21 Mar My Oldest Patient Turns 96
One of my favorite patients, Donald, is about to turn 96! We met almost 3 years ago. He’s a transplant from Florida, has wet ARMD and needs periodic injections for his wet ARMD in the right eye. The vision in the left eye was lost years ago from wet ARMD, too.
Donald moved to Virginia to be closer to his family (kids, grand and great grandchildren).
I now see him every 3 months to give him an injection of Avastin to his right eye. He still sees well. He still lives independently (I’m told he still cooks and cleans!).
More importantly, his story highlights the importance and value of trust, not to mention the remarkable success of treatment for eye disease.
Finding a Retina Specialist
Just before moving here, his doctor had given him an injection of Lucentis to the right eye. Donald’s quest was to find a doctor to continue therapy as the periodic injections kept his vision at about 20/30. He had been receiving Lucentis injections every 4-6 weeks for the past 2 years prior to his arrival at my office.
Donald was not eager to continue the injections, however, despite a letter from his former doctor suggesting continued therapy. As it turns out, Donald was most concerned about pain – he hated the injections even though they saved his vision.
We agreed to wait and see if he really needed continued injections. Soon after his first visit, the leakage returned. The injection was scheduled for the next week.
Avastin Injections Do Not Hurt
Our usual protocol for Avastin injections includes and 20 minute period where a series of 3 Q-tips soaked in numbing medicine (Lidocaine) are pressed against the eye. We’ve tried small injections of the Lidocaine and topical solutions, but Wendell, Dee and I have found this is the best in achieving complete numbing.
Wendell and Dee are my assistants. They’ve help me develop this method which keeps the eye injections painless.
Induction Treatment vs. Maintenance Treatment
Upon initial diagnosis of wet ARMD, most retina specialists treat with a series of injections to determine the efficacy of the treatment, that is, do the shots work? I start out with 3 shots given 4 weeks apart. This is called induction treatment.
Treatment given to prevent recurrence of the wet ARMD is called maintenance treatment. These are injections are given to keep the vision stable.
What Does This Mean?
It’s hard to takeover the care of a new patient. It’s easy to repeat or continue the treatment. It’s hard to replicate the trust.
What makes a great doctor patient relationship? Trust. Donald had to trust me, the new doctor, and trust his daughter who was recommending me.
In Donald’s case, an elderly, very acute gentleman. I let him participate in his treatment, that is, I let him wait for my first injection instead of forcing him. I empowered him.
Second, I promised no pain. This helped build the trust.
Item last. His vision is still great. We see each other every 3 months for an injection. He knows to call if things change.
Happy Birthday Donald!