19415 Deerfield Avenue
Lansdowne, Virginia 20176
Updates on this page will be posted with the most recent at the top. If this is your first visit to this page, read all of the posts, not just the most recent post, for full information.
MARCH 26, 2020
Hello out there!
So I received this communication today, and as a member of the American Society of Breast Surgeons (ASBrS), I will follow their lead on the recommendation at this time to delay routine mammograms, as in this joint statement with the American College of Radiology (ACR), printed below.
Be assured, however, that if you have a breast symptom or new concern, I am available to you, so please call the office. I am still doing cancer surgery, and of course no one is suggesting that you not seek care if you have a symptom or self exam change. Radiology facilities are still providing imaging workups for those with clincal concerns, biopsies are still being performed. It is just the routine imaging that is being affected. Please feel free to call the office if you are unsure of how to proceed.
March 26, 2020
With the COVID-19 situation evolving quickly, we must act decisively. As such, out of an abundance of caution, to help stem the spread of this disease in our communities and to protect our patients and our staff, The American Society of Breast Surgeons (ASBrS) and the American College of Radiology (ACR) recommend that medical facilities postpone all breast screening exams (to include screening mammography, ultrasound, and MRI) effective immediately.
The recommendation above should be effective immediately and continue until the pandemic is under control and then be re-evaluated on a weekly basis based upon each community’s impact by the current pandemic.
In addition to screening mammograms, routine breast visits and consultations for non-urgent breast abnormalities should also be delayed.
These are unprecedented times and call for extraordinary measures. These actions during this pandemic are for the utmost protection of our patients and staff. There is no evidence that delaying screening mammography for the proposed short time period will affect mortality but there is plenty of evidence that being exposed to the coronavirus can impact mortality.
ASBrS Board of Directors
ACR Board of Directors
MARCH 20, 2020
Happy Friday everyone.
I need to comment here about how you should handle having a screening mammogram that might be due for at this time.
Some radiology sites have discontinued doing screening mammograms until the quarantine is over.
We cannot predict how long the recommendations for "social distancing" will be in place.
Having a screening mammogram is not a "social event". It is important health care. It should not be postponed.
The considerations for going to any location outside the home, whether it be the grocery store, the lab to have your blood drawn, or any other personal or medical necessity, should be followed for your screening mammogram:
DO NOT go out if you have respiratory symptoms, fever, have traveled to an area where COVID is rampant, or if you have close proximity to someone who is sick.
Every healthcare facility is asking screening questions to decide which patients should not enter the facility. Those who "fail" the screening questions are told to stay away.
I do not recommend that you skip or postpone your screening mammogram. Mammogram machines are routinely disinfected between each and every patient, this has always been done well before this virus outbreak. Yes, the mammography technologist will be touching you. Every medical professional has had the need for handwashing between patients beaten into their brain from their first day of training, and clearly with the heightened awareness of COVID, there will be more diligence than ever.
You should also strongly consider having your mammogram performed in an outpatient facility that is not attached to a hospital. This will reduce the possibility that anyone sick may have been in that location. Outpatient free-standing imaging locations are getting people in and out rapidly and in many cases no one stops in the waiting room.
I am not yet due for my annual mammogram, but if I were, I would definitely go. We need to protect ourselves from other important medical conditions besides COVID, conditions that just like COVID can be symptomless.
Of course, you must make the medical decisions with which you are most comfortable. I am not supportive of a facility making that decision for you, by taking away your choice or denying important health screenings that can be done in a manner that minimizes contact with others. I am here, however, to support you however I may. Feel free to call the office if you need help with decision making in this regard, or if you want an imaging center referral.
MARCH 18, 2020
As this situation evolves, things can change on an almost daily basis until we discover the new (and hopefullly temproary!) normal. Check back here frequently for updates.
For the immediate time, here are some guidelines:
The office will NOT be taking appointments for routine annual follow ups for established patients with no new breast problems for now. Stay home and be safe.
NEW PATIENTS will be able to be seen in the office for the following problems: BIRADS 4 or 5 mammograms, already performed biopsies that have abnormal results, mastitis/breast infections not responsive to treatment by your PCP or OB/GYN.
What is BIRADS 4 or 5? If you look at the radiology report from your mammogram, this will be printed at the very bottom. Washington Radiology uses the term "Final Assessment" rather than BIRADS on their reports. If you were given a sheet of paper with boxes checked by hand by the radiologist, it would have the box marked saying that a biopsy has been suggested. If you are a patient seen by another practice within Loudoun Medical Group, most LMG practices share an electronic medical records system, and my staff can check to see if your report(s) are already available to us. If th reports are not, you will need to call the imaging center where you had your mammogram/ultrasound/biopsy, and have them fax the reports, including any pathology report, to my office fax, 571-346-1921. We will look at the reports and respond back to you on they same day the reports are received.
If you are a new patient and feel you need to be seen, but you do not fit the above criteria, please ask your referring provider to contact me directly.
Established patients who are coming in for office ultrasound follow ups WILL be able to make appointments for that.
We are investigating the use of telemedicine and how it might be appropriately used in a breast surgery practice. For right now, this is being reserved for ESTABLISHED patients (whom I have already met in person and examined) whom I have sent for additional imaging or testing, or for preop visits with those for whom surgery is being planned.
Again, this is a fluid situation. The phones are open. Be sensible and be safe. Call us if you are uncertain. We are here to help, but also have our families and the greater community to protect. Thanks for your patience and understanding.
Virginia Chiantella MD FACS
ORIGINAL POST 03/15/2020:
Physicians are in uncharted territory when it comes to how to manage their practices in the midst of the COVID virus outbreak.
You are all, I am sure, aware of the personal precautions you should take to help reduce your infection risk: strict and frequent handwashing for at least 20 seconds with soap and water, using hand sanitizer if soap and water are not available, covering your cough or sneeze with a tissue or sleeve (not your hands), avoiding crowds, avoiding touching your eyes, nose and mouth, avoiding non-essential travel, staying at home when you are sick, and cleaning and disinfecting frequently touched objects and surfaces. Much more comprehensive detail about the COVID virus outbreak is available on the Virginia Department of Health's website, vdh.virginia.gov, and I strongly recommend you take a look there, as well as the website Loudoun.gov, for local responses and recommendations.
It is not the purpose of my entry here to repeat the information on the above sites. However, I do need to address some issues that have a direct impact on my office practice, and your visits there.
First, my office is a shared office with a primary care practice. That practice is actively screening their sick patients on the phone before they come to the office, and any patient with symptoms suggestive of this viral illness are being directed to the ER and not being seen in the office. Any patient with an acute illness, who then is permitted to come to the office, is being taken directly from the waiting room into an exam room and is not being kept in the waiting room. Although I do share that waiting room for my patients, I DO NOT share any exam rooms, or any staff, with the primary care office.
Second, there is consideration being given to putting elective surgery on hold. This is current recommendation of the American College of Surgeons:
"Each hospital, health system, and surgeon should thoughtfully review all scheduled elective procedures with a plan to minimize, postpone, or cancel electively scheduled operations, endoscopies, or other invasive procedures until we have passed the predicted inflection point in the exposure graph and can be confident that our health care infrastructure can support a potentially rapid and overwhelming uptick in critical patient care needs".
As of today, none of the facilities where I do surgery (Inova Loudoun Hosptial, Reston Hospital, StoneSprings Hospital, or Reston Surgery Center) has directed its surgeons to reschedule any elective surgical procedures. This MAY happen, I just do not know at this time. However, I cannot forsee that cancer surgery would be considered elective.
My office staff and I are, of course, personally impacted by this event, just as you are. Kids are home from school, we have elderly parents (90+ years old in my case). It is indeed a challenging time.
We will be contacting our patients in advance of their appointments just to do a quick wellness check. If any symptoms are detected, we may reschedule you for a later time.
Please do not come to the office if you do not feel well. Please call us if you can not keep your appointment, and please do not bring children or babies to your appointment. Please consider not bringing anyone else to your appointment unless strictly necessary for emotional suport or for transportation needs. If someone else wishes to hear my discussion with the patient, they are welcome to call in during the visit.
If you prefer to reschedule your appointment, please feel free to call us.
We are looking into certain telemedicine options which will allow virtual visits, with the patient being outside the office, via FaceTime or similar applications.
We may also be consolidating our office hours schedule to certain days of the week in order to make the days more efficient and help my staff with their childcare needs while the kids are home from school.
This is an unprecedented time in my almost 32 years of practice. We have tried over these years to always put the needs of our patients first. Now we must also consider our families, our office staff, and those with whom I personally come in contact in the hospital (both patients and staff), and right now there is no clear answer as to how long these restrictions may go on.
We need to face this with calm and understanding, together. We will find creative ways to navigate this unprecedented time. Please feel free to call the office with your concerns, or suggestions. The phones will be open for the full work week just as they are now. As you might guess, the phones will be busier than usual, so please be aware that we do listen to, and respond to, all of our voice messages. We are also developing email commmunications through our electronic medical records system, and we will announce that on this page when it goes live.
Check back to this page frequently, I will keep it updated as things evolve.
Thanks in advance for your patience.
Virginia Chiantella MD FACS 03/15/2020