Friday, April 22, 2016

Fauquier Hospital Intermediate Care Nursery Ready to Accept Patients

Neonatologist Dr. Elsie Mainali is the new medical director of the Intermediate Care Nursery at Fauquier Hospital.


Beverlyn Silberbauer, RN, makes last-minute adjustments
to prepare for the nursery’s opening.
During an open house last Wednesday at Fauquier Hospital’s FamilyBirthing Center, neonatologist Dr. Elsie Mainali smiled broadly as she patted an infant resuscitator machine like a mother stroking a child. Dr. Mainali said that the hospital’s newly renovated Level 2 Intermediate Care Nursery (ICN) is the best equipped of any ICN in the area. “We are truly state-of-the-art.”

As of April 14, the new seven-bed unit (up from four beds) will welcome newborns who need special care. The nursery has been closed since November 2015, when construction began.
Beverlyn Silberbauer, ICN RN, explained that the each of the tiny patient beds is equipped with a myriad of monitoring equipment, a scale, and temperature and humidity controls. “The temperature control keeps the infant’s body temperature stable, and the humidity regulator protects the baby’s delicate skin.”

Stations are also equipped with phototherapy lamps and special blankets that cover the small
pod-like beds, so that the babies can rest in complete darkness – “just as if they are still in utero.” There are “portholes” in the sides of the beds, so parents can reach in and interact with their babies easily. Silberbauer said, “Even with the portholes open, the air inside the bed doesn’t leave and the air from the outside doesn’t get in, so the temperature stays consistent. It’s amazing technology.”

When a child is born prematurely, he or she may have respiratory issues, jaundice, or present other difficulties that require special attention. The ICN can provide around-the-clock care for newborns that are born after 32 weeks and are at least 3.3 pounds. Before Fauquier Health opened the ICN in 2013, these babies were transferred to a neonatal intensive care unit in Northern Virginia or at the University of Virginia.

The ICN also cares for babies born addicted to opioids. Silberbauer said, “Sometimes it takes months for those babies to go through the withdrawal process. Our job is to make sure the baby is healthy and the mom has the support she needs to take care of her baby when they go home.”

Dr. Mainali agreed, “We see quite a number of these babies.”

The Intermediate Care Nursery was expanded to better meet the needs of patients and their families, as well as to meet newer space requirements for an intermediate nursery – set by the state health commissioner, Virginia Department of Health. Historically, the nursery has hosted an average of three babies, but the volume would sometimes surge to five or six. The new space will more comfortably handle demand.

Of the 762 babies born in 2015 (before the ICN closed for construction), 71 were cared for in the ICN. During construction, 15 newborns that would have stayed in the ICN were transferred for higher level care.

In addition to enlarging the space, other highly specialized equipment for at-risk babies has been added. The security system has been updated and new isolates and radiant warmers have been installed, as have wireless scanners for medication, a PACS system for radiology services, mobile computers and respiratory equipment.

The construction cost $991,000; equipment added another $480,000. (This equipment was purchased in 2013 as part of the original project opening, and was raised through a Mars family gift of $382,000 and other fundraising efforts.)

The ICN will be staffed with two neonatal intensive care unit registered nurses 24 hours a day. Respiratory services, lactation experts, case management workers, an RN clinical coordinator and another physician will support the effort. Dr. Mainali added, “All nurses have Neonatal Resuscitation Program (NRP) certification; most come from higher-level care nurseries and have years of experience.”

Fauquier Health’s ICN also has a collaborative relationship with neonatologists at the University of Virginia’s Neonatal Intensive Care Nursery, to ensure local babies have the resources of a university-level facility. Dr. Mainali explained, “We currently have telemedicine capabilities; experts at UVA are able to receive data about a newborn in our nursery, examine the baby remotely and work with our staff via video feed.”

The nursery features open visiting hours, and mothers are encouraged to breastfeed their babies if they choose. Two private rooms can accommodate newborns who need readmission after being home. When babies are ready to be discharged, parents are invited to stay overnight in a private room and work with nursing services to understand how to care for their newborns.

Dr. Mainali said that Fauquier Health Home Care Services is available to visit mom and baby at home, to assist with any lingering issues. “We want to ensure that there is a smooth transition.” CPR training for parents is available prior to discharge and outpatient lactation services recently have been added.
Community pediatricians are invited to visit with their patients in the ICN. All newborns that are admitted to the ICN are under the care of Dr. Mainali, who said, “We view it as a collaborative effort and understand that the community pediatricians are guiding care after discharge. Having their engagement and ensuring we are communicating effectively is a priority.”

Pediatrician Dr. Joshua Jakum of Piedmont Pediatrics said, “I am thrilled that Dr. Elsie Mainali is joining Fauquier Health. The academic knowledge she brings is outstanding. We have already begun working on quality improvement initiatives that have demonstrated promise for neonates as well as our general newborn population.”


Friday, April 8, 2016

Fauquier Hospital Hosts Open House to Celebrate Intermediate Care Nursery Renovation and Expansion




Fauquier Hospital's Family Birthing Center will hold an open house on Wednesday, April 13, from 4 to 7 p.m. to celebrate the renovation and expansion of the Intermediate Care Nursery.

Tours of the new space will be offered and visitors will be able to meet the ICN's new neonatologist and medical director, Dr. Elsie Mainali. Refreshments will be served.

The recent renovations at the ICN have doubled its size and added four beds, for a total of seven. The neonatal ICN -- designed to provide care for babies who are born at Fauquier Hospital but are born prematurely or are too sick to go home right away -- means that parents of these babies can be with their newborns every day without having to travel to Northern Virginia or Charlottesville. Some infants will still need the care that can only be provided in a Neonatal Intensive Care Unit – a higher level of care -- but many babies will be able to remain in Fauquier, near their loved ones.

The nursery operates under the guidance of neonatologist Dr. Elsie Mainali, the nursery’s new medical director. Rodger Baker, CEO of Fauquier Health, said, “Having a neonatologist overseeing the nursery is providing a level of care beyond what we have been able to provide in the past.”

Dr. Mainali and neonatal nurse practitioners will provide ongoing bedside care for babies who need extra attention until they are strong enough to reunite with their families.

Monday, February 29, 2016

A Q&A from the CDC About the Zika Virus

What is Zika virus disease?
Zika is a disease caused by Zika virus that is spread to people primarily through the bite of an infected Aedes species mosquito.

Why are we hearing so much about Zika?
Recent outbreaks throughout Central and South America have generated national attention on this virus. While many will only experience mild symptoms, Zika virus has been linked to a serious birth defect of the brain called microcephaly (a condition in which a baby’s head is smaller than expected when compared to babies of the same sex and age) and other poor pregnancy outcomes in babies of mothers who were infected with Zika virus while pregnant.

What are the symptoms of Zika?
About 1 in 5 people infected with Zika will get sick. For people who get sick, the illness is usually mild. For this reason, many people might not realize they have been infected.

The most common symptoms of Zika virus disease are fever, rash, joint pain, or conjunctivitis (red eyes). Symptoms typically begin 2 to 7 days after being bitten by an infected mosquito.

Are children or elderly at increased risk of complications?
No. Otherwise healthy children and elderly populations will likely experience the same signs and symptoms, with minimal risk for complications.

If your child develops any of the signs or symptoms of Zika, see your child’s primary doctor for evaluation and let him/her know of any recent trips the family or family members have taken.

What types of complications can occur?
Complications and hospitalizations are rare with Zika virus.

How is Zika transmitted?
Zika is primarily transmitted through the bite of infected Aedes mosquitoes, the same mosquitoes that spread Chikungunya and dengue. These mosquitoes are aggressive daytime biters and they can also bite at night. Mosquitoes become infected when they bite a person already infected with the virus. Infected mosquitoes can then spread the virus to other people through bites. It can also be transmitted from a pregnant mother to her baby during pregnancy or around the time of birth. The CDC is studying how some mothers can pass the virus to their babies. While not the most common form of transmission, spread of the virus through blood transfusion and sexual contact have been reported.

Who is at risk of being infected?
Anyone who lives in or travels to an area where Zika virus is found and has not already been infected with Zika virus can get it from mosquito bites. While not common, cases of transmission through sexual contact have been reported. If you or your partner have recently traveled to an area where Zika virus has been found, there is a chance that you could transmit the virus through sexual contact.

What countries have Zika?
Specific areas where Zika virus transmission is ongoing are often difficult to determine and are likely to change over time. If traveling, please visit the CDC Travelers’ Health site for the most updated travel information.

What can people do to prevent becoming infected with Zika?

There is no vaccine to prevent Zika. The best way to prevent diseases spread by mosquitoes is to protect yourself and your family from mosquito bites. Here’s how:

  • Wear long-sleeved shirts and long pants. 
  • Stay in places with air conditioning or that use window and door screens to keep mosquitoes outside. 
  • Use Environmental Protection Agency (EPA)-registered insect repellents. All EPA-registered insect repellents are evaluated for safety and effectiveness. 
  • Always follow the product label instructions. 
  • Reapply insect repellent as directed. 
  • Do not spray repellent on the skin under clothing. 
  • If you are also using sunscreen, apply sunscreen before applying insect repellent. 
If you have a baby or child:
  • Do not use insect repellent on babies younger than 2 months of age. 
  • Dress your child in clothing that covers arms and legs, or 
  • Cover crib, stroller, and baby carrier with mosquito netting. 
  • Do not apply insect repellent onto a child’s hands, eyes, mouth, and cut or irritated skin. 
  • Adults: Spray insect repellent onto your hands and then apply to a child’s face. 
  • Treat clothing and gear with permethrin or buy permethrin-treated items. 
  • Treated clothing remains protective after multiple washings. See product information to learn how long the protection will last. 
  • If treating items yourself, follow the product instructions carefully. 
  • Do NOT use permethrin products directly on skin. They are intended to treat clothing. 
  • Sleep under a mosquito bed net if you are overseas or outside and are not able to protect yourself from mosquito bites.



What is the treatment for Zika?


There is no vaccine or specific medicine to treat Zika virus infections.

With the Zika virus, doctors treat the symptoms:
  • Get plenty of rest. 
  • Drink fluids to prevent dehydration. 
  • Take medicine such as acetaminophen to reduce fever and pain. 
  • Do not take aspirin or other non-steroidal anti-inflammatory drugs. 
  • If you are taking medicine for another medical condition, talk to your healthcare provider before taking additional medication.
How is Zika diagnosed?

If you develop symptoms of Zika virus (fever, rash, joint pain, red eyes), see your regular healthcare provider. Be sure to tell your doctor if you have recently traveled, even within the continental U.S.

Your healthcare provider may order blood tests to look for Zika or other similar viral diseases like dengue or chikungunya.

What should I do if I have Zika?

Treat the symptoms:
  • Get plenty of rest 
  • Drink fluids to prevent dehydration 
  • Take medicine such as acetaminophen to reduce fever and pain 
  • Do not take aspirin or other non-steroidal anti-inflammatory drugs

Protect others: During the first week of infection, Zika virus can be found in the blood and passed from an infected person to another person through mosquito bites. An infected mosquito can then spread the virus to other people. To help prevent others from getting sick, avoid mosquito bites during the first week of illness.

See your healthcare provider if you are pregnant and develop a fever, rash, joint pain, or red eyes within two (2) weeks after traveling to a place where Zika has been reported. Be sure to tell your health care provider where you traveled.

Is there a vaccine to prevent or medicine to treat Zika?

No. There is no vaccine to prevent infection or medicine to treat Zika.

Are you immune for life once infected?
Once a person has been infected, he or she is likely to be protected from future infections.

Does Zika virus infection in pregnant women cause birth defects?
There have been reports of a serious birth defect of the brain called microcephaly (a condition in which a baby’s head is smaller than expected when compared to babies of the same sex and age) and other poor pregnancy outcomes in babies of mothers who were infected with Zika virus while pregnant. Knowledge of the link between Zika and these outcomes is evolving, but until more is known, CDC recommends special precautions for the following groups:
Women who are pregnant (in any trimester):
  • Consider postponing travel to any area where Zika virus transmission is ongoing. 
  • If you must travel to one of these areas, talk to your doctor first and strictly follow steps to prevent mosquito bites during your trip. 
Women who are trying to become pregnant:
  • Before you travel, talk to your doctor about your plans to become pregnant and the risk of Zika virus infection. 
  • Strictly follow steps to prevent mosquito bites during your trip.
For more questions and answers on Zika and pregnancy, see the CDC’s Questions and Answers: Zika and Pregnancy.

Does Zika virus infection cause Guillain-Barré syndrome (GBS)?


Guillain-BarrĂ© syndrome (GBS) is a rare disorder where a person’s own immune system damages the nerve cells, causing muscle weakness and sometimes, paralysis. These symptoms can last a few weeks or several months. While most people fully recover from GBS, some people have permanent damage and in rare cases, people have died.

The CDC does not know if Zika virus infection causes GBS. It is difficult to determine if any particular germ “causes” GBS. The Brazil Ministry of Health (MOH) is reporting an increased number of people affected with GBS. CDC is collaborating with the Brazil MOH to determine if having Zika makes it more likely you will get GBS.

Is this a new virus?

No. Outbreaks of Zika previously have been reported in tropical Africa, Southeast Asia, and the Pacific Islands. Zika virus likely will continue to spread to new areas. In May 2015, the Pan American Health Organization (PAHO) issued an alert regarding the first confirmed Zika virus infection in Brazil. Since that time, local transmission has been reported in many other countries and territories.

How many travel-associated cases have been diagnosed in the United States?

CDC continues to work with states to monitor the United States for mosquito-borne diseases, including Zika. As an arboviral disease, Zika is nationally notifiable. Healthcare providers are encouraged to report suspected cases to their state or local health departments to facilitate diagnosis and mitigate the risk of local transmission. Limited local transmission may occur in the mainland United States but it’s unlikely that we will see widespread transmission of Zika in the mainland U.S.

Should we be concerned about Zika in the United States?

The U.S. mainland does have Aedes species mosquitoes that can become infected with and spread Zika virus. U.S. travelers who visit a country where Zika is found could become infected if bitten by a mosquito.

With the recent outbreaks, the number of Zika virus disease cases among travelers visiting or returning to the United States will likely increase. These imported cases may result in local spread of the virus in some areas of the United States. CDC has been monitoring these epidemics and is prepared to address cases imported into the United States and cases transmitted locally.

What is CDC doing about Zika?

CDC has been aware of Zika for some time and has been preparing for its possible introduction into the United States. Laboratories in many countries have been trained to test for chikungunya and dengue. These skills have prepared these laboratories for Zika testing.

CDC is working with international public health partners and with state health departments to:
  • Alert healthcare providers and the public about Zika. 
  • Post travel notices and other travel-related guidance. 
  • Provide state health laboratories with diagnostic tests. 
  • Detect and report cases, which will help prevent further spread.

The arrival of Zika in the Americas demonstrates the risks posed by this and other exotic viruses. CDC’s health security plans are designed to effectively monitor for disease, equip diagnostic laboratories, and support mosquito control programs both in the United States and around the world.

How can I learn more about Zika virus?

CDC has a number of resources available to learn more about Zika virus. Visit the website at www.cdc.gov/zika.

March Is Colorectal Cancer Awareness Month



Colorectal Cancer: Know the Symptoms, Know the Risks

According to the American Cancer Society, colorectal cancers are the third most commonly diagnosed cancer in the United States and the second-leading cause of cancer death in men and women in the U.S. While more than 130,000 new cases of colon and rectal cancers are expected to be diagnosed in 2016, the overall incidence and death rates associated with this disease have been on the decline for more than a decade. Effective screening in the form of colonoscopies is the primary driver of these declines, which is why it is recommended that all men and women begin routine testing at the age of 50.

If found early, the five-year survival rate for colon cancer is about 92%, and the five-year survival rate for rectal cancer is roughly 87%. Unfortunately, only 40% of colorectal cancers are diagnosed at an early stage, partly due to low screening rates.

Colorectal cancers are much more treatable when they are caught early. Colonoscopies can not only improve the ability to detect colorectal cancer quickly, they can help identify and remove polyps before they become cancerous.

What are the symptoms of colorectal cancer?


In the early stages, colorectal cancers are often symptomless, which is why screening is so important. While 90% of new cases occur in people 50 or older, colorectal cancers do not discriminate and can happen to men and women at any age.

See your doctor if you have any of these warning signs:
  • Bleeding from the rectum;
  • Blood in the stool or in the toilet after a bowel movement;
  • A change in your bowel habits, including diarrhea or constipation or a change in the consistency of your stool;
  • Persistent cramping or discomfort in the lower abdomen;
  • An urge to have a bowl movement when the bowel is empty;
  • Constipation or diarrhea that lasts for more than a few days;
  • Decreased appetite, nausea or vomiting; or
  • Unintentional weight loss.
While these symptoms also can be associated with other health conditions, your doctor can help you determine the cause.

Preventing colorectal cancer
  • Screening is the number one way you can reduce your risk of colorectal cancer. 
  • Most cases of colorectal cancers begin as small, noncancerous clumps of cells called adenomatous polyps. Over time some of these polyps become cancerous. Screening helps physicians detect and remove polyps to prevent cancer from occurring. 
  • Proactively preventing colorectal cancer also involves a healthy lifestyle. Daily exercise, eating a healthy diet, maintaining a healthy weight, limiting your alcohol intake, and not smoking all can reduce your risk of colorectal and many other forms of cancer.
  • Knowing your family history is also helpful. Those with an immediate relative (parent, sibling or offspring) diagnosed with colorectal cancer are two to three times more likely to develop the disease.
What to expect during a screening or colonoscopy
  • If you're over 50, high risk or symptomatic, it’s important to talk to your doctor about getting checked. 
  • Colonoscopies are easier procedures than many realize. Shortly before the procedure, you will likely be given pain medication and a sedative to minimize discomfort during the colonoscopy. 
  • During the procedure, any polyps found will be removed by the doctor and tissue samples will be sent for biopsy. The procedure typically lasts 30 minutes to an hour.
  • Keep in mind that you will need to follow a special diet the day before your colonoscopy and have someone available to take you home after it is over.
Contact your doctor or visit Fauquier Hospital's website to learn more about colorectal cancer symptoms, detection and prevention, local resources, and how to schedule a screening.


Dr. Esther Bahk Discusses Stroke and TIA

Dr. Esther Bahk
Internal medicine specialist Esther Bahk, MD, MPH, of Fauquier Health Internal Medicine at Lake Manassas will speak on stroke and transient ischemic attack (TIA, sometimes known as a mini stroke), at 7 p.m. on Wednesday, March 9. The lecture will be held in Fauquier Hospital’s Sycamore Room.

A stroke is the sudden interruption in the blood supply of the brain by blockage or rupture of blood vessel. In a TIA the blockage is temporary and symptoms last only a short time. There is no lasting damage. A TIA is a warning sign, though. Fifteen percent of strokes are preceded by a TIA. Stroke is the fourth leading cause of death in the United States. Stroke accounts for one out of every 19 deaths.

Dr. Bahk will speak on risk factors for stroke, symptoms and what people can do to minimize the long-term effects of a stroke.

Register for the talk by calling 540-316-3588.

Fauquier Health Celebrates Nutrition Month with Healthy Eating Talks


In recognition of National Nutrition Month, Fauquier Health’s registered dietitians will speak on healthy eating during three Senior Supper Club nights in March. All talks will be held at 5 p.m. in the Bistro on the Hill.

  • Franny Jaynes, RD, will speak on Tuesday, March 15 on “Sodium: How much is too much?
  • Lauren Witkowski, RD, will speak on “Healthy Snacking Tips” on Thursday, March 24.
  • Suzanne Amoruso, RD, CDE, will talk about “Diabetes Meal Planning on Tuesday, March 29.
The Senior Supper Club is held every Tuesday and Thursday from 4:30 to 6:30 p.m. at Fauquier Hospital’s Bistro on the Hill restaurant. The evenings were conceived to give those 55 and older an option for a delicious, healthy three-course meal at a reduced cost of $5.49. Visitors may choose from a variety of entrees, and enjoy a salad or soup, dessert and coffee or tea. Regulars to the Supper Club like to bring their friends, or come to make new ones.

Anyone may attend the lectures, but the special reduced price dinner is only for those 55 and older. Those planning to attend the talks should call 540-316-4406 to reserve a sp
ot.

Wednesday, February 17, 2016

Fauquier Health Wound Healing Center Discusses Connection Between Heart Health and Wound Healing



Chronic wounds affect approximately 6.7 million people in the United States, and these wounds cost more than $50 billion annually. If left untreated, chronic wounds can lead to a diminished quality of life and possible amputation of the affected limb. Heart health is an important factor in wound healing.

“Coronary artery disease, peripheral arterial disease and other issues with the heart and vessels can hinder blood flow, oxygen and nutrition to a wound,” explains D. Scott Covington, MD, FACS, chief medical officer for Healogics. “February is American Heart Month and an opportunity for patients to understand how their heart can affect their wound healing.”

Fauquier Health Wound Healing Center, a member of the Healogics, Inc. network, offers the following tips to live a heart healthy life:

  • Live an active lifestyle with 30 minutes of exercise on most days
  • Don’t smoke or use tobacco of any kind; it is one of the most significant risk factors for developing heart disease.
  • Eat a diet that is heart healthy. This includes lots of fruits, vegetables, whole grains, beans and other low-fat sources of protein.
  • Maintain a healthy weight. Obesity can lead to high blood pressure, high cholesterol and diabetes. All of these chronic conditions can lead to heart disease.
  • Ensure you get quality sleep by making it a priority in your life. Most adults need seven to nine hours of sleep each night.
  • Manage your stress in a healthy way with positive self-talk, using stress stoppers, engaging in activities you enjoy, and relaxing on a regular basis.
  • See your healthcare provider for regular screenings,, including blood pressure, cholesterol and diabetes screenings.

For more information about how your heart health can affect wound healing, contact the Fauquier Health Wound Healing Center, 493 Blackwell Road, Suite 101A, Warrenton, VA; 540-316-HEAL (4325).