Consequences for missing shot?

[Kathy73]

I was supposed to get my prescription for Pegasys yesterday and it didn't come. When I called Curascript they told me they were supposed to notify me that my doctor hadn't sent int he prior authorization form for insurance. Then I called my doctor's office and they said the insurance wouldn't approve until they had my 12 week blood work. Long story short my doctor's office is terrible. When I saw them a week ago they never told me anything was needed for insurance. Now the PA is calling Curascript to see if they will release my meds. I was supposed to take my shot last night. It seems obvious that I won't be receiving it today or probably tomorrow either. What to do???

[Kathy73]

I wish mine did...they don't have a clue as far as being competent. I'm switching doctors!

[jankar]

My pharmacist keeps spares in the fridge.

[HectorSF]

"5 log drop at 4 weeks"! That's awesome! That is an excellent response.
Glad you got the med. You should be okay.

Make sure you always have your meds in the future. ;-)

Let us know the results of your HCV RNA test.
HectorSF

[Kathy73]

I just took my 12 week bloodwork so I don't know if I'm UND or not until they call me. I had almost a 5 log drop at 4 weeks so I'm hopeful. My normal day for my shot was Thursday and I didn't get the shot until Saturday. I hope that won't affect the end result. I have an appt for another hepatologist tomorrow and am hopeful that he and his staff are better. The problem is knowing if the are any better until they screw up and then you know!

[HectorSF]

nygirl7 comments are always right on target.
Yes, we have all learned through experience how things can go wrong. So extra Interferon in the frig is good insurance.

Your experience reinforces my point to everyone about getting a good doctor BEFORE you start treatment. We are all dependent on our health care professionals to a greater or lesser extent while being treated. It takes BOTH a medical professional and a compliant patient to successfully treat HCV.

Also...I assume/hope your HCV RNA was undetectable before this issue come along???

As someone said, Interferon lasts for about 7 days so you should be okay if you are UND.
"Several studies have now demonstrated that mild reductions in the doses of either peginterferon alfa and/or ribavirin will not adversely affect the chance of achieving SVR, especially if this strategy is employed after the patient achieves undetectable HCV RNA. By contrast, interrupting treatment for more than 7 days because of adverse events leads to breakthrough and relapse. Whenever the doses of peginterferon alfa and ribavirin are modified or temporarily interrupted, HCV RNA testing should be performed again to ensure that breakthrough has not occurred". Mitchell L. Shiffman, MD

I wouldn't wait for week 24 to find out if the virus has come back due to Dr. Quack's office being incompetent.

Best of luck.
Good luck with your new doctor.
HectorSF

[meakea]

Kathy, after my first response to you, I got busy at work and wasn't able to check back until now.  I'm glad you've got this kind of sorted out but I'm so sorry you have had to go through this.  Your doc and his staff are total incompetents and I'm so glad you are switching docs.

As others have said, I also learned from the bad experiences of others from sites like this and I stock piled my shots before starting my treatment so that I have at least 2 shots ahead at all times.  My doc didn't tell me to do this, in fact, when I asked him if I should he acted like I was ridiculous.  Well, so far, I haven't had any problems with delivery of my meds BUT it just takes one time.  After reading of your experience, it just makes me just that much happier that I have two shots ahead on my meds.

Best of luck to you!!!!  Let us know when you get your meds!

[Kathy73]

This is the reason I love this forum. You are each and every one a true angel. You made it possible to keep my sanity and not start screaming (at work) after spending multiple hours on the phone with the doctor's office, the PA and Curascript. It should be delivered tomorrow. You are correct, we all have to be our own advocates. If I had just rolled over who knows when I would have gotten this medication. FIGuy, thank you for your advice. I plan on following it. jmjm and Trinity, I agree, I wonder how many people go through this? I've gone through it repeatedly and I'm working with a Hepatologist. And they wonder why they have to pay such high malpractice insurance fees! I don't wonder any more!

[zazza]

My nurse told me to always order my new shots when I took my second to last shot. That way I would have two weeks to get them delivered. I needed those two weeks many times, because everything that could go wrong with delivery went wrong during the 72 weeks I treated.

[Emilio44]

I'm so glad it's sorted now.  If you can't get hold of a peg shot (anyone?) sorry I'm in Australia.  Maybe take an extra 100mg riba daily, but only if your hgb and rbc's are okay.  I wonder how many people failed tx due to bad doctoring?  I'd be down at the doctors making a pretty big noise, can you ring an advocate to deal with this for you. Do you have things like local state hep c councils?  Emi  

[nygirl7]

If they COULD call I know my personal pharmacies does get fedex deliveries from the drug company on Saturday - every company in the world COULD hit the "saturday delivery" box on the fedex form...it might be worth paying for it yourself if possible just to get it two days early.

Agree with FLGuy - switch back to the night of your "desires' for the next shot if you have complications like work and stuff to deal with.  Taking it early is fine taking it late is the problem you know?

Good luck either way Kathy.  I can tell you won't be letting this problem happen again any time soon :) Thank GOD you were well into treatment and it should hurt less :)

[jmjm530]

hey, nothing ventured nothing gained. It's only a phone call. Call me obsessive, but I'd be on the phone all day calling pharmacies trying to get the shot tonight. YMMV

[Trinity4]

Since we only represent a very very small percentage of people who are currently treating I often wonder how many people run into these same types of snags and what the outcome is when they have to postpone shots or even skip a shot due to substandard care from their medical provider.  
You've stressed considerably about all this Kathy.  Sounds like you are reasonably comfortable with receiving your meds on Monday.  It's 3:50 pm EST here so if you are in the same time zone that is probably the best you can expect.  No need to stress anymore than necessary so I agree with FIGuy, go for it first thing Monday morning.  I think you'll be fine.
Trinity

[jmjm530]

Monday is four days late. I would call him up and try for early Saturday delivery.

[FlGuy]

Nice result, about the best you could have done.  When the courrier arives on Monday have your alcohol swab all ready and then....

Something else that you might wonder about..If you take the newly arrive Peg on Monday or Tuesday you'll realize that you previously took the Peg on Thursday or Friday, or whatever the day was.  If your family-work situation determines that the best night is Friday you could make an adjustment.  What I would do (and this is just me) I would take that Peg shot as soone as it arrives.  Then, I'd take the next one on the night of my desires, even if it was the following Thurs or Friday (even if it was only 3 or 4 days since the prior one.  Then, I'd stick with the same day onward.  Keep up with the riba!

If the new doc writes a new script you might have a bunch of procedural stuff to go thru with the insurance company and pharmacy.  So, plan your supplies accordingly.

[Kathy73]

As it turns out, and after numerous phone calls and stress, my insurance company will waive the bloodwork requirement of 12 weeks and will send me the pegasys after all. Of course I probably won't get it until Monday. Either way, this works for me. I'm going to switch doctors next week. I can't take any more of this nonsence with this doctor, his office and PA.

[FlGuy]

Not sure if this was covered in one of the other replies, did not read all of them minutely.  Maybe bring the new hepatologist into the fray.  Perhaps the have an opening today on a crash basis.  If they are on top of their game, they are aware of the dangers of tx interruption.  And, they may have a peg in the office refirgerator.  Can't hurt, given them a call too.

[Kathy73]

I wish I had done that! It would make today so much less stressful! The service extended by my hepatolgist, his staff and the NP is so bad I'm contemplating legal action. I've only sued one person before (my ex-husband for divorce) but these people are putting me in that position!

[orleans]

Hey, My NP has twice told me to skip my Peg shot because of my low WBC/NEUPS. I refused both times but that tells me that it is not THE END OF TX if you miss a shot.  NEWBIES that have yet to start TX, a little trick I learned on this forum. When you are supposed to start treatment, DON'T, delay a week or two. (this may mess up your Drs little chart but I say F him if he can't take a joke!!)That will put you a little ahead on the Peg shipments and give you a little breathing space. I did this and it was a good thing too as I had some of the same problems that Kathy has. jerry

[Kathy73]

I have an appointment with another doctor next Tuesday. I made that appointment 2 months ago when I first started having difficulty with this doctor, his PA and his office personnel. They are incompetent at best (and that is being nice). I had called the script service on Monday and had the delivery arranged for yesterday. Then I called to confirm on Wednesday and still no script yesterday. As usual it is a breakdown with my doctor's office.

You're the best!

[nygirl7]

have an appointment with another heptatologist next week because these people are soooo baddd,

Sorry I didn't see that before ..... at least you are set that way but do NOT give up on getting those meds right now no matter what you do. Seriously try calling Roche and explaining - the patient assistance program workers at the companies are EXCELLENT and they just might know what to do? Maybe they could even call your local hospital and see if for any reason they have any in their pharmacy - this stuff IS used for other things than hep.

[jmjm530]

until things are resolved, and calling roach is a very good idea, why don't you get a prescription from your doctor today and try to get it filled locally, possibly at a hospital pharmacy. You may end up going out of pocket for the one-shot, or perhaps roach will somehow reimburse. I would make best efforts to take that shot within the next day or so.

[Kathy73]

Thank you for the calming words. I really needed them. My blood pressure is probably through the roof! I'm waiting for word from the PA about getting me a shot. If I don't hear back shortly I'll be calling the pharmacy companies.

[nygirl7]

You have to get that shot somehow or you are going to end up stopping treatment and starting over.  That doctors office has got to be bound by ethics or something to get you that shot - this isn't a med you can skip and they know it!

That doc can have this handled in five minutes you realize.  The place could overnight the drugs but you might get stuck because of the weekend - but on his end all he has to do is call them and HE should be able to straighten it out. JERKS!!!!!

Kathy, do not give up.  Keep calling them until they get it for and do not give up. I agree that you should call the folks over at Roche - they know better than anyone how important your schedule is.

This is just another example of a lesson hard learned...you have to always make sure there is one shot in the fridge when you order the meds.  I had the prior authorization problem once myself but still had that shot in the fridge so I was ok.

FIND A NEW DOCTOR ASAP - start calling while you are waiting for them to fix this problem for you.....it might keep you busy in the meantime so you don't freak out.

And call those incompetent SOBs every hour on the hour - you have to be your own best advocate a LOT with this disease and these incompetent doctors/nurses/pharmacies etc etc etc.

Good luck, if I was still on tx I would send you one overnight somehow but I've been off for two years (and I was on Intron but I"m sure you know what I mean).

God I"m SO ANGRY now!!!!!!!!!!!!!!!!!!!!!

[HCA]

Don't panic.
Peg has a half-life of 72 hours which means that at that pont half the dose has been excreted from your body.
After seven days it has subsided altogether.
A two or three day delay although not desirable is probably not critical.
Some patients have to skip a dose due to complications.
As suggested contact the Schering or Roche helpline for advice and reassurance.
Change doctors.