Store and Forward Pre-Op Surgical Clearance

Seeing a specialist right before a major surgery can be challenging, if not impossible. The process of authorization approval, scheduling an appointment, and going to the specialist on short notice can be daunting even in the most efficient of health systems.

New technology makes it possible to get surgical clearance from a specialist before the patient goes under the knife for surgery. SynerMed CONSULT has handled two such cases within the past month, one for a mastectomy, and another for eye surgery. Both were for cardiology clearances. EKGs were submitted for both cases, along with history, medication, and allergies.

The cardiologist was able to answer each case within the same business day, with each member going in to surgery a few days later. An example of the case studies (minus identifying information) are included below:

Case 1 - Mastectomy

PCP Office: No known allergies. Medications and EKG are included. Patient has diabetes mellitus and needs an evaluation for Pre-Op with a diagnosis of carcinoma of the breast. Patient will go in for mastectomy three days from now.

Specialist: The EKG is normal. If the patient is clinically stable and asymptomatic, no further testing is required for cardiac clearance for intermediate risk surgery. Patient is considered at risk, but no contrandications.

CASE 2 - Eye Surgery

PCP Office: Pt with preoperative examination and Abnormal EKG.; Clinical Question: Pt has abnormal EKG, needs pre-op cardiac clearance asap. Please review and clear for pt catract surgery. thanks.

Specialist: Patient is cleared for cataract surgery, no further tests are necessary, perioperative beta blockade is recommended.

Both surgeries were a success and were able to be reviewed by the cardiologist in time for their respective surgeries. Another score for telehealth! CONSULT - specialist access when you need it.

Non-Invasive Colon Cancer Screening

The Problem If you are over fifty years, your doctor probably told you to get a colonoscopy or a sigmoidoscopy. This entails fasting for a short while and getting a tube inserted into my rectum. Not fun! What did I do in order to be subject to this kind of torture? Is there anything else I can do to avoid this? Colorectal cancer occurs in the colon or rectum. The colon is the large intestine or large bowel, while the rectum is the passageway that connects the colon to the anus. Colorectal cancer affects men and women of all racial and ethnic groups, and is most often found in people aged 50 years or older. In the United States, it is the third most common cancer for men and women. Of cancers that affect both men and women, colorectal cancer is the second leading cancer killer in the United States. If everybody aged 50 or older had regular screening tests, as many as 60% of deaths from colorectal cancer could be prevented. Screening can find precancerous polyps—abnormal growths in the colon or rectum—that can be removed before turning into cancer. About nine out of every 10 people whose colorectal cancer is found early and treated are still alive five years later. http://www.cdc.gov/cancer/colorectal/basic_info/index.htm

The Solution

There are three types of screening that can test for colorectal cancer. Any one of these three methods can be used to test for Colorectal Cancer, but only the FOBT is non invasive (and can be done in your own home):

High-Sensitivity FOBT (Stool Test): This is the least invasive method. You receive a test kit from your doctor. At home, you use a stick or brush to obtain a small amount of stool. You return the test kit to the doctor or a lab, where the stool samples analyzed for blood. This should be performed once per year.           

Flexible Sigmoidoscopy: For this test, the doctor puts a short, thin, flexible, lighted tube into your rectum. The doctor checks for polyps or cancer inside the rectum and lower third of the colon. If the FOBT is not done, this should be done every five years.

Colonoscopy: This is similar to flexible sigmoidoscopy, except the doctor uses a longer, thin, flexible, lighted tube to check for polyps or cancer inside the rectum and the entire colon. During the test, the doctor can find and remove most polyps and some cancers. If the FOBT is not done, this should be done every ten years. Colonoscopy also is used as a follow-up test if anything unusual is found during one of the other screening tests.

The Non-Invasive Option

The FOBT is quick, efficient, and convenient. The next time your doctor tries to send you for a pipe cleaning, ask about the FOBT option. Our CONSULT Gastroenterologist would be happy to interpret results and give you any further recommendations.

Get the FOBT and catch Colorectal Cancer early!

Thomas Manetti, MPH | CONSULT Project Manager

SynerMed – Innovating Healthcare

1600 Corporate Center Drive | Monterey Park, CA 91754

tel 213 406 2820 | fax 213.572.3808 | tmanetti@synermed.com

Follow us on Twitter: https://www.twitter.com/synermedCONSULT

 

Viral Warts go Sub-Zero

Want to get rid of those stubborn warts on your finger? It's quick, easy and over the counter! 

Your science teacher's definition: The most common wart is called Verruca Vulgaris, which has been described as "a raised wart with roughened surface, most common on hands, but can grow anywhere on the body." Warts are caused by the HPV (Human Papilloma Virus).

 Source: http://en.wikipedia.org/wiki/Viral_wart

Try this first!

Products containing salicylic acid and silver nitrate have been effective in removing some warts. These are available at your local supermarket or pharmacy/drug store. "Dr Scholl's Freeze Away Common and Plantar Wart Remover" and "Compound W Freeze Off" are commonly used to freeze away your common wart.  Both products are between $10 - $20, with the generic equivalents at cheaper price points.

Basic Instructions (for pressurized can applicators):

1)     Clean the area with the wart with a mild soap and wash clean.

2)     Prepare the pressurized can and applicator

3)     Apply the freezing compound to the wart (be sure to cover the entire wart, but avoid contact with non-affected areas)

4)     Discard the applicator tip (avoid contact with the tip, as it can infect another area)

5)     Wait 24 hours after treatment and wash the area with soap and water

Disclaimer: Be sure not to use these products around the eyes, lips, nose, genital, or anal areas.

Source: http://www.ehow.com/how_4796410_scholls-freeze-away-wart-remover.html

or use the Home Remedy (unproven by medical science, but mama says it works): put duct tape on the wart and change the duct tape until the wart falls off. Isn’t duct tape good for everything?

If all else fails:

Not to worry! There's stronger stuff! Liquid Nitrogen is commonly used to treat those more stubborn warts.  Your doctor may even have some available in the office. Since warts are fed by your blood vessels (that's why they throb sometimes), they need to be frozen at very low temperatures at the localized site. These blood vessels are damaged/killed by the cold temperatures produced by the liquid nitrogen. Just ask your doctor to freeze it off!

Source: http://www.wikihow.com/Freeze-a-Wart-With-Liquid-Nitrogen

After your treatment:

Unless you want some gross, virus filled fluid running all over your skin, RESIST THE URGE TO POP THE BLISTER! Tissue under the blister can be re-infected and your wart can grow back.  Put a Band-Aid over it.

Viral Warts is the most commonly seen condition on CONSULT Dermatology. Wart freezing is simple, quick, and able to be handled by either the patient or primary care physician. Let's freeze those warts off!

Thomas Manetti, MPH | CONSULT Project Manager

SynerMed – Innovating Healthcare

tel 213 406 2820 | tmanetti@synermed.com

www.synermed.com

CONSULT – Bringing Telemedicine to You               

Stinky Feet!

Ever wonder what that nasty stench in your high school locker room is? It's your foot. It's your neighbor's foot. It's coming from that guy down your row that everyone is avoiding! A common foot condition – Tinea Pedis - more commonly known as “Athlete’s Foot” is often the root of those smelly feet!   And it doesn’t just affect sport stars!

Some symptoms of Athlete's Foot include dry skin, itching, inflammation, and blisters. According to our very own CONSULT podiatrist - Dr. Ruby Maher - and her awesome blog, Athlete Foot sufferers should keep in mind the following:

·         Avoid walking barefoot in the locker room or anywhere for that matter

·         Use shower shoes

·         Use powder on the feet to reduce perspiration

·         Wear clean socks to keep feet dry

If it gets unbearable then over-the-counter anti-fungals such as Lamisil, Lotrimin or tough actin’ Tinactin can help!  But if it gets really, really bad, then a Doctor or CONSULT Specialist will need to prescribe something a tad bit stronger.  Don’t forget the pictures!

The mHealth Enabler

The practice of medicine continues to evolve.  Innovative companies like Ring-a-Doc and Interactive MD are delivering medical care with the use of mobile devices and computers.  These services expand the traditional physician practice well beyond its physical walls.  Others, such as Healthcare Magic and Health Tap, have taken the approach of using the disseminating qualities of the internet to create advice forums.  In each case, they are bringing telemedicine directly to the consumer.  At SynerMed, we approach the problem differently.

SynerMed has pioneered the marriage of telemedicine directly into the software and workflow of its very own managed care telemedicine and authorization portal - CONNECT.  Other managed care organizations have had trouble integrating mHealth into their networks due to the lack of payment and medical schemas to operationalize the effort.  SynerMed, with its ever-growing network of at-risk independent provider groups, can seamlessly integrate clinical algorithms with its claims payment system.  These elements enable a fully functional platform to deliver remote clinical services.  This service is FREE to our involved physicians (we actually pay the PCP to participate) within our network, which translates to better care. As a privately-owned organization, SynerMed fully funds this program, designed to increase access and timeliness standards for specialty services.

Currently, CONSULT is the vehicle for coordinating patient treatment plans on a case-by-case basis. A primary care physician submits a case for review to the appropriate specialist. This communication occurs via our HIPAA-secured encrypted portal.  A specialist typically answers within 48 hours. The primary care physician has the option to request more information, refer the patient for a face-to-face evaluation, or accept the treatment advice by caring for the patient within their office.  About 14% of all cases have been successfully handled through the CONSULT telemedicine platform.