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.
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.
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.
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.
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.