Today I had my second follow appointment with my doctor after leaving the hospital. He was happy with how things were going. The blood counts continue to improve and the side-effects, limited so far mainly to fatigue, and the occasional nausea and diarrhea, are typical.
I learned a few things. For example, the transplant nurse explained to me that the sources of fatigue are not particularly well understood, but that I could expect it to vary from day to day and that it could last six months, possibly even a year. I also learned that the fibrosis that was scarring my bone marrow and inhibiting blood production does not simply disappear when the old bone marrow is killed and the new develops. Rather, it disappears only slowly over time, and probably never fully. But it will be very significantly diminished and will not degenerate further. So, it will not pose any health threats.
The continued presence of the fibrosis explains why, when they performed another bone marrow biopsy today—my fourth in a year, but hey who’s counting?—they had such difficulty finding blood in my marrow. It was the familiar process of anaesthetizing the muscle tissue outside the hip bone, and then with great force puncturing the bone, causing a sharp pain from deep within that made me want to squeal, and finally turning the big firm needle this way and that way to extract a core of the marrow for laboratory study. The problem was that they didn’t only want marrow, they also wanted a sample of blood from inside the marrow. That was not to be found on the first four attempts at ramming the biopsy needle into my hip. So, they made one last courageous attempt and came up in the end with a very small sample, which they hoped would be enough. I hoped so too.
Apparently I will have to endure this a couple more time in the next year as they study the retreat of the fibrosis.
This afternoon I succumbed to the fatigue and rested on the couch. But I found myself strangely bothered. I couldn’t help but think about how contingent on good fortune my success up this point had been, how much harder it might have been, how it might not have worked at all. A thread of fortune had supported me, kept me from falling into dire circumstances. Some day that thread breaks for all of us. I couldn’t chase away these thoughts and was sufficiently exercised by them that I didn’t really sleep, or even rest all that much. So, it goes. Those were, I think, episodic thoughts. So far nothing like that has kept me up at night. And I don’t expect tonight to different.