D+28 — Blood, Breath, and Bone

(Friday)

Lauren left Wednesday morning, and my mom came in Wednesday evening, the final leg of the Seeley Family Relay — dad, Lauren, mom, each coming in from the Boston area.

On Friday, my mom and I drove up for a bunch of tests: blood work, pulmonary function, and a bone marrow biopsy.

I check in at the clinic, and they send me to Apheresis for my blood work. When I get there, they say I have to go to Phlebotomy. (Apheresis draws from my lines, Phlebotomy from my arm.) The first clinic blood draw was faulty, because they drew from my line and got invalid Prograf levels. The second time I had blood drawn, I was sent to Apheresis and then (correctly) redirected to Phlebotomy. The Prograf level was measured fine, but they had to redraw for some other tests because a sample clotted. Anyway, I go off to Phlebotomy without a fuss. Maybe the third time will be the charm.

When I arrive at Phlebotomy, the clerk tells me I need to have my blood drawn at Apheresis.  I tell her I'm sure I am supposed to have the blood drawn from my arm, and she accepts that. (There's no downside to the arm stick, except the arm stick, whereas drawing from the line can distort test results.)

Once I'm in the Phlebotomy bloodletting room, I start reading the appointment sheet I was handed when I checked in. There's a note saying, "Blood must be drawn at Apheresis!", so I start to doubt my decision to insist on Phletobomy. I page my doctor, who (as always) calls back within minutes. I tell her there is some confusion about where I should have my blood drawn. She is not surprised. Despite the note directing me to Apheresis, she wants the blood drawn at Phlebotomy, because one of the tests is a Prograf level. Uh oh.

I don't recall hearing we were testing my Prograf level, so I took my Prograf in the morning, which invalidates the results. My doctor tells me it no longer matters where they draw my blood, so I have it drawn where I am. I will get a Prograf level when I return on Monday.

Then I'm off to the Pulmonary Function Test. I had one of these during my hospitalization, pre-transplant, as a benchmark, and the goal is to compare then to now. I sit in a cylindrical booth while the tech explains what's going to happen. There are several different tests, repeated a few times. I clamp my mouth around a breathing tube and obey instructions. For a couple of the tests, the booth is sealed around me -- combined with the tube in my mouth, I feel slightly claustrophobic. It's a good thing the booth has transparent sides.

The first time I took this battery of tests, the tech used a drill sergeant approach. She would tell me to breathe in deeply and then breathe out as hard and as long as I can. Then she would start yelling, "Keep going! More! More! More!", even as I was sure I had breathed out every whiff and maybe a wisp of lung. Then we would do it again. Each time, I felt like I had let her down because I stopped breathing out before she stopped yelling at me. (It's not a mean yell, and I have heard from others that this is a common technique for getting people to maximize their scores on these tests.)

Today's tech has a much more relaxed style. He tells me what we are going to do and then calmly directs me through each test. He has the monitor turned so that I can see my own data being recorded, and I see that even when I think I can squeeze no more from my lungs, the numbers are still climbing. So I keep exhaling. The biofeedback approach, intentional or not, suits me better than being yelled at.

I have no idea how today's numbers compare to my earlier numbers, but I feel like my lungs are fully functional. On my way back out to the waiting room, I hear the tech from my first test battery, behind closed doors, barking, "More! More! Keep going!"

Off for the biopsy, my fourth in 2011. Sadly for my insurance company, there is no "every fourth one free" policy. I'm fairly relaxed, because these biopsies have not been too uncomfortable. The woman doing the drilling this time has little trouble getting through for the marrow pull. In the past, there have been a couple of short painful pulls. This first pull is surprisingly painful and feels like it is drawing marrow from my hip, my thigh, my shin, and my ankle. I know this is not physically the case, since even though the hip bone is connected to the thigh bone, and so on, their marrows are not connected. The second pull is less painful. And each of the next four — I had previously consented to supply marrow for research, so they're collecting much more than usual — is less painful than the one before.

Then it's on to extracting a core sample of bone, in the same numbed spot. She spends some time finding just the right place and angle, but once she settles on one, she has pulled out a sample — extra large, again for research —before I realize that she's done.

I'm feeling good. On Monday, all these test results will let me know if I'm doing as well as I think I am.