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I Don’t Have Enough Blood

At my surgery pre-admission appointment a couple of weeks back I received an overwhelming amount of information. One of the most significant things I learned is that my hemoglobin level is low, which is why the doctor who saw me at the end of the marathon appointment advised me to eat as much red meat as possible every day leading up to surgery. Because of my low blood level I had to meet with the Blood Conservation Team on Tuesday afternoon. At the hospital where I’m receiving treatment, this group is also called Patient Blood Management, but the nurse assigned to manage my case didn’t just manage me. She was incredibly supportive and educated me extensively about what she would do to help me increase blood levels to prevent the chance I might have to have a blood transfusion during surgery; and the associated risks attached to that help.

My nurse’s name is Anna. Her support started last week when she called me after my pre-admission appointment to assess my overall health and schedule my blood management appointment. She explained that the primary concern about my hemoglobin level is that since I had bloodwork completed in February my blood level has dropped by more than ten points from 126 g/L down to 111 g/L. The normal hemoglobin level for adult women is from 120 g/L to 160 g/L. According to Anna, the one positive is that because I have been taking iron supplements since becoming ill I have iron stores to build on – just not fast enough before I have surgery. We also discussed my high blood pressure that I now have because of my pain, and which she sees as another point of concern. Anna became very sympathetic when I explained the full circumstances of my illness and how it has decreased my quality of life over the past two years. After discussing the rest of my medical history, she explained what she felt was the best solution for me.

So how do they increase your hemoglobin level within weeks, or in my case a week, of having surgery? First, they change your iron supplement to one that is more easily absorbed. In my case, the iron supplement I started taking just over a week ago is FeraMAX. It is specially coated so it “allows the iron to pass through the stomach relatively intact where it is absorbed through the small intestine and is then delivered to the bloodstream.” Simply put, I’m getting bigger doses of iron now, and I hope this higher dose will make a difference. The second part of the treatment is to get an injection of a drug called EPREX, which I received during my appointment with Anna on Tuesday. The active ingredient in Eprex is “epoetin alfa, a protein that stimulates bone marrow to produce more red blood cells.” The dose I received came in a prefilled syringe that Anna injected into my upper left arm. I have a bit of a needle phobia, which means I squeezed my eyes shut as she uncapped the syringe and found the right spot for injection on my arm. Anna warned me that the Eprex solution is very thick, which translated means it hurts like hell when it’s plunged into your arm.

As beneficial as that single, $500, dose of Eprex should be Anna did educate me about the potential side effects. The least complicated side effect is feeling like you might have the flu within a day or two of receiving the injection. I’m happy to report that I did not experience a fever or feeling achy all over my body from a painful shot in my arm. Moving down the list – or would that be up because of severity? – would have been a severe allergic reaction to any or all the ingredients in Eprex. I’m also happy to report that I have not had a rash and/or itching at the injection site, nor did I go into any phase of anaphylactic shock immediately after. Last but not least: blood clots. This side effect is one that might take a little longer to detect. It will depend on how much my hemoglobin level increases, which may affect the thickening of my blood. The one thing that might offset this is that during surgery next week I will receive blood thinners, which I assume is the primary reason having a low hemoglobin level beforehand is so problematic.

So, will I have more blood in me by next Tuesday? According to Anna, they usually see the best result seven days after a single dose of Eprex. Fingers crossed that this will be true for me. Otherwise, when I’m done with all of this surgery business, they will have to get to work on figuring out why I don’t have enough blood.

 

Foreigner – Hot Blooded

Gratitude and Creativity: Does Silence Celebrate

My muse keeps inspiring me. who is bert in his 100th silent share asked the question: does silence celebrate at all? That question woke me up yesterday morning and took me on a poetic walk. Thanks again Bert.

Does Silence Celebrate

 

 

Simon and Garfunkel – The Sound of Silence

Sudden Rainstorms and Laughter

I had forgotten how good it feels to get caught in the rain – until yesterday. My friend M, who is one of my oldest and dearest friends, sent me a text yesterday afternoon asking if I wanted to hang out. I asked when. He said whenever I could be ready. I told him I needed an hour to take a shower. Then we were on. Just as things used to happen before I was ill. After taking my shower, I was in my closet searching for something to wear and it struck me that I own a lot of clothes that I never wear anymore. It’s as if I allow my illness to dictate my wardrobe. In some respects, it does because wearing a belt or something with a tight waistband is extremely uncomfortable, but aside from that, I can wear anything. So yesterday, I picked out a summer dress I’d bought but never worn. It wasn’t shapeless or loose like the clothes I’ve become accustomed to wearing; and it felt good to put it on.

When M came to get me, he was impressed with my effort. I got in the car and we started to drive with nothing in mind but getting something good to eat. Then it became something good to eat that we could get to take-out and eat by the lake. We decided on burgers and landed at a burger joint where the owner added character, a history lesson, and laughter to our ordering experience. Once we had our massive burgers, fries with homemade gravy and drinks to go, we headed toward the water. We went to a familiar place that we’d been to before on hot summer days. When we got there, M opened the trunk of his car and pulled out two folding chairs he bought on his way to pick me up, which is such a typically impromptu thing for him to do. In the past, it might have been running into a department store to buy shorts because the pants he wore to work that day would hinder his enjoyment of the warmth of a patio somewhere that was our destination to sit, have drinks, laugh, and talk about whatever came to mind.

His preparedness made me smile. We started walking across the sand to find a spot to plant our chairs and dig into the food we earlier watched being made on a grill and was now sending wonderful aromas floating out of the bag. We settled on a spot close to the water’s edge where we could watch kite surfers and kayakers moved across the water by the wind and the waves. M set up my chair and made sure I was comfortable – going as far as draping his jacket over my bare legs to keep them warm. Then we each bit into the best hamburgers we’d ever tasted. The meat of the burger – that’s right I’m eating meat as ordered by my doctors – was so tender and juicy it required little chewing, and the gravy for the fries added another layer of delicious.

We were sitting for a short time when we noticed a line of dark clouds moving steadily over the line of trees behind us. We knew that a storm would hit soon, but we may have underestimated its arrival time. After snapping a few shots of the clouds with my phone, the wind picked up and started to whip the sand. M decided it was time for us to start moving back to the car. While I finished my burger, he began packing up the remaining food from our meal and our chairs. When I swallowed my last bite of burger, he told me to head for the car. By that point, the wind was fiercely stirring the sand and we had to shield our faces as we pushed our way in the direction of the car. Steps away from our target the skies opened and released big, heavy drops of rain that soaked us as soon as they made contact with our bodies.

Rainstorms & Laughter
Rainstorms & Laughter
Rainstorms & Laughter

We started laughing as M got me safely inside the car then worked frantically to get everything else into the trunk. We were laughing because this was one more incident to add to the long list of antics we’ve collected over the span of our thirty plus years of friendship – a nice day at the beach ending with a sandstorm and torrential rains. While I sat drying in the car, I could see M through the rear window struggling to shield himself with his golf umbrella while he tried to get what he needed in and out of the trunk. Finally, he made his way to the driver’s side of the car and as he got into his seat, the wind nearly ripped the green and white umbrella out of his hands. This only made us laugh more. We sat out the rainstorm in the car and watched lightning flash across the grey sky through the moon roof, as drops of rain pooled on the glass.

When the rain finally stopped, we went for a short walk. There was a point along the shore that M wanted to show me. From that vantage point, it’s possible to see the entire skyline of our city, and it was beautifully framed by breaking clouds that allowed a golden glow of setting sunlight to shine through. It was the perfect end to a day spent with one of my favourite people.

 

Eddie Rabbitt – I Love A Rainy Night