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Instill Question: Solu-cortef instill issue

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  • Instill Question: Solu-cortef instill issue

    Okay, I am trying a new instillation. It is Solu-cortef, 3 cc sodium bicarb, 25 cc marcaine, and 20,000 units of heparin. The solution is really cloudy, and a precipitate is forming (a solid). I don't know why this is not mixing, and has anyone had any issues, or any suggestions. Do I just instill it or could I add a little sterile water in order to get it to go into solution?

    I called an on-call nurse, and my own nurse and no one is returning my call. I am freaking out.

    Erin
    24 year old Ph.D student in Organic Chemistry

    Loves to listen to music, play with my animals (cat, fish, 2 hamsters), and live life to the fullest each and every day.

    My blog (just started):

    http://imaginenoworries.blogspot.com/

    Medications:
    Elavil 25mg (helped with nighttime urination-used to be 7 or more times a night, now just once)
    Cymbalta 60mg
    Gabapentin (Neurontin) (3200mg/day)
    Zyrtec 10mg
    Xanax 0.5mg up to 3 times a day(spasms, anxiety)
    Uribel
    Macrobid 100mg (only on days when doing an instill)
    Albuterol
    Yaz Birth Control (3 months on birth control, then period)
    Pelvic floor therapy
    Valium 5 mg (inserted vaginally)
    MScontin 30 mg (3 times a day)
    Percocet 10/325mg (every 6 hours)
    TENS Therapy, CVS machine, 30 minutes once or twice a day
    Sanctura XR 60 mg (to help control severe bladder spasms that are causing urinary retention episodes and enable normal bladder sensations)

    *** 1/4 of a teaspoon of baking soda in an 8 ounce glass of water up to 4 times a day*****

    Instill:

    Currently doing hyaluronic acid instillations (cystistat-6 instillations, once a week, already had 4...not sure if helping)

    Used to do these:

    Solu-Cortef (act-o-vial) 100 mg: 2 mL
    Marcaine (bupivicaine) 0.5 % 25 mL
    20,000 units Heparin
    3 mL sodium bicarbonate

    Diagnoses: Moderate IC, scoliosis, asthma, ovarian cysts, PFD, IBS, Fibromyalgia, vulvodynia, Fowler's syndrome (mild) 'Central Sensitivity Syndrome.'

  • #2
    I would wait for the call before instilling it. Marcaine is fairly thick --- could that be it?

    Donna
    Stay safe


    Elmiron Eye Disease Information Center - https://www.ic-network.com/elmiron-p...mation-center/
    Elmiron Eye Disease Fact Sheet (Downloadable) - https://www.ic-network.com/wp-conten...nFactSheet.pdf

    Have you checked the ICN Shop?
    Click on ICN Shop at the top of this page. You'll find Bladder Builder and Bladder Rest, both of which we are finding have excellent results.

    Patient Help: http://www.ic-network.com/patientlinks.html

    Sub-types https://www.ic-network.com/five-pote...markably-well/

    Diet list: https://www.ic-network.com/interstitial-cystitis-diet/

    AUA Guidelines: https://www.ic-network.com/aua-guide...tial-cystitis/

    I am not a medical authority nor do I offer medical advice. In all cases, I strongly encourage you to discuss your medical treatment with your personal medical care provider. Only they can, and should, give medical recommendations to you.
    [3MG]

    Anyone who says something is foolproof hasn't met a determined fool

    Comment


    • #3
      Hello,

      I did hear back from the on call nurse. She said that some mixtures with solu-cortef are cloudy. I am a chemist, so I was thinking of chemistry things, and it could be that because of reconstituting the solucortef (starts out in a powder form then a liquid is added to it in the acto-vial) it turns clear, but there could be solubility issues with the other ingredients. Plus there are other salts contained in the ingredient list on the pharmacological data that could crash out due to to the marcaine or the sodium bicarb. I believe I got most of it in (nurse said aim for 90% and try to add sterile water to get any particulates that were not going in). I did that and they did not dissolve in water. I know for a fact that hydrocortisone sodium succinate (solu-cortef) does. I even tried dissolving what was left in the container and dissolve it in tap water and would not go away (did not put this in my bladder). I got everything in the toomey (what attaches to the catheter to go away), and what I could to go in. I had some minor discomfort when I did it (probably stress), but right now I feel soothed by it, feels kind of weird. I hope I can urinate on my own, and not have to re-cath (generally have to with instills). Hopefully it works. I can always work with my doctor if something needs to be added to increase solubility.

      Sorry if I am a bit too scientific with this. I was hoping you would reply, since I knew you had experience with solu-cortef, but yours was in DMSO, correct? If so, DMSO is a magical solvent that dissolves almost anything. I use it in my line of work! Kind of sucks being a sciency nerd with this stuff, since I am so critical, but at least I can analyze it!

      Let's hope it works (even if it is something expensive!).

      Erin
      Last edited by ermkenne; 03-18-2011, 12:53 PM. Reason: *** I did not add the tap water, to my bladder, when I tried to dissolve the stuff in the cup**
      24 year old Ph.D student in Organic Chemistry

      Loves to listen to music, play with my animals (cat, fish, 2 hamsters), and live life to the fullest each and every day.

      My blog (just started):

      http://imaginenoworries.blogspot.com/

      Medications:
      Elavil 25mg (helped with nighttime urination-used to be 7 or more times a night, now just once)
      Cymbalta 60mg
      Gabapentin (Neurontin) (3200mg/day)
      Zyrtec 10mg
      Xanax 0.5mg up to 3 times a day(spasms, anxiety)
      Uribel
      Macrobid 100mg (only on days when doing an instill)
      Albuterol
      Yaz Birth Control (3 months on birth control, then period)
      Pelvic floor therapy
      Valium 5 mg (inserted vaginally)
      MScontin 30 mg (3 times a day)
      Percocet 10/325mg (every 6 hours)
      TENS Therapy, CVS machine, 30 minutes once or twice a day
      Sanctura XR 60 mg (to help control severe bladder spasms that are causing urinary retention episodes and enable normal bladder sensations)

      *** 1/4 of a teaspoon of baking soda in an 8 ounce glass of water up to 4 times a day*****

      Instill:

      Currently doing hyaluronic acid instillations (cystistat-6 instillations, once a week, already had 4...not sure if helping)

      Used to do these:

      Solu-Cortef (act-o-vial) 100 mg: 2 mL
      Marcaine (bupivicaine) 0.5 % 25 mL
      20,000 units Heparin
      3 mL sodium bicarbonate

      Diagnoses: Moderate IC, scoliosis, asthma, ovarian cysts, PFD, IBS, Fibromyalgia, vulvodynia, Fowler's syndrome (mild) 'Central Sensitivity Syndrome.'

      Comment


      • #4
        I didn't have solu-cortef at the same time as the DMSO. I found solu-cortef was soothing. It wasn't mixed with anything but the liquid to dilute it. We tried different instillations over the years --- I let my uro know I was willing to experiment. Most of the treatments did help.

        Donna
        Stay safe


        Elmiron Eye Disease Information Center - https://www.ic-network.com/elmiron-p...mation-center/
        Elmiron Eye Disease Fact Sheet (Downloadable) - https://www.ic-network.com/wp-conten...nFactSheet.pdf

        Have you checked the ICN Shop?
        Click on ICN Shop at the top of this page. You'll find Bladder Builder and Bladder Rest, both of which we are finding have excellent results.

        Patient Help: http://www.ic-network.com/patientlinks.html

        Sub-types https://www.ic-network.com/five-pote...markably-well/

        Diet list: https://www.ic-network.com/interstitial-cystitis-diet/

        AUA Guidelines: https://www.ic-network.com/aua-guide...tial-cystitis/

        I am not a medical authority nor do I offer medical advice. In all cases, I strongly encourage you to discuss your medical treatment with your personal medical care provider. Only they can, and should, give medical recommendations to you.
        [3MG]

        Anyone who says something is foolproof hasn't met a determined fool

        Comment


        • #5
          I don't use solu-cortef in my instillations, just Marcaine, Sodium Bicarbonate, Heparin, Sterile Water. If my bathroom is humid - already steamy or if it's a humid day - I notice that the Sodium Bicarbonate doesn't completely dissolve. I've wondered about this, but it hasn't made any difference in how the instillation works.
          Kadi

          -------------------------------------------------------------
          I am not a medical authority nor do I offer medical advice. In all cases, I strongly encourage you to discuss your medical treatment with your personal medical care provider. Only they can, and should, give medical recommendations to you.
          ------------------------------------------------------


          New favorite quote: "God gives us only what we can handle. Apparently God thinks I'm a bad-ass" ~Author Unknown
          Source - Pinterest
          "


          Current treatments:
          -IC diet
          -Elavil 50mg at night
          -Continuous use birth control pills (4-5 periods/year)
          -Heparin/Marcaine/Sodium Bicarb home instills at night 3-4x per week, more often if needed
          -Pyridium if needed,
          -Pain medicine at bedtime daily, as needed during the day several times per week
          -Antibiotic when doing an instillation to prevent UTI
          -Colace & SmartFiber to treat chronic constipation from meds, Fleet enema as needed
          -Dye Free Benadryl 50 mg at bedtime
          -"Your Pace Yoga: Relieving Pelvic Pain" dvd, walking, treadmill at gym
          -Managing stress= VERY important!
          -Fur therapy: Hugging the cat!

          Comment


          • #6
            Yeah, temperature can have an effect on how things dissolve. Sometimes if it is warmer it can increase the solubility or decrease it, just depends on the chemicals involved. Plus sodium bicarb. is made a certain way in a liquid so it may crash out if some conditions are not 'optimal' but it will still work.

            I kind of did my own experiment to see if the order of what I added made a difference, and it sure did. I added the solu-cortef solution, added sodium bicarb (clear solution) then added marcaine (turned very cloudy, so it is a result of the high viscosity of it), added heparin (still cloudy), but no particulates formed. This made me very happy, it was cloudy, but looked like what the nurse told me. Had to be a nerd about it, but that is just in my nature!

            Also, I do not have retention with this instill. I have had it with every other one I tried. I think it was the lidocaine (only different thing), so I have not had to re-cath!
            24 year old Ph.D student in Organic Chemistry

            Loves to listen to music, play with my animals (cat, fish, 2 hamsters), and live life to the fullest each and every day.

            My blog (just started):

            http://imaginenoworries.blogspot.com/

            Medications:
            Elavil 25mg (helped with nighttime urination-used to be 7 or more times a night, now just once)
            Cymbalta 60mg
            Gabapentin (Neurontin) (3200mg/day)
            Zyrtec 10mg
            Xanax 0.5mg up to 3 times a day(spasms, anxiety)
            Uribel
            Macrobid 100mg (only on days when doing an instill)
            Albuterol
            Yaz Birth Control (3 months on birth control, then period)
            Pelvic floor therapy
            Valium 5 mg (inserted vaginally)
            MScontin 30 mg (3 times a day)
            Percocet 10/325mg (every 6 hours)
            TENS Therapy, CVS machine, 30 minutes once or twice a day
            Sanctura XR 60 mg (to help control severe bladder spasms that are causing urinary retention episodes and enable normal bladder sensations)

            *** 1/4 of a teaspoon of baking soda in an 8 ounce glass of water up to 4 times a day*****

            Instill:

            Currently doing hyaluronic acid instillations (cystistat-6 instillations, once a week, already had 4...not sure if helping)

            Used to do these:

            Solu-Cortef (act-o-vial) 100 mg: 2 mL
            Marcaine (bupivicaine) 0.5 % 25 mL
            20,000 units Heparin
            3 mL sodium bicarbonate

            Diagnoses: Moderate IC, scoliosis, asthma, ovarian cysts, PFD, IBS, Fibromyalgia, vulvodynia, Fowler's syndrome (mild) 'Central Sensitivity Syndrome.'

            Comment


            • #7
              I have never used that particular drug in my instills but I was never able to get Elmiron to dissolve in my instills.

              If air gets into the lidocaine vial the mixture in the syringe can become cloudy. Since I use the negative pressure way to fill my syringe I always have air in the vial but rarely does it become cloudy. The few times it did become cloudy the vials were a different temperature than the room. I was told that since it was not being injected I didn't need to be concerned with the cloudiness. BUT you have a different cocktail so don't take my word on it.
              TREATMENT: PRN lidocaine/heparin Home Instillations since 2004
              My Helpful Hints for Home Instillation: http://www.ic-network.com/forum/show...985#post309985

              Institute of Female Pelvic Medicine (J. Dell, My MD) http://www.mypelvicmedicine.com/index.asp
              Thank you for allowing me to share my experiences and offer support. Your physician is the only one to give you medical advice. I hope sharing the information from this site will help you and your physician develop successful management of your IC.
              I post to encourage and offer total support for rescue instillations.
              Find me on facebook: L. Clark Thomas
              Louann

              Comment


              • #8
                I was told the same thing about the cloudiness. My nurse told me they experience the same thing, and not to worry about it. It's just because of being a chemist. To me things should go into solution, so it bothers me, . So far it seems to be working okay, and really soothes my bladder when it is in pain. I have NEVER had a rescue instillation do that. I think that I had some sort of reaction to the lidocaine or that was not helping. Last two instills involved that and I think it was the problem. I think the steroid addition is helping, just not sure what the long term effects of that and the heparin are.
                24 year old Ph.D student in Organic Chemistry

                Loves to listen to music, play with my animals (cat, fish, 2 hamsters), and live life to the fullest each and every day.

                My blog (just started):

                http://imaginenoworries.blogspot.com/

                Medications:
                Elavil 25mg (helped with nighttime urination-used to be 7 or more times a night, now just once)
                Cymbalta 60mg
                Gabapentin (Neurontin) (3200mg/day)
                Zyrtec 10mg
                Xanax 0.5mg up to 3 times a day(spasms, anxiety)
                Uribel
                Macrobid 100mg (only on days when doing an instill)
                Albuterol
                Yaz Birth Control (3 months on birth control, then period)
                Pelvic floor therapy
                Valium 5 mg (inserted vaginally)
                MScontin 30 mg (3 times a day)
                Percocet 10/325mg (every 6 hours)
                TENS Therapy, CVS machine, 30 minutes once or twice a day
                Sanctura XR 60 mg (to help control severe bladder spasms that are causing urinary retention episodes and enable normal bladder sensations)

                *** 1/4 of a teaspoon of baking soda in an 8 ounce glass of water up to 4 times a day*****

                Instill:

                Currently doing hyaluronic acid instillations (cystistat-6 instillations, once a week, already had 4...not sure if helping)

                Used to do these:

                Solu-Cortef (act-o-vial) 100 mg: 2 mL
                Marcaine (bupivicaine) 0.5 % 25 mL
                20,000 units Heparin
                3 mL sodium bicarbonate

                Diagnoses: Moderate IC, scoliosis, asthma, ovarian cysts, PFD, IBS, Fibromyalgia, vulvodynia, Fowler's syndrome (mild) 'Central Sensitivity Syndrome.'

                Comment

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