Saturday, May 22, 2010

Back Into The World Of Air Travel In The USofA!

When I lived in Hong Kong I did quite a bit of traveling for work.  I arrived in late October of 1999 and by January of 2000 I had already reached the second highest level of Cathay's membership.  Travel in Asia, albeit still stuck in a tin can for 4-8 hours depending upon where you're going, was spoiling.  Truly spoiling.  For that reason, I do not really travel for work any longer.  I'm sorry, but travel, in any class, on a US airline in the USA, pales in comparison to travel in economy on DragonAir!  Throw in Cathay or Singapore Air and it's like having a pint of Guinness in a small pub in Ireland for your entire life and then being given a Coors Light (sorry sir, that's all we have and that will be $5 please.)

So tomorrow I head off for 5 days: LA, Seattle, SanFran and back, departing Sunday, returning Thursday.  This wouldn't be of concern but of course I have other issues now - and one of the concerns with Revlimid is clotting.  Now I take a baby aspirin every day to assist with this.  And that was the first recommendation of the doctor.  But since I've got a flight cross country, to be cautious, he's recommended I use Lovenox 40 prior to my long flights.  Now this is a drug that is self-injected - that's correct, you inject yourself, with a needle, right at home (or hotel, or airport bathroom - I feel so....Trainspotting!)  He asked if I had ever self injected before, to which I responded emphatically, "no -- I've given them to my cat, but not myself."  Grab that fatty spot around your belly into a nice pinch, simply stick it in and plunge.  Tomorrow I get to give that a whirl.  I'm soooo looking forward to that!  I've also been instructed to walk around every hour or so on the flight.  What's interesting, is when I got the script, there were no instructions.  And of course, they take the script when filling it, so even his notes (which, in typical fashion, are barely legible) were gone.  

When do I take the drug?  Just before, a few hours before?  I pose the question, asked almost every day (but usually due to a need for some senseless drivel), "what would we do without the internet?"
I would discuss (and probably recommend) a pre-flight heparin shot (such as Fragmin® 2,500 U or Lovenox®40 mg 1-4 hours before the flight) with these patients. However, often these patients are on long-term anticoagulants anyway. I would then not add additional heparin (see "A").
Now there were other sites that actually mentioned the fact that you were given a pre-loaded syringe with really no instructions whatsoever.  No detail as to how to inject, where to inject, when to inject, etc.  So I will include this in my page on 'drugs and their effects" when I get around to actually updating that page!

So, for now, don't expect anything till next weekend unless I get some gob smacker of a story while traveling.  The next fun bit will be next Friday.  I go back to the doctors on Friday and need my clearance check for the next dosage of Rev.  The trick is to get that 'go-ahead' and get my order processed in time to get the drugs on Saturday in time to start on Monday.  All of this shouldn't be an issue - except the fact that Friday, 28 May, is the last day my doctors will actually be at St Vincents.  For those in the city, you're quite aware of the issues that St Vincent's, the hospital, has been facing.  In addition to being the primary location where the injured were taken during Sept 11th, I recently found out that St Vincent's was the hospital where all the injured from The Titanic were also taken.  Talk about a loss of history!  Well SVCCC, not directly affiliated with SVH, was bought out by Beth Israel Hospital (approximately 3 blocks from my house).  So I was thinking it can only get better - but apparently BI has no interest in MM as two of the doctors are moving to Mt Sinai (where I'll be going) and one of them is going to NYU.  I'm not sure if that leaves anyone associated with MM.  I'm covered but it's a shame as SVCCC was a great place - my hat's off to everyone working there!  The good news is I received a letter today notifying me that my stem cells (currently in a really cold refrigerator) will be moved to Mt Sinai as well - so I'm good in that respect. 

Till next week - happy flying!


Lorri said...

ok, wow, NY is a renegade place,...letting patients figure out what to do with drugs on their own. :)

1. make sure please that you use an alcohol wipe to the area before you inject. (no Guinness does not count)

2. this is a relatively short acting medicine...must be used every 12 hours. I would inject at least 2 hours prior to flight. (in fact, starting the night before is not a bad idea if they gave you enough)

3. they are right, get up and move while on the plane.

4. don't pick up skydiving this week. Any significant trauma (fall on head, ...not that you are planning on that) or signs of bleeding from any orifice or really bad bruising...get it checked. This is a low dose of lovenox so you should be absolutely FINE, no issues at all. Just saying.

OK, enough butting in. Have a great, great trip :)


rugbyhubby said...

Ha - I should have come to you first! Apparently this isn't an uncommon (i.e., not limited to NYC) occurrence. Google "lovenox air travel" and you'll find a few references to the fact that the makers don't have any instructions as this isn't it's primary use. They're thinking about doing something but that's all. The instructions I got from my Doc was 3 weeks ago - you know my memory doesn't work beyond next day (ask my wife! But i blame the Nortriptylene!)

Kelly Lyons said...

Just found your post while searching for that exact same answer: how soon do I inject Fragmin before my flight? I had ankle surgery 9 weeks ago and am flying only on a 2 hour 50 min flight but my surgeon insists that I inject before and after the flight each way. I think I will do it before I leave home so I'm more comfortable. Thanks for finding the 1-4 hours before the flight reference! Also, I will try not to bend the needle (read your next post!!)

rugbyhubby said...

Its amazing to me how many people find my blog and find relevant content. Although that may have been my original intention, my thought (at the time) is relating the story, in as humorous manner as possible, of what I had to go through. I never consider that others encounter the same assinine lack of information for something the end user considers relatively important. For this response I sincerely thank you for commenting as it only enforces the fact that my sometimes verbal diarrhea, actually has importance! ;)

Best of luck with the shot, with getting the cover off the needle and with hopefully not bending the needle (and finding the spot to put the bandaid on afterwards!)

Let me know how it goes.