While it has undoubtedly been a tough year for everyone, those in the healthcare sector have felt the pressure more than most. A relentless pandemic rages on, and Oklahoma’s best and brightest work tirelessly to keep us safe. We explore the ins and outs of COVID-19 and its effects on healthcare workers. We also cover advancements in cancer care, telemedicine and orthopedics, and give a general overview on lifelong health.

The EXTENSIVE
Effects of COVID-19

It’s no secret that the pandemic has impacted healthcare in major ways. We check in with some of Oklahoma’s top health systems to get the basics on the disease, see how frontline workers are coping, and look ahead to the looming threat of the flu season.

The Basics

Over seven million cases of COVID-19 have been reported in the United States. As of this writing, Oklahoma has more than 80,000 confirmed cases and around 1,000 deaths resulting from the virus. There are several large-scale studies underway in an effort to develop a vaccine for COVID-19. Until then, here’s what is known about this infectious disease:

  • The novel coronavirus is similar to SARS-CoV – therefore, it was named SARS-CoV-2. The disease caused by the virus was named COVID-19 (COronVIrusDisease-2019) to indicate it was discovered in 2019.
  • A person can be infected with the virus for 2 to 14 days before they feel sick, while some people never show symptoms. Older adults and people of any age who have serious underlying medical conditions may be at higher risk for more severe symptoms.  
  • Symptoms can range from mild to severe and include cough; shortness of breath or difficulty breathing; fever or chills; muscle or body aches; vomiting or diarrhea; and/or a new loss of taste or smell.
  • A person can become infected from respiratory droplets when an infected person coughs, sneezes or talks. It’s also possible to get it by touching a surface or an object that has the virus on it, and then touching your mouth, nose or eyes. 
  • To avoid spreading infections, it is recommended that people infected with the virus avoid others until they experience three days without fever, their symptoms have cleared, and 10 days have passed since their symptoms started. 

Source: Centers for Disease Control and Prevention

The Teamwork it Takes

Healthcare workers are at the center of the fight against COVID-19. For months, they have worked non-stop. Doctors and nurses have received well-deserved praise, but the size and scope of the response has called upon every member of the community. 

“Excellent patient care requires an entire team. It’s not just the frontline staff – from the bedside to the back office, everyone contributes to the patient care experience,” says Barry Steichen, executive vice president and chief operating officer for Saint Francis Health System. “When you think about the number of people and the number of departments that a patient interacts with, it’s significant.”

He says there isn’t a staff member at Saint Francis that has gone unaffected.

“When most employees leave work, they’re able to leave their emotions at work. With COVID-19, it’s different,” says Steichen. “Healthcare workers never get a break; it consumes their day and is also present outside their work lives.”

In response to the pandemic, Saint Francis established a 24/7 command center, which serves as a central hub for all updates and communications within the health system. Steichen says an unforgettable moment occurred during a primary command center meeting. 

“I remember sitting at the head of the command center table, seeing reps from every part of the hospital – nursing, information technology, pharmacy, laboratory sciences, security, housekeeping, human resources, communications and finance. People from every part of the organization were present, and the teamwork and trust represented in that room was very moving,” he says. “During the greatest public health crisis of our lives, that room was calm and full of collaboration. We worked hard to develop innovative ways to test and treat people with this virus.”

COVID-19 Testing

Physician Anil Kaul is an OSU Center for Health Sciences clinical professor and the clinical diagnostic laboratory director at OSU-CHS in Tulsa and OSU in Stillwater. He has spent years researching and teaching about infectious diseases and world pandemic scenarios. Since the novel coronavirus reached the state, he has devoted all of his time to the testing for COVID-19. 

“My biggest responsibility is to get all patient samples tested accurately and results sent out in a timely manner, so that our lab can make an impact in limiting the spread of COVID-19,” says Kaul. To date, his team has tested approximately 100,000 samples.

“It’s not a real challenge if it doesn’t feel too big, and I knew it was a big challenge … and I knew that I had to step up,” he says. “Personally, I feel that it is a privilege to be able to contribute and help during this pandemic.”

Kaul says it’s been the encouragement and support from others that has helped him stay dedicated to the cause. 

“During this current crisis, whenever there has been a slump in my motivation, what keeps me going is a co-worker stopping me in the hallway or even stopping by my office to convey their appreciation,” says Kaul. “It means a lot when senior administrators offer dinner or lunch when our lab is working late at night or over the weekend – but it’s the team members that I am fortunate to work with who are the real heroes.”

Protecting the Protectors

The mental and physical strain on healthcare workers during the pandemic is taking its toll. Many people are reporting increased anxiety and stress, compassion fatigue, and even post-traumatic stress disorder. 

“One of the most difficult challenges facing our current situation is that this is a marathon, not a sprint,” says Kelly Dunn, a psychiatrist with OSU Center for Health Sciences. “Healthcare workers, in particular, are great at responding to acute crises. However, the chronicity of the stress from COVID-19 has challenged all of us to change our paradigm to something we can overcome to something we learn to live and function meaningfully with.”

Brandon Keppner, the executive director of Laureate Psychiatric Clinic and Hospital, believes reframing the way healthcare works perceive their jobs can help with burnout. 

“One of the strongest tools to avoid burnout is to apply meaning to your work,” he says. “Rather than ‘putting in time for a paycheck,’ put more of your heart into your service, whatever that may be. The harder you work, the bigger the eventual reward. I can choose to find satisfaction in the smallest of victories and not view present failures as permanent – rather works in progress.”

The infectious nature of COVID-19 has caused additional duress, as healthcare workers must take extra safety measures to avoid infection, meaning limited contact with patients. 

“One of the amazing attributes of those who are called into the healthcare field is their desire to connect and empathize with others,” says Dunn. “Seeing patients isolated and having to take precautions that limit the way we are able to connect violates the core values healthcare workers hold, and can lead to moral injury, even though we know it is necessary.”

Kurt VanMatre, a licensed professional counselor and marriage and family therapist, acts as the director of outpatient clinic and utilization management at Laureate. He agrees that healthcare workers, at their cores, strive for connection.

“Human connection is at the heart of healthcare, and especially inherent in mental healthcare,” he says. “Masks may cover half of our face, but true connection isn’t affected by a mask. Our clinicians are trained to work with patients to break through barriers, [helping] patients make steps toward recovery.”

It’s certainly the resilient nature of healthcare workers that’s helped them overcome challenges and find new ways to connect to patients, but there’s no shame in asking for help, says Rebecca Brumm, the director of operations within the eating disorders program at Laureate, as well as a licensed professional counselor and certified eating disorder specialist and supervisor.

“In essence, it’s okay to not be okay,” she says. “The magnitude and scope of how this pandemic has changed daily living is unique compared to what most of greater society has ever experienced in their lifetimes. The entire situation is a litany of negativity. At the same time, there is opportunity for growth, resilience and change. Change, though painful, can produce unexpected positive development.”

Dunn seconds: “If you need help, ask for it. Healthcare workers are often the ‘helpers’ and have a harder time asking for help for themselves. You are valuable and worthy of the time and care to be the healthiest version of yourself, both physically and mentally.”

Influenza + COVID-19

Fall marks the beginning of shorter days, cooler weather and, unfortunately, flu season. As COVID-19 continues to spread throughout the U.S., there’s ongoing concern and varying opinions of what this flu season might bring. 

Physician Mousumi Som, OSU Medical Center chief of staff, says the 2019-2020 flu season was shortened by about six weeks due the ‘safer at home’ measures, and there’s the possibility that continued restrictions may flatten the curve of both COVID-19 and influenza. However, with the winter months forcing people indoors, social distancing may be more difficult. 

“We know that influenza sends 100,000 people to the hospital,” says Som. “This may put an additional stressor on our healthcare system if we have ongoing bedding shortages and are unsuccessful in containing both COVID-19 and influenza with social distancing, masking, virtual medicine when available, and overall better focus on good hygiene.”  

Since influenza and COVID-19 can have similar symptoms, testing will be required to differentiate the two diseases, says physician Dale Bratzler, OU Medicine Enterprise chief quality officer.

“Both diseases can cause severe complications, and while the severity of illness and mortality from COVID-19 appears to be greater than seen in most patients with influenza, if we see a bad flu season, we could quickly overwhelm our health systems with patients,” he says.

To avoid this scenario, Bratzler says it’s important for people to get the flu vaccine. 

“The United States has ordered 20 million more doses of influenza vaccine than were produced last year, so there will be plenty of vaccine,” he says. Regarding treatments for the two viruses, antiviral medications, including oral medications, can be used to treat influenza.

“These drugs, when started early in the course of illness, may shorten the duration of the illness and may reduce the severity of disease,” says Bratzler. “Currently, we do not have any medications to prevent COVID-19 and no outpatient medications to treat the disease.”

Som also points out that COVID-19 has brought to the forefront racial disparities, behavioral health disparities and socioeconomic inequity in obtaining medical care and the privilege of social distancing.  

“If COVID-19 and influenza both surge, we can only imagine the toll this will have on these populations at risk,” she says.  

Advancements
in Telemedicine 

The pandemic has brought telemedicine to the forefront of patient care more than ever before. Systems have encountered an unprecedented demand to deliver virtual services to meet patient needs amid the restrictions brought on by COVID-19.

“Prior to COVID-19, our telemedicine service offering was fairly limited and used sparingly by patients and physicians alike,” says Rhett Stover, chief executive officer of OSU Medicine. He says rapidly expanding services during a time of high stress and high need has its obstacles.

“The first challenges we had to deal with was speed of installation, resource alignment, accelerating a digital team-based environment, and ensuring a high level of clinical quality and safety for all involved: patients, physicians and nursing team members,” says Stover. “To their credit, our physician teams and clinical partners responded with great purpose. And with the support of an innovative technology platform, in a very short period of time, OSU TeleHealth Solution was able to establish hospitalist medicine services in approximately 16 critical access communities across our state.”  

Previously described as a modest virtual care program, OU Medicine also quickly scaled its telehealth program by expanding its internal telehealth team, onboarding more than 800 providers across all specialties, and conducting more than 25,000 virtual visits since March. 

“We were eager and excited to implement telehealth quickly, because our patients were anxious, overwhelmed and filled with questions in response to the early pandemic and closings,” says Elizabeth Nelson, family medicine physician with OU Physicians in Edmond. 

Despite its limitations, Nelson has been impressed with the level of examination possible via telemedicine.

“For my patients who have utilized telehealth, I think the overwhelming majority are extremely pleased,” she says. “It’s easy to access from their phones or computers, gives focused face-time with their provider, and allows a more detailed visit verses a phone call. So much communication happens non-verbally, and virtual visits capture empathy and understanding which could be missed on the phone.”  

Virtual visits bring unique challenges, but the transition was made easier through industry collaboration. 

“One of the best experiences was the generosity of teletherapy providers and therapy/assessment companies providing resources for use – many of them for free,” says Mona Ryan, a speech language pathologist with the University of Oklahoma College of Allied Health Keys Speech and Hearing Center. “Professionals joined arms to help others learning the process of teletherapy. We also saw many of our school-age and preschool clients make better gains when we were able to engage the parents in the sessions.”

She also saw success with adult clients. 

“Many families were so happy with the time saving and ease of connecting rather than driving in for therapy,” says Ryan. “We are hoping that our insurances will finally recognize the benefit of quality teletherapy services and will continue to reimburse for teletherapy services.”  

Stover says the pandemic has significantly accelerated consumer exploration, acceptance and application of virtual care.

“As we peak towards the horizon and future state of healthcare delivery, I think it’s safe to say that telemedicine has permanently and firmly established itself as a pillar within our healthcare delivery system,” he says. “Whether in rural areas or their urban counterparts, telemedicine and the innovation associated with it is here to stay.”

Good Health through life

Whether you’re welcoming adulthood or ushering in the golden years, the choices you make today can impact your future wellbeing.  

Young Adults

Healthy habits and preventative healthcare are the recurring themes for young adults. 

“It’s well known that people who exercise when they’re young have stronger bones when they get to age 25, which is when the bones have the maximum strength they’re going to have,” says Kathryn Reilly, an OU Medicine family medicine physician. “People who don’t exercise enough when they’re young have an increased risk of osteoporosis in their later adult years, which can cause hip fractures and fractures in the spine – affecting their quality of life.”

Young people often feel invincible, but a carefree diet can have its consequences.  

“What you eat at a younger age can be reflected in your adult years,” says Reilly. “It can affect your risk of getting various kinds of cancers, such as colon cancer if you eat a lot of processed meat. Overall, eating well will benefit you throughout life.”

Cancer prevention begins in young adulthood, says physician Lora Cotton, interim chair of the OSU Medicine Family Medicine Department and clinical professor of Family Medicine for the OSU College of Osteopathic Medicine.

“Cervical cancer screening begins at age 21,” says Cotton. “Screening for high blood pressure, high cholesterol and diabetes is particularly important for young adults, because often, people have uncontrolled blood pressure or high blood sugar for years before starting treatment. During those years of uncontrolled hypertension and diabetes, arterial damage is occurring that can lead to strokes, heart attacks and kidney failure.”  

She also emphasizes the need for young people to talk with their primary care provider about how to reduce the risk of a sexually transmitted infection, viral hepatitis and HIV. 

Middle Age

Life after 40 brings physical changes, but it’s never too late to become stronger and healthier.

“Our body composition begins to shift with an increase in fat tissue and a decrease in muscle tissue, but this can be prevented or slowed with exercise,” says Cotton. “Colon cancer screening begins at 45 for people who have an average risk of developing colon cancer, and annual screening for cardiovascular disease risk factors becomes more important because for most people, this is when those risk factors develop.”

When facing health issues, be sure to consider the positive effects of a good diet and exercise.  

“While someone diagnosed with diabetes can never take away the fact that they have a propensity for this disease, if they become very serious about doing regular exercise, changing their diet and losing weight, they can take away the high blood sugar that causes problems with the heart, the kidneys, the eyes and the brain,” says Reilly. “It can make a big difference.” 

Senior Years

Older adults should focus on maintaining the mind and body. 

“Quality of life as a primary goal increases with advancing age,” says Cotton. “Improving and maintaining balance, strength and flexibility, as well as cardiovascular endurance, are incredibly important in achieving the goals of independent function and quality of life. The human body is capable of growth, renewal and healing at any age.  By stopping harmful behaviors and starting healthy behaviors, you give yourself the opportunity to enjoy life at every age.”

Yogesh Mittal, an orthopedic surgeon, typically works with patients who have degenerative arthritis in the knee, and those with sports-related injuries.
Photo courtesy the Orthopaedic Center

The World of Orthopedics

Chronic pain or injuries to joints can limit mobility, making daily life a challenge. Problem areas often involve the knee, hip, foot and ankle. 

 “Including the ankle joint, the foot has 33 different joints, which gives people ample opportunity to develop wear and tear in any one of those joints,” says Brian Clowers, an orthopedic surgeon with Norman Regional Health System. “The most common orthopedic conditions I treat in the foot and ankle usually revolve around inflammation in either a joint or in a structure such as a tendon or a ligament.”

Plantar fasciitis is inflammation of the plantar fascia ligament on the bottom of the foot, which typically causes pain first thing in the morning or after periods of inactivity. Clowers says plantar fasciitis usually responds well to physical therapy, focusing on stretching and soft tissue massage, but some cases may need anti-inflammatory management through oral, topical or injectable medications. 

“For arthritis, anti-inflammatory medications play a very large role, in addition to devices that help to support and rest those joints, such as braces and orthotic devices,” says Clowers.  

Yogesh Mittal, an orthopedic surgeon with The Orthopaedic Center in Tulsa, commonly treats patients with degenerative arthritis in the knee joint and sports injuries such as medial meniscus tears. 

He says the best candidates for a knee replacement are those who have tried to manage their discomfort through nonsurgical treatments but are still experiencing a significant amount of pain.

“I usually tell patients if their arthritis is affecting their life – their activities and mobility – and keeping them from being happy, then it’s time to consider surgery,” says Mittal. He also regularly treats hip arthritis and hip bursitis.

“Arthritis is in the joint and needs surgery, while bursitis is in the muscles around the joint and can benefit from therapy and injections,” he says. 

Technological
Advancements in Orthopedics

“Advances in surgical technique and the use of robotics in joint replacement have revolutionized the field,” says Mittal. “The ability to create a 3-D model before surgery and customize the implant positioning to a patient’s anatomy has been extraordinary. Patients have the ability to recover faster and perform better with these techniques.”

Regarding image guidance and computer assistance, Clowers says “these modalities have not replaced the surgeon, but have improved the accuracy with which we are able to perform certain surgeries.”

There’s also been substantial progress in biological therapies.

“These treatments focus on stimulating the body to heal bone, or produce desired types of tissue for certain conditions,” says Clowers. “This can be in the setting of someone who is unable to mount a healing response to a broken bone or tissue injury, or in a situation where there’s been significant tissue loss, and the body is not able to overcome the degree of injury that has been sustained.”

Cancer Overview

By the end of 2020, approximately 1.8 million people will be diagnosed with cancer in the United States, according to the National Cancer Institute. A few of the most common cancers, affecting both men and women, are lung, colorectal and breast cancer. 

Lung Cancer

“More than 228,000 Americans will be diagnosed with lung cancer in 2020. Unfortunately, lung cancer is the leading cause of cancer death, making up almost 25% of all people that die from cancer,” says Matthew Reinersman, a thoracic oncology surgeon at Stephenson Cancer Center. “More people die from lung cancer than from colon cancer, breast cancer and prostate cancer combined.”

The leading cause of lung cancer is smoking, which contributes to 80 to 90% of lung cancers, says Reinersman. Less common causes include exposure to radon, asbestos and air pollution. The life expectancy of someone diagnosed with lung cancer depends on the size of the cancer and whether or not it has spread to other parts of the body.

“Patients with small cancers that have not spread have an over 90% chance to be cured with surgery,” says Reinersman. “The main treatment options in more advanced cancers include chemotherapy, radiation therapy and surgery. Even in patients with cancers that have spread outside the lungs (Stage IV), we have much more effective treatments than in the past. 

“Over the last few years, many new chemotherapy drugs have become available to treat advanced disease. These include targeted therapies that attack specific DNA changes in the cancer cells, and are often taken as a pill and much better tolerated than traditional chemotherapy. Another major game changer has been the introduction of immunotherapy – or medications that stimulate the patient’s own immune system to fight the cancer.”

Colorectal Cancer

The most common type of colorectal cancer is adenocarcinoma, says Kristina Booth, a colorectal cancer surgeon with Stephenson Cancer Center. 

“This type of cancer is the second most common cancer in females and the third most common in males,” she says. “However, males die from colon cancer at a higher rate than females do. It is unsure exactly why this is, but it may have to do with their compliance with colonoscopy recommendations.” 

There is another population unequally affected by colon and rectal cancer, says Booth.

“African Americans have a higher rate of colon and rectal cancer and also can be affected at a younger age,” she says. “It’s unclear if this is due to genetic differences, disproportionate healthcare access, or both.”

Booth says the most important factor in a patient’s prognosis is how quickly the cancer is found. 

“When colon cancer is found early in its growth cycle, the cure rate is very high,” she says. “This is a stage when colon cancer is often not causing any symptoms, and the patient may not have any clue that it is growing in them. That’s why screening colonoscopies are so very important. They help doctors find cancers when they are most likely to be successfully treated easily. Also, colonoscopies can prevent colon cancers by removing pre-cancers.”

Breast Cancer

According to the American Cancer Society, breast cancer is the second leading cause of cancer death in women. However, new technologies now offer more diagnostic tools and better treatment options.  

“In addition to traditional mammography, we have a newer technology called tomosynthesis – a type of digital mammography that creates 2D and 3D-like pictures of the breast,” says Juan Claros-Sorto, a breast surgical oncologist with Stephenson Cancer Center. “This helps to reduce the need for follow-up imaging, detects slightly more cancers than standard mammograms alone, and improves detection in dense breast tissue. There’s also more and better genetic testing available for patients with a strong family history of cancers, which allows us to better determine high risk patients, and can help drive care.” 

The two most common types of breast cancers, ductal carcinoma and lobular carcinoma, make up more than 90% of breast cancer diagnoses.

“There have been great advancements in treatment options for breast cancer,” says Claros-Sorto. “We have better tolerated chemotherapy regimens; more immunotherapies that specifically target each patient’s specific tumor biology; and tumor genomic testing to determine the real benefit of chemotherapy and/or radiation. Across the nation, and at our center, we also have more and better options of oncoplastic surgery, which allows women to save their breast with better cosmetic results.” 

Shrinking Technology

A Pacemaker the Size of a Pill

A revolutionizing new technology, the Micra pacemaker, is the world’s smallest pacemaker – about the size of a large pill and 93% smaller than conventional pacemakers. While most pacemakers are surgically placed into a patient’s chest, the Micra is implanted into the heart without invasive surgery. 

“The Micra is very small – the size of a .22 caliber bullet – and is directly implanted into the heart using a catheter delivery system, without the need for a surgically created pocket under the skin and without leads, [which are] insulated wires that attach both to conventional pacemakers placed in the surgically created pockets and to the heart, traversing veins,” says physician Dwight Reynolds, OU Medicine chief of cardiovascular medicine. “This lack of a pocket under the skin and the absence of leads reduces much of the risks and complications, both short and especially long term, that can occur with conventional pacemakers.”

Benefits of the Micra include no risk of an infection or bleeding into a pocket under the skin; no risk of lead fractures or dislodgement; a lower risk of serious blood stream infections; and less risk of damage to the tricuspid heart valve. The estimated average battery life for a Micra device is approximately 8 to 13 years after implantation. 

“The Micra employs the very latest in miniaturized circuit technology, electrode technology and a very state-of-the-art battery chemistry – all of which allow the dramatic size reduction,” says Reynolds.

Patients who may be eligible for the Micra include individuals with bradycardias, where the heart beats too slowly, and those with problems related to obstructed veins, tricuspid heart valve issues, or a high risk of infection. 

Patients who are not ideal for the current versions of this pacemaker are those who require pacing in the heart’s upper chambers (atria) or in multiple chambers. However, Reynolds says advancements in those directions are occurring now.

“I anticipate that pacemakers over the next couple of decades will become increasingly leadless, employing many of the principles embodied in the Micra devices,” he says.

Autoimmune Diseases

A healthy immune system protects the body from harmful microorganisms, such as viruses and bacteria, by mounting a defense with targeted antibodies. But for those with an autoimmune disease, the body turns on itself, causing the immune system to attack healthy tissue. There are more than 100 autoimmune diseases, and more than 23.5 million Americans suffer from an autoimmune disease, according to the National Institutes of Health. 

Common autoimmune diseases include rheumatoid arthritis, psoriasis, Type 1 diabetes, multiple sclerosis, lupus, Sjögren syndrome, Hashimoto’s disease, and inflammatory bowel diseases, such as Crohn’s disease.

Symptoms vary by disease, but a few common symptoms include fatigue, joint pain and swelling, skin problems, abdominal or digestive issues, recurring fever and swollen glands. 

Sleep Disorders

Can’t sleep? You’re not alone. About 70 million U.S. adults have a sleep disorder. The most common disorders include insomnia, sleep apnea and narcolepsy. 

Insomnia refers to difficulty falling asleep or staying asleep. Sleep apnea is characterized by repetitive pauses in breathing during sleep, causing the sleeper to wake up. Narcolepsy is associated with excessive daytime sleepiness, sleep paralysis, cataplexy and sleep hallucinations. Individuals feel constantly tired and when they do sleep, it’s not restful. 

To help get a good night’s sleep, experts recommend the following tips:

  • Maintain a regular sleep routine.
  • Avoid daytime naps.
  • Upon waking, don’t stay in bed awake for more than 5 to 10 minutes. If you wake during the night, get up and sit in a chair until you feel sleepy, then return to bed. 
  • Don’t watch TV, use the computer, or read in bed. 
  • Watch your caffeine intake. Try to drink it before noon. 
  • Create a quiet and comfortable bedroom. 

Source: American Sleep Association