June 23, 2025
The Lay of the Land
For whatever reason - the prednisone, the fact that I'm more caught up on my sleep than usual, or just the fact that there is so much going on at the moment to think about in the world and our small lives, I have a very restless night. One plus though is that a mystery that's been vexing us for the last week - why can't we find our Hop Card from last winter I used to make my way around town while the Raven was still downtown and I couldn't drive yet anyway? Probably triggered by a fleet of blog comments that came in from Bruce, it triggers my memory. They're not hidden in the storage unit in some place I haven't thought to look yet because I gave it to Bruce before we left for Bari, thinking he and Andrea could make use of its remaining balance since we planned to be out of the country for the whole rest of the year anyway.
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We plan on biking together today but it's a complex, three part plan: a bike ride with both a business and a lunch stop. It 's complicated enough and my track record lately is shabby enough that I should break out Team Anderson's Rules again and refresh my mind on the requirements for an outing like this. The three components: a bike ride north on Williams and then east along the Columbia to Blue Lake and back; then stopping off for lunch at La Cucina (not to be confused with Nuestra Cucina, our long-time favorite on the east side), the place with the rainbow-hued tables I saw for the first time yesterday; a detour to Kaiser for a blood test and to pick up some medications: Tyeene, my new drug to replace prednisone, and an emergency refill for my cholesterol-controlling statin.
None of that happens today after all because soon after I return to the apartment a message from the rheumatologist comes in and gets read and discussed with great interest. It's the response to a message I sent in last night, a list of follow-up questions we'd like answered so we understand our situation better. Our questions:
His responses are all clear and clarifying, and it feels like we know or can quickly get access to all the information we need for fully understanding our box and start forming real plans that extend for more than a month into the future. So of course we're eager to take that on and we'vequickly decide that today's ride plan can get pushed out to another day. Instead we spend the better part of an hour hashing and rehashing what we've just learned. And when we get done we walk the short distance to Via Delizia for lunch and then come back to the apartment, turning this into more or less a work day. On the way back we walk across the street and sit on the wall overlooking Tanner Springs Park, slowly spooning out our takeaway gelato (she's got pistachio of course, and I try the Turkish coffee and vanilla bean, just like my first breakfast at Ovation).
We head back to the apartment, stopping along the way to check out the flowers and other life along the water, surprised by how serenely beautiful this one block pocket park has become after ground was broken on it nearly fifteen years ago. We should do this more often since it's so close at hand.
Note that I didn't caption anything here. I cipould have done but they're pretty self-explanatory and I have other priorities at the moment.
Once we're back home Rachael settles into a book for a while until she's done digesting enough to take a walk along the waterfront. My plan is to bike over to Kaiser to pick up my meds and then come back and resume work on the planning project. That doesn't happen though because a minor catastrophe occurs (minor only if compared against the succession of real catastrophes we've been dealing with over the last four months). I set my iPad on the counter preparing to sit down in front of it when it slips off, drops a couple of feet, and loudly lands face-flat on the wood floor. Crack! It's terrible, and I blame it on either the prednisone or my lack of depth perception. I need to just keep working at the problem and reducing the frequency of mishaps like this. Rachael agrees. She'd really like to see a little less excitement of this sort in our lib
Ves.
She's a goner I'm thinking since she wasn't wearing a helmet; and I'm unfortunately right. I flip it over to assess the damage, hoping for the best but not finding it. Instead I find a spiderweb, which I think we can agree is not a healthy look for this sort of thing. So biking over to Kaiser can wait for tomorrow too while we research what to do with the situation. Research consists of interrogating Apple's website over the possibilities of getting the glass replaced (doable, but likely nearly as expensive as a new tablet); finding that its trade-in value is roughly zero, under the circumstances; and seeing the recommended and obvious course of action: bring the old one in for recycling, and buy a new iPad.
So that's the plan, and I'll head down to the Apple Store first thing tomorrow morning. For now though I turn to detailing the box we're in as the next step before Rachael and I review the situation and try to reach an agreement on what's next after we land in London on August 4th. First let's review the facts as provided in Doctor Greenberg's responses and gleaned from subsequent research.
Medication distribution:
- The standard distribution is a one month supply. That's the most we can receive at one time without obtaining an exception for out-of-state travel.
- The travel exception is a single one month supply per calendar year, beginning on January 1.
- Kaiser will dispense medications through its mail-order service and will mail medications to most states and provinces in Canada and the U.S., including all that we have an interest in visiting.
- Kaiser will not mail medications overseas. If we are overseas and have exhausted our supply, we will need to either return to a location they will mail to or buy a new supply locally out of pocket.
- The cost of the medication is prohibitively expensive, and is only covered by our insurance if ordered from Kaiser.
Medication storage and usage:
- The medication can remain in original unopened packaging at room temperature for up to 14 days.
- Once opened, it must remain refrigerated at a temperature range between 36 and 46 degrees Fahrenheit.
- Properly refrigerated, it can be stored indefinitely and remain viable.
- Needles are not required. Tyeene has developed a reusable injection pen that has also been prescribed for me.
- There is no reason we cannot travel with the medication as long as it remains suitably refrigerated, such as in a portable refrigeration unit.
- Not that it's of any great significance on the scale of things, but this fact is worth being aware of: the European beand name for the same drug) is not known to interact with alcohol.
Dosages, testing, etc:
- Unless something changes I will need an injection every two weeks.
- I'll need to continue getting ESR and CRP tests every other week. Also I'll now require a CBP and alt test every 2-3 months, and a Lipid panel every six months.
Implications:
- A one month supply should really let us travel out of country for six weeks at a time if we align our travel dates appropriately. I'll dose just before leaving the country, use our travel supply for injections at the end of weeks two and four, and then we'll fly home two weeks later for the next injection.
- We can use our one travel allotment per year flexibly, either by adding it to one trip to stretch it to 10 weeks or by splitting it between two eight week tours.
- Within Canada and the U.S. we can travel indefinitely as long as we stay in or close to a destination Kaiser supports, such as by spending an entire winter in the southwest or autumn in New England and the Maritime Provinces.
- As I understand it, the travel allowance is a use it or lose it situation. Even if we have no plans to stay longer overseas some year we should tap the supply anyway and bank it for future flexibility.
- And of course if we want to stay overseas even longer than that, there are options for that too. Not that we anticipate doing this often if ever, but we're always free to bite the bullet and buy more one expensive month at a time out of pocket, or find a cheap flight back to the states for a refill.
- The fact that the new medication isn't known to interact with alcohol is interesting, and will be discussed with Dr. Greenberg at our next meeting. If true, the information will be used wisely and age-appropriately; but it won't be a surprise if an occasional real real ale or similar beverage gets lifted this autumn when there's cause for celebration.
So, there we have it. And although it's not ideal this actually gives us quite a bit of flexibility and much more than we first anticipated. In a normal year we can travel all we want within Canada and the U.S. and take as much as four six week tours overseas with an extra month thrown in once a year. That's a constraint, but a pretty modest one that we'll have no trouble living with..
That's really all we need to form a plan for the rest of the year, and unsurprisingly we have the framework of one ready for review.. And once we have one we'll share at least the first part of it with you but we really should talk it over together between ourselves first, don't you think?
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