Banding Bulletin – February 2018
Avoiding Phone Calls!
Treating your hemorrhoid patients with the CRH O’Regan System and following the suggested treatment protocols should afford you and your patients at least a 90% success rate, with a complication rate of 1% or less. That being said, every now and again, the phone will ring and when it does, the “Information Sheet for Cross-Covering Physicians” (found HERE) addresses the most frequent questions you will receive. In addition, there are a few easy things you can do in order to keep those calls to an absolute minimum!
- Make certain to stress to the patient that (s)he should feel absolutely no pain or “pinching” after the procedure. Most patients have a close friend or relative that has had a hemorrhoidectomy and have heard the horror stories, so they expect the banding procedure to be uncomfortable. If you stress that they should feel ZERO pain and ZERO “pinching”, let them know that even a little pain or “pinch”, if left alone, will worsen, and tell them that you can address that little pain or pinch right now in the office, you’ll save yourself the hassle of a patient leaving the office, getting half-way home, and turning around because they hurt.
- Keep your patient in the office for at least 10 minutes after their first banding. It takes a few minutes for the patient to register what has transpired and whether or not they are uncomfortable. In our clinic, we always had the staff member that checks each banding patient out ask about pain or “pinching”, and if either existed or if the patient looked at all uncomfortable, they were taken back to a room for us to assess.
- Don’t band the patient if an exam is very uncomfortable. These folks most likely have a fissure. By treating that fissure for a couple of weeks, and THEN beginning your banding sessions, you will see far fewer post-banding issues. If a partially healed, not particularly tender fissure is identified, then band away, treating the fissure and the hemorrhoids concurrently.
- Identify and pretreat fissures and spasm when you first meet the patient at the time of colonoscopy! Many of your initial encounters with your hemorrhoid patients are in the endo suite. If they have ANY perianal symptoms, a simple anorectal exam PRIOR to sedation will help to identify many cases of fissure and spasm, and beginning treatment at that time will have the patient ready to go when they come back to the office for banding.
- NTG, NTG, NTG, NTG! Remember the movie, “My Big Fat Greek Wedding” and the father’s incessant use of Windex to cure any ills? For me, NTG is even better than Windex! If the patient displays ANY hint of a small fissure, or significant sphincter spasm, a course of topical NTG makes all right with the world again! In our clinics, we saw that 30% of our hemorrhoid patients also had fissures (the literature indicates this number is 20%). Another 20-30% will have “spasm”. While this recommendation is certainly “off-label”, we’ve had tremendous success treating these folks with NTG while we take care of their hemorrhoids. We continue the NTG for 3 months if a fissure is present, and until a week or so after we’ve finished the banding process for the “spasm” patients.
Watch the NEW Video from CRH Anesthesia
If you’d like to learn more about the benefits of a partnership with CRH Anesthesia (and in under two minutes!), check out our new video HERE. We’re now servicing 35 ASCs in 7 states, performing approximately 235,000 procedures annually and we would love the opportunity to work with your practice as well! Feel free to contact ME or CARTER BLANTON, who serves as the VP of Business Development for CRH Anesthesia, if you have any questions.
The CRH Medical App for iOS and Android
One of my many New Years’ Resolutions is to make sure that I stress the value of downloading the CRH Medical app to your tablet or smartphone. The app has links to videos, a variety of support documents, our contact information, etc. Please consider downloading the app, and let us know if there is anything that we can do in order to improve it!
Let Us Know How We Can Help!
Please contact ME if there is anything we can do to support you and your banding practice. If you’d like a “refresher” session, if you have partners or NPs/PAs that would like to be trained, if an in-service for your staff would be helpful . . . please just say the word and we’ll get you on our calendar! Thanks again for checking out this Bulletin and we’ll hope to catch up with you again soon.