Visiting your MO

[fourputt]

From a practical stand point, with the communication abilities we have today, is it really ever necessary to meet personally with your MO after your initial visit ? I don't see why one's treatment couldn't be overseen by an MO a thousand miles away just as well as one who's just across town. I apologize up front as I'm sure that I'm behind the times and this a stupid question but it looks like I may have to change MO's although I don't want to (currently using Dr Sartor) and I'm not sure how I should proceed.

[mrscruffy]

Don't see why you can't do that but in the end I guess it is with doctor approval. I prefer in person myself

[fourputt in reply to mrscruffy]

Oh I do too, it just appears that may logistically difficult from where I'm located. I haven't given up finding someone in my area (central Mississippi) but just trying to lay some ground work for if I can't. Thanks

[Tall_Allen]

As misguided as it sounds, some states have laws against televisits with out of state patients. Don't tell anyone I said this 😆 but if you lie and just say that you are currently visiting friends in state, they won't check your ISP.

[Concerned-wife in reply to Tall_Allen]

gosh, I wished we’d figured that out earlier. We respected his out of state doctors but they said no more video consults.

I did read some people driving across state border and sitting in parking lots to achieve this

The interesting thing is most of the important cancer centers offer virtual second opinions with ..large out of pocket charges but won’t do for insurance billing. So they figured out a way

[tallguy2]

my MO’s in Houston and Georgia cannot practice medicine in Tennessee. Not even by virtual visits. They can order prescriptions, however. So for my upcoming Pluvicto infusions I had to establish a relationship with a local MO to manage my pain, transfusions, etc. in partnership with the Pluvicto MO who is in Georgia.

[EdBacon]

One thing that many people do is have a local oncologist they see and also someone who specializes in PCa that is part of the team. They and/or their oncologist can consult as needed and the patient can stay in their local area for the most part.

I would think that doctors would be opposed to an arrangement where they don't physically see the patient. There are a lot of subtleties that a good doctor can pick up by seeing the patient and examining them in person.

Wishing you the best.

[fourputt in reply to EdBacon]

Thank you. At this point I fortunately can travel anywhere I need to to see a doctor as often as he thinks that's necessary...and will. Since the pandemic started though I've had to do a number of tele visits and it's all been good and wondered if going forward I might be able to find an MO who'll allow tele visits to be part of my treatment regimen from the start.

[Kittenlover50]

I prefer in person. Everytime I have written to Mayo, I get the Nurse Practioner, while we only see ours once yearly we travel the , 1500 miles to see Kwon but been with him since 2014. You could always stay with yours, I think the distance is probably less than ours.

[Drandma]

we are also in central Mississippi and my husband sees Dr. Sartor. He is scheduled for a scan on February 24 and a televisit on March 13. Wondering why a televisit from LA to MS is okay but not from Mayo to MS. My understanding is that Dr. Sartor will no longer see patients in LA after the end of March.

[fourputt in reply to Drandma]

I, like many others, am still in shock that Dr. Sartor is leaving Tulane given his long history in Louisiana. I 've been to his office a number of times and I have never met a harder working more passionate doctor who is "in to" what he does than him. I would call him a doctor's doctor. He'll be sorely missed at Tulane and the the city of New Orleans. Mn. is a long way from me but I'll make the trip if he continues to see patients.

[Time2talk]

Their is one note, your insurance may not cover the full expense. I travel 7 months a year so I need to use a teleconference communication to discuss test results. It works and I actually enjoy the call much more than going to the doc. Office. But my insurance makes me pay $45 for the visit.

[hfl20]

I had this same concern since I chose to travel 500 miles for my cancer diagnosis and treatment (after initial MRI diagnosis in my home city). Besides the cost (about $1k min for a trip whether I fly or drive) and the time (a couple of days minimum), there is the added exposure when traveling to viruses, bacteria, foodborne pathogens, etc. that may cause complications since I'm already compromised. And this is true for an appointment that generally lasts at most 15 to 30 minutes with the doctor.

Video visits and telemedicine are offered at MD Anderson where I go, but this state line nonsense won't allow me to schedule one from Oklahoma. I live in Tulsa about 80 miles from Kansas, Missouri, and Arkansas so I asked the scheduler if I could “temporarily reside” at a hotel, my rv, or wherever in one of those states for a video or telephone appointment and found out that Missouri and Arkansas would work just fine. I ended up flying to Texas anyway because other appointments were added for more testing.

After my initial visits with the MO, he is now fine with telephone visits regardless of where I am and I recently got a notice on mychart of an upcoming video appointment in a few months with my RO. While I was staying in Houston for my 8 weeks of proton radiation, I had several telephone and/or video visits from doctors and other medical personnel and though I was only a couple of miles from their office(s), it was far easier than driving, parking, checking in, waiting, triage with a nurse, waiting some more, etc.

I think for initial visits during diagnosis and treatment planning it's probably best to meet in person, but for routine short visits during treatment and followup check-ins to discuss bloodwork results, etc. the video and telephone visits are far more appropriate and better use of time for both doctor and patient.

I just looked back at my schedule and note that I made 4 trips for diagnosis and treatment planning (3 were for a week or more with various scans and appointments with urologist, MO, and/or RO) and a 5th to move into an apartment for 2 months of treatment. I will be getting my bloodwork done here in my home city, following up by telephone or video visit, though willing to go to Texas for any further scans or concerns that warrant the time and expense involved.

As for getting around the issue of “where you reside” as a requirement for scheduling a telephone or video visit, a simple VPN on your device (phone/computer/etc) can provide you with an IP address anywhere in the world even if they have the capability to use your IP address to check. I use PIA (private internet access) VPN and can select locations for an IP address in any state or country.

[fourputt in reply to hfl20]

Great info . Thank you very much.

[EdBar]

I’m also a patient of Dr. Sartor, and I too was saddened when I heard of his move. I live in the Atlanta area and traveling to NOLA was not a problem but MN is quite far away. I asked him if we could continue via telehealth etc. to coordinate my treatment with my local MO however he told me that he didn’t feel it was appropriate to manage patients that he never sees, and I totally get it given the impact advanced cancer treatments can have on one’s wellbeing.

I’ve decided to follow him up to MN and see him at Mayo either once or twice every year. For me being willing to travel to see the best qualified doctors like Snuffy Myers and then Sartor has benefited me greatly so I’m going to plan on continuing to do so.

Ed

[fourputt in reply to EdBar]

Thanks, I can make it up to Mn. a couple of times a year if that's what it takes. I'm going to stay on this.

Thanks again and best of luck to you !

[EdBar in reply to fourputt]

When he was at Tulane he offered to see me just once a year since I’m doing pretty well but I opted for twice a year to keep the relationship solid and because I like poboys and beignets 😀 I’ll bet once a year will be sufficient unless things start going sideways.

Ed

[Zengal79]

We ran into this a lot in the past year. With the state licensing laws and insurance issues, access to telehealth is becoming less available rather than more available, unfortunately.

It was a great physical hardship to travel to California for a second (or third or fourth 🤪) opinion from Tanya Dorff. She could not do virtual due to not being licensed in Illinois. So we flew to California in spite of the physical difficulty it was. There was nothing that would have been different about her recommendations virtually. All she needed was the scans and labs which she had already.

I ended up driving and hour to the Indiana border for my weekly therapy visits due to my therapist not being licensed in illinois. The software knew what time zone I was in and that scared me enough to quit fibbing about my location.

For most things, I prefer to be seen in person. However there are many circumstances where telehealth is more preferable and it’s unfortunate the direction things seem to be going. Best wishes to you!

[spencoid2]

It is a 10 hour round trip to my MO so most visits are virtual. Occasionally pair with chemo but then need to stay overnight so there is a real benefit to virtual. However it is occasionally helpful to have an in person checkup.

[Ian996]

I have a monthly phone call with my MO and he is local. My RO on the other hand is at UCLA

and we communicate by e mail and zoom meetings and that works for me as UCLA is over a thousand miles away from Vancouver BC

[gsun in reply to Ian996]

Why do you have an RO at UCLA? Nobody in Vancouver fits the bill?

[Ian996 in reply to gsun]

This is a long story but here it is

A CT scan showed 1 lesion on my L1 in late 2020. I asked my local RO if there are more and about the availability of a PSMA Pet scan He said scan is not readily available and not recommended because they might find more. To which I said are you F@#King kidding me. I asked can I get the scan in the USA . He said sure you can but you will have to pay for it, I did some research on line and discovered UCSF and UCLA had just received FDA approval. I reached out to UCSF and UCLA. UCLA responded quickly and said come on down. 2 weeks and $3200 latter I had the scan. and a follow up consultation with DR Rettig, He informed me I had mets on L1 T9 and T10 I was diagnosed as being oligometastatic. He recommended SBRT. I asked my BC Cancer RO about SBRT and he said no Lets just wait and see what happens. I said no not waiting Meanwhile my PSA was 14. I made the appointment had a zoom call with Dr Kishan and on June 29 2021 I had the SBRT to the Mets. Since then I have been in frequent contact with Dr Kishan, I stared Extandi in late May 2022 my PSA dropped but started rising again. A recent CT scan showed more Mets on T4 and T6. I am currently making arrangements for another PSMA PET to be followed up with more SBRT provided there aren't more than 5 lesions

So... BC Cancer are non responsive to my concerns They don't provide the scans or the treatment

UCLA exceed my expectations. I have a high degree of confidence in them

[gsun in reply to Ian996]

That's messed up. i am at BC Cancer. Been OK so far but I am responding to ADT + Abi for a while now. I am gathering info for when it doesn't work anymore. Thanks for the info.

[Ian996]

we should talk

[LifeQuality]

I've never seen my MO in person! I've only consulted with her via Zoom, and she has no trouble pulling up scans for us to discuss, etc. Maybe it's just my situation, but I haven't encountered a need for her to physically examine me. (Now for my PCP, I'd never put up with not seeing her in person.) And maybe it's because I'm in Kaiser, that has it's own electronic messaging system, but I've consulted online with my MO when I've been traveling in British Columbia as well as a couple of other states, and there have never been any barriers. She messages me after each monthly blood panel, talks to me about how I'm feeling; I don't think I'd get in to see her that often if I had to rely on in-person visits.

[j-o-h-n]

Good idea to visit if your M.O. has a pole dancer performing in the waiting room....

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 02/20/2023 10:08 PM EST

[pdold]

I live in central FL and was dx'd in 2018 with a surprise increase from psa in low single digits to 1700 14 months later. While I first went to the local cancer center where I actually knew the MO for work reasons, after a few months I just didn't feel that this was going to be my best choice. liked the Doc but the facility kept making errors (lost an MRI??) Since I had grown up in NYC I knew the reputation of Memorial Sloan Kettering from family experience. This is my 5th year with them and I'm quite satisfied. I handle the distance by establishing local support with Tampa's Moffit Cancer center which also has a very good rep. As long as I can continue to use telemedicine to MSKCC and the Moffitt facility for clinical support (Labs, Scans, an occasional Lupron shot and some conversations with a likeable MO I will continue to vis t NY periodically for several checkups /yr and my basic treatment planning. The biggest issue I've had was being (with my wifes help) my own Care Manager for a complex illness. It takes reading, membership in this group and careful documentation but for a guy with Advanced PC and 5 years on Lupron. Zytiga and Prednisone, I feel pretty good - Some mets, but luckily no pain and stable numbers for labs. Bottom line is that with good care and local support, the 1200 mile distance is workable.

PDOld

[fourputt in reply to pdold]

Thank you. That is very encouraging and what I wanted to hear and I wish you the very best of luck on your journey.