Hi GC, thanks for your reply to my BFN post earlier...I'm on Enbrel
<br/>and per DB I will have to increase it to 3x/week with a positive
<br/>pregnancy test. He will tell me how to space the doses when the time
<br/>comes. I've already m/c'd on Enbrel and Remicade. Seems like I need
<br/>lots of IVIG along with Enbrel and the increase is due to the fact
<br/>that my nk's act up after I become pregnant. I'm on the 2x/week dose
<br/>for preconception.
<br/>
<br/>Theresa
<br/>
<br/>--- In immunologysupport@yahoogroups.com, GC <ghunisec@y...> wrote:
<br/>> Hi, has DB ever prescribed anyone to take enbrel more frequently
<br/>than every 3.5 days? If so, what was the reason?
<br/>> Thanks
<br/>> GC
<br/>

> I want to share my success story with you, as it may raise your
<br/>> spirits and make you feel better about your decision to go with
<br/>> Enbrel. I did Enbrel for 7 weeks before my FET, got pregnant with
<br/>> twins, and continued with Enbrel until we saw heartbeats. Now I
<br/>> know your situation is different than mine, in the sense that I was
<br/>> not on Enbrel prior to retrieval (only after), so I can't really
<br/>> tell you if it effected my egg quality. One thing it did do, which
<br/>> I think is equally important, if not ore important, is provide a
<br/>> healthy, non hostile evironment for your embryo/s to implant and
<br/>> grow. The last thing you want is for your fragile embryo to be
<br/>> killed by NK's! So, that is my two cents. I had some frustration
<br/>> with Enbrel at first--it made me flare slightly. Of course this
<br/>> made me extremely nervous, since I was preparing for an FET.
<br/>> Luckily, the flare was short lived, and the numbers came down
<br/>nicely
<br/>> after 3 or so weeks. Another thing, for a while, DB was only
<br/>> heavily prescribing Enbrel to his patients with great success.
<br/>> THose women that found success were called the "Enbrellas." Maybe
<br/>> you'll be addedd to this list of happy success stories! It's not
<br/>as
<br/>> commonly prescribed another more, the way Humira is, but it's still
<br/>> a powerful and helpful drug for many. Best of luck!!
<br/>> Ligia
<br/>> 14w6d preg. w/ twins
<br/>>
<br/>

Hi Michelle,
<br/>
<br/>In answer to your question, yes, many may ladies have taken Enbrel
<br/>well into their pregnancies. I have known 6 patients who took Enbrel
<br/>up to the 30th week.
<br/>
<br/>Below I have added some Dr Beer posts about all this. According to
<br/>one of the posts below, Enbrel does NOT cross the placenta.
<br/>
<br/>Hope this helps!
<br/>
<br/>Also (just added tonight), I have added a patient delivery list (37
<br/>pages long) to our group files. There are many Enbrel pregnancy
<br/>stories contained in there. Click:
<br/>
<br/>http://groups.yahoo.com/group/immunologysupport/files/
<br/>
<br/>Look under "Success stories" under "Delivery list". Also see Dr
<br/>Beer's posts below.
<br/>
<br/>BTW, many of the patients who took Enbrel into the 3rd trimester on
<br/>the list were NOT Dr Beer's patients.
<br/>
<br/>Jane
<br/>
<br/>
<br/>Enbrel posts
<br/>
<br/>----------------
<br/>Hi Dr. Beer,
<br/>>
<br/>>Just a quick question to see
<br/>>if you're still feeling comfortable
<br/>>with patients taking Enbrel while
<br/>>pregnant. I took Enbrel
<br/>>for three months pre-conception, then
<br/>>til 10w gestation, under your
<br/>>care (along with my RE),
<br/>>early in my pregnancy.
<br/>>I'm now coming up on
<br/>>25w with twins. (YAY!)
<br/>I AM HAPPY FOR YOU.
<br/>>
<br/>>
<br/>>But since this is such a
<br/>>new drug, and since I
<br/>>am constantly met with either
<br/>>blank or concerned looks when
<br/>>I tell people (including physicians)
<br/>>that I took this drug,
<br/>>I am worried about whether
<br/>>or not this was a
<br/>>safe thing to do for
<br/>>the future health of these
<br/>>babies.
<br/>
<br/>I HAVE LEARNED NOTHING TO RECONSIDER THAT ENBREL IS NOT SAFE. THERE
<br/>HAVE BEEN NO ABNORMAL BABIES BORN OR ABNORMAL BABIES BEING CARRIED.
<br/>IT DOES NOT CROSS THE PLACENTA AND APPEARS SAFE.
<br/>
<br/>>
<br/>>Have you learned anything in the
<br/>>past few months that makes
<br/>>you re-consider Enbrel's safety for
<br/>>your pregnant patients?
<br/>
<br/>NONE. I CONTINUE IT UNTIL I SEE A HEART BEAT IN THE FETUSES (BOTH
<br/>FETUES) AND THE NK ASSAY AT 50:1 IS 15% OR BELOW AND THE CD 56+ CELLS
<br/>ARE 12% OR BELOW. IN SOME WOMEN I HAVE HAD TO CONTINUE IT INTO THE
<br/>SECOND TRIMESTER AND ALSO GIVE IVIG TO SOME OF THE MOST DIFFICULT
<br/>WOMEN.
<br/>
<br/>Or
<br/>>are you even more of
<br/>>a believer than ever, with
<br/>>every Enbrel baby born?
<br/>
<br/>YES THIS I AM.
<br/>
<br/>>I guess I just need
<br/>>a bit of ressurance --
<br/>>thanks so much!
<br/>
<br/>-------------------
<br/>
<br/>I am planning
<br/>>to get pregnant again and
<br/>>am considering taking Enbrel, however
<br/>>I am concerned about side
<br/>>effects of this drug.
<br/>PLEASE DO NOT BE OF GREAT CONCERN. VISIT MY SITE AND READ ABOUT THE
<br/>SIDE EFFECTS REPORTED BY MY PATIENTS. I HAVE 200 THAT ARE CURRENTLY
<br/>PREGNANT OR ALREADY DELIVERED THEIR BABIES. THE DATA BASE IS ON THE
<br/>PRIVATE ENBREL DISCUSSION SITE.
<br/>>I was wondering if you
<br/>>recommend enbrel or any other
<br/>>drug that might help with
<br/>>the arthritis, without serious side
<br/>>effects to the baby?
<br/>THIS HAS NOT BEEN A CONCERN FOR WE HAVE SEEN NO EFFECTS ON THE BABY
<br/>LINKED TO ENBREL. WE ALSO STOP IT USUALLY WITH A POSITIVE PREGNANCY
<br/>TEST OR IN OTHERS 30 DAYS BEFORE PREGNANCY IS ESTABLISHED.
<br/>>I have consulted with my
<br/>>RA doc but he won't
<br/>>suggest anything other than prednisone.
<br/>THIS WILL PROBABLY NOT BE ENOUGH FOR YOU. I RECOMMEND AN ENDOMETRIAL
<br/>BIOPSY ON CYCLE DAY 26 TO SEE HOW MANY NK CELLS YOU HAVE IN YOUR
<br/>UTERUS.
<br/>
<br/>
<br/>------------------------
<br/>
<br/>Hi Dr. Beer,
<br/>I am at 18 weeks with twins and my U/S looks good. The Enbrel helps
<br/>me very much with fatigue and overall body aches which plague me even
<br/>when not pregnant. Is it OK to take Enbrel right up to delivery?
<br/>
<br/>NO I ADVISE THAT YOU STOP IT NOW. THE CARRY OVER EFFECT MAY BE VERY
<br/>LONG LASTING FOR YOU AND WE CAN CONSIDER STARTING IT AGAIN POST
<br/>PARTUM.
<br/>
<br/>The warning label says that Enbrel is not recommended for breast
<br/>feeding, so I will stay off of it after delivery as long as I am
<br/>breast feeding.
<br/>
<br/>I have tried twice to get my local Rheumy to agree to prescribe it
<br/>for me, but he won't. I have family history with RA and no side
<br/>effects from taking Enbrel. I can't imagine caring for twins without
<br/>this drug. Do you prescribe this drug for your patients who are not
<br/>actively ttc?
<br/>
<br/>I DO THIS FOR MY PATIENTS WHO ARE REGISTERED WITH ME AND NEED IT AS
<br/>PART OF THEIR HEALTH MANAGEMENT.
<br/>
<br/>---------------------------
<br/>

CONTENTS
<br/>
<br/>Disclaimer
<br/>Introduction to Enbrel
<br/>Why Enbrel is Used With Reproductive Immunology Patients
<br/>Indicators of NK Cells in the Uterine Lining
<br/>How is Enbrel Administered?
<br/>What are the Side Effects of Enbrel?
<br/>Is Enbrel Safe?
<br/>Insurance Coverage / Cost of Enbrel
<br/>Enbrel Vaginal Gel
<br/>Resources
<br/>
<br/>
<br/>DISCLAIMER
<br/>Informed reproductive immunology patients prepared this document. The
<br/>data was gathered from doctors, nurses, medical papers, shared
<br/>knowledge among patients using Enbrel, and from personal experience.
<br/>You are encouraged to research and ask questions of your physician
<br/>until you are personally satisfied that the benefits of this
<br/>treatment exceed the possible risks. The information provided is not
<br/>intended to substitute for the advice of a doctor.
<br/>
<br/>
<br/>
<br/>II. INTRODUCTION TO ENBREL
<br/>
<br/>Enbrel (etanercept) was developed for patients who have severe
<br/>rheumatoid arthritis. It was approved by the Federal Drug
<br/>Administration for use in these patients in November of 1998.
<br/>Enbrel's function is to bind with tumor necrosis factor alpha (TNFa),
<br/>which is secreted by activated Natural Killer (NK) cells. Patients
<br/>with rheumatoid arthritis have been found to have elevated levels of
<br/>TNFa in their joints. Enbrel binds to the TNFa, rendering it
<br/>biologically inactive, resulting in significant reduction of
<br/>inflammatory activity.
<br/>
<br/>
<br/>
<br/>III. WHY ENBREL IS USED WITH REPRODUCTIVE IMMUNOLOGY PATIENTS
<br/>
<br/>Enbrel is used with reproductive immunology patients who have been
<br/>found to have evidence of active NK cells residing in their uterine
<br/>lining (NKUs). Women who have active NK cells in their uterine lining
<br/>that are secreting TNFa are prone to a disordered lining development,
<br/>failed implantation, poor embryo development and/or pregnancy
<br/>failure . At the time of ovulation these women often have thin
<br/>endometriums, often only 7-8mm thick. A full week before menstruation
<br/>there is often evidence of stromal hemorrhages in the uterine lining
<br/>as well.
<br/>
<br/>TNFa produced by the Natural Killer cells in the uterus damages the
<br/>embryo and it often fails to grow, divide, and implant. TNFa also
<br/>damages the blood vessels in zone three of the endometrium. This
<br/>often creates stromal hemorrhages and robs blood and nutrients from
<br/>the embryo. This also results in thinner than normal endometrium.
<br/>
<br/>
<br/>A cycle day-26 endometrial biopsy, or an analysis of the products of
<br/>conception following miscarriage, can confirm the presence of NK
<br/>cells in the uterus (NKUs). If confirmed, Enbrel is prescribed to
<br/>neutralize TNFa. Enbrel is used for a minimum of 30 days before
<br/>trying a cycle of conception. See: http://repro-
<br/>med.net/tests/endomet.php
<br/>
<br/>
<br/>
<br/>IV. INDICATORS OF NK CELLS IN THE UTERINE LINING
<br/>
<br/>The following factors may indicate the presence of NK cells in the
<br/>uterus (NKUs):
<br/>
<br/>(1) Highest incidence is in women with one live-born child and then a
<br/>history of infertility or recurrent miscarriage.
<br/>
<br/>History of endometriosis.
<br/>History of mononucleosis.
<br/>History of HPV or Herpes.
<br/>Those who experience flu-like symptoms with implantation or IVF
<br/>transfer.
<br/>Those who have IgA anticardiolopin antibodies.
<br/>Those who have a positive skin test allergic reaction to HCG within
<br/>30 minutes.
<br/>History of IVF failures (2 or more).
<br/>Those who have a known autoimmune disorder (such as fibromyaglia,
<br/>lupus, rheumatoid arthritis, Crohn's disease, thyroiditis, chronic
<br/>fatigue syndrome, Raynaud's disease).
<br/>Those who have a history of dysplasia of the cervix.
<br/>Those who have recurrent spontaneous abortions, who lose their
<br/>pregnancies earlier, have implantation failures, or who have
<br/>secondary infertility.
<br/>Those who have luteal phase defects.
<br/>Those who experience premenstrual spotting.
<br/>Those who have odd/irregular menstrual cycles.
<br/>Those who have poor egg quality.
<br/>Those who experience failure to carry to term with all other
<br/>traditional immune treatments (i.e. IVIg and LIT).
<br/>
<br/>
<br/>HOW IS ENBREL ADMINISTERED?
<br/>Enbrel is administered by subcutaneous injection in the thigh,
<br/>stomach, or back of the upper arm. It is given every 84 hours, or
<br/>twice a week. An example of a typical weekly schedule might be to
<br/>administer the first injection Saturday at 6 p.m. and a second
<br/>injection on Wednesday at 6 a.m. Enbrel is packaged with four doses
<br/>in each box, which provides a two-week supply. Each of the four doses
<br/>comes in an individually wrapped tray, which includes the syringe,
<br/>one 25mg vial of Enbrel, one plunger and two alcohol swabs. The drug
<br/>should be refrigerated. Enbrel's manufacturer, Amgen, provides an
<br/>information service at 1-888-436-2735 to answer any questions
<br/>consumers might have. Website: http://www.embrel.com/home.jsp?fvar=1 .
<br/>
<br/>
<br/>It is important to note that Enbrel users should dispose of the used
<br/>syringes appropriately. A Sharps container for correct disposal of
<br/>used syringes may be requested of your providing pharmacy or your
<br/>physician.
<br/>
<br/>
<br/>
<br/>WHAT ARE THE SIDE EFFECTS OF ENBREL?
<br/>As with any drug, it is advisable to notify any physician (including
<br/>dentists) that you are on this medication. Live vaccines should not
<br/>be given concurrently with Enbrel. Also, it is important that you
<br/>check with your doctor if you develop a cold or any other infection
<br/>while on Enbrel. The current label for Enbrel states that the drug
<br/>should not be used with patients who develop a serious infection or
<br/>have sepsis. It should also be noted that the needle cover of the
<br/>syringe contains dry natural rubber (latex) which should not be
<br/>handled by people who are sensitive to this substance.
<br/>
<br/>Possible side effects that have been noted are included below. If you
<br/>experience any other side effects not listed below, or any side
<br/>effects that cause you concern, please contact your physician.
<br/>
<br/>pain, redness, itching, swelling, or bruising at the injection site
<br/>(rash is often delayed, often starting after the 4th injection )
<br/>joint pain and/or flu-like symptoms and fatigue for the first 30
<br/>days, decreased body aches after 30 days
<br/>increased energy
<br/>positive menstrual cycle changes including ovulation closer to day 14
<br/>(for those who experienced later ovulation), heavier menstrual flow
<br/>(in those who formerly had light periods), LH surge more defined and
<br/>recognizable with the use of an LH kit, increase in the quantity of
<br/>cervical mucus, cervical mucus more closely synchronized with
<br/>ovulation, and decreased pre-menstrual syndrome
<br/>negative menstrual cycle changes including possible harsher menstrual
<br/>cramping, increased breast tenderness, anovulatory cycles, late
<br/>ovulation, poor lining and follicle development, and little cervical
<br/>mucus in some cycles (most cycles become more normal after longer use
<br/>of Enbrel)
<br/>dizzinesss, queasiness
<br/>increased nightsweats (which usually decrease with longer use of
<br/>Enbrel)
<br/>heart palpitations, pounding, high blood pressure (notify physician
<br/>immediately if these occur)
<br/>vivid dreams
<br/>sleeplessness
<br/>increased risk of complications as a consequence of respiratory
<br/>infections (colds) and sinus infections
<br/>anxiety/nervousness
<br/>shakiness and/or panic attack (less common)
<br/>
<br/>
<br/>IS ENBREL SAFE?
<br/>The FDA classifies drugs into 5 categories with respect to pregnancy:
<br/>Category A, B, C, D, and X, with A being deemed the safest. Enbrel
<br/>has been classified as category B; there have been studies in animals
<br/>at doses 60 to 100 times higher than human doses that have revealed
<br/>no evidence of harm to the fetus. At this time, there are no formal
<br/>studies with pregnant women.
<br/>
<br/>Enbrel is usually taken until the patient is pregnant and a heartbeat
<br/>is confirmed on ultrasound and until the NK assay at 50:1 is 15% or
<br/>less and the NK cell numbers are 12% or below. Current data suggests
<br/>that Enbrel does not pass the placenta to the fetus. Dr Beer's
<br/>patient support group reported 162 successful deliveries after Enbrel
<br/>use as of July 2003.
<br/>
<br/>Additionally, women are concerned that Enbrel might have a
<br/>detrimental effect on their bodies' natural cancer fighting ability.
<br/>Current data suggests that use of Enbrel does not reduce the body's
<br/>ability to fight cancer.
<br/>
<br/>Also, Enbrel does not increase a woman's susceptibility to catch
<br/>colds or viruses. However, if a woman does catch a cold or virus
<br/>while on Enbrel, it is important to notify the physician.
<br/>
<br/>
<br/>
<br/>VIII. INSURANCE COVERAGE / COST OF ENBREL
<br/>
<br/>The use of Enbrel for reproductive immunology is a newly emerging
<br/>treatment. As such, some insurance companies will not cover Enbrel if
<br/>they are aware that it is not for treatment of rheumatoid arthritis.
<br/>The out-of-pocket cost for the drug can vary significantly. It may
<br/>range from $400 to $750 for a two-week supply. Some users consider it
<br/>advisable to submit an Enbrel prescription on a separate occasion
<br/>from other fertility drugs.
<br/>

gave him all the specifics and told him that I have Enbrel on hand--
<br/>should I start it or wait for more instructions on Monday. He said to
<br/>start the Enbrel and do it every other day until I get the IVIG and
<br/>then switch to every 84 hours. As far as the high cytokine numbers he
<br/>said that it's common in early pregnancy and that he'd be worried if
<br/>the NK assay was elevated.
<br/>
<br/>I'm supposed to get my IVIG today. I'm waiting on FedEx right now and
<br/>my nurse is standing by. I hope it doesn't get here too late in the
<br/>day. I'm gonna try to call Columbia Pharmacy (not sure if they're
<br/>open on Sat?) to get a tracking number.
<br/>
<br/>So, as usual, I feel much better after hearing from him. Now I have
<br/>to go wake up DH (we're late sleepers on the weekends...but hopefully
<br/>not for much longer-like about 8 more months!!)so he can get the
<br/>Enbrel ready for me.
<br/>

Hi Monika, welcome aboard and congratulations with your pregnancy.  I took enbrel during my pregnancy and stopped at 11 weeks.  I was taking the enbrel because I was diagnosed with uterine natural killer cells.  My nk's were pretty much under control at the 11 week mark so Dr. Beer said I could stop.  I do know that he was considering prescribing it for someone on this board a little later in their pregnancy because of an nk flare.  I think it was Shelley --- who is due in about 4 weeks so I don't know if she'll get a chance to post an answer to you.  Enbrel helped to get me and keep me pregnant and we will be doing it again this cycle as we work for #2.  What does your ob/RA say about it?  From past experience it sounds like you should be ok -----like I said enbrel helped to keep me pg and there are a few others on this board who have had success with enbrel.  I don't know anyone who has taken it throughout the entire pregnancy.  Best of luck,
<br/>GC
<br/>
<br/>12周

Hi all,
<br/>> > >
<br/>> > > Just an update...I had my consult today with DB (I had a m/c
<br/>last
<br/>> > > month--a 'blighted ovum') and the good news is that there is no
<br/>> > > evidence of any immune activity in my pathology. According to
<br/>DB
<br/>> my
<br/>> > > uterus was perfectly prepared for pregnancy. Unfortunately the
<br/>> > > pregnancy was not viable. Sad to say but I am relieved that
<br/>this
<br/>> > > could have happened to 'anyone' not just those of us with
<br/>immune
<br/>> > > problems. Oh, and neither Dr. Beer or my local ob found any
<br/>fetal
<br/>> > > cells in their pathology, but DB assured me that it was not
<br/>> > necessary
<br/>> > > to see that and that my endometrium showed definite signs of
<br/>> > > pregnancy.
<br/>> > >
<br/>> > > On to my protocol changes: I did Remicade last summer (3x) Then
<br/>> > when
<br/>> > > I got pregnant DB had me start Enbrel after my cytokines shot
<br/>up
<br/>> to
<br/>> > > 60. I was also on IVIG (4 or 5, can't remember). I had a
<br/>cytokine
<br/>> > > test drawn the day before my d&c (betas were still rising
<br/>slowly,
<br/>> > but
<br/>> > > still showed nothing on u/s) and they came back completely
<br/>> normal,
<br/>> > > actually a little lower than they were after I did Remicade. So
<br/>> my
<br/>> > > new protocol is: Enbrel for 30 days, then test nk assay and
<br/>> > > cytokines, then ttc and do IVIG on cd6, IUI/ovulation and with
<br/>a
<br/>> +
<br/>> > > pregnancy test. Also after a + pg test I have to increase the
<br/>> > Enbrel
<br/>> > > to 3 times a week. DB feels (and I agree) that my immune system
<br/>> is
<br/>> > > fairly quiet until a pregnancy is established, so Enbrel is a
<br/>> > better
<br/>> > > choice for me since it can be used during pregnancy. All my
<br/>other
<br/>> > > meds will stay the same--glucophage 1500/day, prozac 40mg/day,
<br/>> baby
<br/>> > > aspirin, Folgard, dexamethasone 1mg/day, Lovenox 40mg starting
<br/>on
<br/>> > > cd6, and progesterone supplements. Oh, and of course a prenatal
<br/>> > > vitamin :)
<br/>> > >
<br/>> > > So I am very happy and extremely relieved that the immune
<br/>> > treatments
<br/>> > > did work for me. Hopefully next time it will be a viable
<br/>> pregnancy
<br/>> > > and everything will go well. It has been a very difficult month
<br/>> for
<br/>> > > me, with waiting for pathology results and to speak to DB, but
<br/>> now
<br/>> > I
<br/>> > > plan on really enjoying the holiday season without worrying
<br/>about
<br/>> > any
<br/>> > > of this. A new year is around the corner, hopefully it will be
<br/>a
<br/>> > very
<br/>> > > good one for all of us!
<br/>> > >
<br/>> > > Theresa
<br/>
<br/>
<br/>

20. Aches, *muscle cramps, joint pain, *pelvic pain, tendonitis/
<br/>bursitis flare杣p (32)
<br/>
<br/>
<br/>1) 1/13/00: " I had bursitis/tendonitis in my rt elbow and in tendons
<br/>by my
<br/>fingers but am left handed (so it's not tennis elbow!) I asked Dr.
<br/>Beer about it and he had no other known incidents of this in his
<br/>patients, so i'd recommend putting on your most infreqently listed
<br/>negative side effects. Also bursitis I believe is listed in the
<br/>Enbrel package insert as an occasional side effect. It was the first
<br/>time for me to have any joint or near-joint
<br/>symptoms, since i don't have arthritis."
<br/>
<br/>2) 2/15/00: " I also had Nausea, back pain, cramps, felt like crap.."
<br/>
<br/>3) 1/23/00 " Also recently started having some muscle aches, joint
<br/>pain that I had not had for
<br/>a while"
<br/>
<br/>4) 1/21/00: "Thanks for clearing that up. I had my first injection of
<br/>Enbrel Wednesday
<br/>night, and Thursday and today I have had some muscle aches in my legs
<br/>and
<br/>stomach. I did the injection in my stomach. I did not have the red
<br/>welts or
<br/>itching that I have read others talk about. Has anyone else had the
<br/>muscle
<br/>aches and does it go away later on or do you have the aches after
<br/>every
<br/>shot?."
<br/>
<br/>5) 1/22/00: "After 7th week on ENBREL I just started noticing muscle
<br/>aches, and joint
<br/>aches this past week.."
<br/>
<br/>6) 4/18/00: "I have had major flare up of
<br/>tendonitis/arthritis/etc. (Dr. Beer calls it Fibromyalgia pain but I
<br/>haven't been diagnosed officially with that). Every month since on
<br/>Enbrel
<br/>around ovulation time my symptoms are nearly unbearable."
<br/>
<br/>7) 5/17/00: "My spirits are definitely better and my head is more
<br/>clear (I'm also on Prozac), but I still have the muscle/joint pain
<br/>and headaches along w/the above symptoms. Does anyone know when I can
<br/>expect pain relief, or am I just cursed?!"
<br/>
<br/>8) 5/17/00: "I too had very little response to my first couple shots
<br/>of Enbrel. Sunday I took shot #3 and since then have been achy and
<br/>sore in joints and muscles, it is also my time for ovulation. I am so
<br/>tired also."
<br/>
<br/>9) 5/25/00: "I have recently been told to stop enbrel because of a
<br/>sinus and upper respiratory infection. I took the antibiotics my
<br/>family doctor prescribed and am feeling much better. However, five
<br/>days after stopping the enbrel I got horrible aches in my arms and
<br/>legs. Now I'm debating if I should take it anymore. I did not have
<br/>this problem before enbrel and I'm afraid it has caused problems I
<br/>didn't have in the first place. Has anyone else had a similar
<br/>experience?"
<br/>
<br/>10) 5/26/00: "I had excruciating pain (I have fibromyalgia) in Feb,
<br/>the second month on
<br/>Enbrel. Call Dr. Beer's office and tell them and either take
<br/>ibuprofen
<br/>(see if that helps) or ask them for a prescription for something
<br/>stronger--
<br/>I took celebrex. I stayed on the Enbrel and it got better, but it is
<br/>common "
<br/>
<br/>11) 7/1/00: "Side effects: Well, I ran the gamut of flu-like symptoms
<br/>from wk 3 thru wk
<br/>6. I had no energy, joint pain, headaches, and generally crabby"
<br/>
<br/>12) 9/24/00: "I am on month 3 now but have not had any of the bumps
<br/>or welts or that type of reaction from Enbrel thus far. My rheumatoid-
<br/>like pains were almost gone the first month I used it but this month
<br/>the pain has killed me with the sudden and constant weather changes.
<br/>Maybe, instead of the welts I am getting the pain... who knows?"
<br/>
<br/>13) 9/28/00: "..since I started the second and third months on Enbrel
<br/>my knees have been killing me from what it seems like rheumatoid
<br/>pain. My lower back as well. My back makes sense since I have
<br/>injuries on it. My knees usually hurt with the weather changes."
<br/>
<br/>14) 10/10/00: "I have been on Enbrel four months and have terrible
<br/>arthritis pains. Getting up in the morning is painful, but it's not
<br/>the worst side effect I have had."
<br/>
<br/>15) 10/13/00: "I have been on Enbrel for 4 months and didn't really
<br/>have any side effects until the last two months. My cycles have been
<br/>normal all along with both gel and injections, maybe just a bit
<br/>heavier. Although, I have had TERRIBLE joint pain lately. It was
<br/>almost unbearable to get out of bed in the morning. Dr. Beer has
<br/>given me Celebrex, which so far has helped."
<br/>
<br/>16) 10/30/00: "For the last 3 weeks I have been experiencing pain in
<br/>my upper spine. The top of my spine seems to be raised and at times I
<br/>have a lot of tingling and cracking. This came on suddenly and
<br/>without any possible cause due to injury. I have been on Enbrel for 3
<br/>months now. I have never had this problem before taking Enbrel. Dr.
<br/>Beer said this is not from the Enbrel but I am not so sure. The
<br/>symptoms seem to be like RA which I have never had before."
<br/>
<br/>17) 11/25/00: "I've been on Enbrel 5 months. After two months I had
<br/>the same reaction at the injection site along with actual arthritis
<br/>pain (I've never had arthritis before). I told Dr. Beer about it and
<br/>he put me on Celebrex. Celebrex helped, but when I started IVIg all
<br/>of the Enbrel side effects went away."
<br/>
<br/>
<br/>18) 12/14/00: "I started Enbrel several weeks ago to treat my
<br/>rheumatoid arthritis & hopefully, help me get pregnant too. After my
<br/>3rd shot, I felt great all week, then my arthritis symptoms started
<br/>to worsen again. I've now had 7 shots & my arthritis pain is about
<br/>the same as it was before I started the Enbrel. Does this mean the
<br/>Enbrel is not working for me? I'm worried."
<br/>
<br/>19) 1/21/01: "I too have the pains, and now I have been on Vioxx,
<br/>since my start with the Enbrel gel. My rheumatoid arthritic pains
<br/>have been with me at a lower level of pain since I was younger.
<br/>After being on Enbrel, they were a bit more noticeable, but then
<br/>again, I am not so sure because I had that unfortunate incident with
<br/>the heparin overdose, and quiting prozac cold turkey, and I believe
<br/>having antis to neurotransmitters, does contribute to feeling pain
<br/>more intensely."
<br/>
<br/>20) 1/21/01: "When I went off Enbrel, almost two months ago, I
<br/>started to have terrible arthritis pain. I've never had arthritis
<br/>before treatments with Dr. Beer, but now I do. I now see a
<br/>Rheumotologist (sp?) for the arthritis. I have to think it was
<br/>because of the Enbrel, but don't know for certain."
<br/>
<br/>21) 3/25/01: "It has always puzzled me. With this last blighted ovum
<br/>I had, I noticed the hip pain was there during the 6th week, which is
<br/>when I m/c'd. This was also alarming to me. Well, last night when I
<br/>did my Enbrel injection, I got the hip pain immediately afterwards.
<br/>This is odd to me because I usually only get it during my
<br/>period/ovulation. Could this be some sort of nk flare up? I was just
<br/>curious if this was induced by the Enbrel. Any imput would be
<br/>appreciated."
<br/>
<br/>
<br/>
<br/>22) 4/9/01: "I was on it ( Enbrel) for four months, during which time
<br/>I had a variety of symptoms including debilitating fatigue, pelvic
<br/>pain, and headaches."
<br/>23) 4/17/01: "After being on Enbrel for 2 1/2 months I began to
<br/>experience pain and stiffness in my upper back area. This got better
<br/>after I stopped Enbrel. I restarted Enbrel after 3 months and the
<br/>pain got worse then better then a little worse. I am now on Vioxx but
<br/>it does not seem to be helping."
<br/>
<br/>24) 7/10/01: "Well, I got my period & it was really heavy. The lower
<br/>back pain has not gone away & seems to be getting worse. This morning
<br/>I had to take Advil since I have to sit at my desk all day & it is
<br/>really bothering me. 匢'm wondering if this lower back pain is from
<br/>the Enbrel?? Anyone experience this? My husband thinks that maybe I
<br/>hurt my back, however I don't remember doing anything to hurt it. Any
<br/>comments are appreciated. Thanks!"
<br/>
<br/>25) *8/18/01: "I took my first dose of Enbrel last Wednesday night. I
<br/>used to be a runner and had problems with one knee because of it. I
<br/>haven't run in ages and haven't had any problems with my knee since
<br/>then, but Thursday morning I woke up with my knee really bothering me
<br/>again. By last night it hurt to climb the stairs. Since I haven't
<br/>done anything to aggravate my knee, I was wondering if it could be
<br/>associated with the Enbrel somehow?"
<br/>
<br/>
<br/>26) *8/20/01: "I'm not experiencing anything like you, but my knee is
<br/>hurting so much since my first dose of Enbrel (2nd one this morning,
<br/>and I even did it all by myself!!! What a relief that was!). This
<br/>afternoon I can't climb stairs, and I have aches in my hip joints."
<br/>
<br/>27) *8/22/01: "I'm sorry you are having such scary side effects from
<br/>the Enbrel. I had some pretty strong side effects as well when I
<br/>restarted the Enbrel after a month break. Mine were lower back pain,
<br/>pelvic achiness, restless legs, major fatigue, and an overall yucky
<br/>feeling. It lasted for about two weeks. I know it was from my NKU's
<br/>fighting back."
<br/>
<br/>28) *8/27/01: "You were right - my knee pain got slightly worse but
<br/>now after my 4th injection this morning, I don't feel a thing in my
<br/>knee!"
<br/>
<br/>29) *9/8/01: "Anyone experience night leg cramps. I've never had one
<br/>in my life until the past two night I've awaken with a horrible cramp
<br/>in my calf. Maybe just coincidence or Enbrel?"
<br/>
<br/>
<br/>30) *9/9/01: " I do know that as soon as I started taking Enbrel I
<br/>felt terrible all over. Headaches, joint pain, fatigue, etc. As soon
<br/>as I stopped Enbrel I felt better."
<br/>
<br/>31) *9/11/01: `I also have terrible leg pain and I can't turn my head
<br/>to one side because of neck pain - I think due to the 6 Enbrel
<br/>injections I've taken so far?"
<br/>
<br/>32) *9/18/01: "Once I restarted Enbrel after the transfer, I had
<br/>pains abdominal and lower back and lots of nightsweats"
<br/>
<br/>
<br/>

说到具体费用就我个人而言，前期产检费用一共$3381.5，除去医保cover掉自付$706.54。分娩当天加之后住院两天费用一共$11383，目前保险公司核算还未给出结果，但据生完的前辈们讲，一共下来差不多$2000左右，如果剖腹产，费用可能要再增加50-60%。当然，这个自负的部分跟你的医保有很大关系，如果你的医保好，比如工作了的人，很多都是一人工作，全家都有医保，而且福利好的单位给员工上的医保也很好，自付部分自然就少，cover的种类也多。我这个是学生医保，相当烂的说，能cover这些也已经不错了。
<br/> 6.        其他的一些福利
<br/> 就我从怀孕到现在，也申请了一些福利项目。比如有一个妇婴计划，从怀孕开始，孕妇
<br/> 每个月可以免费领到一些必须的营养品，包括每月4个加仑的牛奶（将近30斤，反正
<br/> 以中国人的喝奶速度是绝对喝不完的），一打鸡蛋，一包全麦面包，两大盒麦片，一瓶花生酱，10刀的水果蔬菜券，1.78L的橙汁，一斤豆子，差不多这些吧，一共加起来一个月不到一百刀的东西吧。孩子出生后，一个月会给四罐雅培的奶粉，还有一些纸尿片之类的。孩子出生后，只要在美国，也需要缴纳医保，但是他作为美国人，就可以享受美国公民的一些福利了。我们给孩子申请了相关的医保，就不需要额外的缴纳孩子的医保了。当然，作为一个在美国的一个外国人，我们能够享受的福利很有限，如果是US citizen或者resident，可以申请的福利项目就更多一些。
<br/>     基本想起来的也就这么
<br/> 文章来自: 播种网社区( www.bozhong.com) 详文参考：http://bbs.bozhong.com/forum.php?mod=viewthread&tid=36398082

所以我太理解你在上海看病的情况，说真的，你没有想过申请个签证来美国生孩子吗？只是来这里三个月孩子生好再回上海。9月底我一个上海朋友来美国生孩子。本来是打算上海生的，后来听了我建议。全家申请旅游签证。我在这里帮他们租了房子，他们来以后找了产科医生，10月底顺利生了可爱的女儿。LA是美国生孩子最便宜的城市了，顺产三千多美金，跑妇产五千多美金（只收现金）。就是因为来美国生孩子的太多，这样的医生也很多，所以市场都很成熟，其实你也可以考虑一下。如果你决定来美国生孩子，建议别住月子中心，我去视察过一次，一个房间至少4500，跟鸟窝一样，吃的就是大锅饭，说真的我看的都吃不下去。宁可来这里租一个房子，请一个月嫂都和这个价格差不多。另外，我前几天听我上海朋友讲，今年上海生龙宝宝的人比去年多很多，孕妇都要在怀孕6个月的时候开始预约产房（这是长宁妇保院的消息）。如果你决定在上海生，还是要早点做准备哦。
<br/> 文章来自: 播种网社区( www.bozhong.com) 详文参考：http://bbs.bozhong.com/forum.php ... ;page=3#pid25954536