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Posts tagged ‘rheumatologist’

Separating Systemic Lupus from Traumatic Injuries

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Separating the Injury Claims

When a lupus patient has an auto accident, work comp injury, or some other personal injury where an accident insurance claim may be involved, sorting out treatment and claims can get pretty tricky.  Personal experience with these type of insurance claims provided some perspectives about working with doctors to sort out each new injury, and distinguish it from previous injuries and chronic illness.  The most recent auto accident that happened makes dealing with several issues fresh all over again!

Years ago, two different injuries resulted in insurance claims.  First, an auto accident followed a few weeks later by a fall down stairs at work.  Communication was the key to sorting out the differences between injuries.  Now, a recent auto accident was followed by a trip and fall at the shopping mall, and the same approach is needed once again.

Granted, with auto-immune illness, there are always many days with pain and discomfort, but new injuries seem to make coping even more difficult.   Day by day it has taken patience through the recovery, meanwhile remembering to ask God for the grace to be able to refrain from too much grumbling.  This too will pass, and the Bible says that the rain falls on everyone, so the storm becomes a little personal.  The new traumas also caused lupus to flare for several weeks.

Because of ongoing medical problems from chronic disease, communication with a doctor after a traumatic injury is very important.  Providing very complete, specific, and accurate information helped doctors and employers understand new symptoms and distinguish accident-related time off work.  Although several past accident injury claims were unfortunate, a few personal kernels of reality and wisdom emerged from the experiences.  While clearly not legal advice (which would be extremely unethical for this non-lawyer to provide), these personal observations may give some helpful insight to others patients with chronic illness who are facing a similar accidental injury situation.

A doctor will finally understand it is lupus

Communicate Well with Your Doctors

Three foundational, if not simplistic, realizations:

  1. Only medical problems clearly a result of the accident injury were covered by any of the claims.
  2. Unchanged pre-existing medical problems were not part of the injury insurance claims. (Obvious but worth saying)
  3. Flares of of pre-existing medical problems clearly triggered by the injury were able to be included in the claims, but only to the degree this diagnosis was included in medical records statements that supported how the autoimmune illness had worsened after the accidents, and because of the accidents.

Four conversations throughout various stages of recovery that it helped to chat with the doctor about:

  1. Asking what percent the doctor thought recovery from the first accident was reached, right after the second accident happened.  This helped establish a milestone in the treatment that we would work our way back toward during recovery from the second accident.
  2. Asking the doctor about how they thought injuries from the second accident were different than the first.  It helped when the doctor compared and contrasted between both injuries, and this gave clear information to use talking to both insurance companies.
  3. If the doctor doesn’t mention the idea, suggesting the concept to the doctor of a “window” in the recovery from the first accident while the second accident recovery was in progress.  This helped work with both insurance companies to make clear agreement about who was paying for what and when.  This helped the first insurance company know what to expect, and to realize they would be resuming responsibility for medical treatment costs after the recovery milestone was reached.
  4. Asking about total recovery in percentages after resuming the treatment just for the remaining first accident injuries, helped keep things straight with the insurance company.  Ongoing conversation about status of recovery with the doctor and claims adjuster helped keep everyone’s expectations and timelines clear.
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June 14th is Flag Day – Happy Birthday, Sis!

After having a couple of previous injuries, three serious car accidents, a work comp fall down stairs on the job, and two slip and fall injuries, personal experiences helped clarify the impact of an accident injury on overall lupus condition and general health.  It seems that if both adjusters and doctors had not been part of the conversations during recovery, proving diagnosis of increased lupus activity due to the traumatic injury would have been much harder.  It seemed better for everyone to be involved in ongoing discussion about the degree pre-accident health had be reached.

Of course, with lupus or any autoimmune disease, there is no “back to normal”, but with good communication, it can become clear when near “normal” health was regained.  Each day, no matter what it brings, is a glorious new day to be alive, what ever “normal” ends up being.

Benlysta for Lupus Without Infusions?

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Benlysta (belimumab) for Lupus

 FDA approved Lupus drugs

Clinical trials are an incredibly important contribution to new drugs for lupus.  Before 2011, there had not been any new FDA approved drugs for systemic lupus in over 50 years.  Before that there were only three, aspirin, plaquenil and prednisone.  Now, with Benlysta, there are four.  New biologic drugs like Benlysta are constantly being researched and we will likely have more soon.  We all hope it won’t take another 50 years to get number five!  In the mean time, there are still things we can do to improve treatment.

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Using Auto Injuector

One of the drawbacks to Benlysta is the great cost for the drug and the infusions.  It is mixed following exacting rules before infusion, taking at least thirty minutes to prepare.  Living within walking distance from my new rheumatologist, I am also within each reach of the research arm of the practice.  The practice is participating in a handful of lupus related research trials, including some patients from the first Benlysta clinical trials.  The next chapter of my lupus treatment will mean a break in the monthly infusion routine.

What comes next?

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Practicing self-injection

After having my last infusion a few days ago, in about ten more days weekly self-injections of 1/4 the amount of Benlysta will begin to replace monthly infusions.  The next couple of months will be spent participating in a clinical trial to test an auto injector that delivers Benlysta as a subcutaneous injection.  Last week, I had my training in how to use the auto injector and shot (wasted) a whole real dose of Benlysta into a fake “skin” device to prepare for my first self-injection.  The plan is to do the first and two of the other eight injections under the watchful tutoring of the research nurse, and the rest of my weekly infusions are at home.

Official information about the clinical trial

GlaxoSmithKline’s Phase II Open-Label Single-Arm Study to Evaluate the Reliability of an Autoinjector that Administers Belimumab Subcutaneously in Subjects with Systemic Lupus Erythematosus (SLE)

The primary outcome of the study is to assess the suitability of the autoinjector for self-administration of belimumab by subjects with SLE in real-life conditions. The study will assess the use of the autoinjector inside the clinic setting and outside the clinic setting. The study will also assess the safety and tolerability of belimumab administered subcutaneously (SC) via the autoinjector. Subjects will self-administer belimumab SC into the thigh or abdomen using the autoinjector device for 8 weekly doses. Subjects will return for a follow-up visit 4 weeks after the last SC dose of belimumab. All injections will be assessed by the investigators for success based on direct observation and/or the subject diary. A total of 118 subjects (treated with at least one dose of study drug) are planned to be enrolled in this study. The study will last through mid-2015 and is being done in these cities:

Gilbert and Phoenix, Arizona
Lansing, Michigan
Charlotte and Greenville, N. Carolina
Greenville, S. Carolina

autoinjection sites

Benlysta injection sites

Nearly foolproof auto injector

It seems like this will be nearly foolproof.  I am no stranger to “Sub Q” injections, after giving scores of them the old-fashioned way helping my husband with blood thinning Lovenox injections.  After a bed-side crash course in his hospital room a few years ago, I became a pro at using short-needles with pre-filled injections, and jabbing him in the tummy to help stave off the return of massive blood clots.  I stayed pretty calm doing them, so I have no apprehension about doing them with an auto injector with Benlysta.  In comparison, the new auto injector seems like child’s play.  Just like many other “Sub Q”  injections, it is injected somewhere either in a U-shaped area around the navel, or in either upper thigh.

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Making a difference

Fewer flares?

Because with the monthly infusions I tend to flare during the last week, it will be great to find out if evening out the dose to weekly injections will help prevent the recurring monthly flare cycle. I will be keeping a journal as part of the study, so look for updates here, too.

It is my hope that by my participation I will help decrease the costs of getting Benlysta to the people who need it most.  One bonus?  During my participation in the clinical trial, there is no cost for seeing my rheumatologist, lab work or the medication.  Also, at the end of the trial, there will be a small stipend coming to me of $5o for each in-office visit during the study.  There is always room in my wallet for a little fun money!

Book Review: The Lupus Encyclopedia

Lupus Book Review

The Lupus Encyclopedia

The Lupus Encyclopedia

The Lupus Encyclopedia: A Comprehensive Guide for Patients and Families (A Johns Hopkins Press Health Book) by Donald E. Thomas, Jr., M.D., FACP, FACR, was recently released.  Within the astounding 43 chapters is an in-depth and exhaustive discussion of the many facets of lupus.  This book is for lupus patients, but is not a quick read, but between two covers holds a broad library of balanced lupus topics that are worthy of investing some time and study.

There is so much in this book, but where should you start?  Begin in the Preface, where Dr. Thomas sets forth seven specific steps a lupus patient may use right away to get the greatest benefits from his book:

  1. Go to the 3 page Lupus Secrets Checklist in Chapter 44
  2. Read the listed specific chapters Dr. Thomas recommends reading next
  3. Get a copy of your medical records, notes, labs, x-rays, etc.
  4. Skim interesting chapters to find and go back to spend more time on ones that apply most to you
  5. Consult the Patient Resources at the end of the book
  6. Visit Dr. Thomas’ Facebook page and follow him on Twitter for current lupus news
  7. Consider sending an email to Dr. Thomas with suggestions for future editions

After ferreting out reliable lupus information for more than twenty years since my diagnosis in the early 1990s, it really seemed there were few sources of fresh information about Lupus, without going to books and references written for the medical community.  This book provides an understandable reference resource appropriate for patients. Happily, there is great depth and much to learn from reading and referring to this important book!

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Check out this new Lupus book!

Dr. Thomas clearly demonstrates his broad understanding of Lupus, and this book should stand the test of time as one of the great books about this complex auto-immune disease.  The first printing of this exhaustive patient reference initially sold out in both hard and soft cover edition at a reduced price through Amazon.com but a few more copies are now available, and more are on the way.  It is also sold at BarnesandNoble.com in both cover styles and as a Nook e-book at the lowest price I have seen online so far.  If other sources are out of stock and you don’t mind paying full list price, purchase it direct from the publisher’s website at John Hopkin’s University Press.

I heartily recommend The Lupus Encyclopedia, and urge you to check it out, too.

Lupus and General Health Facebook Chat – Hospital for Special Surgery

HSS Lupus and General Health Updated AnnoucementThis afternoon at work included an unusual break from other duties, by joining a one-hour Facebook chat “Lupus and General Health” that was hosted at 5:30 EST/2:30 PST by the Hospital for Special  Surgery (HHS), Molly’s Fund and the Lupus Foundation of America.  Questions were submitted through reader’s comments after the first HHS welcoming Facebook post, and each of the panel members wrote responsive comments to answer almost most of the questions that were submitted.

My question about Benlysta was answered by Peggy Crow from HHS:

Lupus Adventurer: How might extended Benlysta infusion therapy affect lupus biomarkers, such as ANA titer, etc.?

Peggy Crow: To Lupus Adventurer. That’s a really interesting question. In fact some of my research colleagues and I were just asking ourselves a related question today. When the clinical trials were performed, some biomarker and autoantibody data were tested, but not much. As I recall, some antibody levels decreased a bit, but not all of the antibody types. I doubt that the ANA would disappear. In any case, it’s a great question and one that deserves more research. Understanding effects of a drug on biomarkers can help us understand more about what is going on with the immune system in lupus

Lupus Adventurer:  I ask because my biomarkers are now quiet, after 20 years lupus treatment, with methotrexate, imuran, plaquenil plus clincial trial of Rituxan (amazing) and now almost 3 years of Benlysta. Previous ANA would be in the 1:1300 range, now 1:40. Symptoms are quite moderated again with Benlysta, but I am curious about the correlation between this medication and biomarker activity. Thanks!

Peggy Crow:  L.A. It is really great to hear that you are doing much better than in the past. What I would say about Benlysta and ANAs is that while I doubt that the Benlysta would directly reduce the antibodies enough to bring down the ANA titer as much as you describe, it is certainly possible that you have shown a good therapeutic response to Benlysta and the generally reduced disease activity is being reflected in the lower ANA titer. Benlysta works well in some but not all lupus patients. So it sounds like you are one of the fortunate responders.

Lupus Adventurer: This gives me something to think about and discuss with my doctor. Thank you so much for your response!

th24684V04Click on this Hospital for Special Surgery link to go to the HHS Facebook page and read the all the readers’ questions and the panel’s outstanding responses.  This was an excellent event with a knowledgeable panel and sponsors!

Lupus Adventures Reader Survey

Please help with your answers

In order to help fine-tune the focus of articles to Lupus Adventures readers’ needs and interests, your help with a simple three-question survey would be great.  Even if you are not a lupus patient, or your connection to lupus is through a family member, friend or your work, please answer the first question.

Please choose the best answer for each question, and click “vote” at the end of each question.  As soon as you vote, you will see the survey results for that question.

Thank you!

Lupus Adventurer

Three-Question Survey

Your connection to Lupus?

How many years since your lupus diagnosis?

What was your age at diagnosis with lupus?

Thank you so much for your response!

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Your help is appreciated!

 

Benlysta for Lupus, the first 1,000 days

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1,000 days of Benlysta

This week (yesterday) marked a quiet little anniversary, the 1,000 day mark after beginning monthly Benlysta infusions for Systemic Lupus Erythematosus on August 24, 2011.  So, without pomp or celebration, today begins as day 1,001 since starting Benlysta.  From the beginning, the Benlysta adventure is chronicled here, and a special page indexes all the posts about this journey.

This 1,000 day Benlysta milestone gave me pause to ponder whether there were any other 1,000 day milestones I could  use to compare to this span of time.  A little research led to an interesting group of comparisons, some were serious and some were fun, some were history and culture changing, and some were of fleeting and trivial impact.

1,000 days might be enough to carry out significant change, or long enough to waste accomplishing absolutely nothing meaningful at all. I will let you be the judge, but history will judge with perspective, and ultimately God will always be the final judge.

How long is a thousand days?

1,000 days is equal to exactly 2 years, 270 days (unless one of the years is a leap year, resulting in 1,000 days being equal to 2 years, 269 days. Also, 1,000 days expressed as a decimal fraction is 2.74 years.

1,000 day comparisons

  • thH9WE6Z7AThe approximate length of the public ministry of Jesus Christ from the first miracle in Cana to his death on a cross outside the City of Jerusalem, as documented in the first four books of New Testament, the gospels of Matthew, Mark, Luke and John.  History and life changing!
  • The length of a Columbian civil war (The Thousand Days War) fought between 1899 and 1902 over an ideological conflict between liberals and conservatives that divided families and took the lives of 100,000 Colombians before a mutual cease-fire was reached.  An end to strife.
  • th7SY4JSR2The approximate length of the presidential administration of John F. Kennedy, that lasted 1037 days, from his January 20, 1961 inauguration  to his assassination on November 22, 1963.  A death that shook the nation.
  • 1,000 days from the start of a woman’s pregnancy until her child’s 2nd birthday, a crucial period for proper nutrition that allows children to develop without permanent cognitive and physical delays.  Important beginnings.
  • How many consecutive days a 6th grade boy from Holmen, Wisconsin wore a Green Bay Packer’s player Aaron Rodgers’ jersey, while living in a household of Minnesota Vikings fans.  Much ado about nothing!
  • How long Kate Middleton has been a duchess after marrying Prince William.  She reached the 1,000 days milestone in her marriage and acquired royalty earlier this week on May 20, 2014.  A royal beginning.
  • thSTW4CIIDThe length of time it takes for Landana 1,000 Days Dutch Gouda cheese to naturally ripen, while stored at a closely guarded secret specific temperature and humidity. The fruit of patience.
  • The length of time the famous Schatz 1000 day clocks can run without winding. Schatz 1000 day clocks bear a “54” in a circle on the back of their movements, and were first made in 1954. An engineering marvel for its day.

Lupus before the 1,000 days

My past 1,000 days with Benlysta have significantly stabilized my Lupus, after all other treatments we tried before it were exhausted.  1,000 days ago I had come out of a five-year, Rituxan-induced remission, and was facing the likelihood of an early disability retirement.  Those were rough days, things were getting worse by the week, and I felt absolutely physically miserable most the time.  But, I was not in despair!  The joy of the Lord was my strength, and my daily walk in dependence upon Him helped me keep personal peace, patience and hope.

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August 24, 2011

1,000 days ago, my joints were swollen constantly, my CNS symptoms were lasting all day long some days, I was increasing unable to manage my work, had significant cognitive difficulty with memory, problem solving, logical thinking, written business communication, and managing my government law office.  I was in an unending siege of bone-tired fatigue.  Mouth and nasal ulcers were almost constant, and my health was a wreck.  I was in the middle of a long, slow, unremitted lupus flare.

While trying to keep up with my job, I was struggling.  I was using up all my sick leave, plus using all my vacation leave in lieu of sick leave, and occasionally had to take a few days off without pay to deal with Lupus.  It was a rugged ride and a very challenging adventure!

Lupus status on day 1,001

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Benlysta after 1,000 days

Gradually after beginning Benlysta, my Lupus problems began to lessen and then become generally well controlled.  I still have bad mornings, but now rarely have to take more than a half-day off due to lupus.  I continually have a modest balance left of my monthly sick leave accrual, and have not had to dip into other types of leave for lupus-related work absences in over a year or so.  Although I don’t feel like my health is “amazing,” most days I feel generally well and handle my daily responsibilities.

Benlysta is expensive, there is no question, and it cost my employer between $8,000 and $13,000 each month, an annual total of about $100,000 for each of the first two years.  A few months ago, my new doctor learned from representatives at GlaxoSmithKline that I was the only patient receiving Benlysta at a hospital.  They told her I was “famous” to them because of this unusual requirement, and that they all knew immediately who I was when she started describing me and began discussing my case.  I thought that was a little bit spooky!

The first two years of Benlysta cost more than double my current annual cost that my insurance pays now for infusions at my doctor’s office.  Only after leaving my previous out-of-network rheumatologist, it was revealed that the insurance-imposed hospital infusion requirement was strictly because my rheumatologist was an out-of-network doctor.  Now, with my new in-network rheumatologist, the average monthly cost to my self-insured employer is only $3,500, and my cost is an affordable $35 co-pay.

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Thankful for Benlysta

I am thankful that because of Benlysta, a premature end and early medical retirement from my career was averted narrowly .  This month, I finally reached full retirement age based on years of service and age, and now qualify for my full government pension.  Now, if for some reason I need to suddenly stop working for health reasons, my full pension is available to support me through life’s next chapter.

My hope is to work at least about 18 months longer, when my retirement percentage formula will reach the last higher level pay adjustment before reaching age 63. I plan to be out and about enjoying new lupus adventures before that age!

 

 

HHS Lupus and General Health Chat on May 29, 2014

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Questions About Lupus?

Lupus Chat with HSS

On the afternoon of May 29, 2014 at 5:30 p.m. EST (2:30 PST) the Hospital for Special Surgery (HSS) will host a one-hour live Facebook chat featuring both the Lupus Foundation of America and Molly’s Fund Fighting Lupus about Lupus and General Health.

This new chat is a follow up in a series to answer many remaining questions asked by participants on a chat on February, 2014, that featured Rheumatologists Dr. Jane Salmon and Dr. Michael Lockshin, Dermatologist Dr. Joanna Harp, and HHS’ Rheumatology Social Worker Emily Reiss, LMSW  answering questions on conditions co-occurring with lupus and social work.  This chat picks up where the February chat left off, answering a host of added lupus-related questions.

What is HSS?

HSS is based in New York City and is nationally ranked #1 in orthopedics, and #4 in rheumatology by U.S.News & World Report (2013-2014). HSS has locations in Manhattan, Queens, Long Island and Upstate New York, as well as Connecticut, Florida and New Jersey. HSS has been top-ranked in the Northeast for both orthopedics and rheumatology for the 23rd consecutive year.

Don’t miss this!

Don’t Miss Out!

Click on the Link in the image above to go to the Facebook page for HHS and learn more about how to take part in this upcoming online Lupus awareness and educational event.

 

May 15, 2014 Post Update:

Check out the information from HSS’ email announcement that gives more information about the panel members.  It is a little fuzzy, but it gives more detail than was provided in my previous post.

To join the chat:

  1. Visit https://www.facebook.com/HSpecialSurgery
  2. Like the HSS facebook page
  3. Join the conversation

HSS Lupus and General Health Updated Annoucement

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