Bloodletting

I had no idea that was one word until I typed it out on here.  Bloodletting.  That’s the next thing for me.  Over the past several weeks my liver numbers have been creeping up and at one point spiked up fairly significantly.  At first we thought it might be graft vs host disease.  A little is good.  Too much is bad.  Riding that line is hard.  While we ran some tests, they loaded me up on prednisone.  I have mixed feelings about prednisone.  On one hand, man, I can get things done.  On the other hand, it makes me feel weird and I can’t sleep at all.  Now granted my dosage is a little high.  They started me out on 90mgs per day.  

I had no idea what 90mgs was.  It wasn’t until I was talking to the triage nurse when I got the sense that it was high.  They always ask if any of my medications have changed and I responded by saying that they had added prednisone.  Her reaction said it all.  Her response was bordering between impressed and astonished.  This is a lady that sees 50% of the patients.  Her coworker sees the other 50%.  And they mix and match.  So I might not see the same one every time.  So they in effect will likely see everybody at some point.  My meaning is that they’ve seen patients on prednisone.  And my dosage was high to them.  I feel like that’s saying something.  

So anyway, beyond prednisone.  The steroid did nothing to my liver numbers.  They went up anyway.  They doubled my actigall, which is a medication used to help protect the liver.  After about a week it started to slightly come down.  

In the meantime, we’ve done a liver biopsy (and wow, that was a trip!) as well as a full abdomen ultrasound.  The ultrasound was mainly looking at the liver but just as easy to do the whole thing. 

Quick side note about the liver biopsy:

With most of those usual operations, I’ve been loaded up on so much general anesthesia that either I pass out or don’t remember anything.  I vividly recall the liver biopsy.  I talked to the folks through most of it.  

So to get a liver biopsy, they used an ultrasound machine to guide the needle in through my belly to get the tissue samples.  I’m on my back in the hospital bed.  The ultrasound screen is set up to my left and the doctor is on the other side, on my right side.  I have my right arm up over my head to give them clear access to the top and side of my abdominal area.  A few little lidocaine pokes and the area is numbed up.  I’m relatively calm under the influence of fentanyl and something else I don’t remember.  So I’m just chatting up.  I don’t remember the conversation but I do remember the procedure.  

I’m watching the ultrasound machine and I watch as they guide the needle into my side.  He’s talking me through what he’s doing the whole time which is pretty cool.  They use a 17gauge needle as a base.  They then insert an 18g needle into that to take the samples.  They take four samples from various regions of the liver.  I can feel each clamp as they snip part of the liver.  There’s this “clamping” sound.  It comes from within the body and it’s really weird.  It reverberates in your head and you feel it in your belly.  It’s such an odd sound and feeling.  No pain.  Just this snipping happening inside of the body.  If I hadn’t been doped up I’m pretty sure I would have been pretty unnerved.  

By this time I’m feeling pretty spunky so I actually take a quick peek at the needle still sticking out of my belly.  So weird!  There’s just this random needle hanging out.  It’s not connected to anything.  Just a long needle buried into my side.  

By this point he was finished and they removed the needle, bandaged me up, and wheeled me back out to recovery.  Nothing really more special to say.  They just had to monitor the site for about an hour or so to make sure that there was no excess bleeding.  It all went off without a hitch.  Pretty routine stuff but still, I can’t say it enough, so weird to actually be coherent for most of it.  

Getting back on track.  Bloodletting.  So all the reports came back without signs of GvHD.  The other report on my liver was my ferritin levels.  For those that remember the atomic symbol for iron is Fe.  Ferritin is the iron level in my liver.  My levels are fifteen times what they’re supposed to be.  So yeah, that’s the next guess as to what’s making my liver angry.  All the blood transfusions over the past year and a half have poured iron into my system.  Well, men don’t have a way of getting rid of excess iron.  Women have their periods, which can help.  Men, well, we have to be bled.  

So they’re sending me to the phlebotomists this week.  I think they said that they were going to take about 250ccs of blood to start and then process it from there.  I’d have labs done the following week and they would make the determination as to whether I’d get monthly or twice monthly blood withdrawals.  

Bloodletting is the better alternative to iron chelation therapy that would involve some serious GI discomfort.  I’m okay with them draining blood if I don’t have to sit all day, or several days, on the toilet.  All part of the fun.