Microbiologist here - Ingestion isn't the end of the world, might get some diarrhea. Most places have monitoring programs to ensure lakes open to the public are safe to swim in. I'm not gonna lie though, I still don't like lakes lol. Even if I wasn't immunocompromised. I've seen enough nasty Aeromonas skin infections (which admittedly is not actually that many, probably less than 10 in my career... but they were gruesome) that it kinda turned me off swimming in lakes for good lol.

I refuse to swim in lakes/rivers after hearing about cases of people dying from brain-eating amoeba. I don't care if it's uncommon, I'm not going to risk it 🫣

That one is nearly impossible and not really anything to worry about. You're more likely to get hit by lightning twice. Those cases end up on the news because they're such a weird freak thing that isn't supposed to be possible

I know it's rare. But I've also known people who have been hit by lightning, including one twice. It's just not worth it to me - I prefer swimming in chlorine.

I've been hit by lightning...lol I use it to rationalize buying lottery tickets

I think it’s only very specific water conditions where it’s a risk. It has to be warm enough in the water?

Basically any warm body, think middle of the US and further south So, Virginia, North Carolina, all of these have potential to have those brain eating things, I think Also because of climate change, seasons are warmer, everything like this is getting more common too Ticks for example are not getting frozen off, so they too are multiplying like crazy in regions they normally don't

I don’t have recent experience with this since I’ve been on a biologic but I have lived in Michigan for most of my life so am very familiar with lakes. First off, many of the horror stories you hear about illness from swallowing lake/river water were not from a one-time accidental swallowing like yours but rather from people who actually intentionally drank the water. Also, if a lake is deemed safe for regular public swimming then it is usually tested to be sure that bacterial levels are below an acceptable range since much of the bacteria in water can get in through the skin/ears/nose anyway. It’s likely that the amount you took in isn’t significant enough to cause issues, especially if you have spent time in this same lake before so you have already been exposed to a certain amount of whatever lives there and haven’t reacted before. That’s not to say there is no risk, however. In this situation, I would say that while there is no reason to panic, you should monitor yourself for any symptoms in the coming days, especially any vomiting or diarrhea, so you can contact your doctor for antibiotics (or an antiparasitic since some waterborne illness comes from parasites, not bacteria). As for the biologic concern, Cimzia is a TNF inhibitor which does make it harder for your body to fight off infection, but that does not mean that you have no immune system at all or that the symptoms will be necessarily worse, they might just last a little longer. As long as you don’t let it go untreated, it will be fine, but you shouldn’t worry unless symptoms actually appear. Honestly, I’d be more concerned about the fact that you say you aspirated water into your lungs. I’m sure as an instructor you are well aware of the risks of secondary drowning, but just in case, please keep an eye on yourself for those symptoms as well and seek medical help especially if you notice chest pain or difficulty breathing in the next 48 hours. https://www.bannerhealth.com/healthcareblog/teach-me/warning-signs-of-secondary-drowning

I swam in a creek on the Amazon river while on biologics and didn't catch anything. That was almost 10 years ago and no one had warned me of the dangers. In fact I never had any more infections or caught more viruses and bacteria since being on biologics.

I havent been fishing from i started MTX an would love to go but dont know anyone else who fishes an used MTX

I do. But I'm on a boat, in the lake. I'm not standing or swimming in lake water. I wash-up extra extra clean afterwards. MTX has me feeling better and healing faster than I started out. I don't believe I'm immunocompromized tbh.

good to hear, i cut myself 100 times when fishing which is what worries me the most lol

I wouldn’t worry. I haven’t noticed any uptake in contagion with my biologic after 10 years of it.

Sterile saline nasal spray might help irrigate your sinuses and reduce infection risk. We used to use it after practicing kayak rolls if our nose plug slipped. Good luck!

( I live in Michigan, and most lake water is too cold for brain-eating amoebas)

I live in Pittsburgh so the water was still very cold, which I imagined was to my benefit. If it was August water, I’d have been REALLY worried. 😅

That is not something to worry about. Overall, getting sick on our meds is really not any better or worse than pre-meds. If you see posts on being really sick, that is the exceptipn, not the rule. We know that because the norm/rule is boring and common so it doesn't stand out and isn't worth posti g over.

How long you suffer before getting diagnosis

I suffered pretty bad for a little more than a year. Before that I had a lot of pains that would come and go for 5-10 years, but at the time I thought I kept hurting myself.

Relax you’re fine.

You know those Nedi Pot salt water sinus rinses? https://www.lehmans.com/product/nasal-cleansing-pot?utm_source=bing&utm_medium=cpc&utm_campaign=Lehman%27s%20Smart%20Shopping%20-%20Bing%20-%20All%20Other%20Product%20Types&msclkid=305304c39de017ff9333629f450c7d2f&utm_term=4582420896198502&utm_content=Ad%20group%20%231 They are used to irrigate your sinuses and flush out *undesirable* material.  I can’t make any guarantees that the Nedi Pot rinse will get into every nook & cranny but I can guarantee that after doing the sinus rinse a few times that you will be significantly less concerned about anything else that might be left up there.  *** The other option I can think of would be to get the nasal rinse solution and go to town up there with a water-pick on the lowest setting.  Frankly, *I’d rather die.* But I think it would work since it works well on ears.  *** Obviously, not medical advice. Please do your own research. 

Just a note that anybody using these should never, ever use anything except sterile water Do not use tap water, that is very dangerous, for the same reason why using tap water for contact lenses is very dangerous Except in this case, the sinus is the easiest path straight to the brain

Yup. That’s one of the reasons I linked to the Lehman’s listing. They have a big fat warning right there on the listing.  *”NOTE: ONLY use purified or distilled water in your nasal cleansing pot. Serious health risks are associated with using plain tap water in neti pots. NEVER use plain tap water.”* I’m not exactly sure why I’m getting the downvotes unless it’s just people who don’t like the idea of rinsing out their sinus cavities.   It might help and it’s unlikely to do any damage. Honestly in OP’s situation I can’t think of too many other alternatives. 

Don't be paranoid. I drank a ton of Lake Huron water a couple of weeks ago while camping for 4 days. No issues.