Not long ago, I jabbed a needle(!) into my belly.
Ewww! Don’t deny it! I know you’re saying that because I said the same thing the first time I heard of someone doing such a crazy, flesh-shuddering thing. “Ewww!” I cried. “Oh, ow! In your stomach?!” I clutched my own with both hands as decades-old stories about the terrible shots they forced you to endure if you were unlucky enough to have a rabid animal bite you flashed through my mind. They said the shots were horribly painful. They did them in sets, for days. For weeks. In the stomach. *
If I had to choose between those shots and rabies, it would be a real toss-up.
Biologics and Needles
It doesn’t take long after most of us are diagnosed with rheumatoid disease before we start hearing about biologics, the powerful and most mysterious class of drugs sometimes used to treat its moderate and severe forms. Not only are biologics mysterious because of their type—they’re not simply inert chemicals and compounds, but actually contain living cells—but also because of the way they’re administered.
You know. With needles.
Now, I’ve had RD long enough that I’ve pretty much gotten over my squeamishness about needles. Over the last nearly 30 years I’ve had blood drawn countless times. I watch the phlebotomist slide that needle into the vein in my elbow, the side of my forearm, or the back of my hand with Clint Eastwood-like coolness. Even when it takes three or four jabs before my body gives up some blood I stay calm. Cool, Collected.
But I’ll admit the idea of sticking a needle into myself sounded, well, awful.
The first biologic I took came in an autoinjector, a pen-like gadget that only requires that you place the business end on chosen injection site and press the button on the other end. The needle, concealed inside the pen, shoots out, pierces the skin, and delivers an automatic stream of premeasured drug. When it’s empty, the needle automatically retracts back up into the pen. You never see it.
I didn’t like injecting with the autopen, but I got used to it. And I learned there were hacks to make it sting less: let the refrigerated autoinjector warm to room temperature before using it, and numb the area you plan to inject with an icepack, first.
With the second biologic, I learned that it was much more comfortable when I injected in my stomach instead of my upper thigh. It took some guts (sorry, again) to do the jab there, but once I did, I was glad.
The third biologic I took was via infusion at an infusion center. The needle for that is larger, of course, but I was blessed with nurses who placed it painlessly, usually on the first try. The only drawback to infusions is the time they take. Although I only had them once every six months, they lasted for more than six hours each time.
Unfortunately, none of those biologics had the slightest effect on my rheumatoid disease. So, now I’m on my fourth biologic. I had a choice between infusions or self-injecting at home. I chose the latter so I wouldn’t need to spend hours at an infusion center.
So, you can imagine my …surprise… when I discovered this new biologic doesn’t come in an autoinjector. It comes in a syringe.
Now, I’m one of those people who’s fascinated with medical stuff. I’m not squeamish. I once watched a veterinarian spay a fat little dachshund for a story I was doing for a newspaper. Although I was astonished by the roughness required to reach into the dog’s abdomen to find the uterus, snip it out and stitch things back up, I was utterly spellbound. Seeing the dogs living innards, along with the associated blood and gore didn’t bother me a bit.
But I’ll admit I gave that set of prettily designed syringes the side-eye when they showed up in the mail. I put them, in their box, in the refrigerator as directed. They were ready to work at a moment’s notice, but it took me three full days to work up the courage to give myself the first weekly injection.
I did all the prep work: I took the syringe out of the fridge and let it warm to room temperature for an hour. I laid the necessary things out on a clean paper towel: an alcohol wipe to thoroughly clean the injection area; a cotton ball to soak up any blood droplets afterward, and a dot bandage to stick over the tiny wound. I washed my hands well with hot water and soap.
As with the autoinjectors, I had a choice of injection sites: the top of my upper thigh; my belly (avoiding a two-inch circle around my navel); and with this biologic drug, the outer side of my upper arm (if I had someone who could inject there for me). Remembering that the injections were inexplicably more comfortable in the belly than the thigh, I chose to inject my belly.
I cleaned the area, waited for the alcohol to dry, and pulled the protective cap off the business end of the syringe. There it was: the needle. It was barely thicker than a hair, and as I watched, a droplet of fluid formed at its tip. With my left hand, I pinched up a roll of fat (unfortunately, easy to do). Holding the syringe with my right hand and placing the needle over the perfect spot, I took a deep breath, and jabbed, as smoothly as I could.
To my surprise, the needle slid in totally painlessly. I pushed the plunger down slowly. I felt nothing at first, but then a slight, burning sting started. I stopping pressing down the plunger and waited until the little sting stopped. Then I went on.
In the end, it took me about 30 seconds to empty the syringe—and it was nearly painless. Since then, I’ve gotten better and practiced, and the injection is totally pain-free. I like using the syringe. I can control how fast the drug injects, which takes the sting out of it. And when the plunger reaches the bottom, the needle automatically retracts up into the body of the syringe. All that’s left is to put the dot bandage on. I don’t really need it, but it helps to remind me which side I injected when it’s time to do it again a week later. The idea is to alternate sides.
I’ve written about this to take the mystery—and with it, the fear—away from self-injecting biologic drugs to treat rheumatoid disease. They can have an almost miraculous effect, and for many people they relieve symptoms and slow the progression of the disease down almost to a stop. I’ve only been on this latest biologic for a month, too soon to know if it will do that for me. I’m hopeful—and proud that I’m brave enough to jab a needle into my stomach.
*Today’s rabies treatment is much less painful and prolonged, I’m glad to say. Yay for progress!
On a scale of 1(low) to 5(high), how difficult is it for you to talk about having RA?