How I got used to using a needle for my DMT

I’ve had Multiple Sclerosis for more than forty years, and I can tell you that I see a real difference between the twenty two years I spent without using a Disease Modifying Therapy (DMT) and the twenty years I’ve spent on a DMT that suits me as if it were designed for me. There are plenty of different methods of taking those drugs. There are medications you take as a daily pill, a daily shot, a less frequent shot, by infusion at an infusion center. But in 2000, there were only DMTs that were administered by shots.

Feeling pretty helpless

When I first started showing symptoms in 1978, there wasn't anything doctors could offer us to manage the disease. My neurologist told me to go home and rest. I felt pretty helpless when I was finally diagnosed with a demyelinating disease in 1981. If I were experiencing an active exacerbation, that could be managed with a five day course of Methylprednisolone-- or some other steroidal anti-inflammatory drug. I had a doozy of an exacerbation eleven years after my diagnosis, and my doctor promoted me to Secondary Progressive Multiple Sclerosis.

My fear of needles

Now I have always been terrified of needles, as have a lot of us, and my beloved primary care physician has always kind of coddled me when it came to shots and blood tests. Little tiny veins go along with coppery hair, evidently. However, when I turned fifty, all bets were off. Dr. Blackwood looked me in the eye during my annual physical and said, "You are getting a pneumonia shot today AND YOU CAN'T TALK ME OUT OF IT! You're getting the shot!" Well, I was left in the room all alone until the nurse came in and swabbed my upper arm. I started shaking so badly that the nurse asked me what was wrong. I asked her when she was going to give me the shot, because I hadn't felt anything, and she started laughing. "Oh Therry," she said. "I've already given you the shot, and I gave you a flu shot and I gave you a tetanus shot, because I have no idea how long it's been since you had one of those!" I stared at her in horror and demanded to see the needles! What to my wondering eye should appear but a fairly short and VERY thin little needle that explained why several intramuscular injections hadn't really registered with me. Gone were the four inch long, half inch thick needles I remembered from the dentist and from the immunizations I had received as a child. I asked the doctor's office to make me an immediate appointment with my neurologist because if that's all that was involved, I wanted to start on a disease modifying therapy right away.

Getting over my fear with a little help

And I did indeed get an early appointment and my dour Scottish neurologist prescribed Copaxone, which was administered in 20 ml doses, injected every day. He set me up with an appointment with a nurse who came to my house and showed me how to put the shots together. In the bad old days, the injections did not come pre-assembled, as they have for close to the last nineteen years. At the time I had a very fine ginger tomcat whose name was Saint Jerome, and Jerome was FASCINATED by the ritual of putting together the shot. You were given a setup that included a syringe, two needles, one fat and one thin, a vial of purified water, and a vial of white powder. You would fit the fat needle into the syringe, stick it into the bottle of water and draw the water into the syringe. Then you would stick the syringe into the vial of white powder and vigorously mix the water with the white powder. Then you would unscrew the fat needle, dispose of it into a sharps container, and screw the thin needle into the syringe. Then you would tear open a small packet that contained an alcohol prep pad, swab the area you were going to inject, wait for it to dry, pinch the flesh between two fingers, slip the needle into the pinched flesh and depress the plunger.

Becoming routine

Now, I never used the Autoject device that the pharmaceutical company supplied because I liked the ability to tailor the speed of the injection to my comfort level. And I noticed that as long as you had a bit of subcutaneous fat into which to place the injection, it didn't really make much of a sensation. The problem was that you were supposed to circulate the site of the shot to seven locations around your body, including the top of your thigh. Every single time I tried to inject myself into the prescribed location on my leg, I would invariably hit a capillary and have to staunch the flow of blood. I eventually came to the conclusion that since I had PLENTY of subcutaneous fat around my middle, my shots ended up in my tummy. I've been shooting up with Copaxone and its various generic names for more than twenty years. I have lots of tiny little scars under my skin, although I've never experienced the lipohypertrophy that some users of Copaxone have experienced.

Getting used to it all

But my point is that having assembled the injection for about five years, during which time Saint Jerome attended every single assembly ritual and subsequent injection, I got very used to handling needles and introducing them into my skin. And as they say, familiarity breeds, if not contempt, then at least comfort. I even found that drawing blood no longer bothered me much. I could always say "This isn't my first needle today."

Systematic desensitization

Doctors who treat phobias speak of this process as systematic desensitization. The patient is exposed to progressively more anxiety-provoking stimuli and taught relaxation techniques. I could tell you the most horrifying encounter I had with needles during an iron infusion treatment, but you haven't been trained in relaxation techniques. I will tell you that when the makers of Copaxone started distributing the injection in pre-filled syringes, Saint Jerome abandoned me for the lack of entertainment value in a simple injection without the attendant assembly. But by then I was over my fear of needles. We're often asked in advertisements for the many different treatments available for several different types of Multiple Sclerosis if we're tired of injections, and so far my answer is "Nope! Not today!"

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