I headed up to the outpatient special procedure room a little before noon. I walked in to to the treatment room where I was met by one of my nursing friends who runs the small unit. She was running around, very busy, dealing with other patients there for infusions, injections, etc. Most everyone receiving treatments were well over 60 years old. Needless to say, I felt a little out of place. The nurse registered me into the computer system quickly and called down to the pharmacy so the IV medication could be delivered. She told me to sit wherever I wanted to. There were about 10 large, comfy, reclining chairs all around the room with an IV pole at each chair.
I waited and chatted with my mom, waiting to begin the treatments. The nurse comes over and takes my VS. She took my blood pressure and was surprised at how high it was. (I'm pretty sure it was something like 145/90) It had been running that high when I was admitted to the hospital that past weekend. All my other vitals were fine. Just that darn high BP and high heart rate (which I have always had).
The nurse sends some of the patients who are done with treatments on their way. It's just me sitting next to a sweet, little elderly lady who is receiving a blood transfusion. The nurse then puts in my IV and begins the treatments.
Knowing that I am a nurse, she gets me the IV solution and treatment medication book out so I can look at symptoms, side effects, etc. of the drug. Each treatment will be a whopping 750mg! The nurses, including myself, were a bit surprised at such a large dose, saying that we had never given a dose that large before. All I could do was laugh at the "firsts" I was experiencing and pray this treatment would reverse the damage to my kidneys.
If your like me and want a more detailed explanation, this is why steroids are used for treatment of my lupus nephritis class IV:
Classes III and IV
Patients with either focal (class III) or diffuse (class IV)
lupus nephritis are at high risk of progressing to ESRD (End Stage Renal
Disease) and thus require aggressive therapy.
Administer prednisone 1 mg/kg/day for at least 4 weeks,
depending on clinical response. Then, taper it gradually to a daily maintenance
dose of 5-10 mg/day for approximately 2 years. In acutely ill patients,
intravenous (IV) methylprednisolone at a dosage of up to 1000 mg/day for 3 days
may be used to initiate corticosteroid therapy.
In patients who do not respond to corticosteroids alone, who
have unacceptable toxicity to corticosteroids, who have worsening renal
function, who have severe proliferative lesions, or who have evidence of
sclerosis on renal biopsy specimens, use immunosuppressive drugs in addition to
corticosteroids.
Mechanism of Action
Glucocorticoid; controls or prevents inflammation by controling the rate of protein synthesis, suppressing migration of PMNs & fibroblasts, reversing capillary permeability, & stabilizing lysosome at cellular levelShe started my treatment and explained that I would probably have a terrible taste in my mouth after the treatment. Boy was she right! The horrible taste started within 15 minutes of the treatment! I tried chewing gum to take the taste away but that hardly helped. It's so hard to describe the taste: metallic, bitter, nauseating, unnatural...disgusting! Lol. This taste lasted pretty much till evening every treatment day. I did learn, after day one, to order a meal tray before, and eat lunch during the treatment. This helped a little bit. The infusion lasted about an hour each day. I was usually there for at least 2 hours due to; IV placement, waiting on pharmacy to deliver meds, the nurse who was very busy each day, and of course, computer problems! :)
I asked if I could keep the IV in place since I was coming back for another treatment the next day. I thought, no sense in poking me twice if I don't have to be! The nurse wrapped it up good and gave me a couple flushes so I could be sure it was going to stay intact. With Elin pulling on it saying 'boo boo' all the time, showering and dressing, I was surprisingly able to keep it in until the next day!
By the 3rd day of treatment I knew my IV wasn't going to make it. It was starting to become red, painful and just plain annoying. So, I pulled it out Friday night! I figured I'd just get stuck again. No big deal.
My mom was awesome! She took me to get groceries after my treatment because we didnt have much of anything to eat in the house. I had been so busy with doctor and hospital visits and not feeling up to it. Even though I was feeling pretty bad, I wanted to prove to myself, and others, that I was still able to function. HA! (I still say that and act like it on a daily basis) ;) As I was walking down the aisles at the grocery store by myself, (mom was getting her own groceries) I remember feeling like I was having an out of body experience. I was dizzy, in a total fog, ready to pass out from exhaustion. I ran into one of my moms friends (surprisingly, not literally) and talked for a minute about how I was doing. Once again lying about how "good" I was feeling! Then later, my mom tells me how her friend told her how out of it I was. My mom agreed. I was not really "there". Walking around the grocery store was the most activity that I had done in weeks and boy did I push my limits with that one!
I guess I expected that I would be completely healed up and feeling amazing by the end of the 3 IV treatments. HA. That's funny. Aside from having a lot of energy at 4:00 in the morning (thank you steroids) I was still just as exhausted, in pain, and now much more moody and on edge (thank you again...steroids).
Sunday I began my PO prednisone of 60mg. Yes, this is a very high dose of steroids. I was just wondering when the side-effects would start kicking in. Oh, and did they ever! Little did I know that next Wednesday at my nephrologist appointment, I would be substantially adding to my pill collection. Oh boy!
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