I was wheeled up to the 11th floor for my last plasmapheresis treatment around 4pm yesterday. My nurse up there was in the room throughout the whole treatment. He was a talkative guy. He gave me a lot of insight on picking a career in health. He grew up in Hawaii and went to college in NY so he has an Hawaiian accent but an east coast attitude. He worked at NYU medical center for over 10 years and told me NYU is way overrated. He wished that he transferred to SF sooner. I think he was only staying in my room because I was his last patient before his break. He seemed anxious to get my treatment done. There's two tubes that I'm hooked up to, one where my blood exits and one where it's returned to me. Before the machine was done returning blood, the nurse unclamped me from the tube that took away my blood. Before the machine beeped he released me from the other tube too. I wonder how much blood I loss during this hospital stay. I'm sure it's not much as 2004, but they were giving me blood then.
I was free from getting normal saline for awhile because my nurse yesterday decided that I didn't need to take my Trans-pal up during plasmapheresis and she didn't reattach me when I got back. The pharmacy didn't send the Rituximab until 7pm, so it didn't get started until 11:00 pm.
The medicine was only set for 25 ml/hr (compared to 100-500 ml/hr when I get normal saline or 100-175 ml/hr when I get IVIG). The nurse that night had to stay in my room to check my vitals every 15 minutes the first hour; everything was normal so she boosted up the rate to 50ml/hr. The next hour was suppose to be checking every half an hour. At 12:30pm the nurse increased the rate to 62.75. Around 12:45pm my stomach started to hurt. Then I felt nauseated. I waited it out a bit to see if it would go away, but then my legs began to tremble. I pushed the nurse's button. By the time she got to my room my lips were starting to shake. My vitals were normal, so the nurse decided to bring in another nurse on a second opinion as to what to do. That nurse brought me a small pill for nausea. They had a couple of buckets placed around my bed just in case I hurled. I had a cool towel placed on the back of my neck too. The nurse decreased the rate of the infusion back to 50 and called for the doctor. Both the doctors that came and assessed me seemed a bit confused on what to do. One of them asked me what I thought, which was weird. The nurse noticed that my stomach looked a lot fuller and said it felt tender. I then noticed that my stomach aches had decreased and I felt blotted. It was the nurses that gave the idea of stopping the medicine. That sort of made me wonder why only residents stay the night in the hospital. Shouldn't at least one doctor from each department who have finished their residency be in the hospital at all times? I think it was the best idea since the nurses did say that more people would be able to watch me during the day. Plus, I really wanted to sleep.
The neurologists talked to me this morning. They're deciding to continue with Rituximab but give it to me at a slower rate. Plus, instead of 25 mg of Benadryl, they're gonna give me 50 before the infusion. They think the symptoms are just due to an allergic reaction.
Rituximab is an interesting drug. It expires within 24 hrs if it's refrigerated and 12 hr if it's not. I'm now waiting for a new bag since the one that was used yesterday is out-of-date. I wish I knew more about this stuff, like the reactions and the composition of the drug. One of my cousins who's currently in pharmacy school wrote a report about Rituximab and sent it to me. He said it was a last resort drug, but I don't think he's aware that the side effects of Rituximab are different for the different diseases it's used for. His report was only explaining what would happen in one type of illness.
Sorry, this is a very bland entry. I'm exhausted from not getting enough sleep the whole week. Last night, after everything got sorted out it was already 2:30am. At 4:00 the nurse came in to poke me for some labs. At 5:00am RT came. At 7am this guy knocked on the door and gave me 12 cans of formula, which turned out not to be mine. I'm only running on 20 hours of sleep starting from Monday. Not to mention, my catheter is starting to itch. Oh, when will pharmacy send that new bag of Rituximab??? Infusion's probably gonna be 8 hours instead of 4 now. Maybe I'll be discharged tomorrow afternoon/night.
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