Challenges in 2020

By Barbara Petroff posted 8 days ago

Like everyone else 2020 presented many challenges. In my case my personal life intersected with my professional life in unexpected ways My oldest daughter developed psoriasis in late January. A trip to 'Cancun and a week in the sun helped and it was almost gone by the time we returned. The pandemic reared its ugly head and she was under stress with no job and concerns on how to meet her financial obligations. The psoriasis worsened and the dermatology offices were closed. The only option was a remote visit with an online nurse from one of the pharmacies. As a result she only had a low dose steroid cream available, As time progressed she developed a virus infection that caused extreme fatigue, weakness and loss of appetite. She did not want to go to the ER because of the COVID scare but she deteriorated with time. By the end of April she had lost 30 pounds and could barely get off the ouch. As May started physicians were beginning to see patients again and a trip to the dermatologist confirmed a severe case of psoriasis. She began to complain of a feeling of "wearing a bodysuit" all the time and started having difficulty walking. Her internist ordered a battery of tests and labs, On the day of the first test she was unable to stand or walk and we made the trip to the emergency room instead. She spent the next eight weeks in the hospital undergoing almost every test in the book. No one could figure out what she had but after multiple tests they knew it wasn't COVID. Treatment included steroids, antibiotics and a dose of IVIG. They did not do a full induction dose as her heart rate was high. Eventually they did a nerve biopsy to determine the extent of nerve damage As a pharmacist that has spent many years treating neurological diseases with IVIG I did question why they did not continue but did not receive answers that made sense to me. Fortunately, the hospital had an inpatient physical rehabilitation center and she spent four weeks in intense physical and occupational therapy. Since that time she has seen two neurologists who agree that her condition is a result of an auto-immune reaction to a virus infection that caused severe nerve damage. The neurologist did order high dose IVIG consistent with the treatment I have seen through my years. The accompanying neuropathy causes intense pain at times and they have added gabapentin and baclofen to her regimen. They also ordered metoprolol for the elevated heart rate and she has had no side effects of the IVIG at all. She is now able to stand and walk short distances with braces and a cane. It has been very educational to see first hand how a treatment I have been working with for years works. When her physicians learned that I was a long time home infusion pharmacists with experience in IVIG they did request my advice when ordering the medications. After seeing my patients get better I was hopeful she would have a similar recovery but it really taught me how the patients and their families are impacted. Hopefully I will be a better provider for my patients with the things I learned.