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Neel,
If his level of fatigue has changed noticeably since he started taking thalidomide then that's evidence that it's a side effect. The doctor has the hard job of finding a dosage that will balance the positive and negative effects of the drug.
Your father's fatigue can also be a result of the MDS itself and not directly related to his hemoglobin level. Fatigue affects most MDS patients. One theory is that it's a result of elevated cytokines that are a typical aspect of the disease. It's hard to be physically active when you're sick, tired, and under treatment but patients tend to feel less fatigued if they can get up and move around. Even minimal exercise can help. Your father could try this if the doctor says OK.
The red dots are from low platelets. It's called petechiae.
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