#ive been back on iron since the transfusion but not every day while i heal so i might have to increase that lol

[gay-jewish-bucky]

ahhhh thanks for letting me know!!!

[crohnsawarenessproject]

‘A Bloody Good Time’ July 12th, 2021 #abloodygoodtime © Outhouse Cartoons/C.A.P 2021

I’ve done it, I’ve been on one of the scariest medical adventures of my life to date. I’ve now sat in an ER watching bags of blood being transfused into my body after hitting a scary low red blood cell level due to chronic bleeding issues that snowballed over the last couple of months. Things were a mixed bag at first. Doctors worried the Entyvio wasn't working and instead could be causing my severe bleeding.

Let’s take a step back.

A few months ago, my Entyvio was adjusted from every eight weeks to every four weeks, which was around the same time my temporary GI had switched my standing blood work order from every month to every two months. Shortly after these changes, I started to see blood in my stool.

At first I didn’t think too much of it. A lot of us living with IBD have experienced blood in our stools. It’s not unheard of. A weekend went by, though, where it was just non stop. Everytime I went to the washroom, I would lose a fair amount of blood. Sometimes It would just be blood.

My initial reaction was that it was something I’d eaten. I thought about it, realizing my intake of beef had gone up that week and usually that would cause some issues for me. That had to be it. So I cut back on my beef.

Another week of constant bleeding went by without letting up. I was starting to feel it now. I was getting a bit scared. I reached out to friends and family and someone mentioned that, ‘women lose blood every month so [I] should be fine,’ so I let it slide again.

A few more weeks passed, no changes, I was really starting to feel it now and my blood work was finally in. I could show them what was going on. I had proof. The results show my hemoglobin sitting at 80 points and the rest of my profile being completely out of whack. This should light a fire, and I’d be the one to start it. '

I called the GI office asking for iron (this is all I knew to ask for at the time), stating what I was going through and how I felt. At this point I could barely stand and or walk. My heart felt like it wanted to race out of my chest. I was getting really scared now. I’ve never felt this bad throughout everything I’ve gone through. This was getting to be too much.

This is when they set up an emergency scope. Another week passed before scope day arrived. It was determined that my guts were pretty clean. They mentioned hemorrhoids but an ER doctor clarified that they were only level one which causes minimal issues. This proved a point that I had been trying to make previously, that my health was better than ever, where my Crohn's was considered. This was new. Is new. '

However at that exact moment I wasn’t feeling that great. I was also supposed to receive iron and/or a blood transfusion that day but it never ended up happening. This was a Friday and we all know what would happen over the next couple of days. Absolutely nothing. I knew the numbers everyone was working with were old. Too old. They didn’t have all the current facts nor did they understand how bad I felt.

I tried calling and leaving a message for the doctor just the same. Maybe I could make it to Monday and they could just get me into the IV lab real fast. Well, I barely made it to Monday but thankfully they got back to me first thing in the morning informing me that to get in for IV therapy would take over a week and that I should go to the ER if I believed I needed it sooner. That was an understatement, so we immediately started packing, getting me ready for the ER.

Once we arrived we managed to get through triage pretty quick. I told them what was going on and the moment I noticed a brow begin to furrow I reached into my bag, producing the blood work results from two weeks prior. The moment they saw the numbers things got moving.

Going back through my medical records, I’ve noticed that I’ve never really been in the normal hemoglobin levels but I rarely was under 100 points. When they did my blood work in the ER I was sitting at a cool 40, a number they claimed they hadn’t seen in some time.

Hey, at least I’m shaking things up. Going on new adventures. Like how when they moved me to the trauma ward to give me my IV. Something that normally goes pretty smoothly for me. I have big juicy veins, although they do roll, but as long as I bring this up, it’s usually accounted for. Not this time. No.

First of all, this was the most painful of any IV I’ve ever had, and it started when they accidentally blew a vein in my forearm, causing blood to squirt all over my leg and the floor, they then moved to my hand to put two more in. The pain was almost more than I could take, I wasn’t ready for this when I came in but at least the job was done and they were placed. I thanked my nurse as I always do and I was moved to another section.

I was still pretty chill at this point even though things weren’t the best. I knew why I was there and what I wanted, but there was one thing I wasn’t ready for. A new nurse came in to tell me what was on the docket. I was lined up for a blood transfusion. Three bags worth, but I was going to be admitted and the procedure states that you need to be COVID swabbed. My heart dropped, my smile disappeared and my heart which had slowed a touch since arriving began to pump faster. I had never had a COVID swab. I’ve kept home away from everyone and everything and always wear my mask while I’m out.

Now my thoughts were racing due to the things I had heard or read about in the past regarding people's experiences swabbing. I was so thankful for the fact that I had a very kind and patient nurse who talked me through the entire thing and after everything I had gone through getting the IVs in my arm, it was a piece of cake. It didn’t feel great, that’s for sure. But it was nowhere near as bad as I thought and not even on the same level as what I had gone through with the IVs. Teaching me that my years of experiences have helped me to build a thicker skin. Something younger me wouldn’t have been able to comprehend.

The rest of the night was fairly uneventful. They gave me my first bag of blood, during which the ER doc came to talk to me. They basically wanted a GI doctor to go over everything with me, but they were good after I told them that my Crohn’s was doing pretty good and that I had all of that under control with my GI/GP and that it was my GI’s office that had instructed me to come in for the transfusion.

Shortly after my first bag of blood, I was moved into my own private room in another section of the ER where I received another two bags of blood. I’d end up spending another 8 hours through the night watching my tablet, unable to get any kind of sleep due to the warm temperature of the room. Once the morning shift nurse arrived, I was up, showing how much better I was feeling, ready to go home but it’d be another hour before they’d make it to my room.

Luckily the ER doctor fully agreed with my self-diagnosis, releasing me to be picked up and taken home. We made sure to hit up my favourite diner on the way home, filling me up with a good breakfast after a long night.

The moment I got home I called up my GI office requesting to get the new monocyte iron infusion I was promised the week before as well as to have them revert my standing order back to every month as I was not comfortable with it staying at every two. I was put on Entocort to try and heal some ulcers and it seems that for now it has mostly stopped the bleeding. I’m not entirely convinced that we’ve solved the problem, but for now we’ve put a very good bandaid on it.

Have you ever had serious issues with your hemoglobin before? How’d you and your medical team navigate it? Tell us in the comments below.

[words-writ-in-starlight]

And ALSO talk to me about Roy and Riza in the aftermath and a pair of hospital beds close enough together to hold hands

The adrenaline crash started to hit Riza while Roy was commandeering the army.  With General Armstrong currently missing and, on last report, injured--and widely suspected to have a hand in the coup, as far as the public was concerned--Roy held the dubious honor of highest rank left alive and unarrested.  And he’d always had that talent for gathering up the pieces of a chaotic mess and putting them back together in accordance with his goals.

He was issuing orders to the remainder of Briggs and Central to bring forward their wounded so that ambulances could get the worst to Central General when Riza wavered.

She didn’t feel it coming, the end of her strength.  It washed over her all at once like ice water--her vision greyed, her breathing hitched, and her heart hammered in her ears, so strong it made her head ache.  Closing her hand sharply on Roy’s arm, where she had been holding on to guide him, took more effort than moving a mountain.

“Lieutenant?”

“I’m sorry, sir, but I think I’m about to fall over,” Riza said politely as she swayed in place.

“What--damn,” and then there was an arm around her ribs, her arm draped hastily over the shoulders of a military uniform, and the Colonel was taking her weight, half-holding her on her feet.  “You should have said something.”

“I did say something, sir.”

“Said something earlier, then.  Can we walk to the ambulances?”

Riza took a moment to assess, blinking away the sparkling grey and black haze in her vision until she could see a tunnel of clarity directly ahead of her.  Can we walk meant can you see, right now, and they both knew it.  

"Yes, sir,” she said once she was reasonably sure of herself.  Talking was so much work.  “But I’m not going to the ambulances.  Take me to the medical tents.”  The medical tents were barely more than a staging area with a tarp tacked up on poles to offer some shade.  It was the first thing thrown together when the nurses and doctors and paramedics showed up from anywhere and everywhere, and anyone whose injuries were not immediately life threatening was getting stopgap care in its shade.

It was also right in the center of the ruin that had been Central Command, a perfect place for Roy to hold court while Riza drank some juice or whatever they had in store for her.  The idea of leaving, of leaving Roy here alone without her, was horrifyingly wrong to some intrinsic part of her blurred mind.  She would stay, here, with him, where she could protect him, as shoddy a job as she’d done of that over the last day or so.

“Lieutenant, you’re going to the hospital.”

“I most certainly am not,” she said stubbornly.  Her vision was beginning to go again, and she took a deep breath as she tried to force it to clear.  One of Roy’s hands flashed in front of her as he made an angry gesture with his free hand, the glove still marred with blood and split open from Bradley’s sword.  She should make him go to the hospital.

“You had your throat slit barely an hour ago, Hawkeye, I’m not kidding around--”

“I’m not bleeding--”

“Riza.”

Her name stopped her cold.  It was ragged, as if it had been torn out of his throat, and his arm closed so tightly around her ribs that they creaked, and his blind eyes turned to her wide and not a little desperate.  She could hear the strain of having been in control of himself for all these hours beginning to show.

“Please,” Roy said quietly.  “Please go to the hospital.”

“You should too,” she said.  “Your hands--”

“I will.  I will, as soon as I’m sure things are secure here.  I’ll make sure the medical tents have a look at me, and we have people to fall back on.  But you’re going to collapse before then.”  His voice faded even farther, until it was as fragile as it had been underground, when he had been trying to hold her life inside her throat.  “You lost so much blood--”

Riza took a deep breath and then another, trying to slow her stumbling heartbeat and soothe her spinning head.  “All right,” she finally agreed.  “Eighty yards to two o’clock, then, sir.  And watch your step for the rubble.”

Roy tried to grin at her through the layer of dust and soot and occasional smudged blood.  The smile fell short of success, and his voice was still thinner than usual when he said, “That’s your job, Lieutenant.”

The two of them made slow but respectably steady progress across the ruined foundations, Riza aware that she was mostly upright by virtue of Roy’s iron grip on her, murmuring warnings to step around or over broken stone or cracked pavement.  Roy continued giving orders as they went, whenever Riza greeted someone approaching them, and she focused on her breathing, keeping it deep and steady, to get and keep as much oxygen in her system as possible.  Her fingers were so cold they were starting to go numb.

She felt like she should be applauded, for managing to stave off unconsciousness until they were nearly at the feet of a paramedic.  Roy caught her on the way down, and she felt his hand close around her arm as she was bundled onto a stretcher.

“You’re still under orders, Lieutenant,” he said sharply--so dramatic all the time, her Colonel--and then the world faded away.

Riza woke several times, half-surfacing to consciousness in a hospital room that seemed, according to her experience, understaffed.  She was fairly sure, by the second time, that she was being given a sedative, based on how quickly the darkness surged up to take her again, but by the time she caught a nurse’s sleeve, she was already sinking again.

She woke for the fourth and final time with a sudden rush of--not panic, exactly, but the abrupt and acute knowledge that she had failed to do something important.  Sitting up made her head spin and ache, and she dragged in a few breaths through her gritted teeth as her chest ached and her stomach rebelled.

“Oh, Lieutenant Hawkeye,” a nurse said, smiling.  “You’re--”

“Where’s the Colonel?” Riza interrupted, one hand clenched around the rail of the bed to keep her up, and the nurse’s smile turned resigned.

“He’s fine, Lieutenant--”

“Where is Colonel Mustang?”

“He’s in the long-term care ward, being a pain in another nurse’s ass, I’m sure,” the nurse said dryly.  “And if you try to get up,” she went on as Riza started to scuffle her way out from under the sheet, “I’ll sedate you again.  You’re staying in urgent care for a while longer, Lieutenant, whether you like it or not.  You were in rough shape when we got you.”

“I feel fine,” Riza lied.

“I very much doubt that.  As you can imagine,” the nurse said as she paced over to inspect the IV shunt in Riza’s forearm, “we’re under a lot of strain for resources right now, especially blood, so you haven’t had as many units as you should.  You lost what we’ve estimated to be about thirty percent of your blood volume, Lieutenant, maybe a little more.”  She gave the IV bag, full of clear fluid, a quick tap and turned back to Riza.  “You’re extremely lucky to be alive.”

Thirty percent.  It had been a long time since Riza needed to know medical statistics, but that one every soldier knew by heart--if a comrade lost forty percent of their blood volume and there wasn’t a doctor already there, the best you could do was bring home their dog tags.

“Noted,” Riza said, subdued.

“Ideally, we should have given you four units of blood as soon as you came in,” the nurse went on, a little more gently now that her patient wasn’t actively trying to escape.  “But we’re dealing with a lot of casualties, so we’ve been trying to ration our blood supply and you only got about half that.  We’ve put out a general call for donors, anyone who can pretty much has, but we’re going to be short for quite some time.  We’re keeping your blood volume up with saline until we can get you at least one more unit to bring your hemoglobin levels to a more stable level.  That’s why you’re dizzy, by the way.  And then,” she added to cut Riza off before she could speak, “you will be moved to the long-term care ward, yes.  We wouldn’t normally, but we just don’t have the luxury of keeping people here for observation when we need the beds so badly.”

“Thank you,” Riza said, and sighed, settling back against her pillows.  “How long has it been since the battle?”

“About nine hours.  We kept you sedated for most of it, trying to keep your system as calm as possible while we gave you transfusions.  Also because you tried to leave the first time you woke up, which I assume you don’t remember.”

“No.”

“Massive hemorrhage can do that.  Now,” the nurse said, arms crossed.  “Are you going to go back to sleep or do I have to drug you again?  Short of a few more units of blood, sleep’s going to be better for you than anything else.”

Riza smiled faintly and closed her eyes.  Maybe it wasn’t just the sedatives dragging her down, then--she remembered dozing for hours upon hours every day while her back was healing.  Then, she had been in her apartment, getting checked on twice weekly by a doctor who had been sworn to eighteen different kinds of secrecy by Madame Christmas, and being fretted over by Roy whenever she was awake.  He worried himself sick at every turn of the healing process, no matter how many times she swore that yes, she really was getting better, no, he really hadn’t done permanent damage, yes, she still had full range of motion, and on and on.  She hadn’t held his anxiety against him then, but she wouldn’t much want to be the nurse keeping him in the long-term care ward now.

Someone in the distance coded, and Riza tried to stir herself to see what was going on, but the darkness was dragging her down again.

She woke again to morning light and someone switching out her IV, and Riza was startled to see that it was blood, this time.

“I thought you were out,” she said, blinking, and her nurse gave her a look.

“This,” the nurse said, “is specifically marked for your use by the donor.  As long as I’m on the subject, you soldiers and your dog tags--so helpful.  We normally run out of O-neg in the first hour of a crisis but almost everyone came in helpfully labeled, this time.  This is O-pos, by the way.”  Not the same type as Riza, but a donor match.  Blood types and the various ways that donations did and did not cross was something else every soldier in combat knew--in a pinch, Riza could probably have figured out an emergency donation, and knew that Roy had done it at least once.  

Riza wasn’t a convenient donor type, A-positive.  But Roy--Roy could donate to eighty percent of the population, give or take.  

Riza looked at the tube running down to her arm, red and glossy in the light, and said, “Thank you.”

“Once we’re sure this transfusion goes well, we’re going to move you, which I’m sure you’re thrilled about,” her nurse went on, picking up Riza’s chart.  “But that’ll be a few more hours.  So sit tight.  Have another nap, maybe.”

Riza didn’t go back to sleep.  She held polite conversation with the nurses and doctors who popped in and out, and wished, idly, that she could have visitors.  It was as hectic in the urgent care ward as her nurse had claimed, though, every bed filled and patients being turned out as soon as they were stable enough to be passed onto some other ward.  It made her eye the IV bag with a fresh level of appreciation for her condition, to know that they had kept her there anyway.

It was possible, of course, that they had kept her in urgent care because they’d been reluctant to let someone directly involved with saving the country get lost in the shuffle.

“How do you feel?” her nurse asked as she unhooked the IV bag and replaced it with something that she’d casually identified as a banana bag, which was a bridge too far for Riza’s limited medical vocabulary.

“I feel fine,” Riza said.  She was still a bit dazed and light-headed, but her heartbeat didn’t hurt in the thin skin of her temples and throat anymore, so.  “Much better.”

“Are you lying to me?”

“No,” Riza said with a bit of a grin.  “I’m stubborn, not stupid.”

“Good answer.  I’ve been given orders to take you to long-term care, where they’ve apparently managed to clear a bed for you.  Shared room, but everywhere except urgent care is sharing right now.  You’re right down the hall from those two boys, I’m sure you’ll be pleased to hear it."

"The Elric brothers?  How are they?”

“Well, one of them’s had about a dozen bits of metal pulled out of his shoulder and the other one can’t stand up without falling down in a heap, from what I hear, but you’d think they’d both won the lottery from the way everyone who talks to them comes away grinning like an idiot.  Oh, no ma’am you are getting in this wheelchair,” her nurse added sharply when Riza started to stand.  “I’ve been on shift for twenty-three hours, you don’t want to fight me on this one.”

Riza considered the look on her nurse’s face for a moment, and nodded.  “Fair enough.”  Once she had been bundled unceremoniously into the chair, she asked, “Has everyone here been working since the battle?”

“Yes,” the nurse said without hesitation.  “Some of us have been here almost thirty-six hours, if they were working before it started.  We’ll start sending them home at the forty-hour mark, probably, assuming nothing else goes wrong before then.”

Shaking her head, Riza said, “We always have the easy part, don’t we.  Soldiers, I mean.  We just break things and wait for you to put them back together.”

“Sometimes,” her nurse said, quiet and considering.  “But from what I’ve seen outside, no one had the easy part today.  Come on.”

They made their way through the hospital in silence.

“All right,” her nurse said brightly as they stopped at a door.  “Here we go, Major.”

“I’m a lieutenant,” Riza was saying as her nurse opened the door.

“Actually, you’ve been promoted,” Roy said from his bed, turning blindly toward the door and smiling.  His hands were bandaged, although not heavily, and there was an inexplicable stack of books already taking up residence on the table at his elbow.  He looked, not to put too fine a point on it, absolutely terrible.  “I said they couldn’t take my assistant away when they made me Brigadier General.”

“Sir,” Riza said, a rush of relief making the word raw.  Roy’s smile softened a little at her tone.

“How are you feeling, Major?” he asked.  He blinked quickly a few times, as if to clear his vision, and Riza felt something in her chest wrench--she’d gotten so used to the regard of those dark, cunning eyes, for most of her life between his time as her father’s student and Ishval and her time as his second.  Now his eyes were clouded to grey, and his unfocused gaze was pointed just over her shoulder, not quite pinpointing her face at the distance.

“Better, sir,” she said, her voice steady.  Her nurse wheeled her over to the bed and helped her up, and offered her a smile and a wink before departing with the chair.  Riza waited for the door to close before she untangled herself from the bed and wheeled her IV stand along with her to Roy’s bed.  “What about you?”

“Sit down, before you fall down,” Roy said sharply, and Riza made a dismissive noise, but she did as she was told and settled carefully on the edge of his bed.  “How’s your throat?”

“Much better,” she said.  “Ms. Chang didn’t quite get all of the damage, but it probably won’t even scar.”  

Roy reached out carefully and bumped into her shoulder, then tracked his fingers up until he encountered the square of gauze taped over the last of what had once been a mortal wound.  “Good,” he said.  Riza held very still, feeling his fingers tremble against the bandage and the thin skin of her throat.  “I--good.”

“You did the right thing, sir,” Riza said firmly.  “No matter what might have happened, you did the right thing.”

He made a sound that could have been a laugh, or at least an attempt at one, and his hand dropped from her throat to rest on the bed near her knee.  “I thought I’d finally gotten you killed."

“Well, sir, with all due respect, I’m perfectly capable of getting my own self killed,” Riza said, a touch of humor in her tone.  Roy tried to smile at her.  “Really, sir, how are you feeling?  You look exhausted.”  She reached up thoughtlessly and stopped herself just short of touching his cheek, pale and drawn with sleepless circles under his eyes.  Letting her hand drop, she asked,  “Have you slept at all?”

He pressed his lips together, but there was only a moment’s pause before he admitted, “No.  I’ve been--worrying.”

“About?”

“What isn’t there to worry about,” he said frankly.  “The country’s a wreck.  Your grandfather is taking the throne, obviously, and he seems to have it pretty well in hand, but I’m sure we’re going to be rooting out corruption for the next ten years.  And everyone’s having to face the reality of Ishval--I’ve been reading up, or rather making the others read me up, so I think we can be useful there.  And,” he said reluctantly, “I’ve been worrying about you.  No visitors in urgent care until things are under control there.”

“I did notice that there was suddenly another unit of blood from a mysterious O-positive donor,” Riza said calmly.  “Marked for my particular use.  Aren’t you O-positive, General?”

She watched calmly as Roy’s exhaustion-grey cheeks slowly colored, until he was blushing as red as he ever had as a schoolboy.

That night, once the nurse--almost deliriously happy to have Roy rendered mostly compliant--had turned off the light, Riza dozed lightly and listened to Roy’s breathing to her right, deep and steady, calming.

When he startled awake with a cry strangled on his lips, she blinked open her eyes and murmured, “It’s okay.  It’s all over.  We’re okay.”

“Riza,” he said, and she didn’t need to ask what he had seen.

“I’m fine, Roy,” she said, shifting onto her back.  She could see the shadow of his hand in the dark, reaching through the barred support of the bed toward her, like they had from time to time in Ishval.

Their beds were just close enough that she could lace her fingers through his and squeeze.

“It’s all over,” she repeated, holding onto his hand.  

“I know,” he said quietly, and squeezed back.

[inadeepanddarkdecember]

[[ this is kinda rambly and piecemeal and out of order since its an edited convo off of discord from before cy’s heart got replaced, but i decided i wanted this Extra Large thalassemia infodump on my blog. go read this primer first for basic info on thal; cyrus’s form is beta thalassemia major. ]]

even with a perfectly healthy and functional heart, cy'd still have a too fast pulse and likely have arrhythmias; that comes with the territory of his anemia, and he could still develop heart failure again later in life. the problem with cy's current heart is that its been scarred to shit by the extra iron in his body from his blood transfusions and hes developed cardiomyopathy as a result, which at this point is virtually guaranteed to kill him before he turns 30, even if he takes perfect care of himself and never develops any other complications from his thalassemia ever (which aint fuckin likely). this failing heart just deals worse with arrhythmias he already has, especially under stress, and already struggles to keep up enough blood pressure.

bone marrow transplants are currently the closest thing to a cure for thalassemia we have and hellll no he has not had that done i doubt hes even on a waiting list. with his shit in the state hes in, its questionable if he'd even survive the process its pretty intense, nevermind the finances and healing and finding a match and even so much as qualifying to have it done.

cyrus goes in for a blood transfusion every three weeks. when transfusion dates get close, within a few days, hes more tired; he doesnt go out; he can be moodier; he can get headaches and dizzy spells. he feels best after a transfusion, then its just a slow decline till the date rolls around again. i tend to rp him within a week or two of being transfused most of the time simply bc its easier to get him out there interacting with people.

sometimes they coincide with transfusion dates, sometimes they don't, but he has longer appointments to check up on his other bodily functions every so often. theres general stuff, looking at his counts, then more specialized appointments to keep an eye specifically on his heart or check up on his liver and other organs as needed.

thalassemia by itself kills a person through not having enough blood to get oxygen around the body; this is solved through blood transfusions. chronic anemia means chronic transfusions. which would be fine! except chronic transfusions cause a build-up of iron in the body, and that shit is toxic and where the more fatal complications tend to stem from for thalassemia patients. also, being anemic means your body thinks it needs iron, so it's prone to absorb more from food than the average person, an added bonus. consequently, there are certain foods cyrus avoids. legumes, dark leafy greens, etc. look up any list of iron-rich foods, and thats a list of shit cyrus ought to be avoiding or indulging rarely. (funnily enough, these lists also are often advertised towards anemic people because those who arent transfused have the opposite problem.) part of his tea drinking habit is because tea inhibits iron absorption, along with he just likes it. coffee works too and he doesnt object to it, but he prefers tea.

another consequence of chronic transfusions is that you end up with a lot of old shitty dead blood cells in your system, and your spleen is left to clean it up. unfortunately, when faced with that much to clean, it can enlarge (splenomegaly) and become overactive (hypersplenism). so it starts removing healthy blood cells too quickly and too early, which can cause the anemic patient to need more blood when being transfused, which risks more iron, and not to mention its generally uncomfortable for the patient with the enlarged spleen. in short, this happened to cyrus, so his spleen has been removed. spleens, however, also play an important role in the immune system, so he was already kinda vulnerable as an anemic, but having no spleen makes him doubly at risk of infections. he takes antibiotics as part of his daily pharmaceutical regime.

during cold and flu season, docs tend to strongly suggest he wear surgical masks during school and whenever hes around a lot of people in public places, but he almost never does. he doesnt like the attention it gets him esp in school, but sometimes he'll do it when hes on public transit or anything. he does carry hand sanitizer with him a lot of the time tho

bc his immune system is fragile, he often goes in-patient for what would be minor sicknesses for us, esp if theres a fever. he tends to be hit hard by them, and being sick can make his counts plummet as his body tries to fight off the disease.

coming back around to iron related bullshit, iron overload is treated by iron chelation, for which there are mainly two medicines, deferoxamine and deferasirox, and cyrus uses the latter because i have never been able to find out enough goddamn information about deferoxamine. deferoxamine is the more common and cheaper of the two medicines; its injected subcutaneously over the course of 8-12 hours and has its own list of side effects and the process itself tends to be kinda painful from the accounts ive read. its done at home, often while the patient sleeps bc... well, when else are you gonna get a child to sit still for 8-12 hours. its definitely the one cyrus was on for a while, when he was younger. bc ive had a hellish time finding info on the pump used for deferoxamine and more about that medicine generally, cy’s currently on deferasirox. slightly different side effects, but otherwise does the same job in pill form.

thalassemia patients who've been cared for properly should be healthier than cyrus is. most patients his age havent had a heart attack already and arent dealing with heart failure, not yet. his parents have always struggled financially to keep up with his medical bills, but there was a time when he was still young that they still thought they could manage if they just worked hard enough. they were too proud to accept help, and he suffered for it. they eventually gave in but even then still struggled to keep up. sometimes a sudden unexpected change in insurance policy would fuck em for a while finanacially. so sometimes they'd not fill a perscription for a while or wait longer than they should to take him in-patient, hoping he might just tough out a cold or smth. sometimes he'd manage to do that and have abysmal blood counts next time he went in, and a couple of times he got so sick he was legit on death's doorstep by the time he got to the hospital and needed way longer to recover. sometimes cyrus would be too fussy about the deferoxamine and they didnt have the energy that night to force him to accept it or he'd turn off the machine himself after they left. not too often, he was pretty good about just accepting it and did most of the time, but it def happened more than a few times. and if it had already been activated, they couldnt reuse it and had to throw the dose out, in which case that was it he skips it no replacement they cant afford it not in the budget.

and because the effects of iron overload are long-term ones for the most part, it was easy to be like "ehh he seems fine for now". like, they knew the risks, but it was hard to see them as anything but so far in the distance as to be irrelevant. cyrus himself isnt great about the whole self-care thing either; his depression has helped nothing. he's been known to just flush or toss pills in a small spiteful act of rebellion, all his parents care about is that hes still alive and their money, and medicine's expensive, so wouldnt it just piss em off to throw it all away. he'll eat foods he shouldnt for similar reasons, along with just the pleasure of it. and sometimes he hits the sort of suicidal low where he just.... doesnt see the point. each dose he takes is a choice to keep living, and sometimes that choice isnt one he wants to make.

no one quite realized how bad he was tho till his first heart attack. he was so young; the docs dont rly know when hes skipping, so they werent watching too closely for the effects of it. and the damage his body took over time was amplified by his frequent stress. the heart and liver are the ones most affected by iron overload; his liver is somewhat damaged too, but thats not too bad yet, not as bad as his heart.

other little thal things: hormone levels can get super fucked. cy's puberty was a bit delayed, and his testosterone levels remain kinda low compared to average, so hes not as hairy as his genetics might otherwise dictate. he will never be able to grow a proper beard; it'll always be way too patchy and uneven. and despite what his touch aversion and other factors like stress and said low testosterone might lead you to believe, hes got a pretty strong sex drive, though he suppresses the hell out of it.

he was homeschooled for his first few years of elementary bc health concerns, but that couldnt be sustained bc of cost. so he rejoined public school since then. i wouldnt be surprised if his peers used his puberty delays against him, but i'd expect they were making fun of him less bc he was a late bloomer and more at his general girlishness, esp since this would also be around the time he was growing out his hair.

he has had people do the "lookit me ive befriended the sad disabled kid arent i good <3" schtick (which esp pisses him off bc its similar to shit melinda pulls) and hes met the people who try to be nice to him for three days then turn a 180 on him when he doesnt immediately cheer up and get all buddy buddy with them. and hence he now treats kindness from strangers with extreme skepticism, suspicion, and aggression. (thomas also feeds into this but ye) it scares off plenty of legitimately nice people who he could have befriended, buuut.

Oh, a couple Fun Facts I forgot to mention. bc anemia, he bruises easy and injuries generally take longer than normal to heal. And in part bc depression and in part bc meds are prone to fucking with his appetite, either killing it entirely or just making him nauseated, he tends to not eat enough and is kind of underweight. Melinda put him in charge of dinner most nights as part of a genuine good faith effort to ensure he's getting at least one good meal and get him home when he's supposed to be.