### Patient: Doctor, I have been experiencing skin tightening and thickening of my fingers for the past few months, along with difficulty in swallowing and breathing. 
### Doctor: It seems like you might be suffering from Scleroderma. To confirm the diagnosis, we would need to perform a complete physical skin exam, along with a biopsy of the affected skin. In addition, an excision of any skin lesions might be needed, along with wound care management. We will also need to evaluate and consult with you about any other diagnostic procedures that might be required, such as a pelvis exam, to ensure the disease has not progressed to your internal organs.