DOC'S LIFE
BRITISH COLUMBIA
 Justin Dragoman (Medical student), Chi Zhang MD (Chief of Nephrology and the Department of Medicine), Marlene Johnson RN (Dialysis Nurse), and Dharma Paul L. Raju MD (Nephrologist and Project Coordinator) Even established medical practices like dialysis can benefit from new approaches. A Kootenay Boundary Regional Hospital team pooled their skills to search for a safe way to remove lung fluids during dialysis treatment. The team followed their hypothesis and analyzed the side effects of fluid retention on hemodialysis patients. Their goal was to see what benefits lung ultrasounds could provide for patients experiencing hypertension during treatment. The Lung Ultrasonographic Assessment of Volume Status in Hemodialysis team was keen to test Point of Care Ultrasound (POCUS) to identify extravascular lung water volume overload. It requires care and accuracy before taking action. “If you remove fluid too excessively, it can precipitate low blood pressure, loss of consciousness, heart attacks,” said DharmaPaul L. Raju MD (Nephrologist and Project Coordinator). “It can be quite dangerous.” Results give new insights and options The team members represented the variety of service providers a dialysis patient might come in touch with during treatment. This Physician Quality Improvement project was conducted by Justin Dragoman (Medical student), Chi Zhang MD (Chief of Nephrology and the Department of Medicine), Marlene Johnson RN (Dialysis Nurse), and Dharma Paul L. Raju MD (Nephrologist and Project Coordinator) at KBRH. The lung ultrasound results demonstrated a statistical decrease in the overall time patients were hypertensive while on dialysis. Also, the ultrasound allowed the researchers to identify patients with sub-clinical congestive heart failure (those without signs or symptoms of heart failure) who benefited from additional fluid removal. Most of the test patients were asymptomatic, leading to improved targeted ultrafiltration (UF) for patients with subclinical volume overload. UBC Medical student Justin Dragoman explained how the first step was to assess how often patients were becoming hypotensive during treatment. “We determined patients spent about 40 percent of their time in hypotension when they are undergoing a dialysis session.” Using lung ultrasound technology helped reduce the patient’s time in hypotension by 12 percent and deal with low blood pressure issues. Looking to the future “As physicians, we want to make sure we improve patient outcomes,” said Chi Zhang MD, Chief of Nephrology and the Department of Medicine. “But also we want to improve their physical well-being and experience with dialysis.” Lung ultrasonography has already been utilized by ICU and Emergency Room physicians. The project plans to expand throughout Interior Health and engage students and nurses throughout the region. Using this simple invaluable bedside tool can enhance patient safety in rural areas without easy access to hospital services. Review this project report here If you want to learn more about this initiative or anything else about living and working as a physician in Kootenay Boundary, please get in touch with Sylvain Turgeon, Head of the KB Doctors Recruitment Team. Like, Share and Follow us @kbdoctors.ca Facebook l Instagram l LinkedIn l Youtube  The Family! Next to the Columbia River, Trail. KB doctors are innovating again with the opening of a new Chronic Pain Clinic in Trail. The clinic is the brainchild of Kootenay Boundary Regional Hospital’s Dr. Sri Kollipara, Acting Head, Anesthesia and Pain Medicine. Dr. Kollipara came to the region as a locum and shortly after joined KBRH’s Anesthesiology team full-time.
The Kollipara family are excited about working and living in the beautiful Kootenay Boundary region, likening it to a working vacation. “You don't need to take a break to go somewhere. Every day you are in vacation mode!” says Kollipara. “My wife, Dr. Szilvia Szarvas (also an anesthetist at KBRH), and my daughter like going out on their bikes. We enjoy walking along the river and driving around taking in the breathtaking views.” Dr. Kollipara, one of the thirty FRCPC certified in Pain Medicine in the country, was motivated to expand regional chronic pain services to benefit individuals and communities in Kootenay Boundary. Along with other practitioners in the region, he is keen to explore how this common source of suffering for upwards of 20% of area residents could benefit from new, innovative, and proven approaches. Supporting chronic pain sufferers Dr. Kollipara is taking a very proactive approach to pain management, knowing the benefits of facing this mountain head on. If pain is not treated early, the patient’s journey can go off track and they can end up with longer term, chronic pain. The Clinic’s team is working hard to reduce the serious, long-term side effects that come with pain, knowing it can affect families, work, and quality of life, leading to more clinic visits, hospital stays, and pain medications. “Chronic pain can lead to a decrease in community productivity, misuse of opioids, addiction issues and their consequences,” says Kollipara. “Supporting patients during their vulnerable times is very important.” The KB Pain Clinic is one of two IH supported Advanced 1 and 2 pain intervention sites. The team is combining professional strengths to search for solutions. Patients are actively involved in their own treatment and ongoing self-management. “As a region, we can be proud of this new clinic and the impact it will have in helping our patients manage their chronic pain,” says Kollipara. “The KBRH Foundation did a fantastic job gathering the community's support. Every patient who walked into the Clinic expressed gratitude to the Interior Health Authority for making this happen. Every colleague was very excited about this venture.” Kollipara reflected on the community collaboration. “I have not seen this togetherness anywhere else since leaving India 25 years ago.” Strength in numbers Pain management usually starts with the family doctor, but the multi-disciplinary approach of involving pain management practitioners, physiotherapists, occupational therapists, and other specialists is at the heart of the Clinic’s method. Dr. Kollipara partners with Dr. Rodica Janz of Solis clinic, Nelson, as a physician lead for the chronic pain steering committee. They are also fully connected with Bill Nelem's pain and research center in Kelowna. As it evolves, primary, community, and Indigenous partnerships will be formed, and more services added. “We would like to provide neuromodulation programs with spinal cord stimulation and advanced procedures for cancer patients locally, to help reduce people’s travel time and get them the support they need, locally. Dealing with this gigantic problem from the grassroots level, while delivering the tertiary care, is important to me,” he says. If you want to learn more about this initiative or anything else about living and working as a physician in Kootenay Boundary, please get in touch with Sylvain Turgeon, Head of the KB Doctors Recruitment Team. Check out the Anesthesia position available now (February 2021) at the Kootenay Boundary Regiona Hospital, Permanent or Locum. Like, Share and Follow us @kbdoctors.ca Facebook l Instagram l LinkedIn l Youtube
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