Thursday, November 1, 2012

Shot Clinic

When I got sick in September, there were three factors that made the situation so critical:

1. My IBD. I am missing 7.5 feet of intestine, so I don't absorb fluids well anyways. I became extremely dehydrated extremely quickly. I estimate I had lost over 2 liters of fluid from my ostomy alone (plus more from vomiting) by the time the paramedics arrived, and I lost a few more liters at the hospital.
2. My autoimmune reaction that causes my body to overreact to stresses/illnesses.
3. My adrenal insufficiency, which makes my body unable to respond to the stress of illness, causing my blood pressure to drop, my heart to race.

All these things combined resulted in me tottering on the brink of shock and sepsis just a few hours after getting sick. Obviously, I can't do anything about the fact that I'm missing intestine. I'm on more methotrexate now to try to suppress my immune system so that I won't have another SIRS reaction when I get sick. And, I am teaching my parents how to give me shots.

As an Adrenal Insufficiency patient,. I am supposed to carry around a vial of Solu-Cortef (steroid) and a needle. If I get severely ill or injured (e.g., if I am in a car wreck or begin vomiting), I'm supposed to immediately inject the mega-dose of steroids into a muscle. When a normal person experiences a highly stressful situation like that, their body gives them a big jolt of cortisol to help them cope with the trauma. My body can't do that, so I am at high risk for going into shock in these situations unless I inject steroids. 

I think that giving myself a steroid injection before calling 911 would have really helped me be more stable. Once I got to the hospital, it took them HOURS to give me the steroids my body so desperately needed - and I started feeling much better very soon after I got them. I insisted from the beginning that I needed more steroids, and the doctors agreed, but red tape and bureaucracy and pharmacy and delays prevented me from getting the dose until I got to the floor from the ER!

The Solu-Cortef is not an easy shot to give. The medicine is in powder form, so you must first reconstitute the powder, gently roll the vial to mix the powder and sterile water, then draw up the correct amount, and administer the (big) shot into a large muscle. I was far too sick and out of it to have been able to give myself a shot - I was practically incoherent most of the day - so someone else needs to know how to draw up and give the medicine in the event that I become incapacitated.

So, I made a little Solu-Cortef kit, stored in a well-labeled bag kept in an easily accessible pre-determined location. It contains the med, two syringes and needles, alcohol swabs, bandaids, step-by-step instructions on how to give the shot, and a note to show medical personnel (it says that I am adrenally insufficient, has my normal steroid dosage and the dosage of my shot, and my Endocrine doctor's number).

Then, I held Shot Clinic. I showed my parents the kit, and walked them through the steps of mixing the med, drawing up the liquid, choosing an injection site, and giving an injection! Then... it was time to practice. I have to inject methrotrexate semiweekly, so there's lots of chances to try. The meth shot is much more user-friendly than the steroid stuff, but the process is very similar. They both tried their hand at it. I am proud to say that they both performed admirably, successfully gave me injections, and are well on their way to their honorary nursing degrees. ;) Just another example of the sacrifices my parents continue to make to take care of me... giving shots was never on the list of life skills either one wanted to learn, but they have taken it in stride and bravely rose to the occasion. I am thankful for their love and care. And I have greater peace of mind knowing that they can give me a shot if I were to get very sick again - although I sincerely pray that there won't be a "next time" for getting so sick!

Hannah ;)