11.09.12
This past July my wife and her family had a reunion in their hometown of Peoria, IL, about a three-hour drive from where we live near Chicago. Before we left the house, my wife’s sister, Patti, called in a panic. She had arrived in Peoria absent her medication and asked if we could stop by her home, pick it up and bring it down with us. No problem.
Patti was diagnosed with multiple sclerosis late in 2011 and she has had a pretty rough year. Her Interferon medication had provided a source of some relief from her symptoms, but her self-injections frequently led to a spate of side effects that she described as being “like a horrible hangover without the benefit of having the night before.” Her malaise included joint pain, headaches, dizziness and nausea. (Sure sounds like a hangover to me!) To help take the edge off, she got in the habit of taking a prescription dose of ibuprofen on the days she took her Interferon injections and then again the following day. Her regimen requires her to self-inject three times a week. So she was feeling pretty terrible most days — although some days were better than others — and wrote it off simply as unavoidable side effects from the drug combined with flare-ups of MS.
When my wife and I arrived at Patti’s Chicago bungalow, I searched through her refrigerator but could not find her medication.
“What are you doing?” asked my wife, Colleen.
“Looking for Patti’s meds,” I said.
“She told me they’d be in here,” my wife declared as she quickly opened and closed several kitchen cabinet drawers. “Here it is!” She exclaimed grabbing a fist-full of pre-filled syringes in blister packs and a nylon case containing an auto injector. “Let’s go!” She said, jamming the medication into her oversized purse.
“Wait a minute,” I said, as I grabbed her handbag. “We can’t brings those all the way down to Peoria like that — it’s 95 degrees outside!”
“So?” She said.
“So? So, Interferon needs to be kept refrigerated.” I told her, sorting through her purse.
“They’ve been sitting in the drawer, Kevin.” My wife stated, “It’ll be fine.”
“It’s not fine,” I said. “And I’m not going to be responsible for cooking her medication. Look, it says right here: keep refrigerated, DO NOT FREEZE.”
“Well, why would Patti keep them in the drawer?” Colleen asked.
I shook my head. “Either she doesn’t know not to, or someone told her that it would be alright to keep them someplace handy other than in the fridge. Regardless,” I continued, “We’re refrigerating them.”
“And how do you suggest we do that?” Colleen asked.
“Look around here for a little picnic cooler,” I said. “She’s got to have one somewhere.”
While my wife peeked through the kitchen cabinets for a small picnic cooler, I searched the drawers until I found where Patti stashed the zip-lock plastic bags. I filled four quart-sized bags with ice cubes from the freezer. Colleen handed me a red and white cooler she found in a bottom drawer beside Patti’s cookware. I placed two of the ice bags on the bottom of the cooler and wrapped the pre-filled syringes in a dishtowel and placed them on top of the bags of ice. I covered the syringes with the remaining two baggies of ice and told Colleen that we had to drive back home to pack the medicine properly and get a temperature data logger to put in the container.
“You’re not serious?” My wife said in that tone, known to husbands everywhere.
“I’m dead serious.” I said.
“That’s going to put us another hour behind schedule,” She said.
I just shrugged my shoulders.
“Captain Cold Chain to the rescue!” My wife declared as we walked out of Patti’s house. “All you’re missing is your cape.”
When we arrived back home I went to the kitchen and removed two leftover frozen 48oz. gel packs that had been stashed in our freezer from our 4th of July picnic. I placed them on the counter. I went upstairs to my office and grabbed an unused Tag Alert device, a Libero PDF data logger and a FridgeTag monthly data logger for refrigerators — they were all recent donations from Sensitech, Elpro and Berlinger that I had returned home with from a recent training course on Good Distribution Practices.
I replaced the Igloo picnic cooler with a vacuum panel GreenBox container I had in the basement from my days at ThermoSafe. My wife looked on curiously as I spread the packaging out across the kitchen counter. I activated the Tag Alert and the USB-style data logger from Elpro, and wrapped them in a sheet of bubble wrap along with Patti’s syringes of Interferon and explained to Colleen the how, what and why of what I was doing. I sandwiched the assembly in the box between the two frozen gel packs. Lastly, I wedged the unactivated FridgeTag in with an informational instruction sheet down the side, put the vacuum panel lid on the container and closed the flaps until the Velcro grabbed securely.
Giving the box a quick, satisfying spin on the counter I exclaimed, “Alright, we’re ready to go!”
“You’re going through an awful lot of trouble, Kev,” Colleen sighed.
“I can’t help it. It’s the right thing to do. It’s plenty hot outside and Peoria is three hours away. Besides, it’s for Patti.”
“Well, c’mon then, Captain Cold Chain,” my wife said, patting me on the shoulder as she pushed me toward the door.
When we arrived in Peoria, I handed the GreenBox to Patti. She looked at me quizzically.
“What’s this?” She asked.
“Your meds,” I said smartly.
“Oh my God! Are you kidding me?” She laughed.
I helped her carefully unpack the box, explaining the details of how it was packed and why and showed her how the data loggers worked as I went. She giggled and shook her head.
“You’re a freak, O’Donnell!” she teased. “You didn’t have to go through all that,” Patti said shaking her head and pointing her finger at me. “Colleen, will you talk to him?”
My wife rolled her eyes and shook her head in exasperation.
“I know that this seems over the top to you, but this is nothing.” I told her. “This medicine is critical for your health and well-being, and that’s important to me.”
I extolled the virtues of proper storage conditions, but she interrupted, saying, “But Kevin, my doctor never said anything, and the home health care nurse said I could keep in in the kitchen drawer.”
I just looked at her over the top of my glasses, unmoved. By now, several of her family members had gathered around us to listen to our exchange.
“I’m certain they wouldn’t intentionally lead you down the wrong path, Patti,” I said, “But if you knew what I know about the last mile in cold chain. . . Let me ask you this: if you left a glass of milk in your kitchen drawer for a week like you do your drugs, would you drink it?”
“No way!”
I explained, “Milk is made up of long strands of protein that break when subjected to elevated temperatures. As this biodegradation takes place, it soon becomes pretty obvious to us because it curdles, sours and stinks. Refrigeration limits that degradation process.” I held up one of her syringes before putting it in the refrigerator, and said “This is also a protein. It breaks down just like milk. Only instead of curdling and going sour it still looks the same and smells the same but it effectiveness can be severely diminished.”
“Do you think this might be why I feel so lousy sometimes after taking it?” She asked.
“It’s definitely possible,” I said. “Here’s what I’d like you to do. Just humor me, okay?” I went on to demonstrate how the Fridge Tag device functioned and she took a genuine interest.
“When you get home,” I said, “lay this device in your refrigerator and check the temperature regularly. Here’s how you can scroll through the days, the times, the min and max temperatures. You’re looking to keep it between 2 and 8°C, that’s about 36 to 46° Fahrenheit. Look for the alarm indications to see if it goes outside that range. It’s critical you don’t freeze the drug. You will probably find the top shelf of your refrigerator is the coldest and often goes below 0°C.
Never store your Interferon where you see it goes below 0°okay?”
“That’s freezing, right?” She asked.
“Right,” I said. “Move the Fridge Tag around every couple of days and scroll through the data. Find the location in your fridge that has the most consistent and stable temperature. That’s where you want to keep your syringes until you use them. Meantime, put them on a middle shelf you can even lay them on top of a non-frozen gel pack; it’ll act as a cold sink and help keep the temperature constant. Remove a syringe a half-hour or so before you inject. It’s only a few milliliters of medication so it will warm up to room temperature quickly. And use this packaging to bring the rest of your stash home with you at the end of the week.”
Patti soon revealed to me how she received her medication via UPS in a “Styrofoam” box with frozen gel packs and encased in bubble wrap. She explained that she receives it the morning after calling in the order to her Pharmacy Benefit Manager the previous day. I filled her in on the merits of this process and the potential pitfalls.
Patti called the other day and during our chat she thanked me again for the advice I gave her over the summer and for explaining to her the importance of proper storage for her Interferon. “I had no idea,” She said, “No idea.”
I said, “Yeah, well Captain Cold Chain will convert the masses one patient at a time, if he has to.”
She laughed, then told me she no longer has to take ibuprofen nearly as often after her shot as she did before. “I told the doctor on my last visit that I’m feeling better more consistently now than I was before. So thank you for that,” she said.
“Don’t tell your sister,” I said. “She’ll want to measure me for a cape.”
Kevin O’Donnell is senior partner at Exelsius Cold Chain Management Consultancy – U.S. He is the former chair for the International Air Transport Association (IATA) Time & Temperature Task Force, a member of the USP Expert Committee on Packaging, Storage and Distribution, a temporary advisor and certified mentor to the World Health Organization (WHO), co-author of PDA Technical Report No. 39, and a member of the International Safe Transit Association (ISTA) Thermal Council. He blogs at www.clutchcargo.us. He can be reached at kevin.odonnell@exelsius.us.
Patti was diagnosed with multiple sclerosis late in 2011 and she has had a pretty rough year. Her Interferon medication had provided a source of some relief from her symptoms, but her self-injections frequently led to a spate of side effects that she described as being “like a horrible hangover without the benefit of having the night before.” Her malaise included joint pain, headaches, dizziness and nausea. (Sure sounds like a hangover to me!) To help take the edge off, she got in the habit of taking a prescription dose of ibuprofen on the days she took her Interferon injections and then again the following day. Her regimen requires her to self-inject three times a week. So she was feeling pretty terrible most days — although some days were better than others — and wrote it off simply as unavoidable side effects from the drug combined with flare-ups of MS.
When my wife and I arrived at Patti’s Chicago bungalow, I searched through her refrigerator but could not find her medication.
“What are you doing?” asked my wife, Colleen.
“Looking for Patti’s meds,” I said.
“She told me they’d be in here,” my wife declared as she quickly opened and closed several kitchen cabinet drawers. “Here it is!” She exclaimed grabbing a fist-full of pre-filled syringes in blister packs and a nylon case containing an auto injector. “Let’s go!” She said, jamming the medication into her oversized purse.
“Wait a minute,” I said, as I grabbed her handbag. “We can’t brings those all the way down to Peoria like that — it’s 95 degrees outside!”
“So?” She said.
“So? So, Interferon needs to be kept refrigerated.” I told her, sorting through her purse.
“They’ve been sitting in the drawer, Kevin.” My wife stated, “It’ll be fine.”
“It’s not fine,” I said. “And I’m not going to be responsible for cooking her medication. Look, it says right here: keep refrigerated, DO NOT FREEZE.”
“Well, why would Patti keep them in the drawer?” Colleen asked.
I shook my head. “Either she doesn’t know not to, or someone told her that it would be alright to keep them someplace handy other than in the fridge. Regardless,” I continued, “We’re refrigerating them.”
“And how do you suggest we do that?” Colleen asked.
“Look around here for a little picnic cooler,” I said. “She’s got to have one somewhere.”
While my wife peeked through the kitchen cabinets for a small picnic cooler, I searched the drawers until I found where Patti stashed the zip-lock plastic bags. I filled four quart-sized bags with ice cubes from the freezer. Colleen handed me a red and white cooler she found in a bottom drawer beside Patti’s cookware. I placed two of the ice bags on the bottom of the cooler and wrapped the pre-filled syringes in a dishtowel and placed them on top of the bags of ice. I covered the syringes with the remaining two baggies of ice and told Colleen that we had to drive back home to pack the medicine properly and get a temperature data logger to put in the container.
“You’re not serious?” My wife said in that tone, known to husbands everywhere.
“I’m dead serious.” I said.
“That’s going to put us another hour behind schedule,” She said.
I just shrugged my shoulders.
“Captain Cold Chain to the rescue!” My wife declared as we walked out of Patti’s house. “All you’re missing is your cape.”
When we arrived back home I went to the kitchen and removed two leftover frozen 48oz. gel packs that had been stashed in our freezer from our 4th of July picnic. I placed them on the counter. I went upstairs to my office and grabbed an unused Tag Alert device, a Libero PDF data logger and a FridgeTag monthly data logger for refrigerators — they were all recent donations from Sensitech, Elpro and Berlinger that I had returned home with from a recent training course on Good Distribution Practices.
I replaced the Igloo picnic cooler with a vacuum panel GreenBox container I had in the basement from my days at ThermoSafe. My wife looked on curiously as I spread the packaging out across the kitchen counter. I activated the Tag Alert and the USB-style data logger from Elpro, and wrapped them in a sheet of bubble wrap along with Patti’s syringes of Interferon and explained to Colleen the how, what and why of what I was doing. I sandwiched the assembly in the box between the two frozen gel packs. Lastly, I wedged the unactivated FridgeTag in with an informational instruction sheet down the side, put the vacuum panel lid on the container and closed the flaps until the Velcro grabbed securely.
Giving the box a quick, satisfying spin on the counter I exclaimed, “Alright, we’re ready to go!”
“You’re going through an awful lot of trouble, Kev,” Colleen sighed.
“I can’t help it. It’s the right thing to do. It’s plenty hot outside and Peoria is three hours away. Besides, it’s for Patti.”
“Well, c’mon then, Captain Cold Chain,” my wife said, patting me on the shoulder as she pushed me toward the door.
When we arrived in Peoria, I handed the GreenBox to Patti. She looked at me quizzically.
“What’s this?” She asked.
“Your meds,” I said smartly.
“Oh my God! Are you kidding me?” She laughed.
I helped her carefully unpack the box, explaining the details of how it was packed and why and showed her how the data loggers worked as I went. She giggled and shook her head.
“You’re a freak, O’Donnell!” she teased. “You didn’t have to go through all that,” Patti said shaking her head and pointing her finger at me. “Colleen, will you talk to him?”
My wife rolled her eyes and shook her head in exasperation.
“I know that this seems over the top to you, but this is nothing.” I told her. “This medicine is critical for your health and well-being, and that’s important to me.”
I extolled the virtues of proper storage conditions, but she interrupted, saying, “But Kevin, my doctor never said anything, and the home health care nurse said I could keep in in the kitchen drawer.”
I just looked at her over the top of my glasses, unmoved. By now, several of her family members had gathered around us to listen to our exchange.
“I’m certain they wouldn’t intentionally lead you down the wrong path, Patti,” I said, “But if you knew what I know about the last mile in cold chain. . . Let me ask you this: if you left a glass of milk in your kitchen drawer for a week like you do your drugs, would you drink it?”
“No way!”
I explained, “Milk is made up of long strands of protein that break when subjected to elevated temperatures. As this biodegradation takes place, it soon becomes pretty obvious to us because it curdles, sours and stinks. Refrigeration limits that degradation process.” I held up one of her syringes before putting it in the refrigerator, and said “This is also a protein. It breaks down just like milk. Only instead of curdling and going sour it still looks the same and smells the same but it effectiveness can be severely diminished.”
“Do you think this might be why I feel so lousy sometimes after taking it?” She asked.
“It’s definitely possible,” I said. “Here’s what I’d like you to do. Just humor me, okay?” I went on to demonstrate how the Fridge Tag device functioned and she took a genuine interest.
“When you get home,” I said, “lay this device in your refrigerator and check the temperature regularly. Here’s how you can scroll through the days, the times, the min and max temperatures. You’re looking to keep it between 2 and 8°C, that’s about 36 to 46° Fahrenheit. Look for the alarm indications to see if it goes outside that range. It’s critical you don’t freeze the drug. You will probably find the top shelf of your refrigerator is the coldest and often goes below 0°C.
Never store your Interferon where you see it goes below 0°okay?”
“That’s freezing, right?” She asked.
“Right,” I said. “Move the Fridge Tag around every couple of days and scroll through the data. Find the location in your fridge that has the most consistent and stable temperature. That’s where you want to keep your syringes until you use them. Meantime, put them on a middle shelf you can even lay them on top of a non-frozen gel pack; it’ll act as a cold sink and help keep the temperature constant. Remove a syringe a half-hour or so before you inject. It’s only a few milliliters of medication so it will warm up to room temperature quickly. And use this packaging to bring the rest of your stash home with you at the end of the week.”
Patti soon revealed to me how she received her medication via UPS in a “Styrofoam” box with frozen gel packs and encased in bubble wrap. She explained that she receives it the morning after calling in the order to her Pharmacy Benefit Manager the previous day. I filled her in on the merits of this process and the potential pitfalls.
Patti called the other day and during our chat she thanked me again for the advice I gave her over the summer and for explaining to her the importance of proper storage for her Interferon. “I had no idea,” She said, “No idea.”
I said, “Yeah, well Captain Cold Chain will convert the masses one patient at a time, if he has to.”
She laughed, then told me she no longer has to take ibuprofen nearly as often after her shot as she did before. “I told the doctor on my last visit that I’m feeling better more consistently now than I was before. So thank you for that,” she said.
“Don’t tell your sister,” I said. “She’ll want to measure me for a cape.”
Kevin O’Donnell is senior partner at Exelsius Cold Chain Management Consultancy – U.S. He is the former chair for the International Air Transport Association (IATA) Time & Temperature Task Force, a member of the USP Expert Committee on Packaging, Storage and Distribution, a temporary advisor and certified mentor to the World Health Organization (WHO), co-author of PDA Technical Report No. 39, and a member of the International Safe Transit Association (ISTA) Thermal Council. He blogs at www.clutchcargo.us. He can be reached at kevin.odonnell@exelsius.us.