Thursday, March 13, 2014

What's Your Assessment?

Mmmmmmmm. Yummy Taco Bell pintos and cheese image found here

It's been a bit over a week since my rituximab infusion cycle began, and many of you have asked for a post-infusion status update. I'd be happy to oblige since blabbing about myself is what I unfortunately do best...

Rituximab is given in a two infusion cycle. I received my first dose on March 4th and will receive my second on March 18th. The IV drug is accompanied by a burst and taper prednisone dose. The cycles can be repeated as often as every six months, so if I have a good response, theoretically I could repeat the treatment somewhere in September/October.

How's it going, you ask? Hm. Pretty well, I'd guess. It's too early to assess my authentic energy level response since prednisone confuses the issue, but we'll be tapering off the prednisone soon. I tolerated the infusion itself well with the expected few days of altered taste/smell and feeling overall more tired, after which I returned to my usual expected reaction to this drug.

I think that he most accurate way to communicate my ongoing response may be to re-visit an old school style of documentation in medicine: SOAP notes. This method is probably needed since it requires the documenter to actually justify his or her assessment, and having had my required dose of prednisone AND a cup of coffee this morning making me a bit loopy.....well, any extra organization of thoughts is a good idea.


I was thinking that I may not be the best person to provide an impartial observation of my status. So sling your stethoscopes around your necks and pull on the scrub suits, people. Y'all going to play nurse today. Just imagine yourselves entering an exam room to greet John and me as we report for a follow up rituximab exam. I would expect that documentation similar to this would be the result:

  • S (Subjective data most often recorded as patient quotes): "Whoooeeeeee!" Patient reports burst of energy following AM prednisone dose followed by afternoon "crash". "Zzzzzzzzzzzzzzzzzzzz." "Ooo. Where did all my spots go?" "My life would not be complete if I didn't buy a new iPhone case."
  • O (Objective data): Venipuncture site healed without infection or bruising. Temperature, blood pressure, pulse, respiration within normal limits. Skin rash erythema diminished considerably. Appetite robust with decided tendencies to ingest high carbohydrate food items. Amazon online shopping account activity dramatically increased with corresponding credit card account amounts. Personal living space littered with multiple scraps of paper upon which are scribbled lengthy task lists of varying nature; none of which are marked as completed. Husband reports expenditures for vehicle gasoline elevated accompanied by significantly increased vehicle odometer readings; uncertain of daily vehicle destinations. Examination of vehicle reveals multiple bowl shaped disposable food containers labeled with the words, "Taco Bell". Husband perplexed by evidence of increased patient activity since upon arrival home from work he describes her activity levels as "sluggish". 
  • A (Assessment): Physical response to rituximab and prednisone therapy within normal limits and progressing as expected. Potential for significant weight gain. Potential for significant financial impact as a result of hyper-reactive shopping activity. Potential for appearance of noxious odors in patient's personal space as a result of ingesting large amounts of legumes. 
  • P (Plan):  Second rituximab infusion of cycle prescribed and scheduled per attending physician. Patient instructed on follow up labs, prednisone dose taper, and monitoring and reporting symptoms of infection. Patient advised of health benefits of substituting fresh organic fruits for fast food refried beans and cheese. Will attempt to convince patient to step on bathroom scale weekly and record weight. Will plan to increase reported weights by 10 - 20% in anticipation of patient error. Husband instructed to remove credit cards from patient possession during absence during day and to place air freshener products in strategic locations throughout the home. 

So there you have it. Job well done, Reasonably Well medical staff! Oh by the way, don't forget to turn in your time sheets by Friday. And there will be a mandatory inservice on biohazards in the workplace on Tuesday. Remember to submit requests for vacation hours to the staffing office one month prior to expected use of said vacation hours... and blah.....blah.......blah blah blah. What's that? You want to QUIT this job?

I don't blame you one bit.


Kelly said...

I would use this acronym to describe the patient:

So Hip =

Sense Of Humor In Place

And as long as the patient can laugh, things are probably going well. Oh, and last time I checked, beans were classified as health food.

mcspires said...

Loved this. Your humor and honesty make my day!

Debbie said...

Love your sense of humor! I so needed this post & it was delivered just as I was hanging up the phone with my rheumatologist's nurse. I get my first Rituxan infusion next week. I have been perusing your blog for the last two weeks reading every post on Rituxan. Your info was instrumental in helping me make this decision. I pray you continue to do well & receive many months of improved health. Thanks for all you do! :-)