For five years now I’ve been getting infusions to keep my body from fighting itself. Infusing meds are a big part of modern rheumatology. Thanks to the large population of folks with rheumatoid arthritis, there are now a growing class of IV or intravenous meds aimed at helping those of us who have immune systems misprogrammed to attack ourselves. These meds are generally designed to halt, slow, or shift that process, although some, like IVIG, provide additional antibodies to help bolster and support our immune system since ours are so disastrously misfiring.
My infusions take place in an infusion clinic within my rheumatologist’s office. (A rheumatologist treats patients with autoimmune diseases.) Many patients do not have this option. Perhaps their infusions are administered in a clinic within a hospital, some may go an oncology clinic and receive infusions along with cancer patients receiving chemo treatments. There are several models for providing IV treatments. What’s wonderful about going to my rheumatology clinic is that there are only two nurses who work there so they have come to know me over the years (and I them), and my doctor is always on hand if we have questions about my treatment or care we can usually get his ear for a few minutes even if I’m between appointments. With only eight recliners in the space, I’ve met folks over the years and see some of them again and again as we come in for our infusions. Because of this, I’ve come to look forward to my treatment days.
Most of the infusing meds given for autoimmune patients are called biologics. They are called that because they are therapies derived from animals. Because of the complex nature of these medicines, they have to be refrigerated until use. Often, the Nurse or Medical Assistant will start to bring the meds to room temperature when the patient arrives and then proceed to mix them. Most of our drugs get diluted into glucose or saline before they are put into our veins. Intravenous meds are delivered by vein because would break down or be eliminated in the GI track if they were delivered orally. Administration in the veins allows for a slow absorption rate. A majority of biologics are TNF blockers, this class of meds are powerful anti-inflammatories and keep our bodies from doing as much damage to our systems – like joints, blood vessels, connective tissue, etc. Other classes of biologics impact the proteins in our cells, changing the production of anti-bodies. One of the meds that I am on, Rituxan (Rituximab) targets a specific part of the immune system, the B cell, and keeps those from maturing. While there are different methods or actions for these different drugs, different doses, different schedules for each patient, the goal for each of them is similar: encourage the patient’s body to stop fighting herself and her tissue so precipitously.
After I’ve checked in, had my weight, blood pressure, pulse, and meds list checked off, my nurses are busily mixing my medicines. I sit in a recliner and the medical assistant, who has already brought me a warm blanket, asks me if she can bring me a coffee or snack (they have some well-stocked snacks. The peanut M&Ms are everyone’s favorite, second only to the peanut butter filled pretzels.) After a few minutes the one of the nurses wheels over with a stool to sit on and a rolling tray of her supplies. She hugs me warmly, checks in on what’s been happening since we’ve last seen one another and prepares to administer my IV. The most common way to get an infusion is in the vein. Much like having your blood drawn, the infusion nurse will find a vein that can sustain the infusion (anywhere, from 40 minutes to 7 hours) and inserts a small catheter attached to tubing, attached to a meds bag, and the tubing runs through a pump (that speeds and slows the rate of infusion). Once she’s found a suitable vein, she secures the catheter (like a thin needle) in place with tape, or gauze and starts the fluids running.
I, however, have lousy veins. They collapse, they do not tolerate much use, they are prone to getting fistulas. For my body, a portacath, an internal, medical device makes more sense. This small mechanical device is surgically implanted under the skin above my right breast, with a thin length of tubing (catheter) that threads into my jugular. When It’s time for me to get connected to my IV, the nurse cleans and sterilizes the skin above the device. Resting just under my skin, the port has a rubber top with protrusions (a little like your keyboard letters “G” and “J”) which help the nurse know where to aim her needle to poke the right spot on the device. Then the meds feed into that device and through my veins. I receive my infusions without having to use any of my peripheral veins that are prone to collapsing, wearing out, or have trouble with the infusion. We’re pumping the medicine, through the mechanical device, strait into my jugular – preserving the veins in my arms, hands, etc.
Most of us get some cocktail of premeds. Premeds help stave off the potential reaction one might have to our infusing meds. Infusion reactions are pretty common, particularly for your first (or first several) infusions. Premeds can be things like Tylenol, and Benadryl to control histamine reactions, or anti-inflammatories like Solumedrol (a steroid), to meds like Ondansteron to calm nausea. These meds and others can be given orally or mixed with saline and administered intravenously prior to starting with the meds. Then, the nurses can hang your meds on your pump, set the pump for the right infusion rate – not so fast it pushes you into having an infusion reaction, not so slow you won’t leave until closing time. Barring the fact that you may have to stop an infusion because of a reaction, your nurses can give you a pretty accurate time for just how long your infusion is going to take.
My current infusion takes about 7 hours. My drug, Rituxan, is one of the longest biologic administrations. However, I don’t have to be there very often. It’s an odd schedule, I go 14 weeks then 2 weeks, then 14 weeks, then 2 weeks. I can’t complain. I used to go 5 days on 4 weeks off 5 days on 4 weeks off. So, I much prefer the amount of life the current schedule allows. Regardless of the frequency, IV medications have transformed the way that I live and perhaps the fact that I AM ALIVE. I’m so grateful we have these therapies. They have transformed my existence. What about you? Have you tried IV medications? What is your experience?