Thursday, August 28, 2008

Iron Pyrites in a World Based on the Gold Standard.

The trouble with having a disease like hemochromatosis is that no one takes you seriously. Who has ever heard of it? "Hemochromawhatzit?" is the usual reaction. How many intense victims of iron over-loading are featured in prime time broadcasts? "Yes, Katie, things are looking grim here at the Beeblebrox household. Big Z just got the news from 'Doc Holliday' that he has the Big H." But when Wolf Blitzer and company discover that the malady isn't Hepatitis D or even hemoroids, the house lights go down and the camera crews all slink off into the night, except for the CNN colonoscopy crew. While it is true that terrible ancillary diseases can be contracted as a result of hemochromatosis, the inevitable response at such a development would be "So, your iron-caked liver and pancreas could have been avoided, eh? Boy what a non-story this is!"

Another aspect of the non-importance of the disease is the nature of its cure or treatment. There is the four to six months of phlebotomies which might have an appeal to the viewing public save for the fact that we have far more exciting blood-lettings on the five o'clock news. If I were to say, "Hey, the 14-gauge needle is no picnic, boys!" The reply would have to be "Poor baby" which, of course, implies that I only have neonatal hemochromatosis. Nothing here but patronizing of the first water.

In addition, it is clear that not much research has been done in discovering a cure for this genetic malady. I have in my salmon folder articles from the "Iron Disorders Institute", the "Iron Overload Diseases Association", "Life Extension" , a bunch of other stuff from "", Northwestern University, the US Department of Health and Human Services, Adult Health Advisor 2008, "", plus all of the detritus that I have obtained from "Doc Holliday". Most of this material looks just like my blog except for the humor and the rather dubious taste in music. What is interesting about all of this is that none of the parties in the business have reached a consensus with any of the others, except by plagiarism. Most of the statistical information that I have provided the readers of my blog has come from the U.S. Department of Health and Human Services and "" My motive for doing so was that I thought that I actually understood what they were saying. For example: in speaking of liver complications, the USDHHS simply states that iron-overloading will cause cirrhosis of the liver which will seriously effect the ability of the liver to help with digestion and the removal of toxins from the body. That seems to be fairly clear, so clear in fact that I could easily compare it to a failing sewer system. The "Iron Disorders Institute", however, lists the complications thusly

Signs in the symptomatic patient by system:
Liver/Spleen/Gastrointestinal ---
Cutaneous stigmata of chronic liver disease
Portal hypertensions
Esophageal varices

Now there is no fun in this, even though I understand every third word. So my statistics come from sources who can actually communicate in the English language instead of Pig-Latin and Fraternity Greek. That may be an iffy sort of approach, but I couldn't tell a joke to Socrates to save my life.

The heart of the matter is that there is no money in doing research, finding a cure, or even making the treatment protocol more appealing. Who is going to give a $50,000,000.00 grant to someone to invent a 14-gauge needle that doesn't hurt going in? In a country boasting 250,000,000 souls, only 1.5 million have the gene mutation for hemochromatosis according to the U.S Centers for Disease Control and Prevention. How many of them even know that they have the affliction? To the American Medical Association we are iron pyrites, Fool's Gold. We look like we ought to be cash cows, but we aren't. So where can you go to get a little respect for iron pyrite over-load? Maybe Jamaica.

Wednesday, August 27, 2008

The Mother Lode

How does one come to have a vein of iron ore a mile wide running through one's body? Well, as it turns out, there are a number of ways. Secondary hemochromatosis is caused by anemia or alcoholism. I, however, do not suffer from either one of these inasmuch as I have no trouble finding healthy things to eat, like maple bars. Macy's has scads of them. Inasmuch as the last time I had any alcohol it was in conjunction with a box of vanilla wafers, alcoholism does not lend itself to my personal diagnosis. Juvenile hemochromatosis would only have application to me if it were a personality disease. Neonatal hemochromatosis doesn't seem to have immediate application either, unless one considers my emotional state at having to go the Infusion Center for another withdrawal. What I have is called primary hemochromatosis or hereditary hemochromatosis.

For those of you who have a stake in the gene pool, hereditary hemochromatosis is caused by the mutations of HFE, specifically C282Y and H63D. Don't ask me what this stuff means; the medical profession is numbering things like this so you cannot figure it out on your own. It is almost as if they were afraid for you to find out that in order to cure yourself of C282Y all you would have to do is smear Peter Pan peanut butter all over your left arm pit. So, instead of calling it the "gene that can be fixed with Peter Pan peanut butter", they call it C282Y. Would you be surprised to know that in their coffee clutches this gene is really known as 3PB? I certainly would not. Only five out of a thousand people, or about .5% have the double gene that makes a person susceptible to the genetic disease. It has confined itself primarily to those of English, French, Swedish, and Portuguese extraction. I personally have the English (the Earl of Clarendon) and the French (Charlemagne). Trillium is a French-Canadian/Swede on her father's side. As far as we know we have no Portuguese influence except for our son who went to Brazil for two years.

Now could I have acquired this disorder by way of osmosis from Trillium or David? That is about as likely as having picked it up as a result of living near the Hull-Rust-Mahoning Open Pit Iron Mine in Hibbing, Minnesota, for three years. No, I got this mother lode from the Mother Lode and, of course, from the Father Lode as well. Hereditary hemochromatosis can only be acquired if both the mother and the father have one of the mutated genes. One out of 200 people in the world have at least one; they are the carriers. From what we can tell, my Mother may very well have had hemochromatosis without knowing it. It is unlikely, however, that her doctor ever tested her for it.

I have stated before that iron is in just about everything. It is as ubiquitous as dirt. No matter what we eat, there is bound to be some iron in it, except for maple bars which have absolutely no iron whatsoever. That's my story and I'm sticking to it. I may never grill another tri-tip steak again, but the last thing that will be pried from my cold, dead fingers will be a fresh maple bar from Macy's bakery. Healthy people absorb about 10 percent of the iron they ingest. People like me have a tendency to absorb 30 percent of the iron they eat. Over time, we hemochromatosis types absorb and retain 5 to 20 times more iron than we need. This is stored in some rather interesting places, including the heart, the liver, the brain, and the pancreas.

I have written about the effects caused by excess iron on these organs before. The function of the liver is to help digest food and rid the body of toxins and waste products. Having excess iron there scars the liver (cirrhosis) and the end effect is like having your sewer lines back up into the house. Other than producing the "clanking" sound in the heart instead of the gentle "thump", excess iron can also cause arrhythmia, irregular heart beat (something like "clankity-clank-clank-clunkity-ping"). Excess iron in the pancreas may cause a decrease in insulin production, in turn causing your blood sugar to rise, in turn inducing diabetes, which if left unchecked will cause the cold, dead fingers from which your next of kin will be prying a fresh maple bar. Iron over-loading in the brain causes "iron-hammers" disease which causes you to forget everything you ever knew because of the extreme, ringing headaches. The brain, in an attempt to rid itself of the iron, shoves it all down to the left shoulder into a huge subcutaneous pouch. One can easily tell if the brain has been affected because the patient runs around, holding his head, and shouting, "The Bells!!! The Bells!!!" This is found more frequently to be part of the French syndrome of symptoms. Excess iron also can cause early menopause and erectile dysfunction (and if you think that I am going anywhere near those two, think again). I have mentioned arthritis before and "bronzing". There are other side effects as well, but these should suffice.

Now, finally. When I have died, will my fossilized remains be toxic to the ground water? Not if you bury me in Hibbing, Minnesota. In fact, I might just be contributing to the US economy. Since 2005, after 30 years of dormancy, the iron mining industry has enjoyed a resurgence. Plant me right next to Robert Allen Zimmerman, native son of the Mesabi Iron Range. It is clear that Bob Dylan not only ate as much dirt as he could find in Hibbing, all the iron went straight to his throat.

Sunday, August 24, 2008

The 12,000 Iron Ingot Diet

Now that Michael Phelps and the Olympics are finally over, we can get back to the really important stuff like, "So when am I going to die?" I am reminded of an event that took place several months ago when a member of my ward had an episode that prostrated him on the floor of the bathroom. I arrived shortly after the paramedics did and we gave the fellow a blessing. The frantic wife, after the blessing, asked me imploringly, "Is my husband going to die?" I said "Yes..... But probably not today." Trillium found this piece of unveiled humor particularly macabre and thought that I ought to avoid it in the future. I have been moderately successful, but I am having some difficulty pulling it off on this blog.

As I have indicated before, the treatment, if not the cure, for hemochromatosis is phlebotomies, or "blood-letting". The recommendation is to take a pint or two for several weeks until the ferritin level drops to almost the "anemic" level, and then draw a pint about once a quarter thereafter. As the body regenerates the new blood, it looks around for stored iron in order to make the blood capable of carrying the oxygen to all the tissue in the body. Iron binds with oxygen and releases the oxygen once it arrives at the proper locations. Without iron, the oxygen could not be carried about easily. Iron-overloading, as it turns out, does little to provide more oxygen. Getting back to my point; it is the creation of new blood that requires more iron. The more blood that is drawn, the more the body has to draw on those stored iron molecules. After a while, most of the stored iron is extracted and tissues like the kidneys, the liver, and the pancreas return to normal. So, the patient has the blood drawn, drinks vast amounts of fluids (preferably not Mountain Dew, Chris), and then waits upon nature to deliver him from the normal effects of hemochromatosis. Typically, the drawing of a pint of blood reduces the ferritin level by 40 or 50 points. Inasmuch as my ferritin level was (perhaps is) at 827, I would need to have about 16 pints of blood drawn. This works out to about four months of treatment by following the recommended technique. Some physicians recommend two pints a week; at that rate I would be at a normal ferritin level in about eight weeks. There are obviously far more radical treatments possible, but the chances of survival begin to wane considerably.

In conjunction with phlebotomies, the standard treatment also encourages improved eating habits. Red meat is discouraged, wiping out such delicacies as rack of beef ribs, tri-tip steak, any $6.00 burger, anything from the Sizzler menu, liver, beef tongue, kidney pie, blood sausage, menudo, chicken feet, flank of horse, seal flippers, and any more than six ounces of whale blubber at a time. In the spirit of the appropriate diet for my condition, I decided to exclude the last nine items from my repasts.

Oddly enough, taking over-the-counter vitamin C tablets is discouraged, the reason being that vitamin C facilitates the absorption of non-heme iron. Thus, if I were to consume the "Green Drink" with 2000 or 3000 units of vitamin C (which I have done on occasion), it would be tantamount to injecting 20 ounces of bacon fat into my jugular vein. So, as a result, my morning ritual of pill popping has been simplified by one letter of the alphabet. Also, vitamin C will cause the heart to store abnormal amounts of iron, causing a rather irksome "clanking" sound every time there should be a tender "thump". Finally, the vitamin C will facilitate the storage of iron in the joints, welding the bones together with arthritis, causing further "clanks", "clunks", and "squeaks". Needless to say this can be unnerving to anyone within a seven-block radius.

Sushi is a "no-no"; a real heart-breaker that! A hemochromatosis patient should not even handle raw seafood. While this allows me to scurry out of the kitchen whenever the halibut appears, there is another downside to this particular problem. I can no longer walk on the beach barefoot. There is in sea water a bacteria called "Vibrio vulnificus" which, when it encounters stored iron is catastrophically toxic. Never mind about the Great White out there just beyond the breakwater; that big toothy guy is part of the treatment. Imagine, one bite and Wow!, a whole bunch of stored iron instantaneously gone, with aggravated phlebotomies as a chaser. Some things just seem counter intuitive.

Green tea inhibits absorption of iron of any kind. It is the tannin in tea that does the trick. Green Tea HP, a single cup of which is equal to 52 cups of regular tea, will dissolve an Abrams tank in fifteen minutes, so think what it would do to the stored iron in your body. Patients must understand that this will not be a replacement for protocol treatments, but will provide some entertainment value for the the nurse assigned to the task of taking your blood. How much fun would it be to draw a pint from a highly agitated moving target with a 14-gauge needle? It provides sufficient inducement for acquiring a stun-gun with 15 ccs of Demerol, I'll tell you.

So, with all of this information before me, how is that the day after I had my first pint drawn that I found myself at the home of Barbara and Jay eating a half-pound of tri-tip steak? Barbara had invited Trillium and I to their place because of some service that we and several neighbors had rendered to them. I was asked to grill the meat, which I did. Grilling ten pounds of tri-tip will disorient anyone, regardless of the diseases with which they may or may not be afflicted. I considered marinating the meat in Green Tea HP, but thought that B-J really wanted to have a subdued get-together.

Last Friday, suffering from an extreme case of cabin-fever, I invited Trillium to lunch. We decided to go to Kneaders, a place where the sandwiches are completely iron-free, so long as you eat only the lettuce and avoid the lemonade. BYU was in the midst of Education Week and the place was packed. We left without parking. "Where shall we go? Trillium asked. I said that there was another Kneaders in north Orem. As we pulled back onto Bulldog Avenue (named for the mascot of Provo High School) she said, "How about there?" Like Pavlov's dog, I started drooling. "You mean it? (slurp, slurp)" "Sure. What would you have if we ate here?" I knew that this was a test. I thought for a nanosecond and replied, "I would have the $6.00 Guacamole Bacon Burger, with fries and a lemonade (clank, clunk, squeak)". I really said that as a joke, thinking that I would have something else less ferrous. I could not resist, however, when it came time to order. After I took my first bite, I began to feel faint; my head was swimming, Trillium thought that I was having a stroke. "What's wrong with you?" she queried. "Twenty ounces of bacon fat!" I gasped. Trillium looked a little frantic, "Is my husband going to die?" "Yes," I said,".... but probably not today."

Friday, August 22, 2008

Iron-Clad Humor

It would appear that there are only two people other than myself that are reading my blog: my wife and my youngest daughter. When I was beginning school at BYU, my Freshman composition teacher, Steve Walker (yes, the Steve Walker), taught me that every writer has to be aware of his audience and adapt appropriately. Yesterday afternoon, half of my readership suggested that I was trying too hard to be funny, that the second entry was a somewhat strained effort when compared with the first. I reread both and failed to see the difference. This morning Trillium brought me a four-page paper written by my friend Marvin Payne (yes, the Marvin Payne) that had appeared in Meridian Magazine. "This is funny", she announced. I read it over toast, a piece about rocks, water conservation, and a pioneer what had three wives at the same time each of whom was named "Mary Ann". I found it more droll than funny and told Trillium so. She smiled and went off to her workroom to put the finishing touches on my mother-in-law's new blog.

I have to say that I can make my wife laugh, generally in public, and from time to time in private. I am always surprised when it happens. Trillium is far from being dower and my 41 years plus with her has been filled with a great deal of laughter. But she has a unique sense of humor which I have had some difficulty understanding and far less success exploiting. I may have just expressed a universal truth about husbands and wives.

I have always tried to make people laugh. I think that it is true because that I, myself, enjoy laughing. I find humor in just about everything. This has sometimes been misinterpreted as light-mindedness, perhaps a victory for the gas-giant theorists of my life. I have discovered, however, that together with my desire to have everyone around be in a good mood, I almost always break into joviality when I am under stress or have some kind of impending doom to deal with. This business of hemochromatosis serves as a case in point.

At the first consultation with "Doc Holliday" after I was diagnosed with my genetic condition, the whole business of the "cure" came up. The "cure", of course, is to have one's blood drawn weekly for a time and then on a regular basis. The whole "14-gauge" needle and subsequent "buckshot" jokes derived from that. As I have stated elsewhere, needles trouble me deeply, and I dealt with my cringiness the best that I could. At some point, "Doc" said that I ought to look into giving blood to the Red Cross. I did so. The folks at ARC Headquarters said that at present only those of my ilk living in the Northwest part of the United States (Washington, Oregon, and environs) could donate blood to the Red Cross. The Northwest was accepting blood from hemochromatosis patients on a trial basis. It is now known that hemochromatosis is a digestive condition more than a "blood" disease. The Red Cross told me that my region (Utah, Idaho, and Montana) would probably begin accepting hemochromatosis blood after the first of the year. The financial aspects of this scenario were not lost on me.

When I was considerably younger, the Red Cross was extremely proactive in getting out the blood-donors. The media blitz was extraordinary. Blood drives were being held everywhere. The Eagle candidates of our Stake in Garden Grove, California, were using the blood drives as part of their Eagle Projects, and I, as an avid Scouter did my best to keep up. Notwithstanding my preternatural fear of needles, I volunteered to give blood when any of these drives came along. The Red Cross was delighted for my generosity, inasmuch that my blood type, B+, was somewhat rare and extremely useful (who knew that my blood type was an expression of my fundamental personality and could be passed on to others?) After a few of these visits, however, the folks at the Red Cross invited me not to participate again. Apparently the quart of orange juice, the fifteen cookies and the gurney that was occupied for 45 minutes did not figure into their idea of efficiency, temporal or financial. More than a generation has passed away since I last gave blood; perhaps no one will remember me.

In younger days, I gave blood for money. For a quick pint, the blood bank would give me $25.00. I do not know whether or not they still do. When I went to the "Infusion Center" in Provo, I asked them what they were going to do with my blood, since it was unacceptable to the American Red Cross. The nurse said that they would probably just throw it away. Sad; I could have used the money. What I found out later was they they were going to charge Medicare nearly $200.00 for extracting that singular iron-ladened pint. I thought to myself, "Well, I can save my government a fabulous amount of money as soon as the Red Cross gives the Utah Region the go-ahead to take blood from hemochromatosis patients. I wonder if the ARC will give me $25.00 for my trouble." Then the thought occurred to me, "What if I have to give $12.50 to 'Doc Holliday'?" So I asked him. Trillium laughed, the "Doc" grimaced. Once again, I had only managed to entertain half of my audience.

Trillium suggests that I provide a little information along with my ruminations, so that after I am gone, the other members of my family will know how they are going to go, and when. The blood analysis reports are filled with fun facts, most of which are undecipherable to those with degrees from the School of Humanities. I believe that the medical profession has arranged this on purpose in conjunction with their inability to write legibly. I have already given a little bit on the "Blood Urea Nitrogen" fiasco and the ripple about the "eGFR" results. There are many other delightful aspects of a blood analysis that can set the heart to racing. For now I will focus on the hemochromatosis data.

There are, at present, four components to hemochromatosis testing: Serum Iron, Iron Binding Capacity, Iron Saturation, and Ferritin. What is given below as standards, vary from laboratory to laboratory and, thus, are not really "standards" at all. The information provided is in the parking lot, if not actually in the ball park.

Serum Iron: Men and women in the "normal" range have between 20 to 150 nanograms of iron per milliliter of blood. At least that is what I think "ng/mL" means. As of the last test, my count is 207. "Doc Holliday" says that when the Iron Serum gets to 300, I start "clanking" when I move. The treatment for lowering the serum iron is to draw blood until the level drops to 15. In other schools of thought, this is known as "bleeding out".

Total Iron Binding Capacity: Because this phrase almost makes sense, most medical practitioners have abbreviated it to "TIBC" just to keep their patients guessing. "TIBC" measures how well a person's blood can transport iron. For men and women, the normal range is 250 to 450 ng/mL (what the heck is a nanogram? It sounds like a Hallmark card for one's grandmother). In my case, my Total Iron Binding Capacity is not good at 195. What I found completely fascinating is that when one has high serum iron (which I do) and low TIBC (which I also do) one probably has sideroblastic anemia (oh joy!), a condition that prevents my red blood cells from using iron. Whether I have this condition or not is irrelevant ("clank").

Iron Saturation: This must mean what it seems to mean, but probably in reference to where the "sideroblastic anemia" is stuffing all of the extra iron that the blood is not using. Maybe this is where "bronzing" comes in. Since one does not excrete iron (a circumstance that would bring a whole new meaning to constipation), perhaps the body is attempting to push the excess iron out of the pores. Normal people (unlike myself) have from between 20 to 55 % Iron Saturation and I have 106.2 % (thus saith the deponent from the University of Utah lab). WOW! I am 100% iron and have extended my ironness 6.2% into the realm of wherever. Needless to say, the medical profession has concluded this to be high ("clank, clank"). It is data like this which compels me to break into nervous laughter. Transferrin Saturation, in reality, is a figure derived by dividing amount of Serum Iron by the TIBC. This is, of course, a mathematical calculation which is outside of the pay grade of most medical types. It is certainly outside of mine; I have no clue what it means so I am forced to make stuff up.

Ferritin: Prior to being diagnosed with hemochromatosis, I though that "ferritin" had to do with the work of private investigators. I have since been disabused of that notion and of what I thought was the accompanying humor. The ferritin count indicates storage iron which is not essential to maintain life. Normal people (again, not yours truly) have a reading of between 17.9 to 464 ng/mL, except for 100% of my readership whose range should be between 20 and 120 ng/mL. It is not that 100% of my readership is abnormal (which does make some sense), its just that 100% of them right now are women. As I reported previously, my Ferritin level is 827 ng/mL. This, according to my own lights, would make me a great private eye, but ("clank, clank, clank") not all that private.

Well, there you have it. My status as of today. I have had one pint of blood withdrawn. I have clipped my fingernails, brushed my hair, vigorously bathed, all of which apparently helps in getting rid of the excess iron. Trillium says that I am more pleasant to be around even though my humor is still a little heavy-handed.

Thursday, August 21, 2008

The Effects of Iron Over-loading on Time and Space

My wife, the lovely Trillium, after reading my initial entry, suggested that I was imposing anachronistic data upon my readers. She explained; I agreed. So I am up at the crack of dawn to correct any misconceptions derived from my errata. The whole problem, however, can be laid at the feet of iron-overloading.

When one has the brain the size of a planet, excess iron in the body is bound to fuss with the mechanics of memory. My daughters, unsympathetic as usual, point out that as a gas-giant, my brain should not be adversely effected by anything of a ferrous nature; to wit, Shoemaker-Levy and the Red Spot. My sons, currently enjoying their own gravitational wells, have down-graded me to a planetoid and refer to their father as "Play-doh". I suppose that I should be grateful that they no longer think of me as the god of the Underworld. My sister, Judie, has bought into the iron-overloading theory, observing that it is the easiest explanation for my continuous "Aurora Boring-All-Us", which observation brings us ultimately back to the gas-giant theory of most of the other women in my life.

Getting back to the specific memory problem, Trillium said that the miscommunication between "Doc Holliday" and myself took place during our trip to Southern California, where we had gone to watch one of our grandsons dance the Cha-Cha in front of 10,000 people and a television crew (more Demerol, please). I tried to imagine the connection between the trip and the four days on the river. I wondered if the 1600-mile drive was anything like being pulled underwater for twenty minutes by a 365 horse-power inboard motorboat. I decided that it was exactly the same. I also concluded that I consumed enough red meat iron at the Virgin River Casino Buffet in Mesquite, Nevada, to make my own Nautilus-class submarine, a device which I later water-tested in the depths of Yuba Lake. The confusion was understandable.

In the meantime, Trillium was continuing her researches into my malady. "Bronzing" became extremely important once I came home from the river trip. I was sitting at my computer key-board trying to conjure up a piece of deathless prose when she came into my den and provocatively put her alabaster arm next to mine. "Hmmmmm," she said. "Bronzing". "Bronzing", I retorted. "What bronzing?" "Iron-overloading causes bronzing of the skin," she said sweetly. "So does four days in the blazing sun of central Utah," I said. I was eventually able to prove to her satisfaction that the bronzing of my fore-arms was probably not a symptom of my disease.

I generally swim fully clothed. I wear a shirt, long pants, shoes and socks almost every time I get into the water. From the time I was a child, I have been a water-baby. Growing up in Southern California, close to the beach, I spent vast amounts of time on the sea-shore nearly naked. My switch to clothed bathing came about as the result of an ill-fated hunting trip in the mountains above Denver, Colorado. It was a lovely day at 10,000 feet above sea-level; the sky was crystal blue, the sun was bright and warm. I decided to take off my shirt and hunt Amerindian style. I ended up with a second and third-degree sunburn. The experience was so painful that I decided that I would never allow myself to suffer in that way again. Hence, the current configuration of my swimming togs. This, of course, has saved me from other indignities, like having Greenpeace try to get me back into the water or being harpooned by some near-sighted Ahab.

The day that I was dragged submersibly by my friend's motorboat, I was wearing a flowered Hawaiian shirt, blue jeans cinched tight with one of my leather Woodbadge belts, white socks and deck shoes. The pull through the water nearly divested me of all of my clothing. Someone actually shouted "Thar she blows" and something whistled by my right ear. I managed to scamper back into the boat; no harm no foul. As Trillium looked at our parallel arms, I pulled the cuff of my short-sleeved shirt up to my shoulder. She stared at the exposed flesh for a moment and then said, "No worries then", made a little mark on her clip board and went back to her computer.

Several months before I was diagnosed with hemochromatosis, I decided that it was time for a weight-loss program. I was tipping the scales at nearly 250 pounds; I thought that I should be more demure, perhaps at 205. I tried a number of things, but my weight merely fluctuated between 249 and 228. Then Trillium discovered "Green Drink", a sort of smoothie made of spinach, strawberries, bananas, and fruit juice. She offered it to me one morning. I recoiled some; it looked ever so much like 50-weight motor oil (actually, that is the polite description that I am using now; the original is unprintable). I closed my eyes, took a swig, and to my shock and wonder, it was delicious. I was hooked from the first moment I tasted it. Every morning I would hammer down a large glass of the stuff, finding that I suffered no hunger until mid-afternoon. I began to shed the weight. I was nearing the 219 barrier when I was diagnosed with hemochromatosis. I remembered that I had read somewhere that spinach was an excellent source of iron, dreaded cirrhosis-inducing iron, iron that would take out my pancreas without batting an eye, iron that would turn my kidneys into an excuse for a 14-gauge dialysis team's prodding and probing. As the prospects dawned on me, I said to myself, "I knew it; I am actually going to have to exercise in order to lose weight." It was then that I learned the difference between heme and non-heme iron.

Iron is in just about everything. It stands to reason that since the core of the earth is a gigantic mass of liquid iron, that iron would be in just about everything else as well. How does one then avoid consuming iron? One can't, but one does have a choice between consumable irons. Heme iron is that which is found in animal matter; it is the very thing that gives tri-tip steak its marvelous texture and taste. It is one of the eleven secret herbs and spices in Kentucky Fried Chicken. It is the main ingredient in a Whopper. Non-heme iron is found in almost all vegetable matter and is, as it turns out, significantly more difficult to absorb. Spinach, in addition, is provided with oxalic acid which binds with the non-heme iron making it virtually impossible to be absorbed. This state of affairs, at first, puzzled me. Heme iron seems to be actually designed for human consumption; non-heme iron seems to be designed for something else. In other words, my spontaneous drooling whenever I passed by Carl's Jr. was as natural as breathing. When I realized that distinction, that I could no longer consume heme iron with impunity, but was relegated to sipping "Shreck Juice" for the rest of my life instead, my brain the size of a planet epiphanized, "I really do have a DISEASE!"

Wednesday, August 20, 2008

Heavy Blood out of the Blue

A man can live all of his life thinking all is well; well, mostly well. Forty-one years of marriage, seven children, 23 grandchildren, four advanced academic degrees, and a bibliography that is astonishing even to myself. In an instant, however, all this seems to be hardly more than detritus, the kitchen middens of my second estate. Now, lest I be misunderstood, I am not particular depressed about the diagnosis or even the prognosis, I am just a little aggravated about having another thing to think about, something unforeseen, something that I had to learn about from my younger sister, of all people.

About two years ago, Judie called to ask me if I had ever had extensive blood work done. I told her that I had not, that I was perfectly content to let my blood stay right where it was and did not wish to have anyone fiddling with my veins or the contents thereof. I have a phobia of sorts that began when my sister was but two years of age. I fell victim to some sort of bacterial infection and for a period of time our family physician thought that it would be in the best interests of humanity if I received frequent injections of one sort or another to ward off the burgeoning disease running rampant throughout my body. Everyday after kindergarten for about a month I was ushered into the doctor's office where I was administered antibacterial drugs using a 14-gauge hypodermic needle. For those of you who are having trouble imagining a 14-gauge needle, think of the corresponding size shotgun and you will have the 4-year old's impression of what was happening to me every afternoon. As it turned out, the medical practitioners in that particular office were not as accurate nor as exacting as a nervous 4-year old might have hoped. The tabla rasa of my emotional life is, therefore, somewhat blood-splattered and that accounts for my continuing hesitancy to have the medical profession tap into my life force. About ever six weeks or so from the time that Judie first contacted me about the blood tests, she would e-mail me or telephone me about my progress. Eventually, I decided that the only thing that would keep me from having anxiety attacks about any impending communique from my sibling was to actually have the blood tests done.

When I reached my 65th birthday, I assumed the role of being able to depend on the governmental largess of Medicare. One of the first things expected of me was the dreaded Medicare physical which involved all sorts of probing and prodding, the sufferance of which was ameliorated by an occasional dose of Demerol, the effect of which seemed to be something along the lines of "liquid smooth". I unconsciously missed my colonoscopy altogether, though I dare say that CNN bought the broadcast rights. Apparently it was a slow day for the news. Aside from the 14-gauge television camera stuffed into my nethermost part, I was only seriously distressed by one other aspect of the physical: the withdrawal from my personal bank of two rather large vials of blood. While I was trying to remain calm at the prospect of the imminent garden-hose extraction, I told my doctor about the request that my sister had made about a particular blood test. My physician, in his paternalistic way (I am twenty years older than he is), said that I should not worry, it would be taken care of.

When the inevitable consultation came regarding my overall health, I asked about the hemochromatosis test. "Hmmmm," said he, "It appears that it was not done. Not to worry; we can do it later." The point that my physician failed to appreciate that I was in no mood for another wrestling match with his nurse about the extraction device. Another six months would pass before I gathered up sufficient nerve to proposed the appropriate blood test again. By this time I had receive 647 IM's, e-mails, snail mails, and/or phone calls from my sister wanting to know about the results. "Doc Holliday", the master of all things 14-gauge, said that we could go ahead with the hemochromatosis test together with a few other things that he thought that would be useful now that I had celebrated the 66th anniversary of my birth. A few minutes later the doctor's nurse and a young thing of not quite twenty years, flounced into the examination room announcing that they were about to take my blood. The twenty-something was invited to do the honors; she was a student nurse. "Oh," said I, "I suppose that this is your first time taking blood from a patient." "Oh, no," said she, "I have done it, like loads of times." More blood-splattering.

A week or so later, I called my physician about the results, inasmuch as Judie was threatening a two-month camping trip in my den if I did not cough up the numbers. The nurse with who I spoke said, "Oh, your tests were cancelled." "Cancelled?" I said unbelievingly. "Who cancelled them?" "I don't know," she answered. "But I will find out and call you back." Thus, for the next hour or so I was back on proverbial, though hardly metaphorical, tenterhooks. Eventually, she called me back and announced that the labs in Salt Lake City had cancelled the test because the blood samples were lost, or stolen, or contaminated, or became part of some "cock and bull" story being generated by the bowels of the University of Utah. In any event, I was welcome to return to the office where they would again "14-gauge" me free of charge. I was experiencing the transports of delight, I tell you.

I went back to the office, the nurse and her colleagues apologizing profusely for the inconvenience. She asked if there were any way they could make it up to me. I said that Demerol would be nice. "Liquid smooth", however, was not to be. "Once more into the breach, dear friends," Henrietta cried, as she took another fifth. I staggered home.

About this time, I was commissioned to accompany a group of Venture and Varsity Scouts to the Seviere River and its Yuba Lake. I had a glorious time. When I arrived home afterwards, however, I found that "Doc Holliday" had called several times, but had not been able to talk with anyone. He said on the answering machine that he was mailing the results to me and that I should call him as soon as possible. The results came. Lo and behold, I was declared the proud possessor of the genome governing hemochromatosis. Judie and I were really brother and sister. I am certain that was a relief to everyone concerned.

In the report, however, I discovered that I also had abnormally high Blood Urea Nitrogen and, to my horror, Chronic Kidney Disease as indicated by my Glomerular Filtration Rate. According to the chart, I was 36 points away from kidney failure. My Serum Iron was high, my Iron Binding Capacity was low, my Saturation was off the chart. I concluded that I was a Dead Man Walking. For all of this, however, the most frightening part of the whole piece of paper was the note at the bottom "Collect Venous Blood/Venipunct Qty:1" They wanted more!

I called the "Doc" and found out, through a labyrinth of toadies and inepts, that I would not be able to see my doctor for a week, inasmuch as he was on vacation. To make a long story short..... no, it doesn't.... I eventually had a chat with the good doctor who calmed my nerves about everything. Yes, I did have chronic kidney disease, but I would probably die from an interstellar debris fall before it killed me. Yes, I did have high blood urea nitrogen, but that was probably due to dehydration the morning that I had the blood drawn. My Serum iron was high (207) but we were not going to worry about that until it hit 300 or so. Having been prompted by my sister I asked, "Well, what is my ferritin level?" He said, "I don't know. We didn't test for that." "Well,'" said I, "My sister is getting a little ornery about this. I have to have a number." "Alright"," he said, and with that he hailed the 14-gauge sump pump operator and we were engaged once again. As an aside, I have since learned that the treatment for hemochromatosis is phlebotomy, or put simply, "blood-letting". By this time I was half-way through the cure.

Another couple of days passed. By this time I had done a great deal of reading on the subject. I now knew that if this condition were to go untreated I would be regaled with such complications as cirrhosis of the liver, pancreatic diabetes, and kidneys that would function only insofar as their shape was concerned. One morning I received a phone call from the clinic. It was my doctor. "Well," said he, "It would appear that your ferritin levels are at 827; another 173 points and you will cause a reversal of the magnetic poles of the earth. We need to have you draw blood."

I will not, at this point, describe the rather winsome conversation that I had with the American Red Cross about the acceptability of my blood, except to say that if I had been calling from Portland, Oregon, they would have taken my blood without hesitation. Apparently my level of ferritin is less of a threat there. Eventually I was sent to the Infusion Center in Provo. I thought that it would have been more aptly named the "Diffusion Center", given the circumstances. I came up with a bevy of rather clever jokes about Stephanie Meyers and the reason why I was there. Not everyone was feeling as lugubrious as I. I spoke about the bag of ball bearings that they were about to take from me. The nurse said, "No, it will be more like buckshot" as she pulled out her 14 -gauge.