A Rad Update

Step 1. Gather the required materials.

One box of Radicava, which contains two 100ml bags. Two saline flush syringes. One package of IV tubing. At least two alcohol prep pads. One IV pole.

If we were taking labs, or redressing the PICC line, there would be so many more components. This, though, is the minimum. There will come a time when this is routine and second nature, but for now, everything is still double and triple checked. We lay things out like we’re preparing for surgery. It’s not far from the truth.

Step 2. Wash your hands.

There’s hand sanitizer, which also gets liberal use, but there’s no substitute for scrubbing your hands with soap and hot water. I find it almost impossible to wash my hands well these days, and drying is a nightmare, so I typically opt for the sanitizer only. If your hands work, though, go wash them.

Step 3. Open all the packaging.

The box of Radicava contains two trays of 100 ml bags of medicine, each with a silica bag and a little pink oxygen indicator. We peel back the lids on the bags, which each have a plastic seal over the input valve. We leave those intact until the last minute. We unwrap the two saline syringes, but leave the caps on. We open the first alcohol prep pad and set it aside. We unwrap the IV line and hang it over the IV pole. OK. I think we’re ready.

I’m appalled every day at how much waste this generates.

Step 4. Prep the line and bag.

We close the IV line, either through the clamp or dial, depending on the tubing style. Removing the bag’s seal and uncapping the IV line’s spike, we push the spike into the gray seal on the bag as straight as possible so as not to split the bag. It takes a surprising amount of force to do this. Because the line is clamped, nothing happens yet. We squeeze the tube’s chamber to fill it about half full of medicine. Carefully, slowly, we unclamp the line and allow the medicine to flow through the tube, stopping it just before it spills out of the end. We clamp it off and set it aside, dangling harmlessly from the IV pole for now.

Step 5. Sanitize the input valve on the PICC line.

The alcohol pad is scrubbed over the PICC’s blue input valve for 15 seconds. It doesn’t have a cap, so it’s out in the open all the time, well, tucked up under the sock against my skin, and must be cleaned carefully. We let it air dry.

Step 6. Saline Flush to clear the line.

Uncapping the saline syringe, the plunger is pushed juuuuuuust a little bit to push the air out. Or, you know, accidentally create a beautiful arc of saline in the air if you push too hard. The syringe is then coupled to the blue port on my PICC, twisted in place to secure it, and the saline injected a push at a time, to the rhythm of a heartbeat. Bublump. Bublump. On the second push, I feel the cold liquid in my vein, and a moment later, I smell and taste the saline in the back of my throat. It’s a hospital smell. The rest of the syringe is injected, decoupled, and disposed of in the biohazard bin.

Step 7. Insert tubing into PICC and begin infusion.

The IV tube is pushed into the blue PICC port, the little plastic collar screwed tight to secure the connection. The tube is unclamped or undialed, and the Radicava begins to flow into my vein. It feels like nothing. It’s not cold, like the saline, it has no taste, no burning like some antiseptics and anisthetics. There is no sensation at all, and the only reason I know I’m getting medicine is to watch the IV chamber steadily drip drip drip drip…

Step 8. Swap bags when the first one is empty.

The tricky part to this is allowing all of the medicine to drain out of the bag without letting the chamber empty, which will allow air down the line. Air in the line is bad. I have remedy available, if that should happen; it’s easy enough to use a saline syringe at the bottom of the line to force liquid back up into the chamber and clear air out. But it’s best to not let that happen. We swap the bags and sit back to wait some more. This is supposed to be a 1 hour infusion, but it’s taking closer to 2. A lot of the reason for this is an extension of the PICC line we added so that I can reach the ports myself, which bottlenecks the flow AND adds extra distance for the medicine to have to travel.

I can do a lot of this myself, except the coupling of the IV line to the PICC. Both ends are very floppy and you can’t touch the ends without having to start over and resterilize. Doing all these things, though, cause my hands to cramp up a lot and then be completely useless for the rest of the day, so I happily leave it to others when I can. J’s been doing it the last couple days, which is marvelously helpful.

Step 9. Bleed the line carefully.

Once the bag is empty, we play a game of chicken with the medicine, allowing it to drain down the line until the air is allllllllllllllmost to the PICC line. We don’t want air in my line, obviously, but we also want every last drop of the insanely expensive medicine in my veins and not in the trash. Once the line’s drained as far as we dare, the line is clamped, decoupled, and the entire bag and IV line is discarded. More trash.

Step 10. Saline flush.

Hands are washed and sanitized again. After another scrub of the port, the second saline syringe is rid of air pockets, attached to the blue port, and screwed in. More heartbeat push, more cold, more hospital smell and taste. Yummy. The syringe goes in the biohazard bin, even though it never really touched my fluids. Quite the opposite.

Step 11. Redress and cleanup.

We’re done! Everything is thrown out, the IV pole is collapsed and stowed, and the PICC line is coiled up and tucked under the itchy fishnet sock around my arm keeping everything covered.


Today will be day 5. Fortunately, it is not time sensitive in application like an antibiotic might be, so as long as I do it sometime on that day, it’s fine, it doesn’t need strict scheduling. Last night’s dose began around 8; tonight will be closer to 10 or 11, my first ever dose was 9 AM. For the second round, I have to do 10 infusions over 14 days, and I can also pick and choose dates and times. If I want to do Monday through Friday and skip weekends, I can. If I want to do all 10 days up front and get it done, I can. It’s up to me.

The main problem I’ve had so far has been dealing with the PICC, in that it’s inconvenient as hell (I miss showering – I can only shower if I take these huge complicated precautions to wrap it all up watertight and I just can’t pull it off on my own) and itchy AF. The bandage tape is itchy, the sock is itchy, the lines are tickly and like to snake their way out of the sock and say hi to the world from under my sleeve. It’s convenient as hell for not having to have an IV poked in every single time, but everything else about it sucks. I’ve already decided to get the port-a-cath installed once I’m done with this round.

I’m tolerating the drug just fine. I *think* it’s exacerbating my headaches, but nothing unbearable, and it may be causing night sweats, but I have to research that to find out if it’s even a thing that might happen. Otherwise I’m doing good. We’ll find out in March if it’s affected my decline in the least bit.

So that’s everything so far about radicava, darlings. It’s going well. I’m still terribly excited about all of this.

This Was Spinal Tap

This Was Spinal Tap

So yeah! Part of my diagnosis cha-cha was getting a spinal tap – lumbar puncture if ya wanna be all techyface about it. It was primarily to eliminate the possibility that I had MS. Of all of the testing and poking and everything, this was the only procedure that I had any real nervousness about. I got some practical advice from t3h J03 who had been through one already, which helped, but I was kinda braced for it to be awful. I’d seen a lot of episodes of House, where they tell the patient to curl up on their side and brace themselves because… *dramatic sympathetic look* …it was going to hurt. I knew it wouldn’t be NEARLY as bad as House makes it look; I wasn’t afraid of the pain, but I had concerns about the possible side effects or complications and just kind of freaked out in general because OHMY GOD THEY ARE GOING TO SHOVE A NEEDLE IN! MY! SPIIIIIIINE!!! YOU HAVE A FINITE AMOUNT OF SPINAL FLUID AND IT COULD ALL LEAK OUT EVERYWHERE!! I COULD DIE!

Obviously I did not die.

It was actually a piece of cake. I’ve honestly had routine blood draws more painful. I wanted to post about it, for the curious, and also to reassure anyone who might need one. THEY ARE LEGIT NOT A BIG DEAL. Technology is amazing, and it’s not nearly as archaic as the tv shows make it to be, and it seriously did not really even hurt. Here’s how it all went down:

I was crazy early, and they also had some emergencies come through so they actually took me back 45 minutes late. They were playing The View on the little waiting room TV, which cemented my hatred of daytime television. So many screeching women talking about shit that doesn’t matter. When you have the former World’s Fattest Man on your show to talk about his amazing weight loss story and his reentry into society, and his girlfriend joins the panel, IT IS VERY RUDE TO ASK ABOUT THE MECHANICS OF THEIR SEX LIFE. Specially as he was so, so very British. I could FEEL the discomfort off of the television.  UGH HOW DO PEOPLE WATCH TELEVISION.

So I was very happy to be taken back!

I changed out of my clothes into pants and gown big enough to swim in. My tech apologized that she did not have smaller pants, just do the best I could. I could have fit in them three times over. We went into the radiology room, where I had a bit of blood drawn for something or other, and I literally did not feel it. I watched him do it and everything, and commented on his magic touch. Blood draws aren’t particularly painful or anything, but it was weird to feel nothing at all. 

The tech explained everything that was going to happen, step by step. Here is this big-ass table, upon which you will lie as still as you can, we will use live x-ray to see exactly where we are going, and if you feel any discomfort at all please tell us. The radiologist came in and did the same, and I signed the consent forms and crawled up on to the table. They had me lay flat on my stomach, and the tech was all “I’m just gonna pull these down a bit,” meaning the pants, and promptly exposed my entire ass to the room. THANKS LADY. HI HAVE THAT. They chatted amicably while they worked, about skiing vacations and everything while he washed my back down with iodine which I swear to GOD they store in the freezer. I was warned it was going to be cold but HOLY CRAP KIDS. That, I think, was the worst part of the whole ordeal, and really it was nothing. He marked the spot he wanted, and jabbed lidocaine under my skin. That pricked a little, but no big deal. He was watching himself work under the x-ray monitor to guide the needle through. I felt it push in, which was a weird jolt of pressure, and kept waiting for the pain, which never came. He pulled out a vial of maybe like, a tablespoon of fluid, and then three more vials of like a half teaspoon each. One of them would be tested for MS, and I’m not sure what other battery of tests were done. It was weird to see these vials of clear fluid and think that your brain is floating in that stuff. 

And then we were done. I think I was in that room for twenty minutes, most of which was waiting for the doctor to show up. Maybe ten minutes on the table, tops. I was wheeled on a gurney to a recovery room, where I had to lay for twenty five minutes or so to make sure my spine wasn’t going to leak out everywhere. They gave me a sammich to eat while hanging out. I kinda expected to feel…something. But I was totally fine. No headache, no nausea, no dizziness, nothing. So I got dressed and we got out of there. Danielle hung out with me that afternoon to keep an eye on me, but I think she was a little surprised at how little I needed tending to; she even made a comment as she left about feeling useless. I was perfectly fine, and able to get around okay.  The only result from the tap was eventually I got a bit of soreness across my lower back, which just felt like I was sitting too long, and the rare side effect of a spinal headache. I had actually resigned myself to getting a spinal headache, since headaches and I have such a close relationship, but most people don’t. Spinal headaches are strange; if you stand up, it hurts, but reclined in bed you feel perfectly fine.  I was able to go back to work quickly, but I had to kick my feet up on the desk and recline for most of the day. It’s not a conducive posture to actually getting much work done.

All in all, I think it felt a bit anticlimactic, if anything. I was geared up for ….something, and it was totally nothing. No big deal. At all.

So now you know.