The Epic Tale of Immunoglobulin Therapy

Immunoglobulin Therapy

Today (Leap Day!) is Rare Disease Day so I thought I’d share my experiences having a Primary Immunodeficiency and being on immunoglobulin therapy. Two years ago I started weekly immunoglobulin therapy. It’s been quite the journey.

Getting a Diagnosis

When I was diagnosed with MCAS in the Fall of 2015, one of the things my immunologist and I discussed was my frequency of chest colds. Blood work looking for immunodeficiencies was normal (of course they were, sigh). Over the next few years, I continued to get chest infections that would trigger mast cell reactions. After several rounds of immunoglobulin labs with normal results (ugh), my immunologist wanted to try another round of labs that involved getting vaccinated. The lab tested my levels of response before and six weeks after the pneumococcal vaccine. I had little response after. And I anaphylacted to the vaccine. Ah, so not only is my body “blind” to pneumococcal, but I’m allergic to it. Of course I am. So no more pneumococcal vaccines for me. But I definitely recommend and encourage other people to get vaccinated, if you can!

We *finally* found the answer! I have Specific Antibody Deficiency (“SAD”) and my body doesn’t see streptococcus/pneumococcal bacteria. Basically I get chest colds almost anytime anyone sneezes near me. Getting the diagnosis was like another piece of my medical puzzle clicked into place. And yes, my family has teased me plenty for having a SAD diagnosis on top of everything else. Hahaha

Some months before, my doctor and I were discussing alternative treatment ideas. I felt like I was not getting ahead of my MCAS reactions. I had been doing some research and had heard some people had good luck with IV immunoglobulin (IVIG) therapy, so I brought it up to my doctor. He hedged a bit and said that he wasn’t aware of any studies that showed IVIG as a treatment for MCAS. He didn’t think my insurance would cover it, since it wasn’t an FDA approved treatment, and he warned it was expensive.

Getting Started

With the new diagnosis of SAD, I was now eligible for immunoglobulin therapy to be covered by my insurance (not all insurances cover SAD). Whew. 

Treatment for immunodeficiencies is immunoglobulin therapy–which is derived from human plasma–which is donated, like blood donations. Plasma is processed and filtered to get just the immunoglobulin. Then 10,000 or more donations are combined together in order to get adequate immunoglobulin coverage. IVIG is typically administered via an IV once a month. Basically this treatment is supplementing and boosting my own body’s immune response. It’s covering the gaps. You can learn more about it here. There has been a national shortage and some people haven’t been able to get their infusions (I’ve been lucky). Please donate, or encourage others to donate!

My doctor and I discussed IVIG options and he felt that monthly IVIG would be pushing my body too much and not protect my immune system enough before the next dose, so we decided weekly subcutaneous (SCIG) infusions would be best. They can be done at home and the immunoglobulin is injected with small needles under the skin. They generally are tolerated better and are easier to manage. Both of those sound good to me! 

My arm wrapped during my first immunoglobulin infusion
The kind nurse wrapped the needles up so we didn’t have to use Tegaderm adhesive during my first infusion. I later learned how to avoid reactions from the adhesive by using Cavilon wipes.

So we gave it a try. The drug company provided a 4-week trial while insurance approval was pending. I started the Cuvitru trial within a week of diagnosis. The company made arrangements for a delightful nurse to come and teach me how to do the infusions.

My insurance approved immunoglobulin therapy. Yay! But they wouldn’t approve Cuvitru because it wasn’t on the formulary. So I was going to have to switch to Hizentra–a comparable immunoglobulin with preservatives, something we were concerned I would react to. Ugh, but okay.

Then I tried to make arrangements for a nurse, the medication, and the supplies–all of which are necessary. (The nurse was necessary till I felt comfortable doing the infusions on my own. Now I only use them occasionally when I need to do them in my back.) Well, the only “approved” pharmacy that the insurance would approve to distribute the immunoglobulin wouldn’t provide the nurse or the supplies. What?! And the insurance wouldn’t approve me to use the infusion clinics that were on the in-network list?! WHAT?! At least 65 phone calls later (not exaggerating, I counted), I was finally able to get an exception approved to use an infusion clinic on the approved list. I hope you hear my eyes rolling through the computer. It was painful and so frustrating. BUT, it got taken care of in time that I didn’t miss a weekly dose. Whew. 

When I got my first statement from the pharmacy I was shocked. It was just under $20,000. For ONE MONTH of 25 grams of Hizentra immunoglobulin and supplies. The supplies were only $200ish. Fortunately, with my insurance coverage and then the copay assistance coverage from the pharmaceutical company, I only pay a tiny portion of that. 

I just got my next summary statement from my pharmacy. They forgot to bill me for supplies, I think. But my medication is $4,430 a week. That’s $221.50 per gram. Just for perspective, the price of gold per gram (as of this post) is $51.07. Yeahhhh. There’s a reason immunoglobulin is nicknamed “liquid gold.”

My latest immunoglobulin and supplies statement
The latest statement from my specialty pharmacy. Insane, right?!

Treatment

My leg with an infusion going
My leg with the infusion set up and going. This time it was 6 sites. If sites ever fail or started leaking, I can cap them off, but that means the infusion will take longer. I try really hard not to have that happen.

Right away I noticed I was not tolerating the Hizentra as well, but I wasn’t having severe reactions so I had to stick with it. Thank you benadryl (new band name; I call it!). Because I was doing infusions by myself, I could only do them in my abdomen or thighs. It became quickly apparent that my infusions are way slower than they should be according to some magical math equations. We still don’t know why what should be a 2-hour infusion takes almost 5 hours. So we tried adding more needle sites to try to speed it up. So at one point, I was doing 7 sites a week. My abdomen wasn’t having it. Every time I did it there, I would end up with horrible bruises, swelling, and itching that would last several weeks. I finally just stopped doing it in my abdomen. For over a year, I did infusions alternating between each thigh and changing the sites’ locations. 

Infusion Reactions
My leg after a particularly rough infusion. Site reactions are normal, but this was was coupled with other MCAS symptoms too.

During all of this, my pharmacist was fantastic. He has worked so hard trying to find ways to make this work for me. Trying different needle lengths (switching between 9mm and 12mm) and flow rates. Trying varying numbers of needle sites and locations on my body.  My immunologist over time also lowered my dose a few times to see if that would help too. But over time, the infusions in my legs became more and more painful to the point that my thighs constantly ached all the time.

I told my immunologist my concerns and he thought it might be time to switch medications to Cuvitru (the preferred medication). But remember how the year before it wasn’t on the formulary for my insurance? I reminded my doctor. “Formularies change. I think we should at least ask. Sometimes they’ll approve it if they know you aren’t tolerating the approved one.” 

Lo and behold, they did approve it! And they covered it! (That was also a big concern.) So I switched and it’s been much better. I have also reduced the number of sites down to four and just deal with the infusion taking 5 hours every Saturday evening. These together have helped and my legs only sometimes hurt now. I think what has happened to my legs, especially my left, is that the weekly puncturing with so many needles has caused scar tissue to build up. If I pick the wrong spot, it can be really painful to try to insert the little needle. 

Let me just tell you–there’s helpful introductory video that one of the drug companies created that shows how to do an infusion. But it also cheesily shows a man strolling down the street all casually walking his dog like it ain’t no thing to be pumping medicine into his abdomen. “You can do anything while you do infusions!” Ha! Yeah right. I feel yucky during and after these infusions. And generally do not feel up to strolling down the street. I have run some quick errands, but try not to do so. DoorDash is the best on Saturday nights. 🙂 And then I sleep for 10-14 hours after. It’s exhausting.

Two Years Later…

My current regimen is 20g of Cuvitru weekly. The goal has been to find the lowest level of immunoglobulin I need to stay healthy. With the severe cold I got this winter, I think we might have hit my lower threshold. Bummer. I was hoping to get to a lower dose (lower dose = lower cost). Oh well. 

But overall, the immunoglobulin therapy has helped so much.  I haven’t gotten sick nearly as much, or as severely. Getting sick was a big trigger for me on several levels–so eliminating that has kept me out of the hospital and anaphylaxis free for 18 months. A new record! As hard as this treatment can be, it’s been worth it.  

Unfortunately, right now there is no alternative way to treat primary immunodeficiency–which is why additional awareness or additional research is needed. You can support patients like me by donating plasma (sometimes you can get paid for it!) or donating to organizations like the Immune Deficiency Foundation.

The Cost of Chronic Illness

In 2019 I thought I’d keep track of the cost of chronic illness, or at least mine, for a year. Keep in mind this year I was pretty stable AND I’ve gone a whole year without an ER visit and anaphylaxis. Winning!! The last time I went a whole year without an ER visit was when I was in high school. My doctors and I are all thrilled about this.

It’s important to know that I have really good health insurance through my employer. I will fight tooth and nail to keep working so I can keep my insurance. My insurance is generally very good about covering whatever I need. They’ve pushed back on a few things, including iron infusions this year, but nothing that was critical. Unfortunately, this year they changed how they were billing some of my more expensive medications and that has increased my actual out of pocket expenses this year. (I barely squeaked in hitting my out-of-pocket maximum and had it cover my new BiPAP machine. Whew.) In past years, with basically the same treatment plan, I hit it in May. And next year my out-of-pocket maximum is going up by almost $1000. Which means, unless something drastically changes, I won’t hit it next year. It’s hard not to hit my out-of-pocket max–I really love having my insurance cover everything at 100%. 🙂

Medical Bills

Any guesses what my doctors billed out? 

$295,000. For a year. To keep me stable. $225,000 was prescriptions. Painful, right? 

It was a cheap year too. No procedures or surgeries in 2019. (In 2018 it was about $400,000.)

My actual out of pocket expenses were around $5,000. Some of that was covered thanks to prescription co-pay assistance programs put on by the different drug companies that make my medications. Plus whatever over-the-counter medications or supplies I bought that didn’t go through insurance.

I don’t know what the answer is for health care in the US, but I have no idea how people with chronic illnesses who are under or uninsured are expected to be productive, healthy members of society.

Anyway, back to the numbers for a “normal” year where my doctors consider me stable. Remember, stable means not getting worse. I still regularly have reactions to whatever my body wants to react to. 

Other Costs

I thought it would be interesting to keep track of how much medication I took and how much effort I had to put into staying as healthy as I can. 

Time and Medication Costs of Chronic Illness

Benadryl is the biggest rescue medicine I use. Whenever I start having a reaction, I take 50mg (2, 25mg pills) of medication. So 318 really reflects 159 doses. Fortunately, we found a new-to-me mast cell stabilizer that is helping (Ketotifen) and since starting it in September I have needed less Benadryl. Which is good, because there is a concern that frequent use of Benadryl can lead to dementia. Goody.

The same counting thing happens with Tylenol. I usually take 2, 500 mg pills, so it’s really 127 doses.

I keep a list of all the medications I’m on or use as needed. We added a few this year. I’m now on 28. Sigh. We’ve tried to take me off some of them. It didn’t work out. 

For fun, here’s a photo of all the pill bottles from all my medications this year. This doesn’t include all the immunoglobulin vials from my weekly infusions (that just seemed excessive to keep, hahaha).

pills are a cost of chronic illness
73 bottles. 16 bottles were just Zantac. And this photo doesn’t include the 36 syringes of Xolair that I got at my doctor’s office over the year.

In my doctor’s appointments numbers, I include the weekly infusion treatments that I do at home. 

It’s exhausting trying to keep everything scheduled and straight in my calendar. I also included the time and energy for phone calls and emails between me and my doctors and the insurance company to be part of the cost of chronic illness. Chronic illness takes so much effort and work to manage. Nothing ever is easy and takes multiple contacts to arrange, approve, finalize, or confirm. It’s a massive energy cost.

But It’s All Worth It

Good news is that all of this resulted in:

  • 0 ER visits
  • 0 hospital stays
  • 0 events of anaphylaxis
  • 0 chest infections
  • 1 minor cold that I got over in a few days
  • 1 week of prednisone (that’s a normal course for a significant reaction)

Those are some excellent stats. It makes all the above-listed cost of chronic illness and the overwhelming amounts of medication and time feel worth it.

Paper Egret Orchid Stems in a Vase

Paper Egret Orchid Stems in a Paper Vase
Paper Egret Orchid Stems in a Paper Vase

Today I’m sharing some Egret Orchid Stems made from paper and wire. Such a fun project to put together. I’m pretty happy with how they turned out! 

A real Egret Orchid. Such a stunning flower.

I have a friend that is a plant killer (her words, not mine) and I wanted to give her a plant she couldn’t kill. I also wanted to try out making out a 3D flower and thought I’d make my own design. 

Looking online at different flowers, I came across this beautiful Egret Orchid and knew this was the one I wanted to make. 

How I Made Them

I took the photo of the Egret Orchid and imported it into my Silhouette Software and traced it, fiddling with the settings until I got a version I was happy with. I also had to simplify the cut lines and delete a bunch of edit points to make the shape manageable. I used this tutorial from Silhouette School (love that website!) to learn to trace images. I use this function all.the.time. I even trace shapes from my library if I need an outline. Such a versatile function!  

Once I had the top wing portion and the bottom petal portions created, I found some other orchid shapes in the Silhouette Design Store I could use to create the rest of the orchid shape. I cut them out, inked them for dimension, and glued them together. 

The vase was really easy to put together. I inked the paper with several colors to give it a cement look and then glued the pieces together. Inside the vase is floral foam to hold the wire stems. Next time I would put the floral foam inside before I put the vase together. It was a little tricky getting the floral foam inside the narrow top. I also would have liked to have weighted the bottom with something so it wasn’t quite so light. I did pour some of the little pebbles in the bottom, but that’s not enough. 

I used the leftover hexagon from the top of the vase to cover the floral foam. I covered it in the black rocks and poked some holes where I wanted to place the stems. I then stuck the leaves in. I used hot glue to secure the stems and leaves and added more rocks to cover the glue. 

To create the two main stems, I took a three-foot piece of 12 gauge floral wire, folded it in half, and then twisted it to make it stiffer. For each of the flower stems, I took shorter pieces of 22 gauge wire and did the same thing and wrapped one end around the 12 gauge stem, leaving the other end free. One branch for each flower or bud. Then I wrapped the whole thing in floral tape to make it look like one stem. The twists in the wire give the stem a cool, natural texture. The flowers are hot glued to each of the smaller stems. 

The leaves were simple. I wanted a leaf that was similar to the Egret Orchid’s actual leaves, and found one in the Silhouette Design Store. I elongated them in Design Studio and cut them in a medium green paper. Then added several different green inks to give each of them dimension. I cut lengths of 22 gauge wire and attached them to the back of the leaves with hot glue. I left the wire longer than the leaf so I could use it to stick into the floral foam. When the glue was dry, I used the wire to shape the leaf so they had some life. 

I’m pleased with how the paper Egret Orchid stems turned out. Figuring out how to do the flowers took me a long time, so I’m really happy with how they turned out. I learned some things and next time I’ll do some things differently, but I thought this little project turned out pretty good. 

Materials Used: 

So there you have it. Pretty paper Egret Orchid stems for Christmas. And they won’t ever die. 🙂

Simple Winter Flocked Teardrop Door Swag

Winter Flocked Teardrop Door Swag

Today I’m sharing my simple winter flocked teardrop door swag I made for my front door. As you can see in the photos, I have a very cheery bright yellow door. Normally I love it, but it makes using traditional holiday colors a little difficult. The wreath I’ve used in years past wouldn’t work on this door. I prefer traditional holiday colors with lots of green and pops of red and white, and perhaps touches of other colors mixed in. But with this new-to-me yellow door, I was not loving the idea of using green and red.

I’ve been searching for something that would work and came across this lovely flocked pine teardrop door swag. I love the big flocked pine cones. I wanted it to have a little more body so I added a few more pine picks with smaller pine cones using floral wire I had on hand. Then I added a sparkly white ribbon to finish it off.  I looped the ribbon three times (twisting it so the sparkle was on the outside). I used a piece of floral wire around the center to form the bow and attach it to the swag. The long ends of the ribbons are a separate piece that I attached with floral wire. It came together easily and thanks to good a Michael’s sales and coupons the whole hanging was less than the original price of the swag by itself. 

I think the winter flocked teardrop door swag works well on my cheery yellow door and will be nice even after Christmas. 

Winter Flocked Teardrop Door Swag

What kind of holiday projects are you working on? 

xoxo

Mast Cell Disease Friendly Gift Suggestions

Gift Suggestions for Mast Cell Patients

Looking for gift suggestions for a friend or family member with a Mast Cell disease (your “Mastie”)? Giving and receiving gifts for a Mast Cell patient can be tricky due to everyone’s very individual trigger list. I thought I would try to put together a list of suggestions if you are looking to give a gift to a Mastie. Of course, best practice is to ask your friend or family member what they would like. But if you need some ideas, here you go!

These ideas came from the mast cell disease community and me. Please remember that every person has their own set of triggers, so some of these items may not work for every person. Please ask your Mastie friend before purchasing something if you aren’t absolutely sure it’s safe. Please include a receipt so it can be returned, if needed. Because many of us are so sensitive, we have to use very expensive items to be safe. I know I would appreciate receiving some as a gift.

Gift Suggestions

Soft Fuzzy Blankets! Can someone have too many? I think not. 🙂

Socks–again, can never have too many. Also these socks have zebras! Always a win with a mastie! (It’s a mascot for rare diseases.) Caution: some socks can contain elastic that can irritate some people’s skin.

Soft clothing. Cotton or bamboo can be a great natural option. Skin sensitivity is a big problem. I adore soft clothing!

Benadryl. Children’s clear liquid diphenhydramine is often what people use. I’m lucky in that I don’t have a problem with dyes at this point, so regular benadryl/diphenhydramine (in bulk!) works great for me.

Pill Organizers. Keeping track of medication is difficult. Especially when you take 20 pills a day. So having a large pill organizer helps immensely. And it’s nice to only sort pills for two weeks since I only take pills twice a day. If you take pills 4 times a day, this large pill organizer could be really useful. I also use a smaller week pill organizer to keep rescue meds easily accessible. And it’s convenient for traveling too!

Cold Storage Pack. Epi-pens and other medications used by Masties often need to be kept in cool storage, especially when living or traveling in warmer climates. 

Medicine/First Aid Bag. I love my first aid bag that I keep in my backpack-purse. It holds my EpiPens (I don’t live in a hot climate, so I’m not worried about temperature exposure), Benadryl and other rescue meds that I like to have on hand. My backpack-purse and the medicine/first aid bag each also have one of these “Medicine Inside” zipper pulls. 

Tissues. I’m personally partial to Puffs plus lotion. I have a lot of congestion and these are heaven-sent. 🙂 Not everyone will be able to tolerate this kind, so please check with your Mastie what their preference is.

Audiobook gift cards or subscriptions like Audible. Or help them get set up with their local library’s Libby/Overdrive system to get audiobooks for free.

Reusable Water Bottles or Mugs. Ask if metal or plastic would be better. Some Masties do better with one or the other. 

A Go-bag. A small bag or backpack to have on hand pre-packed with hospital essentials to make it easier to have everything a patient needs at the hospital. Maybe include some of the other things on this list?

Extra long phone chargers. You might need to check the kind of phone they have so you can get the right kind of plug. Most newer phones use the USB-C port now. These are practically a necessity when stuck in the hospital!

Magazine Subscription. Do they have a hobby that has a magazine? 

Air Purifier & Filters. I have this one at work and I like it. I want this one for home. If your local Mastie has an air purifier, consider purchasing replacement filters for them.

Magic Masto Lotion. Safe lotion (I use CeraVe–but check with your Mastie for their favorite) GET UNSCENTED! Cromolyn Sodium (available over the counter as an eye drop). Recipe found here.

Hot packs or Cold packs (or these that double as both). Many of us have difficulties regulating our body temperatures (super fun!) so having something to help externally is a blessing!

Over the Counter Medications. (USE CAUTION) I use a lot of over the counter medications. And at the higher than normal doses I take them, they get expensive. Consider a gift card to your friend’s favorite pharmacy (trust me, they have one 🙂 ) or buying a few bottles. If you want to buy the specific bottles, this may be difficult. Many patients require very specific formulations (no dyes, specific fillers, specific brands). Please be sure you can buy the exact kind they use (no substitutions) and include a receipt so they can return it if it doesn’t work out.

Bathroom Items:

Calendars or planners. Keeping track of medications, symptoms, and doctors’ appointments is tricky. It’s helpful to have someplace to put it all.

Funny gifts to make them smile. The smiles are needed for the hard days.

Lap activities: books or coloring books (I love this coloring book) with easy-grip pencils.

Amazon Prime. Because of my scent sensitivity, it’s hard for me to shop in public. Amazon Prime is ahhhmazing. Free shipping, usually two days, but sometimes same-day or next-day shipping is available! And it includes TV, movies, and music, and a lot of other things. 

Streaming Subscriptions (Amazon Prime, Netflix, Hulu, Disney Plus) Chronically ill people spend a lot of time recovering. This often means a lot of time in front of the TV. Consider helping them by giving them some variety, or letting them catch up on shows from their childhood (hello Disney Plus! hahaha)

Apple or Google Play Gift cards. We like to keep ourselves entertained while we’re not feeling well.

Maintenance Services. Yard, cleaning, laundry services would be amazing. These activities often trigger reactions for so they are difficult to do. It would be great to have someone help out.

gift suggestion of time
Easy gift suggestion: Your Time! Photo by freestocks.org on Unsplash

Time with You at their place on their terms, no questions asked. How about a night in with a movie, safe snacks, or a favorite board/card game? With no pressure to talk, or to talk all they want. And if your Mastie friend is isolating themselves due to a reaction, it’s okay. How about a video chat?

Ask your friend to start a wishlist on Amazon or Pinterest so you can know exactly what to get them. Let’s make life easier for everyone! 🙂

WHAT NOT TO GET

Anything scented

  • No candles, essential oils, diffusers
  • Lotions
  • Soaps
  • Perfume
  • Bath bombs

Plants–unless you know they are okay. Personally I’m okay (and slightly obsessed) with them. hahaha

Food. Many people have a long list of ingredients they cannot or should not eat. To make things easier for us, please don’t drop off goodies. While the thought is nice, I’ll end up tossing it out. For some people, exposure to an ingredient is enough to trigger anaphylaxis. Let’s not make this a scary holiday. 

From personal experience, if I don’t know the person very well or they haven’t talked to me prior about what to cook for me, I won’t eat the treats. The list of people that I let cook for me is very, very short. 98% of the time I decline treats, even when “guaranteed” they are safe. I can usually guarantee they are probably not safe treats. Most people cannot handle the depth of ingredient checking I have to do. And that’s okay. I don’t expect them to. 

Let’s make this easier for everyone: Don’t bring treats!

Here are some suggestions of what to give instead:

  • Whole Foods gift card (or other local health food store)
  • Trader Joe’s gift card
  • Sprouts gift card
  • Packaged treats your friend has specifically identified as safe for them to eat (they may not have any). If they give you one, please buy the exact brand and kind they identify. Many are similar, but those differences can cause huge problems. Even differences between sizes in the same flavor can sometimes have different ingredients (yeah, I don’t understand that either).

Want to Help Support a Mast Cell Patient? 

Consider supporting their side hustle this holiday season. Many of us have little side hustles to help us pay our medical bills (always so.many.bills). 

Donations to Charities that Support Patients:

The Mastocytosis Foundation and Super T’s Mast Cell Foundation are two I personally support. 

Did you know you can also use smile.amazon.com to support a charity at no cost to you? By purchasing through smile.amazon.com and selecting a charity (both the above are options, plus many others), you can have Amazon donate a small portion of your purchase price to the charity. And it costs you nothing! Winning!

Hope these gift suggestions helps you! 

Did I miss something? Do you want your etsy shop/small business listed in this article? Send me an email with your website info at luckystarsstudio517 at gmail dot com.

xoxo