In Stage 4 and starting Epo shots tomorrow...

[KarenInWA]

Helllo everyone,

I saw my neph today.  My HGB was 9.6 and my hematocrit was 29.3 on a blood draw done last Friday.  And no, it was not due to my period, either.  I remember going home after doing that blood draw, and ended up taking a 2 hour nap on the couch for an exciting Friday night.  Now that all makes sense....

Anyway, what can you tell me about this?  I am a little nervous about it, but am hoping for the best.  My GFR went up from 25 to 27, but my creatinine remains steady at 2.2.  My other labs are within the normal range, except for the usual BUN, albumin, etc, yadda.  I've been especially tired this week, but doing the whole Daylight time change *and* having to work OT at work hasn't helped, either!

Tomorow (Friday) at 5:30pm I go to my local hospital and check in as an outpatient.  Go to the lab, then on up to the 8th floor for my first sub-cutaneous shot.  How's that for a Happy Hour? 

KarenInWA

[-Lady Noir-]

Oooh, how many times a week will you have to do the shots?

[okarol]

Jenna does the shots in her thigh here at home, started 2 weeks ago and her RBC is slowly improving. She has 2 weeks more of shots.

[galvo]

I get my EPO with dialysis each Saturday. Makes my weekend.

[-Lady Noir-]

Mikes on these shots over here called neorecormon, which he has 1x a week. The bloods show it works but he feels no different. No suprises there though, even diaylsis makes him feel the same as he did before 

[KarenInWA]

I will be having my shots once every other week until my levels stabilize.  I wish I could do them at home, but for some reason they're making me go to the local hospital as an out patient.  I gues that's good for the first few times, but what about after that?

[monrein]

I used to use Aranesp (synthetic epo) and gave myself the shots at home, subcutaneously into my belly fat or thigh.  On D I had them into my lines, but I have read that actual EPO is better absorbed and we don't need to use as much if it's given subQ rather than into the machine.  I asked my neph about this and that was the info I was given also.  It's a pretty easy thing to give oneself since the needle is tiny.

[Darthvadar]

Mum's on Arenesp...

She needs one 10mg shot every two weeks...

The hospital wanted to arrange for the Community Nurse to call and administer them.... No chance!..... Wasting a nurse's time that another patient could need...

I spoke to a Junior doc, asked her to show me how it's done, and I do it every two weeks... As Monrein said, the needles are TINY!.... Mum's too chicken to do it, but I'd suggest you put it to the hosp. that you want to do them yourself.... Saves you going to a hosp. every couple of weeks...

Good luck with it!....

Darth....

[looneytunes]

Karen..hubby was taking Epo in various amounts while he was on PD by injecting himself at home with a tiny little needle.  His amounts were from 5600 units up to 10,000.  After he returned to clinical hemo, he is getting 15,000 units each time he hooks up through the lines.  We also were told that Epo is more effective when given by injection.  Best of luck to you on this but Happy Hour can be saved if you learn to do it yourself!   

[MooseMom]

I had to take epo shots for a couple of months in 2008 because I had "women's troubles" and was becoming anemic.  A hysterectomy cured that, but until surgery, I took the shots.  At that particular moment in time, I just could not fit one more thing into my brain, and I really didn't think I'd be able to handle learning how to inject myself.  I told my neph's nurse that I'd learn to do it after the surgery, but not before.  She took pity upon me and just told me to pop around every other thursday and she'd inject me.

It's important to treat anemia in a CKD patient because untreated, anemia contributes to LVH.  Sometimes Stage 4 patients are overlooked, so it is good that your neph is looking out for you.  Anything that you can do to keep you healthy is worth doing. 

[Sunny]

I'm stage 4 and just started EPO last month. My doctor trained my husband and me how to administer it and it's very easy. Maybe if you are going to need it for prolonged periods, you can ask your doctor or a nurse to train you. The needles are very short and only require injection in to fat, which makes it much easier. Plus, I always take mine out of the frig and get it to room temp before injection.It would save you a trip to the hospital, where germs abound anyway. I hope you see good results soon.

[RichardMEL]

Karen why don't you ask them to show you how to give it to yourself? You're a capable young lady - unless you're a wimp like me and don't want to do it to yourself - I see no reason why you couldn't do it at home and not waste your time and the hospital's time to give you a shot that takes a few seconds.

Anyhoo I hope the first one was fine !!!

[Meinuk]

I don't understand why they are bringing you in.  EPO can be easily administered with an insulin needle at home.

One thing about EPO though.  Make sure that your Iron is being monitored.  If you have EPO without having sufficient Iron, it will just wipe out your Iron stores, and you'll feel worse.  This is a big scandal in the dialysis industry. I took Chromagen Forte to supplement my Iron when I was pre dialysis, and I hated it.

This is from 2006 and for people on dialysis, so please check with your medical team for the current protocol, but this is what I was told in Feb 07/ when I was in my first month of dialysis:

   

The clinical target for treatment of anemia in this population, per the KDOQI 2000 recommendations, was a hemoglobin level of 11- 12 mg/dL. To reach this hemoglobin level, patients need to have their iron stores replenished with intravenous iron, and they also need to receive EPO, which stimulates red blood cell production and thereby works to correct the anemia. The recommended target for iron stores was a serum ferritin level of at least 100ng/mL.

   The guideline called for an initial EPO dose of 120-180 units per kg per week, which we assume remained the dose during the study period. We calculated
the recommended dosage of EPO based on a 72.5 kg adult, which is the average weight of hemodialysis patients reported by USRDS. For iron, the recommended dose for adults was 100-125mg of intravenously at every hemodialysis session for 8-10 doses followed by a maintenance dose of 25-125mg per week upon reaching the target ferritin level.

[RichardMEL]

Good point about the Iron.

We have IV Iron every month which handles all that, and they do ferratin studies 3 monthly so I think we're being looked after

[lola]

Otto gets his epo here at home and feels much better now that his HGB is higher.

[Yvonne]

John has been on EPO injections now for about 2 years.  At first when he was very ill when he first came out of hospital the District nurse use to come in and inject John. Then they asked me if I could do it and said I could not so then John decided to do it for himself, a little needle goes into his tummy every Monday morning.  He dose not think twice about it anymore, he is still gets very tired so it didn't stop that.

[paris]

I don't know why they are making you go to the hospital for the shots.  Many do them at home. I get mine at my neph's office--his nurse does it.  I could do it, but I live 3 minutes from his office, so I just stop by.   It seems to add to the cost of everything by making you go to the hospital as an outpatient.  It is a simple shot.    Let us know how it goes.  I hope you feel better as your level increases.

[jbeany]

I was on epo for a decade before I started D.  I started on Procrit, which I did once a month, since it wiped me out for the whole next day when I took it.  I was switched to Aranesp, which didn't have such rough side effects.  It only made me sleepier and gave me muscle aches for the day I took it, so I took that every two weeks to keep my hemoglobin on a more even keel.  I did the shots at home, too.

It takes about two weeks for the first dose to really kick in.  After that, you should have more energy.  Eat some spinach, too!