In rural Georgia, internist puts heart into cardiac rehab
From the April ACP Observer, copyright © 2006 by the American College of Physicians.
By Janet Colwell
The cardiac patients playing volleyball as part of their overall wellness program welcome a familiar player into their midst: F. Stuart Sanders, FACP, small-town internist, fellow athlete and the inspiration behind the fitness program.
Sports medicine has taken F. Stuart Sanders, FACP, from bobsled runs with Olympic athletes to weekly volleyball games with his patients.
In 1985, when Dr. Sanders first set up his practice in Demorest, Ga., a rural community (pop. 2,500) nestled in the mountains of northern Georgia, he was struck by the number of patients who survived heart attacks or strokes, but then fell back into bad habits after returning from treatment in Atlanta. The missing link, he discovered, was a local support system.
As the town's first full-time general internist, he stepped up to the plate. Just one year later, with three patients, a few exercise bicycles and a rowing machine, Dr. Sanders helped establish a cardiac rehabilitation program tucked away in one corner of the 53-bed Habersham County Medical Center. The following year the program expanded into pulmonary rehab, and over the next several years his participant rate shot up to 150 participants and four other volunteer physicians.
The program has no official funding source, getting by on community support. The hospital provides space and some equipment, while a local bank helped buy exercise equipment.
Enrollment in a homegrown community program has mushroomed from three patients to more than 1,000.
Today, about 1,000 adult patients participate in the adult fitness program and 100 others are enrolled in the Habersham Cardiac Disease Reversal and Rehabilitation Program, proving that you don't have to be a cardiologist to get involved in cardiac rehab. Dr. Sanders and his volunteer colleagues don't track outcomes—no one has time—but the general medical consensus is that there's been a decrease in cardiac deaths and a big improvement in community health.
"I got to be known as 'the country doctor who does cardiac rehab,' " said Dr. Sanders, who has traveled all over the country and abroad to speak about Demorest's programs. "I can help people understand the practical points of running a rehab program and making it successful."
The cornerstone of the Habersham program, which is certified by the American Association of Cardiovascular and Pulmonary Rehabilitation, is an intensive three-month physician-guided outpatient exercise regimen and lifestyle counseling on such topics as diabetes management and heart disease prevention, followed by ongoing maintenance support. A local hospital nurse and a volunteer physician teach stress reduction classes while local companies pitch in with donated equipment and office supplies.
Dr. Sanders has found ways to overcome barriers—such as the hospital's lack of space for a fitness center—and make the venture work. Ten years ago, Piedmont College, a local liberal arts institution, agreed to let rehab patients use its facilities and, four years ago, made available its new two-level fitness center equipped with an indoor running track.
For the most part, commercial insurers cover the first three months of the rehab program. In addition, several self-insured large employers in the area cover employee visits to the wellness center for fitness programs as well as stress tests, blood work and limited physicals.
The son of a family practitioner in Decatur, Ga., Dr. Sanders said his father, who practiced in the same town for 45 years before retiring, was a role model when he was growing up. "I never thought you could volunteer too much," he said. "I found that you benefit from every volunteer experience."
He came to Demorest directly after completing his residency at Greenville Hospital System in Greenville, S.C., drawn by rural Georgia's chronic shortage of physicians and surfeit of elderly patients. He was also struck by these grim statistics: The death rate from heart disease in rural Georgia was 41% higher than in other areas of the state, and many heart attack survivors in rural areas had little or no access to rehabilitation services.
Walking the walk
Part of his success is due to his hands-on approach. Dr. Sanders, now age 51, often participates in the weekly volleyball games as well as social events and graduation ceremonies for rehab participants. "Playing volleyball breaks down barriers between doctors and patients," he explained. "I'm an old athlete myself and I'm in that group that's trying to stay healthy and maintain cardiovascular fitness."
Board certified in sports medicine, he's kept in the game himself as team doctor for local college and high school sports teams and as a physician at Olympic Games in Salt Lake City, Nagano, Japan, and Atlanta. At the 1996 summer Olympics in Atlanta, he worked as doping control escort coordinator for the men's and women's volleyball teams and team physician for the marathon teams. In Salt Lake City in 2002, he worked as team physician for the bobsled and luge teams.
He also mentors aspiring physicians as clinical associate professor of medicine at Emory University School of Medicine in Atlanta. The third-year students who spend a month shadowing him in his practice hear Dr. Sanders rave about the how internists can benefit from becoming certified in sports medicine.
But he's most focused on helping his cardiac patients discover the "joy of sports." To that end, he remains very involved with the International Heart and Lung Games, which host Olympic-style events ranging from table tennis and golf putting to walking, basketball shooting, volleyball and swimming for cardiac and pulmonary rehab patients. He chairs the 2006 executive planning committee for the upcoming games in Chicago next month, where several Habersham alumni will participate as part of Georgia's 30- to 40-member team.
The games are just one more way to motivate rehab patients, Dr. Sanders said. "After having a heart attack or any kind of acute coronary syndrome, patients are shook up and scared about their own mortality," he explained. "To see them three weeks later strutting down the hall at cardiac rehab and eventually feeling like jocks again—it's a lot of fun."
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