Visiting your doctor

Just like a car needs regular oil changes or home furnaces need an annual inspection, humans benefit from regular maintenance.

In the pandemic, though, some people have skipped out on checkups and teeth cleanings, even as mental health issues have increased.

“Last March, virtually overnight, people just stopped coming in,” said Dr. Melissa Volansky, chief medical officer for Lamoille Health Partners.

Volansky said it’s troublesome if people skip out on appointments, especially for patients with conditions like kidney or heart disease, which are progressive and, if left untreated, can get worse over time.

“We always think an ounce of prevention is worth a pound of cure,” she said. “There are a lot of people who thought they were invincible, and that damage over time is cumulative.”

Stuart May is president and CEO of Lamoille Health Partners — it recently rebranded from Community Health Services of Lamoille Valley. May said the public, by April or May, generally felt comfortable putting on a mask and going to the grocery store for staples, but still felt uneasy about going to a doctor’s office. He attributed it to a combination of health experts’ constantly evolving early advice and the echo chamber that is social media.

“You only know what you know at that time, and, as the saying goes, it’s like drinking water from a fire hose,” May said.

He said, for instance, the American Dental Association was advising dentists to, basically, shut down and stop doing procedures for a while, and the dentists’ offices only started opening up again when the rest of the economy did.

“In family dentistry, we are still battling patients’ concerns of transmission and have seen volume reduced by approximately 25 percent,” he said.

There have been adjustments, and physicians and dentists still have the pause button on certain procedures. Dentists, for instance, eschew the loud, buzzing rubber-tipped toothbrush to avoid water spraying out of the patient’s mouth.

Volansky said physicians don’t perform spirometry, which tests how much air one inhales or exhales, to test lungs for asthma or COPD. And they don’t use any nebulizers, which turn liquid medicines into mists that people can inhale.

“Maybe if it were nice outside,” she said. “But, this is winter in Vermont.”

Remote reach

Much like teachers were forced to learn quickly how to conduct remote lessons, May and company had to figure out how to deliver health care remotely. “Humbly, prior to the pandemic, it wasn’t on our radar screen,” he said.

Early in the pandemic, May said remote behavioral health consultations constituted roughly 96 percent of all mental health interactions, and rarely dipped below 90 percent.

Now the organization, particularly the mental health side of it, is confident enough providing telehealth that it will become part of its regular services even after the pandemic ends. For instance, people who don’t have reliable transportation but who have a good enough internet connection will still be able to video chat with their doctor. Those who don’t can do it over the phone.

There are ideas afoot to partner with Northern Vermont University’s Johnson campus, and create a telehealth center and “at least cut some of the transportation access issues,” May said.

Getting the population vaccinated will be a game changer, especially for the most vulnerable, older populations that are in the most danger if they skip their appointments.

Matthew Sadowsky, the clinic director for Lamoille Health Partners’ behavioral health and wellness branch, said the organization was able to acquire several Wi-Fi extenders and iPads through federal funds, to help bridge the technological gap.

Although telehealth has been used extensively in the mental health fields, physicians have found some uses for it too, Volansky said.

Patients who are able to monitor their blood pressure or blood sugar levels are able to relay that information to doctors without leaving their homes, and Volansky said just hearing a person’s voice can give indicators of whether that person has respiratory issues. Her office has monitored patients who had COVID-19 through oxygen monitors supplied by the state health department.

Volansky said there are obvious limitations to telehealth for physicians — “I can’t really put a stethoscope on their chest,” she said. And there’s another rub, especially when it comes to non-video telephone consultations: insurance.

“The insurance companies are somewhat skeptical about those types of phone-only visits, and not all them will pay for those,” she said.

Mental health

The CDC has shown “considerably elevated” levels of mental health disorders due to the pandemic, especially a rise in cases of depression and anxiety. Sadowsky has seen that locally, as well.

He and his crew also predicted it. “In the beginning, there were so many people running on adrenaline, but I figured if this whole thing stuck around and didn’t change, once fall was over and we got into winter, we’d see a huge increase. And we did,” he said.

The behavioral wellness branch has 18 therapists and four psychological staff and sometimes see “well over” 500 individual patients a week. May said behavioral health visits have grown from 1,400 a month to 1,900 a month since the beginning of the pandemic. That’s a lot of Zooming, “which stretches us thin,” Sadowsky said.

He said he’s never, in his professional career, seen such a dramatic need over the past half year, especially leading into the holidays. He’s never experienced so many people acknowledging suicidal thoughts.

He said Lamoille Health Partners offers pretty robust psychiatric supports via telehealth beyond the county borders — there are patients in St. Johnsbury to the east and St. Albans to the west.

The behavioral wellness branch is also the state’s local alcohol and drug abuse program provider, and Sadowsky said telehealth has been a boon for those struggling with addiction.

“The pandemic will certainly end up being traumatic for a number of people,” he said. “But many people will grow and evolve because of this.”

All connected

Some people, when they bring their car in for service, only get one thing done. Others use the visit to take care of multiple problems.

It can be the same with one’s body and mind.

May refers to the integrated services offered by Lamoille Health Partners as a “tripod” — primary care, oral health and behavioral wellness. He said they’re all connected, and the doctors within the organization are able to provide a continuum of care without a patient having to leave the network.

“You know, oral health is a big piece that can affect your primary care, and then, if you’re not feeling good and can’t get to work and everything else, then one’s mental well-being goes,” he said.

Sadowsky referred to a portion of some patient visits as “the warm handoff.” For instance, a physician may pull up a patient’s record and notice there’s a history of depression, or draw a line between some physical malady and a mental one — or just observe a few cavities. That doctor might call up a therapist or a dentist on a video chat, who can then try and set the patient up with the relevant services.

“You have a doc who says, ‘Hey, I can tell something’s wrong. We have somebody right down the hall,’” Sadowsky said. “It’s been so cool to be pulled into a room with a 65-year-old multigenerational Vermonter who says, ‘I’ve never talked to a therapist.’”

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