Now, from Rick:
First a disclaimer: I will not swear to the accuracy of anything here; best I recall from med school and the reading I have done for Joe and just sorta a summary off the top of my head.
This is just a short summary of the medical condition that has led our good friend AJ to find himself in his current dire medical straits, where, to be frank, with the withdraw of Dialysis treatments Joe has but days or at best weeks to live. His disease is now causing significant pain in the bones of his spine, and with the kidneys no longer filtering the metabolism products from his blood and the Narcotics used to treat his pain no longer being removed, he will just drift to a state of lesser mental acuity, and kind of a sleeping, "mead-like" not really drunkeness, but sort of lack of awareness. It really seems a pretty nice way to go, when your time is up. And in his current situation, there will be none of that shoving plastic tubes down your throat, cracking ribs with CPR, that too many people suffer in their last few moments of life in an acute care hospital as the Lord
comes to take you to his arms.
Joe has had for years a long term low grade type of blood "disorder" sort of like a low grade lymphoma where his platelet making cells are too active, they are very low grade "cancerous", one might say. His body's immune system, which is the function of the immune system, is chronically attacking these bad crazy cells, causing inflammation and scaring - and over the years, he has been on various low grade anticancer drugs to slow the crazy cells, but there really is no "kill the cancer" treatment for his condition.
Over time, with the chronic inflammation of the places you usually make white and red blood cells and other blood elements, the scaring is making your back, and your pelvis, and your sternum just scar filled spaces rather than sites of active blood element production. Thus, your normal "protected" places to make blood elements are being slowly anatomically eliminated.
In response, your spleen is getting bigger. First, it is grabbing some of these weird, large irregular atypical platelet cells and trapping them; this fills it with lymphocytes and other white cells essentially containing these low grade cancer cells.
IN ADDITION, your body has to find other places now to make your red blood cells, white cells, normal platelets, etc -- this would be the SPLEEN AGAIN, as well as spaces in the LIVER. As the spleen grows bigger, it pushes and squeezes other organs, and becomes more fragile and less effective as a lypmphocytic
organ itself. Thus, both the liver and spleen swell, becoming less efficient and more fragile to fracture from say external trauma.
So, these are definite problems. as the problem grows beyond the ability of the body to cope, and the low grade anti cancer drugs to help, the blood is more screwed up for carrying oxygen, and can get "sludgy", and all kinds of stuff. As things in your normally healthy blood become more "messed up", this is bad for all of your organs..... most specifically of concern, the heart and kidneys. So, as this disease progresses, you finally get to the stage Joe is at; you have multiple organ failure, a huge spleen, limited normal function of any organ, etc. From then on, the cause of your tiredness and lethargy is not a single problem like heart failure, but just a big blubbery mess of low efficiency and function, and in essence you just sort of "spiral down".
The usual only exception, which did not happen to Joe, is that the crazy platelet cells go totally wacky, and multiply like crazy, and fill your blood stream -- we call that LEUKEMIA... [The process is call a Blast process, as in mekakaryocytic blast cells, not as in "it's a blast to do this"] and the leukemia is pretty instant, massive, and usually you die of sepsis within a few days.
But that is pretty much the basic medical issue, best I can put it in lay terms.