Scleroderma – Page 4 – Yarn, Books & Roses

Hannah and the CoalBear: Caturday Updates

Hi. I’m Mateo.

I’m all grown up now. I should be trusted outdoors on my own, right?

This has been a busy week at Casa Mother-of-Cats. The shower broke and she had to get a plumber to fix it. Hannah practically teleported into the closet for that! Then the Mother of Cats had to go get some blood work done for her crazy scleroderma and she has been dragging sadly around the house waiting for the doctor to call. Finally, the Mother of Cats pulled herself together and went to the garden center to buy roasted green chiles: Yeow! Those chiles are stinky!! Hannah refused to go into the kitchen while the Mother of Cats was packing them up for freezing. Late in the week the Mother of Cats got some knitting done and early this evening the doctor messaged her, and she has finally perked up.

Through the whole week she took a lot of pictures, so here they come:

There is a bunny hanging out in the front yard that makes the Mother of Cats happy every time she sees it.

These mums came home from the garden center with the green chiles.

The leaves are starting to change on the trees.

I managed to escape from the catio last night and ran wild through the yard under that supermoon for a couple of hours before the Mother of Cats came looking for me. So. Much. Fun. I looked everywhere for that bunny, but I couldn’t find it. There was a garter snake in the yard last week too, and that sounds like a lot of fun, but I couldn’t find it either. Unable to have really outstanding fun ~~or a bunny snack~~, I just ate a bunch of bugs and threw them up on the bed after I came back in… why does the Mother of Cats get worked up so easily?

Hannah: I was a good girl and stayed on the catio.

Oh, yeah. I almost forgot. There was a lot of knitting that went on this week, too.

This heap of pink mess is the beginning of the new Weekender Crew sweater. I’m sure that it will actually look like a sweater some day.

The sweater is being knit inside-out, so the Mother of Cats tried to pull the knitted tube open so you could see the part of the sweater that will be on the outside. It is totally a mystery to me, but hopefully you will kind of get the idea. The color is nice, right?

The Mother of Cats really made progress on the new arm warmers. The first one is done, and she has started on the second one; they are so long they go up above her elbow. The next time she had a medical adventure they should help keep her nice and warm!

Well, that’s all for now. I’m going to carry on downstairs for awhile to see if I can get Hannah to come chase me.

Hannah: that would be a big NOPE!! CoalBear. It is bedtime for me…

Happy Caturday, everyone!

This is Mateo the CoalBear, signing off.

Notes from the Mother of Cats:

The last few weeks have seen the emergence of new symptoms: my hair is falling out, I have more edema, bruises are popping up everywhere, and I get sudden muscle cramps. Itching has become a problem, and cuts are slow to heal. Fatigue is back in a big way. I finally contacted my doctor, and she ordered some testing to make sure I wasn’t going into kidney failure.

Kidney failure!! Cue the panic sirens!!!!

Seriously, one of the things that I fear most is kidney failure. Last year, when my lung disease was so bad, letting my kidneys go to save my lungs was an actual topic of discussion; I was a hard no on that treatment option. Ironically, a low kidney function test was one of the first clues that led to my scleroderma diagnosis, but my kidneys have improved over the last couple of years to a comfortable stage 3 level of disease. Discussion of kidney failure again seemed like a huge blow, and I have been sad this week. I cast on the arm warmers during the afternoons when I’m stuck indoors on oxygen during the heat.

The message from my doctor today was reassuring. My kidney function has maintained, but I am very low on protein levels in my blood. This is kind of a scleroderma thing too, as digested food doesn’t get absorbed well through fibrotic intestinal tissue, but I’m so immunosuppressed, it might be because I can’t make antibodies. More testing is on the horizon, but I’m not losing any sleep over this. I am, however, going to be much more careful about wearing my mask!

I’m making good progress on those arm warmers… if I hurry, I can cast on another project like maybe those pressed flowers socks early next week. 🙂

Have a good Caturday!

The Scleroderma Chronicles: Thoughts on the Night of the Blue Supermoon…

Did you look at the moon tonight? It is just huge, shining in the night like it knows that it is something special. Well, it is. This is the Blue Supermoon of 2023, my friends. Not to be seen again for 14 years. Just the sight of it makes me feel happy.

This is also the anniversary of the day that I was told that I had systemic sclerosis and Sjogren’s Disease. Actually, it is 9 years and one day since I drove to my first rheumatologist appointment; I was a little emotional that morning as I passed fields of beautiful sunflowers, their faces glowing in the light of the morning sun rising behind me. You’d think that the date would be kind of a bummer, but nope. As it turns out, there are lots of things that are making me feel happy at the moment.

Do you see that black bag with my purse and cane? That is my portable oxygen concentrator!

That’s right, after languishing for 18 months on the waiting list, my name came up for the portable oxygen concentrator that I have been desperately needing. Look at that baby!!! It only weighs 5 pounds, it works great, I can adjust the level of flow on the fly, it can charge in the car, and it is exactly what I need. Yay!!! I got it yesterday on the exact 9-year anniversary of my diagnosis.

So happy, feeling absolutely empowered, I headed to the yarn store after picking up the concentrator. Time to take this baby for a spin, right? I have been struggling for months to make a decision about the yarn for the La Prairie cardigan that I want to knit next. I bought a kit of yarn to make the cardigan, but I’m not happy with it. I needed a new skein to go into the mix…

The yarn picture on the left is the original kit. The one on the right is the new variation that I’m not completely happy with. Feeling hopeful and more than a little determined, I sat on the floor in front of the most likely candidate yarns and, rocking my new O2 concentrator, holding up my phone with the yarns on the screen, I kept looking at different ideas for the fade…

Winner, winner, chicken dinner! I suddenly realized that the Stitch Together yarn (second from the top) was exactly what I was looking for. There it is. I asked others in the store what they thought, and the consensus was that I had nailed down my fade. Yay!!! Finding that yarn made me happy.

So, I also bought the special edition Babe set from Spun Right Round.

I’m going to make that Barbie pink yarn into hats for the community knitting group that I knit for because… wait for it… the color makes me happy!! I had one of the original Barbie dolls, and just the thought of Barbie makes me… happy!

On the way home from the yarn store, still sucking down oxygen in the car and feeling pretty good, I stopped at the grocery store to buy some tiramisu because I was absolutely having a tiramisu kind of day, and there at the front of the store were sunflowers. You know, it is the end of August, and it is sunflower time. Shine like a sunflower!!

Pretty good looking, huh. Sunflowers are used as a symbol of scleroderma hope in some parts of the world (Hello, Australia! Talking to you!), and you know I bought these too.

By the time I got home I was tallying up all of the things that made me happy. The leaves are starting to change on the trees in town, and the ornamental grasses are covered with rich golden plumes atop bright green stems. That makes me happy. Pumpkin spice is back at Starbucks. The kittens loved the new toys that I bought them. I ordered new clothes this week that fit great even though they are a smaller size than usual. I found new shoes to wear that are really helping a lot. Happy. I am happy.

The shoes are shaped like walking boots on the bottom, but inside there is great arch support and a cushy insole. I am walking now with much less pain. Did you notice the purple detailing and the silver loops for the laces? Happy. These are happy shoes.

Once home, I headed outside to the catio with my yarn, the tiramisu, and a cup of coffee from my new Keurig machine (yep… happy), and as I set the plate and coffee cup on the table, a pair of adult cottontail rabbits raced around the corner of the deck and zoomed under my side gate. Looks like I will be having baby bunnies again. I am happy.

Nine years ago, I asked that first rheumatologist what my life would be like in five years time. He refused to answer, and it was my first clue that I might be in some trouble here. 18 months ago, my pulmonologist told me it was okay to cry when the first lung scans showed serious interstitial lung disease. One year ago, my pulmonologist told me that they were very worried about me after my lung biopsy… nothing was working, and he wasn’t sure I’d make it. Last month, the technician who did my latest pulmonary function test told me that I was too bad to walk any longer without portable oxygen. I came home, looked at the bottles that are too heavy for me to carry, and cried.

Tonight, under the blue supermoon, with sunflowers on my table, I am happy. One month later, I have my portable oxygen. 18 months later, my lung disease appears to be stable. 9 years later, I’m still here, rolling with the punches of new complications, facing down the monster, and finding ways to shine.

I am happy.

Shine on supermoon, shine on.

The Scleroderma Chronicles: Bioethical Dilemmas and Unintended Consequences

I was a biology teacher in the time of the Human Genome Project. This week, with the coming release of the newest movie about Oppenheimer and the development of the atomic bomb, I’ve been thinking about the DNA and genes again (I know, it is a biogeek thing…), because one of the candidates running for the Republican nomination in the US wants to cut the Department of Energy if elected.

Kind of a loose chain of threads, you’re probably thinking. Am I right? Well… the Department of Energy is the agency that is responsible for the regulation of the nuclear energy industry in the US. There’s a lot of waste coming out of those nuclear reactors, and there was some concern about how much mutational damage was being done to DNA through exposure to radiation. Well, to figure that out, you need to know what undamaged DNA looks like. The initial drive to figure out what the human genome looks like came from that agency and once the results came in early this century the world completely changed. Like a big change. Like an atomic bomb level change. Like, there are now sites that have huge depositories of biotechnical data and tools to aid in research.

In the classroom we biology teachers began to teach about the Human Genome Project and also did a week-long unit around the ethical problems associated with this new knowledge (bioethics, if you will). The kids grappled with dilemmas like… if you had the gene for a fatal, untreatable illness, would you want to know? If you were a child at risk for this gene, would it be okay for your parents to have you tested for it before you are 18? If your unborn child tested positive for this condition, what would you do? Would it be okay for human organs to be grown for transplantation? Who should get the transplant… a single father of 4, or a 16-year-old student in your high school? Should your employer allow you to continue in your airline pilot job if a genetic test shows you are high risk for a sudden cardiac event. Should genetic test results be private? Whew. Lots to grapple with in this unit.

Makes your head hurt, doesn’t it. Check out my knitting progress this week!

So, shit kind of got real this week. One of the members of an online support group for pulmonary arterial hypertension (a progressive and fatal heart/lung condition that I have thanks to systemic sclerosis) has just been identified with a gene (bpmr2) that causes the condition; her PAH is caused by this gene and can be inherited; she has a different type from me, but it is still PAH. Oh, boy. This is not good at all. The life expectancy right now is up to about 7 years, but you only need one copy of the gene to be at risk for PAH… there is a 50% chance for each of her children that they inherited the gene. Only 20% of people with the gene will develop PAH, but that is still a big risk.

Should she tell her two children? she is asking in the forum. They are in their late 20s. If she does, and they get tested, should they have their own children if they have the gene? Her heart is broken, literally.

Life expectancy has greatly improved over the last few years with new medications being generated in the modern climate of expanding cellular and molecular biological information. Untreated PAH (and PH kind of gets lumped together with it according to my pulmonologist…) has a life expectancy of about 2.8 years… not good.

Rose break! By the end of the discussion thread, she was leaning towards telling the kids.

Which brings me to the next shitty bioethical item that occurred this week. One of the members of another support group caught Covid and had to go off her drugs while fighting the virus. She has been slow to recover, and still feels pretty bad, but she took a pregnancy test and restarted her medications again a few weeks ago, only to discover this week that she is actually 12 weeks pregnant. Why did she have to take a pregnancy test before restarting her drugs? Because some of the drugs used to treat PAH can cause extreme damage to a human fetus. The enrollment process is very strict, and every effort is made to keep patients from this situation.

I am in grief for this woman. The doctors think that the baby has been spared the worst of the drug toxicity, but now she is working her way through whether to abort or not, to restart her drugs, or not. To risk death to save the baby, or to abort and restart treatment. If the baby is born in good health, will she live long enough to see it enter kindergarten. If the baby is born with health problems, her medical burden is increased. She is young. This is a horrible mess, and she is already too far along to get an abortion in many states in the US. I don’t know if she has other children, or what her support structure is…

This week I heard that some states are demanding private health records to identify any out-of-state abortions or transgender care that has happened in another state. I hope that this woman lives in another country…

Then I heard that a popular hamburger joint near my home is now going to fire employees who wear a mask. Say, WHAT?! Let me tell you, any person who has a serious lung/heart condition like mine wants to wear a mask, and they are so grateful if the person at the service window is also wearing a mask. Sometimes people offer to put on a mask when they see that I am wearing one. Now that person can be fired for putting on a mask… remember the young PAH patient whose nightmare began with catching Covid? Truthfully, any random virus can cause serious damage to patients with PAH, especially if they are also immunosuppressed.

So, there are a lot of bioethical dilemmas here, and the unintended consequences of people who want to make sweeping decisions without understanding all the interlocking systems involved and the potential ramifications are staggering. NO, you can’t just disband the Department of Energy, and sweeping, inflexible decisions about reproductive issues (that seem to be smugly self-righteous to me) can be disastrous. It is easy to order up genetic tests, but what happens once you have the information can be life-altering.

And don’t get me started on this animosity towards mask wearing…

I can’t help but think that no one should attempt to enact legislation without ~~suffering through~~ experiencing something like the bioethics unit that was taught at the high school where I used to work. I keep wondering, do these legislators actually understand nuclear power and weapons? Have they heard of the Human Genome Project? About gene testing? About rare diseases? They absolutely need to go see the Oppenheimer movie, maybe, and then write me a report about the Human Genome Project. I’m pretty sure that they would struggle with epigenetics, but it would do them good if they looked into it. They can get extra credit for a summary of pulmonary arterial hypertension. I would like to give them a book list of summer reading to get through on their breaks, because only the well-informed and educated should attempt to make decisions about these issues in the seven levels of bioethical hell that is the life of patients like me.

Because this week was a really hard one; for too many people this shit is real.

PS: Have you seen the show House? I kind of think that he could use a little bioethics sensitivity training, too.

The Scleroderma Chronicles: Be a Rose.

So, I got a little testy in one of my Facebook support groups for systemic sclerosis this morning. A member of the group kind of disparaged me and another person for not being positive enough. It was “you need to refuse to let scleroderma define you” in response to the first person sadly saying that she missed her old life, and me giving her an online hug with the comment that if only a positive attitude was enough…

In my defense I had just experienced a Kaiser employee visibly reacting to my lack of wrinkles. As in, wow, that’s great! Like not having wrinkles makes this all worth it.

I lost another 4 pounds at my last check-in, which is concerning, but the nurse was thrilled for me. Me, I was a little teary at the continued loss.

Um, people… do you think that you might be a little shallow here?

I was out on the deck/catio with the cats drinking my morning latte when I hit this emotional wall, and after I had fired off the somewhat testy response, I spent some time in the garden. There were my roses, blooming like the utter champs that they are.

This is my Princess Alexandra of Kent rose.

This rose is looking great this year. Never before has the plant been able to hold up the blooms without the weight pulling the stems over. The problem is our semi-arid climate with hard winters; the plant grows back from the roots every year and it doesn’t have time to put in enough supportive tissue to hold up the blooms. This year, with all the rain and cool weather that we have had, the plant was able to put in enough of this tissue to do the job. The tissue that I’m talking about, a type of ground tissue, is called sclerenchyma. If you’re ever snapped a celery stalk in half and pulled out the strings, you were pulling out sclerenchyma tissue. This tissue is made of dry, hardened cells in the stem of the rose and I suspect that the “scler” part of the word is of the same origin as scleroderma. Look at that. The hardened cells are doing something good for this rose!

In me, not so much. Things have been a little difficult as my poor heart and lungs are not benefiting from the hardening and thickening going on in the cells and tissues of those organs. All of my tendons are seriously pissed off at the moment. Edema has become a problem, and it is becoming increasing clear that I need to stay on oxygen 24/7.

That’s my arm with the imprint of a quilt in it, in case you didn’t immediately recognize it… Edema is kind of a tip off that my heart is struggling and that’s new. The weight loss is also related to my heart/lungs because if oxygen isn’t getting down to my cells like it should, they can’t use energy efficiently, and then, you know, weight loss occurs. The tendon issue is scleroderma actively attacking them and gradually hardening them to bone. Bad scleroderma, bad!!

So, what did I say in my testy response? Reality bites. Some of us have progressed to the point where we have to admit that no amount of positive thinking will allow us to attend that family function that we were invited to, or to visit the annual Wool Market in the mountains, or to even walk to the mailbox. To suggest that we could do things if we just had a more positive attitude is hurtful and not supportive. No matter how much you want to believe otherwise, scleroderma does define me and everyone else who is dealing with it. Courage requires us to face down the monster and to accept the reality of our disease. How we choose to function within that framework is up to us.

I may no longer be as mobile as I once was, and the life that I used to have is now mostly gone, but I choose to continue to bloom in place.

Like a rose.

Updates/Notes from the ScleroFront:

Do you like to wear linen? Those fibers are from the water tubes (xylem) in the flax plant, and made of sclerenchyma.
The bunny-murdering neighbor put her house up for sale!!
My Alpine Bloom sweater is coming right along!

Thoughts while knitting to Demon Copperhead

Okay, I don’t get out much. When I have to go to a medical appointment across town it is kind of a big deal. I have to adjust my drugs and diet for a couple of days. My oxygen bottles need to be ready to go. I need to minimize my time out of the house (brain fog becomes a big problem after about 3 hours) so I use my smart phone for everything that I can: check in, payment, and navigation to the medical center. My car, named Stumpy, handles my email along the way, tells me the route, and also gives me weather reports. I love technology!!

The last time I went to my rheumatologist’s office I didn’t get into the elevator in time before it closed its door and left. Hey, there are a lot of elevators there and they don’t all go to the floor that I needed. Behind me, I heard the voice of a man who complained loudly about how impossible modern technology is, and he advised me to push the button again and to hope for the best. I pushed the button, and this time when my elevator car arrived, I had sorted things out and managed to get in the right one on time. He joined me and continued to rant about technology, and then suddenly began to vent about “needing our country back” and assured me that it would take a long time, but that we were going to “get the country back.”

Stunned, I looked at him from across the elevator car. He was an older white man in work clothes, someone who looked like he lived in a rural area. I may have backed up a little more. All I could manage to get out was that I had a different opinion from him, and immediately his manner changed, and he became polite. Yeah, right. I saw that rage you’ve got going on under your farm hat…I got out at my stop, got my little ol’ liberal butt out of there, and didn’t look back. How did that segue from frustration with technology to MAGA extremism in a heartbeat?

The incident really hit me because I was reading (well, listening to) Demon Copperhead at the time.

Demon Copperhead (by Barbara Kingsolver) seems to be a modern rendition of David Copperfield set in rural southern Appalachia (Lee County, Virginia) that has packed into it all the horrors of vulnerable populations in one neat package. It was the kind of book that is just horrifying while completely engaging you in the story. Demon is the child of a mother who dies young and is forced to enter the foster system. In placement after placement, he is mistreated and sometimes starved as he is used for labor or a source of income by his foster parents. As I read the book, I became aware of how bad things can be in an at-risk population where the job opportunities are few and far between, resources are limited, and education substandard. These communities, insular and tightly knit, cling to each other to help out and somehow survive as they are preyed upon and abused by corporations and pharmaceutical companies.

In spite of all of this, and even though Demon is betrayed again and again by the people in whose care he is placed, he survives, comes to terms with his history and the people in his life, and shines on as the author of a comic series about his people, the Appalachians. All the events and understandings of his life, the good and bad, come to life in his comic series called RedNeck, that shines a light on the people of his community.

This book is just amazing, and it really made me learn new things and start thinking about the world around me in new ways as I knitted along listening. Towards the end of the book, Demon mulls about the differences between people who live on the land, relying on each other, and the people in cities who scramble for money since money is needed for everything. From the perspective of advanced technology and more money, city people look down on land people as unsophisticated and ignorant, when in truth people should be more important than things. Conversely, it is also easy to feel intimidated and overwhelmed in unfamiliar situations; a modern high tech city (or medical center) certainly can be that to people who don’t have weekly trash pickup, sidewalks, or, yes, elevators. Suddenly I was back in the elevator in the Kaiser building, looking at a frumpy man who was furious about technology and the loss of his country.

This is me a few years ago, deep in a flare, clinging to my beloved cat, and living my best little scleroderma life. It was at about this time that my pulmonologist referred me to palliative care.

I’ve always been a fairly reflective person, but lately I’ve had more time than usual to think about things. I know people who are consumed by money and who hunger for expensive possessions. Some of these people want expensive things as status symbols, and there really isn’t enough money to make them happy. I recently ghosted someone who thought that I envied and resented their inheritance. I no longer correspond with a family member who told me that they would have more things if they hadn’t had children. My tax preparer last year exclaimed, in a shocked tone of voice, that I hadn’t made any money at all last year!

Well, yeah. After you have been referred to palliative care you just don’t worry about money anymore; I have everything that I need, and why would I want more? My prognosis has improved since then, but the lesson remained. Demon’s thoughts about the divisions between the people of the land and people who live in cities based on economies remain with me. In a way, the division between the healthy and the chronically ill is similar. The divisions between different ethnic and religious groups. The divisions between gun owners and those of us who want gun regulation. How many of these divisions are rooted in the underlying social/economic structures glimpsed in Demon Copperhead? I guess you could say that this book was life changing. I’m knitting to a new book these days, but the reflections rooted in Demon Copperhead go on.

Yesterday Demon Copperhead won the Pulitzer Prize!!

Knitting after the Cath Lab

Hey. I know that I’ve been missing for a while (again). In my last post I wrote about my upcoming trip to the cath lab to get a right heart catherization. This procedure involves having a small sensing device threaded into your heart to check (in my case) the internal blood pressure. Normal pressure in the right side of your heart should be about 14mm Hg; mine had measured 44 mm Hg in an echocardiogram so my cardiologist wanted to get a direct reading.

Here I am, rocking my scleroderma symptoms along with the cath wound. Puffy hands, bluish nose and lips, tons of little red dots on my face… That bandage came off the next day and the entry wound healed right up.

The procedure went well. My pressure measured in the low 20s, which was soooo much better than my cardiologist feared. The number was higher than the last time I had a direct measurement, so my pulmonary hypertension has advanced, especially since I am now on medication to treat my condition, but I’ll take it! It was, once again, a really positive experience and I felt well cared for by all the staff. I was pretty exhausted, hungry, but upbeat on the drive home.

Then I went into a flare… I slept for almost the entire week after the procedure. Seriously, like 12 hours a night and a couple of naps. I had to go back onto daytime oxygen. My hair started falling out again. I was dizzy and exhausted. My joints really hurt. A flare.

This week I’m finally awake again and I pulled out the blanket that I’m knitting. I knitted more hexagons and measured the blanket on the bed. I went out and bought more yarn. I have the hexagons to add another row and the blanket is slowly growing…

I think that I’m going to need more yarn… this is the Nectar Blanket by Ysolde Teague.

I’m really happy with the progress of the blanket, but I have to admit that it is becoming a little boring. I dream of other knitting projects as I sew the hexagons together. I have a serious urge to knit a new sweater in some fabulous colors.

Look at this little topper sweater!! It is called La Prairie (by Joji Locatelli) and I seriously want this sweater. I want to knit in cool colors. Did I mention that I live on the edge of the Great Plains? I long to wind yarn and to cast on and to start knitting those waves and bobbles…

I broke down and bought this kit to knit the sweater online a few weeks ago.

The trouble is, I just have to dream and fuss about colors before I am happy. I’m not sure about the order in the kit yarn. I’m not completely a fan of the middle yarn, and I feel like the lavender should be in the middle. I’ve been digging in the stash and trying to image the finished product with other blends of color…

Here are three more spins on the yarn. I like the one on the left the most, with the yarn fading from dark purple to the light grey at the sleeves and bottom of the sweater, but I’m kind of interested in the middle and right versions. I have to ask myself… which version will have the most flexibility in the wardrobe? Definitely, it would be the first spin on the kit, the version with the light grey at the sleeves.

I also desperately want to buy yarn to knit a Soldatna Crop sweater, and some new arm warmers, and then there are those PICC line covers and hats to get done… Did I mention that I have been looking at more yarn online and dreaming of sweaters with lots of colors in DK weight yarn? I’m totally on a knitting drive, but my wrists are not on board with all this needle action. It could be that I’m not completely done with the flare…

Sigh. Guess I’ll just cast on another hexagon or two…

PS I’m still dealing with shortness of breath and low on oxygen; lung testing happens next month as my doctors continue to sort me out. 🙂

The Scleroderma Chronicles: Rare Disease Day, 2023

Well, here it is again. Rare Disease Day. I kind of was going to ignore it this year because I’m quite frankly worn out by my… wait for it… rare diseases, but I also feel like I should pull myself together and represent for the community again.

People with rare diseases are referred to as Zebras in the medical community. I obtained my zebra status when I was diagnosed with systemic sclerosis in 2014. This zebra was sent to me last week by my *Most Knitworthy Niece* Melissa.

I wrote a pretty darn good post last year about my journey with a rare disease which you can read here if you want. I talked about rare diseases in general, my specific conditions, and the many things that have been said to me by my doctors over the years. I thought about just reposting what I wrote last year, but I’ve been reflecting all morning on some recent events that kind of shine a light on my situation and that of other people who are coping with rare conditions.

I recently managed to go knit with my fellow members of Frayed Knots. This was a big social outing for me because it’s hard to get out of the house, and I have to be having a really good day to go to something like this. Knitting with friends is just “normal” for most people, and it would just be a little part of their day, but for me this was something that I had to prepare for a couple of days in advance, and then recover from in bed the next day. Many rare conditions are chronic, and chronic illnesses can be very isolating by their very nature.
A woman at the knitting group questioned my decision to wear a mask. I started to explain, but she cut me off to say that I was doing it so I could feel comfortable. It was a little condescending and suggested that I was being paranoid. Truthfully, my immune system, crushed by the drugs that I am taking right now, is compromised in its ability to make antibodies. If I catch a viral disease like the flu or Covid, there is a good chance that I won’t survive. My vaccinations have a low chance of protecting me for the same reason. For people with rare diseases, life is fraught and full of difficult decisions. For me, and for many other immunocompromised individuals, simple decisions involve life/death level risk analysis.
Another woman at the knitting table was struggling with long Covid and shared her difficulties with returning to work. She especially felt crushed by the attitudes of her coworkers who seemed to feel that she was “fine” and just trying to get attention. Yep. Been there, done that. Many rare diseases are genetic or largely invisible to others. Invisible illnesses are especially hard to cope with because others tend to question their validity.
I’m in several online support groups, and there are always discussions about what drugs to take, and whether the side effects are worth the risks. Yep. There are no specific drugs for systemic sclerosis, no cure, and treatment can involve a patchwork of risky off-label drugs. The drugs that are used are often non-specific carpet-bombing like approaches. Rare diseases have fewer treatment options because there are only a limited number of patients.

Over the last year my wonderful team of physicians have been suggesting that I am really unusual and have been extremely responsive to my emails. They clear an hour for appointments with me. I’m one of the very lucky zebras who has managed to get diagnoses, secured treatment, and am benefiting from a team of collaborative, interdisciplinary physicians who actively communicate with each other and with me; just last week my rheumatologist told me that for a patient with my status this is the only way to deliver care. I’m so grateful to have secured this level of medical attention, but I also feel a little nervous about it. I spent some time this morning trying to work out the probability of one person having the several medical diagnoses that I’ve racked up since 2014. Like, just how rare am I?

The National Organization for Rare Disorders estimates that there are 100,000 patients with systemic sclerosis in the United States. That’s rare, but still, a big club, right?

The 15% Rule is a general measurement of the risk of severe organ involvement in systemic sclerosis. As it turns out, quite a few of the major lung, heart, and kidney complications associated with systemic sclerosis happen about 15% of the time. I have Sjogren’s Disease overlap with my systemic sclerosis, which happens in about 13% of patients. Suddenly, I’m in a much smaller group of about 13,000 patients.

My most worrisome complicating conditions are diastolic dysfunction (a type of heart failure), pulmonary arterial hypertension (PAH) and interstitial lung disease (SSc-ILD). I looked up the risk of having each of these conditions using the 15% rule data, and it turns out the risks are 16% (diastolic dysfunction), 15% (PAH) and 35% for the SSc-ILD. Did you notice the the ILD doesn’t fit the 15% rule? Yep. It’s much more common and is the leading cause of death in systemic sclerosis patients. I found that risk factor here.

I brushed up on my probability math (you multiply the probabilities of independent events…), and after running the numbers:

100,000(13/100 x 16/100 x 15/100 x 35/100)

I came to a grand total of 116 other patients in the US who share my set of diagnosed conditions.

Oh.

See, I have lots and lots of stripes. Stripes in purple, teal, periwinkle, red, green, and blue: these are the awareness colors for my conditions.

I just ordered that rainbow zebra unicorn shirt! I plan to wear it with my mask on my next social outing…

You can learn more about Rare Disease Day or my conditions at the links below.

The Scleroderma Chronicles: So, there was this flare…

Wow. It has been some time since I last posted. Ironically, the last post was about the Mother of Cats being broken. I felt really good, and I was casting on a plethora of projects and was all over the place with my knitting, reading, projects, you name it. Hannah was complaining in that post that I was broken, and that I wasn’t devoting myself to making her a blanket.

Then scleroderma lowered the boom on me. I went into a flare of epic proportions. I hurt all over, I struggled to do just simple tasks, I started sleeping 10-12 hours a day, and I had to go back onto daytime oxygen. I kept heat packs on my sore joints, but I really needed a total body heat pack to cope with what was going on: every single tendon in my body was under attack!! I couldn’t regulate my body temperature and took multiple naps a day because I was too cold to stay awake. I developed chest pain. My brain fog became so bad I wasn’t safe to drive anymore… Yep. Broken.

Okay, I also accidently drank some Miracle Gro fertilizer that I had stored in a Snapple bottle. That is some serious brain fog, people!! (Yes, I did have to call poison control, I did eat burnt toast and I did drink a lot of water, and I don’t want to talk about this anymore…) Yep. Broken.

I managed to get some knitting done in spite of my ill-behaved health. I got some wristers made as Christmas presents and sewed zippered pouches for my sister and cousin.

Wristers and a zippered project pouch.

Sewing was a riot as I had to get the sewing room organized so I didn’t have to stand up very much as I cut, sewed, and pressed fabric to make the bags, but with some creative thinking and furniture arrangements I pulled it off.

I also finished my Emma sweater. I made a hat. I made some socks. I made some slippers. Everything was on big needles and used heavy weight yarn as I got too tired to knit more than a few minutes at a time.

This sweater was knit using the CocoKnits method and I learned some new methods of shaping and finishing. The yarn was chunky weight and is warm and comfy. I got it done early in the flare and it was just perfect for the days to come. The yarn that was left over was used to make a hat and a pair of slippers.

I did read some nice books, but mostly I slept and waited this miserable thing out. In the weeks while I was mostly bedbound my orchids started to grew stems for future blossoms, the first snows arrived, and my son moved in with his cats.

This is handsome Jonesy. Hannah does not like Jonesy, so there is now a chicken wire barricade at the top of the stairs to keep the two groups of cats separated. My son also has a long-haired tuxedo cat who just doesn’t care about my cats. Hannah, however, has a complete meltdown if Jonesy comes near her, so… barricade.

Mateo: I love Jonesy and I go through the barricade every day to rough house with my new best bud while Hannah hangs out with the Mother of Cats. Jonesy is the wild playmate of my dreams!

So, I think that I am out of the flare now as the multiple naps a day have stopped, and my appetite is back. Yesterday we made lasagna for Christmas and here is the present that I got from my son:

Perfect, right?

Can you see my blue lips? The bad news is that the Blue-Lipped Zebra is back in full force. I finally emailed my cardiologist to let him know that I am once again panting for air and feeling light-headed from doing simple tasks like… lifting a pan out of the cupboard or grating cheese. Ugh. I’m pretty sure that I am heading back into the cath lab for another look at my pulmonary pressures, but right now I am glad to be back on my feet and out of the flare. My son is still here (he works from home, so he just moved his operation over to my house) and things are going well in the combined household.

Hannah: as long as Jonesy stays on his side of the barricade!! Also, maybe the Mother of Cats will now settle down and get my new blanket done!!

The Scleroderma Chronicles: Chasing down the Cytokines

There was more response than I expected from my last post about my efforts to obtain a better understanding about my chronic conditions, the new drugs I was taking, and how to lower my inflammation. I offered in that post to share the links that I used to figure out what foods impact the levels of cytokines that are important in my systemic sclerosis. I’ve gotten feedback/requests for the spreadsheet with my links that I used in my adventures at PubMed.

I’ve been thinking about this for a couple of days, and I think that the most useful thing to do would be to share my process as I hunted down information about cytokines involved in my systemic sclerosis (SSc), and the cytokines that I needed to pay attention to in my diet.

I started out asking: What are the cytokines involved in systemic sclerosis? I did searches using terms like cytokines and systemic sclerosis. Here are some of the links to papers that I found.

I kept a list of the cytokines that were being measured in these studies and I finally began to get a sense of the four big players that were being measured and considered as targets for therapy: Tumor Necrosis Factor alpha (TNFα), Interferon gamma (IFN-γ), Interleukin-6 (IL-6), and Interleukin-1beta (IL-1β). You can follow the same process to research any inflammatory disease that you are interested in; you may get different results. (For example, C-Reactive Protein, called CRP for short, features in many inflammatory conditions. For little SSc me, not so much… my levels are normal.) Anyway, once I had the cytokines of interest, I did searches on all 4 of them. Here’s my info on TNF-α.

Information	Source
TNF-α is also a potent inflammatory mediator and apoptosis inducer	The role of Tumor Necrosis Factor-alpha (TNF-α) in the pathogenesis of systemic lupus erythematosus
Produced by activated immune cells (macrophages, NK cells, T-cells) known to trigger a series of various inflammatory molecules, including other cytokines and chemokines	The Role of Tumor Necrosis Factor Alpha (TNF-α) in Autoimmune Disease and Current TNF-α Inhibitors in Therapeutics
TNF-α causes other immune response cells to produce IL-1 and IL-6	Tumor necrosis factor – Wikipedia

My question: What does TNF-α do?

I did the same for the other three cytokines and it turns out that for me, it is best to reduce all of them in my blood. At this point I made a little chart with the 4 cytokines at the top and began to do searches on different foods that I thought were anti-inflammatory.

Food	TNFα	IFN-γ	IL-6	IL-1β
Chile (Capsaicin)
Tart Cherry
Tomatoes (Lycopene)

Question: Which foods/supplements will decrease these cytokines levels

Now the searching gets easy. I just typed in the questions in the search bar like, “Does capsaicin reduce TNFα” or maybe “Does capsaicin reduce cytokines” and the answer would quickly pop up with some resources. Warning: the search engine will give you the pertinent text and then you are on your own as you search through these papers! If you just go with the fast answers, you will take some risks… I told my sister that tomatoes were bad because I didn’t read the whole text, and I’m not sure if she has forgiven me yet…

Anyway, here are some papers about the foods/supplements above:

If I found a source that said one of the cytokines was reduced by one of my targeted foods, I just put an “X” in that box and moved on. I was no longer recording all of the links in my excitement, and as I found info it sometimes confirmed previous finds, but not always. If I got contradictory information, I was forced to read whole papers. Ugh. Also, you might want to try a different search engine; I used Chrome on my phone and Explorer on the computer, which is another reason for incomplete links on the computer. For the three foods in the table above it ended looking like this.

Food	TNFα	IFN-γ	IL-6	IL-1β
Chile (Capsaicin)	x		x
Tart Cherry	x			x
Tomatoes (Lycopene)	x	x		x

Question: Which foods/supplements will decrease these cytokines levels

I hope this unpacks the process that I used and helps with any searches that you decide to do that are specific to your own needs/interests.

Happy Caturday!!

The Scleroderma Chronicles: Song of the Cell, Dance of the Cytokines

I’m reading a really wonderful book right now that is really speaking to me on so many levels.

This man is a BioGeek of the first order! He interweaves his experiences, patients, memories, and the history of cells together in a way that makes me green with envy. He unpacks the history of our understanding of cells by bringing those scientists to life in a way that makes me care about them; if only I could write that well. He is the teacher that I wish I had been as he reveals to us how cells work together to create complex human systems, and then ties all of that to the treatment of disease. I’m still in the first parts of the book, but I have already filled my kindle with highlights and notes.

This book was published at the exact right moment when I needed it. I have totally gone down the rabbit hole at PubMed over the last two weeks as I have read paper after paper while chasing down the major players in my chronic conditions (why am I sick, and what exactly are these new meds doing…) and how they link to inflammation. Why would anyone do something like this?

Well, it all comes down to this. I’m on high-risk drugs with some serious side effectss, and I want to make informed decisions about whether I continue taking them. I also had a run-in with elderberry juice, and was rescued by green chile; as a BioGeek I was sucked down the curiosity rabbit hole after that whole adventure. What? That doesn’t happen to you? Listen, it has been so bad I haven’t even been knitting!!!

These are the two drugs that I’m trying to understand. In his book Siddhartha Mukherjee argues that our understanding of cells, and how they work, has transformed medicine into the modern miracle that I am currently benefiting from. Drugs that directly interact with the molecular machinery of cells, the signals between them and the biochemical pathways that cells use to function, are the first of the major transformative directions modern medicine is taking in the treatment of so many pathologies such as cancer, diabetes, neurological, and autoimmune diseases such as mine.

Systemic sclerosis is really darn complicated, as it turns out, and the sequence of events that have been happening in my body are so convoluted it’s hard to track them all. It started in the cells lining my blood vessels. As those cells got injured, they sent out signals that activated parts of my immune system. Signals from the immune cells caused other cells to transform and they began to produce scar tissue… scleroderma means “hard skin”, the hallmark of my condition. Whew. Here’s a condensed version of all that if you want to torture yourself and/or fall asleep.

Let’s go back to my meds. Ambrisentan blocks a molecule that is involved in making blood vessels constrict and raises blood pressure when it is active. That molecule, endothelin, is getting turned off by the drug, and there is evidence that this will improve my exercise-induced pulmonary hypertension and will also keep it from progressing; it plays nice with my other pulmonary hypertension drug which shuts down an enzyme pathway involved in blood pressure. Ofev is my new (fairy dust) drug, and it disables some of the essential enzymes in the cells of my lungs that are involved in creating scar tissue. Interstitial lung disease is currently the leading cause of death for systemic sclerosis patients; mine is being treated by side railing the process in the cells that are essential players in the pathology.

Yay! Molecular trickery at the cellular level saves the day! I will be staying on these meds as long as I can.

Dancing to the tune of the song of immune system cells are cytokines, the messenger molecules that travel between immune system cells and other cells that they interact with. The dance is complex, with all the different messengers traveling through the blood to target cells in the body, latching on and causing the cells to take actions. Some cytokines increase inflammation, and other will shut it down. Your immune system can get dialed up or shut down, depending on what the messages are. In my travels through research papers at PubMed I focused first on what cytokines were involved in systemic sclerosis, and then I hunted for papers that had measured the levels of these cytokines when people ate different foods.

Foods that you consume can make a big difference, evidently. Elderberry made me much worse (I cried in two different doctor’s offices), and green chile saved the day. I was done doing google searches for “anti-inflammatory foods” and was going after hard data.

.What did you expect? I’m a BioGeek. OF COURSE I made a spreadsheet with the data!

Tumor Necrosis Factor alpha (TNFα) is a big driver in the whole systemic sclerosis story along with Interferon gamma (IFN-γ). They cause an increase in two more cytokines that promote inflammation, Interleukin-6 (IL-6) and Interleukin-1 beta (IL-1β). All four of these bad boys will make my inflammation worse and (probably… I’m guessing here) encourage my conditions to progress. A lot of these foods/supplements will lower the levels of these cytokines, which explains why I feel better when I eat them. ELDERBERRY increases three of these cytokines which is why I felt like death warmed over while drinking it. Google said it was anti-inflammatory… can you see why I switched to research papers and cytokines? Green chile stew has tomatoes and green chile in it (and some yummy pork and garlic!); no wonder it turned things around. I will try to eat as many of the “good” foods as I can, but I’m going to focus on ones that really shut down TNFα and IL-6. I’m ignoring the IL-10 and CRP info because it wasn’t really as well supported as the others, and I know that my CRP (C-Reactive Protein) levels are normal.

My lunch smoothie: tart cherries, raspberries, banana, spinach, yogurt, chia seed (gag) and cranberry juice. For dinner I’m having a green chile cheesy corn pudding thing that tastes pretty darn good.

Wow. Did you read all of that stuff above? You deserve a prize for perseverance.

Here’s your prize. It’s like a “Where’s Waldo” picture, but this one is Where’s Hannah!

So, there is all is. Inside my systemic sclerosis, pulmonary hypertension, interstitial lung disease self, there are all these dancing cytokines, following the song of cells. Scientists who were captured by all of this and who were entranced by the Song of the Cell have developed the drugs that are treating the two life-threatening complications of systemic sclerosis that have come my way. Inside me, the promise of the song goes on.

Time to get back to my book.

Notes:

Okay, I made a whole other spreadsheet with links to all of the research papers that I used to get some understanding about these cytokines, and which were important in my disease. You don’t want to see all of that, right? If you do, say so in a comment and I’ll send some links your way!
I became curious about what is happening with Covid patients and the cytokine storm that can cause severe symptoms. Yep. It’s happening because of TNFα, IFN-γ, and IL-6. If you catch Covid, I don’t recommend elderberry.
Clinical trials are currently underway to see if an IL-6 inhibitor will be an effective treatment for systemic sclerosis.
I’m a lucky, lucky girl. I have a degree in molecular biology, used to work in an immunology lab that focused on IL-1, was involved in a scleroderma research project, and finished up my lab days on a project looking at the impact of capsaicin on rheumatoid arthritis. I can almost understand what I’m reading on PubMed. Almost.