T + 428 Keep Working the Jab (PG)

Rated PG for pictures of warts on my.......toe.

I went to the transplant clinic this morning and was seen by the same consultant as last time. Overall things were fairly routine and we are going to reduce my prednisone steroid dose from 5mg one day and 2.5mg the next to just 2.5mg every day.

I've been here before, briefly, but at the time I didn't have the extra support from the hydrocortisone and fludrocortisone so my adrenals crashed and burned and I was in a bit of a state ( plus I then got a viral infection of some kind. ) Hopefully this time round I should keep reasonable energy levels as I taper down my steroid dose.

I mentioned in passing that I had got a wart or verruca on my big toe as I wanted to check if it was ok to use over the counter remedies to try and get rid of it. The doc said this was very common in transplant patients. Verrucas are caused by a virus, we many of us get them as kids and then we develop antibodies and probably never see them again. However my immune system needs to learn all about them again. He did say some people get some quite "florid" infections of them. ( As an aside that is a lovely multi-purpose use of the word "florid" which my dictionary application defines as :-

1 having a red or flushed complexion : a stout man with a florid face.2 elaborately or excessively intricate or complicated : florid operatic-style music was out.3(of language) using unusual words or complicated rhetorical constructions : the florid prose of the nineteenth century.4 Medicine (of a disease or its manifestations) occurring in a fully developed form : florid symptoms of psychiatric disorder.
He said I was ok to use over the counter-meds but that they can take ages to get rid off. It's been a while since we have had any gruesome pics so I knew you'd appreciate seeing my big toe.
At least I'm not going swimming so I don't have to wear those strange little socks you used to have to wear as a kid. They now seem remarkably prescient forerunners of the modern sneaker-sock, back then they were weird now they are fashionable albeit for a different purpose.
It does sometimes feel like I end up treating these consultations like a session with my GP but I have learnt that there can be all sorts of things that might seem irrelevant, unrelated or unaffected by my treatment that actually do need to be checked. The use of over the counter medicines is one of them.
Last time I saw the doc I had some problems with shoulder and elbow twinges but I am pleased to report they have died down now.
My blood counts were basically ok though my haemoglobin had fallen to 10.4 from just under 12 last time. The doc said it can do that from time to time and indeed this had happened with me over the last few months even though I'd not needed a transplant since March. I certainly haven't been feeling too bad and have been able to go for walks at lunchtime etc. so hopefully its not too serious and the trend reverses. It is something they will keep an eye on over the coming weeks.
He then said that my red cells had been getting bigger over the last few tests. A little puzzled at his wording of cells getting bigger when my count was dropping I asked him what he meant by bigger. Turns out he meant exactly what it says on the tin. My red cells are getting physically bigger in volume. One of the measurements they do is the average red cell volume and this has been getting bigger. This is actually a sign of immature red cells and could be caused by breaking them down too quickly or having a shortage of vitamin B12.

The effects of a lack of vitamin B12 are sometimes known as pernicious anaemia and can be caused either by a lack of B12 in the diet or the inability to take up and process B12 caused by a lack of "intrinsic factor" in the gut. B12 is found in eggs, meat and especially liver. It is also found in Marmite which might go some way to explaining a recent phenomena I have experienced. More of which anon.

The doc ordered a blood test to check for B12 levels and a couple of other things and I'll get the results when I go back in 2 weeks' time.

The doc was also able to give me the haematology department's official line on swine flu and regular flu vaccinations. Namely a letter is being sent to all patients and I should get the jabs ( though they may not work because my immune system is depressed ) and any "household contacts" should get the jab too. With that in mind I am getting my jabs on Monday and Gareth is getting his tomorrow.

So, the Marmite thing....well I have always been in the "I hate marmite camp" however the other day I was "persuaded" to try first a Marmite flavoured crisp and then some of the actual "evil" stuff itself. Turns out I now like Marmite. At the time I jokingly put it down to some weird effect of my donor's immune system or maybe my suppressed immune system couldn't raise a response against the "poison".

However Marmite is a good source of B12 so I just wonder if my body somehow knows what it needs, bit like pregnant women supposedly do with cravings. (Despite appearances to the contrary, by the way, I am pretty sure I am not pregnant ).

Liver is also a good source of B12 so it is a great excuse to have liver, bacon and onions for dinner one evening.


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