What this means in practice, is that my health insurance doesn't actually pay for any of my medical care until after I've met my deductible for the year. I cover this deductible gap with money from my HSA. The HSA allows me to save money for health care expenses tax free - sort of like a Traditional IRA - only the money goes towards health care expenses rather than retirement.
A couple of wonderful aspects of this HSA money:
Tax deductible - you don't pay taxes on the money you put in the plan
Carries over - if you don't spend all of this money, it is available in following years
Eligible for retirement - you may transfer some of this money into a retirement account
Because I require so much medical care, I have spent all of my HSA money in every year. In some years (like last one), I end up spending significantly more on medical care than the money I set aside in my HSA - this money comes out of my pocket.
I contribute some of each paycheck to my HSA. However, this means that the money accrues through the year and that the account hasn't received all of the contributions until the end of the year. Because the HDMP incurs most of its costs at the beginning of the year, this can leave the patient scrambling to pay very high medical costs if they happen early in the year.
FSA
The Flexible Spending account money does not roll-over into another year. If you do not spend all of the Flexible Spending account money, then it disappears (to whose benefit, I've never figured out). Recently the IRS relaxed the rules in this area and the money only needs to be spent by March 15th of the following year. I presume that this date depends upon the tax filing deadline of April 15th.
However, my FSA has one benefit that my HSA does not. All FSA money appears in the account at the beginning of the year. This means that I can cover any dental or vision expenses immediately with the money in that account.
My abdominal bloating continues to subside. In most clothing someone not very familiar with me would not be able to tell that I am still bloated. Sometimes I actually feel lean now :)
The scar continues to heal. I don't have any incision pain. I easily tolerate vigorous activity including shoveling our horse shed, splitting oak firewood, playing fetch with my dog, and wrestling with my dog.
Other than some mild bloating and some tenderness right on the incision when the dog jumps on it, I don't have any real complaints.
Front View
Side View
Sorry about the poor picture quality - this is what I could do with my arm outstretched while taking the picture.
On Wednesday 2/18, I had to clean the horse sheds, clean the horse waterers, move firewood, and refill the horse waterers. I did all of this in quite brisk temperatures (lower teens).
It took me about 80 minutes to do all of this and I maintained a heart rate of about 130 during most of the time.
While I watched one of my favorite all-time SF TV shows on Monday, I decided to get a little exercise. Unfortunately, my daughter also needed to be picked up so I stepped up my pace and reduced my work out time.
I also discovered that my Timex Heart Rate Monitor strap doesn't work anymore. It read a heart rate of 130 as a heart rate of 32. Nothing I did (changed battery, cleaned contacts, moistening contacts), helped it work any better.
I performed this workout on 2/14 rather than the post date of 2/19.
History
I had gotten up to week 5 of the Couch to 5K (C25K) program before Christmas of 2014. However, the week before Christmas I was exposed to and contracted a mild case of the flu. That combined with my existing lung problems knocked me out of training for several weeks.
When I finally recovered enough to resume vigorous workouts, I needed that time to perform chores around the house instead of performing dedicated running routines. However, this last week, someone motivated me to perform a dedicated "run" workout. Besides it was way too nasty outside to perform vigorous outside chores.
Details
I use the " marks because my workout was actually on an elliptical machine. The workouts are similar but still different. Someone just used to one sort of workout (e.g. running) would usually get quite sore trying to perform that same routine on the other.
Anyway, I walked/ran for about 30 minutes. My average speed was over 4.5 mph with my peak speed above 5.5 mph. Normally for me, this is "no man's land" - too slow to run and too fast to walk. However, the large "step" of the elliptical means that if I put in a slow run's worth of exertion, my steps per minute (spm) is slower than when running but I actually move faster than my spm would move me on pavement.
Anyway, I've restarted running (HURRAH!).
Summary
Measure
Value
Units
Distance
2.5
miles
Time
30
min
Avg. Heart Rate
125
bpm
Max. Heart Rate
135
bpm
My heart rate indicated that this was not a difficult workout at all. However, my legs and lungs disagreed. They thought this was a moderately difficult workout.
However, I have remained very physically active. I think I've gotten tendonitis in my left shoulder from chopping wood and shoveling the horse shed. When I take medicines like ibuprofen, it gives me terrible cramps and diarrhea.
Each time I think about taking pain medication for my shoulder, I have to weigh the benefits against the pain, discomfort, and trouble it will cause in my intestinal tract.
This has troubled me since before Thanksgiving and it hasn't gotten better (or worse). I've decided to seek advice from my general practice (GP) doctor. I'm hoping he can do something (advice or treatment) for me to help. I'm really hoping that he doesn't recommend super strength ibuprofen!
Today was the day and it was a long time coming. I was first approved to begin treatment with Remicade back in June of 2014, so it has been more than eight months from approval to my first infusion.
What is Remicade
Remicade is one of the class of most powerful drugs used to treat Crohn's Disease. These drugs are called "biologicals" or "biologics":
"biological, is any medicinal product manufactured in or extracted from biological sources. Biopharmaceuticals are distinct from chemically synthesized pharmaceutical products." Biopharmaceutical, Wikipedia
and more specifically:
"However, in most cases, the term "biologics" is used more restrictively
for a class of therapeutics (either approved or in development) that are
produced by means of biological processes involving recombinant DNA technology. ... Monoclonal antibodies.
These are similar to the antibodies that the human immune system uses
to fight off bacteria and viruses, but they are "custom-designed" (using
hybridoma
technology or other methods) and can therefore be made specifically to
counteract or block any given substance in the body, or to target any
specific cell type..." Recombinant DNA, Wikipedia
In these texts the follow terms mean the same thing:
anti-TNF
TNF antagonist
TNF inhibitor
Another interesting bit, is that there is more than one type of TNF cytokines. The one specifically identified as the cause of Crohn's Disease is TNF-α. I vaguely recall that TNF-β is involved in Ulcerative Colitis.
What does that all mean?
Remicade was developed
in mice by combining human and mouse DNA to form antibodies to tumor necrosis factor (TNF). The
antibody protein formed is a chimeric antibody - part mouse protein/part
human protein.
TNF
is part of the metabolic pathway that is the damage mechanism in
Crohn's Disease (CD). Diseases like Ulcerative Colitis (UC) and Rheumatoid Arthritis (RA) use the same metabolic cascade
up to a point and then diverge. This is why Remicade is sometimes less effective in other diseases.
Remicade
was biologically engineered to shutdown the CD damage mechanism.
However, they discovered it also helped with a number of other
autoimmune diseases like RA & UC.
Similarly, Humira was biologically engineered to shutdown the RA damage mechanism
but was shown to be effective in other diseases like CD & UC.
"Mighty Mouse Juice?"
Because the drug was first developed in mice and the antibody includes part of a mouse protein, people taking it often affectionately call Remicade "mouse juice". Some people add on "Mighty" because the drug stops the body's attack on itself and allows the patients to feel much better - with much better = Mighty.
Reactions
Infusion Common
Remicade infusions often cause a number of negative side effects. Perhaps the most common but not dangerous of these are:
Fatigue
Headache
Joint Aches
Infusion Dangerous
Because part of the antibody is a mouse protein, it's possible that the patient will suffer a severe reaction that requires immediate medical attention. The drug is administered in a specialized infusion center with a doctor and drugs to treat these emergency medical conditions. Uncommon or rare reactions during infusion that may require treatment are:
Anaphylaxis (allergic reaction)
Tachycardia (rapid heart rate)
Blood pressure drop
Blood pressure spike
Increased Vulnerability
Remicade works by shutting off a key component of the human immune system. This makes patients more vulnerable to certain disease - especially cancer and certain infections. I already have one of these infections - fungal pneumonia. However, I'm being treated for it and I seem to be rapidly overcoming the disease. While taking this drug (which I may have to take for the rest of my life), I'll be more vulnerable to:
Fungal pneumonia
Tuberculosis
Cancer
My infusion
My doctor prescribed no premedications (aka "pre-meds"). These are medications that can reduce the negative side-effects of the Remicade infusion. However, my doctor recommended that on my own I take a couple of Tylenol before going to the infusion center.
While at the infusion center they pushed a small IV bag of saline solution to improve my hydration Good hydration levels seem to help stave off negative side-effects. My wife took this picture right after finishing this bag but right before we started the infusion.
Preparing for Remicade infusion
The infusion took about two hours. I took this "selfie" right at the end of the infusion. I don't know if you can tell but I got very drowsy right at the end of the infusion.
My Remicade "selfie"
Because I am doing my loading doses (I'll do another post on that), they wanted to ensure I could tolerate the drug. They used the following dosing schedule to infuse 400 mg over 120 minutes:
3 mg/15 min
14 mg/15 min
46 mg/30 min
112 mg/30 min
225 mg/30 min
The maximum rate of infusion is equal to about three times the rate of
infusion they expect to use during a normal infusion. This made me
think of something called proof testing of cannons, in which a cannon is fired with 2-3 times its normal charge to ensure it can be used safely.
The rapid rate of infusion at the end proves that I can tolerate the medication and am unlikely to experience bad side-effects.
I've had pain coming and going for the last several months. Over the last month I've needed a pain pill on more days than I haven't needed any.
I spoke to my doctor about this and my fears that my Crohn's is active in my intestines again. He elected to get a scope on it on 3/3. He also felt that the pain may be due to adhesions (intestines sticking to things) rather than Crohn's inflammatory process.
Also to help stop any inflammatory process as well as to help heal up my two fistulas, I'll be starting Remicade (a TNF inhibitor) soon (I'm hoping it'll be Friday).
It's hard to choose between incapacitation due to pain and incapacitation due to feeling tired. I'm really hoping the Remicade helps stop the pain.
The good news is if my pain is due to adhesions, then my Crohn's Disease isn't damaging my intestines. The bad news is that if true, then the Remicade won't help relieve the pain.
I take many medications. Medical professionals with different specialties prescribe medications for me. Physicians in one specialty are rarely familiar enough with medications out of their specialty to know which drugs might cause interactions. Therefore, it is up to you and your pharmacist to ensure your medications don't produce harmful drug interactions.
I've spent many weeks working with both a clinical pharmacologist and online research tools to figure out which drug interactions I must avoid. I am not currently taking all of these drugs, instead this list represents the list of drugs I've researched because I have taken or thought I might take them in the future.
Some of these interactions are more dangerous than others. If you have a condition similar to that described (e.g. congenital long QT interval + heart arrhythmia), then you should strongly consider avoiding that combination.
Do not stop taking your medications because of a drug interaction but do contact your physician and figure out alternative medications. Standard Disclaimer: I am not a medical professional. You should not base your treatment upon the following list.
With no further adieu, here's my list of drug interactions for the drugs I have taken, will take, or thought I might take.
Drug 1
Drug 2
Notes
Acetaminophen
Norco
/ Vicodin
Norco
contains Acetaminophen keep daily dosage of Acetaminophen under 3000 mg
Aspirin
Ciprofloxicin
Rare
tremors, seizures, hallucinations
Aspirin
Ibuprofen
Do
not take together.
Aspirin
Methotrexate
Increases
effects of methotrexate
Azathioprine
Methotrexate
Do not take together
Azathioprine
Prednisone
Increased
risk of infection
Azathioprine
Remicade
Increased
risk of infection
Azathioprine
Sulfasalazine
Increased
risk of infection
Bentyl
Levsin
ER
Do
not take together.
Bentyl
Loperamide
HCl
Amplifies
Bentyl's and Imodium's effects
Bentyl
Meclizine
Can
amplify effects
Centrum Multivitamin
Ciprofloxicin
Calcium
in Centrum blocks the absorption of Ciprofloxicin
Ciprofloxicin
Aspirin
Rare
tremors, seizures, hallucinations
Ciprofloxicin
Centrum
Multivitamin
Calcium
blocks absorption of Cipro
Ciprofloxicin
Ibuprofen
Rare
tremors, seizures, hallucinations
Ciprofloxicin
Norco
/ Vicodin
Increases
effects of hydrocodone
Diflucan
Fish
oil
Blocks
absorption of Diflucan
Diflucan
Norco
/ Vicodin
Increases
effects of hydrocodone
Diflucan
Omeprazole
Potential
heart arrhythmia
Diflucan
Phenergan
Potential
heart arrhythmia
Diflucan
Zofran
Potential
heart arrhythmia
Fish Oil
Diflucan
Fish
oil blocks absorption of Diflucan
Flagyl
Does
not interact with my drugs
Floucinolone Acetonide
Does
not interact with my drugs
Ibuprofen
Ciprofloxicin
Rare
tremors, seizures, hallucinations
Lansoprazole
Fish
oil
Assume
Lansoprazole blocks absorption of Fish oil
Lansoprazole
Vitamin
D
Assume
Lansoprazole blocks absorption Vit D
Levsin ER
Bentyl
Do
not take together.
Levsin ER
Loperamide
HCl
Can
amplify effects
Levsin ER
Meclizine
Can
amplify effects
Loperamide
Bentyl
Can
amplify effects
Loperamide
Levsin
ER
Can
amplify effects
Loperamide
Meclizine
Can
amplify effects
Meclizine
Bentyl
Can
amplify effects
Meclizine
Loperamide
HCl
Can
amplify effects
Meclizine
Levsin
ER
Can
amplify effects
Melatonin
Does
not interact with my drugs
Methotrexate
Acetaminophen
Possible
liver damage
Methotrexate
Azathioprine
Do not take together
Methotrexate
Prednisone
Increased
risk of infection
Methotrexate
Remicade
Increased
risk of infection
Methotrexate
Sulfasalazine
Increased
risk of infection
Niacin
Does
not interact with my drugs
Norco
Acetaminophen
Norco
contains Acetaminophen keep cumulative daily dosage of Acetaminophen under 3000 mg
Norco
Ciprofloxicin
Amplifies
effects of hydrocodone
Norco
Diflucan
Amplifies
effects of hydrocodone
Omeprazole
Diflucan
Can
cause heart arrhythmia
Omeprazole
Fish
oil
Blocks
absorption of Fish Oil
Omeprazole
Vitamin
D
Blocks
absorption of Vitamin D
Phenergan
Bentyl
Amplifies
effects of Bentyl & Phenergan
Phenergan
Diflucan
Can
cause heart arrhythmia
Phenergan
Loperamide
HCl
Amplifies
anti-motility effects
Prednisone
Azathioprine
Increased
risk of infection
Prednisone
Methotrexate
Increased
risk of infection
Prednisone
Remicade
Increased
risk of infection
Prednisone
Sulfasalazine
Increased
risk of infection
Remicade
Azathioprine
Increased
risk of infection
Remicade
Methotrexate
Increased
risk of infection
Remicade
Prednisone
Increased
risk of infection
Remicade
Sulfasalazine
Increased
risk of infection
Sulfasalazine
Azathioprine
Increased
risk of infection
Sulfasalazine
Methotrexate
Increased
risk of infection
Sulfasalazine
Prednisone
Increased
risk of infection
Sulfasalazine
Remicade
Increased
risk of infection
Trilipix
Does
not interact with my drugs
Vitamin B-12
Does
not interact with my drugs
Vitamin C
Does
not interact with my drugs
Vitamin D3
Diflucan
Vitamin
D blocks absorption of Diflucan
Vitamin D3
Lansoprazole
Blocks
absorption of Vitamin D
Vitamin D3
Omeprazole
Blocks
absorption of Vitamin D
Zofran
Diflucan
Can
cause heart arrhythmia
If you want to check your drug interactions, I suggest using sites like Drugs.com to check for your specific drug interaction.
