Eight jabs to go

I have two unopened boxes with four syringes each sitting in the fridge. I took my shot late Friday night. Seems like the side effects have really hit me this week. I had to get on a three-hour conference call on Saturday from 10:30 to 1:30 — that project is running headlong into reality. A bunch of contractual deadlines created at the Nineteenth Hole with no particular connection to what needs to happen. But I digress.

I typically sleep late on Saturday after the interferon shot and this Saturday was no exception. I got up with time to grab something to eat drink my coffee and get on the phone. Due to the craziness in the project The Boss scheduled a three-hour call. He didn't join, of course. By the time the call was over, I was starting to feel sides. That afternoon I cleaned the pool and did some other light chores, but wasn't feeling my best.

We had dinner plans with friends, our kids, and their kids. It was good. I still didn't feel so hot, but it got me out and distracted. A distraction is good. Sometimes the worst thing you can do with side effects is to sit around wallowing in it. We decided to rent a movie and went over to their house. It was The Ringer which was all about a guy who decides to fix the Special Olympics. Our kids are old enough to appreciate the cynical humor.

How to inject Pegasys

This is an expanded version of a comment I posted in another blog. It might be useful for someone starting treatment. I've made some minor updates, if anyone is keeping track. Thanks to everyone at Ron Metcalfe's Hepatitis C Forum.

November 20, 2006 update. I've added a recommendation for the injection process itself. Quick and smooth is better than slow.

I use the Roche Pegasys syringe. These are the directions they fail to give you.

Roche Pegasys Syringe

(Picture raided from a post on ronmetcalfe.com by Ginjura)

Assembling the syringe

The syringe doesn't come with the needle installed. The needle is in a separate bubble pack. It's in two layers of plastic. Peel apart the needle package and remove the needle.

I prefer to loosen the plastic cap before installing the needle. I remove it and then put it back on loosely. You'll be able to see where the little semi-transparent needle cap meets the needle assembly. The orange post-use safety cap attaches to the base of the needle.

Hold the the needle assembly tightly down at the base where the orange cap connects and give the clear cap a straight tug. You don't want to twist it off, just pull it straight. Don't try to just loosen it — it doesn't work that way. Pull it straight off in one motion and get your hand away from the needle. I say this because I once tried just loosening it. When it came free, the natural reaction was to try to stop my hands from separating. I ended up pushing the cap back on. I could have just as easily stuck my hand with the needle. Not that that'd be an earth-shattering event, but it would be shattering to me in my shaky emotional state which is exacerbated by my dislike of needles.

Replace the semi-transparent cap loosely. Remove the grey cap from the syringe. You'll see that the glass of the syringe is frosted down at the tip where the needle goes on. That's supposedly to allow a tight friction fit.

Again holding the needle by the base where the orange cap connects, push the needle assembly tightly onto the end of the syringe, being careful not to press the clear cap back onto the needle. Don't worry about the syringe being made of glass. It is not fragile, at least not to straight pressure. I've never experimented to see what it would take to break a syringe, but I've never done it by accident either.

Don't try to twist the needle on. — you won't be able to anyway, as the attachment for the orange cap will just turn around the needle. The needle assembly will not click into place, it's just a friction fit. Push it tightly. I had one come loose as I was injecting and it was disconcerting, to say the least.

Preparing to inject

I usually use a bit of my rather meager love handles for the injection. Sites range from as far back as I can reach on either side to about an inch and change away from my navel. I've also injected above the navel and in the outsides of my thighs or high on my hips. Injections usually leave a silver dollar sized welt. Some folks report itching. I've never experienced it. Use them as markers of previous shots. Don't inject where there's already a welt.

Once I select a site, I scrub it down with an alcohol swab. If you have skin issues, you may skip this step. I haven't had any problem. The reason I scrub isn't because I'm obsessive, but to de-sensitize the area.

While the alcohol dries, push some of the air out of the syringe. This does two things. First, you don't want to inject a bunch of air (although some won't hurt, and can actually help, as we'll see). Second, the plunger has been stuck in one position for some time. Moving it prior to injecting makes it easier to inject.

Injecting

Next, grab a pinch of skin and inject. The Roche instructions recommend jabbing quickly. They're right! For the first forty or sow weeks, I couldn't bring myself to do it quickly. But a recent trip to get a flu shot convinced me other wise. The needle was the better part of three inches (7 centimeters) and it went somewhere near the bone deep in my deltoid. The guy who gave the shot pushed it in with a single smooth motion. I hardly felt anything. I now try to emulate his technique. Don't rush, just straight, smooth, and without hesitation (yeh, that's the hard part!).

I've found that the best feature of the Pegasys kit is that the needle is unspeakably sharp. It slides right in. I've found it is easier to focus on the syringe rather than the needle. At one point when I was more squeamish, I'd block the view of the needle actually entering with a finger.

I've learned that if you're going in an any angle at all, make sure that the bevel is up, away from the skin. In other words, the longer side of the bevel to the skin, the short side away. It takes advantage of the sharpness of the needle (Again, thanks to the Ron Metcalfe forum).

Choose an angle that keeps the needle down and the plunger end up. You want a small air bubble against the plunger. The idea is to empty the syringe of the drug. There's some controversy here. Some say that the syringe is slightly overfilled and that by fully empying it, I am getting a larger dose. It can't be more than a drop, so I don't sweat it. If I were really curious, I suppose I could measure it into a graduated cylinder, but I'm honestly not that worried. Anyway, there's an advantage of injecting a bit of air at the last. It prevents the medicine from leaking back out.

The instructions say that once the needle has been inserted to pull back on the syringe. Skip this step — it's lawyer repellant. It's unlikely you'll hit a vein in the belly or outsides of the thighs.

Push the plunger. Some say slowly, some say quickly or smoothly. I've found it makes no real difference. Just get the juice in your body and get on with killing the bug!

Pull the needle out. Again, do it quickly. Hesitation hurts. You'll probably find yourself letting a held breath out. I do anyway, and my heart is usually racing. This after forty weeks of injecting this stuff once a week, and close to thirty weeks of one interferon, plus a Procrit and three Neupogen injections each week.

Post injection

I usually swab the site again with the alcohol pad. Again, some folks report a bit of leakage and itchiness where the medicine gets on the skin. I haven't experienced this, possibley because I always wipe down afterwards.

Click the post-use cap in place and drop the syringe into the sharps container.

Cross this week's injection off. You've got another one down!

Will you ever get used to it? Maybe. Will you ever learn to like it? I hope not. Does it ever get easy? It depends on how you define "easy." It does get to be routine. I have a diabetic friend who does not feel sorry for me. He takes anywhere from three to five insulin injectons a day. Heppers get little sympathy from him.