Multiple Sclerosis Centers of Excellence
Kevin Byrne Describes MS Injections
AVONEX® (Interferon beta-1a) is a 166 amino acid glycoprotein with a predicted molecular weight of approximately 22,500 daltons.
April 14, 2010 marked my 541st interferon beta-1a (Avonex) injection, dating back to 2 December 1999. It was a quiet celebration at my bedside with very little fanfare. Afterwards, I spent a little bit of time thinking about my intimate relationship with that 23 gauge, 1.25 inch needle.
Not Exactly Sure
I remember first reading the Avonex medication guide way back. My favorite FAQ was “Q: How does Avonex work? A: No one is exactly sure how Avonex works but it has statistically shown to……”.
No one is exactly sure? Great.
Everyone who takes a regular injection has their favorite Injection Story. Here’s mine. When I was first diagnosed, I was an Aviation Captain commanding an Air Cav Troop in Korea. The first few weeks were a whirlwind of tests and ‘trying to figure out my fate.’ I was allowed to remain in-country and be treated there for the time. So, the US Army ordered my medicine interferon beta-1a (Avonex). When it arrived at the Yongsan Army Garrison hospital in Seoul, I took a 3 hour drive from base camp. There, the medical team gave me a 6-month supply of Avonex and a videotape on how to inject myself. When I got back to my camp I watched the tape, mixed my medication and prepared the injection site. Hooah! I then prepared to execute a clear & crisp “stabbing motion” with the needle into my thigh. I sat there holding the needle in my hand for the next 3 or 4 hours. “Do I really want to stick that thing into my leg?” was the only thought I could muster for hours.
I eventually did that first injection. It hurt – I would love to meet whoever said that a quick stabbing motion is an ideal way to inject yourself. We would definitely have words. I’m a lot better at the injections now. Last night, it was easy-squeezey! Here’s my trick:
>First, the preparation. No mixing the pellet and water anymore – that’s good. I gotta let it warm up a bit, so I take my medicine out of the fridge and let it sit for a while, or warm it up in my hands. If I don’t warm it up a bit, I have cold medicine going into my muscle. Brrrr!
>Next, take ibuprofen (Advil). At least 10 minutes before, but I try for a ½ hour. That helps my body have less of a reaction to the medication.
>Now comes the shot. The guide says you can do it into the top of the legs or the back of the arms. I have only done the leg muscles. The other is hard for self-injection. I normally sit on the end of the bed when I inject. I get my shot put together, swab my leg and start. First, I tense my leg muscle up as much as I can and hold it. Only for a few seconds but enough for my leg to feel the strain. Then I relax…relax my leg as much as I can and put the tip of the needle against my skin. Slowly, I press the needle into my leg: straight and gentle. Sometimes it fights breaking the surface. Sometimes it hurts a bit while it fights breaking that skin. I just keep slow, steady pressure. Last night was easy and straight in all the way. When I inject all the medicine, I unpack the bandage, remove the needle and cover it. Done!
>Final step, go to bed! My body hasn’t fought issues that much for a while but I still just go to bed.
>Done... All good.
Day of Week
That’s tricky. I try to figure out the best day; when I am most likely home relaxing. In my Army days, the best chance of that was Saturday night. Now that I am living the laid back, fat-and-happy retired life (right!) I have switched to Wednesday night. It’s my routine now. My cell phone sends me a reminder at 7:30PM each evening. I also have my beautiful wife to remind me. There is no way that I can forget! Except when I forget! Those weeks I have to stumble through the day after a Thursday AM injection.
Not Everything is MS
My other favorite line is “Flu-like symptoms are manageable. For many people, these symptoms will likely go away over time. So as you stay on AVONEX, these symptoms may lessen, leaving you feeling better.”
That wasn’t true for me. My flu-like symptoms occurred every few weeks. They were the worst nights of my life (drenched with fever, terrible shaking chills) that rolled into painful, bruised days. I dreaded the next shot, but chalked it up to flu-like symptoms because of my MS medication. Stupid MS.
In June of 2007, Brie and I moved to Portland to start brand new jobs. June 20 was that infamous injection. June 25, I started my new job. June 28, I was in the VA emergency room. The flu-like symptoms and pain in my leg since the 20th was too much to bear. The next day they checked me in. Was it my medication? Did I have a piece of needle in my leg? They weren’t sure. Four days later, the surgeons opened up my leg and drained a massive infection. Afterwards, my doctor’s words to me were that I was “a day or two from leaving the hospital without my leg…if I left at all.”
So what was causing my flu-like symptoms? A splinter. A splinter in my leg since I was a child. My injection used to irritate the splinter deep in my leg. My flu-like symptoms were me fighting an infection caused by a childhood splinter. After my June 20th injection, I lost the fight.
Regardless of this being just a splinter, Stupid MS. So here I am. 541 Injections down. Is it working? I’m not exactly sure but statistically speaking I am better off.