Saturday, June 18, 2011

Copaxone Vs Other Injection Types

The other day I had a flu shot and a couple of days later I had an MRI with gadolinium contrast, and well we all know by now, I have daily injections of Copaxone for MS.  Thus I think I am qualified (although probably not highly) to blog about injection type and the pain involved with each.

The flu shot was an intramuscular injection and it was injected into my left deltoid muscle... in my upper arm.  I was at the doctor's surgery and I was with my kids, Chynna and Sabin and we were all getting the shot.  Chynna literally begged to go first, but once we were in the nurse's room she quickly changed her mind.  Poor little Sabin was the nurse's first victim.  He let out a little yelp, but was very brave.  I was next.

I think I pissed the nurse off, because I had to buy a flu shot from the pharmacy next store.  It was super, just out of the fridge cold and I figured I would warm it up a little, so I took the shot of it's packet and put it under my arm.  The nurse in question spotted the injection under my arm and gave me the, what the hell do you think you're doing look.  While she said nothing, I felt compelled to offer her an explanation... the injection was cold, very cold, icy cold and that it would hurt if the close to freezing 10mls was injected into an arm.  She tsked, clucked and puffed herself up like a blow fish before saying it only takes a few seconds out of the fridge to warm up to room temperature.... a few seconds my arse!!  Clearly I never said that, because she was going to be the one holding the syringe in a few short minutes time.  She was obviously having a bad day anyway as was pretty short and abrupt with us.  Who knows, perhaps she had to lance a boil on some old lady's bum, or got stuck in traffic having to listen to Justin Beiber or woke up on the wrong side of the bed then tripped over the cat on the way to the bathroom prior to seeing us.  We all have days like that, well perhaps not lancing a boil on an old lady's bum, but fortunately we don't have to shove pointy instruments of terror into another human's arm either.

The nurse lined up my arm and then stuck me with the needle - far out!  I couldn't yelp or even scrunch up my face for that matter, as my daughter had to have her shot next, and I can tell you, she was watching me like a hawk... looking for any excuse to fall into a blubbering heap on the floor.  Although I am not fazed about having injections, this one really hurt, especially because I couldn't release the pain via a yelp.  I didn't have long to think about it though, because the nurse had seated Chynna on my lap and was placing my hands on her arms to hold her in place.

Chynna was whimpering.  The nurse had the needle poised above Chynna's arm, when I saw what the problem was... The needle was like a toothpick - MASSIVE!  I was pretty sure the nurse was going to stick Chynna with it only to find that it was poking out the other side of her skinny five-year-old arm.  But before I could voice my concerns the needle was in and Chynna was like a screeching plank of wood.  Just by her reaction I could tell the pain was about a nine point nine, nine, nine out of ten on her scale. 

Chynna used to be amazing with needles.  She breezed through all her immunisations without so much as a peep, until the four year old ones, which involved two injections.  The same grumpy nurse as mentioned earlier decided in all her nursely wisdom, without consulting me decided it would best if she and another nurse hammered Chynna with the two needles simultaneously.  So there I was holding my little slip of a child, when without warning they struck, banging the injections into to her arms so quick that her head and mine were left spinning.  If they had of asked, I would have said, oh, one needle at a time is fine - she'll sit still for the second because she's really good with needles.  But instead they ruined her for me... meaning that they are not the ones that will have to deal with her anguish at being injected and her lamenting afterwards until she’s all grown up and even then I bet she still asks me to go with her! 

Luckily I had a three pack Twirl on hand to soothe our pain.  I'm not sure about Sabin because he can't talk yet, but Chynna's arm and my arm were pretty sore for the next few days, I couldn't sleep on my favoured side in my usual sleeping position because my arm was so pulverized.

A few days later I had a scheduled MRI to check if the Copaxone I have been injecting for six months is having any modulating effect on my MS.  In the past, I have had an intravenous cannula put in my arm for the super quick administration of the gadolinium contrast in between slices being taken... slices being the images the MRI takes.  Instead this time I was in the machine on the narrow table with the head cage on when they pulled me out took my arm and said, just a little scratch then carefully slid the needle into my vein.  Talk about feeling vulnerable, but it didn't hurt anymore than a scratch, which was a good thing because I didn't have much room to squirm.  Then I was pushed back into the machine.  It mustn't have been a big deal for me because I am pretty sure I fell fast asleep. 

It's been about six days since the IV injection of gadolinium contrast and I still have a bruise at the entry site, quite disproportionate to the amount of pain felt.

By now, giving myself the daily Copaxone injections is pretty routine.  Copaxone is injected subcutaneously into any fatty areas (I have a lot of those) just below the skin, usually in my belly, thigh or hip.  Thigh injections I find sting the most... but they are nowhere near bee sting proportion as is most often reported on the web.  Chynna was stung by a bee two or so years ago and she writhed around and squealed in pain for about an hour before she would take any medication.  And she is still distressed by bees till this day.  I definitely do not do squeal and writhe around every day after my injection because my injections do no feel like a red hot bee sting... not even in the slightest on the worst day.  On the worst day I have a welt the size of an egg hanging off my leg (o I do exaggerate - slightly), but usually by the next day it has gone down considerably.  Sometimes, but not very often now, after a couple of days the injection site might itch, but it's nothing some anti-itching cream can't stop. 

My husband used to give me my hip injections for a long time because your hips are in a difficult position to reach, if you are holding an auto-injector that needs to be in the engaged position while you press the button to send the injection hurtling into your skin.  I asked him to inject me the other day... and as he placed the auto-injector towards the back of my hip I flipped out.  The thought of someone else injecting me now, is too much.  I like to have control of where I place the Copaxone and when I press the button - c-o-n-t-r-o-l freak you are thinking... hey it's my fatty bits we're sticking a sharp pointy object into.

All in all, if I had to have an injection every day (woops, I do!) I would not choose to have the intramuscular flu variety - too painful for too long.  As I am appraising injection types on the pain they cause I guess I would not pick daily subcutaneous injections of Copaxone either... but this would more be due to the side effects I think.  I'm not saying there isn't any pain associated with subcutaneous injections of Copaxone - it's not like a bee sting... it is a sting that tends to be a little different every day depending on the injection site, but mostly they are pretty harmless.  So I guess that leaves me with my experience of an intravenous injection of gadolinium... hmmm it was like a sharp scratch - not very painful at all. On the down side, I bet you would have to have a steady hand, there are only so many accessible veins you could inject into and well, people would suspect you were a junkie with your track marks.

This is my final rating of injection types (in comparison to each other) that I was given last week.
Intramuscular flu shot: 8/10
Subcutaneous Copaxone: 5/10
Intravenous gadolinium contrast: 2/10

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