AN INFUSION OF HOPE DELIVERY DEVICES GIVE PATIENTS INDEPENDENCE.Byline: Evan Henerson Staff Writer DURING HER NUMEROUS and lengthy stays in hospital intensive-care units, Farzaneh Heidari would sketch out dress designs that she gave to her husband to take back to the workers in her home studio. In this way, the Woodland Hills-based fashion designer's business could continue even while its owner could not. This took place while the Iranian-born designer of custom dresses and wedding gowns was battling a disease that prevented her from speaking or even swallowing her own saliva. ``It was just stunning,'' recalls nurse Beth Donowho, ``that she could keep going.'' Certainly, amazing feats can be accomplished from a hospital bed, but proponents of home infusion therapy home infusion therapy The IV administration of therapeutics–analgesics, antibiotics, chemotherapy, parenteral nutrition–outside of a formal healthcare environment. See Hyperalimentation, Patient-controlled analgesics, TPN. maintain nothing beats the comfort, convenience - and often substantially lower cost - of home treatment. ``Overall, it seems to be a really good trend,'' says Dr. Cesar Chavarria, a pediatric pediatric /pe·di·at·ric/ (pe?de-at´rik) pertaining to the health of children. pe·di·at·ric adj. Of or relating to pediatrics. pulmonologist pul·mo·nol·o·gist n. A physician who specializes in the diagnosis and treatment of respiratory disorders. at Encino Tarzana Regional Medical Center. ``Rather than having patients and their families being prisoners in the hospital, all treatment is done at home. Sometimes the results are even better since the patient is free of being exposed to other infections and free of complications that happen in hospitals.'' Infusion is used for pain management, chemotherapy or the delivery of antibiotics. Those unobtrusive portable pumps help fight off chronic infections of the heart and bones, control pain for people who have a terminal illness or process food when a patient's digestive system isn't functioning properly - all the while letting them work a job or attend classes. For the past eight years, Donowho, a nurse with Crescent Healthcare, has helped Heidari administer regular doses of IntraVenous Immune Globulin intravenous immune globulin A formulation of concentrated antibodies–aka immune globulins, predominantly IgG, prepared by pooling plasma from ±1000 donors, with a broad spectrum of activity against CMV, HAV, HBV, measles, rubella, tetanus, varicella (IVIG IVIG Intravenous immunoglobulin, see there ). Every three weeks, for three consecutive days, Heidari is hooked up to a computerized portable infusion pump infusion pump A device designed to deliver drugs and/or 'biologicals', at low doses and at a constant or controllable rate; ↑ rates of delivery in such devices may be associated with local hemolysis, compromising the potential benefits of a calibrated delivery that keeps the autoimmune disease autoimmune disease, any of a number of abnormal conditions caused when the body produces antibodies to its own substances. In rheumatoid arthritis, a group of antibody molecules called collectively RF, or rheumatoid factor, is complexed to the individual's own gamma myasthenia gravis myasthenia gravis (mīəsthē`nēə grä`vĭs), chronic disorder of the muscles characterized by weakness and a tendency to tire easily. under control. Heidari enjoys Donowho's company and looks forward to her visits. Best of all, the treatment takes place in her home, where Heidari can run her business and continue her daily routines. ``I didn't have to depend on anyone even when I came back from the ICU ICU intensive care unit. ICU abbr. intensive care unit ICU see intensive care unit. ICU and it was very hard to even button my dress,'' says Heidari, 51. ``I'm not the type who likes to depend on anybody. When Beth comes, she's a member of the family. We have fun together.'' Their rapport is a bonus because Heidari's condition will require careful monitoring for the rest of her life. If it's not Donowho finding a vein and hooking up the IVIG pump, it will be another nur Healthcare, one of the largest providers of home infusion in California. Some patients achieve a certain amount of independence in their own infusion treatment, but 24-hour help must always be a telephone call away. If Heidari wasn't receiving IVIG, she would most likely be getting plasma pharesis, a procedure always conducted within a hospital where the patient's blood plasma blood plasma n. The yellow or gray-yellow, protein-containing fluid portion of blood in which the blood cells and platelets are normally suspended. is cleansed and then recycled into the body. ``IVIG can be done at home, and lots of patients work while they're getting infusion,'' said Crescent Healthcare president Dr. Sohail Masood. ``There's no dizziness or other side effects Side effects Effects of a proposed project on other parts of the firm. that compromise motor functions. A lot of patients who were otherwise not functional, really went back to living and leading a more normal life.'' The practice of infusion therapy is hardly new. In the early 1980s, when researchers were learning about the HIV HIV (Human Immunodeficiency Virus), either of two closely related retroviruses that invade T-helper lymphocytes and are responsible for AIDS. There are two types of HIV: HIV-1 and HIV-2. HIV-1 is responsible for the vast majority of AIDS in the United States. virus, HIV-infected patients would stop into their doctor's offices, get their pumps refilled and go to work, their portable pumps hidden under their coats. The popularity of infusion is increasing with the development of every new infusion pump, needle or delivery system. Organizations within the industry now estimate the value of the industry at $4.5 billion. In a survey published last October, the Remington Report, a home health-care magazine, estimated that the home-infusion-therapy business has grown 7 percent per year over the last five years in sheer number of patients and 6 percent per year on a gross charge basis. Nor is infusion simply relegated to homes. The 11-year-old National Home Infusion Association estimates there are 4,500 infusion therapy sites nationwide, from hospital-affiliated organizations to national and local facilities. California, with its proliferation of managed care facilities, is a substantial home infusion market, according to NHIA NHIA New Hampshire Institute of Art NHIA National Home Infusion Association (Alexandria, Virginia) NHIA National Health Information Awards (Health Information Resource Center) NHIA New Hampshire Internet Awards executive director Lorrie Kaplan, who estimates that home infusion therapy can cost one-third the amount of an inpatient hospital stay. ``But there are some people who it would not be appropriate for,'' says Kaplan. ``Patients have to meet certain criteria for the home environment. Demands for individual therapy can range from very simple, infrequent doses to people who are on continuous chemotherapy or pain management.'' Home infusion also has its drawbacks, says Encino-Tarzana's Chavarria. ``If everything is going well, it's wonderful.'' he says. ``But when you start to have little problems or difficulties, you don't have quite as ready access to doctors and nurses for troubleshooting and treating the problem. You're on your own a little more.'' Infusion is not cheap. For the 24-hour care of their son Trevor - who was born with severe cerebral palsy cerebral palsy (sərē`brəl pôl`zē), disability caused by brain damage before or during birth or in the first years, resulting in a loss of voluntary muscular control and coordination. - Laura and Quinn Kilty of Denver spend $600 a day for medications and $500 a week for a nurse five days a week. Private insurance takes care of the bill. His infusion therapy is administered through the Orange County-based Apria Healthcare. Trevor, who is 10, gets the type of continuous care that a newborn would require. Because his gastrointestinal system gastrointestinal system: see digestive system. doesn't work properly, Trevor receives total parental nutrition via a central line in his chest. The infusion device infusion device Therapeutics A device used to administer therapeutics–eg, analgesics, antimicrobials, blood products, chemotherapy, nutrients. See Elastomeric infusion device, Electronic syringe infusion device, Mechanical infusion pump, Minibag. can be plugged into the wall or it can run on batteries, allowing Trevor to attend his siblings' school sports events or accompany his parents on errands. The Kiltys have to keep a sharp eye out for possible infection, which, Laura Kilty says, could kill her son in a matter of hours. But infusion therapy was their only viable option, and the Kiltys are glad to have Trevor at home. ``He was losing weight and he would have starved to death,'' said Laura Kilty. ``We thought if we gave him 'gut rest,' maybe his stomach just needed a rest and we could get him back on his formulas through a tube, but that's never going to happen.'' ``This is very hard on his system,'' she continues. ``The risk of kidney and liver failure liver failure Clinical medicine Liver insufficiency that results in death, requires a liver transplant, or is characterized by recovery after encephalopathy, or while awaiting a transplant; also defined as a condition with ≥ 3 of following: albumin < 3. is very high, but we're kind of caught. We tried everything else.'' CAPTION(S): 4 photos Photo: (1 -- cover -- color) Bringing the hospital home Infusion therapy allows patients to work and play while receiving medication (2 -- 3) Every three weeks, nurse Beth Donowho, right, comes to Farzaneh Heidari's Woodland Hills home to help administer an infusion. Heidari suffers from myasthenia gravis, an autoimmune disease that would otherwise keep her in intensive care. (4) Heidari, wearing the pump that delivers life-saving IntraVenous Immune Globulin, tends to her work as a fashion designer in her home studio. Charlotte Schmid-Maybach/Staff Photographer |
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