January 12, 2019

Health care. Who'da thought it would be so complicated?

My Instagram seems idle, too, but I promise you it'll pick up when bees start flying again.

I promised I'd never be that blogger who lost interest in their blog and just disappeared, and I know it seems that way… but the truth of the matter is I'm STILL getting allergy shots for my honeybee sting allergy. It's been a LONG haul, and I thought I'd share some healthcare insurance-type information as well as some immunotherapy minutiae with you.

12 Ways Kaiser-Permanente Does VIT Differently

When I started venom immunotherapy, I was covered by United Healthcare. Three years in, I changed insurance which meant changing allergists. While the basics of VIT remain the same (a build phase leading to a maintenance phase), my experience at Kaiser Permanente has been quite different from that at Colorado Allergy & Asthma Centers.
    Kaiser Permanente CAAC


  1. The build phase for venom immunotherapy at KP is 15 injections 7-10 days apart. No ifs-ands-or-buts, no matter how much you beg to come in twice a week to get it done faster. That's a minimum of 15 weeks but don't complain; the schedule for environmental allergies is 28 weeks.
  2. Twice a week shots for 12-16 weeks.


  3. Before your first injection they have you blow into a Peak Flow Meter to get a baseline for your lung function should you ever have a reaction to an injection.
  4. Maybe they do this for asthma patients. IDK


  5. Kaiser draws from an antigen "pool" rather than patient-specific vials. In other words, you don't have to lay out a bunch of money periodically for personal vials.
  6. You get and pay for your own private set of vials.


  7. As a matter of fact, you don't pay for antigens at all, or injections for that matter. You do pay for an office visit, though, and strangely the office fee can vary from week to week.

  8. My "How much does Venom Immunotherapy cost?" post lays out the costs for antigens and injections.


  9. Instead of color-coded vials, the nurses at KP need to read the vials carefully to make sure they grabbed the right "concentration".


  10. Blue, green, yellow, and red vial caps indicate the "dilution".


  11. Antigens are ordered annually. May or June, when the antigens are freshest, is a good time to start the build phase.


  12. As needed. The lab produces enough to last no more than six months.



  13. In May or June, patients who are at maintenance will be dropped into a mini-build phase to make sure the fresh antigens aren't stronger than they can tolerate. [Insert ka-ching sound here.]
  14. When your vials run low, they make you sign and prepay for refills.


  15. At KP, I always get the same two injections in my right arm and one in my left. They won't inject into your muffin top because they wouldn't be apply a tourniquet if needed. (That's what the nurse said. The PA said that was the strangest thing he ever heard.) The nurse scribbles the time and 3X on the back of my check-in sheet.


  16. CAAC nurses use a computer in the injection room to track which venom goes into which arm (or hip), recording the time as well.



  17. KP nurses keep one eye on patients, with the aid of a fish-eye mirror, as they go about their business. Patients should pay extra attention and self-report adverse reactions. As a reminder, indicators include any reaction away from the injection site and swelling larger than the palm of your hand.
  18. Closed-circuit cameras allow the nurses to monitor patients.


  19. KP nurses aren't as careful with injections, most preferring your arm hung straight down. Expect a lot of bleeding and bruising.
  20. Hand-on-hip, shoulder rolled back shows the nurse where your muscle is so they can avoid injecting into it.


  21. Ice packs are available upon request. They provide one-time use packs so if you care about the environment, bring your own reusable ice pack.
  22. Reusable ice packs are in a self-serve mini fridge.


  23. They always offer to apply anti-itch cream when they do your 30-minute check.
  24. They just send you on your merry way.

The nurses know I'm a VIT veteran, and I haven't been shy about asking questions. Here's a few more things I learned in the year-and-a-half (!) since I last posted on my VIT
  • The reason the mixed vespids injection is not given in the same arm as the honeybee or paper wasp injection isn't that they would react badly; it's simply that the m.vespids is 3-in-1 and the cumulative amount of venom could be too much in one spot for a patient.
  • The post-injection waiting period is 30 minutes because studies have shown that 40% of severe reactions occur 20-30 minutes after.
  • Heat increases histamines so getting in the hot car in July could very well explain unusual swelling.
And here's the winner.
  • Since I've been on VIT for so many years, I get to go 6-8 weeks between shots instead of 4.
YAY! Going through this therapy is all about gaining back quality of life. Having to go to the doctor's less often has gone a long way towards that, but to be totally honest, even going every 8 weeks has gotten old. I just want to be done! But I also don't want to be dumb about it. So I found a way to be smart (continue with therapy until my next blood test show good numbers) and get shots less often. I asked a what-if question on missing the 6-8 week window.

At every phase of VIT, there is a grace period during which you can miss an injection and not be dropped a dose and into a build phase. The longer you're at maintenance, the longer the grace period. Since I started VIT the summer of 2013, I can go 14 days after the 8-week deadline. At 15 days, they'd give me a dropped down dose and make me come back the next week to get the missed maintenance dose. At 28 days, I'd be dropped 2 doses. They're not keen on this strategy BTW but it's not their time and finances, so TS.

Let me know if you have any questions about venom immunotherapy. Drop a comment and I'll get it in my email!

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