Prepping meds

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After 4+ years of managing Quinn’s medications, we’ve got a system that has worked well for our family. In the early years, Quinn’s seizure medication would change every other week so we were constantly titrating (building up or weaning down) medication. We must have went through five different medications the first year. It was a rollercoaster journey because we would slowly build up the medication only to discover a bad side effect and have to slowly bring down the medication. Seizure medication needs to be slowly weaned from the system or it could result with more seizures. On top of that, most of time the medication did very little, if nothing, to control her seizures.

Our system is not perfect and it is constantly evolving as we discover new products or tricks. Hopefully, this will inspire you to develop a system that works for your family.

Why it matters

You’ll hear me mention anxiety here and there. If you’re someone who’s not really stressed out about med time, that’s great, you probably won’t find this article too helpful. But for those of us who find medicine crazy stressful, I found it easier to manage my anxiety when things are easy and controlled. These tips might seeing very minimal, but if they can take just an ounce of stress off my very stressful day, it’s worth it. Cortisol is what your brain produces when it’s under a lot of stress. There’s lots of research describing the ill side effects of what high levels of cortisol can do to your body. If you can decrease it even just a tiny bit, why not? Believe me, I have enough things to get my brain producing cortisol every day. I don’t need anymore reasons.

I was a waitress for quite a few summers in my youth. One of the valuable skills I learned was the efficiency of smooth processes and prepping ahead of time. Napkins would be prefolded, carrots would be pre-cut, pitchers would be pre-filled, etc so things are ready to go when it’s go time. So I like to run my house as efficiently as a restaurant would. Diapers, wipes, granola bars, syringes, etc are always stacked in accessible bins so it’s easy to grab just one and go. I don’t want to deal with opening packaging and dealing with the trash if I can do all that ahead of time.

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In addition, I keep all her meds in one location and in one box/container (if possible). I also keep a notepad where I write down her current dosages and when we last implemented it. We have this information on a Google calendar, as well. The notepad just makes it nice and easy because everything is in one place. So if there’s ever a question with the dosage, and that has happened especially in the early days, we have a quick history documented in that notepad. Now if my husband has a question of why her dosage is lower or higher this time, he can check the notebook and see that it’s been changed recently. This is another way to keep us in check in case I am not available or having a brain fart.

Weekly Prep

This may seem obvious, but for those who are resisting getting a pill case, DO IT! Everything is opened, crushed, and measured for the rest of the week. It really makes things easy for others to administer meds besides myself. When we first started on this epilepsy journey, Quinn’s medication dosage would change every other week. This pill case eliminates the overhead of communicating all the med changes to all of Quinn’s caregivers.

I start off by pre-measuring Quinn’s meds in advance. In the early years, we were doing all the prepping and double-checking right before we were administering medicine. Planning anything (i.e. measuring meds) actually take a lot of brain power. She has 4 medications she takes two times a day, each with their own AM and PM dosage quantity. I found it much easier to prepare her meds for multiple doses ahead of time, when it’s most convenient for me (i.e. when my brain is calmer)? Now when it’s go time (med administering), I just have to grab 1 container and/or syringe and go. I call this consolidating brain power. I don’t have to double-check dosages with med type and with time of day. It saves me a lot of mental energy.

Another handy thing with this pill case is that it gives me a visual reminder of when it’s time for a refill. I know her pharmacies have their own reminder system but some of them are too early. Our current insurance won’t pay for the medication to be refilled more than 5 days in advance and this pill case a simple way to keep me in check.

Daily Prep

I like to prep a day’s worth of meds on the night before. This is a great way to catch when we’ve missed a dose, which happened to us a lot in the early days. Quinn takes meds twice a day so I make up 2 syringes and 2 pill jars. If there’s a leftover one at the end of the day, we know we messed up and can try to fix it! 🙊 I learned this lesson pretty quickly because it’s not fun waking a toddler up to administer missed meds. I never prep more than a day’s worth for this reason. It’s easier to know at a glance that there are 0 med jars or syringes, then to count how many we should have at the end of the day.

Liquid Medication

This is the part where I speak of the ease of using good tools. Whether you’re a painting or mowing the lawn, everyone knows the job is so much easier if you use the right tools. In the early years, we would only use the free syringes from the pharmacy, because it’s free! Well, it occurred to me a few months in that since we administer meds so often, we should really get good tools. What’s the difference between free syringes and paid syringes? I’m glad you asked.

• Good syringes slide in and out like butter!! The bad ones are a pain to measure because they keep getting stuck or require a lot of force just to pull the medication in. So many times we’ve battled to get the air bubble right out of the tip. With bad syringes, it’s a gamble of what the right amount of pressure is. Sometimes it’s just a small speed bump in the barrel (so you just have to apply a little bit more pressure past a tiny section and then the syringe will be smooth again) or it’s just stuck and you have to apply constant pressure to the whole barrel. This is the perfect recipe to accidentally shoot the medication out too fast and project its contents onto the counter (a waste) or worse, into the back of your child’s throat causing possible gagging. It’s just so frustrating for everyone and is not necessary.
• Good syringes have measurements that stay on between washes.
• Good syringes are dishwasher safe. This this was vital because they are a pain to wash.
• When you buy a package, you have so many that it’s very easy to have five syringes on rotation. Just imagine watching one or two baby bottles after each use. It gets annoying pretty quickly. If you have multiple syringes, you can pile the syringes until it’s convenient to wash them together, like baby bottles, or better yet, stick them in the dishwasher.

Having said all that, I don’t have a syringe I absolutely love. If you do, please help a mama out and comment below. This is the one I use and it’s good enough. When brand new, it moves like butter! After a couple washings, it does get stuck or the markings wash off. That’s when I switch it out for a new one.

GREEN ALERT: I really don’t like the waste syringes generate but I haven’t figured out a better alternative. I also make it a point to give back the syringe to the pharmacy as soon as they give it to me. They won’t take the syringes back if you leave the premise, even if it’s still wrapped in the plastic. I’ve tried giving them away to the school nurse but she’s fully stocked now. Someone told me that science teachers could use them so I may have to do that. Comment below if you can use pharmacy syringes and I’ll mail them to you.

Invest in a bottle adapter for your syringes! They are removable and reusable! You see these at doctor offices and hospitals. If there’s a liquid med to be measured, they always have an adapter so you can flip the bottle upside down and measure the liquid meds more easily. There’s a reason why. This saves a TON of headaches, medicine, and extra things to wash. If your current medication bottle is too large or small for one, ask the pharmacist for a smaller bottle so the adapter will fit properly.

Pills

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Two of her meds require cutting, crushing, and opening sprinkle capsules. The sprinkle capsules are self-explanatory. You just open it up and pour it in. And yes, I feel like a junkie every time I do this.

To split pills, I use this pill splitter. Again, good tools make a difference. I posted a picture of the pill cutter I use. What makes a nice pill cutter?? I’m glad you asked:

• They are sharp enough to make a clean cut. Cheaper pill cutters tend to cut but also crush/crumble the pills.
• They are small
• They have supports to hold pills in place

This one has served me well. I like that there is a reservoir to hold pills but I don’t really use it. I also like that it’s clear. One of Quinn’s dosages require a quarter of a pill (I know, if I didn’t see a difference I would not have kept this up). So since this container is clear, I am able to mark the spot where I should place the pill so I can cut a quarter pill the same way each time.

To crush pills, we use these two tools. My husband prefers the traditional pill crusher (green one) that we started with. At some point, it wouldn’t fit all of Quinn’s pills so I was finding myself opening and crushing it too many times. Plus one of her meds actually has a little moisture(?) so it sticks to the sides of the pill crusher. In comes the pestle (the silver one). It takes some getting used to but I prefer it. I wash it after each use so the inside stays nice and smooth. It’s solid and heavy. Besides for the messy medication, the crushed pills really does slide right off.

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I find that putting everything in a baby food container is the easiest way to make this a “grab and go” item. All you need is to add applesauce and you’re ready for business. These baby food containers are the best. There are small, have no grooves, and are spoon friendly. It’s very easy to scrape every last drop. They also come in colors!!! I use yellow for AM and purple for PM so if my brain is ever on the fritz, I’ll remember the colors by association.

Side note: these jars are screw caps so they make excellent OT opportunities. You can use the extra containers for their snacks so they can practice wrist rotations. It really beats the small Glad containers.

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The spoons we use are bought from the dollar store. Quinn really likes these spoons when she was younger and was learning how to feed herself. They are small, portable, and reusable. They make perfect medicine spoons.

Lastly, we have a makeup spatula to help scrape every last pill from the pill crusher or sometimes to administer meds instead of the spoon. In the past we would mix her crushed pills into a food substance to make a paste. This tool was great for scraping that paste. The paste method is only recommended if you do not have very much volume in pills. They make plastic spatulas too but the silver one works better in the pill crusher barrel.

So there you have it!

I hope you find these tips and tricks helpful. If you can make any part of your process easier, it really does make a difference on your anxiety level. As stated before, meds are a constantly evolving thing for us. Sadly with kids, epilepsy medications will likely change due to their growing body. Our hope is always to control her epilepsy seizures so that her brain can outgrow them and we don’t need medication anymore. That is the hope but most of the time, not reality. So we expect to have many iterations of prepping meds, as well as administering meds.

If you have another trick that I haven’t mentioned, please comment below. There is strength in collecting and sharing knowledge among special needs parents. We need all the support we can get. Thanks and good luck!