[00:00:00] Jill Brook: Hello fellow POTS patients and super cool people who care about POTS patients. I'm Jill Brook, your hyper adrenergic host, and today we have an episode of the POTS Practitioners where we are going to discuss home infusions with registered nurse and infusion nurse specialist Jonathan Abraham, who is giving me an infusion right now. Jonathan, thank you so much for joining us today.
[00:00:23] Jonathan Abraham: Oh, thank you for having me. I'm glad to be here.
[00:00:25] Jill Brook: Can you start out by describing your background and describing your job?
[00:00:30] Jonathan Abraham: Currently right now I work for a home infusion company that does specialty infusions such as IVIG.
Before that I managed a respiratory ICU during COVID, took care of open hearts and worked in an emergency room, and that's pretty much my nursing experience. Before that, I was a respiratory therapist for 10 years. So the last 16 years I've been in the healthcare industry.
[00:00:55] Jill Brook: I think that you are so impressive in your job because what it looks like to me at least, is that you drive hours to get to me sometimes through snow, sometimes through wildfire smoke, always through mountains. Then you have to find a vein in my arm, which is not the easiest thing. Then you make sure the whole infusion goes smoothly. You're all on your own if it doesn't go smoothly and then you drive all the way back. And it seems like it's a really long day, a lot of pressure, a lot of stress. How is it from your perspective?
[00:01:32] Jonathan Abraham: There is that stress of, if I don't get the IV in, there's no one to back me up. It is always a little interesting when you meet your patients for the first time, especially going to their house. But, it's a fun job. It has its own different stresses. I mean, working in a hospital was one type of stress. My wife, who's a registered nurse, I tell her the biggest stress I have is the fact that I hit traffic while she has to deal with four tele patients.
[00:02:01] Jill Brook: Okay, let's talk about your day. So first you drive to wherever you're having to go, and then you show up, and the first thing you have to do is... immediately get access to somebody's vein
[00:02:13] Jonathan Abraham: Yeah we need to get a vein in. That can be the difficult part because some people take medications like diuretics that make you pee out.
Or if they're not drinking a lot of water. If they smoked, fatty fried foods and sugary foods. I've seen a difference in that compared to eating a good, well balanced diet.
[00:02:33] Jill Brook: So what are things that patients can do to make it easier for you to get access to a vein?
[00:02:41] Jonathan Abraham: Start getting IVIG like you for example, you know what you need to do. Soon as I show up, here you go. You jump in the sauna get your arms all nice, to get those veins plumped up.
Biggest thing people can do, drink water. Just be well hydrated. One, it helps with the veins, it helps getting access, but it also helps with the side effects that are associated with the iVIG
[00:03:03] Jill Brook: So how did you get trained to find veins?
[00:03:06] Jonathan Abraham: The best way to get trained and when you work in a hospital, you go to the emergency room. The emergency room, everybody gets an IV. Go to the ER for a day, cuz you will put in probably about 30 to 40 IVs
[00:03:21] Jill Brook: Can you walk us through what you're thinking about as you're trying to find a vein?
[00:03:26] Jonathan Abraham: What I do is I sit there and I look at your arms and see what's just showing out right there. I look to make sure it's not in a bending area, because that's gonna make the pump alarm constantly. You don't wanna put it somewhere where it's gonna inhibit you from doing anything. If I can't see anything good, I start feeling. You can feel around a vein. It feels like a piece of rubber. Make sure it's not too valvy. You don't want something that has a lot of valves. Valves are normal in everyone's veins. They help prevent blood from flowing back the other way. They're just like a little door and You can see 'em. So usually what we do when my patients with ports, when we do their infusion, they usually wear a tank top. We sterilize it with chlorhexidine. We use sterile gloves. Everything is sterile with it, because the biggest complications you're gonna get from a port is infection and clotting.
[00:04:19] Jill Brook: Is that limiting then, for what you can do? For example, do you need to be careful about moving around too much?
[00:04:25] Jonathan Abraham: As far as swimming and getting it wet, it'll heal up completely. The first month you gotta be a little careful raising your arm, especially people who are hard sticks.
[00:04:34] Jill Brook: Can you talk more about people who are hard sticks vs. easy sticks? What do you notice that's different between those types of people
[00:04:43] Jonathan Abraham: Hard sticks, believe it or not for me, are diabetics. Sugar is such a large molecule. It's like sandpaper on the inside of your veins and vessels and arteries. So it in a sense, gets that stenosis going on, that hardening of the inside of it and Diabetics, especially if they're non-compliant or don't adhere to their diabetic diets, they're usually vascularly dry. They don't have a lot of fluid in their vascular system. So trying to get an IV on them can be a little difficult.
[00:05:17] Jill Brook: So what about men versus women, old people versus young people, big people versus small people? Is there a big difference there?
[00:05:24] Jonathan Abraham: The hard ones if they're older with mobility issues, Using your muscles, walking more, you're creating veins. You become very sedentary and you start losing those veins. With older people, I can tell with they're left-handed or right-handed for the most part by looking at their hands. Cuz whatever hand they write with has a lot better veins. The other thing, believe it or not, people who smoke. Especially if they smoke one right before infusions.
[00:05:51] Jill Brook: Okay, so once the infusion is started, what are you looking out for? Or what are you thinking about?
[00:05:58] Jonathan Abraham: We're monitoring any type of reaction. So you can have, in a sense any type of tissue- related reaction as far as an anaphylactic reaction, to something mild where just restlessness. We wanna just monitor, make sure the infusions, going in smoothly, making sure the IV doesn't blow or leak out. We wanna make sure you're just having the easiest time with this to make it as comfortable for you as possible.
[00:06:27] Jill Brook: What happens if someone does start having some sort of a reaction
[00:06:32] Jonathan Abraham: It could be either reaction to the IVIG itself, or it could be a rate reaction. The biggest rate reaction based on the speed, maybe it's going in too fast, is a headache. So when you start getting a headache, we'll slow it down a little. If it's the IVIG itself, if you're having a true like anaphylactic reaction, hopefully give you the Benadryl and that stops it. We call the pharmacy, we let 'em know you have a reaction to it. They write the lot down and see and in their database to see if anyone else has had a reaction to that lot.
[00:07:06] Jill Brook: So that sounds like the stressful part of your job. Can you talk more about the difference between getting an infusion at home versus in a hospital or in an infusion center? I was kind of surprised that my pharmacy actually preferred for me to do this at home, where it's comfortable. I've got my dog, I've got my husband. You've let us go for a walk before and it's so much better than being in an infusion center. And I'm kind of shocked that apparently it's cheaper.
[00:07:37] Jonathan Abraham: The hospital I worked at did a lot of iron. infusions, Their infusion center, they had though outside of the hospital, that was mainly a lot of chemo patients. It did have some IVIG, but for the most part because chemo's such a specialty that you, I believe you need to be in the actual infusion center for it. There's not a lot of room for IVIG people to come in there for the infusion. So I think especially with how COVID was, this really shows that we can administer IVIG safely at home. Especially people who are getting it, who have autoimmune deficiencies, like they're getting this cuz they have no immunity. The last thing they want to do is walk inside a hospital, especially into a chemo center that has a lot of people who are immunocompromised themselves.
[00:08:31] Jill Brook: So be honest. How weird is it to show up at a stranger's house with a bunch of needles
[00:08:38] Jonathan Abraham: Well I wonder what their neighbors think. Snoopy neighbors are Oh, this guy comes in once a month. He has that bag. I see the tourniquets out and all that. I mean, how does it feel when the first time I came over, you're like, Who is this guy?
You know, some guy's coming over and he's gonna stick me in arm. And I'm sure you know, you've been in and out of the hospital enough to know there's people who can do IVs and there's people who can't do IVs. And then you're like, What if he can't find it? What am I gonna do? What is he gonna do? It's awkward at first when you first meet 'em, but slowly over time you become the regular thing that comes around once a month.
[00:09:12] Jill Brook: Online in patient communities, people who are soon to start getting infusions, I see one major question that they have is, Okay, so am I supposed to like, do anything special? Am I supposed to serve lunch? Am I supposed to like entertain this person?
[00:09:27] Jonathan Abraham: I have heard of nurses requesting lunch and I think that's incredibly awkward and rude. You're getting paid to do this job, not to get lunch. What I would tell people that pretty much it should be as professional as possible. Let 'em know where the bathroom is. Especially for people with home infusion, cuz some of the nurses, they been sitting in that car for two to three hours drinking water you know, that's the first thing they want to do when they get to your house.
[00:09:56] Jill Brook: What is the best part of your job
[00:09:59] Jonathan Abraham: Traveling. I get to travel all up and down California and It's a great state. So the best part is being able to travel I have to tell you, when I drive up, most of the time I take the longest way. I get off the freeway and I take the back roads because I'd rather prefer country road to the the freeway.
So that's why I don't see any patients in the Bay Area cuz it's just freeway. But the best part would have the traveling
[00:10:24] Jill Brook: What's the worst part of your job
[00:10:26] Jonathan Abraham: the traveling is also the worst part .Thank goodness I bought a hybrid when I did. Especially with gas prices being up there. I'm I plan my days pretty well on my long days that I have, that are usually stay at night, it's usually on a weekend that my wife's working so my daughter can go to my mother's house.
[00:10:47] Jill Brook: And sometimes you stay overnight, you said, right?
[00:10:49] Jonathan Abraham: I I do stay overnight. So get a good credit card with good hotel points and yeah, you get a lot of free hotel rooms.
[00:10:57] Jill Brook: Okay. What is the hardest part about your job
[00:11:00] Jonathan Abraham: Sometimes putting the IV in. I've heard one of my patients sat there and tell me the nurse before you that worked for another company picked up contract, poked to the guy 20 times and couldn't get an IV in
[00:11:13] Jill Brook: One thing I always appreciate about you is that you're always not only calm, but humorous. And I don't know if that's just your personality or if you do that a little bit on purpose cuz you know, it helps put people at ease. But I like it that you make jokes and when I used to go to a cancer infusion center, one thing that was always tough there is some of the people when they would be trying to get a vein, they would not hide their anxiety. And so they'd be cursing and saying, Oh, come on, come on, come on. Oh, shoot. Oh shoot. And so I am just curious if you put thought into the bedside manner or are you just a naturally funny, calm person?
[00:11:59] Jonathan Abraham: I am a naturally funny guy. Trust me, I'm not calm. My most difficult IV patient. As soon as I poke her you get that flash of blood. I'm like relax. And I have to sit there with the needle without able to advance it, just to give her a chance to relax so I can advance the catheter through
[00:12:16] Jill Brook: Oh, so you can actually observe a blood vessel relaxing a little bit as the person relaxes?
[00:12:23] Jonathan Abraham: Not observe it per se, but if they're having a vaso constriction, if they're stressed and they're constricting, you can have problems with trying to thread that, catheter through. So, yeah, sometimes you just sit there and wait, let it relax, and then you can advance the needle.
[00:12:40] Jill Brook: Okay. So the next thing I wanted to just say is a stereotype I have of nurses. Which is that they are always really can do people with cool hobbies and you fit this like you fly fish, you are a really good chef. You make your own interesting infusions. You, you like do all these different really hands on sort of technical hobbies. And I've just kind of wondered have you always been that way and that made you not intimidated to become the kind of nurse that has to be getting access to veins?
[00:13:12] Jonathan Abraham: I think a little bit of that is I was a Marine, so I have a little bit of that cockiness of being a Marine you know, that confidence. But as far as the hobbies, I've always liked to doing things. I grew up fly fishing. I like to golf, I like to cook and all that. I think I can do it now cuz this job, I have a lot more time to do it. I'm not stuck in a hospital for 12 hours. You know, I go to someone's house, I may have a three hour drive, go to their house, do their infusion, we're done by one or two afternoon. Guess who brought their golf clubs in his trunk and who's gonna go play some golf after work.
[00:13:46] Jill Brook: Very cool. Okay. I just have one more question, and I know that since your wife is also a registered nurse have dual insights on this, but what are things that in general patients can do to help you help them?
[00:14:02] Jonathan Abraham: Be honest. We're not here to judge you. We're not gonna sit there and gossip behind your back. We need to know what's going on. The other thing, advocate for yourself. You gotta advocate for yourself.
[00:14:13] Jill Brook: Well, thank you so much. I have so much respect for what you do and just the hands on taking care of people like nobody else does. I really just have so much admiration for the strength and training and positivity. You know, you can't call in sick because, you have all these patients waiting for you.
[00:14:35] Jonathan Abraham: And that's the bad thing. Unfortunately, if I can't call in sick, I have to reschedule you. If I reschedule one person, and if it's on the beginning of a big chain of patients, everybody gets moved. And that's why I wear a mask everywhere. Everyone's like, Why are you wearing a mask? Because I see so many patients, I can't afford to move one patient over because if I move one patient over it moves everyone after him over, and then in a sense I inconvenience six people
[00:15:02] Jill Brook: Yeah. So just thank you for the performance day in, day out of doing amazing work
[00:15:08] Jonathan Abraham: Thank you for your support.
And you're doing a great job with this podcast and spreading it out and teaching people and just advocating for it too. So we appreciate that because this stuff does help. It helps patients that are newly diagnosed with a Syndrome like POTS. So it really does help out there. It helps let them start advocating for themselves, so we appreciate that.
[00:15:30] Jill Brook: Awesome. Okay, well I can see I'm almost due for my next bottle, so I'll let you actually work. But thanks a million, Jonathan, Hey listeners, that's all for today. We hope you enjoyed our conversation. We'll be back next week. But until then, thank you for listening. Remember, you're not alone, and please join us again. soon