Fauquier Health Makes the Big Time

Fauquier Health made an appearance on the local FOX News station this morning. The TV network shot in the lobby of the hospital from about 6:30 a.m. to almost 9:00 a.m.

Making a big impression were the Pet Therapy dogs of Fauquier Hospital. About nine were on the makeshift "set" and Jamie, a Dalmatian, visited a patient room on camera. Sheryl Vollrath proudly told the TV audience about the Pet Therapy program.

Lisa Spitzer, Fauquier Health's concierge and Linda Sharkey, vice president of Patient Care, represented Fauquier Health well, speaking about our Planetree initiatives and patient-centered care.

Hunter Payne, a loyal volunteer, played the piano in the lobby and hot chocolate chip cookies brightened the scene -- and fed the crew.

See the videos at: MyFox Washington DC Fauquier Hospital Dogs On Call Program
(Be sure to see both segments. One is under "related video" to the right of the main video box.)

In the first person

Dr. Jorge Minera, family practice physician at Piedmont Family Medicine, is concerned about an issue that has been all over the Internet lately: Because heart attack symptoms in women are different and less definitive than those in men, women’s symptoms may not be taken seriously enough, he says. (See next blog, below.)

On Monday morning, I found out first-hand that it’s not the case at Fauquier Health.

Making an attempt to keep up with the avalanche of Christmas cookies infiltrating my house, I was at the Fauquier Health LIFE Center at 7:30 a.m. climbing aboard the elliptical machine. By 7:34, I was out of breath and feeling weakness in my arms.

Now, I will admit I’m not in tip-top shape, but I can usually manage more than 4 minutes on the elliptical. I sheepishly made it over to the nurses’ station and admitted that I wasn’t feeling well. At the words, “short of breath” and “feeling week,” the women were genuinely concerned. At “chest tightness,” they flew into action.

The next hour or so was a blur as I was shipped off by ambulance to Fauquier Hospital, hooked up to an EKG machine and given aspirin and nitroglycerin tablets. I found that the folks in the Emergency Department took my condition very seriously indeed and worked hard to find out what was causing my discomfort.

For the next two days, it was echocardiograms, telemetry monitoring, blood draws and a stress test. Turns out, my heart is in great shape. For a while there, we thought it was a blood clot, but a CT scan ruled that out too. With the life-threatening possibilities ruled out, I was cleared to resume my normal activities while waiting for further test results to pinpoint the issue.

I was back in the LIFE Center Wednesday morning, feeling rested and ready to resume the battle against the cookies. The nurses welcomed me back and asked if I had doctor’s clearance to work out. They said they believed me, but I could tell they were keeping an eye on me, anyway.

It’s nice to know.

Key to women’s health is education

Pap smears and mammograms are vital tools that help doctors address women’s health needs, but comprehensive health care for women is a lot more complicated.

Dr. Jorge Minera of Piedmont Family Practice has a special interest in women’s health issues; he believes that education is the most important ingredient for healthier living.
Heart attacks in women, for instance, are largely misunderstood. Dr. Minera said, “Heart attacks have always been thought of as a man’s malady. Although equivalent numbers of men and women suffer heart attacks, more women than men die of heart attacks because women’s symptoms are different and are not as easily recognized.”

According to the National Institutes of Health, women’s symptoms can begin as much as a month before the heart attack and can include:

• Unusual fatigue
• Sleep disturbance
• Shortness of breath
• Indigestion
• Anxiety
• Weakness in the upper arms

Major symptoms during the heart attack include:
• Shortness of breath
• Weakness
• Unusual fatigue
• Cold sweat
• Dizziness
Dr. Minera said that although many women are conscientious about getting preventive care, when the issue is acute, they may delay getting help because of their many responsibilities. And the warning signs of heart attacks in women are often overlooked or attributed to other causes. “Often when women do seek help with these kinds of symptoms, their concerns are not validated; they are dismissed because their symptoms are more subtle.”

The doctor said that as a family practice physician, he has an advantage because of his previous experience with his patients. “We have the time to get a complete history, and consider all the risk factors -- tobacco use, cholesterol, blood pressure, is there diabetes in the family, or heart disease? Has there been a recent increase in stress? We can look at the patient as a whole and maybe see things differently.”

Weight management

When Dr. Minera and Piedmont Family Practice nurse practitioner Angelina Harman are asked, “What’s the most serious health problem women face today?” they agree wholeheartedly: obesity.

Dr, Minera said that he spends a lot of time with his patients on weight management education. “As someone who was once overweight myself, I understand that it is a struggle. But the rewards of achieving a healthy weight are tremendous. Sensible eating and exercise are the keys.

“I don’t want my patients to think of exercise as something they set aside time for and have to fit in. Being active, playing with your kids, taking long walks, they should just be part of your everyday life.”

Dr. Minera said that when it comes to weight management, having a previous relationship with a patient is extremely helpful. “Because we have seen the patient -- and maybe their family --- over a number of months or years, there is trust there, and they may feel comfortable telling us things they might not tell someone they are seeing for the first time.

“We want to find out what the stumbling blocks are. Is there a history of weight problems in the family? Has the weight gain been progressive or sudden? What is the diet history? Has there been a change in the stress level? After I have the history, I always get blood work done, test lipids (cholesterol) and thyroid to really find out what’s going on.”
Dr. Minera would like to see the “ideal weight” charts and BMI tests thrown out. “Waist to hip ratios are a much better indicator of health risks than just weight or BMI.”

Sometimes, Dr. Minera prescribes medication to assist with weight loss, but these require close follow-up.

And obesity is not the only weight management concern. Dr. Minera and Harman both see a fair number of adolescent girls and agree that eating disorders are not uncommon. For these teens, their weight can drop quickly into the danger zone. Harmon said, “We see a lot of it.”

Weight issues are complex, long-term problems that require careful monitoring and a lot of listening, said Dr. Minera. “These are not situations where one visit is going to ‘fix it.’ They require the patient and doctor to work together toward a long-term solution.”

The HPV vaccine

Better education is also needed about the vaccine that protects against human papillomavirus (HPV), which can cause cervical cancer. This is especially true now that the state of Virginia mandates the vaccine for rising sixth grade girls. Enacted by the Virginia General Assembly in 2007, the regulation went into effect Oct. 1 of this year.

Dr. Minera said the vaccine has been misunderstood and blamed for causing serious side effects. “There have been a lot of extreme reports floating around about problems attributed to the vaccine, but the connection has never been proven. The fact is that the types of HPV prevented by the vaccine cause 70 percent of cervical cancer cases and 90 percent of genital warts cases.”

Even though the legislation mandates that girls be vaccinated before they enter middle school, parents can opt-opt for their daughters. Dr. Minera believes that with education, parents will see how important the vaccine is and agree to protect their children -- before they become sexually active.

Dr. Minera said he is happy to be in family medicine. “I am able to see children and geriatric patients, and everyone in-between. I do simple biopsies, screen for depression, and even do a little counseling. Between me and my patients, it’s a good partnership.”

Warrenton physician specializes in pain relief

When interventional pain management specialist Dr. Daniel Heller was working at a pain clinic in Richmond, his patients were men and women who had already been to a slew of other doctors, desperately seeking an escape from debilitating pain. He said, “These were people who may have had numerous spine surgeries and were placed on high-dose narcotic medicines. Through the use of spinal cord stimulation, we were able to wean them off narcotics entirely, reduce their pain levels significantly and get them back to work.

“That was satisfying.”

Now a physician with
Blue Ridge Orthopaedic and Spine Center, Dr. Heller is helping patients in Warrenton find relief from chronic pain.

Spinal cord stimulation involves placing a small battery (about the size of a golf ball, but flat instead of spherical) under the skin, with wires extending out toward the spinal column. The electric impulses produced by the battery modulate the pain signals between the brain and the spinal cord. “Many patients experience about a 50 percent reduction in pain,” said Dr. Heller. He added that before implanting the battery, a patient will undergo a trial procedure for a week or so to confirm that the therapy will be helpful. “They can test drive it; if it provides significant relief we can implant it using minimally invasive surgery.”

He’s enthusiastic about the treatment. “The procedure has been around for 30 years, but the technology has advanced so much in the last ten years. It’s an alternative that shouldn’t be overlooked,” he said.

Spinal cord stimulation is an effective treatment, but it’s only one in Dr. Heller’s pain management arsenal. He believes in a multi-faceted approach, which may include site-specific injections, oral medication, physical therapy, even psychological treatments – or a combination of several techniques.

More than medicine

Dr. Heller said that eighty percent of opiate pain relievers are prescribed by primary care physicians, but sometimes, even these strong medicines don’t provide relief.

“Morphine can be effective, but if it’s not the right pain reliever for the problem, it won’t take care of the pain,” Dr. Heller said.

The key to pain relief is a good diagnosis, said Heller. “Sometimes, opiates are prescribed for chronic pain and when they don’t work, the dosages are increased until they get to a level the doctor is not comfortable prescribing. But if the problem is a nerve injury, an opiate may never work, regardless of the dose. It may be a pain signaling problem, where the brain is signaling pain even when there is nothing anatomically wrong. You’ve got to know what the root cause is before you can come up with a pain management strategy.

“Diagnosis is everything.”

Sometimes, the diagnosis requires a little detective work. Take for an example a case where the pain complaint does not match up with what the MRI reveals. “Sometimes there is more than one problem,” said Dr. Heller. “A person may have arthritis in the hip and a disc problem in the back. The pain might manifest itself in the same way for either injury. In order to devise a treatment plan, you have to know exactly what is causing the pain.”

Sometimes Dr. Heller uses an injection to help with diagnosis. He injects anesthetic into one of the problem areas. If the pain is greatly reduced in that area, that means the pain is originating from the place of the injection. If the pain continues unabated, the pain is being caused by another injury. Again, Dr. Heller emphasizes, “The treatment that may help with disc pain may not work on arthritis-type pain. The treatment must be specific to the diagnosis.”

Multi-discipline treatment

Once the diagnosis is complete, a treatment plan is outlined. Dr. Heller looks at each patient’s history with a holistic eye. Has the pain been chronic and severe? Is the patient experiencing anxiety or depression as a result of the pain? Has a sleep disorder developed because of the long-term pain?

“We take all these factors into account,” said Dr. Heller. “There are situations when we can target more than one problem with a single medication. Some pain medications can have a mood-lifting effect. Others can make a person sleepy. We can take advantage of the side effects to solve multiple problems.”

Sometimes when one medication fails to reduce pain, another – or a combination of medicines – will succeed.

Dr. Heller believes in using the least intrusive treatment possible. A peripheral joint injection directly at the problem area can utilize a lower dosage of steroids than an oral medication, for instance.

Radiofrequency ablation is another minimally invasive technique that can be used to treat pain. After isolating the specific sensory nerve, or nerves, causing the pain a site-specific diagnostic injection -- a needle with a heated tip -- is used to ablate, or destroy, the nerve. This technique, effective for arthritis-type neck and back pain, can relieve discomfort for six to 12 months, until the nerve regenerates.

Benefits of spinal cord stimulation

• A trial can be done first to make sure the patient has the pain reduction they are looking for before a permanent implant is placed.

• It is easily reversible.

• It has few side effects.

• Implantation is a minimally invasive procedure, requiring a minor surgical procedure on an outpatient basis.

• Pain relief can allow patients to reduce or eliminate their use of narcotic drugs.

• Some batteries are rechargeable; others last seven to ten years.

• The pain management system is completely implanted. Patients can travel anywhere and participate in many non-impact recreational activities, including swimming.

Who may be a candidate for spinal cord stimulation?
• If you have chronic trunk or limb pain

• If you have had spine surgery, but still have chronic pain

• If you have peripheral neuropathy

• If you have peripheral vascular disease

• If you have complex regional pain syndrome

• If other treatments have not helped your pain

• If you do not have a pacemaker and are not pregnant

Bistro Is Recognized by Board of Health

Anyone who has visited Fauquier Health's Bistro on the Hill knows it's a few steps up from a typical hospital cafeteria. With a fresh salad bar, homemade pizza, Mongolian barbeque, and homestyle specials every day, the variety is exceptional and the quality first class.

Operating the Bistro on the Hill is a vast undertaking.

Vernon Rhea runs the full-scale restaurant with kindly precision. He stays on top of every detail and knows every staffer.

His efforts have paid off again. On a recent inspection carried out by the Virginia Health Department, the Bistro exceeded all state standards, and had no deficiencies -- for the third inspection in a row.

The Virginia Health Department normally does inspections twice a year, one in the fall and one in the spring. The inspections take about an hour per visit. The focus is on food safety as it relates to temperatures of food and equipment, general sanitation and employee personal cleanliness during preparation of foods.

Vernon said, "They check on our Food Service Serv-Safe Certification. We exceeded all state standards by having 23 of our Food Service Employees certified as Safe Food Handlers. The requirement is to have one Serv-Safe Certified employee on premises during hours of operation."

Congratulations to the Bistro staff!

Now, what's for lunch?

News from the L.I.F.E. Center

Fauquier Health's L.I.F.E. Center will host a Holiday Open House on December 17. The event is an annual gathering hosted by the staff and members.

Everyone brings a dish to share with others. Come for the good people, good food and good cheer. The Open House starts at 6 a.m., when the L.I.F.E. Center opens, and continues until closing time at 8 p.m.

Everyone is welcome. The more, the merrier. The L.I.F.E. Center is located at 419 Holiday Court in Warrenton, Suite 200. The phone number is 540.316.2640.

The second L.I.F.E. Center event will be for members only. On December 10, the L.I.F.E. Center will hold fitness reassessments. This can be a follow up to the fitness assessment members had at signup. L.I.F.E. Center experts will check height, weight, flexibility, balance, waist measurement, grip strength and blood pressure.

Reassessments will take place in the L.I.F.E. Center's Studio 1. They will begin at 9:30 a.m. and will continue all day. Appointments are not necessary; members will be seen on a first-come, first-served basis.