Day +12

Hemoglobin is one of the components of red blood. It has the important role of transporting oxygen, which is why people who are anemic experience fatigue. In adult men the normal range for hemoglobin is 13.5-17.5 g/dl; in women it’s 12-16 g/dl. For several years I have lived with hemoglobin counts in the 10s, which is classified as mild anemia. I used to say that I simply lived at a higher altitude than everyone else. The fall in my counts had been gradual over several years—an early indication of myelofibrosis—and it didn’t affect my life in any significant way. Exercise and a busy lifestyle were still possible. More than that, I had the benefit of a ready excuse to offer BF and MF should I fall asleep while watching a movie! Before being admitted to the hospital my hemoglobin count was in the 8-9 g/dl range, which is moderate anemia. On Sunday my count had fallen to 6.8 g/dl, severe anemia. The transfusion later that day resulted in a count yesterday of 7.8 g/dl, still severe but much easier to handle. That gave me enough energy to both ride the bike and lift weights. Today the count had fallen to 7.2. g/dl. And all I could muster was 15 minutes on the bike. I will probably have another red transfusion tomorrow.

One symptom occasionally experienced by people with anemia is pica, the urge to eat unusual things, like ice, clay, cardboard, crunchy foods, or raw starch. Fortunately I have never had that! But I find that when my counts fall into the 8s, I am more easily cold. So, I’ve been chilly and fatigued today. It’s just the afternoon and I’ve already taken two naps under the covers of nearly an hour each.

The fatigue is augmented, I think, by an antihistamine that I took to deal with itchiness. It’s not clear whether I’m itchy as a side-effect of one of the many medications I take or as a result of the chemo induced dry skin. But the sensation has gotten progressively worse. Strangely, there is no rash just the itchy feeling on my forearms, shoulders, back, chest, and ankles. I think that I have fairly high pain threshold, but my itchy threshold is low! I can’t hold out long without scratching. And as amazingly satisfying as a good scratch can be to a persistent itch, it typically does not have a lasting effect. As soon as the scratching stops the itch is back, sometimes even stronger. The cycle can be vicious. The scratching itself becomes a problem; the skin gets red and then raw. In the Gorgias (494c) Socrates asks Callicles whether a man who has an itch and wants to scratch it, can pass his life happily in continual scratching. I’m here to testify that he most certainly cannot.

During the day it’s easier to get distracted by the other things and not notice the pin pricking itchiness. But at night in bed it’s much harder. I woke up this morning with red patches on my right arm, presumably due to nighttime scratching. So, today the nurse prescribed an antihistamine, which has conspired with my anemia to leave me especially fatigued.

The last three or so days I have been suffering from another odd and unexplained side-effect. The hiccups. I hate the hiccups almost as much as I hate being itchy! These are severe enough to incapacitate me when they are especially intense. They come in waves, and it feels like the release of gastric pressure in my lower throat and upper gut. Sometimes they are strong enough to hurt mildly. And every now and then they also trigger additional pain in my sore throat. But on the whole they are much more a nuisance than a cause of pain. The doctor tells me that they are not uncommon in patients in the transplant ward, but that they do not know what causes them. There is some medication that I can take that should help. I plan on doing that. I have no intention of being a hiccup hero.

It could be worse. The pain is not bad. I don’t have a fever. And I don’t have nausea or diarrhea any longer. I’m not miserable, just somewhat uncomfortable.

The oncological psychotherapist just stopped by with two ice cream bars. This is going to be a good evening!

Day +13

Day +11