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The world of Endoscopy at Lady Minto Hospital

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There are many things to be thankful for at Lady Minto Hospital. In our Summer 2013 Minto Messenger we featured the Emergency Room and talked about the importance of having 24/7 coverage. Another one of the hidden (or not so hidden for some patients) treasures of our community hospital is the Endoscopy Suite. This is the department where patients are admitted for day care procedures such as gastroscopies and colonoscopies. Here they are met with the expert care of our endoscopy team, which includes Dr. John Morse, General Internist, Drs. David Woodley and David Butcher, Anesthetists, Janet Franklin, Endoscopy Nurse Supervisor, and a roster of specialized nurses and technicians who work in the procedure room, in recovery and also in the processing room.

I spent an afternoon in the department and was able to observe the high tech nature of these diagnostic procedures and to see what it takes to run such a professional and efficient service. The sense of teamwork and enthusiam was impressive. I have heard many testimonials from patients who have had the procedure here and report how well cared for they were. I have included one such testimonial by Carl Graham who is grateful that the procedure was available to him so quickly, here on Salt Spring.

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When I sat down to talk with Janet Franklin, the Endoscopy Nurse Supervisor, I could see right away that she shared a passion for this work and leading her team of nurses. She has been the supervisor now for four years and took over from Dona Mackie who retired. She worked previously at Cowichan District Hospital and commutes from her home in Ladysmith on scope days. “I absolutely love my job”, she says, and doesn’t complain if it requires her to stay a little longer. “I try my best to ensure that no case is cancelled even if we run overtime. Patients must prepare for the procedure for two days and it is terrible if they have to cancel.”It is important that everyone follow the preparation instructions carefully. A successful procedure depends on correct preparation and all patients must be driven home and not be alone for 24 hours following the procedure. This is a standard for all patients receiving I.V. sedation. Having the service here on Salt Spring makes it so much easier to complete the preparation, particularly for the older patients. Having to travel by ferry and car for several hours before and after would be difficult.

Janet praises her team of nurses and technicians and says that Dr. Morse is “wonderful to work with and easy going”. Our new scopes and processing room have put our unit at the top of its class. She has worked in many units at other hospitals and states that Lady Minto by far has the best equipment, facilities and staff.

The hospital is funded for 52 endoscopy days per year. With 10 or 11 cases booked per day, this allows for just over 570 cases per year. When the program began just over 3 years ago, only half that number of cases was funded. Under the B.C. “Colon Cancer Check”program which began in March 2013, patients should be booked for colonscopy within a specific period of time following a positive FIT (fecal immunochemical test). The FIT test is easy for patients to do and results in greater compliance.

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Janet Hartwig, L.P.N., has been on staff at Lady Minto since 1975 and was trained to work in the endoscopy processing room. Her shift is intense and requires her to be proficient and systematic in every step of the cleaning process. The unit now has the deluxe Medivator, a machine that is fully computerized and cleans the equipment through various cycles using a series of special cleaning solutions. Post-processing solutions are checked for precision to ensure quality control. Once the scopes are ready to be put away for the next clinic day, they are stored in a special temperature controlled cupboard and hooked up to air flow tubes to ensure that they remain dust and moisture free. Dr. Morse is particularly pleased with the cleaning process as this gives him confidence that the scopes are safe and external evaluators have shown that our endoscopy room exceeds the Island Health requirements.

With the financial support of our community of donors, we have been able to upgrade the endoscopy equipment and recently purchased a new colonoscope that uses CO2, and works with the Olympus Scope Guide. The scope guide provides a virtual image on how the scope is moving through the colon using a magnetic strip imbedded in the scope. No radiation is required, making the procedure even safer. The Foundation also purchased the special storage cupboard, an endoscopy cautery unit, and a number of new gastroscopes and colonoscopes over the past few years. This year’s contribution from the Foundation totalled $71,000 for two new scopes.

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We are lucky to have an experienced expert like Dr. Morse on our team. He joined the Lady Minto Staff in 2010 after an 18 year stint in Yellowknife. After meeting Dr. Barclay up north and hearing about Salt Spring Island, he moved first to Maple Bay and then as workload demanded, he and his wife Gail made the move to Salt Spring. Gail works as his office manager and has expertise in computerized health records. Following in the footsteps of her father and grandfather, Dr. Morse’s daughter Amy became a Gastroenterologist and currently works in endoscopy in Edmonton. They often compare notes and the latest research and technology.

“It gives me great personal satisfaction to know that I have prevented cancer by performing this procedure,”Dr. Morse says. He explains that colorectal polyps almost always lead to cancer. It takes about ten years for a polyp to become cancerous. Through screening programs he can remove polyps before this happens, thus saving lives.

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Dr. Woodley and Dr. Butcher rotate shifts in the endoscopy suite and provide I.V. sedation and monitoring of patients during the procedure. I spoke to Dr. Woodley, who has worked at Lady Minto for 19 years as a general practitioner and anaesthetist. “We can’t underestimate how vital this service is in our community. As a primary care physician, I can speak with John [Morse] and Janet directly and when my patients require urgent investigation, the procedure will be booked. Patients are not lost in the numbers game as they are in the big centres. ”

Having a second physician in the room that is specialized in I.V. sedation is a great advantage for patients. Dr. Woodley and Dr. Butcher monitor the medications and adjust them as required. The new scope which uses CO2 [rather than air to distend the bowel] allows for less cramping and discomfort. Patients who are anxious about colonoscopy are calmer and the experience is positive.

Janet tells me that the department’s budget was recently increased for 5 extra scope days. This means an extra day for the next few weeks to reduce the waiting list. She and Dr. Morse review the referrals and triage the bookings according to urgency.

I learned a great deal from Janet and her team while visiting the unit. The sense of camaraderie, professionalism and calm is just what the doctor ordered if you have to have a scope. I would have no hesitation at all to undergo this procedure should the need ever arise.

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