That's me today. Let me tell you why.
Maybe a tempest in a teapot but nevertheless it left me distressed and a bit angry.
I had an appointment to get my second eyeball injection of avastin for the macular degeneration in my right retina. I had the first injection October 17th and it went fairly well even though I was a bit apprehensive on a couple of scores. My retinologist that has been my specialist for years and years was not available at the office I normally use. This group has five office locations over the metro Phoenix area. I haven't counted the list of specialists in the practice but the list frosted on the window glass of the office lists them all and there may be ten to fifteen. My opthalmologist on October 16 decided that what he was observing required immediate attention so even though I had a standing appointment with my usual retinologist on the 23, he said not to wait and through his office he arranged for me to see another of the retinologists at the office closest where I normally go. To go to my regular one would have been a very long commute through the worst of Phoenix traffic. So I chose to see the new one after being assured by my op doc that he also was a top notch specialist and I confirmed that to my satisfaction by checking his credentials online at a website that the group maintains. The imaging (both fluorescin and OCT) confirmed that my dry AMD had morphed into wet and that I would most likely benefit from the fairly new treatment of eyeball injections with avastin and if that did not help retard the problem or eradicate it, then the other med would be tried. There is a professional and marketing hassle going over the use of avastin and lucentis, both developed by Genentech but only the latter has been FDA approved for AMD use and Genentech does not want the specialists to use the alternative. The price differential is immense. So you can see that the higher profit is likely in the higher priced one. I haven't seen a claim process through my coverages yet, but the figures mentioned were something like the avastin only costing about one-third of the other. I have no problem with using the avastin......I knew before hand through searching on the net of all this.
The procedure was tolerable and the eye area felt bruised and uncomfortable for four or five days, then there is aftercare routine of eyedrops, etc. which are more a nuisance than anything else. The newbie doc was very skilled in doing the injection and the nursing and tech team also seemed very well co-ordinated. The problem that day was that I got misplaced on the human conveyor belt of handling a busy practice and the tech that handled the OCT imaging had never worked at the location previously and did not know where to find me when my turn to be imaged came up, he went to the front waiting room and called for me but the nurse tech had sent me to wait for that procedure in the back waiting room that the OCT guy didn't know existed. Finally it was noticed that I was in that waiting room a long long time, before someone asked me if I were waiting for another patient, (it turns out this is the newbie doc) so I said "I am a patient and am waiting for my OCT imaging, so he got that straightened out. This consumed much more time and I was there for over four hours and by the time I received the injection the short winter daylight was disappearing.
I had been assured by both my opthalmologist and the retinologists' staff that I would be able to do my own driving afterwards. WRONG!!! It was like driving blind, the riskiest thing I have ever experienced. From all the dilation, the headlights, streetlights all literally blinded me. I had enough forethought to not take the freeway, thinking if I ran into a problem it would be easier to be driving at the slower speeds on the arterial streets, but the frequency of the traffic control lights only added to the difficulty. I made it home safely but vowed that my next appointment would not be in the afternoon.
So off I went today for the 10:45 a.m. appointment. After the routine eye exam, dilating, OCT imaging (skipped the fluorescin image this time) - I was prepped for the injection. Only this time I felt they did not get the eyeball numbed completely and remarked to the tech that I could still feel the burning of the numbing drops etc. and I repeated that observation to my regular retinologist when he walked in to inject the avastin. He did not inform me of what the imaging showed etc, which I expected. He did the injection, and it was much more felt than the initial one in October. I was also a bit ticked because I wanted to know how the imaging compared so when the tech came back to clean up the eye I told her I wanted information about imaging results so off she trotted to fetch the doctor, but he was involved with another patient and soon another strange doctor came in, introduced himself, said he reviewed the imaging and that there was no decisive change. So much for technology. I knew that over the time since the first injection that I could not detect any positive improvement but I thought the superiority of the OCT process could be more definitive.
I dawdled taking my time at the elevator and took my time getting to my car in the darkened parking garage - letting my eyes readjust, had on dark glasses but even after sitting in the car for around fifteen minutes and munching some crackers and quenching my thirst with the water I always have with me.......the vision was still bothersome, the right eye useless and the left was like looking through frosted glass. So again I took to the streets with a bit of trepidation and a determination be totally focused on driving safely home, which I did....but next appointment I do plan to make arrangements for a spare driver.
The whole experience left me with ruffled feathers. Now I am faced with whether I want to tell the office that I want any further injections to be done by the doctor that did the initial one or stick with my regular retinologist.
There is more. When given the aftercare sheet indicating the eye drop schedule, it was entirely different from the first. When I questioned that, the nurse says each doc has his way of doing the procedure and the aftercare! With the first - two different types of drops were used for a week, One an antibiotic to avoid infection the other a prednisone type, used for a period of a week four times daily after the first day when you dose on an every two hour schedule. This second instruction uses only the antibiotic for four days. No prescriptions were offered so I questioned whether there would be enough from the small bottle of the antibiotic one scripted the initial time to finish this time. The answer I got was that the orginal normally is written for two refills and if not to get back to them. In retrospect I should have checked with the pharmacy - that 20/20 hindsight stuff - and I had not taken the original meds along to the appointment since they are refrigerated. Soooo- you guessed it-- there are zero refills on the original so twice I tried reaching the office to tell them to call a new RX into the pharmacy and couldn't get through, put on hold and either dropped or forgotten. Perhaps overnight I will regain some patience, but this is big on inefficiency and low on the previous standards that I have experienced through the years at this office and by my regular retinologist. And how do I solve the possible professional egos that seem apparent, or am I imagining that?
Groan.......I don't appreciate being in this position. Time is so lacking for these specialists in high demand that I can't do what I would like which is sit down with my opthalmologist and sort it through with him, he knows these pros......and should appreciate the patients point of view.
I guess when I get in touch to have the script renewed I will just broach this matter with whomever I get on the phone and see what is advised.
graysmoke
