A Biologic Agent Named Enbrel


I know it’s been a few days since I’ve posted- grad school and a college roommate of Andrew’s visiting = no time for anything else! Regardless, as promised as a follow-up to my Rheumy appointment and TB test, I had to go back in on Friday to learn how to use the self-injector for Enbrel. I HATE needles. This is my nurse —> she was the one to take my blood on the first appointment and the one to give me my TB test on the second appointment. Naturally, she was my “needle teacher” too.

First, I’ll start off with the expectations. I expected to see a self-auto injector as opposed to a syringe. I don’t know how people can feasibly use a syringe to inject themselves but more power to them- I never want to do that. I expected it to look similar to an Epi-pen. I have used this before– I’m allergic to bees and they keep me alive so even though it’s a needle, I can rationalize that between death and a needle, I’ll take the needle. I expected her to show me how to use it without a needle in it and then tell me that once my insurance gets approved, I’ll go pick it up and go from there. I also expected it to hurt but be over quickly- and that mentality was what got me to the appointment in the first place.

Now, what actually happened. The nurse was very friendly (she always is). She had an auto-injector there without a needle in it and she showed me the steps: wash your hands, use an alcohol swab to swab the area, let the alcohol dry, pinch a chunk of thigh (or underneath your bell button), press the injector down hard onto your skin, keep it straight and in a way that you can see the view window, press the button on top, listen for a click, wait, listen for a second click, then pull it out and put it into your sharps container. You’re done.

Easy enough I thought. I’ll have a week or so to prep. Then she gave me a fake chunk of skin and a needless auto-injector and told me to practice the process and that she would wait and watch me do it as many times as I needed to until I felt comfortable with it. At this point, I wondered outloud, does anyone ever get comfortable with it? I think probably not. After a few times, I handed the stuff back to her, then she said it was time for the real thing. Ack. I was tricked! Here I thought I wouldn’t be using the real thing, but I was going to have to.

Naturally, my pants wouldn’t roll up far enough, so here I am pantsless holding an alcohol swab in one hand and an injector in the left, trying not have an anxiety attack. awesome. So I swabbed and she reminded me to let it dry so it wouldn’t sting. Then she said, well, it will sting anyway, I’m just telling you like it is. At least she’s truthful and not sugar-coating it. So, I pushed the thing down a felt the needle go in, not too bad, I thought, I can do this. Then I clicked the button. As I mentioned above, I thought it would be like an epi-pen. quick and dirty. I was WRONG. It was a good 16 seconds that I had to wait until I heard the second click and the medicine went in. It was absolute stinging– like a bee with a gigantic stinger was pushing his stinger deeper and deeper into my leg for 16 seconds. I had to keep my eyes closed.

I don’t consider myself to be a big baby or a wimp, but I guess with needles I am. It was really uncomfortable. The nurse was nice and gave me a bandaid for the blood and promised it would get easier. Then she walked me through my nice little “shot box” (think lunch box but full of drugs) and reminded me that it had to be refrigerated. Of course, I am flying to Denver for work in a week, so she had to get me a signed letter stating that I have to give myself injections and that it’s ok for me to be carrying needles. Joy. So that was my trip. Oh and side effects? I now have a half dollar sized bruise on my thigh and a headache from hell. Really. a really really bad headache.

So what is enbrel?
It’s used to treat a number of diseases. The idea is that it targets specific components of the immune system that are involved in the disease process. In auto-immune diseases, your immune system is attacking your body’s own tissues instead of just invaders like infections or viruses. It’s supposed to help reduce inflammation.

How much does it set you back?
Apparently is costs about $250-$300 a week. I have  pretty good insurance so we’ll see what that covers. In addition, they give you an enbrel insurance card. While it’s not clear where exactly this coverage comes from, the idea is that it will help subsidize the costs of the enbrel. So again, once I pick up my actual dosages, I’ll report back.

So, that was my Friday afternoon. Awesome, right? From here, I schedule a PT assessment with the PT at the Rheumy’s office and then take my shots for a month and then go back in and get blood tests taken again to see where we’re at.


5 responses »

  1. Pingback: Tired, Itchy, and Calculating Submitted Charges « Taking the World by Storm

  2. I’m not going to lie – sometimes that 15-16 seconds feels like the LOOOONGEST time. But, after 2 years of practice, I do have a few suggestions for making it slightly less horrible:

    (1) Most important thing I have learned is this: let the Enbrel sit out of the fridge for about 10 minutes before injecting. This makes it sting A LOT less. It’s important not to let it sit out for longer than 10 minutes – if it gets too warm it won’t work – but if you let it warm up just a little bit it will sting a lot less. We usually set a timer on one of our phones when we take it out of the fridge so we don’t forget about it and ruin a dose (which has also happened before)

    (2) You probably won’t get a bruise every time. I’ve had a few truly horrible ones (like this one: http://fromthispoint-forward.blogspot.com/2010/12/enbrel-bruise.html) but those are actually pretty rare occasions considering I’ve been doing this for two years now. I’ve also heard that if you are really having trouble with bruising it can help to ice the injection site before doing the injection. I’ve heard this can help with the pain too.

    (3) Experiment with spots on your leg – some will be easier than others. And it helps to switch legs with each injection so you don’t stress your thighs out. Because, honestly, who wants stressed out thighs?

    (4) Occasionally when I do my injection the site will get extremely itchy afterwards – it is the weirdest thing because it only happens every once in a while. When it does, there is usually a little lump on the injection site afterwards. I’ve found the best way to deal with this is to ice it until it dies down.

    (5) These days, APL pretty much does all my injections. He shares your abject fear of needles, yet somehow he is able to handle injecting them in to me. I actually find this is a pretty good system. I show him where I want the injection and then pretty much think about something else until it is done. Sometimes not having to press that little button myself is a lifesaver. I’m sure Andrew would be willing to press the button for you once and a while, to give you a break.

    Ok. That’s all the lecture I can think of right now. Please remember that I’m really not trying to tell you what to do, just sharing my own experiences. ~;o) Let me know if you have any other specific questions you think I might be able to help with. Back to catching up on your blog!!!

  3. Pingback: I’ve Never Had Allergies (other than bees). « Taking the World by Storm

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