Sunday, June 28, 2009

Drip, Drip, Drip

On Tuesday we went back to Jemsek Specialty Clinic(JSC). The purpose do the trip was 3 fold. My task was to change Lynette's PICC line dressing. She was due to try out a new antibiotic called clindamycin. And thirdly Anna had an appointment to see Dr. Jemsek.

The PICC line dressing change was stressful for me since I'd never done it before. I had to be extremely cautious about sterile technique. The two nurses that supervised me were very helpful and encouraging. It went fairly well. Since the dressing needs to be changed once a week, this coming Tuesday I get to go it alone.

Lynette did fine with the new medicine and she is now infusing meropenem and clindamycin twice a day on Monday, Wednesday, and Friday. The whole process is settling down now and becoming somewhat routine. We have placed hooks in strategic places on walls in our home to hold IV bags. We have purchased a rolling storage container with drawers to put all the various supplies in. We are buying socks and cutting them into tubes to cover up the PICC line site.

The infusion process starts with a saline flush. After sterilizing the end of the PICC line with an alcohol prep, a small syringe of saline is screwed onto the PICC line and slowly emptied into the line. Each of the antibiotics comes with a 100ml bag of saline and a small bottle of medicine. The meropenem is powdered and needs to be mixed prior to administration. The clindamycin comes the same way but it is liquid so there is one less step.

Both medicines have rather ingenious ways of attaching the medicine to the IV bag to prepare and dilute it, and to keep it sterile. Once the drugs are mixed the IV bag is spiked with the end of a tubing set up. After purging all the air out of the tubing line it then gets hooked up to the PICC line. At 1 drip per second the medicine is administered over a 30 minute period. That is followed by another saline flush, the next medicine, and then another saline flush. Finally the line is flushed with a small syringe of Heparin which is an anti-coagulant.

On days when Lynette does not receive the antibiotics, she still gets a saline flush followed by a heparin flush. Also on her days off she can choose to infuse a liter bag of lactated ringers(LR). As I said in a previous post, we did not know at what rate to administer the LR. We found out at JSC that we should run it wide open. Lynette did a bag in about 75 minutes yesterday. She said she felt like it gave her a little boost in energy.

Dr. Jemsek will also start Lynette on a couple of new medicines in the next two weeks. They are both intended to target the babesia infection. The first drug is called Mepron. It is a thick, vibrant yellow liquid. The bottle of Mepron is a 10 days supply. The cost to the insurance company for this drug is $920. I had heard that it was expensive, but I was still surprised when I found out how much it actually was. Fortunately our insurance benefit maxes out at $100 out of pocket per prescription. Whew!

The other medicine that Lynette will be taking is Artemisinin. This is an herbal remedy shown to have beneficial effects against the babesia infection. It does not require a prescription, but it does have to be ordered on line. We have been placing orders with Moss Nutrition and VitaCost about every other week for supplements. Last night we ordered from both!

JSC set us up with enough IV supplies to last us for the next few of weeks. We left JSC with 3 boxes of supplies. It required a hand truck for me to load everything into the car in one trip. We also left with a receipt for a $6200 charge. Lynette will be on a drug holiday when we go on our annual family beach trip. She will return to JSC the Wednesday following our trip, so she will get a 12 day break from all prescribed medicines.

Anna expressed some apprehension about seeing Dr. Jemsek. She said she thought he was scary. There is no doubt that he is intense. I find his level of knowledge somewhat intimidating. He started off the appointment by telling a funny story about his 4 year old son and his mother in-law. We all had a good laugh and I think Anna felt better after that. Anna's regimen is not changing much. Dr. Jemsek suggested a couple more supplements for Anna. His greatest concern seemed to be that she get enough sleep. She has had problems falling asleep, staying asleep, and going back to sleep when she wakes up. Dr. Jemsek gave us a drug schedule for Anna that will continue her treatment through the next 12 weeks. She doesn't have to return until that time.

1 comment:

  1. Hi, I'm also a North Carolinian Lymie.

    I know a lady that makes beautiful picc line covers. I requested her make some for me, but she hadn't made them in time for my PICC treatment ... BUT she her own etsy store for them. They are quite attractive.

    Good luck with Dr. Jemsek. (I don't see him, but see another LLMD that's in NC)