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3184673 tn?1347154895

Doctor vs. RN for visits

Well. Everything is finally ready to go. My dr told me he wanted me on Riba weight based. My insurance co says SOC is 800mg for G3 so it will not cover 1200mg daily. Good news is the RN I am working with said if the dr is adamant about me being weight based, she will provide me the Riba free of charge.

So other than that, I am set to begin tx this Sunday. Excited and nervous. The question I want to ask is, I was given a choice, I can make my appts during tx with my RN/PA or I can make them with my hepatologist. My Nurse has been working with people in tx for over 10 years and her appt scheduling is much more flexible. But, my hepatologist is obviously a doctor.

So who should I make them with? Also, my nurse would obviously have more time for me during an appt than the hepatologist would. Am I best off cutting out the middleman (nurse) and working with the dr? Or would I be ok with just the nurse. I am g3 and will only be doing the pegintron and ribavirin, but I have hemochromatosis which could complicate things. I'm kinda torn about what is best.

Thanks so much.
Jeanie
16 Responses
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Avatar universal
The nurse should be fine.  They don't do any procedures on you during your visits and the nurse will undoubtedly give you more time, support.  I'm sure if you run into big issues, you can always request to see the doc.  Good luck.  Hopefully you'll do great.
Helpful - 0
163305 tn?1333668571
I was seen monthly during tx and rotated between the hepatologist and the hepatology NP. Perhaps you can do the same ?
Helpful - 0
179856 tn?1333547362
PAs are great, Most of us treated that way. Learn what you need to know then if anything seems out of line, you can ask for the doc. But if she's been doing it this long.....hopefully she's well informed.

I was a G1a and B so I'm not sure of the SOC rules of a G3 but sometimes G3 can be a real pain, as hard as a G1 so I'd personally treat as aggressively as possible, at least at first.
Helpful - 0
766573 tn?1365166466
I alternate between the two. There are times when you want extensive Q&A with the nurse (who is more than qualified to guide you through therapy); then there will be times you want to talk to the doctor himself. If for anything to hear it directly from the horse's mouth, as the saying goes.

________
I was under dosed the first time I treated with only 800 mg of RIBA and my doctor gave me a bottle of Riba. I was standing there and he opened a cabinet full of HCV meds. It was a little too late in my case. I am glad the nurse is reasonable and recognizes you ought to at least start out on a higher dose.
Helpful - 0
1840891 tn?1431547793
I just completed 48 weeks of triple tx, and other than the visit before starting tx I only had one office visit with my hepatologist the entire time, and zero visits with any nurses or pa's. It worked fine because my doctor was almost always very much available via email or telephone. He put in standing orders for the blood tests and he posted them on the web for me within a day or two, along with any comments, questions or requests for extra tests whenever my numbers looked particularly bad. I emailed him whenever I had a non-urgent question and got a reply within two days, or I telephoned if it was urgent, like when the telaprevir nausea had me barfing up my meds and I needed Zofran ASAP. I would think the regular visits with a nurse would be perfect as long as your hepatologist can give you ways to contact him directly if you feel the need. Good luck!
Helpful - 0
3184673 tn?1347154895
Thanks so much everyone for the input. I think I'll stick with the Nurse and if anything is wrong, or out of sorts, I'll get in with the Doc. I did really like her, she was very comforting and she spent over an hour with me at my teaching letting me write everything down, and help me to set everything up. And it sounds like everyone's had good experience with them. =)

Thanks everyone =)
Helpful - 0
Avatar universal
Your NP sounds like she is on the ball and I agree about tx agressively with the Riba.  Did you happen to ask her about the Hemo?

Jules
Helpful - 0
Avatar universal
  If I were you, I would schedule a visit with your Hepatologist, 5 weeks after your Treatment begins, so he can answer your questions, concerning your 4 week viral load and other labs. At that point, if a potential problem has cropped up, concerning the hematomachrosis,  that specialized topic can be addressed.
   Other than that,  the NP sounds great, good luck starting Tx :)
Helpful - 0
Avatar universal
" At that point, if a potential problem has cropped up, concerning the hematomachrosis,  that specialized topic can be addressed. "

***********
Bo, this should be addressed BEFORE tx.

Jules
Helpful - 0
3184673 tn?1347154895
I did ask her, she told me that she's only had a few patients with the hemochromatosis and that some responded well to tx, some didn't. She said that more often she sees them relapse after tx though. Since I am G3 she said she is hopeful and I should def see Someone following tx for phlebotomies to keep it in check and that will help.
Helpful - 0
Avatar universal
The NP saw my husband monthly, or more frequently as needed, throughout all treatments.  She was kind, knowledgeable, efficient, got back to phone calls on the same day, called in prescriptions on the same day, took time with each appointment, called personally with any important information such as VL, etc.  The hepatologist sees my husband more infrequently, at 6 month check ins on or off treatment and at decision making times to discuss options and decisions.  This system has worked wonderfully well for us for the past 5 years.  Also, since the NP works directly with the hepatologist, she can ask her questions immediately and get back to us same day.
Advocate1955
Helpful - 0
Avatar universal
"Since I am G3 she said she is hopeful and I should def see Someone following tx for phlebotomies to keep it in check and that will help."

**********
Since your NP is "hopeful" I would want to hear something a little more concrete.  Also she said you should see "someone" for the phlebotomies...you should be seeing her for the orders.  

Bashly I am just trying to be helpful her. I wish you the very best during tx.

Jules
Helpful - 0
3184673 tn?1347154895
I understand, it's ok. She didn't tell me who to see since she is not sure who is in my network. I have an appointment with my PCP to discuss going into tx and also my hemochromatosis. Although she did warn me that I would not be basing my time on tx by my genotype because of this. She said I may have to do the 48 weeks and that would be decided by my viral load at certain points. I asked her what the chances were of longer tx and she said not to stress about it. We will cross that bridge when we get to it. I have a big problem with stressing and constantly asking what if? Guess I hate not being in charge of what's happening to my body lol.
Helpful - 0
Avatar universal
Hi Bashly,
Just as an FYI, generally speaking most PCPs are not very knowledgeable about Hep C.  They may have some general information, but most do not have up to date information or have an understanding of the specifics about Hep C treatments.  Perhaps your PCP has more knowledge than most, but that hasn't been my experience so far over the past 5 years.  If I were you, I would ask him/her about experience and knowledge with Hep C.
Advocate1955
Helpful - 0
3184673 tn?1347154895
Oh I'm not seeing her for the hep c. She is the one I see for my asthma and such. She said treatment can be rough so she wants to see me more often during tx. She has a basic knowledge of hep c but not enough to treat it. Lol. I usually only see my PCP for referrals, med refills and basic stuff.  
Helpful - 0
Avatar universal
Oh, that's good.  It sounds like she's a good PCP if she wants to see you more frequently while on Hep C treatment.  
Your hepatologist (or the NP) will probably be checking your counts (white blood and red blood) every week in the beginning of treatment, and then probably every 2 weeks if things are going well.  Be sure to ask for copies of your labs to share with your PCP.
Advocate1955
Helpful - 0
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