Friday, July 6, 2018

"A" Is for Anemia: Malady of the Month

Ain't modern medicine grand! So today I could go on a 13-hour fast to get my fasting bloodwork done, wait an hour for my turn to have my arm stuck and bleed, then hasten to Southern Pancake House to stoke up on perfect eggs, link sausage, and pancakes to prevent my blood sugar from dropping through the floor (and me with it).

Later in the afternoon, I could sign on to my Patient Portal and -- voila! -- all my bloodwork numbers magically appear. Service faster than the blood draw. Now, with this information, I am armed to make my own diagnosis.

It isn't difficult. Hemoglobin and hematocrit (H&H) are clearly trending downward. Big drops the last three  draws. Anemia. I've been on that spiral before.

About six years ago, a previous doctor was so alarmed by my H&H slide (which is indicative of anemia, a shortage of red blood cells to transport adequate oxygen to the body's cells) that he referred me to a regional cancer center. I had to check in every few months to have blood drawn and be examined by a stern-looking cancer specialist -- a hematologist. Each visit my hemoglobin numbers dropped a bit more, and each time the cancer doc would darkly inform me that if they tumbled much more, he would have to give me a very unpleasant test. What he had in mind was a bone marrow biopsy, wherein they insert a long needle squarely into the pelvic bone to remove marrow for a look-see under a microscope.

Obviously he had me pegged as a candidate for the big "L" -- leukemia. What I didn't tell him is that I am no stranger to leukemia, my wife and I having lost our precious first-born child, Katrina, to an acute form of this insidious bone-marrow cancer 48 years ago. An extraordinarily active toddler, "Trina Bird" would go flying around the house and yard; however, whenever she bumped into anything, she would bruise. We had a wonderful doctor from the Medical College of Virginia who made the difficult diagnosis and gave her and her young parents compassionate care.

It went fast. She played hard when she got back home, we all went to bed, and the next morning I found that Trina had left us during her sleep in her crib. If the nasty leukemia that took our baby ever returns for me, I will not be terrorized. I will fight it hard. I have lived a good life, 76 years. Beautiful Katrina was only 15 months old. Damned leukemia! (But thank goodness many advances have been made to save a great many people, many of them children, since those days).

Anyway, before the cancer center doctor had a chance to pull out that long needle and use it on me a few years ago, I decided to play Doctor Google. I learned from Internet searches of medical documents that sometimes long-term use of the blood-pressure-drug Lisinopril (an ACE inhibitor) can make hemoglobin decline in the elderly. I suggested that to the doctors -- even wrote them a long letter with medical references -- and instead of being wowed, they no doubt decided just to humor me. But guess what: Soon after dropping Lisinopril, my hemoglobin numbers climbed steadily -- a whole gram in a year. The cancer doc seemed stunned and maybe a tad disappointed; he interrogated me as to whether I had taken any substance to fool with the numbers. No I hadn't. We had subtracted a medicine, added nothing.

Well, actually, they did substitute a different blood-pressure med, Losartan (an ACE receptor blocker), which I have been on since. Now, playing Doctor Google again tonight in hopes of heading off a return assignment to the cancer center, I have found (from the Cleveland Clinic) that extended use of Losartan also can cause declines in hemoglobin. So I am hopeful another switch-out to a different med might put H&H on the upswing again. Maybe it would, maybe it wouldn't -- but why not try? I see my doctor this week. I don't know what reception my research will receive, but I will present it.

If not just a medicinal side-effect, the causes and types of anemia are multifarious. According to the Mayo Clinic, they include: iron deficiency anemia, vitamin deficiency anemia, anemia of chronic disease, aplastic anemia, anemias associated with bone marrow disease (the aforementioned leukemia), hemolytic anemia, and sickle cell anemia. A few are common and can be treated fairly simply: iron supplements, B-12 shots. Some not so much.

Why do I ramble on? Because when I started this blog, I intended it to be a chronicle of the joys and challenges of senior living. I hope some people may find help, and perhaps some can help me. God bless us one and all.

                                                    © Robert Gray Holland  (2018)

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