I've been having a frustrating/bad day.
Apr. 5th, 2006 03:32 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
asterrocI missed my bus transfer.
The first bus drops me off on the side of City Hall, and I have to catch one of two busses in front of City Hall. As I turned the corner around the fancy stairs, I saw both put on their blinkers and pull out from the curb. One line comes every half hour, the other every hour. So I waited another 30 minutes in the cold and snow (!) until the next bus. In all, instead of 15 min when driving, instead of 40 min like yesterday, it was 1:15.
I had a reaction to the infusion.
I borrowed S******'s car, which drove very nicely, thank you, and got to the office just in time. Took the usual painkiller and antihistamine and waited for the doc. Had the pre-treatment talk. He said he thought the bumps looked better - smaller and less red - but I'm not convinced. I mentioned how the last two times I got dizzy and flushed, and he said it's a delayed allergic reaction. I could try Benadryl next time to help with that, as it's a fast-acting antihistamine, but it leaves you drowsy, so he didn't think it was a good idea if I'm scheduled to teach a class soon after.
I think the rheumatologist was having a bad day too, as after he let his first patient go, she came back in five minutes later because her bandage wasn't stopping her bleeding. She patched up fine though. After a while, I realized my left arm, where the drip was, was tingling. I tend to think these sorts of effects are psychological, so I ignored it. It was stinging at the site of insertion too, a mild pain, which I also ignored. But it was persistent - if it's just my imagination I can usually forget about it for a while - and I looked at my arm and saw a small bulge in the skin. I told the doctor about it. Apparently the needle had slipped further into my arm and fallen out of the vein, so the saline/Remicade solution was going into my skin, and also was dripping more slowly because there was less space for it. So sadly he had to switch it to the other arm, where the bandage after would likely interfere with my writing on the board. Que sera, sera. Ickily in the process he spilled some of my blood onto the floor and I never noticed him clean it up. Good thing I don't have AIDS! (And that AIDS can't live outside a host for long.)
The rheumatologist started it in the other arm, and it was back up to a normal speed, he checked on another patient, and left the room. And I realized I was dizzy, but again it was probably my imagination so I ignored it. But I got dizzier, enough that I commented aloud to the other patient. Then I realized that I was nauseous as well, and I asked whether he thought Dr. Garg was nearby. The man started trying to get up to find Dr. Garg, and I called out as strongly as I could for him, as I was getting weaker and dizzier. Garg came in before the patient got anywhere, and started mumbling a comment about the man moving around. I interrupted with "I'm feeling dizzy." He saw the drip was going faster than before, sometime in then I managed to say again that I was dizzy and weak, maybe I said I was worried about fainting, I know I said I thought I was going to vomit. He yanked the needle, helped me get my water, raised my legs, etc. etc.
He explained what had happened to me, and earlier had explained how Remicade works. Your body uses TNF-α to tell cells when to start causing inflammation, by binding to receptors on the cell. Remicade is part manufactured and part mouse-based (chimeric) and mimics the cell receptors, so it binds to the TNF-α in the body. Enbrel and Humira, on the other hand, mimic TNF-α and bind to the cells' receptors. Enbrel apparently is also chimeric, and includes some Remicade-like molecules. Humira is based upon human cell receptors instead. Remicade is via IV so it can get into the bloodstream fast and interact with all the TNF-α quickly. Enbrel and Humira are into fatty tissue so they can diffuse out more slowly since a fast dose would entirely shut down cell receptors and break the immune system completely.
After each infusion, said the doctor, some of the Remicade was left in my blood stream, until today it built up to a level where my body had an allergic reaction to it. That allergic reaction caused a drop in blood pressure. In addition, sticking a needle in someone can stimulate the vagal nerve, which not only causes constriction of blood vessels, and therefore dizziness, but a need to vomit. (This also happens to me when I donate blood.) This is why he pulled the needle.
We ceased the infusion at that point, but I will have future infusions. For next time, he wants me to take my Claritin daily for ten days ahead of time. At the appointment he will give me Benadryl, which is fast acting, but also causes drowsiness. Therefore I'm putting the appointment in the afternoon after I get done with classes. Though I just realized the date is finals week, so I need to double check when I have finals. And lastly, we'll do it a heck of a lot slower, so my body has time to adjust.
Interestingly, he told me in a debriefing while he took my blood pressure (105/80, still below normal but higher than before) that 20% of patients without rheumatoid arthritis have a reaction to Remicade. Patients with RA are usually on an additional drug that seems to act as a buffer for reactions. Not that they know why.
No one has a clue what's wrong with my car.
So sayeth Aaron, landlord and mechanic, at 2:30 pm. I will call back imminently to see if there's any better clue, but after hours working on it they'd tried a bunch of things and there wasn't any code that Aaron could read on his machine. Might have to send it to a dealer to read the full codes. If they'll take a car this old. I mentioned to Aaron in passing that I might end up buying another car, and he sounded interested in buying it. I mentioned this to Dad, and he said "yeah, and I bet Aaron fixes it the day after you sell it to him." :-P Woody Allen.
I didn't go to the Toyota dealer after work though, as I would've had to wait (just under) an hour after work to catch the next bus to get there, and then wait again to get a bus home after, all for an additional $1.25 to see cars I hopefully won't have to buy. My office-mate doesn't like the dealer anyway. And I was tired. She drove me home. I have nice friends at work. :)
I'm now having Saltines with Smucker's Natural Peanut Butter. Yum. Sleep.
The first bus drops me off on the side of City Hall, and I have to catch one of two busses in front of City Hall. As I turned the corner around the fancy stairs, I saw both put on their blinkers and pull out from the curb. One line comes every half hour, the other every hour. So I waited another 30 minutes in the cold and snow (!) until the next bus. In all, instead of 15 min when driving, instead of 40 min like yesterday, it was 1:15.
I had a reaction to the infusion.
I borrowed S******'s car, which drove very nicely, thank you, and got to the office just in time. Took the usual painkiller and antihistamine and waited for the doc. Had the pre-treatment talk. He said he thought the bumps looked better - smaller and less red - but I'm not convinced. I mentioned how the last two times I got dizzy and flushed, and he said it's a delayed allergic reaction. I could try Benadryl next time to help with that, as it's a fast-acting antihistamine, but it leaves you drowsy, so he didn't think it was a good idea if I'm scheduled to teach a class soon after.
I think the rheumatologist was having a bad day too, as after he let his first patient go, she came back in five minutes later because her bandage wasn't stopping her bleeding. She patched up fine though. After a while, I realized my left arm, where the drip was, was tingling. I tend to think these sorts of effects are psychological, so I ignored it. It was stinging at the site of insertion too, a mild pain, which I also ignored. But it was persistent - if it's just my imagination I can usually forget about it for a while - and I looked at my arm and saw a small bulge in the skin. I told the doctor about it. Apparently the needle had slipped further into my arm and fallen out of the vein, so the saline/Remicade solution was going into my skin, and also was dripping more slowly because there was less space for it. So sadly he had to switch it to the other arm, where the bandage after would likely interfere with my writing on the board. Que sera, sera. Ickily in the process he spilled some of my blood onto the floor and I never noticed him clean it up. Good thing I don't have AIDS! (And that AIDS can't live outside a host for long.)
The rheumatologist started it in the other arm, and it was back up to a normal speed, he checked on another patient, and left the room. And I realized I was dizzy, but again it was probably my imagination so I ignored it. But I got dizzier, enough that I commented aloud to the other patient. Then I realized that I was nauseous as well, and I asked whether he thought Dr. Garg was nearby. The man started trying to get up to find Dr. Garg, and I called out as strongly as I could for him, as I was getting weaker and dizzier. Garg came in before the patient got anywhere, and started mumbling a comment about the man moving around. I interrupted with "I'm feeling dizzy." He saw the drip was going faster than before, sometime in then I managed to say again that I was dizzy and weak, maybe I said I was worried about fainting, I know I said I thought I was going to vomit. He yanked the needle, helped me get my water, raised my legs, etc. etc.
He explained what had happened to me, and earlier had explained how Remicade works. Your body uses TNF-α to tell cells when to start causing inflammation, by binding to receptors on the cell. Remicade is part manufactured and part mouse-based (chimeric) and mimics the cell receptors, so it binds to the TNF-α in the body. Enbrel and Humira, on the other hand, mimic TNF-α and bind to the cells' receptors. Enbrel apparently is also chimeric, and includes some Remicade-like molecules. Humira is based upon human cell receptors instead. Remicade is via IV so it can get into the bloodstream fast and interact with all the TNF-α quickly. Enbrel and Humira are into fatty tissue so they can diffuse out more slowly since a fast dose would entirely shut down cell receptors and break the immune system completely.
After each infusion, said the doctor, some of the Remicade was left in my blood stream, until today it built up to a level where my body had an allergic reaction to it. That allergic reaction caused a drop in blood pressure. In addition, sticking a needle in someone can stimulate the vagal nerve, which not only causes constriction of blood vessels, and therefore dizziness, but a need to vomit. (This also happens to me when I donate blood.) This is why he pulled the needle.
We ceased the infusion at that point, but I will have future infusions. For next time, he wants me to take my Claritin daily for ten days ahead of time. At the appointment he will give me Benadryl, which is fast acting, but also causes drowsiness. Therefore I'm putting the appointment in the afternoon after I get done with classes. Though I just realized the date is finals week, so I need to double check when I have finals. And lastly, we'll do it a heck of a lot slower, so my body has time to adjust.
Interestingly, he told me in a debriefing while he took my blood pressure (105/80, still below normal but higher than before) that 20% of patients without rheumatoid arthritis have a reaction to Remicade. Patients with RA are usually on an additional drug that seems to act as a buffer for reactions. Not that they know why.
No one has a clue what's wrong with my car.
So sayeth Aaron, landlord and mechanic, at 2:30 pm. I will call back imminently to see if there's any better clue, but after hours working on it they'd tried a bunch of things and there wasn't any code that Aaron could read on his machine. Might have to send it to a dealer to read the full codes. If they'll take a car this old. I mentioned to Aaron in passing that I might end up buying another car, and he sounded interested in buying it. I mentioned this to Dad, and he said "yeah, and I bet Aaron fixes it the day after you sell it to him." :-P Woody Allen.
I didn't go to the Toyota dealer after work though, as I would've had to wait (just under) an hour after work to catch the next bus to get there, and then wait again to get a bus home after, all for an additional $1.25 to see cars I hopefully won't have to buy. My office-mate doesn't like the dealer anyway. And I was tired. She drove me home. I have nice friends at work. :)
I'm now having Saltines with Smucker's Natural Peanut Butter. Yum. Sleep.
