Health Canada has endorsed Remicade for the “treatment of adults with rheumatoid arthritis, ankylosing spondylitis, Crohn's disease, ulcerative colitis, psoriatic arthritis, and chronic plaque psoriasis”. Patients with Crohn’s are treated with Remicade when the disease is still active even though other treatments have been tried. According to Bio Advance’s treatment guide, Remicade “works by binding to, and neutralizing, TNF-alphas (tumour necrosis factor-alpha), inflammatory cytokine which are being over produced.” Some side effects they list are:
- shortness of breath, coughing (upper respiratory infections)
- rash, itchiness
- headache
- urinary tract infections
- upset stomach
- pain: abdominal, back
- dizziness
- fatigue
Some of the side effects can be serious and require treatment.
The following are situations where you must not take Remicade:
- have a serious infection: sepsis, tuberculosis, abscesses
- moderate to severe heart failure
- allergic to infliximab
- history of allergies to mouse proteins
Network Health Group Support System
In my wife’s case, the infusion process is coordinated and delivered through the AIM Health Group, a Managed care plan that integrates the financing and delivery of the Remicade. The infusion arm of AIM is MedEmerg, which “has been delivering innovative healthcare staffing solutions to facilities across Canada since 1983”. Within this structure:
- a coordinating nurse in each local area assists with the paperwork and is a liaison with the doctor, specialty pharmacy , and Health Group
- financial support may come from Trillium and the ODB in Ontario: included is a family deductible based on income tax returns
- Remicade will often help with most of the deductible: again based on tax returns
This advice, of course, only applies directly to Ontario residents but could be similar in other jurisdictions.
Administrative Procedures Crohn's Patient Must Consider
Unfortunately, a patient, as my wife discovered, needs to go through several hoops before receiving Remicade. And, for a variety of reasons, some the fault of the patient and others of the system, occasionally it is left too long. In such a case, hopefully, along with surgery, it helps with the prevention of a reoccurrence, all too common with Crohn’s. Following are the steps and some notes:
- your gastroentomologist needs to seek formal approval: often refused the first time, particularly if the patient is out of the hospital setting
- advised to get a tuberculosis test
- contacted by MedEmerg about the infusion appointment
- need to open a window with Trillium for payment of Remicade (sometimes in conference call with Specialty Pharmacy)
- if under nursing care with CCAC the ODP pays for the infusions
- if over 65 years of age the ODP pays for the infusion
- you must obtain letters from your private insurance company when coverage maximum is reached
Clinic Procedures
There is a strict protocol followed in the infusion clinics.
- you are first asked how you are. e.g. any sores or open wounds?
- you are then assigned a recliner: usually 3-6 other people receiving the infusion for the same or different reasons
- your weight is taken: + or – 10 lbs; changes affect the units of Remicade required
- you are then hooked up to an I.V.: before the administering of the Remicade, any necessary blood work is sometimes done and a small dose of a steroid is administered
- your blood pressure and temperature is periodically checked
- the first appointment is usually longer than the normal 2 hours: check for ill effects
- a television, videos and snacks are available in the clinic, and clients are welcome to bring in computers (e.g. may be plug-ins available)
- a release sheet is signed at the end and the next appointment given: usually 6-8 weeks
For many, while the infusions are a tie, the result of feeling good and having a life which is enjoyable far outweighs the need to be infused every 6-8 weeks. My wife’s physician has stated that one of the problems is that patients feel so good they don’t get back for regular appointments.
Sources:
- hc-sc.gc.ca
- med-emerg.com
- aimhealthgroup.com
- bioadvanvce.ca
Disclaimer: The information contained in this article is for educational purposes only and should not be used for diagnosis or to guide treatment without the opinion of a health professional. Any reader who is concerned about his or her health should contact a doctor for advice.
James Gibson - James Gibson is a retired teacher and small business owner. He is a published writer and has a wide spectrum of interests.
Join the Conversation