medicine

It's been less than 10 days since new protocols related to Ebola were put in place at United Memorial Medical Center, but emergency room staff have already passed one key preparedness test.

In an unannounced drill, a man showed up claiming a fever and suffering from weakness and a headache, a staff member asked a newly implemented set of questions that included whether he had traveled recently from Western Africa.

He uttered, "yes," and within 60 seconds he was in an infectious disease isolation room.

"I was very encouraged by the outcome," said Dan Ireland, president of UMMC. "Any time we do an exercise, do a drill, we like to hear the positive feedback that things are working as they should be."

Following CDC guidelines, UMMC, the whole county's health and emergency response leadership, really, have been implementing Ebola protocols, even if it seems like a far-off, distant problem that may never reach Genesee County.

"We do a lot of things based on a long shot," Ireland said. "We prepare for the rare circumstances because those are the ones that can be really significant. Hopefully, it never happens, but we want to be prepared. I was here during the SARS era. We never had a SARS case in this facility, even while it was in Toronto, but we were ready. We have to be ready for those things or you're not doing the public the service that they need."

Ebola is a virus transmitted among mammals through contact with bodily fluid. Symptoms start with fever, sore throat, muscle pain and headaches, much like the flu. Death occurs in about 50 percent of the patients who contract it.  

The first known outbreak was in 1976 in South Sudan and there have been periodic outbreaks since. The latest outbreak started in March and currently about 10,000 people are believed to have the disease. But some scientists believe exponential growth (the number of people with the disease during an outbreak doubles about every 20 days) could mean as many as 500,000 in West Africa could be ill from Ebola (perhaps more than a million, if there is under reporting).

There is currently no Ebola-specific treatment or vaccine, though scientists are fast-tracking research.  

That's way isolation and quarantine are essential to controlling the disease.

Ireland said hospital officials are continuously communicating with staff about Ebola and CDC-recommended protocols.

It's a rapidly evolving situation, Ireland said, and directives and procedures sometimes change with little notice.

For example, today's identification protocol involves questions about travel. If the outbreak grows, that protocol could change.

"It could be very different story for you tomorrow," Ireland said. "That's health care and that's medicine. As new information comes out, health care evolves."

To help with the communication process, so essential to control of the disease should it ever reach Genesee County, the hospital hosted a meeting today of officials from UMMC, Genesee County Emergency Services and the County Health Department.

The word on how to deal with Ebola needs to get out to doctors and nurses throughout the local health community, including health workers at clinics and on ambulances, both paid and volunteer, as well as local law enforcement and fire chiefs.

Anybody who might come into first contact with an Ebola patient needs to know how to respond to the situation, since isolation and quarantine are so critical its control.

Tim Yaeger, emergency management coordinator for the county, said communication is already starting with the agencies his department deals with, and Ebola will be on the agenda of upcoming fire chief and fire service meetings.

"Our job is to maintain awareness and communication," Yaeger said. "We discuss it with our 9-1-1 center, emergency responders and law enforcement officers need to be aware and not make assumptions about how to protect themselves from people who might be infected. The common theme every day is that we're getting new information regarding Ebola and we need to coordinate that with emergency responders."

The county health department hasn't fielded any calls from concerned citizens about Ebola (there's been more calls about enterovirus, which has been reported in Rochester and Buffalo, but not Genesee County), but that doesn't mean county health officials aren't staying on top of the latest information, said Director Paul Pettit. 

The first person to contract Ebola in the U.S. is a Dallas nurse. She appears have been infected while treating a Dallas resident who contracted the disease in Africa.

Another health care worker in Spain contracted the disease after caring for a patient in that country.

In the case in Spain, it's been determined that the health care worker likely did not follow proper protocol for removing protective gear.

It's still speculation, but that may also have been the situation in Dallas.

Typically, health care workers are covered from head to toe in protective garb while interacting with Ebola patients (only those who have actually become sick can transmit the disease).  

The probable cause of health care workers in Spain and Dallas getting sick certainly has local nurses paying close attention to the proper procedures, said Mary Beth Bowen, vice president of nursing for UMMC.

There's even a place for chocolate syrup in the training.  

You see, if there's chocolate syrup on your protective gear and then you take it off and find chocolate syrup on your skin, you've done something wrong.

One reason Ireland wanted to talk about this issue, and bring these local experts together, is that he doesn't want anybody in the community to panic about Ebola.

He's concerned there's a lot of hysteria and misinformation in the media about the disease, and if panic sets in, it may lead to somebody avoiding medical treatment for other conditions, a decision that could be even more dangerous.   

If people understand more about the disease and what the hospital is doing to minimize any risk of transmission, he hopes it will eliminate any such panic in the community.

"We want to avoid any misinformation in the community," Ireland said. "We are doing everything by what the CDC advises."

Photo: Gathered at an office in UMMC to discuss Ebola are Tim Yaeger and Jim Bouton, Office of Emergency Management, Mary Beth Bown, VP of nursing, Paul Pettit, county director of health, and Dan Ireland, president of UMMC.

On the Web:

• The CDC's Ebola Web site.
• Genesee County Health Department
• Emergency Management Services
• UMMC

Batavia High School track star Alex Egeli stopped in to see his chiropractor, Tom Mazurkiewicz, today before heading off to the state championships in Syracuse.

Egeli is ranked the number one runner in the state in the 400 meter hurdles and 110 meter hurdles. He's the first BHS track team member to qualify in four state events (those two, plus 100-yard dash and he's a member of one of the relay teams).

Mazurkiewicz will be at the state championship as well, working as a chiropractor.

Chiropractic care is being increasingly recognized as important by athletes, Mazurkiewicz said, because joint restriction and muscle imbalance can impede performance and increase the chance of injury. It's become a part of the training routine for NFL and Olympic athletes, he said.

Egeli will attend Freedonia next year and then maybe move up to a Division I university.

Next week, look for a new feature on The Batavian: "Ask the Local Doctor."

This will be a new weekly feature on The Batavian sponsored by Insource Urgent Care.

Readers of The Batavian are invited to e-mail medical questions to askthedoc@thebatavian.com and the professional staff at Insource will review the questions and pick one each week to answer in the "Ask the Local Doctor" weekly column.

Insource is tied into a network of local providers as well as partnering with some of the leading clinics and specialists in Western New York such as the Dent Neurologic Institute, Excelsior Orthopedics, UB Neurosurgery and Dr. Ross Sherban, a spine surgeon with Simmons and Sherban Spine and Orthopedics.

The column will give readers access to this broad and deep wealth of local medical knowledge so that a range of medical issues can be addressed.

If a reader's question is selected, the reader will be eligible to receive a free flu shot from Insource.

Of course, questions will be published without the name of the reader who submitted the question.

The e-mail inbox is open. Submit your questions to askthedoc@thebatavian.com

For Krysten Schmidt, “ladies first” is more than just a polite truism – it is a passion.

“I have always been passionate about women’s health,” she said. “We all have a niche, and I found mine.”

That’s why she has opened “Ladies First,” a gynecological care clinic at 47A Batavia City Centre in Batavia.

Services at “Ladies First” is available to females age 13 and older and includes:

• routine annual exams;
• cancer screenings;
• vaginal and urinary tract infection diagnosis and treatment;
• STD diagnosis and treatment;
• family planning;
• birth control;
• menopausal care; and
• osteoporosis treatment.

Schmidt, of Batavia, draws from a 20-year nursing career that has allowed her to work with all kinds of patients "from babies to geriatrics.”

Prior to her new venture, she was a nurse practitioner at the Women's Care Center of United Memorial Medical Center and at the general practice of Mary Obear, M.D., in Pembroke. She has also worked at St. Jerome's and HomeCare & Hospice.

One of the perks she has noticed in being a nurse practitioner is that it fosters a holistic view of the patient.

"I think being a nurse practitioner rather than an M.D., you look at the patient as a whole (rather than) just focus on what the patient came to the office that day for."

To that end, she has worked hard to give "Ladies First" a comfortable and welcoming atmosphere -- complete with solid, Amish-made maple cabinets from Pennsylvania, hardwood flooring and walls painted a warm terra cotta.

"My patients are loving the non-medical feel of the office," Schmidt said.

Construction of "Ladies First" started the first week of August. Schmidt's husband, Edward, collaborated with the contractors in renovating the vacant space next to the office of Lalit Jain, M.D., and "worked hard to get the place done on time."

Once that phase of the project was completed, then came the marketing phase. "Ladies First" has had a very good run so far, and Schmidt attributes much of its success to word of mouth.

"Let's face it," she said, "most women are not going to pick their GYN provider out of the Yellow Pages. Most of my patients come from referrals from their friends, family and coworkers."

Still, Schmidt has done her part to put "Ladies First" out there. She took part in the Business Improvement District's "Taste of Fall Wine Walk," which brought about 300 people to the office. She has also been printing T-shirts and advertising (including on The Batavian).

All of this effort flows from Schmidt's strong desire to use her expertise in the service of other women.

"Women seem to relate better to other women when discussing birth control, menstrual cycles, menopause and sexual health. They are more open to discussion."

Most insurance programs will cover a visit to "Ladies First," according to Schmidt.

"We do have a reduced fee for cash-paying patients depending on the service they need," she said.

As a nurse practitioner, Schmidt cannot provide any surgical or pregnancy-related care. For that, she will refer patients to her collaborating physician, Richard Edwards, M.D.

"Ladies First" is open from 8 a.m. to 7 p.m. Mondays, 8 a.m. to 5 p.m. Tuesdays and Thursdays, and 8 a.m. to noon Fridays. It is closed on Wednesdays.

For more information, call 343-6600.

Photo courtesy of Krysten Schmidt