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The Cost of a One Week Delay

Updated: Jun 3, 2023

I take Tremfya for my Psoriasis and Psoriatic Arthritis. I started Tremfya in late 2021. Tremfya is the 6th biologic I have tried to treat my Psoriatic Disease. What I have learned from taking biologics is that they do not last the entire treatment time. A Tremfya dose is said to last 8 weeks, and I often start flaring at 6 or 7 weeks. That means I am already in a flare-up by the time I am due for my next dose. That flare is generally not severe. My wrists swell a little or get sore easier; I notice my knees when I go upstairs, and my morning stiffness lasts a little longer. So what do you think it is like a week late, aka week 9.

After missing a dose, my symptoms start snowballing. Morning stiffness lasts longer and longer each day. My muscles tighten, causing more pain in my neck, back, shoulders and hips. Cooking is a daunting task. Stirring one bowl of waffle batter causes weakness and soreness in my hand for days. Afternoon crashes turn into morning crashes. No amount of sleep combats the growing fatigue. My clothes become uncomfortable because my skin is dry and irritated. My scalp is itchy; everywhere there is a skin fold or seams in my clothes is itchy and red spots are forming. That rib I wrote about is constantly getting pulled out of place by the tightness in my muscles. No pain reliever provides enough relief. Thank god I get monthly massages and have unlimited chiropractor visits to get what relief is possible.

What can I do besides pain relievers, massages, and chiropractic care? Give myself a break. What am I not good at doing? Giving myself a break. If I took the day off work, worked a little slower, or didn't clean or cook every time I was in pain or tired, I would never do anything. But I had to learn when I was in between medications that you still have to give yourself a break. You have to have varying levels of your routine. Maybe you buy pre-prepped meals, or perhaps you just order out. Maybe you go to bed early or pick one chore to do. Do enough to feel accomplished but not enough to wear you out. If you feel good one morning after feeling like crap for several days, don't overdo it. I love to overdo it when I am feeling good. Man, do I pay for that! So what have I done this week to help give myself a break? I stretched a lot. I used muscle rollers. I wore what laundry was clean instead of doing laundry. I ordered takeout one night. I bought ready-to-cook meals for the long weekend. Do I still feel like crap? Of course. But I am doing what I can to not make myself feel worse.

Why was I late on my medication? I ordered my refill on December 21st. It was scheduled to arrive at my house on the 30th. I was due on January 3rd. I got curious when my injection did not come and noticed my order was on hold. I called the pharmacy, and they said I needed a prior authorization. That dreaded prior authorization process for something I am already taking. I put in the request with my doctor's office. On January 2nd, the prior authorization was sent to the pharmacy. When did the pharmacy finish processing that prior authorization? January 10th. 7 days after I was due. So to summarize, I put my refill request in 13 days before I was due for my injection and received it 10 days after I was due. It makes total sense that they needed 23 days to get it to me. Not.

I am now 2 days post-injection and unsure when this flare will resolve. I will keep up with the self-care and put a reminder on my calendar to request a prior authorization in November to give them two whole months to figure it out in hopes that next January, I am in a different place.

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