One of the primary difficulties facing small, rural hospitals is that of attracting high quality physicians, particularly specialists who face a mountain of debt once they graduate from medical school. Often, locating specialists who are of exceptional quality and who also work to create caring relationships with their patients, is a daunting task. Further, finding them is one thing; getting them to stay is sometimes quite another.
So, when Eastern Plumas Health Care managed to attract Dr. Charles Cox, a Board Certified, Stanford trained Gastroenterologist to its staff, there was cause for celebration. Currently, his dance card is so full, the hospital is working to add days to his schedule. It should shock no one, in a community with a much higher than average elderly population, that a GI specialist would hit the best seller list. What is, perhaps, surprising is that EPHC has managed to retain such a highly qualified specialist, one with thirty years of experience who also prides himself on keeping up with the latest advancements in his field.
He works hand in hand with EPHC’s Nurse Practitioner, Mary Morrison, who has 20 years of experience working with a top notch Truckee GI specialist. Morrison’s expertise in the field, combined with her special interest is working with Hepatitis C patients, offers a much needed in-house resource for area patients.
Dr. Cox currently sees patients in the clinic and does procedures twice a month, but patients can schedule an appointment with Morrison any time. She can deal with most patient issues herself and, if necessary, she can call Dr. Cox for a consultation. Also, she can order necessary labs and x-rays and then schedule patient procedures with Dr. Cox. “It’s like having a second consultant,” he said. “There’s a presence all the time for patient needs.”
Not surprisingly, Dr. Cox performs a lot of colonoscopies—the procedure everyone loves to hate. He stressed the vital importance of colon cancer screenings, and noted that he employs the most current preps. In fact, he has three different preps that patients can choose from, and one requires them to drink much less liquid to achieve the … desired result. Since it’s the preparation aspect that most patients remember most about the experience, this is very good news. Dr. Cox cautioned, however, that patients need to check with their insurance before choosing a prep, as not all insurances cover all three preps.
Dr. Cox said that he gives patients a detailed explanation of what will happen during their procedure, in order to set their minds at ease. The procedure itself takes place in a “discreet, private environment,” in a single room with only Dr. Cox and one nurse in attendance.
In addition, patients are sedated using the minimum amount of sedative they require to be comfortable with the exam. “Less anesthesia,” he said, “means fewer side effects.” He uses the contemporary water infusion technique, which also requires less sedation–filling the colon with water rather than distending it with gas. It’s also easier to move the scope in water which, again, makes the process more comfortable.
Finally, Dr. Cox utilizes the latest cutting edge technique for removing larger polyps. Typically, he said, when these polyps are discovered during a procedure, the patient is referred to a surgery or tertiary care center to have them removed. Dr. Cox is an expert in the latest endoscopic mucosal resection (EMR) techniques, however, allowing patients to have this procedure done right here in Portola. In EMR, the large polyp or lesion wall is “expanded by adding water, which forms a water cushion,” explained Dr. Cox. This makes it much easier to remove the polyp and greatly lessens the possibility of perforation. The incision site is clipped together using hemoclips, which are metallic mechanical devices that close the incision without the need for suturing or surgery.
Dr. Cox sees patients across the spectrum if GI disorders and is complemented by Morrison’s expertise with Hepatitis C patients. Recently, there have been tremendous strides made in Hep C treatment, according to Dr. Cox. “With the new drugs and new regimens, problematic genotypes that are virally difficult to treat are now seeing an 80-90 percent cure rate.” This is especially important for patients who failed their prior treatment, which has until now involved 48 weeks of “extremely uncomfortable” interferon treatment. This treatment not only has bad side effects, its cure rate is fairly low (around fifty percent) for certain genotypes.
The two drugs that are a part of the new treatment are being heralded as “game changers.” Both work much better than the current treatment for Hepatitis C; they cure it more often, in less time, and with fewer side effects. Insurance providers are approving these new very expensive drugs, but with prior authorization and with stipulations, so patients will need to check with their providers prior to starting treatment. Still, good news for Hep C patients has been a long time in coming, and Dr. Cox and Mary Morrison are thrilled to be able to offer it to their patients.
Patients interested in scheduling an appointment with Dr. Cox or getting further information can call the Portola Clinic at 530.832.6600.