9-14-10 Tuesday              

Status: 9.0/10.  Being normal again, drove to the post office, attended a meeting at Rachel’s new high school (she’s loving it), helped with dinner.

Events:  Already scheduled the first of next week for the first evaluation tests (repeat of what I’ve done before), including EKG, echocardiogram, lumbar puncture, and bone marrow.  I’m going to try to enjoy this Hopkins- (and puncture-) free week.  And relating to punctures, as promised some of Lisa’s suggested topics.

Comments:  When they pulled my Hickman catheter because of sepsis (you don’t want to be trying to treat a bloodstream infection while a piece of plastic is in one of your major veins) they had to resort to needlesticks for all of my blood work.  And given my low platelets, those sticks left some hefty bruises, what a doctor might call a subcutaneous hematoma (literally, below the skin blood swelling).

  As you all know, at first the bruise is bluish-purple, and then goes through stages of fading (and expanding) from green to yellow.  The bruise is no more blue than the blood in your veins is blue.  Blood under the skin looks that way because the red portion of the spectrum is absorbed going through the skin.  But why does it change colors after that?  And where does the bruise go?

The answer again is those fabulous white cells.  One type are called macrophages (literally, big eater).  They are the scavengers, trash collectors, and green-leaning enviromentalists of the immune system. Their job is to clean up the debris after any recognized disorderly conduct (infection, outpouring of blood, or what have you).  Encountering blood cells AWOL from the vascular system, they help break down the hemoglobin.  The heme portion of the hemoglobin molecule, which snugly cradles the iron in each molecule, is converted to biliverdin, which you might guess from its name is green (the blue to green evolution) and then converted to bilirubin, which is yellow (the green to yellow), and the bilirubin is transported to the liver and excreted in the bile (the disappearance of the bruise).

What interested Lisa was that my needlestick bruises stayed much longer than you’d imagine and remained blue.  The reason?  I had no white cells and thus no macrophages to break down the errant blood.  The bruises remained that way until my white cell count came back up, then they went through their color evolution and disappearance rather rapidly.

Tomorrow – nails are just extensions of the skin, and I have 10 fingers to prove it.

Love,

-Bruce

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5 Responses to “”

  1. wendy Says:

    OK… SO this is the time to leave a lasting impression of how good you feel.. cause as you know things do change in the near future…so HOLD ON to this as a lasting impression of where things can return to…and take those meds…

  2. Margot Says:

    OK – so I had just recently hear that your blood was actually blue – so I thought we had a world of all blue bloods! If not blue – what color is it – I thought it turned red when it hit the air? Need more education please!
    Have been spreading the word about benadryl and now am getting questions about prescription allergy meds.
    Let me know when you are back in the business of giving personal consultations at a friends and family rate! Your expertise is missed!
    Have great Hopkins free week! So glad Rachel is loving it!

  3. Henry Miller Says:

    Your blog entry today is a good illustration of why you should consider turning these experiences, musings and explications into a book one of these days. It’s fascinating stuff, and you tell it so eloquently.

  4. Bill Schaffner Says:

    Bruce:
    Continue to be delighted that you are doing well – love to hear about your everyday activities. Mundane never sounded so marvelous!
    Also enjoy reading your explanations – so clear, so logical. Continue to hope you will consider putting together a handbook of these to be used by both family members (and patients) directly as well as by medical students, houseofficers and attendings to help them explain stuff to patients and family members.
    Cheer,
    Bill

  5. sharon McDonnell Says:

    Hi there,
    Delighted to hear the lighter tone. It is amazing how good normal or routine can feel when you take off the thumbscrews.

    I wanted to let you know that I …ummmmm…. “dedicated” my blogpost to you last night. I sent you note via email as well because I am not sure if wordpress will allow me to send a link.

    http://gaybumgarnerimages.blogspot.com/2010/09/making-newspbs-newshour-and-effects-of.html

    Why did I dedicate it to you? Because whenever you came to teach my class at Dartmouth you always made fun of my viewing habits as being so far from the mainstream. Me, not mainstream, what a surprise eh? So, this has resulted in little notes of support via email from people telling me that they too watch PBS. Its almost a movement.

    In keeping with my belief that laughter and pre-laughter states are important adjuncts to medical therapy I will be sending you a CD. It is our best shot at a little collection that we hope you will like and that will have the desired physiological effect.

    Sharon

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