The Zofran Pump

 I'm not sure how long I will be on the Zofran pump . . I tried to start decreasing the dose and get off the pump last week, but it didn't go so well . . so I'm going to take this opportunity to document what the Zofran pump and working with Alere Women's & Children's Health is like day-to-day.  Hashtag: journal moment.

At the beginning of October, when I was 8 weeks pregnant, my doctor and I decided to pursue using a Zofran pump and IV fluid hydration to help with the Hyperemesis.  This would all happen through a company called Alere Women's & Children's Health.  

First our insurance had to approve of me using Alere, and then I went to the hospital to have an IV put in my arm.  

{{At first we thought we would do everything - fluids and Zofran - through a PICC line, but the hospital strongly recommended against that because of the risks of PICC lines, which increase during pregnancy.}}

Then, an Alere nurse came to our apartment and introduced us to the company and walked us through what we would need to do . . . 

Every day when I wake up, the first thing I do is test my ketones to see how hydrated/dehydrated I am and then weigh myself.  Throughout each day I keep track of how many ounces of fluids I drink and what percentage of a "normal, pre-pregnancy" diet I eat.  I also keep track of how many hours I'm nauseous and how many times I vomit and dry heave, as well as any environmental triggers for those things (typically noise, smells, and anxiety).  I fill all this information in on a chart and I talk with an Alere nurse on the phone each day to give my daily report.  After several weeks, they transitioned me to only having to call on Mondays, Wednesdays, and Fridays and that has been nice.

I only needed to do IV fluid hydration for the first week.  Every day I flushed my IV and connected myself to a bag of fluids.  Then I hung the fluids on my IV pole and watched TV/slept for about 7 hours.  When the fluids were finished, I would flush my IV, clamp the tubing, and wait to do it again the next day.  It was really scary for me working with an IV and doing it all myself - it's just something I'm not comfortable with.  Luckily, by the end of one week I started to be able to hydrate myself a little bit.  It sure was inconvenient to sleep/shower/other activities of daily living with the IV and the Zofran pump, especially since they were both so new.  Alere told me how to remove the IV from my arm and then . . I had to do it myself!  It's really easy, but again, something I am just not comfortable with at all.  Could have been 5 minutes - took me 30!  Haha.

My IV the first or second day I had it.  Notice the barf/trash can . . it came/comes with me everywhere.

A repeat picture . . but me right after being hooked up to the IV fluids and Zofran pump for the first time.

I just took an IV out of my own arm!

Now I am only using the Zofran pump and I've been using it for 7 weeks so for the most part, I know the routine.

The Zofran pump connects into my body and delivers a constant stream of anti-nausea medication.  {{After trying to lower the dose last week and that not going so well, I'm back up to my previous dose.}}  So I'm on the highest dose available - 0.660 ml/hr.  Each milliliter has 2 milligrams of Zofran, so I am getting 31.68 milligrams of Zofran every 24 hours.  Where the pump connects to my body is called the infusion site and the infusion site has to be changed every 24-28 hours.  So, every other day or so, I get everything ready: pump, new syringe, infusion kit, alcohol swab, and prep swab (which is supposed to help my skin not react so badly . . so far, it has failed).

I clean the site and brush it with the prep swab, gather up some fat, and then Mom, if I'm in Merced, or Ben, if I'm in LA, jabs that little needle into me.  I still can't do it - I'm such a wuss!  And it hurts a lot less if it goes in quickly.  I told Ben he has to do it like Mom - ya gotta just stab me with that thing!

The circular tape sticks to me and then I pull the needle out, but it leaves a tiny little tube (you can kind of see it on the needle) inside of me, which delivers the medicine.  A cap snaps onto the top of the tape, which is connected to a tube, which connects to the syringe in the pump.

Then I press "resume" on the pump and I'm back in business; I put in a new syringe every time it runs out.

A great thing about the pump is "demand doses" - if I am really nauseous, I call Alere, and they authorize my pump to give me a full milliliter in 12 minutes!  I can have 2 of those each day as long as they are 4 hours apart.  Sometimes I go days without one, but sometimes I use both demand doses in a day.

I get to wear this stylishly huge pump with me EVERYWHERE, even in the shower - it has a special bag it goes in to protect it from the water, and even while I sleep.

Even though having the Zofran pump with me all of the time and having to poke and change syringes at random hours of the day/night is inconvenient, I am really grateful for it.  I think it has made a really big difference.  Before I was on the pump, I couldn't even drink water without vomiting, and that made it impossible to take Zofran pills.  So really, this has been a life-saver.

Okay, STOP READING HERE if you don't want to see my nasty stomach.  YOU'RE FAULT if you think it's too much!  ;)

The only downside of the Zofran pump is what it does to my body.  Zofran can be really irritating to the skin and I seem to react very strongly to it!  After maybe 12-20 hours at a new infusion site, I start to get these large, red rashes around the site, and it gets really tender and sore.  When I take out the tubing, etc., the Zofran has left really large lumps under my skin and they last for days . . meaning I can't poke there!  Also, it feels like a really bad bruise for 3-4 days!  I am literally running out of real estate to poke. 

 I can poke my abdomen and my thighs.  So far, the thigh has not sounded appealing, so I've only been using my stomach.  When there was literally no room there, one Alere nurse told me I could try the back of my hips/top of my bum, so I did that on each side, and then I had to go back to the stomach.  Today I ventured to the thigh for the first time - there is just no where else to go!  Maybe it will give me several more days of places to poke so my stomach can heal.  One thing that's really hard is that I've lost 15 pounds and my fat stores have diminished significantly, leaving me with less skin to poke. 

It is hard to shower, get dressed, move around in bed, etc. because I have these tender, bruised spots on my thigh, hips, and stomach.  It just hurts to move!  I am so tender and sore all over.  Alere suggests icing and using warmth on the sites to help them heal.  I could be better at that . . but I'm not convinced it works all that well.

Red rash forming around infusion site.

 You can see multiple past infusion sites in differing degrees of healing.  The one that is most red - this is about 8 hours after changing the infusion site, yikes.

I'm not sure how long I will be using the Zofran pump . . it could be for many more weeks to come, but my experience with Alere has been and is really great - I'm so grateful for this resource!  I still talk to my Alere nurse every Monday, Wednesday, & Friday to report my weight, ketones, ounces of fluid, percentage of normal diet, and episodes of nausea or dry heaving.

I will be 16 weeks pregnant on Sunday and so far I am not showing whatsoever.  I am highly motivated to gain weight, but it is hard.  I bought a fetal doppler a couple of days ago and it's been really fun to listen to the baby's heartbeat.  We have our 16 week appointment on Monday!