Shelley Ensz

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Everything posted by Shelley Ensz

  1. Quiltfairy, as you can tell we are all fascinated by the idea of a peer support person, so please let us know what they are, what they are supposed to do and how we can all get one.
  2. Hi Quiltfairy, First of all, I'm very sorry that you are feeling upset, and I hope that you can somehow mentally make your peace with this soon. I'm glad you turned to us, to help you think things over. Secondly, I've never heard of a peer support person before. I don't know what they are, how you get one, or what they are supposed to do. To me, "peer" usually means someone in pretty much the same boat; someone in a similar situation. But she sounds pretty healthy. So where does the "peer" come in, and in what way is she supposed to be helping you? Probably the closest you're going to come to "peer support" is right here in the forums, and even then, most of us are going to misfire and say things wrong while trying to offer support and a comforting shoulder. I would expect that a trained professional though (if indeed this is what she is) should probably usually have a little bit more wisdom or training when it comes to something like this. I think she was trying to be empathetic. It doesn't sound like she was intending to be mean or hurtful to you. If she was purposefully saying mean things intending to make you feel bad, then I would definitely recommend that you report her. And, of course, I don't know what her role is, her training, how you came about getting her/their services, etc. As you probably know, I've experienced a lot of losses of immediate family members in the past few years. I found that my hurt and grief made me more sensitive than usual. Many people made sincere efforts to comfort me with using some of the most insensitive references, or at least, they seemed insensitive to me. At first I was reeling by what some people said. Then I realized I had to quickly get my footing with it, because likely such sort of comments were going to continue, maybe for years. What I did was I adopted a slogan, "Listen to the music, not the words." I tried to get in touch with the underlying emotion people were trying to express, such as sympathy, empathy, love, or just letting me know they cared. Nobody was trying to be mean or hurtful or upsetting to me; it was just me interpreting it that way. I could have just as easily tuned out their words, listened to the music of their intention to care, felt comforted by that thought, and stayed on my healing path. I must say, even some "trained professionals" like doctors and nurses and social workers said some things that I didn't like. And oh the poor innocent people caught in my path when worse came to worse! One poor nurse, caught in the tsnunami of my grief, exclaimed, "Oh, you must be strong!". I shut her up on that score, probably preventing her from ever ordering any other suddenly grief stricken person to be "strong", by saying, "NO! My goal is not to be strong -- it is to be flexible and resilient!" I really surprised myself, as I seldom have the right words at the right time. I always think of them the next day, or the next week if I mull it over long enough. So I'm very impressed that you had the presence of mind to confront her. I'm pretty sure she saw the error of her ways by the time you were done with her! However, I still rather doubt she'll change unless she is given specific training and practice in how to respond differently, simply because she's human, too, and we all tend to shoot from the hip when we don't have a good script to follow. You're "right" in that, you have every "right" to be upset by anything that anyone ever says or does. But being "right" doesn't always mean there are necessary actions or retribution to make. I tend to think you've already settled the score. But, I may be wrong, I often am, and so I'm very eager to hear what you and others have to say on the subject. Still and all, likely there will be a zillion times in your life when you can keep your spirits intact, and not let others get you down, by listening to the music, not the words. And especially, if I've said anything wrong in this explanation, or any others anywhere on the forums ever, I hope that others listen to my music -- I care! -- and not my words, especially if the music is more soothing.
  3. Hi Miocean, I'm very sorry to hear you are in the hospital. :sick2: I hope you improve enough to get home soon! I'm sending some extra flowers your way! :flowers: But in the meantime, please remember to haul out your camera and take lots of photos for your ISN Medical Photos collection. We can never have too many pictures of yucky hospital equipment! I actually get frustrated when they are taking blood and I can't figure out how to shoot one-handed, and I'm pretty sure we're kindred sisters when it comes to artistic and photographic opportunities! :emoticons-yes: More seriously, that's fantastic that you advocated for keeping your private room. That was smart and sensible and downright necessary. Good going!!
  4. Hi Miocean, Thank you for the update on your pulmonary visit. What I couldn't really tell from your last post is whether or not you were entirely happy with the results of that visit? I know you had high hopes for it, and I often find myself crushed after getting up my hopes, for nearly anything. Did you feel satisfied with the care, and explanations? I absolutely agree that many changes (both good and bad) occur that don't show up on tests, either right away, or ever. I've even had times where I've been feeling and functioning a lot better than usual, but my test results look the same or even worse. That makes it really hard to weigh my perceptions against reality, although if I'm feeling better, it's a very hard sale for anyone to convince me I'm actually worse, and perhaps vice versa, too. :emoticons-group-hug:
  5. Hi Ronald, I'm sorry you had an episode of shortness of breath. I hope you get some more answers soon. Please keep in mind that I'm not a doctor, and have no medical training at all. It's my understanding that rescue inhalers can work near-miracles for the most common causes of shortness of breath (dyspnea), such as most lung problems including asthma, allergies, COPD, and inflammation. However, they won't resolve an episode of shortness of breath if it is caused by other things, such as a pneumothorax (collapsed lung), or issues outside of the lungs such as pulmonary hypertension, heart failure or heart attack, Since so far you've had an isolated event, and it was perhaps mostly inspired by the infection or a clogging of the airways due to phlegm, you might only need the inhaler temporarily. You might want to consider some self-monitoring while things are getting sorted out. They recommend that all people with systemic scleroderma take their own blood pressure daily, to detect and alert for the initial signs of sudden kidney failure or other complications. Simply taking and charting your blood pressure and pulse once a day would establish your baselines (if you aren't already doing this.) Then, since you have lung concerns now, you might really like to have a little device for measuring your oxygen saturation. An oximeter is just a tiny (and rather inexpensive) device you clip onto your finger whenever you want. Normal sats for entirely healthy people are probably about 96 to 100%. Your lung doctor can advise you as to what they consider a reasonable cut-off point for you, but the general guideline for oxygen supplementation to be covered by insurance companies is that sats regularly fall below 88%, on testing in the doctor's office, either at rest or with a medically supervised six-minute walk. Those technical details aside, you can buy a pulse oximeter online, or at a drug store. They are often used by athletes. The peace of mind they can deliver for someone with lung problems is amazing! You can know whether or not you are over-exerting, or if your shortness of breath is caused by an actual lack of oxygen -- or something else. Tracking readings once a day for years can establish a pattern, and you can know very quickly whether you are improving or worsening with medication or exercise. It's something to consider, at least, if you don't already have and use one. :emoticons-group-hug:
  6. Hi Pinkism, Welcome to Sclero Forums! I'm very glad you've found us, and I hope you stick around. As you know, Atrophoderma of Pasisni and Pierini is a very rare disease, and we don't have very much information on it yet. We serve people with scleroderma and related diseases, like yours. We are sort of one big rare disease family around here. I'd most especially like to encourage you to post symptom photos in our Sclero Forums Gallery. Please label them well, so people know what it is, and let us know about it in this thread. It really will help raise awareness, and let others know they are not alone, as well. :emoticons-group-hug:
  7. Hello Maz, Welcome to Sclero Forums. I'm glad you found us, but sorry that your husband is so severely ill. Our forums are for everyone in the world who are affected by scleroderma and related illnesses or symptoms, including spouses, caregivers, friends, family, and surviving loved ones. You'll notice that we grapple with the entire range of issues here, from mild or even frivolous to downright serious end-of-life issues. So you've absolutely come to the right place for support. I'm so very sorry for your predicament. My heart goes out to you. I'm sending some extra hugs your way. :emoticons-group-hug:
  8. Hi Quiltfairy, I'm delighted to hear that you are recovering well from your neck surgery! I'm very sorry about your mom. Sometimes old age itself can seem very scleroderma-like, as health issues multiply. It's pretty rare for scleroderma to run in families, but it does happen. For more info on that, see Genetics and Scleroderma. We also have some info on Diabetes. Now I'll have to go take a peek at your photos! :emoticons-group-hug:
  9. Hi Mystique, Did you happen to also see our Dutch pages? Scleroderma patients without significant joint pain (which is common) frequently encounter rheumatologists who focus primarily on joint pain. Although scleroderma falls in the family of arthritis diseases like lupus and rheumatoid arthritis, and can occur in overlap with them, because scleroderma is so rare, the typical rheumatologist may only see one case in their entire career. It's likely that their comprehensive training on it in medical school included perhaps five minutes on scleroderma, if they were lucky. The major exception is rheumatologists who were fortunate enough to train at a medical school which also has a scleroderma center. Although they may not "specialize" in scleroderma themselves, they are typically an improved patient resource. In really remote areas, or when travel to a scleroderma center is simply impossible, the best bets are the closest largest medical university, or a rheumatologist who happened to study at a major scleroderma center. Luckily, with the internet and online listings of doctor medical histories, it is certainly challenging but usually not impossible to find the best scleroderma resource in any particular state or country, even if they aren't an actual listed expert. But the safest bet is to go to a listed scleroderma specialist, whenever possible. Be aware that *many* rheumatologists will list scleroderma as a specialty on their web pages, even if they don't have a whit of experience in it. This is because many web pages are automatically generated, and scleroderma is considered to be a form of arthritis, so web software (or webmasters) merrily toss that in. So, if they list it, you have to really dig to see if they actually studied at a scleroderma center, whether they are a part of any scleroderma clinical trials organizations, and whether any major scleroderma organization lists them as an expert. Well now I've written a whole thesis on the topic of finding an expert, haven't I? I'm sure it will help you a little bit, but I'm also hopeful it will help others who stumble on this thread, down the road. Hie thee to an expert, Mystique. Then you can rest assured that if you do have scleroderma, or early scleroderma, you can be properly monitored, treated (if necessary), and diagnosed (whenever it is appropriate). :emoticons-group-hug:
  10. Hi Ronald, I'm very sorry you've found out that your lung problems are due to scleroderma. Unfortunately it's normal to encounter more challenges at the ten or twenty year mark, with or without treatment of any sort. It sounds like at least you are not guilty of taking too many medications. Therefore, you probably haven't worn out your liver or kidneys yet, which would mean you'll be in much better shape to undertake any necessary treatment now. Please keep us posted on how your tests are going. I know its a slog and a waiting game. I'm thinking of you and sending good thoughts your way. :emoticons-group-hug:
  11. Hi Mystique, Since many ANA's are false-positive, it is a good idea to really focus on the symptoms instead. Hashimoto's, Raynaud's, and numb hands and feet might be the sickest you ever get, or they might be the harbinger of another autoimmune illness. It's customary in this situation to get baseline testing and then to be monitored for awhile. I've heard of many people in similar situations monitored for even ten to twenty years and then, finally and mercifully, getting the "all clear". As I understand it, with a few symptoms of connective tissue disease and a positive ANA, your odds are about 50% that no other diagnosable autoimmune disease will ever develop. But, that 50% is a lot higher risk than that of a normal, healthy person. Further complicating your situation is that Hashimoto's (and Sjogren's) seem to be the key conditions that tend to set the stage for future autoimmune developments. Its not a certainty, more like just an increased inclination. (See Polyautoimmunity) This leaves you in a delicate position. You might not ever be any sicker, so try to keep your head on straight that your future is definitely not all doom-and-gloom, but by the same token it would be an excellent idea to dutifully continue with your follow-ups until you are given the all-clear. The only thing I would change is that if I were you, and if I were not already doing so, is that I would see if I could be screened and followed by a listed scleroderma expert, because odds are very high that your local rheumatologist is not adept or deeply experienced when it comes to scleroderma. Scleroderma is a very difficult disease to diagnose, and doctors who are not extremely experienced in it can easily miss important clues. Furthermore, they can treat the illness either too aggressively or with way too little, way too late. Therefore, I would sleep a little better at night, knowing you have seen an expert. I know its maybe a huge fuss about nothing, there's at least a 50% chance of that, and certainly, from what you've mentioned so far, it doesn't sound like you are in danger of getting diagnosed with anything (more than you already have), just yet and maybe not ever! But still, it's good to be on the safe side of things, don't you think? Read more at Scleroderma Diagnosis. Or, just sit tight with your local doctors but if additional symptoms develop, then hie thee to an expert. But do put a listed expert on your radar, as it can take months to get in to see them for the first time and for most people it entails a trip out of state since real scleroderma experts are so very few and far between. :emoticons-group-hug:
  12. Dear NorthStarHope, I am so terribly sorry for your loss. My heart goes out to you. Please always remember that we care, and we are always here for you. :emoticons-i-care:
  13. Hi Kathy, I'm just following up to see, is your eye all better now, I hope? :emoticons-group-hug:
  14. I just modified our Mainstream Scientific guideline to read, "To avoid malicious codes, we only allow links that are from and within our www.sclero.org website or from any of the Top Notch medical sites listed on our Googling for a Diagnosis page." The prior version (from 2009) read, "To avoid malicious codes, we only allow links that are from and within our www.sclero.org website" but in reality, we do allow safe links to high quality, recent information on top quality mainstream medical web sites, namely, the ones listed on our Googling for a Diagnosis page. Our general rule of thumb is that we like to stick to medical abstracts that were published within the past three years, whenever possible, and especially when it comes to medications. For some rare or obtuse topics, we realize that just isn't feasible. Thank you for helping us make and keep Sclero Forums a thriving and responsible resource for people, all around the world!
  15. Hi Jet, Welcome to Sclero Forums! I agree with Amanda and Jo entirely, as I am always prone to do. :D This is an issue to discuss with your medical experts. As Amanda pointed out, there really are times when exercise is contra-indicated (although I know it sounds like heresy!). Exercise can increase inflammation in systemic scleroderma, and that may be what you are encountering. It might also be that you just jumped in too fast and did too much too soon! Often our doctors will put us on a graded exercise program under the guidance of a physical therapist. Lacking that, they should give you some clear guidance on how to proceed. Generally when I'm starting from scratch again to build endurance, I need to begin with just gentle moseys for less than five minutes a day, and then increase from there gradually, as I can tolerate it. So you can imagine, I was very impressed with how far you must have gone on your bike ride, even going a few miles would be a huge achievement for me. One thing that happens when we are sick is that we try to use the same yardsticks as back when we were entirely healthy, and thus are continually perplexed as to why we can't do more. It's important to reset our yardstick and our expectations, so that we are beginning again from scratch and building from there as we can tolerate things. Otherwise, we are likely to send inflammation out of control and set our progress back. It's still often possible for us to improve our endurance, but it is very important for us to seek medical advice before we dive into exercise, especially with conditions such as scleroderma and GVHD, etc. See this (older) abstract, Exercise in systemic sclerosis intensifies systemic inflammation and oxidative stress on PubMed. Please keep in touch and let us know how things are going for you. :emoticons-group-hug:
  16. Ronald, how did your chest x-ray turn out? I'm thinking of you and sending good thoughts your way. :emoticons-group-hug:
  17. Dear Northstarhope, I'm terribly sorry to hear of the loss of your dear sweet husband. I can't even imagine the shock this must be for you and your family! My thoughts and sympathy are with you. Please remember that we are here for you, always. In deepest sympathy.
  18. Thank you, Jo, for noticing we didn't even have that vital main directory page, and for making one for us. You rock! :emoticons-yes: :emoticons-line-dance:
  19. Hi Ron, I'm sorry that you have additional health concerns about cancer. As it happens, crackling in the lungs is very common with scleroderma lung involvement (pulmonary fibrosis) and even pneumonia. When it comes to noises, it is my understanding that crackles is more likely to be pulmonary fibrosis, and wheezing is more likely to be caused by hayfever, asthma, COPD (etc) and at worst (and less commonly) lung cancer. That said, you are correct, there is an increased risk of cancer in systemic scleroderma; and family history is always concerning. Please keep us posted on your results. :emoticons-group-hug:
  20. Hi Esme, Welcome to Sclero Forums! I'm sorry you have health concerns right now and send my best wishes to you. Sometimes antibodies are helpful and sometimes they are only temporary or a lab error. Therefore for autoimmune-type diseases, it is usually most helpful to focus just on significant, visible or measurable symptoms. Maybe the antibodies will help explain the muscle issues you are having, and maybe they won't. Your rheumatologist will need to balance your entire medical history and current symptoms against the bloodwork. Often when tests are repeated the abnormal results simply evaporate so try not to get your hopes up that they will provide a solid answer of some sort for you. Please bear in mind that I'm not a doctor and I have no medical training at all, and verify everything I say with a reliable medical source. I know its very hard to discern from online research what constitutes scleroderma skin involvement, and what doesn't so most of us have only a hazy or murky idea of what to be looking for. As it happens, rough spots or calluses on the feet are not a symptom of scleroderma skin involvement. Systemic scleroderma doesn't occur in just little patches, and it doesn't cause rough skin either. It is typically colorless and affects areas (rather than patches). Such as, it might begin as the fingers or toes swelling up and looking like sausages; this phase can last weeks, months or years. Then the swelling might go down and the skin hardens, becoming entirely hard, tethered to the underlying tissues, and unpinchable. It actually becomes smoother, usually hairless, the wrinkles lessen and may even disappear. You are correct in that Raynaud's causes color changes, and having cold feet is not the same as having Raynaud's; poor circulation is far more common and nothing to worry about from a purely scleroderma perspective, although of course, you do want to keep warm, regardless. So, if I were you, those two items I'd take off my radar, at least for this week. Although all of us do it from time to time, we really don't need to go looking for trouble on the net, as one thing about trouble is it will always find us when it is ready! The internet is both good and bad in that it can clue us in, even save our lives if used properly, and it can also freak us out unnecessarily. Unfortunately it is almost totally impossible to draw the line in the right spot without our own specialist medical degree. And much of it is due to hazy things we read, such as "tight skin" and "cold feet", which I know isn't the least bit helpful in the real world when we have health issues and worrisome antibodies to boot! But if I were you, I'd leave the muscle stuff and capillaries on the table. The capillaries are nice and visible and provable! Your muscles were obviously the problem in the first place. And either there is a nefarious cause for them of some sort, in which case the antibody might be helpful, or there isn't. It's possible to have scleroderma, and many other illnesses, without getting the whole nine yards of symptoms, especially at first. The flip side is its also possible to have even many things wrong that are not caused by a worsening or systemic illness. You and your doctors have your work cut out, figuring where you fall on the spectrum of health to illness. Please let us know how things go at your appointment next week. :emoticons-group-hug:
  21. Hi Debbie, I am really glad you joined us. I was just thinking, treatments can certainly help your morphea and probably even stop it from spreading, too. But I am hoping at the same time that you already have, or are developing, a plan to cope with the emotional fall out over it. It's entirely normal for us to isolate ourselves and become depressed over any illness, and all the more likely when the illness affects our looks or our activities. However, just because it happens, and its a natural course, doesn't mean it has to stay that way! It's possible and even necessary to have morphea -- even on your face -- and still be happy and with a fulfilling and broad social circle. Many people even with the harshest form of en coup de sabre -- and other figure-altering conditions, such as survivors of fire or amputations -- have established great careers, married, had children, etc. The thing is, it's neither easy nor natural to do so. It typically involves counseling, medications, lifestyle changes, support networks, and the simple sheer daring to believe that what we want is possible. You've made the perfect first step by joining Sclero Forums, and starting to seek out an expert and some appropriate medical care. I'd like to suggest that you don't stop there! You are entitled to a happy, exciting, and fulfilling life, chock full of all the happiness your heart can contain. You can be an inspiring example to others with morphea, and a living embodiment of "when life hands you lemons, make lemonade!" If you aren't yet fully addressing the issues of isolation and depression (or anyone who is reading this is in a similar bind), then I encourage you to set an appointment with your primary care doctor, right away, to get an evaluation, referral, or care plan. There's not just a light at the end of the tunnel for you -- there is also fun, laughter, friendship, love, and adventure! The world and its many joys are not made only for the Perfect People. In fact, I daresay, us imperfect ones often find much more true joy and satisfaction in life, probably because it doesn't just fall in our laps. We have to really dig for it, which makes it all the more precious, and all the more real. And we'll happily be here for you, all along the way, as you now begin healing your skin, and your heart, and your life. No more regrets. You're in a safe place now, and we'll all just move forward from here, okay? :emoticons-group-hug:
  22. Hi Andee, How are you holding up while waiting? I know it's impossible to follow advice such as "don't even think of scleroderma for the next few weeks" as then it's all we can think about. However this would be a great time to try to focus your thoughts on nearly anything else, as much as possible. Such as devote yourself to an existing hobby or find a new one and see how much you can learn about it in the next few weeks. I'm aware that doesn't work 24 hours a day, but the fine art of distraction is a powerful force for helping us cope with uncertainty and change. I try to put one "happy" thing on my calendar every single day, and then when my mind goes looking for trouble, I try to gently steer it towards all the fun that I have to look forward to. It doesn't have to be much, or even very fancy; they key for me is just defining it and putting it on the calendar. It can be as simple as "take a photo of a flower on Friday"...something, anything that is positive. I know this tip might sound very lame, and it may not be useful for you at all, but it might strike a chord with someone else reading this who is stuck in circumstances similar to yours, and it might be the idea they need to be able to cope better while they are waiting for answers. The thing is, with scleroderma and many other chronic illnesses, the sheer mind-numbing waiting is a chronic condition itself. It never goes away! We are always waiting for the next appointment, the next test, the next batch of results, the next symptom; and while focusing on all those nexts, we can so very quickly and easily lose sight of our life, and our enjoyment of it, today. It's very possible, and even very necessary, to continue to enjoy life -- and even increase our enjoyment of it -- even when our health is threatened or declining. But it does not come naturally! It requires awareness of the threat to our sanguinity and determination to carry our heavy load as though it is light as a feather; taking it seriously but not letting ourselves become serious, all at the same time. Well now, where did I get off on this tangent? I just want to let you know, we all know how very challenging it is to even vaguely wonder about having scleroderma. And most of us would say the very worst time of all for us was when we were left up in the air, just wondering, especially if we had not yet thoroughly developed our stress coping skills! :emoticons-group-hug:
  23. Hi Debbie, Welcome to Sclero Forums! I'm sorry you have Morphea. The good news is that morphea is perhaps the most treatable form of scleroderma. As I'm sure you know (but just for newbies with morphea who stumble across this thread), many people with morphea just have one or two rather inconspicuous patches, that don't worsen or spread significantly, and that it often fades on its own within three to five years, even without any treatment. However, then there are people who have more significant involvement. Perhaps it is just a patch or two, but in very visible places, just as the face. In children, patches sometimes occur over a joint and if the patch goes deep, it can even impair the growth of a limb. Therefore, treatments for morphea range from nothing at all, particularly for those with the small few and well obscured sort of patches, to moderate treatment to slow down expanding or visible patches, and then more aggressive treatments such as for children with a patch threatening to impair a limb. All treatments for morphea are best when used to avert further damage, so the earlier a scleroderma expert is sought out, the better. Today, for most types of morphea, UVA1 Phototherapy is generally considered to be the first line treatment. This is very much like a sun tanning booth. Treatments are just a few seconds (really) and are done several times a week for a few months. It's entirely painless plus it's done to the whole body so you get a delightful suntan as a pleasant side effect. The thing is, it is often quite a chore to find the (few) dermatology offices that have UVA1 booths. But, when you do find them, often their dermatologists have some experience with treating morphea. Keep in mind if/when you are calling places about this that UVB treatments are not the same as UVA1, and really try to find the UVA1 facilities. Since you have facial involvement, you really want to consult closely about that. Sometimes the UVA1 can darken the spots. If your face one is stable (not currently expanding) then you may want to use a face shield for your treatments. Read more about your treatment options at Morphea Treatments, and please let us know how things go for you as you are tracking down an expert or phototherapy place, etc. We hope to hear lots more from you! :emoticons-group-hug:
  24. Hi Miocean, That's a really good question regarding abnormal mammograms and PAPs. As it happens, about 40% of mammograms show up with some sort of abnormal result, and due to this I figure at least 4 out of 10 of my mammograms will have some sort of issue. I am seldom disappointed by this expectation, as fibrocystic changes often drives them around the bend, and I am always having to reassure my new primary care doctor that such-and-such on a manual exam is perfectly normal for me and nothing to panic about. Since, as Jo so aptly pointed out, there is an increased risk of cancer with systemic sclerosis, we can't take anything for granted, even though we also need to take everything with a grain of salt in order to keep our heads on straight, as we have to deal with so many more tests -- and test results -- than the average person. I do wish I had a dollar for every woman I encountered in the imaging waiting areas, who were panic stricken and often in tears over needing to have their mammogram retaken or who needed further testing. It seems the clinics I've been to don't bother to explain that is a NORMAL part of the process and that very few abnormalities are truly abnormal and cancerous, in the end. Us folks with chronic illness are used to the drill, and accustomed to all sorts of false alarms, so we tend to develop a lot more coping skills. But my goodness, even the slightest issue can, understandably, throw a perfectly healthy person having a routine exam into a total tailspin. So yes, most of us should have experienced some abnormal test results, and then on top of that, there would be more abnormal test results that are eventually determined to be more significant, among scleroderma patients, although this would also remain as just a small sliver of those who flunked the initial screenings. :emoticons-group-hug: