November 18, 2010
Every two weeks, my lovely assistant David has to inject me with a medicine, Humira (Adalimumab), using a “pen” (euphemistic) thoroughly engineered for consumer use. It’s a grey and plum cylinder about six inches long and a half an inch in diameter; it feels chunky and comfortable to hold, kind of like on of those felt-tipped markers for toddlers.
I would use maroon instead of plum to describe the accent color, but the Humira people reference it consistently as “plum.” It makes me feel peculiar and sad that “plum” is almost certainly part of a complex corporate branding identity for this…tube of pain. But I digress.
Through my Adventures on Crohn’s Island I have formed a grudging familiarity with needles and poking. I’ve had enough IVs run into the inside of my right elbow that the vein there is near collapse and covered in scar tissue, and there is no end to the combinations of blood work one’s gamut of specialists can think to order up.
Thus it might seem like a no-brainer to switch from a full-on 4-hour-long IV drip every six weeks to a simple stab-n-go (at home, no less!) every two weeks. No more anxiety-wracking trips to the hospital’s chemo center.
I was, perhaps, a bit too blasé*.
The first dose of Humira is typically four shots at once, and is done at a doctor’s office. David and I had our four shots lined up in a row, ready, like soldiers, in an exam room in my gastroenterologist’s bleak basement office. Everything in there always looks to have a shade of weary yellow.
David steeled himself and gave me my first injection, in the side of my thigh. The needle in the Humira pens is, first, invisible—you never see it—and, second, teeny as needles go, narrow gauge and only 1/2 inch long. The stabber merely has to hold the thing in place and press the “Plum Activator Button” (eye roll). They give it that stupid name to distract you from the furiously loud spring-loaded clicking sound it makes and the searing pain—I’m getting ahead of myself.
The experience of my first injection was kind of laughable. Button press, click, oh, this is just like any other shot or blood test or whatever and now wait what is that sense of crescendo and now why does the feeling of pressure seem to be mounting oh me oh my the extreme searing pain! The pain! The OMG stop right now the pain! Then there is some sort of relativistic time dilation. In my universe entire civilizations were born and died. I know what it is to face the void. I’d been meditating beneath the Bodhi tree for 49 days and I’d long since sacrificed one eye to drink from the well of knowledge and had been hanging upside down from the tree of wisdom for eons—all within the 10 or 15 seconds it took for the pen to shove its gook in me, make a dismissive outgassing noise, and quit.
David stepped back and, kind of like a child that has just really stubbed a toe hard, I took a few seconds to get over the shock and decide whether I needed to start screaming at the top of my lungs. A sad little drip of blood ran down my leg.
There were three more shots left.
The sweet-hearted nurse, sensing perhaps the absence of the blood-curdling scream coupled with the fierce forced silence, stuck her head in the door. It was at this intensely embarrassing moment that I noticed that there were tears running down my face.
I’ll spare you the angsty details of the three additional shots. Each hurt as badly as the first. By the end of the four individual torture sessions, I was aghast at the idea that I’d have to do this again. Regularly.
There was clear incentive to work on making this less painful. And finally I get to the point: for those Humira-wary or Humira-pained humans out there, take succor in some recommendations that may, truly, make this experience better for you.
1. First, I am not a pathetic wimp. Nor are you.
This is not about being afraid of getting a shot. Sometimes, Humira feels far, far worse than a normal injection. The medication itself, often brutally cold (the pens are refigerated), does not get along well with one’s bodily tissues. The interaction of it and flesh causes an internal burning-stinging that is very distinctive.
Additionally, the liquid itself is pushed into you with a firm pressure. That pressure, coupled with the chemical sting, is, shall I say euphemistically, uncomfortable.
Even so, I thought I was just being a pathetic, delicate flower. Until I Googled it. There, in various forums, gaggles of patients with some sort of griefy relationship to Humira. Some have full-blown panic attacks before injections, recalling how much it hurt the last time. One woman has to scream into a towel (so as not to frighten her children). And dozens have had to jettison the drug altogether, citing pain as a leading factor.
So yes, Humira can hurt like the dickens.
If there is one thing I can advise to do over all other things with your Humira pen: take it out of the fridge and let it warm up for 30-45 minutes. This single change probably accounts for 50% of the pain reduction I’ve been able to achieve. We’re talking night and day contrast here.
My gastroenterologist looked honestly surprised when I mentioned this to him (though I have seen much mention of it on the Internet). Perhaps it doesn’t work for everyone. But the effect is so marked that I would be doing the world a disservice not to suggest trying it.
3. Hydration, sobriety
Drink a lot of water on the day of your injection. But not booze.
At the peak of my Humira-pained world, I thought a bit of liquid courage might take the proverbial edge off. Doesn’t help at all for pain, in my experience, and alcohol is a blood thinner. Don’t do it.
The other major advance we’ve made is thus: David, before injecting me, pinches a roll of flesh tightly between two fingers in the spot he’s about to jab. Tightly. Not enough to hurt, but enough to keep the flesh removed from its underlying bits and to sort of “overwhelm” the nerves with sensations of pressure. It’s like they’re too busy to fire off “hey, OMG, this hurts real bad” messages.
Also, stay away from the sides of the thighs; tons more nerves there. I’ve found that the best spot for injections—and I do believe this varies very much person-to-person—is the top of my very upper thigh. I have a tiny scar from an X-acto knife incident in my childhood that serves well as a general target area (disclaimer: You’re not supposed to inject into scar tissue).
5. Gentleness post-injection
Most of the time now, my injections are not too bad. But in the few minutes just after, I try to sit very still. The injection site is usually uncomfortable in a distinctive, strange way and any touching or pressure on it is somewhat unbearable. So I just sit there pantsless for 5-10 minutes, with a cotton ball resting lightly on the spot. Then I slap a small bandage on it and go about my business!
* What wonderful etymology: French, from past participle of blaser, to cloy, from French dialectal, to be chronically hung over.