The Side Effects

I hope every day isn’t going to be like today. I wish I could at least know how long these IVIG side effects are going to last. Or I wish I could know how much of what I’m feeling is due to Prednisone withdrawal. I’m inclined to believe it is a combination, like the doctor suggested, but I’m praying most of it is just from the IVIG, meaning it will subside and eventually fade away within the next week or so. If these headaches and lack of concentration are mostly due to Prednisone tapering, I’m screwed for at least the next month. UGH!

The plan today, tomorrow, & Thursday is to work from home, but today was a total fail. I logged on around 8AM, had breakfast, took my pills, worked for about an hour and then the intense migraine set in and looking at the computer screen was making me want to claw my eyes out. I had to walk away.  I took a couple of Percocet and then immediately fell asleep for an hour or hour and a half. By the time I woke up, the painkillers had kicked in and I had about 30-45 useful minutes before my headache returned. Anddddddd repeat the same process. All day. I ended up having to cancel/reschedule my graduate school interview that was scheduled for 6PM via Skype because I couldn’t function for more than a few minutes at a time.  I feel bad cancelling and I hope it doesn’t hurt my chances of admission, but there is no way I would have been able to accurately portray myself in a video interview like this.

By the time dinner rolled around, I didn’t have much of an appetite. I made myself eat anyways, especially since I didn’t eat lunch. Then I had to face my newest enemy – the shower.  Once again, my oxygen level dropped and my heart rate shot up.  I don’t know if it is the steam, the enclosed space, or the fact that I’m standing for more than a couple of minutes, but it is extremely frustrating.

I think the thing that is perhaps the most frustrating, though, is how crappy I feel in general. A couple of weeks ago when my platelet count was awful, I felt totally fine. Things were going crazy inside my body, but on the outside, I had almost no symptoms. At the time it was terrifying, but now I miss it. It’s ironic how “getting better” has made me feel so, so much worse. Now that my platelets have reached an acceptable level, I’m all of a sudden completely broken on the outside. How does that make any sense?!  Maybe this IVIG treatment was more intense than I had originally thought.

The Final IVIG Treatment

Today was a disaster of a day.  From the moment I woke up I had an excruciating headache.  By the time I got to the doctor’s office for my 9AM appointment, I was very shaky and sick to my stomach.  They took me in the back a little after 9:15 and I chose the corner recliner again.  I took two Tylenol and then the nurse drew three vials of blood. Luckily, the vein on my right elbow that they used the first day was healed enough to be used again.  That meant no searching for a vein on my forearm and no bruise!  They started me on a bag of fluids and then the Solu-Medrol.  By this point, it had been almost an hour and my symptoms weren’t improving at all.  I was shaking and whimpering in the chair and writhing around in pain.  Then, the hot flashes started.  I was literally dripping sweat while everyone around me had on blankets.  All of a sudden the nausea hit me HARD and I had to ask for a puke bucket.  The nurses asked if I had eaten any breakfast, which I had (blueberry bagel with butter and jelly), and then pricked my finger to check my blood sugar.  My blood sugar was at 76, which they said was low considering what I’d eaten for breakfast, so they brought me juice and asked me to sip on it.

At this point, the nurses were concerned and called my doctor.  He came back and saw the condition I was in and asked the nurses to give me a Zofran drip to help with the upset stomach.  He then told me that the IVIG was working!  He said my hemoglobin was at 10.5 and my platelets had skyrocketed to 159,000 over the weekend!  Unfortunately, the side effects I was experiencing were a combination of the IVIG taking its toll on my body and the lower dose of steroids (withdrawal).  At least it wasn’t all for nothing!  I would hate to have these miserable side effects AND be told the IVIG didn’t work.

After the doctor left the room the nurse started the Zofran drip followed by the Benadryl, which put me to sleep.  By the time I woke up it was 11:30 already and they were JUST starting the first vial of Carimune NF.  Thankfully, the Zofran helped my stomach immensely!  I still had no appetite though.  I didn’t touch any of my snacks except for a PB&J and even that didn’t settle well.

They ran the first drip slowly because I was already in such a weak state.  The vial finished around 1:00 and the second finished by 2:00.  Based on my timelines from my previous three treatments, I had expected to be done and out of there by 2:00, but I was only halfway done.  Halfway?!  That fact sank in and I started to get visibly upset.  Yes, this means I cried. I was in a room full of elderly patients and I was crying and whimpering in the corner while they stared at me.  I don’t even feel bad.  I can’t even begin to explain the amount of pain I was in.

The nurses started the third vial at 2:15, gave me two more Tylenol, and sped up the drip.  By the time the bottle finished at 3:25, I was in even worse shape.  I have never felt so uncomfortable and miserable in my entire life.  I asked the nurse to talk to the doctor about skipping the fourth and final vial.  Another hour in that chair would have been excruciating.  Luckily, he told the nurse it was fine to skip the last vial and that I should head to his office so we can talk about next steps before I head home.

My husband drove over from work and met me in the doctor’s office so I wouldn’t have to be alone.  The doctor answered my questions (below) and gave me a prescription for Percocet (a combination of Oxycodone & Tylenol) to combat the awful headaches.

I slept in the car while my husband ran into the pharmacy to fill my prescription.  As soon as I got home I took two Percocet (instructions say take 1-2 every 4-6 hours for pain) and passed out.  When I woke up a couple of hours later I felt infinitely better, but the relief was short-lived.

Can I go to the cottage?
Yes, absolutely!

Can I swim in the lake?
Of course!

When is my next appointment/blood draw?
One week from today.  Most places will be closed on the fourth, so Tuesday is fine.  I will need to go to a Quest or LabCorp up near the cottage.  He gave me a prescription for bloodwork and the results just need to be faxed to him.  He is also on vacation next week anyways, so it’s not a big deal that I am not in town.

How frequent will they be after that?
Depends on how the numbers looks.  While I’m still on the steroids, blood draws will likely be once a week to make sure my numbers are holding steady on the lower dose of steroids.  My next appointment with the doctor is Monday, July 11th.

Will I ever be able to drink alcohol again?
Luckily, I didn’t even have to bring this up – he addressed it on his own!  He said that I can definitely have a couple drinks each day like a glass of wine or a beer.  He just doesn’t want me doing keg stands.  So looks like I’ll be able to sip on some Moscato or hard cider next week after all!  I’m still going to take it easy, but it’s nice to know I have options.

How much Prednisone should I be taking and when will my next taper be?
He said taking 75 mg over the weekend was perfect – thank goodness!  He wants me to stay on the 75 mg a day until I see him on July 11th.  My assumption is that he will then taper me to 50 mg a day, so long as my counts are holding steady.

The Halfway Point!

I arrived a little early to my appointment today because my husband had a 10 AM meeting he needed to be at the office for and the hematology center was on the way. When I arrived I asked the receptionist about a sign I had seen in the waiting room mentioning an online portal to view visit summaries, lab results, and future appointment times. She took down my email address and sent me a registration link, which I was able to click on and fill out while waiting for my appointment. Voila! Easy access to all of my lab reports with the touch of a button! What would the world be like without technology?!

The nurse called me back at 10 and placed me in the corner recliner. I immediately plugged in my phone. Upon seeing all the needle marks and petechiae on both of my elbows she decided to use a vein on the back of my forearm. I was nervous about this spot because I hadn’t had an IV there before, but I came to love it. The needle prick was less painful and it was ten times easier to move around. I had almost complete use of my arm. It was also nice to be able to lay my arm flat, rather than turned upright. The only downside was that I could feel the IV when I moved my arm around and it seemed less secure, like it could fall out more easily.

The nurse took a vial of blood to check my numbers and then attached the IV to a bag of fluids. For some reason, though, the tubing/drip was defective and blood started leaving my arm and filling the tubing. The nurse immediately recognized the problem and switched out the tubing. Unfortunately, she needed to unscrew the tube in order to replace it, which meant blood from both the tubing and the active IV leaked onto my arm and her pants when she made the switch. Thankfully, she was quick to get the new tubing screwed in and the IV bag started to drip properly. Crisis averted!

The nurse gave me two Tylenol to prevent a headache and fever and then began my Benadryl drip around 10:20. In the meantime, my numbers came back from my blood work. My hemoglobin dropped to 10.3, which is still a fairly safe number, but it isn’t great that it dropped. Hopefully tomorrow’s number holds steady. My platelets, after one day of IVIG, were up from 16,000 to 33,000! They more than doubled! I can’t wait to see how they look in the morning! This treatment might actually be working!!!

I was excited because the TV was set to USA again and the Law & Order : SVU marathon raged on. About a half hour in another patient asked for a channel change, though, so that was a bummer. I put in my headphones, curled up with a blankie, and fell asleep listening to the Hamilton soundtrack. Benadryl makes me so sleepy!

By the time I woke up it was 12:15 and I was already on my second vial!

10:40 AM – 11:55 AM : Vial 1 : 1 hr, 15 mins
11:55 AM – 1:00 PM : Vial 2 : 1 hr, 5 mins
1:00 PM – 2:05 PM : Vial 3 : 1 hr, 5 mins
2:05 PM – 3:10 PM : Vial 4 : 1 hr, 5 mins
Total time required for IVIG treatment : 4 hrs, 30 mins

Without anything good on TV, the afternoon dragged on once I woke up. I couldn’t manage to fall back asleep. The only remotely interesting thing that happened was that one of the other patients in the room had an allergic reaction to Rituxan. The nurses had to carry her out of the bathroom and call an ambulance. Four EMTs crammed into our little room full of recliners and IV poles to transfer her to a stretcher and wheel her out. I know everyone reacts differently to medications, but I’m glad Rituxan is my last resort and not an immediate possibility – it seems pretty strong. The whole time this was happening I had to use the restroom, but the EMTs were blocking the path, so I anxiously awaited their departure. The rest of the afternoon remained uneventful.

The nurse waited to give me the Solu-Medrol until the end of treatment this time. The drip finished by 3:20. I think she gave it to me at the end today because when she gave it to me in the morning yesterday my hot flashes hit early afternoon while I was still in the chair. She wanted to avoid the reaction I think. Unfortunately all it did was delay the side effects until about 8pm, which meant I got hit with the steroid side effects and the IVIG side effects at the same time.

As I left the hematology center I felt a faint pounding in my head, but it was mostly just uncomfortable, rather than painful. By the time I got home, though, and tried to do some work at my desk I felt shaky and my head was throbbing. I had to lie down in bed for a little while. The headache was only on one side of my head and it felt as though someone was pushing on it. Unfortunately, my nap made my headache worse somehow. I sat at the computer to watch Netflix while I ate dinner, but I had to go back to bed immediately after because the bright screen was killing my eyes. I fell asleep for a little bit. As I am writing this, I have no noticeable side effects from any of the medications. Hopefully I slept them off.

In the morning, I need to remember to ask my doctor for a prescription for painkillers to combat the wicked headache. I also need to double check that I’m not supposed to be taking any steroids at all over the weekend – won’t that send me into withdrawal? It doesn’t seem like a good idea, but if I double check with him and he confirms that I heard him correctly, I’ll trust him.

Two days down, two to go! Halfway there!