The Origins of Hemochromatosis

There are many uncertainties in the universe, but there is one thing that you can count on: when there are two months between phlebotomies, something like that which follows is bound to happen.

“Why me?” This is a cry heard around the world, uttered by one out of every 250 people. “Why is my duodenum extracting every molecule of iron out of my beef burrito and stuffing it into my liver, pancreas, heart, and brain?” Well, as it happens, I have an answer. Actually I have two answers; in matters of such import, a plethora of explanations cannot help but illuminate. Both of these theories have currency. They are at the heart of the meaning of life, the universe, and everything, about which your humble correspondent has some expertise.

The first theory as to why there is iron overloading at all is called "The Big Iron Bang Theory". Approximately 13 billion years ago (you know, when I was a kid going to school, my teachers told me that this event took place 3 billion years ago; time flies when you are having fun), the universe did not exist. There were no stars and planets, no galaxies of any shape or size. In fact, there were no elements as we know them today, just an enormous number of sub-atomic particles living together in an extremely small condominium. Again, about 13 billion years ago, some sort of accident took place; the condo was condemned and all of the sub-atomic particles fled the inner-city to the suburbs. This shift in demographics fundamentally changed all of the sub-atomic particles. Some became hydrogen; in fact most of them became hydrogen. According to Carl Sagan, for every atom of any other element, there are “billions upon billions” of hydrogen atoms. In honor of the great astronomer, this ratio of “billions upon billions to one” is affectionately referred to as a “Sagan” (pronounced with emphasis, it becomes a "Shy-Sagan"). So, as a result, helium is hard to come by, as is oxygen, nitrogen, and argon. Seaborgium and Ununbrium are difficult to pick up at Wal-Mart as well. Iron, as it turns out, is a rare earth metal when compared to the amount of hydrogen bouncing around the universe. Why, then, do I end up with so much of it?

I was watching PBS yesterday and I found out why. It all has to do with the life of a star. In the beginning, a star is formed by the aggregation of an immense number of Bok globules, several Shy-Sagan-Sagan’s worth....... At this point, astronomers want to talk about hydrostatic equilibrium, Herbig-Haro objects, and proto-planetary disks. This, however, would be a digression from our main theme, so we will push on.....

When a star first flares into existence, its business is the fusing of hydrogen atoms together into helium atoms. The more helium there is at the core of the star, the brighter the star becomes. This continues for about 90% of the star’s life. As the star ages, it suffers what Sagan and his boys call “metallicity”, the dreaded creation of elements other than helium. At first, the process merely fuses helium into such innocuous particles like oxygen and carbon, but the malady continues with the specter of the “carbon-burning process”; the “neon-“ , “oxygen-“, and “silicon-burning” processes quickly follow. As might be expected, there is a point of diminishing returns, and that point is when iron is produced by fusion and the star cannot get rid of it. So, you guessed it, the star stuffs the iron into its own liver, pancreas, heart, and brain. Eventually, the inert iron core becomes so massive (about 1.4 times the mass of our own sun) that it collapses under its own weight and a supernova occurs, splattering all of the iron and all of the other elements all over the place, to be used in the formation of planets and all of the life on them. What no one has figured out before, but which I am sharing with you now, is that there are some stars that produce and store three times the amount of iron as regular stars. These are hemochomatosis stars.

Joni Mitchell, a famous songwriter and erstwhile astronomer, wrote a song in 1969 called “Woodstock” in which she explains why it is that we are all the way we are, why it is that I, my sister, and one out of every 250 people on this planet have hemochromatosis. The tag of the song, the chorus if you will, is as follows:

We are stardust
We are golden

And we’ve got to get ourselves

Back to the garden

So there you have it. The disturbing thing about all of this is that no matter what I do, I am gaining more weight. I play racquetball with Jenny for six weeks and I put on six pounds. I resort to eating nothing but heads of lettuce for lunch and I can’t fit into my suit pants. I fear that I am no longer in the hydrogen-fusing stage of my existence. I am a “red-giant” ready to collapse into a “white dwarf”. All I need is just another solar mass of iron before my heavy metals can be blasted all over the earth. It’s time to defrost the tri-tips.

The other theory explaining the existence of hemochromatosis is called the “Intelligent Wrought-Iron Design Theory”, but at present we can only talk about that in the state of Texas.

The Iron Mean

Yesterday I went to visit with the good “Doc Holliday” to find out what kind of condition my condition was in. To everyone’s delight, my ferritin had dropped to 223, 170 points down from January and 600 points down from last August (I say “to everyone’s delight”, only because Trillium and Judie had not, as yet, seen the numbers; they want me to be completely de-magnetized). We spent an hour together poking and prodding each other; he physically, I informationally. All of my organs appear to be in good working order (he thumped and poked a couple of these). Therefore, the hemochromatosis prognosis is good. I am supposed to go to the Infusion Center for a phlebotomy once every two months (bad news for the boys and girls in that institution). Since I dropped fifty points doing that from November to January, I am not opposed to the treatment.

After reviewing all of the blood work, “Doc” thought that my triglycerides were high (248; the high end of normal being 149). My HDL was one point below normal (39 instead of somewhere between 40 and 60). My LDL was 30+ points higher than the extreme (130 instead of between 0 and 99). Some of this could be explained by the fact that I was not fasting at the time the blood was drawn. That’s my story anyway. The truth probably has to do with the number of maple bars and “wheat dogs” that I have eaten during the last couple of weeks…. along with the potato chips, the salt water taffy, and the leftover Chocolate Christmas Oranges that I have been compelled to eat (by compelled, I mean that they were left out in plain sight). He said that I need to exercise (“Ooooohhhhhh! Nooooooooo!”) and change my eating habits (dirt instead of food).

I asked “Doc Holliday” what would happen if I did not pay attention to these numbers, if I just went on my merry way, content that I was not part of the static electricity generating machinery of the planet. He said, “Well, there is a .5 percent chance that you could have a heart attack or a stroke in the next five years.” I then asked what would happen if I went on this regimen that he was suggesting, a procedure that would mean that every time I ate something it would seem like I was grubbing for truffles in the back yard. He replied with a smile, “Well, your risk would be reduced to a .25 percent change of a heart attack or a stroke.”

“So,” I said, “What you are saying to me is that the odds of my not having a stroke or heart attack are 99.5 to 1 if I keep on eating what I am eating, but if I switch to daily doses from my compost pile I can improve my odds to 99.75 to 1.”

“That’s essentially it. Isn’t medicine wonderful? Aren’t you glad you came to seek my advice about all of this? Welcome to the club, brother; we are all going to be miserable together!” I went home with mixed emotions, which I quickly unmixed by having a handful of sour cream and onion potato chips, followed by a pork loin sandwich.

This morning I thought better of all of this and decided that I needed to be a little more rational. During my slumbers I had the phrase “the Golden Mean” pass through my mind several times, together with the phrase “the Iron Mean”. Not wanting to ignore communications from my “space pillow”, I came down early this morning to flesh out this entry by Googling the two phrases. Needless to say, I have enough material now for about six 5000-word essays.

There are four major “Golden Mean” entries to be found on the web. The first is an epistolary novel by Nick Bartoch, the third in the “Griffin and Sabine” trilogy. It sounds boring and since Bartoch lives in British Columbia, it probably is; the book is no doubt beautiful, but boring none the less, kind of like Vancouver.

The second entry has to do with mathematics. I read several articles on the “Golden Triangle”, the “Golden Rectangle”, and the special relationship between a man’s belly button and his nose. The conclusion that I came to was that Johannes Kepler and his fellow mathematicians all had a thing for maple bars and pork loin sandwiches and did not beat the odds. The best thing that can be said about all of their number crunching is that the whole universe may be reduced to the square root of the number 5 divided by 2. These guys may also have been suffering from undetected hemochromatosis with ferritin counts in excess of 1,618,033, all of the iron having been deposited in their brains. I was not impressed.

The third is an Aristotelian concept, suggesting that the relationship between truth and beauty may be mathematically quantified. All the numbers aside, however, the simplest redaction of his ideas may be stated thusly: “Both beauty and truth have symmetry, proportion, and harmony”. I had noted this already in the perfect dimensions of the “Maple Rectangle”.

The fourth articulation of the “Golden Mean” was conjured up by Confucius in the sixth century BC. It is sometimes called the “Unwobbling Pivot”, or the “chung yung”. In this philosophy the mind is to be in a state of constant equilibrium (a kind of intellectual mugwumpism that does not include maple bars or pork loin sandwiches; no extremes of any kind). The advocate of the “Golden Mean” never leaves the path of duty (he does exactly what his doctor, his wife, and his sister tell him). The man that observes the “Golden Mean” is a gentle teacher and never has contempt for his inferiors (which leaves out sarcasm, broad humor, and just about anything that makes me laugh, including this blog). And finally, a man of the “Golden Mean” always behaves himself according to his status in the world (What in the world does that mean?).

I have concluded that I am not fit for any of the preceding definitions of the "Golden Mean" and have decided that I should be an advocate for the “Iron Mean”. I Googled that phrase later this morning and found that there was actually such a thing as the “Iron Mean”. Here is the mathematical formula for the "Iron Mean":

“The percentage of time I love you now far exceeds the moments when I want to brain you with a skillet”.

Iron reduction, truth, and beauty are all interrelated! This is the key to Einstein’s Unified Field Theory! I need another maple bar to see if I am right!

On Tenderhooks

(Yes, yes, I know. “Tenderhooks” should be spelled “Tenterhooks” but I always wanted to start an essay with a parenthetical statement.)

I cannot recall the first time that I heard the phrase “being on tenterhooks”, but I was certain that I heard “tenderhooks”. I knew what it meant simply by understanding what “hooks” were and regardless of what the other two syllables sounded like, if one were on a “hook” it could not be a good thing. I now know precisely what the derivation of the word is and I can assure you that whether you are literally or metaphorically on “tenterhooks,” it is not a good thing.

I went to the Infusion Center yesterday and had a pint drawn. It was a memorably nostalgic experience (Yes, yes, I know, “memorably nostalgic” is a kind of double negative or a semantic reduplication, but I really mean what the words say.) None of the lady nurses would have anything to do with me this time around. They sent “Gory” and his little UVU side-kick “Nickel” to work me over. The first thing that “Gory” said to me when he arrived with his basket of medieval instruments was, “Hi! My name is ‘Gory” and this is my little UVU side-kick ‘Nickel’” (This, of course, constitutes meta-fictional redundancy because I already told you that in the previous sentence.) “Would you mind if ‘Nickel’ does the phlebotomy? She is a nursing student and is only here today during her clinical. She wants to be party to as much blood-spla….., er…, as many medical procedures as possible.”

“Sure,” I replied. “I haven’t long to live anyhow. You might as well move things along.”

“Thanks!” He then turned to the little nursing student, who looked like she was twelve, and began giving her instructions. It was then that I had the memorably nostalgic experience. I was taken back sixty years to the banks of the Middle Fork of the San Joaquin River. My family was camped at Red’s Meadows, then a primitive camping site near Devil’s Postpile in central California. My Dad was taking me fishing for the first time and was teaching me how to bait a hook. Gory’s voice echoed every word my father said to me.

“First you have to find a big juicy one…. Try that one there…. Right…. Now take the point and push it right into the center… Ooops! That went just a little too far. Back it up…. Move it to the left a little…. Now push it in as far as it will go…. Ooooohhh, sorry about that! That’s okay; I have another one over here.”

Then “Gory” turned to me. “You seem a little tense, Dr. Beeblebrox. And clammy! My, you are moist! Dr. Beeblebrox? Dr. Beeblebrox? Zaphod? Are you alright?” Everything went mercifully black for a while. That constituted my literal "tenterhook" episode of the week.

Now I have to wait two weeks in order to have my blood drawn for a check of ferritin levels. I am really curious about this because my last evaluation was in January when my ferritin count had dropped to under four hundred points. Remember that I had started this whole thing with a count of 826, but with each monthly phlebotomy the count dropped an average of 120 points. When I did not have a phlebotomy in December, my ferritin only dropped 50 points or so over the two months. It was then I determined to have a pint drawn in both February and March prior to my annual physical with “Doc Holliday”. If the previous regimen is any indication, I should drop another 240 points of ferritin putting me at about 150 or so. But I will not know for certain until another three weeks have passed. The metaphorical “tenterhook” aspect in all of this is the wait; I want to know now if all that has been going on since the first of the year has been productive, particularly since I am the one who inserted the extra phlebotomy into the calendar. I would really like to know if I have played the fool in this matter. I am, however, as optimistic as ever.

Now for those of you who have been on "tenterhooks" (either literal or metaphorical), wanting and waiting to know the linguistic origins of the word “tenterhook” I submit the following: A “tenter” is a rack or frame upon which woolen or other cloths have been “stretched” after having been washed or dyed. Etymologically, “tenter” derives from the Latin past participle of “tendere” meaning “to stretch”. (Note the “d” in the Latin word; I always seem to intuitively know the right spelling.) Some scholars have also suggested that the word has been influenced by the Middle French word “teindre”, a word meaning “to dye” (But can you trust anyone who likes to eat frogs’ legs?) The tenterhooks were curved nails driven through the frames of the “tenter” which were used to stretch the cloth so that it might retain its intended shape and size. “Tenters” were set out in “tenterfields” to dry. For those of you who are as compulsive as I am about these sorts of linguistic issues, the edges of the cloth that are placed on the “tenterhooks” are called “selvages”, the coarse woven border that usually is discarded when the cloth is finally cut to pattern. This is kind of like the pint of blood that “Gory” and “Nickel” threw away yesterday after dinking around with my veins.

An Open Letter to Ironoverload.info

I began this blog about eight months ago with a desire to accomplish two things. First, I wanted to face my affliction by finding out as much as I could about it and, second, attempt to do so in a humorous way. I find that dealing with problems, even serious medical problems, with a degree of jocularity makes me feel better about the whole thing. This is not everyone’s cup of tea (see below), but it is mine. During these seven months, more than 1900 people have looked at my entries, spending an average of 14 minutes per visit reading the stuff I have been cranking out. I would like to think that it is because I have a deft hand at providing information while inserting a little broad humor along the way (hmmm... maybe it is the reverse).

I have made unblushing fun of myself, my little paranoias and other personality quirks. I have made unblushing fun of my family members and friends, medical personnel and administrators, and even my internet service provider. Everyone has been fair game. I have even provided what I think is pretty good music, even though I know that many of my readers turn the volume down so they can more effectively wade through my rhetoric.

I have enjoyed most of the comments that I have received, though I must admit that the vast majority of them have been from people that I know and love. What a surprise to receive a note from the head of the Hemochromatosis Society in Canada, encouraging me in my attempts to get the American Red Cross to relent in their prohibition of hereditary hemochromatosis sufferers from donating blood on a regular basis! I don’t think that I have been very effective, hardly at all, but I was flattered in any event.

Another fellow, “W.Pat” he signs himself, has also left comments from time to time. His, however, have not been personal comments, but rather little information bombshells dropped in his own inimitable “cut-and-paste” technique. I suppose that I would not take umbrage with his entries except for two things: first, he copies the same thing over and over again, and second, he isn’t funny. What’s up with that? So, having someone walk up to the mouth of my verbal cannon, sticking himself headfirst down the hole, and shouting “Fire”, I feel obliged to respond in the only way I know how. Hold on to your bootstraps “W.Pat”!!!!

I am including below “W.Pat”’s latest comments, conveniently divided up into numbered paragraphs. His text is in italics; my piffle is in normal type. I realize that is counterintuitive, but, hey, this is my story!

1. Learn more about hemochromatosis at my blog than your doctor even knows. Preventing cancer of the liver is crucial. Medications should only be used when absolutely necessary. Hemochromatosis sufferers that test with elevated liver enzymes, must avoid acetemetaphen altogether and alcohol should be avoided.

Well, W.Pat, as it turns out my physician, “Doc Holiday”, knows quite a bit about hemochromatosis because I have been as instructive off-computer as I have been on-computer. As it turns out, he too is a technocrat and knows how to “google” just about anything, and I know that he has been diligent about it because I see his cyperprints everywhere I go. As to “medications”, I assume that you are talking about medications to control hemochromatosis, even though there are no such medicines. The only known effective treatment for hemochromatosis is blood-letting, an ancient yet proven method for dealing with my hereditary disease. Acetemetaphen is harder to avoid than both alcohol and liver since hardly anyone has taken the time to find out what that mouthful means. With any luck at all, it will turn out to be another B-vitamin. With regard to avoiding alcohol, every person on the planet would benefit from avoiding alcohol, not just those of us who have livers at risk because of excess iron

2. Foods containing calcium such as cottage cheese, yogurt, carrots, etc are great for slowing down iron absorbtion.

If by “absorbtion” you mean “absorption” I whole-heartedly concur. It would seem reasonable that if you are hammering down vast quantities of dairy products and vegetables there is not going to be a whole lot of room left for red meat. Calcium should be on the menu anyway for old geezers like ourselves. We wouldn’t want to die of “SpoungeBob” disease before some hereditary infirmity carried us off to an open-pit iron mine in northern Minnesota.

3. Too much iron in the liver is worsened with booze.

As it turns out the reverse to also true; too much iron in the booze brings a whole new meaning to “hard liquor”. I have not consumed any alcohol of any kind in fifty years. That is one of the reasons that hereditary hemochromatosis has not had its way with me.

4. Drinks that have tannins work very well also. Black tea and my favorite, green tea are very helpful. Most herb teas do not contain tannins.

Well, “Dr. W.Pat”, as it turns out there are problems with the tannins and their kin that appear in black and green teas. For all of the benefits that might come with regard to inhibiting iron absorption, there are serious liabilities such that I would never recommend the drinking of these teas that you suggest. Why compound your health issues?

5. Vitamin C enhances the absorption of iron. It is wise only to consume a moderate amount and not take Vitamin C tablets. Vitamin C has been known to precipitate heart palpitations in those with hemochromatosis.

I agree. This is a precept that I have been pounding into the heads of my readers for months. Hopefully, your “coffin-nail” comment will cause them to swear off this malignant vitamin and we can all enjoy a good dose of scurvy.

6. The ingestion of black tea has been shown to decrease the absorption of iron. African tea which is becoming popular may contain iron so too much should not be consumed.Patients with hemochromatosis should not take supplements unless there are documented deficiencies.

There appears to be an echo in this rhetoric. See paragraph #4. With regard to African tea, EVERYTHING CONTAINS IRON AND SO TOO MUCH SHOULD NOT BE CONSUMED! If everyone would follow that advice, we would have less obesity in this country.

7. In severe HH the disorder manifests as potentially life threatening conditions such as septicemia, cirrhosis of the liver, liver cancer, diabetes, heart failure and heart arrhythmias.

All of these conditions are side-effects and no one need worry about any of them if their ferritin levels have been brought under control in time. I have none of these ancillary disorders because my sister bugged the daylights out of me to have the blood work done and because my physician, who is as well-informed on my condition as anyone on the planet (see paragraph #1), has put me on a course of phlebotomies that has effectively brought my ferritin levels down to a moderately safe level, notwithstanding all of the fun I have been poking at him along the way. I started out with my ferritin at 826 or so and a couple of months ago, my ferritin stood at 392. My guess is that my ferritin level will be below 100 when I see him next. These intervening phlebotomies will do the trick. That and the fact that I have cut back my “wheat-dog” consumption to only six per week.

8. Hemochromatosis sufferers should drink lots of water every day to keep the blood thin for easier phlebotomies and to keep the kidneys nice and flushed out.

I drink vast amounts of water because I don’t drink vast amounts of booze. I have a Barq’s Root Beer from time to time and although it sounds like I am swilling down alcohol and caffine, it is not the case. I live in Utah, after all, and Barq’s has to tone their stuff down for us. A flushed out kidney is nice, as fresh as a spring morning.

9. For people who are diagnosed and treated early, normal life spans are possible. If left untreated, HH will lead to critical organ damage and most likely death.

Anyone who knows me is aware that there is nothing normal about me. I am the personification of abnormality, notwithstanding the diagnosis and the treatment of my genetic condition. My paternal grandfather lived into his mid-90s; my maternal grandmother lived to be 101. I don’t think that I am going anywhere soon unless I am taken out by some booze-soaked, red-meat-eating barbarian from California who decides to cross the median on I-15 while I am on my way to the store to pick up an extra gallon of fish oil. As to the death benefit, as far as I can tell, that eventuality is going to transpire no matter what we do. Embrace the fact!

10. You can find lots of real life tips from Pat at his blog:

No doubt, but what you will not find is my kind of humor. The only kind of “real life tips” that I might provide will be cooking on the barbeque as soon as the snow melts. Come on up, “W.Pat”, my tri-tip steaks are to die for…. literally.

11. Http://ironoverload.info

There is the web-site. Go in peace.

Looking for Iron in All the Wrong PLaces

The last three weeks have been boring. Boring! Boring! Boring! But boring can be good, as you are about to discover for yourself.

My usual cast of characters are in retirement, or at least in a state of grace. Barnacle Raff and I have not been biking for about three months. He says that it has something to do with the enormous snowfalls that we have had this winter. I think it has to do with the number of times he has had to carry my limp and unconscious body to the stoop. The Krrrrakin has told Medicare that all of my bones have been properly arranged and that I need not return, on pain of death. The boys and girls at the Infusion Center have boarded up the doors and windows of their office so that no one taller than five foot eleven can get into the place. That's okay, I really don't have to storm the castle for another three weeks. Doc Holliday said that if I showed up at his establishment before the 15th of April he would issue a restraining order. That is about the time I was planning on going there in any event, so no harm no foul. So the fodder for my verbal cannon is out of range, insofar as the medical industry is concerned. That has been the case for three weeks and will continue for another three weeks until I have another pint drawn.

My daily bouts with the computer have continued, however, and I am well along in my writing, finishing one book, starting another, and plowing through the second half of a third. For those of you who are interested in philately (in sixty-six years I have only met three people so afflicted), I have managed to mount more than 43,000 of my little pieces of colored paper, 41K in the last three weeks. I think that I have the materials for an obsession here. TG2 and I have continued to beat the daylights out of each other at the Rec Center. Yesterday Jen said that she had never seen me move as fast as I did playing. I think that I have become a little more agile with less iron.

Not having my ferritin levels checked for a while has made me a little nervous about what I eat. Trillium and I have only been to a restaurant two times in three weeks. We had lunch at Cafe Rio and, in the spirit of living dangerously, I had a chicken tostada. Later, we went to Subway and I plunged into the iron-acquisition mode by ordering a 6-inch Subway Club. The turkey and roast beef were cut "bridal-veil" thin so that with all of the rabbit food on the bun I suspect that not much in the way of hard iron really made it into my system. At home I indulged myself in a new culinary delight by having a tin of lemon-pepper kipper snacks. I am certain that there is a joke in this, but for the life of me I can't think of one.

As to our experience with Comcast, I should probably give you an up-date. After the first fellow came and complained bitterly about my splitters and all, he assured me that someone would be out to fix the problem on the pole. I waited three weeks for an improvement. None came. I called the service number provided and had a chat with "Jake" who said that he would put two of his specialists on it right away. Dispatch called a couple of hours later to tell me that I did not need two specialists, only one. I said that I had entertained two already, separately, one for the house and one for the pole, and there had been no improvement. She basically then called "Jake" a liar by saying that they never send two technicians at a time to the same house. I told her that I had a blog about this sort of thing that was being read by hundreds of people in over twenty nations and that she was fast entering into my range of verbal fire. The house technician showed up soon thereafter to discover what had been discovered three weeks earlier; the pole technician showed up the same day and did what he had failed to do three weeks earlier. The internet seems to be fine now. So..... on to sweating iron.

Apparently it is possible to sweat iron. I include below a clip taken from the Palo Alto Medical Foundation site which seems to be moderately well-informed.

Iron and your body

Iron is an essential mineral in the human body playing an important role in many different types of cells and proteins. The adult body contains 3-4 grams of iron. The majority of this, approximately 2.5 grams, is circulating in the blood as part of the oxygen-carrying protein hemoglobin which is present in red blood cells. One gram of iron is found in tissues as part of the iron storage protein ferritin; most of this extra iron is stored in the liver. Other iron-containing proteins and enzymes that use iron as part of chemical reactions in tissues account for approximately 400 mg of additional iron. A smaller amount of iron is circulating in blood plasma bound to an iron carrying protein known as transferrin. This protein combines with iron that has been absorbed from intestinal cells and carries it to the cells that need it. Cells signal their need for iron by placing receptors for transferrin receptors on their surface. Another protein called HFE is involved in regulating the amount of iron that is absorbed from the intestine and then distributed throughout the body. In hereditary hemochromatosis excess iron is absorbed for unclear reasons, and the most common genetic mutations leading to hereditary hemochromatosis are in this HFE gene.

Iron enters and leaves the body in several ways. The average western daily diet contains 15-25 milligrams of iron of which ten to twenty percent is absorbed. Additional iron may be obtained from vitamin supplements or blood transfusions. The primary location for the absorption of iron is the first part of the small intestine (duodenum). Iron is lost from the body slowly by several different mechanisms. Sweat carries a small amount of iron with it, and loss of aged cells from the skin, digestive tract and urinary tract account for about 1 mg of iron loss per day. Menstrual bleeding results in a small amount of continued blood loss in pre-menopausal women. Small amounts of iron may also be lost in blood from the digestive tract, for example from stomach irritation or colon polyps.

Now don't you feel learned? I discovered another article in the American Journal of Clinical Nutrition that proposed that sitting in a sauna for extended periods of time (about an hour or so) would bring about iron reduction through sweat, on average about 50 nano-grams per liter of sweat. I don't know about you, but I am concerned about the boys at AJCN. Who thought this study up? (To be fair, Doctors Brune, Magnussen, Perssen, and Halberg, Swedes all.) Where did they get the money? (Since the article was written in 1986 by a pack of Swedes, it is unlikely that we will be able to blame the Obama administration. Although.....) How did they convince 11 people to spend 60 minutes stewing in a Swedish bath? (My guess is that they simply invited seven of their friends over to the house.) Who did they persuade to shovel out all of the liquid iron from the sauna? (Probably a graduate assistant; been there, done that.) And what did they do with all of the results of their study? (It is probably in the same place that the German scholars stored their thirty-foot pile of dead human skin cells. See an earlier blog entry on this study. On second thought, don't see the earlier blog on this study. Once is enough).

Wasn't that worth the wait? Aren't you glad that my daughter asked that fateful question, "Dad, can you sweat iron?" I know that I am glad. Now I think I am going to mess with my music list.

Sweating Cannonballs

About twice a week TG2 and I go to the Orem Rec Center to play racquetball. Both of us are trying to lose weight and we think that by vigorously exercising for an hour or two a week we will be the Biggest Losers. To date I have gained three pounds. I have no idea where it is coming from. The up side is, however, that I may very well be dropping my ferritin level by playing.

On our way back home Monday TG2 asked, "Hey! Can you sweat iron?"

"What?"

"I said, 'Can you sweat iron?' Kind of like sweating bullets".

Being a clever sort, I replied, "Actually, bullets are typically made of lead and brass; not much iron in them. I suppose that I could sweat cannonballs, if it were possible to perspire the iron out of my body." Being a dutiful father, I decided to find out just what the relationship was between sweat and iron-overloading.

I went on-line this morning, or at least tried to. We have been having trouble with Comcast's feed to us. I called their service center last week and a fellow came out to check our system. He tried to tell me that it was because of the 437 splitters that I have on my house lines that my signal wasn't working properly. He also testified that the splitters I was using were not especially for the internet and therefore would not serve. I told him that I had put that system together over two years ago and did not begin having any problems until a few weeks ago. He became very quiet. He went about his business which took him out to our phone/cable box at the southeast corner of the house. From there he made his way through the snow to the box in my neighbor's yard and from there to the pole on the fence line that holds the main lines high in the sub-freezing winter winds of Utah Valley. After a few minutes the technician returned to inform me that the problem was probably due to some antiquated connectors on the pole and that in a day or two someone would come out to our place and change the divider out so our signal would be proper. He left and we have not heard from Comcast since. What does this mean?

What it means is that when I went on-line this morning to look up the connection between "sweat" and "iron", I discovered that there was no connection between me and the server. The net result in all of this is that I am going to have to make up something. My guess is that exuding iron molecules while playing racquetball is probably not possible. Would I not come back from the Rec Center looking like I had just rolled around in the dirt in St. George? What is true, is that I look like I should be put under the dirt when I come back from the Rec Center.

I have decided, however, that I did deplete some of my iron-overload last Monday as a product of TG2's mad racquetball skills. The first iron loss took place as the result of a rather magnificent volley early in the first game. TG2, mustering all of her strength, leaped for a fast ball that was sliding by my left side. She whacked me and the ball at the same time. She hit me on the thumb-knuckle of my left hand, scraping off three or four million skin cells with that singular blow. Iron loss! I also had immediate subcutaneous bleeding that eventually decorated my hand in various shades of puke-green and yellow. I would like to think that that event constituted a mini-phlebotomy, but alas it was not to be; the bruise was simply absorbed by my pancreas.

Mid-way through the second game (I was now playing with my right hand), TG2 made another one of her magnificent grand slams, accelerating the ball to a speed approaching Mach 4. The ball hit me in the middle of the back of my head, bounced off the ceiling, ricocheted off three walls and eventually came to rest in a corner where it lay smouldering. TG2 was laughing hysterically. I was trying to figure out what all of the skinny brown snow was drifting about the court. It was my hair! Another massive iron-depletion!

We finished the third game and began the trip home. This, as you will remember, was when she asked the question about sweating bullets. My left foot started to pain me some and by the time I reached Star Gazers Point I felt the need to pull off my shoe to see what was going on. By the look of things, I was again the victim of another of TG2's athletic skills. At some point she must have stepped on my foot, squashing the pinky toe. It was all red and the nail looked like it was ready to fall off. Hooray! More major iron loss!

For those of you hoping for something more insightful, I apologize. I had hoped to be more insightful, I really wanted to be more informative, but Comcast is the culprit. I know that out there somewhere is some hemochromatosis scholar who is on the cusp of discovering the connection between the second sweat gland behind everyone's right earlobe and iron overloading. Oh happy day! But not today.

Two Notable Iron Reductions

This week I had two major iron-reducing procedures. The first was my regular phlebotomy at the local Infusion Center. I was attended to by the "Pink Lady" who was jovial, to the point, and managed to analyze every joke I told. I persisted at my vain attempts at veiny humor because there was, in the three-sided cubical across from me, three or four people who looked like they needed cheering up. Some sort of procedure was going on over there and it wasn't a blood-letting. I don't think it was a blood-getting either. Given the rather grim countenances twenty feet away, I suspect that there was something rather serious transpiring, far more significant than the little iron-depleting exercise I was going through. The "Pink Lady", in her attempt to keep me cheerful during my soap opera with the 14-gauge needle, regaled me with the significance of all of the letters that were printed under her name on her tricked-out name tag. She had an RN degree, a Bachelor's of Nursing, and a credential of some kind that meant she was a master mechanic in all thing vascular. She told me that she needed all of that sort of book-learning in order to administer chemo-therapy, something that regularly happened at the Infusion Center. Suddenly I thought I knew what was happening across the way and why everyone was more than willing to be jollied up by my gasping humor.

While we were there, I asked the "Pink Lady" to let me know what my hemoglobin level was. Inasmuch as I was stepping outside my normal role as patient and doctoring myself by throwing in this extra phlebotomy, I thought that discretion was in order. (Actually, Trillium thought that discretion was in order, but if I gave her credit for everything I came up with, I would be truthful, but not worth very much as far as the public perception of my logical thinking skills is concerned.) My understanding is that 12-14 hemoglobin in an adult male is about right. As might be expected, my level a couple of days ago at the Center was 16 or so, high in almost anybody's book. Phlebotomies are not making me anemic.

Which brings me to micro- and macro-cytosis. My sister commented on a previous blog (and in numerous phone calls) that I might very well be afflicted with macrocytosis along with everything else (actually there isn't anything else except for the iron-overloading, but at the moment I wrote the sentence I was feeling a little sorry for myself). Again, as might be suspected, these two afflictions have to do with the size of one's blood cells, "macro-" being too big, and "micro- being too small.

I went to Wikipedia, my source for all things unknown and unknowable, and picked up the following: "Macrocytosis is the enlargement of red blood cells with near-constant haemoglobin concentration, and is defined by a mean corpuscular volume (MCV) of greater than 100 femtolitres (the precise criterion varies between laboratories)." I followed the definition for the first eight words and then blacked out until the parenthetical statement. I want to know what it all means, but I suspect that it is not worth the effort. But I did want to know in the worst way what a "femtolitre" is. Back to Wiki: "The femtolitre (US femtoliter) is the metric unit of volume equal to 10 to the power of -15 litre, or one quindecillionth (European) or one quadrillionth (American) litre. It is abbreviated fL or fl." I guess that it is kind of like a "nanosplatter", but with a less memorable name. I am now taken with the new and wonderful word "quindecillionth". Should not the federal government be thinking in these numerical terms rather than its opposite as far as the economy is concerned? But I digress...

The Mayo Clinic suggests that there are a number of reasons why a person may have contracted the condition known as macrocytosis. I will comment discretely as I present their findings.

1. Vitamin B-12 deficiency (I have no idea where I am here. I have enough trouble curtailing vitamin C and increasing my vitamin D. Besides, any vitamin having more than five varieties is too hard to keep track of.)

2. Folate deficiency (I suffer this only in the autumn when all of my leaves fall off.)

3. Liver diseases ("Doc Holliday" informs me that if my liver were any healthier I would be stalked by Hannibal Lector)

4. Alcoholism (This could have been a problem in my youth, but I switched to Vanilla Wafers made with artificial vanilla when I was 15).

5. A side effect of chemo-therapy drugs (I, thankfully, do not have to endure this, except in Trillium's van where there is a Cinnamon Air Freshener hanging from the rear-view mirror).

6. Increased blood cell regeneration (A-hah! This comes with blood-loss, whether deliberate or accidental; the bone marrow can't seem to differentiate between the two.)

The boys at the Salad-dressing Clinic have concluded that macrocytosis is not a disease, that it has no symptoms, and there is no known treatment. They will, however, take your money for.... um.... any reason at all. Isn't this fun! Now on to microcytosis!

Micro-psychosis... er .... micro-cytosis is a condition which usually shows up if you have one of the following:

1.Iron deficiency anemia (This... is.... not... my... problem;... clank!)

2. Sideroblastic anemia (I've seen this word before, somewhere, but concluded that I did not fit the profile... at least I don't think I did.)

3. lead poisoning (More heavy metals! The only lead poisoning that I can recall took place in seventh grade when Juanita Barcelona stabbed me in the back of my hand with her pencil. I probably had that coming.)

4. Peridoxine deficiency (This is the sweet name for vitamin B-6. I am no more comfortable with this than I was with vitamin B-12; B-12 is also called Cyanocobalamin for those of you with insatiable linguistic curiosity.)

Now the second iron-depleting procedure that I had this week was a hair cut. As the lovely girl from Richfield was going about her business, she said over and over "Man, you sure have a lot of hair!" I wondered if she meant that in the context of "... for a guy who is five times older than I am!". She wore out three pairs of scissors in the process. As I was leaving, the sweet young thing suggested "Perhaps, Dr. Beeblebrox, you should cut down on your B vitamins, particularly B-essemer." I looked that one up too. Bessemer vitamins are designed to reduce the amount of carbon in pig iron in order to make a higher quality steel. Apparently my follicles are taking over where Geneva Steel left off.