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 Third Treatment

When I woke up this morning, I immediately noticed that yesterday’s infusion spot was bruised/discolored, warm to the touch, and swollen.  Also, I was short of breath, so I was a little nervous that my hemoglobin levels had dropped again, but this morning’s blood work showed my hemoglobin was back up to 11.0.  I’m almost at a “normal” level!  I showed the bruise to the nurses and told them about the shortness of breath I had been feeling and they determined it was merely a reaction to yesterday’s infusion.

The nurse this morning chose a vein on my left forearm for my blood draw and IV.  She drew three vials in order to run a full CBC, as per the doctor’s instructions.  The results showed that after only two days of the IVIG treatments my platelets were up to 59,000!  That is the highest my platelets have been in months and I’m only halfway through my infusions!!!  After the blood draw, the nurse started the IV fluids and I felt an immediate sharp, stabbing pain in my arm.  It turns out the vein blew up.  It isn’t dangerous, but it means the nurse had to immediately remove the IV and find a new vein for the day.  The blown vein is something I hope to never have to endure again – it continued to throb for a half hour or so.

The nurse chose a vein in my right forearm, so I had to keep my arm facing up most of the day, but it wasn’t so bad.  The Benadryl burned a little when it went through the IV today, but I think I was still just on edge from the blown vein.  Between the swollen green bruise on the back of my forearm from yesterday’s infusion site, the blown vein in my left forearm, and the needle marks and petechiae covering both elbows, I feel like a human pincushion.

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I just pray that some of these heal by Monday because I am running out of good veins.

The doctor wasn’t in today and I still needed to ask about this weekend’s Prednisone dosage, so I had to speak with the on-call hematologist.  I explained that I’d been on the 100 mg dose for a month and was worried that taking no steroids at all over the weekend would cause withdrawal.  She completely agreed and told me to take 80 mg Saturday and 80 mg on Sunday and then my doctor would likely decrease my dosage to 60 mg on Monday.  Since the pills I have are 50 mg pills, she said I could simply take one and a half each day (75 mg).  Easy-peasy!  I’m not so sure I’ll be ready to decrease to 60 mg on Monday, but I’ll worry about that when the time comes.

Today was a slow day at the hematology center.  For the first time all week, I was surrounded by patients that wanted to talk, but another patient was talking loudly on her phone right next to my face the entire time she was being transfused.  It was extremely rude and frustrating.  Taking a quick phone call is one thing, but talking loudly over a TV and other patients trying to converse is annoying as hell.  SHH. Thankfully, she was just receiving iron so her transfusion only took about a half hour.  It was refreshing to talk to other patients afterwards about their conditions and treatments.  I felt less alone.

Apparently the office closes early on Fridays and the nurses and doctors can leave as soon as their appointments are done.  By 1:30 I was the only patient left for the day, so the nurse had to stay another two hours just for me.  The room felt sad and lonely with me in the corner surrounded by empty recliners, but I was able to watch Netflix on my laptop.  I threw on “House” and curled up with a blankie and some snacks.

10:45 AM – 11:55 AM : Vial 1 : 1 hr, 10 mins
11:55 AM – 1:05 PM : Vial 2 : 1 hr, 10 mins
1:05 PM – 2:10 PM : Vial 3 : 1 hr, 5 mins
2:10 PM – 3:05 PM : Vial 4 : 1 hr, 5 mins
Total time required for IVIG treatment : 4 hrs, 30 mins

My husband picked me up around 3:30 PM and we headed back to our apartment.  I had a little bit of a headache, but nothing like yesterday’s.  The only difference between Wednesday/today and Thursday was the time of day the Solu-Medrol was administered.  I am inclined to believe that yesterday’s side effects were due to receiving the steroids in the afternoon, rather than the morning.  I’ll make sure to ask for them first thing on Monday.