If there are good hematologists / cancer specialists 6-8 hours away, it could be worth it to schedule an evaluation appointment and ask if follow up appointments could be managed by video virtual visits. They can order lab tests to be done in your local area and sent to them for monitoring when needed. Since this ET and other myloproliferative disorders are rare, some doctors may not have experience with treatment and other medical distinctions.

I have had many virtual appointments and they work out well.