Physician Spotlight: Dr. Sandi Fields
by Larissa Biggers, on October 19, 2018
All physicians want to provide superior care for their patients, but practicing medicine today can be complicated. In the last decade, doctors have been tasked with navigating new technologies, government mandates, and payment guidelines, all of which can detract from caring for patients.
But even in the face of such challenges, there are physicians who shine. Despite her busy schedule, clinical obligations, and yes, a personal life, Dr. Sandi Fields still manages to radiate a passion for medicine and for her patients, providing them with exceptional, individualized patient care. Dr. Fields was an early adopter of ColoWrap and has used the device consistently in all patients for over a year.
Last month the ColoWrap team was fortunate enough to spend an afternoon with Dr. Fields. She not only agreed to be interviewed, but she also opened her home to us (and a film crew). She was patient and good-humored, answering questions about everything from challenges of colonoscopy to her work as Chief of Staff.
The final video cut of Dr. Fields' testimonial is available above and on the ColoWrap website. Below are excerpts from the full interview:
ColoWrap: What attracted you to gastroenterology as a specialty?
Dr. Fields: Day-to-day, gastroenterology is never the same in terms of patients and procedures. No two colons are ever the same; no two upper endoscopies are ever the same. So it’s like the first day of work, every day.
ColoWrap: You’ve performed tens of thousands of colonoscopies. What’s make a colonoscopy challenging?
Dr. Fields: A redundant sigmoid colon, a redundant transverse colon, the looping of the scope, body habitus.
ColoWrap: Can you help us better understand looping?
Dr. Fields: When you enter the colon it’s not just a straight drive to the right side. Sometimes when you go in the scope will form an alpha loop, or it can form a gamma loop, and you have to learn how to reduce it to move the scope forward.
ColoWrap: What problems does looping cause?
Dr. Fields: It can cause patients pain and discomfort, it can increase the procedure time, and it can also increase the amount of sedation you need to use in order to make the patient comfortable. When you increase procedure time and you increase the amount of sedation, that increases the likelihood that you are going to have complications.
ColoWrap: Does looping play a role in failed colonoscopies?
Dr. Fields: Definitely, if you have a more difficult colon, it can reduce the likelihood that you get to the cecum.
ColoWrap: What is the impact of that?
Dr. Fields: The impact for my patients is if I can’t get to the cecum they have to go to a tertiary care center and have [another] colonoscopy with a more rigid overtube and fluoroscopy. I try to avoid making my patients go through two bowel preps and two colonoscopies.
ColoWrap: Before ColoWrap, what would you do when you encountered a difficult colon?
Dr. Fields: It was pressure on the left lateral side. Then we flipped the patient on their back. Then we would apply more pressure. I would retract the scope and try to reduce the loop, then insert the scope. It would extend the procedure time.
ColoWrap: How effective is applying pressure?
Dr. Fields: It can be very effective, [laugh] but now that I use ColoWrap on all of my patients, we don’t really have to apply pressure anymore. But some of the drawbacks are that it puts the patient at risk. So if you are applying pressure to the abdomen and you have a device inside a patient, then you can increase the likelihood of having a perforation of the colon, the spleen, or the liver—or any other organ that does not respond well to the pressure that is being applied. It’s kind of hard for the nurses to know—did they apply too much? Are they applying too little? And as far as the nurses are concerned, it causes wear and tear on them as well. But now that we have ColoWrap, we don’t have to do that in my room.
ColoWrap: Was your initial inclination to use ColoWrap selectively?
Dr. Fields: When I first started using ColoWrap, it was only for the difficult patients. But then, it worked so well that I started using it on all cases [laughs]. It’s better for everyone in the room when you use it. It’s better for me because it takes me less work to get to the cecum. So all the work that I do is on the way out. It’s better for the nurses because they don’t have to worry about fatigue on their bodies or their minds. It’s better for the patient. It makes the patient more comfortable, and because it takes less time to do the procedure, it further minimizes their risk for complications. Those are the three reasons I use ColoWrap on every patient.
ColoWrap: One thing we’ve found in studies is that in certain patients there could be an improvement in ADR. What do you think?
Dr. Fields: It has been my experience that ColoWrap helps detection.
Dr. Fields: It prevents the scope from flipping back, so you do not miss the polyps that are on the back side of the folds. Also, it prevents it from flipping back in the sigmoid colon, so you are more likely to see polyps; when you withdraw, you are not flipping past a segment of colon because the ColoWrap is not allowing that loop to be released so quickly. Whatever we can do to increase our adenoma detection rate during colonoscopy, we should be doing.
ColoWrap: Have you had an opportunity to scope a patient a second time that you had previously marked as difficult?
Dr. Fields: I have had the opportunity to rescope more than one patient. My experience has been when using the ColoWrap that even though they have a redundant colon, it’s still not taking me the same amount of work to get to the cecum. It’s easier for me to get to the cecum.
ColoWrap: What about for you, as the person doing the procedures, what does that mean in terms of your day?
Dr. Fields: It allows me to complete my day sooner. The fact that I have ColoWrap, when I go in and I have a schedule full of back-to-back colonoscopies, it doesn’t faze me one bit. Also, in terms of the physical toll colonoscopies take on your arms and your body, it’s lessened. The longer a colonoscopy takes, the longer you have to stand. Also, I had to have therapy for lateral epicondylitis (tennis elbow) just because of all the torquing that’s involved with doing a colonoscopy. But physically I don’t have any of those problems as long as I use ColoWrap.
ColoWrap: What do you tell patients about ColoWrap?
Dr. Fields: Initially I discuss the procedure and what the potential complications are for colonoscopy. Then I say I’m going to use a belt. It’s called a ColoWrap. What I tell them is that, number one, it makes them more comfortable during the procedure; number two, it decreases the time it takes me to do the procedure; and number three, it further minimizes the risk of getting a hole in anything that I pass through. I have not had one patient complain about the ColoWrap. Using ColoWrap communicates to patients that you are doing everything you can to make sure that their colonoscopy is the best that it could possibly be.