Buffalo Spree's Medicine in WNY 2020

Buffalo Spree Magazine MEDICINE IN WNY

2020

We’ve Got This www.buffalospree.com • 2020

WNYers innovate to fight COVID-19 A periodical supplement to Buffalo Spree November 2020

Local facilities lead with new initiatives

Virtual medical visits

Convenient Access to Quality Cancer Care Matters

By partnering with community cancer and specialty care providers throughout New York, the Roswell Park Care Network provides the most innovative therapies — previously not available in the community — at more locations.

As the only National Cancer Institute-designated comprehensive cancer center in Western and Upstate New York, Roswell Park is improving cancer patient care in our region and beyond by incorporating national best practices and quality standards throughout its network.

We believe that all patients should have access to the latest technology, the most innovative therapies, and evidence-based care plans developed and reviewed by the most experienced cancer teams.

See if there is a location convenient to you. Visit RoswellPark.org/CareNetwork

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ASK THE EXPERT

Telemedicine in the time of COVID-19 - by Kevin Gibbons, MD, Executive Director What is telemedicine?

Telemedicine bridges the expert care of UBMD providers to you, wherever you are. With telemedicine, our providers are able to see patients virtually, giving you care in the comfort of home and ensuring your care continues uninterrupted.

With UBMD CareConnect, our telemedicine service, we provide treatment for primary and specialty care, including some surgical consultations and follow-ups.

UBMD Physicians’ Group ABOUT As the largest medical group in Western New York, with 550+ physicians ready to treat you and your family, UBMD Physicians’ Group is the one source you can turn to — no matter what.

CONTACT ubmd.com LOCATION UBMD physicians care for patients in urban and suburban locations throughout Western New York, making it easy for you to find state-of-the-art care close to home.

On the Buffalo Niagara Medical Campus, several of our practices are together on one floor, making it more convenient for you and your loved ones to access the health care you need.

How does UBMD CareConnect help me?

UBMD CareConnect provides access to the vital care patients need without having to come to the office. Telemedicine visits can be conducted via video or phone call, depending on the patient’s need, while keeping in mind the patient’s available resources.

All UBMD outpatient practices are now offering telemedicine to both new and existing patients.

How can I access UBMD CareConnect?

UBMD CareConnect video visits can be accessed from smartphones, tablets, laptops and desktop computers. CareConnect offers the convenience of having your appointment from wherever you are, using the device you’re most comfortable with.

When making your appointment, the care team will walk you through what a virtual appointment is like. Before your appointment, your provider’s office will also send you instructions on how to check-in.

How can I make the most of my CareConnect visit?

Make a list. Write down your concerns, as well as your current medications, including vitamins, or have the bottles nearby.

Collect data. Before your appointment, have your updated health information readily

available, if possible. Use items already in your possession to provide current data to the care team, such as a scale, thermometer or health information from your smartphone or smartwatch. For instance, this may include temperature, weight, blood pressure, pulse rate, pulse ox, and, if applicable, peak flow or finger-stick glucose.

Check connectivity. Find a quiet place with strong WiFi for your telemedicine appointment.

What if I need to be seen in-person?

If an in-person visit is determined, know that all UBMD spaces have been safeguarded for both our patients and team members. Numerous protocols for COVID-19 screenings and protection measures have been implemented at all locations. Additionally, our already rigorous cleaning practices have been enhanced.

As an alternative to the emergency room for urgent orthopaedic concerns, UB OrthoCare remains open to treat broken bones, strains, sprains, concussions and other emergent orthopaedic needs.

Additionally, some of our practices are now providing care in innovative ways, such as drive-up flu shot clinics or glaucoma screenings. Both are available by appointment.

Visit ubmd.com/careconnect for more information about our telemedicine services.

______________________________________ UBMD Physicians’ Group is the largest medical group in Western New York.

With more than 550 respected doctors in 18 medical specialties, we offer a full range of primary, specialty and surgical care for children, adults and seniors.

In addition to practicing medicine, our doctors teach medical students and residents at the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo.

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MEDICINE IN WNY 2020

2020

2020

P. 16

16 | Necessity is the mother of inventions

WNYers innovate to fight COVID-19.

P. 26

BY STEVE BRACHMANN

26 | Battling COVID close to home

Local facilities lead with new initiatives.

BY NANCY J. PARISI

36 | Virtual visits

Medical care when you can’t get there

44 | Windsong introduces minimally invasive

urinary intervention Patients recover within hours.

BY STEVE BRACHMANN

54 | Double trouble

Preparing for flu season

BY TERRI PARSELL HILMEY

62 | Care that can’t wait

The dangers of delaying doctor’s appointments

BY DEVON DAMS-O’CONNOR

Buffalo Spree Magazine MEDICINE IN WNY

O N T H E C OV E R :

Western New York makes progress in the fight against COVID-19.

Design by Nicholas Vitello

2020

We’ve Got This www.buffalospree.com • 2020

WNYers innovate to fight COVID-19 A periodical supplement to Buffalo Spree November 2020

Local facilities lead progress initiatives

Vitual medical visits

P. 54

EAGLEHAWK PHOTO BY STEPHEN GABRIS; DR. IGOR PUZANOV PHOTO BY NANCY J. PARISI

BY DEVON DAMS-O’CONNOR

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MEDICINE IN WNY 2020

2020

PUBLISHER

Barbara E. Macks EDITORIAL

EDITOR-IN-CHIEF

Elizabeth Licata SENIOR EDITOR

Wendy Guild Swearingen CONTRIBUTING HOME & MEDICINE IN WNY EDITOR

Donna Hoke PROOFREADER

Sharon Levite ART & PRODUCTION

CREATIVE DIRECTOR

Jean-Pierre Thimot SENIOR GRAPHIC DESIGNERS/ILLUSTRATORS

Joshua Flanigan Kim Miers Adam Van Schoonhoven Nicholas Vitello EDITORIAL PHOTOGRAPHERS

Luke Copping Eric Frick Stephen Gabris kc kratt Nancy J. Parisi EVENT PHOTOGRAPHERS

Cheryl Jackson Nancy J. Parisi ADVERTISING & SALES

DIRECTOR OF SALES & ADVERTISING

Barbara E. Macks SENIOR ACCOUNT EXECUTIVES

Mary Beth Holly Caroline Kunze Robin Lenhard ACCOUNT EXECUTIVES

Keren Green Rachel Wasserman NATIONAL AD DIRECTOR

Terri Downey ADVERTISING PHOTOGRAPHERS

Dan Cappellazzo Sean Dowdell Stephen Gabris SALES COORDINATOR

Robin Lenhard MARKETING & CIRCULATION

DIRECTOR OF AUDIENCE DEVELOPMENT

Robin Lenhard DIGITAL

SOCIAL MEDIA DIRECTOR

Wendy Guild Swearingen WEBMASTER

Kim Miers ADMINISTRATIVE & BUSINESS

ADMINISTRATIVE & FINANCE DIRECTOR

Michele Ferguson

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BUFFALOSPREE.COM

LETTER FROM THE EDITOR

Feedback We’d love to hear what you think! Email editor@buffalospree.com.

By mail, contact us at: Letters to the Editor, Buffalo Spree Publishing, 1738 Elmwood Avenue, Ste. 103, Buffalo, NY 14207.

Newsletters To sign up to receive our free monthly email newsletters, with new issue previews, exclusive contests, news, and more, visit our homepage at www.buffalospree.com or email circulation@buffalospree.com.

On the Web Visit buffalospree.com to take a tour of the current issue, get exclusive web-extras content, check out our latest blog posts, or review our updated dining guide.

S

talk has moved (at least some of the time) away from COVID-19 itself and more toward how we live in a world where it still threatens.

Conversations around all aspects of our lives—dining, work, shopping, socializing, and yes, medicine—consider coronavirus, even when not specifically focused on how they’ve been reconfigured to accommodate pandemic precaution. So, too, does current Spree coverage, including this issue.

Because COVID has changed how we see doctors, we’ve got an in-depth piece on telemedicine, which went from being a rare convenience to a necessity—and a practice that is no doubt here to stay. We encourage regular health maintenance, check-ups, and flu prevention at a time when people aren’t focused on all the other medical issues that still exist. As always, we celebrate Western New York’s innovative contributions to the medical field, not just on the pandemic front, but in urinary health.

With or without the pandemic, these stories are still relative and important. They acknowledge that the world has changed because of COVID, but stress that it hasn’t stopped.

S E V E N M O N T H S I N T O PA N D E M I C L I F E ,

PRESIDENT

Sharon Levite PUBLISHER/CHIEF REVENUE OFFICER

Barbara E. Macks ASSOCIATE PUBLISHER/EDITOR-IN-CHIEF

Elizabeth Licata VICE PRESIDENT/ADMINISTRATIVE & FINANCE

Michele Ferguson CORPORATE COUNSEL

Timothy M. O’Mara, Esq.

Donna Hoke EDITOR, MEDICINE IN WNY

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MEDICINE IN WNY 2020

2020

NECESSITY IS THE MOTHER OF INVENTIONS WNYers innovate to fight COVID-19

by Steve Brachmann

T H I S PA S T M A R C H , COVID-19 meant many aspects of everyday life stopped, but local innovators were just getting started. From room sterilization systems in healthcare clinics to emergency ventilator solutions, Buffalo-based firms have responded to the pandemic in big ways.

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PHOTO BY STEPHEN GABRIS

BUFFALOSPREE.COM

Patrick Walsh, CEO, demonstrates how EagleHawk can sanitize large areas inside Shea’s Performing Arts Center.

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MEDICINE IN WNY 2020

Neccessity continued

Rapid Medical Parts

After thirty-one years as a pilot in the US Air Force, Jim Regenor knows a thing or two about aerodynamics. That knowledge came in handy this past spring when, after relocating from Boston to Buffalo during the early days of the COVID-19 pandemic, he literally dreamed up an emergency ventilator solution reliant on Bernoulli’s principle and concepts of fluid dynamics. In April, twelve days after Regenor woke up and sketched a basic design, his new company Rapid Medical Parts had a cooperative agreement with the US Department of Defense to develop the EVS-4, an emergency ventilator solution designed to cost much less than standard ventilators while offering essentially the same functionality.

According to Regenor, the EVS-4 works similarly to an air cycle machine (ACM), which is a refrigeration unit used to control aircraft environments by reducing heat from engine exhaust and internal electronic systems. Unlike a typical air conditioning unit that cools using phase changing material like Freon, an ACM uses air. Similarly, the EVS-4 compresses air to increase its delivery pressure through either invasive or noninvasive intubation into a patient suffering from COVID-19. After meeting on Zoom with several engineers from an aerospace engineering

Rapid Medical Parts (Jim Regenor at center) has designed an emergency ventilator solution.

firm, Regenor finalized the EVS-4’s design a mere twenty-seven days after dreaming up the concept.

While Regenor originally conceived the EVS4 to leverage existing sleep apnea devices like CPAP and BiPAP machines, but with boosted air output, his design evolved into a unit capable of mimicking the cycle of oxygen ventilators that were in short supply for COVID-19 patients.

Despite its robust functionality, the EVS-4 has just forty different parts, and most are designed to be 3D printable for easy reproduction. As a result, each unit costs about $10,000 to produce as opposed to the $60,000 price tag for a standard hospital ventilator.

The EVS-4 may be based upon Regenor’s idea but “it really took a team of thoughtful and thought-provoking engineers and business folks” to bring it to fruition, says Regenor, noting that, although the emergency ventilator solution was designed with the pandemic in mind, it has longterm potential to improve the standard of care in developing countries. “People in these countries should have a right to get high quality medical care at a cost they can afford,” he says. The EVS4 may not replace the entire functionality of a standard ventilator, but its price point could be attractive to medical professionals in healthcare systems with fewer financial resources.

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PHOTO BY STEPHEN GABRIS

Patrick Walsh, co-founder and CEO of EagleHawk, also leveraged a background in aircraft to attack problems posed by COVID-19. A Rochester Institute of Technology graduate, Walsh relocated to Buffalo with his wife in 2016 after spending his career at Lockheed Martin. He was working as a mechanical engineer on drone technologies when the pandemic hit but, afterward, joined forces with Will Schulmeister, a University at Buffalo alum with a degree in geographic data sciences, to develop EagleHawk, a firm offering drone disinfecting for large scale facilities.

Inspired by similar systems used in China and other areas of the world for disinfecting streets and sidewalks, EagleHawk experimented with offthe-shelf agricultural drones before realizing that their tanks couldn’t hold enough liquid disinfectant to properly cover large outdoor venues like Sahlen’s Field or Bills Stadium.

The agricultural drones Walsh and Schulmeister worked with early on had only two-and-a-half gallon tanks.

To overcome this obstacle, the pair devised a system of paired drones, one drone spraying a disinfectant from a hose carried by a second drone capable of properly disinfecting a large outdoor venue forty to fifty percent faster than traditional methods, i.e., humans.

Walsh says the drone system could disinfect a venue as big as Bills Stadium in as little as four to six hours. EagleHawk is also developing drone systems for disinfecting indoor entertainment venues, and Walsh notes that the system, which only requires two human operators, could disinfect the arena in KeyBank Center within three hours. “To do the same job through traditional means, you’d need more than thirty people each carrying forty-pound backpacks full of disinfectant,” Walsh calculates. While backpack tanks can be drained within ten to fifteen minutes of spraying, the drone system can operate continuously for thirty to forty minutes before the tanks need refilling.

“We’re excited to be a part of the solution going forward and get people to a place where they feel comfortable going to venues again,” Walsh says.

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EagleHawk

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MEDICINE IN WNY 2020

LOOK FOR THE HELPERS Buffalo is full of them

2020

Neccessity continued

NewSource UV

C I R C U I T C L I N I C A L : Situated within the medical technology incubator at 43North, this clinical trial and research firm helped to collect saliva samples from dozens of locals. This data was used to accelerate FDA approval for a saliva-based COVID-19 test.

Shatkin F.I.R.S.T.: This local provider of dental implants was one of several grant recipients announced by Governor Andrew Cuomo in late July. Since the start of the pandemic, the company has hired thirty employees to produce more than 200,000 N95 respirator masks for professionals in the healthcare industry.

KSL Diagnostics: Another late July grant recipient, this Williamsville firm has expanded its manufacturing of sample collection and diagnostic testing equipment. Governor Cuomo’s office cited KSL’s plans to invest $2.1 million to produce more than 10,000 COVID-19 test sample kits per week.

CleanSlateUV: This company, which has locations in Buffalo and Toronto, has developed a mobile device sanitization unit designed to eliminate 99.999 percent of bacteria and viruses present on device surfaces using ultraviolet light sterilization, and it only takes about twenty seconds.

— Steve Brachmann

To paraphrase famed American jurist Louis Brandeis, sunshine is the best disinfectant. Although the former Supreme Court Justice was talking more about government transparency, local company NewSource UV and its founders Morgan Lewis and Eric Maziol have taken a more literal route, devising a system that uses UV-C ultraviolet light to neutralize coronavirus—or any other microorganism—on surfaces to prevent spread of infectious disease.

While hospitals have long used UV light sterilization techniques to lower infection rates, Maziol notes that the equipment has typically been too cumbersome for use at the clinical practice level. “Instead of having to wheel UV light equipment into every single room between patients, we needed to come up with a system that was actually in the room,” he says. Although there’s demand for more mobile UV sterilization equipment, NewSource has developed two full-room systems that are operable via push button for two local clinics: Dr. Arvind Wadwha’s internal medicine practice on Division Street in North Tonawanda and Niagara Dermatology’s new Amherst location.

Most people are familiar with the UV-A and UV-B rays of ultraviolet light that the sun emits. According to Lewis and Maziol, UV-C has an even higher energy rate and can do more damage to human skin than a sunburn. When a surface with living coronavirus microorganisms is exposed to UV-C light, the DNA and RNA sequences of these organisms are scrambled, which prevents replication. Lewis and Maziol were quick to assure that the NewSource UV system has a control that prevents operation when a room is occupied.

“Other people have suggested UV-C scanning systems to kill coronavirus on people, but that won’t work unless it does the same thing to your skin,” says Lewis, adding that NewSource wants to distance itself from those UV-C proposals.

The NewSource UV system is simple enough that a doctor can hit a button activate the system upon finishing with one patient and enter the safe and sterilized room with the next patient within minutes. While Lewis and Maziol are uncertain of demand for their system in Western New York, they are looking into other markets, and Maziol himself is planning a Florida sales trip.

While NewSource is currently focused on developing inroom UV-C sterilization systems for healthcare clinics, it’s exploring applications for schools, government facilities, and even retail and restaurant locations. “Other companies have mobile systems, but we’re the only ones that have a room system,” Lewis says. “If you have concerns about the coronavirus and the pandemic situation, or you just want to mitigate the spread of flu and cold season at your facility, we can provide UV solutions for just about anything.”

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PHOTO BY KC KRATT

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Dr. Rodney Haring, PhD and MSW

BATTLING COVID CLOSE TO HOME Local facilities lead with new initiatives

by Nancy J. Parisi

WITH THE WEALTH OF HOSPITALS, healthcare providers, and researchers in Western New York, it should be no surprise that several doctors (both MDs and PhDs) are working on clinical trials, creating critical databases of COVID-19 patients and treatment protocols, and studying the ongoing effects of the crisis. Studies and trials are happening at University at Buffalo, Roswell Park Comprehensive Cancer Center, Erie County Medical Center, Catholic Health, Buffalo General

Medical Center, and Millard Fillmore Suburban Hospital, where professionals are pivoting to be part of the network seeking cogent medical answers and a proven vaccine.

COVID and the Native American population

Dr. Rodney Haring, PhD and MSW, is an enrolled member of the Seneca Nation of Indians, and director of the Center for Indigenous Cancer Research (CICR) founded in January 2020 at Roswell Park. In August, he was named to the twelve-member COVID-19 Prevention Network (CoVPN) Native Expert Panel, formed by the National Institute of Allergy and Infectious Disease—one of twenty-seven centers that make up National Institutes of Health (NIH).

Part of collaborative “Operation Warp Speed” that includes the Centers for Disease Control, Food and Drug Administration, Department of Defense, and more, CoVPN has as one of its main tenets the establishment of an international clinical trials network and a system of volunteer recruitments for “Large-scale Phase 3 trials” for COVID-19 vaccines: the goal is 300 million doses

by January 2021.

Living with his family on the Cattaraugus Indian Reservation, Haring has a lifelong concern with indigenous wellness. “Something that you see everyday is the resiliency of people, and also

PHOTOS BY NANCY J. PARISI

MEDICINE IN WNY 2020

2020

25

Originally, CICR planned a spring launch in Buffalo with internationally invited guests but shifted to a virtual schedule of webinars and keynote speakers open to indigenous cancer researchers from around the world; a speaker series is ongoing. When vaccines are ready for trial, Haring says, “An oversight committee will have to look at the vaccines that are about to embark and collaborate with the federal government to make sure that the trials are being conducted the proper way. It’s important that Native nations are part of the trials.”

One-two immunotherapy punch

Dr. Igor Puzanov wears several hats at Roswell Park: Director of Early Phase Clinical Trials Program, Chief of Melanoma Section, and CoLeader the Experimental Therapeutics Program among them. At Jacobs, he is Clinical Professor of Medicine. And, right now, he is Principal Investigator on a drug trial using rheumatoid arthritis medications to treat COVID-19.

“It affects the body, similar to how cancer and autoimmune conditions affect the body,” says Puzanov. “We have several initiatives, like looking at the patients who had COVID-19 and trying to find out who did well, who had more complications. With Dr. [Kunle] Odunsi [MD and PhD, Chair of Gynecologic Oncology and Executive Director of the Center

Dr. Igor Puzanov

BUFFALOSPREE.COM

the challenges of health, like diabetes and cancer disparities,” says Haring, who attributes those challenges to a lack of resources, the environment, and way of life. “Our indigenous communities across the world are facing challenges during the pandemic,” Haring say. “It’s an issue of testing and access to a test. Some tribes have more of a health center infrastructure, but some of the tribes in the New York region, and even into Canada, don’t.

“There is a need to go out and test, train, and educate—how to get into the next stage of intervening care, isolation, and quarantining,” he continues. “When something of this nature hits a small community of extended families who live and work together, it has devastating effects. The biggest example of this is in the Southwest. The Navajo Nation has over a quarter-million citizens and has an enormous amount of COVID cases— more than some states.”

Across the US, tribes and counties are working together to build infrastructures for contact tracing and information that can provide those stats, but it’s a challenge. “Some smaller, more remote tribes don’t have access to the internet— how are they going to get informed? Some tribes have no access to running water: it’s not good or bad, just a way of life,” Haring says. “How do you wash your hands regularly when you have limited access to running water?”

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MEDICINE IN WNY 2020

2020

Dr. Steven Lipshultz

Battling COVID continued

combination,” two antiviral agents that could benefit COVID-19 patients. The drugs in the clinical trial, rintatolimod and interferon alfa, have been given to cancer patients with COVID-19 to activate an immune response: “The first defense against viruses and against cancer, Puzanov says.

“When COVID-19 came, the patients who were really sick got the virus, so we boosted the immune system to kick the virus out.

Then you don’t get into cytokine storm [when the body attacks its own cells] and ventilators.”

Roswell is connected with the global virus network encompassing clinical trials and work on vaccines—a community of hundreds of doctors— that meets virtually on a regular basis. “We are not an infectious disease hospital,” Puzanov points out.

“We are an oncology hospital but it’s important to understand who got it, who didn’t, how specifically the cancer patients did, and to have your science contribute to solving this problem therapeutically.

We went all in, redeployed our resources, and now we are back in oncology.”

for Immunotherapy at Roswell Park], we are working with our partners at the Catholic Health System looking at genetics, genomics, the whole science behind this disease. The second, ongoing project is with Dr. [Elizabeth] Griffiths, [who focuses on hematologic oncology], collaborating with a group at Vanderbilt [University Medical Center in Nashville] in putting together the largest database of patients with cancer who were infected with COVID-19, to understand the differences or similarities in those patients compared to other patients.”

The third project is in collaboration with Dr. Pawel Kalinski and Dr. Brahm Segal who are investigating “a two-drug immunotherapy

PHOTOS BY NANCY J. PARISI

We are not just doing cookbook medicine; we are leading the world.

This is how we are going to care; this is how we are going to learn.

27

As Chair of the Department of Pediatrics at University at Buffalo and president of UB|MD Pediatrics; Pediatric Chiefof-Service for Kaleida Health; Medical Director of Pediatric Services Business Development at Oishei Children’s Hospital; and National Institute of Health-funded principal investigator, Dr. Steven Lipshultz doesn’t sleep much. Especially now.

“One of the things that I started looking at about thirtyfive years ago was the effects on fetuses, infants, children, adolescents, and young adults of getting viral infection and what it does to their developing hearts and their blood vessels,” says Lipshultz, who studied the effects of HIV on children’s hearts, as well as the impacts of medications, and, lately, the effects of COVID-19. “For children, oftentimes, the effects of viruses far outlive the actual amount of time the virus is in their body. They could have lifelong implications.”

COVID TESTING

If you don’t look, you don’t know.

In May, Lipshultz’s “Rethinking COVID-19 in Children: Lessons learned from pediatric viral and inflammatory cardiovascular diseases,” co-written with Paul Barach, was published in Progress in Pediatric Cardiology, an international journal. “I tried to tell the world that from all these years of studying viruses in children—what they should be thinking about in terms of damage to the heart, and treatments that might help prevent this,” says the pediatric cardiologist. “If you don’t look, you don’t know. At this point, we have enough of an initial safety signal to say that for some children, it can kill them, and for others, it can be life-threatening. There are a number of papers saying that for some children, the virus can trigger the immune system to go out of control and damage and destroy the heart and blood vessels.”

In April, the American Heart Association, the largest organization of heart doctors in the world and publishers of the leading cardiology journal, Circulation, asked Lipshultz to chair a writing committee to formulate the AHA’s position on COVID-19. He estimates it will take six to twelve months to complete, and will make use of the Pediatric Cardiomyopathy Registry, which lists children who have or had various viruses including, now, COVID-19.

“No virus is the same as another,” he says. “That’s why I went to the Children’s Cardiomyopathy Foundation and said, ‘These kids [with COVID-19] deserve a registry to see how this differs from HIV, the flu, and others.’ What is the course, what are the risk factors, what are the best treatments? That’s why registries are so important. Even today, it’s controversial—but shouldn’t be—if we should even be testing children to see if they’re COVID-positive.

“We are here for kids in this region,” he continues. “We are not just doing cookbook medicine; we are leading the world. This is how we are going to care; this is how we are going to learn.

We had a relatively low number of COVID-19-infected children in WNY: some had to be admitted to the hospital, some did not.

We had no kids make it into the ICU, which is remarkable. But just because you go home and you recover, what we’ve learned over forty years is some people have ongoing issues.”

Y O U WA N T T O E X PA N D Y O U R P O D O R V I S I T F A M I LY. You’ve been experiencing symptoms. You

want to contribute to the testing numbers. You’ve been exposed to someone with COVID. These are just some reasons to get a COVID test.

Finding a testing site is as easy as Googling “COVID testing in WNY,” with everywhere from WellNow Urgent Care to Quest to even some CVS stores offering tests.

Find the place nearest you and be sure to check results times, especially if you have urgent need; they vary widely. Also ask if tests are walk-in or by appointment, and if you’ll need a doctor’s referral.

Tests are taken either through a nasal swab that is described as “uncomfortable but not painful” or a saliva sample; both need to be sent to a lab for results so, again, check on that timeframe.

Some testing sites recommend that if you’ve been exposed or are experiencing symptoms, waiting four to five days after exposure or one to three days after the onset of symptoms can help reduce false negatives, cases in which the virus isn’t strong enough to trigger a positive response. If you do test positive, quarantine yourself from others and call your doctor for advice on protocol; if you begin to exhibit symptoms, make use of telemedicine to stay in touch. —Nancy J. Parisi

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Children and COVID-19

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MEDICINE IN WNY 2020 Dr. Oscar Gomez

Battling COVID continued

Databases, education, and prevention

Dr. Oscar Gomez is Division Chief of Pediatric Infectious Diseases in the Department of Pediatrics at UB’s Jacobs School of Medicine and Biomedical Sciences; he’s also Associate Professor of Pediatrics. His list of specialties now includes COVID-19 community intervention.

“Even though my research is not related to viruses per se, when we were confronted with a terrible situation for which we didn’t know much and we were seeing our community suffer, we had to do something,” says Gomez. “There were significant limitations, working with a virus that is so lethal. You have to have special kinds of labs to do the work, so I decided to move my research orientation into more of an epidemiological type that takes into account the data that we have accumulated on this disease.

“I am interested in looking at social determinants of health in regard to COVID-19, like why there is a high disproportion of deaths among AfricanAmericans, Hispanics, and Native Americans communities,” he continues. “Is it biological factors?

Socioeconomic factors? The types of jobs they are doing, or the lack of them? Or is it because of the lack of health insurance? I’m interested in looking at information from our communities in WNY.” A lot of eyes are on pandemic-related disparities; in May, Dr. Gomez and a group of physicians affiliated with the Jacobs School presented at the Virtual Colloquium to Advance

Health Equity Research in Buffalo, held by UB’s Community Health Equity Research Institute.

Now, Gomez is planning surveys with people who had the virus, asking about disease severity, race, ethnicity, housing, education, and employment.

“Based on this information, we can build a database to analyze the relationship between social determinants, health, and disease, the severity, and so on,” he says. “We are requesting volunteers to give saliva and blood samples that will be later studied to see if there is any genetic predisposition to severe COVID-19 disease; we are in the process of collecting this data.” The initial program to collect saliva and blood samples was funded by the SUNY’s Research Seed Grant Program.

Inhalers and a smartphone app

“In addition to being an emergency room doctor and seeing patients that come into the emergency department, I am also the medical director for AMR, overseeing the paramedics, community 9-1-1 work, and transferring patients between hospitals—and our research has looked at a couple different things,” says Dr. Brian Clemency, DO, MBA, FACEP, FAEMS, a UB|MD physician and Associate Professor of Emergency Medicine at the Jacobs School. “We’ve published on what symptoms patients have when they’ve tested positive for COVID-19 but don’t require hospitalization. We’re looking at patients who are

29

patients are asked to log in twice a day to report symptoms, their “pulse ox” (pulse oximetry, a non-invasive, finger reading device measuring the oxygen saturation of the blood), and if they’ve been taking their prescribed medication. “That allows us to moderate them and to see if they are in distress,” he says. “Our patients are being watched very closely, a benefit.”

As of this writing, twenty-five patients are enrolled in Dr. Clemency’s steroid-based inhaler study with the hope of eventually getting that up to 100 local patients. “The entire study nationally will be up to 400 patients,” says Clemency. “The biggest challenge is that you need to be enrolled within seventy-two hours of the swab being up your nose, and most of our patients will find out they’re positive maybe thirty-six to forty-eight hours later. I got a call from a lovely family today for the study but, by the time they found out they were positive, they were already outside the [seventy-two-hour] window.”

“When we face the new normal, how many of these good habits will stick?” Clemency asks.

“Hopefully, hand hygiene at a minimum will be something that sticks around. Everyone, including us in healthcare, had gotten pretty lax about it. That will be the long-lasting legacy of all of this: we won’t have to wear masks the rest of our lives, but we can all do just a little bit better with hand hygiene.”

PHOTOS BY NANCY J. PARISI

Dr. Brian Clemency, DO, MBA, FACEP, FAEMS

2020

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not critically ill, not in the ICU, but are out in the community. Those are the patients who are most likely to spread disease.

“An ICU patient, everyone says ‘Stay away from that person,’ but it’s the young, healthy person who’s not so ill they need care who is potentially the greater spreader of disease,” he continues.

“Understanding what symptoms make you more likely to have COVID-19 and not just a cold—we found the symptom that was most take-it-to-thebank likely you are going to test positive is loss of taste and smell. In our study, more than half who had that symptom tested positive. Fever was also significant, as was a dry and unproductive cough.

“Slowly but surely, we’ve been able to increase our testing capabilities and give more definitive answers as to whether patients are positive or negative.

Currently, we are doing another study looking at patients who’re discharged who are COVID-positive but aren’t sick enough to be in the hospital, and we’re seeing that a steroid-based inhaler can make them feel better; it’s a randomized control trial that happens completely out of their house that allows them to recuperate and practice social distancing.

The entire study is run by telemedicine, telephone, or an iPhone app, which is exciting because it allows us to keep our patients safe.”

With the smartphone app, Dr. Clemency explains,

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MEDICINE IN WNY 2020

VIRTUAL VISITS

Medical care when you can’t get there

by Devon Dams-O’Connor

IT SOUNDS LIKE A SCENE FROM THE JETSONS.

You’ve slammed your finger in a car door and you’re not sure if it’s broken. So, you open your laptop, click on a link, and poof! Your doctor appears onscreen to see what’s up. You show her your hand, wiggle your finger (or not), answer a few questions, and she determines whether you need ice or an X-ray. Just like that, you’ve had a doctor’s appointment in your own home.

It’s called telemedicine and, over the past few months, it’s become the de facto way to receive healthcare. A patient schedules an appointment either by calling the doctor’s office or through the practice’s online patient portal system and receives a secure link to an online meeting room.

Once logged on from their own locations with an internet-connected computer, smartphone, or tablet, doctor and patient can see and hear each other in real time to discuss the medical matter at hand. While telemedicine’s rise in implementation is in response to crisis, it’s nonetheless a practical approach that many local doctors and patients hope is here to stay.

2020

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MEDICINE IN WNY 2020

2020

Virtual visits continued

Why now

Telemedicine isn’t a new concept. For years, many local health insurance providers have offered phone access to an on-call nurse or online chat where members could ask basic medical questions to figure out whether a trip to the doctor is warranted. Doctor on Demand, founded in 2012, and similar online services are staffed by board-certified physicians, as well as licensed psychiatrists, psychologists, and therapists twenty-four hours a day, every day of the year.

Theresa Wagner Roma of Buffalo has been using Doctor on Demand for years, especially when she can’t get to a doctor’s office.

“On New Year’s Day, my daughter had an ear infection, and the doctor’s office wasn’t open,” she says. “The video appointment was a quick solution to get an antibiotic that day. Another time, we were traveling and wanted to make sure we weren’t going out of [our insurance] network, so we called from the road and got what we needed.”

As the coronavirus limited in-person activities, including doctor’s appointments, the medical community sprang into action to find ways to connect with their patients. Many practices, like BestSelf Behavioral Health, had been using telemedicine sparingly, but quickly expanded virtual capabilities.

“The policies and procedures to offer virtual visits had already been approved through our

mobile substance use disorder unit and a rural location in North Collins,” explains Elizabeth Woike-Ganga, LCSW-R, President and CEO of BestSelf. “But it was never fully rolled out throughout all of our locations and programs. It was easier to see people in person. Then, when COVID hit, we went from having less than one percent of visits being telemedicine to ninety-six percent of them going virtual in about ten days.”

While many medical practices had the desire and the technology to introduce virtual doctor visits, the healthcare system wasn’t set up to support it. “Part of the difficulty prior to COVID was that the insurances weren’t covering virtual visits,” says Dr. Sagrock Oh, who led the CareConnect telemedicine implementation at UB|MD Family Medicine. “We couldn’t bill for it, so we couldn’t use it. We had started working with insurers before the COVID to figure out how to change that, and then COVID did it for us.”

Best uses

“Virtual visits have wide-ranging capabilities in primary care,” says Dr. John Notaro, Medical Director at Buffalo Medical Group. “A video visit is a good way of doing physicals. A surprising amount of a physical exam can be done through observation and coaching a patient through elements of it. They also lend themselves well to acute needs like ‘I’m having a fever’ or ‘I think I hit poison ivy while

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E-MERGENCY Virtual visits for urgent issues

A video visit is a good way of doing physicals.

A surprising amount of a physical exam can be done through observation and coaching a patient through elements of it.

“I already have to go to hospital every four weeks for infusions,” explains Laettner. “I don’t want to go in an extra time if I don’t have to, so my doctor offered the option of televisits. She’ll have me use the camera on my phone to check my walking gait, balance, and reflexes. We talked about being extra careful about exposure as a high-risk person, and how I’m handling stress to prevent an MS flare-up. I have an established relationship with all my neurologists, so they already know what my normal looks like.”

Mental health counseling is another area that had already gone virtual in recent years with the rise in popularity of online therapy sites like TalkSpace, BetterHelp, and Regain. Virtual therapy sessions can help people work through substance abuse, depression, marital problems, and anxiety—issues that are seeing spikes as the isolation, economic crisis, and uncertainty brought on by the pandemic and political climate take their toll.

“We are uniquely positioned to take advantage of technology to reach people, because we don’t need to take blood pressure or look in people’s ears,” says BestSelf’s Woike-Ganga. “Some interventions work even better virtually, like parent-child interaction therapy where a therapist observes how parents and children interact and then coaches them. Usually it’s done in a clinic through a two-way mirror, but it’s more effective seeing natural interactions in their home.”

I F Y O U L I S T E N T O B R O A D C A S T O R D I G I TA L R A D I O I N W E S T E R N N E W Y O R K , you may have heard ads for Kaleida

Health’s new virtual ER. And if you’re a thinking person, you may have pondered, “How is that even possible?” We had the same question, so we asked Dr. Josh Lynch, Director of Emergency Medicine at Millard Fillmore Suburban Hospital and DeGraff Medical Park.

“It’s all through a platform called Kaleida Cares, and it’s really easy for members to use,” he says. “If a patient wants to be seen by an ER provider, they can go to the app or website and find an appointment available within the next twenty-four hours. Anything that can wait longer is not an emergency. A physician assistant in emergency medicine or an emergency physician—literally the same people you’d see in the ER—who is working that day gets notified and meets the patient in virtual room via video to talk. We can get quite a bit of information over a camera, like a physical assessment, the backstory of what happened, or symptoms. The PA or doctor can then decide whether to prescribe, order blood test or X-ray, refer into substance treatment, and so on. It’s not meant for timesensitive conditions like a heart attack or stroke. If you would’ve called 911 last summer, you should call it now, too.

“We as physicians felt nervous at the start of the pandemic that for months our numbers were so low in the ER,” Dr. Lynch continues. “Where are all these people? All the regular medical problems didn’t go away. This is one way we can access the patient and visually see them and deal with problems they maybe wouldn’t have sought care for.

“We don’t want people to come to the ER if they don’t need to, [in order to keep] them and our staff safer. We can assess low-risk COVID patients at home. We can extend a virtual hand to patients who should be seen but were afraid to go. We can see people sooner and urge them to get in, help them find the nearest location, or help them at home and avoid a visit.”

— Devon Dams-O’Connor

BUFFALOSPREE.COM

mowing the lawn.’ Specialty care, too. We’ve had specialists who were using video visits to coach patients through complex things like passing a kidney stone. The patient didn’t want to go to the ER, so a urologist helped him through that. Initial consults for specialists can happen over video visits.”

Virtual visits can also be used for follow-up appointments with physicians you’ve already seen in the office, like post-operative consultations or to discuss the results of lab work. East Amherst resident Eve Laettner, who was diagnosed with multiple sclerosis fifteen years ago, has been seeing her neurologist virtually for the past several months to lessen her compromised immune system’s time spent out in public.

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MEDICINE IN WNY 2020

Virtual visits continued

Maybe in the future, we’ll be able to listen to hearts or do preliminary imaging virtually. It’ll be exciting to see how this evolves.

The upsides of virtual visits

Doctors and patients both see a bounty of benefits in remote medical care. Parents don’t have to drag several children to the doctor or find a sitter when only one kid is sick. Time off of work usually isn’t required. There’s no travel time, parking, or waiting. Virtual visits are often less expensive or free for patients as compared to walk-in urgent care fees.

Being able to see a doctor from home also extends access to medical care for people who’ve previously had a hard time going to a physical office. “It’s a hardship for a lot of older patients to come into the office,” says Buffalo Medical Group’s Dr. Notaro.

“They’re not that mobile, and they can’t come in unless a son or daughter can take an afternoon off and bring them. They may need a little tech help with the iPad, but they catch on quickly, and then don’t need help after that.”

“Health access is a big issue in Western New York,” says UB|MD’s Dr. Oh. “People in underserved areas of the city might walk two hours to a clinic,

have multiple part-time jobs with no time off, or have trouble getting a Medicare cab. These are people who are already disproportionately affected by chronic health issues.

Now they can log in and still get health care.”

Woike-Ganga says BestSelf’s appointment no-show rate has definitely gone down because barriers like tricky bus schedules, cars breaking down, and kids being sick or without care aren’t a factor in virtual visits.

The limitations

While telemedicine makes it easier to get healthcare for many people, it’s not accessible to everyone. Virtual visits rely on fast internet service, which isn’t reliably available in lowerincome households and rural areas. They also require patients to have devices with cameras and audio, and the ability to use them.

“When our program first rolled out, people couldn’t get laptops or cameras quickly because everyone was buying them,” explains WoikeGanga. “Tech access is an ongoing concern. We serve older folks and people with lower incomes who don’t have a smart phone or laptop. Or they have a government cell phone plan that limits data usage, so we’ve had to help them extend plans. Some clients have chronic mental health issues that limit their ability to use telemedicine.

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We’re always trying to help people get the technology they’re qualified for, but it can be hard for someone without a permanent address to get tech, hold onto it safely, and use it in a private space. We’ve had to get creative and set up tech in shelters, mobile units, and the Flickinger Center so people can access a counselor. About fifty percent of our clients have trouble accessing telehealth.”

Some things still require in-person visits

Not every medical issue can be treated over the internet, of course.

Emergencies like strokes, heart attacks, and severe injuries still require ambulance trips to an emergency department. Procedures that require diagnostic equipment or physical interaction—e.g., mammograms, chemotherapy, setting broken bones, vaccines, dialysis, stitches, and Pap smears—must be done in person at a medical facility. And, although telemedicine dentistry does exist, it’s only used to triage tooth issues and determine urgency; ninety percent of dentistry is still hands-on.

What’s next

With continuing focus on improving the tech performance and access needed for widespread virtual visits, local medical professionals envision a future that uses a hybrid model of telehealth and in-person appointments. Many insurance companies have recently expanded coverage for telemedicine visits, and providers and patients hope that allowance is permanent.

“We know that we’re never going back,” says Dr. Notaro at Buffalo Medical Group. “Video visits aren’t just for crisis management. They’ll be a legitimate way for patients to have part of their care. As technology advances, patients may have ultrasound or acoustic capabilities in their phones.

Maybe in the future we’ll be able to listen to hearts or do preliminary imaging virtually. It’ll be exciting to see how this evolves.”

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MEDICINE IN WNY 2020 Dr. Lekperic and Windsong Radiology’s PAE procedure

41

WINDSONG INTRODUCES MINIMALLY INVASIVE URINARY INTERVENTION

Patients recover within hours

PHOTO PROVIDED BY WINDSONG

by Steve Brachmann

WHILE DISCUSSING URINARY FREQUENCY isn’t the way to charm new acquaintances or earn the right kind of attention at social gatherings, for men sixty and older, those conversations are happening and, if the prostate gland is involved, having them with healthcare professionals at Windsong Radiology might lead to relief. A new minimally invasive surgical procedure can solve some prostate-related urinary issues in just a few hours and without lengthy recovery and side effects (see sidebar).

The procedure is called prostate artery embolization (PAE) and it is offered by Windsong as an outpatient procedure at its Williamsville location. PAE involves injection of tiny particles called microspheres into the arteries that feed the prostate gland. (Read to the end for a female version of this procedure.) These particles, similar in size to grains of sand, block a portion of blood flow to the prostate, which causes it to shrink. Within a few days, patients report relief from urinary pressure. The procedure is mainly designed for men suffering from benign prostatic hyperplasia (BPH), a condition that results in an enlarged prostate gland caused by hormonal changes brought on by aging.

According to Dr. Safet Lekperic, an interventional radiologist with Windsong, technological advances over the past two decades in microembolic beads and other tools for minimally invasive procedures have enabled the development of PAE. Compared with other health practices offering outpatient services, Windsong has access to radiology technologies, like CT scans, that increase the effectiveness of PAE. “We can actually perform a scan while the patient is on the table and confirm that we’re targeting exactly where we need to be,” says Lekperic, adding that concurrent imaging also improves safety.

Minimally invasive surgical procedures have revolutionized healthcare by substantially reducing recovery time. Instead of putting a patient under heavy anesthesia for major surgery, minimally invasive procedures use targeted small incisions that allow surgeons to use catheters and other equipment to complete the operation without opening a patient’s body in a way that requires weeks, if not months, of recovery time.

With PAE, men with BPH get a small incision either on the wrist or groin. While the groin incision makes sense given its prostate proximity, Dr. Lekperic says it’s the wrist incision that speeds recovery time.

Prior to the procedure, a patient is given a moderate sedative before the incision areas are prepped; the patient lies on an X-ray table, which helps doctors perform the CT scan during the procedure. Once the incision is made, a micro-catheter is fed either through the groin into the femoral artery or through the wrist into the radial artery.

The micro-catheter is then advanced through the body’s network of arteries to reach the left and right arteries feeding the prostate, where the microembolic beads are injected.

“The procedure doesn’t kill the prostate,” Dr. Lekperic says. “It shrinks the prostate and ultimately relieves the symptoms that the patient is suffering from.”

According to Dr. Lekperic, a patient suffering from BPH can come to Windsong for the outpatient PAE procedure and still enjoy most of his day. “You can show up by 9 a.m. and leave by noon,” he says. The procedure itself is completed by Windsong’s medical staff within about two hours, and recovery times are quick, especially if patients elect to have surgical staff work through the wrist; incisions in the groin can take an extra hour or two of recovery time.

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2020

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MEDICINE IN WNY 2020

ALTERNATIVE TREATMENTS FOR BPH

2020

Windsong continued

Male patients with urinary frequency typically need to be diagnosed with BPH to get a referral for PAE. Dr. Lekperic recommends that men with frequenturination problems consult with a urologist or primary care physician first.

“Men with BPH who don’t want to take medication because of the side effects, such as erectile dysfunction or dizziness, are good candidates,” he says. “This is a one-and-done type procedure. It allows people to not be on medication or worry about open surgery.”

PRIOR TO PROSTATE ARTERY EMBOLIZATION (PAE),

options to treat benign prostatic hyperplasia (BPH) were conventional and often involved surgery, longer recoveries, and greater risk of side effects.

PAE is a huge advance from these: Transurethral resection of the prostate (TURP): A surgical procedure involving either electronic cauterization or sharp dissection of prostate material, which is then removed through the urethra.

Although an effective treatment for moderate to severe BPH symptoms, the procedure isn’t minimally invasive and can cause some urinary problems and sexual side effects.

Radical prostatectomy: A surgical procedure to remove either part or all of the prostate gland. Often associated with treatments for prostate cancer, a prostatectomy can treat men with severe BPH symptoms as well. This is a more invasive procedure with longer recovery times that risk injury to other internal organs, bleeding, and sexual side effects.

Holmium laser prostate surgery (HoLEP): A minimally invasive procedure involving laser removal of tissues blocking urinary flow. Like PAE, HoLEP offers faster recovery times and fewer side effects than major surgical procedures.

Rezum: A minimally invasive procedure that uses short bursts of heated water vapor delivered through the urethra to the prostate gland. Although sexual side effects are limited, the procedure can cause inflammation that takes two to four months to heal.

UroLift: A minimally invasive procedure that introduces a UroLift device through the urethra in order to push aside enlarged prostate tissue and increase the urethra’s opening. The UroLift can cause mild to moderate side effects in the form of pelvic pain, pain while urinating, or difficulties controlling urination. — Steve Brachmann

This is a one-and-done type procedure. It allows people to not be on medication or worry about open surgery.

Although PAE is strictly a procedure for men because it focuses on the prostate gland, Windsong can also treat women with urinary frequency issues. The parallel uterine fibroid embolization (UFE) is for women experiencing frequent urination and other symptoms associated with the fibroids, non-cancerous growths, in the uterine lining. Like PAE, UFE is minimally invasive and involves the insertion of a catheter into a female patient’s thigh or wrist. The catheter is then guided with X-ray imaging and microembolic beads are injected into uterine arteries to block flow to the blood vessels feeding the fibroids. Unlike PAE, which typically only results in the shrinking of the prostate gland, women undergoing the UFE procedure may experience discharge of fibroid tissue during their recovery period.

As vascular specialists whose procedures can be used to treat health concerns from chronic venous diseases to cancers to migraines, Dr. Lekperic likened the medical professionals at Windsong Radiology to “the MacGyvers of surgery and medicine. Until the past few decades, interventional radiologists weren’t mainstream, and most people assumed we only make X-rays,” Dr. Lekperic points out. “Today, other doctors come to us when they’re in trouble, because we can perform certain procedures that can be difficult for doctors or surgeons.”

Dr. Lekperic also credits outpatient procedures for interventional radiology’s increased mainstream status. “When you look back at the history of treating arteries and veins, every minimally invasive procedure invented was created by an interventional radiologist,” he says. “We’re definitely pushing the envelope on the cutting edge of medicine.”

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MEDICINE IN WNY 2020

DOUBLE TROUBLE Preparing for flu season

by Terri Parsell Hilmey

F L U S E A S O N I N T H E U N I T E D S T A T E S is considered to be October through March, although infections do occur outside that window.

Symptoms include fever, cough, sore throat, runny or stuffy nose, muscle or body aches, headaches, fatigue, and possible vomiting and diarrhea, though these are more common in children. Complications such as pneumonia, ear infections, or other inflammations of the heart, brain, or muscles can also present. Seasonal flu may be more difficult for those with asthma, chronic heart disease, or other chronic conditions and may, in fact, exacerbate them.

Seasonal flu is commonly spread person to person. Infected people produce virus droplets when they cough, sneeze, talk, or sing, and those can land on or be inhaled by other people up six

feet away and beyond. Far more infrequently, people contract the flu after touching a surface or object with virus on it, then touching their own mouths, noses, or eyes. Healthy adults are most contagious in the first three to four days after they experience symptoms, but may also spread the disease one day before symptoms develop.

Children, and those with weakened immune systems, may be contagious for longer than seven days.

Each year, a seasonal vaccine is developed to protect against influenza virus and its various mutations; it’s updated annually to better match viruses expected to be circulating in the US. This year, the vaccine is designed to protect against the three (trivalent) or four (quadrivalent) viruses that research predicts will be most common this upcoming season. The flu vaccine does not protect against other respiratory ailments, such as the common cold, but is forty to sixty percent effective in preventing flu in the general population. While this is not a perfect solution, it does prevent enough cases and spread to make getting it a benefit to you and those around you. The vaccine is recommended for health care providers, the elderly, those with chronic medical conditions and compromised immune systems, and children from six months old.

This year, management of the normal flu season is even more critical because of the emergence

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and spread of COVID-19 (SARS-CoV-2). While it is difficult to call anything a positive during a pandemic, the encouraged COVID prevention precautions—masks, proper handwashing, diligent disinfecting, and social distancing—will also reduce spread of seasonal flu. And if the cold weather brings another surge of COVID, taking measures that could help avoid busy hospitals is always a good idea.

General good health is no guarantee that you will not contract the flu, but managing medical issues, quitting smoking, following a healthy diet, keeping up with physicals, and getting an annual flu vaccine will all help. For the shot-avoidant, the nasal vaccine will be available this year, but it is recommended only for healthy individuals aged two to forty-nine who are not pregnant. The vaccine prompts us to produce antibodies that protect against infection, with the protection greatest between two weeks and two months after vaccination. A patient cannot contract the flu via the vaccine, but common side effects can include body aches or temporary redness and/or soreness at the injection site.

In the wake of COVID, healthcare officials are emphasizing the importance of taking responsibility for both ourselves and others.

Wear masks. Wash hands often and thoroughly.

Don’t touch your eyes, nose, or mouth. Use hand sanitizer. Keep your distance when you are sick, which means staying home from work, school, and public places. Preventing the spread of any communicable disease—whether flu or COVID-19—requires community responsibility and community response.

FLU V. COVID-19

S E A S O N A L F L U A N D C O V I D - 1 9 are both respiratory illnesses transmitted via droplets, though COVID appears more easily spread because infected people can transmit the disease for longer periods even if they aren’t experiencing symptoms. COVID has also proven to be more dangerous, which understandably gets people anxious, particularly if they start to feel unwell.

Because the flu and COVID-19 share many symptoms— fever, chills, body aches, digestive issues, cough, etc.—it can be hard to know which one you have. The four most common symptoms of COVID are fever, cough, fatigue, and shortness of breath. Additionally, people often report loss of taste or smell. If you have these symptoms, particularly in the absence of other more traditional flu symptoms, get a test and call your doctor. Earlier intervention has proven to be important in effectively treating COVID, so this isn’t the time to tough it out. Keep in mind that whenever you have fear surrounding symptoms, calling your doctor immediately is the right choice.

Resources: COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University: coronavirus.jhu.edu Centers for Disease Control and Prevention: cdc.gov/flu/season/faq-flu-season-2020-2021.htm National Institutes of Health: pubmed.ncbi.nlm.nih.gov/32558810 WebMD: webmd.com/cold-and-flu/flu-cold-symptoms#1 World Health Organization: www.who.int/news-room/q-a-detail/how-can-i-avoid-getting-the-flu US Food and Drug Administration: fda.gov/vaccines-blood-biologics/lot-release/influenzavaccine-2020-2021-season — Terri Parsell Hilmey

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MEDICINE IN WNY 2020

CARE THAT CAN’T WAIT

The dangers of delaying doctor’s appointments

by Devon Dams-O’Connor

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GOING TO THE DOCTOR probably isn’t among anyone’s top ten favorite things. But staying on top of regular screening appointments, following through with doctor recommendations, and getting help quickly when something’s not right are essential parts of maintaining good health. Especially now.

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2020

Care that can’t wait continued

To go or not to go

Since mid-March, one of the biggest barriers to people seeking medical care has been fear of contracting COVID-19, either from visiting facilities where patients are being treated or simply through increased human contact. Even as elective surgery centers and specialists’ offices opened back up, patients have been slow to return.

“There was a real fear of going in and getting exposed to COVID,” explains Dr. Rex Thomas, a general surgeon and Chairman of the Center for Ambulatory Surgery’s Quality Assurance Committee.

“That’s especially true with elderly patients delaying cataract surgery. They can still see, although not very well, but they’re afraid of getting sick.”

Even before COVID, people put off that colonoscopy, knee replacement, and nagging mystery pain. The timing is never ideal. Expense is a factor. Fear of pain or a devastating diagnosis is real. Recovery from minor surgeries can’t overlap with major life events, travel, work responsibilities, or ongoing home projects. Many medical interventions, while necessary, tend to slip down the priority list. That’s especially true for people who reentered the workforce after several weeks or months off during the shutdown.

“People will tell us, ‘I just had three months off of work,’” explains Tom Faith, Vice President of Healthcare Operations at the Center for Ambulatory Surgery. “They can’t ask off two or three days to recovery from surgery. There are always out-of-pocket costs, too, especially if they have to take time off from work.”

Added pressures from a completely new and often complex set of home circumstances also make it tricky to find the time for medical care, even for those who understand its importance.

“Women always put themselves last,” says Dr. Katharine Morrison, OB/GYN at Buffalo Women’s Services in Buffalo. “Now, they’ve been working from home, caring for elderly parents, caring for and educating children. Everything became more difficult for everyone, but women always disproportionately shoulder that load.

These are real reasons; they could not get to an appointment. But, what we’ve seen is that even telemedicine appointments can’t take the place of a lot of important in-person visits. You can’t get a Pap virtually. Consistent prenatal care is difficult virtually. There’s no substitute for a mammogram.”

Danger in waiting

Emergency care for life-threatening events like trauma, strokes, and heart attacks cannot wait to be seen, even during a pandemic. “We were seeing people with chest pains be really afraid to come to the hospital,” explains Dr. Josh Lynch, Director of Emergency Medicine at Millard Fillmore Suburban Hospital and DeGraff Medical Park. “There are sad stories of people who had a heart attack at home and waited until things were dire to reach out.”

If troubling symptoms suddenly appear— numbness in the face or one side of the body, slurred speech, trouble balancing or seeing, severe headache, chest pains—Dr. Lynch urges patients to call 911 or get to the nearest hospital

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NECESSARY PRECAUTIONS

MY BEST FRIENDS

OLIVIA MUNN WITH CHANCE AND FRANKIE: ADOPTED 2014 AND 2016.

THESHELTERPETPROJECT.ORG

I T ’ S I M P O R TA N T T O R E M E M B E R that every medical professional receives extensive training in preventing contamination and the spread of disease. These are daily habits they’ve been practicing their entire careers, long before COVID. Doctors’ offices have added significant additional sanitizing and distancing precautions to make it even safer for patients to visit, including: • Masks required for patients and staff • Increased disinfecting of high-traffic touch points, like doorknobs and elevator buttons • Check-in calls prior to the appointment time to ask about health and symptoms • Temperature checks upon entry • Increased spacing between seats in waiting rooms • Limiting the number of people who can accompany patients into the facility • COVID testing a few days prior to inpatient or outpatient procedures • Telehealth, drive-up testing, and incar triage options — Devon Dams-O’Connor

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MEDICINE IN WNY 2020

ARE ELECTIVE PROCEDURES REALLY ELECTIVE?

T H E W O R D “ E L E C T I V E ” often means “optional,” something you choose to do (or not do). When it comes to medical care, though, the word is misleading: in this case, elective means absolutely recommended for optimal health, but not urgent.

Many people confuse elective procedures with plastic surgery, although elective procedures are used to diagnose and treat a whole host of medical conditions.

• •

•

• •

From a medical perspective, the word “elective” is really meant to differentiate a category of procedures based on urgency.

Emergent procedures need to be done within twenty-four hours to save a patient’s life.

Examples: Trauma, bleeding, heart attack, stroke Urgent procedures should be done within forty-eight hours.

Examples: Stitches, broken bones, appendicitis, gall bladder, kidney stone Elective procedures refer to anything that can wait forty-eight hours or more to be done.

Examples: Biopsy, hip replacement, colonoscopy, hernia, cataracts

“Eighty-two percent of surgeries are considered elective,” explains Dr. David Meyers, Medical Director at the Center for Ambulatory Surgery in West Seneca. “And they’re all medically important.” — Devon Dams-O’Connor

2020

Care that can’t wait continued

emergency department. If the issue isn’t a matter of life or limb, timely help is still important. If it’s not clear whether a bone is broken, the cough is COVID, or stitches are needed, more doctor’s offices and urgent care centers than ever now offer same-day telemedicine appointments. Patients can video chat with a doctor using a web-enabled smartphone or computer from home and get professional help determining how urgent the situation might be, and what to do next.

Preventative screenings to catch dangerous maladies like cancer, diabetes, and cardiovascular concerns shouldn’t be put off, either, as early detection has been shown repeatedly to increase the chance of successful treatment and survival.

“I’ve seen estimates that the three-month delay resulted in 80,000 patients receiving a delayed diagnosis of cancer alone,” says Dr. Thomas. “That’s significant. In the beginning of the pandemic, nobody knew how long we’d have to wait.

Two weeks’ wait would be been OK. Four weeks? More than that? We can’t wait. Once, I had a kid with a spot on his back, aged twenty-four, who wanted to wait until the end of minor league baseball season to get the spot tested. It turned out to be metastatic melanoma, and he was dead within a year. We had another patient who recently canceled her first colonoscopy appointment three times. She’s sixty, and she should have had one at forty. We found colon cancer. There are no re-dos. Patients wait years for their colonoscopy, and had we found a polyp earlier, we could’ve removed it. But now we can’t go back to before it was cancer.”

Even elective surgeries, despite their name, can have lasting implications when delayed. “Waiting to have cataracts removed impacts personal safety, especially while driving at night. You risk accidents with long-term disabilities,” says Faith. “Delays in getting the bad knee replaced affects a person’s job and their ability to do it safely. You can’t work if you can’t climb a ladder. Pain like that really affects quality of life.”

Taking care to get there

Sometimes all it takes to prioritize a medical appointment is a little nudge from someone who cares. “A lot of times, it’s their spouse convincing them to go in,” says Dr. Thomas. “We had a police officer with lump under his arm. He had just taken time off for something else, so he wanted to keep an eye on it and wait. His wife called us four hours later, he went in, and it ended up being lymph node cancer. Primary care physicians are a big help, too. If we’re having trouble getting someone scheduled, often the PCP will chime in and encourage the patient to go in. Often, that doctor has been seeing the person for ten or twenty years, and that has a lot of weight.”

Keeping the bigger picture in mind can also help bump a doctor’s appointment up the priority list. “Often, women are a key pillar in the family whether they have children or not,” says Dr. Morrison. “If they go down, the whole ship goes down.

We encourage women who are putting off medical care to think about their own health as vital to the whole operation.”

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