Banding Bulletin – March 2018
Phone calls and what to do about them
If you are following the recommendations in our last Banding Bulletin, the post-banding phone calls should be few and far between! That being said, here are the calls that you are most likely to receive, and how to best handle them.
- The patient is halfway home and starting to experience pain – The patient should come back and have the band adjusted to relieve the pain. This can almost totally be avoided by:
- Keeping the patient in the office for at least 10 – 15 minutes after a banding, particularly on their first treatment
- Make certain that patients experience ZERO pain and ZERO “pinching”. If they do, then adjust the band or the pain/pinching will worsen.
- Make certain that your staff double-checks the patient, that they have no pinching or pain, and that they look perfectly comfortable. The patient should have a smile on their face and laugh at your joke, whether it was funny or not!!!
- The band was seen in the toilet a day or two after the banding:
- Assure the patient and tell them to come back at the time of their next regularly scheduled appointment. The area will typically NOT need to be retreated, as the band has usually done its job!
- Post-banding pain:
- I’ll ask the patient to come back to the office for a quick recheck if this is an issue, as a 10 second exam can usually define what is going on and help you to prescribe a quick-fix to the issue. In my experience, band manipulation has been quite helpful as long as it is done within 48-72 hours of the banding. While I’ve not found manipulation to be much help after that, your exam can assure you that nothing else is going on.
- If the patient later admits that they DID have some pinching after the banding, I’ll give topical lidocaine (in case my band was a bit too low) and topical nitroglycerin, as it seems to help everything in these patients! If they didn’t feel a pinch after the banding, nitro is my “go-to”.
- About 1:500-600 will develop a thrombosed external hemorrhoid – it is treated like any other thrombosis. I’ve only seen 1 case of a thrombosis internally, and I’ve had 2 patients where the tissue just felt a bit indurated (I’m assuming also from some mild thrombosis). I gave the patient a few days of Flagyl, just to cover all the bases.
- MORE THAN ONE THING CAN BE GOING ON AT THE SAME TIME! I’ve had 2 calls in the last few weeks where the patient complained of perianal pain a few days post-banding. One actually had developed an unrelated pilonidal abscess and another had an unrelated sebaceous abscess on their buttock! A quick peek allowed for a speedy diagnosis and disposition, and reassured both patient and provider!
- Post-banding bleeding:
- Some post-banding bleeding is pretty common. Don’t tell the patient to call if they see any blood, because this will scare the patient if they have a drop or two of blood and it is generally not of significance. We ask the patient to lie down with their feet up, apply ice and drink fluids. Post-banding bleeding that needs to be addressed typically would occur 10 days – 2 weeks post banding, with a lesser occurrence 3-5 days post banding. In the rare cases where this needs to be addressed, cautery is usually the key if it is the typical post-banding ulcer that is the culprit, with a clip or band reserved for a visible vessel.
- Please share our contact information with your cross-covering providers, as we’re always available if questions arise. There is also an “Information Sheet for Cross-Covering Physicians” with much of this information available on our website!
CRH Anesthesia Video
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 if you haven’t already. 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.
CRH on the Road!
CRH is hitting the road this spring, including at the GI Roundtable and ACG/FGS meetings this weekend! You can always find and a list of our upcoming events HERE, but in the meantime, here’s what we have scheduled this spring:
- GI Roundtable March 16-17 in Washington, DC
- CRH O’Regan System Presentation March 16 at 11:30am
- CRH Anesthesia Presentation March 17 at 11:50am
- ACG/FGS Spring Symposium March 16-18 in Bonita Springs, FL
- Colonoscopy: Diagnostic to Therapeutic April 6-7 in Downers Grove, IL (ASGE)
- Hands-on Saturday, April 7 (AM & PM)
- ACG Eastern April 14-15 in Boston, MA
- Hands-on April 14 at 1:25pm
- 10th Annual Penn live April 20-21 in Philadelphia, PA
Please come visit us, as we’ll be able to provide whatever information you might need, address any questions that may have popped up, and provide whatever support we can.