Saturday, 6 August 2011

Dr Choccy and The Loris (Anaemia Saga) part 2: The case of the disappearing Goblins

Well now, I promised the next instalment of the Dr Choccy and the Loris (Anaemia Saga) did I not?

OK, so in part 1 we learned that the GP I saw was as useful as a....
Yes, that's right, a Chocolate Teapot!
© Dave Ansell, The Naked Scientists

Just very quietly. ;)

In this part, Part the Second, I'm going to give you the low-down on the kind of anaemia (<-- this is the proper spelling, by the way) I had, namely, Iron-Deficiency Anaemia - that was caused by the Bloody Nightmare... We shall enter into the wonderful world of Loris Land, whereupon we shall find Haemo Goblins, Myo Goblins, Ferrets, Corpus Kewls, the Claret Corps and Oxygen; and we will maybe learn a bit about what makes even the teensiest parts of our Mortal Coils so utterly amazing (and THIS is why God is just so very, very worthy of our praise!).

pseudoTaxon. Genus. Goblinus, species haemo
Vernacular: Haemo Goblins
©The Loris, 2011
One fine day in Loris Land there was a sudden upset when it was discovered that some wayward Ferrets had had a major falling out with some of the Goblins, resulting in them no longer hanging out together and this FeGang even stopped more Ferrets arriving. The row started with the Haemo Goblins and, as the Ferrets disappeared, some of the Haemo Goblins either withered away or wandered evermore aimlessly along various highways on the sixty-thousand mile round-trip through the capillaries, veins and arteries of Loris Land .

Could these be the Ferrets what have caused a lot of the problems...?
The monstrous FeGang?
picture © Larissa Allen, 2008

pseudoTaxon. Genus. Goblinus, species myo
Vernacular: Myo Goblins
NB This is an oversized Myo Goblin, in his hydration shell
©The Loris, 2011
“Oh, dear, look at those poor Haemos. The Ferrets really have messed about this time. So glad that we are getting no trouble from the FeGang!” Crowed some of the Myo Goblins, who liked to hang out in the striated plains of the Loris’s muscles (obviously these were not lush plains).  But the bothersome FeGang had not finished wreaking their havoc so they stopped co-operating with the Myo Goblins too.

Eventually some of the Haemo Goblins packed up their protenaceous homes and left their Corpus Kewls for good. It was not long before the Myo Goblins did the same. Thus the dreaded Anaemia set in. It had been shooting threatening glances at Loris Land since the Bloody Nightmare began, but now, with the Myo Goblins leaching, the Loris faded fast. 

The remaining Corpus Kewls in the Claret Corps were really struggling to keep up the O2 deliveries. They were not amused at Wombwall’s extravagant demands, and were really rather furious with the Racemate known as Farrawin, who was responsible for masterminding those demands. All was not peace in Loris Land.

A few days later a Wampyr took some of the Claret Corps to one side and sent them off for tests at the Lab. At last the extent of the troublesome FeGang’s damages and deeds were exposed and the Loris was sent to The Hospital, where she was told that reinforcements were on their way to Loris Land.

Sure enough, a few days later, Loris Land was happy to welcome the arrival of some fresh-faced, better-behaved and much more friendly Ferrets and two whole new Companies of the Claret Corps (these guys were donated by an Unknown Wayfaring Stranger to whom TL sends a great many thanks - thanks were sent via Jesus, OK?). Things were most definitely looking much brighter in Loris Land. And the Loris could at last breathe a proper sigh of relief and a prayer of gratitude! 

The End.

Or, for those of you with less of a penchant for the slightly more random, visual or imagination-provoking explanations, well, OK, the slightly more succinct, medical, explanation follows for you miserable Grown-Ups out there (I know there are some "out there, somewhere"). ;]

****Disclaimery bit****
All of the information I'm about to mention regarding ANY of the medical stuff is what I already know from gleanings over the decades... If you have concerns for your own health go to your GP. :) If you have concerns for mine, well, what can I say? Save up to buy me some land so I can build a house on it and have you all round for tea....
****end of disclaimery bit****

"Anaemia" means (translating literally from the Greek) "lack of blood". This translates practically into either less red blood cells ("RBCs") in the blood stream, or less Haemoglobin (Hb) in the RBCs  which then means that the blood is no longer functioning efficiently. The reduction in available Hb  (either through there being less cells or just less Hb itself) means that there is less Oxygen (O) being picked up in the lungs and delivered to the body. (Hb is the substance that oxygen molecules bind to in the RBCs in a wonderfully complex and co-operative manner - I'll spare you the very complicated chemistry, but it's important to understand where the iron fits in and why a lack of it can cause anaemia. 

Haemoglobin is a large, complex protein. It has a quaternary structure (which sort of means it's got four levels of complexity - first, the primary structure is the chain of atoms that make the protein, the secondary structure forms as the hydrogen bonds start linking and cause the whole molecule to coil, the tertiary structure of haemoglobin is determined by the haem molecule, that is to say, a protein with the iron in it, and the fourth level, the quaternary structure of Hb molecules is that, like other massive proteins like this, there are four coils - formed from alpha and beta chains, there are two alphas and two betas, but that is enough for my brain...)

Instead, here's a lovely picture of one of the four globs of haemoglobin, carrying oxygen, by Dr Anna Tanczos at the University of Surrey)

Hb molecule with the haem group
(protein in green, Iron, (Fe) molecule in red) carrying O2 (in blue)
© Anna Tanczos @ University of Surrey

Iron is a key factor (let's call it an 'ingredient') that goes into the making of haemoglobin, so a lack of iron availability in the body can cause the kinds of crises like anaemia to really knock a person for six. 

By now, the haem-less RBCs are no longer picking up oxygen and less oxygen eventually means less energy →  breathlessness → fluid retention → increased heart rate → exhaustion, and in my experience, quite a lot of pain as the muscles start  to work anaerobically (without oxygen) which causes an increase in lactic acid production and can cause cramps or just stop the muscles moving altogether. It is not pleasant.

Unit 1 of 2  of the Claret Corps
©The Loris, 2011
Treatment is fairly simple really – normally it’s either to get more Red Blood cells in or top up the Iron levels with i.v. iron. In my cause it was a combination of low Hb and low Fe that meant this time I had two pints of Claret and a bag of rusty nails (oops, a bag of iron – in saline) to kickstart the system.

The somewhat *coughexciting(alarming) *cough* experience is recorded fully in Part the Third, which is coming up in the next post. :)

 Take care, and remember to eat your greens (except do not eat people called "Green" for that is wrong. That is cannibalism and very, very naughty)!




Friday, 5 August 2011

Dr Choccy and The Loris (Anaemia Saga) part 1: The GP*

It would seem that Barney has sneaked online whilst I was recovering. Well I must say, first of all, that I am very impressed by Dave's ability to not only retain all that information but to relay it to the Barnster too. Such intelligent friends I have...

I think we are, by now, well aware of the fact that the life of the Loris never runs smoothly. And so it was with the most recent of episodes at one's Chelsea residence. It all began with what can only be described as a fothermucker of an horrendous haemorrhagic period lasting 10 days (see references to it in my blog post about the ENO Summer Celebration in June) and causing me to become utterly devoid of energy, to the point where I could hardly walk across the lounge to the kitchen, and making a cup of tea utterly wiped me out for hours. Seriously, it was awful.

After 10 days had passed and nothing seemed to be slowing down I made an appointment with the GP. I said I didn't care which of the doctors at the practice I saw as long as it was soon. I got an appointment for 3 days' time. So, the day arrived, got up and... guess what? Everything had stopped. I couldn't believe it! I know I'd been praying for it to stop, but... on the day I went to get it checked out?!? Seriously?! Lord, my body hoofs me off at times! What ensued, herein disclosed, all but eclipsed the previous ten days' bloody nightmare...

Went in to see the doctor (The Chocolate Teapot**, "Dr Choccy") and when I explained what had been happening over the last week and a half, things started to go downhill immediately:

Dr Choccy: Morning. What can we do for you today, [Loris]?
Loris: Hi. Well, I had a very heavy bleed. It's been horrific (goes into a small amount of detail) and I wondered whe... but she stops speaking after 40 seconds as Dr Choccy seems to either be suffering a stroke or... oh, no, no.. he's just yawning.
Dr Choccy: Er, what? hmm, yes, that can happen on Warfarin. How long have you been on Warfarin now, only a few months isn't it?
Loris: Er, no, fourteen, approaching 15, years...
Dr Choccy: oh... um.. has this ever happened before?
Loris: yes, but this is the worst that it has ever been, which is why I'm here - because I am concerned by it. I'm completely exhausted and wonder whether I might be anaemic (this was the giveaway clue to wake him up)? I'm really breathless, even when sitting down. Could it be my haemoglobin count dropping? Or my Iron counts? (the Loris really was trying to give him a chance to demonstrate his doctoring prowess...)
Dr Choccy: does not react. [Oh dear.]
After some moments...

Dr Choccy: yes, well, you were meant to be getting the [Chelsea pad] to write to me, as we still don't know anything about you. Can you do that please? Oh and get their psych' team to refer to our local mental health team about your depression as it'll be quicker than if I do it.
Loris: er, what, even for a patient that has documented suicidal thoughts and plans?
Dr Choccy: *SILENCE*
Loris: And what about this exhaustion and breathlessness? Could it be anaemia? (At this point the Loris pinches herself to see if this is some terrible dream. "Ow!" Nope. He really is stupid.)
Dr Choccy: Oh, yes, what drugs are you on, again? (He spins round to his trusty PC perhaps he's looking up the word 'anaemia' on A LOT of scrolling on the screen for my so-called non-existant notes later and the Doc chirrups:
Dr Choccy: what's this Amiodarone for?
The Loris, looking somewhat taken aback, incredulous, stunned, alarmed and irate at one and the same time manages to profer (through gritted teeth): For my arrhythmias. 
Dr Choccy: Ah, this is what you started on recently?
Loris: NO! I have been on those for 15 years, too...
Dr Choccy: Oh. Right. So why are you getting...oh yes. Right.
Dr Choccy: *tippety tappity at the PC with back to patient. SILENCE*
Dr Choccy's stance and lack of further utterances indicates to the Loris that his brain is now spent for the day. Which makes her feel bad for all the other patients, since it is only 11am...
Loris: OK, bye.
Loris exits consulting room door and a large sigh is heard issuing forth from her tired and struggling lungs. "The dumb-lazy-arsed BASTID", thought she, unto herself.

This was not a good day for the little Loris, who was by now utterly exhausted because her heart rate had increased considerably and she was now also trying to cross a busy road in order to get the bus home. She actually wanted to cry but didn't have the energy to!

Once back in the flat the Inked Eskimo saw all was not well and fixed a vat of tea and fed this Loris giant cookies, listening all the while to the ridiculous experience that had just sapped me clean out of energy and all desire to ever seek medical attention again.

However, I knew that I was not well and fading more by the hour, so I contacted one of the Nurse Specialists - called Diddy Di - at the hospital and arranged to have a full set of bloods taken when I went in for a regular INR check.

The next day the news was not great:

Diddy: Oh my gawd! You are very, very, very, very anaemic darlin'. I think we'll need to get you in for some iron top-up and quite possibly some blood. No wonder you feel like crap! You sound awful.
Loris: I bloody knew it. Stupid Dr Choccy, the Chocolate Fireguard. *FIZZ*

The next day Diddy called to say that a bed with my name on it was arranged for the Friday. Huzzah! I knew that in a few days I should start to feel a bazillion times better.

--- The Loris's experience in the hospital is reserved for the next post (it'll be worth the wait, trust me) ---

When I came off the phone from talking with Diddy, I was so relieved that I didn't feel so breathless for a moment - for the first time in a week I was actually able to yawn! I was trying to ignore the rising anger at the crap GP I'd seen. For a fairly young doc I would rate him as utterly devoid of focus, disinterested in both patient and post and just plain lazy. If he was 70 and long overdue his retirement I could understand (it still wouldn't be right, but I would understand), but he's not. Grrrrrr.

Now, I fully appreciate the fact that some doctors might find it difficult to deal with patients that either do some research about their symptoms (and self-diagnosing is always a dodgy thing) or actually know more than they do but it is no excuse to not listen, because maybe, when you, dear doctor, listen to what the (pesky) patient is saying you will learn something. It is my unwavering and constantly voiced opinion that doctors, and especially GPs, should endeavour to gain a full picture of each of their patients, so that they are aware of the circumstances surrounding certain of the health, lifestyle, cultural and maybe even religious factors impacting their life. It would be amazing if hospital consultants would also take the time to do this, too, but sadly such consults are few and far between...

So, this little Loris will not be making appointments with Dr Choccy the Chocolate Teapot again any time soon. She hopes other GPs at the practice are more competent... (But she's not holding her breath.)

Hospital escapades up next...

The Loris

* The "Part 1" in the title is there because there are many versions of 'Dr Choccy' in the realm of the Loris. Sadly. :(

© Dave Ansell, The Naked Scientists

**as you might expect of the Loris by now,she does like to be sure of the science to back up her rantings. She knows a thing or two about chocolate and heat, but if you don't believe her, then The Naked Scientists (heroes of the Loris) will show you just how useless a chocolate teapot is...