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Banding Bulletin – November 2014

Banding Bulletin – November 2014

We hope that this month’s edition of the Banding Bulletin finds you well! In this edition, we’ll include another of our favorite “tips and tricks”, and introduce a new service offered by CRH, known as “Medsense”!

Case Report & The “Butt-Selfie”

Problem: A 45-year old male with intermittently “prolapsing” hemorrhoids presented with obvious significant internal hemorrhoids (Grade III in the RA, and Grade II in the RP and LL), and he responded to 3 bandings at 2 week intervals, but still had the occasional “prolapse” noted. He returned to the office approximately 6 weeks after the third banding, and the “prolapse” could not be reproduced at the bedside. Anoscopy didn’t show much residual hemorrhoidal tissue, but there was a bit of laxity in the area between the previous RA and RP bandings, so this “right lateral” area was banded. A phone call a few weeks later revealed that he was still having that very occasional “prolapse”.

Solution: The patient lived 4 hours from our clinic, and with no obvious explanation for this seen at the last visit, I didn’t want him to have to drive 8 hours for me to repeat what was certain to be another nondescript anoscopic exam, so I asked him to take a “butt selfie” the next time that he experienced a prolapse. Sure enough, about 10 days later, I received an image of a swollen EXTERNAL hemorrhoid! He wasn’t prolapsing anything, but despite my best efforts, he was one of the few patients that still had external issues after an internal banding. He provided me with a wide enough angled view so that I could identify the culprit, and a simple external hemorrhoid excision in the office did the trick. This “trick” has been used to discover a couple of cases of true rectal prolapse as well as to allow us to provide more than a few “sidewalk consults”, and most importantly, gross out anyone that would look over my shoulder on a plane or in line at Starbucks after I receive an “interesting” text message! Steve Jobs was certainly a visionary, but I don’t know that he ever thought that his iPhone could be this versatile! Patent pending.

Medsense: Medicine That Makes Sense

CRH is proud to announce a new service for our interested Partners, designed to be convenient for your patients, and provide better quality control for your practice. The Medsense program is designed to be a complete OTC product fulfillment program for you and your patients, eliminating patient guesswork and ensuring that your patients have the medications they need, exactly when they need it! In its original rollout, the first of the “Laxative Series” is now available . . . including Bisacodyl tablets, PEG 3350, Magnesium Citrate and Simethicone. The products (along with your customized instructions for use) can be made available directly from your office, or delivered to the patients’ homes through an online ordering site.

Patients benefit from this program as it is both convenient and cost-competitive. Your practice will enjoy the improved patient satisfaction and compliance, along with generating additional revenue with minimal effort! In the coming months, CRH will also be launching a text messaging tool that will automate your procedural instructions and remind your patients as to what they should be doing at any given time regarding their medications or diet. This tool will be an added feature of the Medsense program, and will only help improve your patients’ compliance and outcomes. If you are interested in learning more about the Medsense program, please contact JESSICA DIDUCH at CRH!

The Thanksgiving Rush

The end of the year means that patients who have met their healthcare deductibles will want to take care of all of their remaining healthcare needs between now and December 31st, so you are likely to see an increased demand for services. This is a great time to bring up hemorrhoid treatment to those patients who have been suffering from symptoms for an extended period of time, but have been delaying treatment. If we can provide any support, or if you’d like a visit from one of our Medical Directors or Clinical Support Specialists, please let ME know and we’ll get you on the calendar!

Here’s wishing you and yours a very happy Thanksgiving, and the start of a fantastic Holiday Season! We’ll be back in touch before the end of the year, and in the meantime, please let us know if we can help in any way.


Mitchel Guttenplan, MD, FACS
Medical Director
CRH Medical Corporation
C: 770.363.0125 F: 770.475.9953

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