The Caterpillar, the Biologic and Rheumatoid Arthritis

I recall my grandfather looking at a Caterpillar bulldozer sitting in his yard at the lakefront property he owned. No one lived at the cottage.

The cottage was used on weekends in the summer, and it was always a place of physical labor for my father and grandfather. They reinforced the sea wall, built piers, and added structures. They did this every year to attempt to hold back the winter flooding. The property was the source of more challenging work than leisure. Their annual summer of challenging work never changed a single thing.

Showing up out of no where

Then unexpectedly, a Caterpillar bulldozer with a large blade showed up on the property one day. My grandfather did not order it and could not afford to rent it, yet here it was. The keys were in it, fully gassed up and just sitting there. When I asked where the tractor came from, my grandfather said it was a puzzle. It just happened. As he got on the tractor seat and started it up, he started pushing dirt around the property. My mother said it was a classic conundrum and its appearance seemed almost mystical.

The connection to RA

This tractor showed up when needed and stayed as if required.
Two weeks later, the tractor was gone. It left as quickly and secretly as it arrived. There was little evidence of it having been there except for my father's photos. My grandfather never received a bill, notice, or even an inquiry about why he had it. I think biologic medications are a lot like that.

Disappearing symptoms and tractors

When taking Remicade for the first time, I felt lousy after the infusion. I had the infusion and I went home with no noticeable improvements. I was not healed when I left and I felt worse for a few days, but slowly, like the tractor that goes away, the stealth action is working. In a week or so, I was back to my regular self.

The transformation was so amazing when I got Remicade over 20 years ago. I would run through the house singing I am free from the rock opera Tommy:

I'M FREE- I'm free,
And freedom tastes of reality,
I am free-I am free,
& I am waiting for you to follow me
I am free-I am free
And freedom tastes of reality
I am free-I am free
And I'm waiting for you to follow¹

Now I know it seems ridiculous to go around singing that song while occasionally leaping as I went, but that was exactly what it was. Remicade released me to be me. It was like RA was a magic lock, and the Remicade key just fit. At first, I could go for 8 weeks and feel great. But then gradually the time decreased. Slowly, I needed the infusion every 7 weeks, then 6 and 4. The lock was getting more stubborn.

No longer free, but still grateful

Then, as if by magic, the key no longer fit. The respite of relief lasted almost 6 years and I was forever thankful. Imagine one day the key worked and the next the key did not. After the infusion, I was no longer free. Not even for a little bit. My Rheumatologist was sympathetic and asked if I wanted to change medications. At first, I was stubborn. Make that key fit, I said. I deserve that the lock be unlocked.

Eventually, I had to give in and move on. But what I never gave up on was how I felt about Remicade. I am on my fifth biologic medication now. But when people ask me what gave me the best relief, I am unequivocal. Nothing was as good as Remicade and how it made me feel with those first infusions. I hope you feel free when you take your medication. I hope you feel free after that injection, infusion, or taking those oral DMARDs. I hope you can sing the song "I'm Free" from the rock opera Tommy.

One more thing...

Oh, and I forgot to mention. The Caterpillar tractor: it turns out it was delivered to the wrong address, and it was free for those two weeks. Now my grandfather did offer to pay for the fuel used. That offer was declined, of course. It was the 1960’s and diesel cost $0.12 per gallon.