RA and injection fatigue


There. I did it. Another biologic DMARD injection for my RA is done, and no more thinking about for another two weeks.

It was easy, as it usually is. What wasn't easy was the anticipatory build-up, starting at the beginning of the week. I look at the calendar and there, on the box marked THURS, in my breezy handwriting, is "Jab Today, R." Which means that Thursday is Biologic DMARD Injection Day, and because I'm the forgetful type, the R stands for my right thigh as the injection site. Don't want to shoot up the same thigh twice in a row.

So, there's the calendar. Then, every day since Monday, I see the marked THURS again, except now it's another day closer. I put it out of my mind, but really, I can't help thinking about it. Because you know what? There is just nothing less natural than positioning a pen-gun on your leg, pressing the trigger, holding it there, and counting to 10 while it fires a needle through your skin, into the layer of subcutaneous fat beneath it, and injects a cold liquid that may--but not always--burn through your nerve endings like a flood of icy fire.

That's the event I anticipate, with a whirl of fluttering butterflies in my belly, each time I glance at that calendar.

And when Thursday finally arrives? All day I think about it. I could get out of bed and inject first thing in the morning--get it over with--but in the four months I've been using this drug for my RA, I haven't been able to do that. I just don't have the required steeliness of mind to shoot myself up that early in the morning.

Instead, I tell myself "later." Like, tonight, before I go to bed. But it stays on my mind throughout the day, a little niggling knowingness: tonight is Jab Night. Maybe it will burn really bad, like that first time I did it, all alone, with no one to show me how or to hold my hand. It brought me to tears, that time, a combination of nerves and shock and yes, some very brief but eye-opening pain. Or, maybe it won't hurt at all. Since that first time, I've learned the technique. I'm methodical, calm, composed, and determined. I'm a veteran.

I get the pen, in it's packaging, out of the refrigerator, where it lives before injection. I set it on my desk to let it warm up to room temperature. I set the alarm on my phone for 30 minutes. When it beeps, I get up and take an ice pack out of the freezer. I put it on the appropriate thigh--my right one, tonight--and reset the alarm for another 25 minutes. When that's gone, it's time. There's no putting it off, now. You can't re-chill the medicine. You must use it, or waste it. And no one in their right mind wastes a medicine that costs more than two nights in a four-star hotel.

My right thigh is nicely iced and numb. I wash my hands with antibacterial soap. I go into the bathroom, sit down, bare my leg, open a tiny, one-use alcohol swab and clean the injection site carefully. As I wait for it to dry completely I open the pen's packaging, take it out, and prepare it for action. I pinch up about an inch of flesh between my thumb and first finger and position the pen on just the right spot. I take a long, deep breath, hold it, blow it out slowly, set my gaze on the opposite wall, and press the button.

And I hisssss... maybe moan a little if it burns, as it sometimes does, and sometimes doesn't. I never know which it's going to be. The bright side is that it never burns very long--just five seconds or so, and then it's over. What remains, as I carefully lift the pen-injector straight up from my thigh and set it aside, is a red pinhole in my skin, blood welling up into a tiny bead. I get the sticky bandage I've got ready and put it on over the pinhole. The area around it is exceedingly tender and hurts like a you-know-what if I press on it, so I'm very, very gentle with the bandage.

I'm done. There's nothing left now but several still-agitated butterflies in my middle. I take the spent pen and put it into the big, red sharps box, my own personal morgue of used biologic DMARD injectors. Amazingly, they're starting to build up in there; I can't believe how many times I've jabbed myself already. Another four or five times and the box will be full. Of course, by then I should know whether this drug is going to work, and whether I'll even need a new sharps box.

The pen-injector is made so that I can't see how much actual medicine is entering my body and absorbed into my bloodstream. It can't be all that much, since the instructions that come with the pen only counsel you to hold the pen-injector in place for 10 seconds after pressing the button, hearing the loud CLICK and feeling the needle punch through the skin. There can't be more than a few thimbles-full of clear-as-water liquid hope.

I've never had any after-effect from the injection. The site stops being tender within a few hours. In some people, the medicine causes some swelling or bruising around the injection site, but that's never happened to me. OK, maybe a tiny, painless bruise, but not every time.

And now, the anticipation begins again. In two weeks, on THURS, I'll repeat this entire ritual, this time jabbing my left thigh. In the meantime, I live in hope that this drug, this medicine that has slowed or stopped the progression of severe rheumatoid arthritis in so many people before me, will do it for me, too. So far, it hasn't. But these drugs can take a full six months before they start to work, and I have have another five injections to go before then.

Every day I hold onto hope. My RA has gotten much worse over the last 18 months. Some days the pain, fatigue, and disability is worse than others, but I can count on waking up to it every single day...

Unless. Maybe this injection will be the one that turns the tide.

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