I left his office, I drove through Mount Olivet Cemetery in Frederick and read some of the headstones, passing by Babyland on the way out, which gave me some perspective. Maybe I wanted to be reminded that I was still alive? I've always enjoyed cemeteries—reading the dates, names, and epitaphs and imagining the lives of those buried as if they were part of an anthology I was writing in my head. My mom isn't in a cemetery, or that's where I would have gone.
I always thought lung cancer would get me before anything else. It got my mom, my brother, and my aunt...and likely many of my ancestors on that side of my family who died young with no cause of death available for me to find. My official diagnosis was ILD-undefined, which means no one knew why I had fibrosis (permanent scarring) at the base of my lungs. My pulmonologist sent me for a 6-month follow-up CT and PFT; slight progression in fibrosis was evident in the CT, but my breathing was still considered healthy. The doctor still couldn't determine the cause of the ILD, especially after testing me for rheumatoid arthritis, which was negative. So he said, "Let's wait and see and keep testing every 6 months." I walked out of his office knowing I probably would never go back. I'm not a wait-and-see kind of person. I knew there were answers out there, so I called Johns Hopkins, which happens to be where my mother established and nurtured her career right up to the months before she died, and they considered me a good candidate to see an ILD specialist. Getting an appointment with a specialist there is a competitive process. You have to really need them, or they won't take you as a patient. A last-minute cancellation got me an appointment the week I had received the confirmation that I could be a patient. Within 2 weeks of confirming my status as a patient at Hopkins, I had blood tests and an hour-and-a-half visit with a young female pulmonologist who probably saved my life. I was heard. I was seen. I was examined. And all the irrational fears I had my entire adult life of dying from lung cancer were converted to a different disease. She suspected an autoimmune issue but couldn't determine the source without bloodwork.
What I didn't know or expect was that those blood tests would provide an answer. I honestly didn't look at the list of tests she ordered before having my blood drawn because I've had so much bloodwork over the years for my various other health conditions that it felt routine. I immediately received a phone call from the pulmonologist after the results were posted in my patient portal, and I was tentatively diagnosed with connective tissue disease–associated ILD. But she could only give me that generic diagnosis because she wasn't a rheumatologist, which is the specialist I needed to see next. She told me she was almost certain I have scleroderma, which is also referred to as systemic sclerosis (SSc). I didn't know the Scl-70 antibody test she snuck in with the litany of standard blood tests would be my golden ticket. I felt like Charlie Bucket in the room with Grandpa Joe, Grandma Josephine, Grandpa George, and Grandma Georgina, experiencing the moment I knew my life would change forever. I never thought I'd be excited to test positive for a rare disease. But I finally had an answer.
According to LabCorp, the Scl-70 antibody is seen in 20% of patients with scleroderma. This antibody is also associated with reduced survival. Scleroderma is classified as a rare disease. It's progressive. There's no cure. The only treatments available are aimed at maintaining quality of life, addressing the symptoms (e.g., reflux, pain), and suppressing the immune system to hopefully slow the progression of the disease. Research is ongoing, but no one has been able to come close to finding a treatment that shows promise for ridding the body of the scleroderma-associated antibodies (there are 3) or reversing the condition. The only thing I can do is take a proton pump inhibitor to prevent reflux from entering my lungs and causing further damage and take an immunosuppressant (Myfortic) to hopefully reduce inflammation and slow progression. So now I'm immunocompromised. I'm one of those people you're supposed to care about infecting with COVID-19, which means I'm also the person you DON'T care about when you choose to deny scientific facts and blow into someone's face because you're angry that people are wearing masks. I will likely need to wear a mask inside stores and buildings for the rest of my life...or at least as long as I know my disease is progressing and I'm taking an immunosuppressant. I can't go to indoor concerts in November. I can't attend a school function with my kids indoors in February when the flu and COVID-19 are running rampant through the halls. My life has changed completely.
Answers That Prompted So Many Questions
Looking back over the past 2 years, so many things were lightbulb moments—having Raynaud's the past 10 years, having to stop for an intense catching-my-breath session while biking downtown with my friend, having reflux that worsened very quickly the past few years and woke me up multiple times a night with coughing fits, having very swollen fingers while taking walks (thinking I had consumed too much sodium), the vitiligo that popped up out of nowhere one summer a few years before we left Virginia, the conversion of my hypothyroidism to Hashimoto's thyroiditis (the autoimmune form of hypothyroidism), my random exhaustion that I attributed to motherhood and working 3 jobs, severely dry skin that was diagnosed as eczema, episodes of severe vaginal bleeding and pain resulting from occasional adenomyosis, and a hiatal hernia that was diagnosed during a colonoscopy/endoscopy a few years ago. I added that up. It's 9 symptoms that were diagnosed as resulting from various conditions, some of which I was already receiving treatments for. Most of them are because of scleroderma.
It took a primary care doctor, then a gynecologist, then an endocrinologist, then a pulmonologist, then a rheumatologist to get me to where I am right now (I'm sure I'm missing an -ologist in there somewhere). And that's only because I was persistent and work as a medical writer. I'm aware of the amount of time patients have to spend advocating for their health and asking for help from doctors who just prescribe a pill and don't run tests that could be run. I had to research even more than I already do for my work. I had to ask for specific tests. I had to bring in published literature to explain what I thought was happening to my body. I had to ask for referrals. I had to walk away from appointments knowing I didn't receive enough information.
Months after I finally met with the pulmonologist at Hopkins, I had been on a path to halting my disease progression with CellCept (which then changed to Myfortic), reducing the Raynaud's flare-ups with a new blood pressure medication, and basking in the glow of a reflux-free life. Finally, after 4 months, I went to my first appointment with the rheumatologist at the scleroderma center at Hopkins on June 1. My appointment lasted 3 hours. Yes, I said hours. She and another doctor, along with a student observing, scanned my entire body for signs of scleroderma after taking copious notes about my symptoms. These people were speaking my language. I was able to save so much time in my appointment by speaking in clinical terms and telling them what I already knew, opening up space to ask some questions I might not have had time for otherwise. They used handheld dermatoscopes to check my nailbed capillaries. They grabbed large chunks of my skin in various locations and exclaimed things like, "Wow! You have such wonderful skin!" while rubbing my arms, wide eyed and complimentary. I felt like a scleroderma queen.
After my very thorough exam, the scleroderma specialist confirmed what I already knew and provided some additional reassurance that scleroderma isn't the death sentence it used to be. If you Google survival for scleroderma, you'll see that survival rates are measured in 5-year increments: X% of people live for 5 years, X% of people live for 10 years, etc. These are old data, and they're scary. CellCept and Myfortic, both the same medication (but one gives you less of a case of the poops), have changed the treatment landscape for scleroderma. People are living longer, healthier lives. Sure, there are those in the minority who need a lung transplant 2 years after diagnosis, and there are those whose bodies slowly harden until their organs turn to stone within 5 years. But my doctor said it's likely I'll live a long life, albeit with some health digressions over time. In order to do so, however, I have to keep taking this medication that severely reduces my immune system and makes me vulnerable to every type of lung infection and every virus or bacteria lurking in the shadows of our lives. I have to stay inside when the wildfires from Canada infiltrate Maryland. I have to be extra careful about heatstroke. I have to avoid being around large amounts of chemicals that can be inhaled.
The Spinning Wheel of Acceptance
My finger issues have fluctuated in severity the past few months. But it's the first new symptom I've had since learning about my diagnosis, so it's terrifying. What's next? Calcinosis? Not being able to type? Losing my job? Asking my family members to pick up and carry everything for me? I wake up thinking about it. I think about it during meetings at work. I think about it when falling asleep at night. The lurking uncertainty about what's next will never go away. I've been spending so much time in therapy to develop tools to maintain a positive attitude and suppress (but only to a certain extent) my desire to seize the day and spend the money. I'm grateful that I have very little if no skin involvement right now, which is a major element of scleroderma. The type of scleroderma I have is associated with fibrosis or hardening of internal organs usually before the skin. I'm not sure which is worse, honestly. Scleroderma is literally targeting my healthy cells and forcing my immune system to work in overdrive, hence the immunosuppressant to calm down those evil cells.
For now, my main problem is keeping my Raynaud's at bay. In the winter, my hands and feet are blue/white multiple times throughout the day, frozen solid and so uncomfortable that when I'm working, it's so hard to concentrate. In the summer, the air conditioning has the same effect. My family has been supportive with this, although it does come with many comments like "I'm soooo hot" or "I'm sweating." I'll take it. I do lower the temperature at night so everyone can sleep comfortably. I keep fingerless gloves at my desk and wear thick socks or slippers most days. I keep sweaters draped over my office chair. I wash my hands in hot water multiple times a day. I purchased a cheap gazebo for my back yard so I can work outside in the heat (which I call my defrosting sessions). We plan to install a screened-in porch so I can basically live out there when it's warm.
I'm depressed. I'm anxious. I'm angry. I'm impatient with and intolerant of ignorant and hateful people. I'm not communicating with people as much. I'm taking things personally. I'm tired of explaining why I can't do that thing you want me to do. I'm worried I won't get to see my kids live adult lives. I feel guilty for the burden this places on my family. I want to educate everyone about this and save people. And I'm tired, tired, TIRED of always worrying. Will I live to age 90? Or will I get cancer before scleroderma can kill me? But none of us know anything. So the only thing I can do is live a more selfish life and FINALLY—for the first time in my adult life—put my needs first. So screw all of you! Just kidding. I still love you. Just let me do what I want. Okay?
June is Scleroderma Awareness Month. I started writing this blog post with the intention of publishing it at the beginning of June to raise awareness and share my news with the hundreds of people who don't know yet. I've told who I can...and if you're offended that I haven't told you, please don't be. I'm exhausted. I couldn't bring myself to finish this blog post until a few days before the end of the month. And that's how it goes these days. Things take forever to do, to feel, to learn, and to understand. Everything comes with a 10-pound weight attached to it. But, dammit, I'm gonna drag that weight into my Jeep, roll the windows down, and blast music while driving to the next awesome place I've been waiting to see. Wanna come?