Vax.

As you know, my program (Occupational Therapy) is a course based Master’s program which consists of about 40% fieldwork (i.e. practicums or placements in the community). This means I will be interacting with and treating people in any number of environments and circumstances. It then makes perfect sense that in order to be in those places (hospitals, clinics, outpatient programs, home care, etc.) and to work with those people (babies, children, seniors, etc.) I need to prove that I have had all of my vaccinations. Both to protect myself from any diseases clients might attempt to pass to me and to protect clients who have not been vaccinated or have weakened immune systems (we all know about vaccines and herd immunity, right?).

Anyways, it turned out to be a slightly more involved process than I initially thought and in the end I was actually missing a few vaccinations. So here is the outrageously interesting story of my vaccination journey over the summer (spoiler: it’s not actually that interesting).

I should preface this with some history:

I don’t particularly like getting vaccinations. I mean to say, I don’t enjoy them. Who does I guess. When I was a child, I was given allergy shots for a few years. If you don’t know what that is, it is when they inject you with slowly increasing doses of certain allergens in an effort to desensitize you. Each round would be a particular allergen or combination of allergens. The first shot would be 1 ml, then a month later 2 ml, then a month later 3 ml, etc. until you were at the point where you were getting 9-10 ml shots. Now, I can’t recall if those numbers are exactly right. Maybe they are wrong, but the premise is correct. And the take away for me was that the first few shots you barely felt, but by the end they were absolutely massive and were quite painful. After a round is done, they begin another one.

Now, to be honest, these didn’t bother me too much. I certainly didn’t like getting the big ones. But they didn’t leave any lasting issues with injections themselves. If anything, they made other vaccinations seem like no big deal. I had just received a massive allergy shot, I wasn’t even concerned I’d feel the little Hepatitis B shot I had to get in school.

BUT THEN. Oh then. I was about to leave on my first trip to Australia and decided I should get Hepatitis A vaccinations. I was just about to leave and didn’t have time to go in to a doctor, but luckily for me (spoiler: it was not lucky), I could get in to a pharmacist to get them done. The pharmacist suggested I also get Tetanus since it had nearly been ten years since my last one. He said he would do the Tetanus in my left arm (since it tends to hurt more) and Hep A in my right. He started with the Hep A and when he put the needle in it hurt like the dickens. Not like, “ow that feels like a lot of liquid in my muscle” pain, more like “I’ve just been thoroughly stabbed” pain. I got instantly dizzy and while he did the Tetanus shot in my other arm I tried to make my eyes focus and stop blurring. As soon as he was done the second shot (which didn’t hurt at all, by the way) I passed out in the chair.

I have never fainted before, at least not out of anything other than extreme illness. And even then, I am not sure I have. When I woke up, the pharmacist was in a sort of quiet panic. I had to call my dad to come and pick me up because I still could not see straight and I certainly couldn’t drive. It took the rest of the day for the dizziness to wear off and the pain in my arm only got worse. I could not move my arm for two or three days. It was horrendously painful. Turns out (as I learned later – when I got my second Hep A shot a year later and explained previous experience to the doctor) he hit my bone with the needle.

Needless to say, this has coloured my feelings about needles being put into my arms. I am still almost always fine. But every once in a while I get just a little bit of a vasovagal response (I get light headed and woozy). It has never lasted more than a few seconds and I have never again fainted (most likely because I have never again been hit in the bone with a needle). But it means vaccinations are no longer the “no big deal” they used to be. It also means that I have to check yes on the “have you ever fainted after an injection” box all the prevaccination forms. Which is annoying and forces me to tell the story over and over and then assure them that I will not faint as long as they don’t push the needle into my bone. Sometimes they still make me lie down while I’m getting the injection.

I also think time has something to do with my feelings about vaccinations. The longer it has been since I have had a vaccination, the more likely I am to feel not awesome about it. I think this is because the most memorable vaccination experience I have (the one that most readily comes to mind) is the terrible one. But as soon as I have a good one I remember that they are not that big of a deal. All this is to say, by the end of this process, vaccinations felt like no big deal. But at the start, it was a less appealing process.

It’s also worth including that these vaccinations and tests came right in the middle of my second and third HPV vaccinations. I missed getting HPV vaccinations when I was younger and finally decided on my own to get them done. They are a doozy of a shot and are more likely than most to cause fainting.

.

Anyways, back to this summer. The first thing I had to do was locate my vaccination records. If you had your vaccinations done through school or at a Public Health Unit, the records should be there. However, when I was a baby, there were no digital records, so while a few of my vaccinations were probably on record at the Health Unit, I was forced to rely on written immunization records given at the time. Luckily for me, my mom was diligent in keeping these and she knew exactly where to find them.

With these records and my program requirements in hand, I made my first appointment at the Health Unit. At this appointment, a public health nurse officially entered all my recorded vaccinations into my official record and we went through the requirements for my program (public health nurses are great!). The requirements for my program are:

  • Three doses of Tetanus/Diptheria (with the last dose within ten years)
  • A dose of acellular pertussis given after the age of 18
  • A strong history of varicella at 1 year or older, positive varicella serology, or proof of vaccination
  • Two doses of measles, mumps, rubella
  • A minimum of three doses of Hepatitis B
  • Hepatitis B serology to prove adequate immunity
  • A tuberculosis skin test (and follow up chest x-rays if required)

My tetanus/diptheria were all done (thanks to the pharmacist who also gave the fateful Hep A vaccination). I had one dose of measles/mumps/rubella (they changed the dosing after I received mine – if you were born before 1995, there is a chance you also only got one MMR vaccination, which means you are susceptible to getting the diseases and also means you can get your second booster for free from Public Health. Which you should do because you don’t want to get the mumps. Remember all those hockey players who got mumps? They are all older than 1995 and probably only had one MMR vaccine and then they got mumps!). I had all three doses of Hepatitis B and although I have a strong history of varicella (chicken pox), I was only 8 months at the time so I required serology to prove my immunity. I had not had a pertussis vaccination after the age of 18. Pertussis is whooping cough and apparently (as my mom related to me from personal experience) it is absolute hell to get as an adult. So even though this one wasn’t covered by Public Health, I felt good about getting it. So this means I had to get a pertussis vaccination, a MMR vaccination, Hep B serology, varicella serology, and a Tb test.

Unfortunately, all of these things had to be done in different places. The Tb test could only be done at the local travel clinic. Pertussis is offered as a dTap (diphtheria, tetanus, and pertussis). While I was more than up to date on tetanus and diphtheria, my last dose did not include pertussis. This was is considered outside of the government vaccination plan, so I had to pay and have it done at the travel clinic as well. So that is where I started. A Tb skin test is a test that requires two appointments scheduled two days apart. At the first appointment they inject some stuff (neutralized Tb) under the skin of your forearm. Then at the second appointment they measure your reaction. The appointments have to be precisely spaced and if you miss your second one, you have to start all over. When I returned for my second appointment I was also given my dTap. My Tb test was negative, so no chest X-ray needed.

(A few days after this I had to get my third HPV vaccination, which was unrelated to this whole deal, but added to my general vaccination load).

Then it was off to the doctor for blood work. For Hepatitis B, it was a check to ensure I did not need an additional round of vaccinations. They had to measure the antibody level in my blood. It was similar for varicella. Since I had the disease so young, they were not sure I would have retained my immunity. If I was not immune, I would need to get the full round of varicella vaccinations. It took a few weeks for the results to come back. I was found to have adequate immunity to both, which saved me from multiple additional injections.

Lastly, my final measles, mumps, rubella. I got this one for free at the Public Health Unit. MMR is a live vaccination. This means that I could not get it before my Tb test as it could affect the test results. You can’t get a TB test if you have had a live vaccination in the last 4-6 weeks. Live vaccinations are not given intramuscularly. The are given subcutaneously (just under the skin). This allows the body to absorb the vaccination slower, which is important given that there is live disease in the injection. I got this vaccination about two weeks before moving to Edmonton. She informed me after giving it to me that I should expect to experience symptoms around 7-10 days after the injection and that they could last up to 5 days. Mainly fatigue, body aches, a rash, and other flu-like symptoms. I was very excited to hear that these would hit me just as I was scrambling to pack and move. Luckily, however, they didn’t seem to bother me too much.

Then the public health nurse went through my forms and records again and we made sure everything was filled out and backed up (did I mention public health nurses are great?). Once I got to Edmonton I had to make an appointment at the University Health Centre to have my forms and records inspected and approved. Luckily the public health nurses I saw were diligent and this was a relatively painless process.

So there you have it. My immunization records are up to date and I am approved to do my school placements. My advice to anyone reading this is that it would probably be a very good idea to locate and take a look through your own immunization records. Before this, I really had no idea what vaccinations I had and just assumed that because I was vaccinated as a child and got all the offered vaccinations in school I was up to date. You might be missing a MMR! Your tetanus might be overdue! You might not have a current pertussis! It would be real bummer to come down with a terrible disease simply because you were unaware that you weren’t protected. If you are missing any vaccinations from the government vaccination plan, they are probably free for you to get. You just need to go to a public health unit. And even if you have to pay, wouldn’t it be better to pay $50 for a pertussis vaccination now than to suffer for months with a insatiable and painful cough?

Get your vaccinations friends.

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