Thursday, February 17, 2005

almost live doctor visit blogging

This is almost live because while I am writing this in real time, I'm doing it in Notepad, 'cause there isn't an internet connection at the doc's office. For those of you who don't care about medical stuff that gets done to me, as opposed to medical stuff I do to others, skip this post.

My appointment this morning is with Dr. H, my rheumatologist. It's been 12 weeks since I saw him last and had my last Remicade infusion. This visit is long overdue, I've had mild increasing to moderate back pain for the past 3 weeks now. I haven't been able to receive the Remicade because I've had an active infection of one sort or another for the past month. Today was the first available appointment I could get since I finished up my last round of antibiotics 10 days ago.

An infusion appointment isn't like a normal visit. It starts off the same, nurse calls me back, "how are you doing today?" etc., and weighs me. Carefully. I'll get back to that in a minute. Then we go to an exam room, looks like every other room I've ever been in - desk, couple of chairs, exam table, some pictures on the wall, medical posters from pharmaceutical companies, etc. There's something a little different inside this room, an IV tree, vials of sterile water, syringes, IV needles, and IV fluid.

I sit down, and immediately the nurse takes my temperature, then blood pressure. Generally the first two questions are "How are you feeling?" (medical quizzing, not the polite question when she first saw me) and "Do you have an infection right now?" Remember, no Remicade with an active infection, it supresses the immune system too much.

Next the nurse looks at my weight, whips out a calculator, and works out some sort of formula. The result is the number of vials I get. This doesn't happen anymore, since my weight is steady, I get 4 vials every time.

Now it's time to get the IV, atleast get a saline drip started and running. Standard IV, 24 gauge in the back of the hand, little 100ml bag of saline. Then the nurse starts to mix the infusion. The Remicade comes dehydrated in the vials, so sterile saline has to be added right before it's administered. Remicade solution doesn't keep more than a few hours. 4 vials get rehydrated, then injected into a 250ml saline IV bag, also known as "spiking the bag". Swap the Remicade bag for the plain saline, set the flowmeter to 250ml/hour, and let it go. The plain saline bag is pinched shut and kept to be used again at the end of my infusion.

Now I get an hour to sit and wait. Whip out the computer and start writing this post.

The nurse just came in to check on everything and take my blood pressure again. Approximately 110/70, which is my norm. If my BP drops more than just sitting and relaxing, or if I get dizzy, the infusion has to be slowed down.

La la la. Sitting here, in a cold exam room, sipping my Dr. Pepper. I'm about to turn on the space heater. Going to finish writing my other post in Notepad, about the sunrise on my way into work this morning.

The nurse just came back for another BP check. Asked I Dr. H had been in to see me yet, then Dr. H walked in. He asked how I've been doing, and I told him how the past 12 weeks have been all sorts of fun, between sinus/respiratory infections, and stomach flu. He said that he knows the medications are making me more susceptible to infection, but we're not going to stop. The infections are easier to treat than the AS or Crohn's, and I agree. I can handle being sick more often than living in pain. I told him it also doesn't help when one is babysitting a sick 3 year old, who sneaks me a kiss full on the lips at bedtime (I was trying to do the last-second-turn kiss on the cheek), then is puking half an hour later. Yep, I was puking the next day.

I also told him that my back has been hurting progressively more over the past 3 weeks. He was not suprised at all to hear this. He asked about my sacroilliac joints, and they've been killing me, too. Then he did a joint check. He feels each joint in my hand, and I tell him if any are tender. Repeat with wrist, elbow, then left side. 2 joints today, right fifth metacarpal (base of pinky finger) and right elbow. Not too bad.

Another BP check, after Dr. H leaves, and new prescriptions on my meds that I'll run out of before the next visit.

Lab tech came in to draw my blood for a CBC and liver profile, to make sure the meds aren't messing me up too much. Curbside service, cool. Don't have to stop by the lab on my way out.

Back to sitting waiting. Infusion is almost done, only about 50ml left in the bag.

Remicade IV is done. Time to swap over. Do it myself, or wait for nurse? I've done it myself before. :)

Did it myself. Save the nurses some time, let them take care of other patients. Besides, gives me a chance to play a little.

Argh! All of this fluid that's been put in me is now wanting to get out of me. Maybe shouldn't have had the Dr. Pepper.

Everything is done. Nurse came in, took out my IV, and sent me on my way. Got my paperwork and was sent on my merry way. In and out in 1 hour 53 minutes. Just might be a new record


Apollon said...

On your Almost Live Doctor Visit post, you put that injecting the meds into the 250mL bag of saline is spiking the bag… annnnnnnnnnnnnnnnnn wrong answer, please try again. Spiking the bag is the process of attaching the infusion set to the bag. Adding a medication to a bag of saline for piggyback purposes is just mixing the meds. Just a friendly reminder from your smart-ass paramedic partner. :) :) :)

mira said...

Duh, I knew that. Shows what happened when my brain is fried. Insomnia finally caught up with me. Need...more...sleep...

Although, now that I think about it, I think I've been around a few too many EMS personnel who didn't know what they were talking about, and didn't have any legitimate excuses. "Spiking a bag is when you add a railroad spike to the IV bag..."

Anonymous said...

Read a few of your blogs, mostly interested in your remicade infusions. Diagnosed at 25 (3 years ago) with RA and started Remicade Thursday (week ago). How has it helped you? How quickly? Any side effects or negatives?
Alice said...

hi, I'm also interested in the remicade infusions, for the same reasons (almost) as the previous poster. my 3-year-old has RA, and we begin remicade infusions tomorrow morning. If you have any thoughts or suggestions, I'm scrambling a little. :-) Thanks!