Anemia

Volkswagens for the Compleat Idiot

Years ago, I owned a variety of Volkswagen Beetles. With the help of John Muir’s revolutionary book, How to Keep Your Volkswagen Alive, I rebuilt and maintained several of the anemic air-cooled engines. I also learned to embrace the author’s most important advice: preventive maintenance.

As children came along, I settled down with a career and a house. I drove other vehicles, which I turned over to real mechanics. However, I continued to apply Muir’s principles to my own well-being. For 30 years, in spite of excellent health, I scheduled annual physical exams with our family physician. Occasionally, because I never had a problem, I wondered if these checkups were not a waste of both the doctor’s and my time.

Along the way, I also became a blood donor. Every 56 days, I would visit the Red Cross mobile collection station when it arrived in our small town of Hood River, OR. I enjoyed the chance to help others. Additionally, donating served the purpose of a mini-physical. I was, in a figurative sense, changing my oil and checking my valve clearances, much as I did with my old VWs.

A sign of spring

In order to donate blood, one’s hematocrit must be 39% or more. Hematocrit is the proportion of the blood that consists of red cells. Fluctuation in the RBC count commonly occurs in women. Men tend to have stable numbers.

I was 59 years old the first time the Red Cross denied me the opportunity to donate. My hematocrit measured 34%. I assumed this was just an anomaly. At the next blood drive, things were back to normal. Ironically, my annual physical occurred at just this moment.  However, my regular doctor was unavailable. His replacement didn’t order blood work. Therefore, my low-grade anemia went undetected. Then, over the course of the next 18 months, as often as not, the Red Cross turned me away.

The tilled area will soon be full of wildflowers

Obviously, I was not firing on all cylinders. Yet, anemia is characterized by a lassitude that blurs one’s sense of well-being. The antennae that should alert me to something being awry, received fuzzy, apathetic signals. Even when other physical problems appeared, procrastination and denial prevailed. I rationalized intermittent heart palpitations as a sign of aging. I convinced myself that the shortness of breath experienced when climbing stairs resulted from poor fitness, surely not illness. Mostly, I wanted to nap. And, with cat-like regularity, I did just that.

Finally, at my next physical exam, which was delayed due to indifference on my part, one routine blood test pointed to the problem. Several other more complex labs led to a definitive diagnosis of multiple myeloma: cancer of the plasma cells in the bone marrow. A hematologist/oncologist staged the disease. Together, we planned a course of action. Over the course of the next nine months, I underwent a regimen of oral chemotherapy, followed by a stem cell transplant. From all that, I’ve enjoyed a sustained remission of 19 months duration.

Feather Reed Grass

Anemia is actually a sign of a disease process rather than a disease itself. Red blood cells live about 100 days so the body is constantly working to replace them. In adults, RBC production occurs in the bone marrow. My hematocrit was low because the cancerous plasma cells were crowding out other healthy cells in that environment.

Normally, a person has 5% or less plasma cells in the marrow. My first bone marrow biopsy revealed 26%. Many patients with myeloma present with percentages above 50%, indicating advanced disease. The imbalance in my blood, though chronic, suggested early detection. For reasons I don’t yet understand, my MM is a less aggressive variety.

Spanky, looking for a mouse

The anemia that alerted me to my illness has not entirely disappeared. The key indicators of hematocrit, RBCs, and hemoglobin still linger outside the normal range, but they are much improved. Though they provide secondary evidence of the myeloma, I don’t intend to treat the condition. Instead, I watch my diet and get plenty of exercise. Since multiple myeloma is an incurable cancer, I’ll likely need treatment in the future. For now, I intend to remain drug free for as long as possible.

Just this week, I visited my primary care physician for the annual physical. As usual, I felt as if I were boring this busy man. He recommended blood tests to check my cholesterol and PSA. Then, he referred me to a surgeon for a colonoscopy evaluation. Otherwise, I am like a finely tuned VW Bug: old, quaint and underpowered.

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8 responses to “Anemia

  1. Another lovely and informative post, John, hereafter also known as VW Bug ;-)…I love your photos, so peaceful and calming…above all, though, I love the photos of Spanky.

    Keep taking good care of your valves…your fan in Florence!

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  2. Way back in 1972 Richard and I bought a new yellow VW beetle which we kept until we had 3 kids/car seats. When I got my MSN in 2000 I treated myself to a silver New Beetle which I replaced with a silver New Beetle convertible in 2004. Love all of those cars!

    Glad to hear all is well with you.

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  3. My family emigrated to the US in 1973 and the first thing my father did (when he earned some money) was buy a golden VW Bug. Both my sister and I learned to drive on that old car.

    On a different note, I find your writing very honest and moving. And I completely understand that willingness to look away and not face the obvious.

    I was diagnosed with breast cancer in 2004. When I look back now, there were all kinds of signs, but I refused to heed them. I was too busy with my family, with my life, and I didn’t want to acknowledge that something was wrong.

    It’s a very human behavior to act like an ostrich.

    My very best to you,
    Liliana

    http://graciouslivingdaybyday.com/2010/04/06/six-month-checkup/

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  4. Like you, I too became a blood donor along the way. And because my iron levels took so long to recover after giving whole blood, I now faithfully donate platelets the second Saturday of each month. I’ve always viewed the simple health check before the donation as somewhat of an early warning system, supplementing annual physicals and cardiology visits.

    Being a platelet donor seemed like an easy way to do some good. You get to lay down and relax for an hour or two, the staff is always fun to talk to and there’s always juice and cookies when finished. But my commitment to being a donor increased when my wife Anita was diagnosed with multiple myeloma in June 2008. I quickly learned that most mm patients need platelet transfusions at some point during the course of their treatments. For Anita, that wasn’t until this past February. Sadly, Anita lost her battle with mm in eary March. My commitment to donating platelets is now even stronger.

    Anita loved your writing John and I believe she may have reached out to you along the way to say so. Your mm insights are always informative and your upbeat approach to life is inspiring in light of the challenges you and your family have faced. And of course, the photographs and beautiful descriptions of the natural wonderland you live in are fantastic (makes a Jersey guy consider moving northwest).

    Thanks for sharing and be well.

    Don

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  5. Thank you for a lovely post which I enjoyed as usual, loving the part about your VW’s and being the owner of two way back in the seventies it really took me back. to those times. My first little turquoise love was super and served me well and then later upgrading to a 1303s which I believe was a 1500 engine, racing green and with nicely chrome trimmed wheels and a few dashing extra’s it held a very special place in my heart.. Thinking about VW Beetles now I could quite fancy one again, such great little cars in every way.
    Quick change of subject., I simply love your photos and particulary like the look of the tilled land ready for the wildflowers, how beautiful it all looks., we live in a rural area in the centre of farmland so I understand how much work is involved. Thank you for the kind comments left on my blog. I continue to send positive thoughts your way for continued well being and add you in my daily prayers, keep well John .

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  6. “The key indicators of hematocrit, RBCs, and hemoglobin still linger outside the normal range, but they are much improved. Though they provide secondary evidence of the myeloma, I don’t intend to treat the condition. ”

    Ideally, one would begin preemptive treatment in sufficient time to avoid, say, a broken bone, surgery, radiation, and pins and rods. Too often a catastrophe signals the beginning of a new phase of chemotherapy.

    The routine blood tests and marrow biopsy don’t seem to help in this as much as we need them to. I had hoped the Ct-PET would show activity before we are surprised with severe damage, but quite often it won’t.

    So, in the end, the basic rule is often violated with multiple myeloma: treat the patient, not the lab tests. Myeloma remains occult.

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