Medical Guide Spring 2021

Inside This Issue 4

Key Things to Know About COVID-19 Vaccines

8

A Fresh Start for a Healthy Heart

10 Pike County Health Department Continues to Provide Services, Maintains Hope for 2021 14 Staying Healthy During COVID 20 COVID-19 has had Far-reaching Effects on Patient Treatment, Medical Community 24 PMC at the Forefront 26 Skin Cancer Detection 29 6 Tips for Controlling Your High Blood Pressure 32 Resolve to Manage Your Weight in 2021

Health Guide Spring 2021

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Taking Care of Our Mental Health;

Get a Hobby!

B Y T R A C I E VA N D E R B E C K S P E C I A L P U B L I C AT I O N S MA N A G E R

2020 was a tough year for everyone, so it’s more important than ever to develop positive physical, mental and emotional wellness routines as you tackle a new year and new challenges. As Americans continue to spend an increased amount of time in front of screens, these new routines can help reduce stress and anxiety by finding ways to stay grounded in your physical environment.

Enter: the hobby. A hobby is a pastime that is neither entirely productive nor entirely passive, but it does require a little active effort.

Watching TV is not a Painting by Sandy Penix hobby; writing a blog about Reader, Sandy Penix, of Pikeville, has taken TV is. And yet watching TV is how Americans spend up painting this winter. She says you’re nevmore than half their leisure er to old to learn something new. We agree! time — two hours and 47 minutes every day, according to the Bureau of Labor Statistics’ American Time Use Survey. And that was before the pandemic.

Imagine devoting 2 - 3 hours daily to learning something new. I did just that a few years ago and taught myself to knit. Born out of an inability to just “sit” and watch TV, I took some online classes, taught myself to knit, developed some skills and eventually taught others to knit offering some evening classes to my friends.

Hobbies are good for us. A 2016 study of elderly Japanese people found that having hobbies was positively associated with greater longevity. Multiple studies have found correlations between hobbies and reduced stress. Creative hobbies such as drawing, playing music or creative writing may be especially beneficial for beating burnout.

The human mind thrives on a certain amount of variety, So we need some new activities to get us through this period of isolation. If jigsaw puzzles and baking projects have lost their appeal, how about drawing or creative writing?

Learn to relax more and restore calm with hobbies like, reading, writing, yoga or meditation. Birding, flower arranging and calligraphy are also good choices. YouTube, Craftsy and Masterclass are great choices for learning something new, whether for playing an instrument or tying a fly.

For some of us, our pent-up energy needs to be directed to something more physical. If you’d like your hobby to keep you fit and healthy, how about trying out dancing, weight lifting, cycling, rollerskating or archery.

Hobbies that teach you a skill keep your mind engaged. Learn to play an instrument, or a learn a new language. Maybe you’ve always wanted to learn to play chess or learn woodworking.

Express yourself with hobbies like painting, photography, creative writing or acting.

Some might feel too busy for a hobby. But taking half an hour to work on a scrapbook or photograph your surroundings makes the day feel more spacious, not more rushed. We get to think of ourselves not only as workers, parents or partners, but as beekeepers, quilters and geocachers.

Consider it a form of self-diversification — and diversification is always a prudent bet in an uncertain environment. If you spend the next six months trying your hand at something new, you probably won’t regret it.

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Key Things to Know About COVID-19 Vaccines Help stop the pandemic by getting vaccinated

Report from Centers For Disease Control and Prevention

What we know

information about their vaccination plans. Use this tool to find more information on how to get vaccinated in your area:

Studies show that COVID-19 vaccines are effective at keeping you from getting COVID-19. Experts also think that getting a COVID-19 vaccine may help keep you from getting seriously ill even if you do get COVID-19.

COVID-19 vaccination is an important tool to help us get back to normal. Learn more about the benefits of getting vaccinated.

COVID-19 vaccines teach our immune systems how to recognize and fight the virus that causes COVID-19. It typically takes a few weeks after vaccination for the body to build protection (immunity) against the virus that causes COVID-19. That means it is possible a person could still get COVID-19 just after vaccination. This is because the vaccine has not had enough time to provide protection.

There are steps you can take to protect yourself until you can get vaccinated. Even after you get vaccinated it’s important to continue using all the tools available to help stop this pandemic as we learn more about how COVID-19 vaccines work in real-world conditions. Even after vaccination, take steps to protect yourself and others from COVID-19.

What we do not know

Although COVID-19 vaccines are effective at keeping you from getting sick, scientists are still learning how well vaccines prevent you from spreading the virus that causes COVID-19 to others, even if you do not get sick.

If you are vaccinated against COVID-19, you may still be exposed to the virus that causes COVID-19. After exposure, people can be infected with or “carry” the virus that causes COVID-19 but not feel sick or have any symptoms. Experts call this “asymptomatic infection.”

For this reason, even after vaccination, we need to continue using all the tools available to help stop this pandemic as we learn more about how COVID-19 vaccines work in real-world conditions.

COVID-19 vaccines are safe

Millions of people in the United States have received COVID-19 vaccines, and these vaccines have undergone the most intensive safety monitoring in U.S. history. This moni6 Health Guide 2021

How Do I Get a Vaccine?

CDC makes recommendations for who should get the vaccine first, then each state makes its own plan. You can contact your local health department, pharmacy or doctor’s office for more information regarding vaccine availability. toring includes using both established and new safety monitoring systems to make sure that COVID-19 vaccines are safe. These vaccines cannot give you COVID-19.

You may have side effects after vaccination, but these are normal

After COVID-19 vaccination, you may have some side effects. These are normal signs that your body is building protection. The side effects from COVID-19 vaccination, such as chills or tiredness, may affect your ability to do daily activities, and they should go away in a few days.

COVID-19 vaccines and herd immunity What we know

Herd immunity means that enough people in a community are protected from getting a disease because they’ve already had the disease or because they’ve been vaccinated.

Herd immunity makes it hard for the disease to spread from person to person, and it even protects those who cannot be vaccinated, like newborns or people who are allergic to the vaccine. The percentage of people who need to have protection to achieve herd immunity varies by disease.

In the coming months, vaccines will become widely available What we do not know

Although the vaccine supply is currently limited, the federal government is working toward making vaccines widely available for everyone at no cost. Learn more about how COVID-19 vaccines get to you and who should get vaccinated first when supplies are limited.

The federal government is providing the vaccine free of charge to people living in the United States. However, your vaccination provider may bill your insurance company, Medicaid, or Medicare for an administration fee. Vaccination providers can be reimbursed for this by the patient’s public or private insurance company or, for uninsured patients, by the Health Resources and Services Administration’s Provider Relief Fund. No one can be denied a vaccine if they are unable to pay the vaccine administration fee.

In the coming months, doctors’ offices, retail pharmacies, hospitals, and clinics will offer COVID-19 vaccine. Your doctor’s office or local pharmacy may have contacted you with

Experts do not yet know what percentage of people would need to get vaccinated to achieve herd immunity to COVID-19. CDC and other experts are studying herd immunity and will provide more information as it is available.

COVID-19 vaccines and new variants of the virus

CDC is continuing to investigate the effectiveness of COVID-19 vaccines. Scientists also are working to learn about new variants of the virus. More studies are needed to understand how new variants may affect the effectiveness of existing COVID-19 vaccines.

Our knowledge of the characteristics of new variants is rapidly growing. CDC will share updates as soon as they are available. For more information, please visit https://www. cdc.gov/coronavirus/2019-ncov/transmission/ variant.html.

What to Expect after Getting a COVID-19 Vaccine

COVID-19 vaccination will help protect you from getting COVID-19. You may have some side effects, which are normal signs that your body is building protection. These side effects may affect your ability to do daily activities, but they should go away in a few days.

Common Side Effects On the arm where you got the shot: • Pain • Swelling

Throughout the rest of your body: • Fever • Chills • Tiredness • Headache

Helpful tips

If you have pain or discomfort, talk to your doctor about taking over-the-counter medicine, such as ibuprofen, aspirin, antihistamines, or acetaminophen, for any pain and discomfort you may experience after getting vaccinated. You can take these medications to relieve post-vaccination side effects if you have no other medical reasons that prevent you from taking these medications normally. It is not recommended you take these medicines before vaccination for the purpose of trying to prevent side effects, because it is not known how these medications may impact how well the vaccine works.

To reduce pain and discomfort where you got the shot:

To reduce discomfort from fever:

• Apply a clean, cool, wet washcloth over the area.

• Use or exercise your arm.

• Drink plenty of fluids.

• Dress lightly.

When to call the doctor

In most cases, discomfort from fever or pain is normal. Contact your doctor or healthcare provider: • If the redness or tenderness where you got the shot increases after 24 hours • If your side effects are worrying you or do not seem to be going away after a few days • If you get a COVID-19 vaccine and you think you might be having a severe allergic reaction after leaving the vaccination site, seek immediate medical care by calling 911.

Scheduling your second shot?

If you need help scheduling your vaccine appointment for your second shot, contact the location that set up your appointment for assistance. With both COVID-19 mRNA vaccines, you will need 2 shots to get the most protection. The timing between your first and second shot depends on which vaccine you received.

• If you received the Pfizer-BioNTech vaccine, you should get your second shot 3 weeks (or 21 days) after your first.

• If you received the Moderna vaccine, you should get your second shot 1 month (or 28 days) after your first.

You should get your second shot as close to the recommended 3-week or 1-month interval as possible. However, your second

dose may be given up to 6 weeks (42 days) after the first dose, if necessary. You should not get the second dose earlier than the recommended interval. ​(Source: CDC)

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A Fresh Start For A Healthy Heart Every February, the United States recognizes American Heart Month to raise awareness about heart health. This year, the Division for Heart Disease and Stroke Prevention is focusing on hypertension, or high blood pressure, which is a leading risk factor for heart disease and stroke.

High blood pressure affects nearly one-third of American adults aged 18 or older, or 67 million people. People with high blood pressure usually do not have any warning signs or symptoms. According to the National Health and Nutrition Examination Survey, 14.1 million Americans are unaware that they have hypertension.

Measuring your blood pressure is the only way to know whether you have high blood pressure. Routine visits with your primary care doctor and knowing your blood pressure numbers are crucial.

Fortunately, people can take steps each day to keep their blood pressure in a healthy range: Eat a Healthy Diet A recent study in the Journal of the American College of Cardiology found that consuming sugary drinks, red and processed meat, and refined carbohydrates made people 38% more likely to develop cardiovascular disease. Instead, people should focus on a diet with more fiber and antioxidants, such as leafy greens, fruit, whole grains, tea and coffee.

Limit Alcohol Intake Drinking alcohol raises blood pressure. According to the Centers for Disease Control and Prevention (CDC), men should have no more than two alcoholic drinks per day, and women should have no more than one alcoholic drink per day.

Get More Sleep If you are tossing and turning regularly, you may be at risk of heart disease, high blood pressure and stroke. Getting sufficient sleep helps keep your heart and blood vessels healthy.

There are plenty of heart health resources available at your primary care provider’s office. You can also talk to your doctor about your risk factors and establish a plan to adopt healthy behaviors to limit and reduce your risk of developing hypertension in the future.

Maintain a Healthy Weight Being overweight increases your risk for high blood pressure.

Talk to your doctor to identify your body mass index and determine if you are at a healthy weight. Although these lifestyle changes may help, those with hypertension generally require one or more medications to lower their blood pressure.

Schedule Physical Activity The pandemic has changed activity routines for many. Scheduling exercise and maintaining a routine will help people stay active in the coming months. Physical activity can help keep you at a healthy weight and lower your blood pressure. The Physical Activity Guidelines for Americans recommends that adults get at least two hours and 30 minutes of moderate-intensity exercise, such as brisk walking or bicycling, every week.

Quit Smoking Smoking raises your blood pressure and puts you at higher risk for heart attack and stroke. Talk to your doctor about ways to help you quit if this is an issue.

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To schedule an appointment with Primary Care Provider, Kelley Cochran, PA-C, call (606) 789-6464 or visit www.PaulBHallAnytime.com.

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Health Guide

Pike County Health Department continues to provide services, maintains hope for 2021

Supplemental nutritional programs including Women, Infants and Children (WIC) and Health Access Nurturing Development Services (HANDS) have flourished during the pandemic primaily as a result of Telehealth, or remote health care.

S TO RY B Y N I C O L E Z I E G E

The Pike County Health Department continues to provide crucial services to the public and maintains hope for the community prioritizing public health in 2021, after it saw varying degrees of impacts to its services during the start of the COVID-19 pandemic in 2020.

As Gov. Andy Beshear issued state closure orders to many public-facing facilities and services in March 2020, Kentuckians were asked to practice social distancing and stay at and work from home if possible in order to prevent the spread of COVID-19.

Pike County Public Health Director Tammy Riley said these state closure orders caused a significant decline through10 Health Guide 2021

out a portion of the year in their clinical services. She added, though, there were certain outlier programs that flourished through the pandemic.

“There was a significant impact on our clinical services. In March of 2020, when Kentucky as a state modified societal practices, the clinical services saw a dramatic decrease in services — for example, in family planning, HIV, STD services, immunization services and tuberculosis services, just to name a few,” Riley said. “Those clinical services are where we really saw a significant decline, but due to relaxed regulations or regulatory modifications, there’s some programs that flourished, like WIC, for example.”

The Pike County Health Department, Riley said, saw positive trends in providing certain other programs during the pandemic in 2020, including the Women, Infants and Children (WIC) program and the Health Access Nurturing Development Services (HANDS) program.

According to the U.S. Department of Agriculture, WIC is a supplemental nutrition program that provides federal grants to states for supplemental foods, health care referrals and nutrition education for low-income pregnant, breast-feeding and non-breastfeeding postpartum women, and to infants and children up to age five who are found to be at nutritional risk. In addition, HANDS is a voluntary home vis-

itation program for any new or expectant parents in order to support families as they build healthy, safe environments for their children’s development, according to the Kentucky Cabinet for Health and Family Services.

Riley said those programs have flourished during the pandemic primarily as a result of Telehealth, or remote health care.

Telehealth allowed patients to maintain social distancing while receiving crucial health care services through a variety of remote methods, and it expanded through the year of 2020 as a result of the pandemic, according to the Centers for Disease Control and Prevention.

“(WIC) has done really well in comparison to clinic services because we’ve been allowed to provide most of those services over the phone or via Telehealth,” Riley said, referring to programs that saw positive growth during the pandemic.

“HANDS is another program. That program has done really well because we’ve been able to provide those home-site visits via secure Telehealth calls.”

Riley noted, though, that there were certain clinical services at the Pike County Health Department that required more face-to-face, in-person care. Therefore, they have not seen the same increase in providing those services through Telehealth as they have with WIC and HANDS. They have continued providing those services in certain ways in their clinic.

“We did modify our approach for services. There was the emergency 30-day extension for prescriptions, and there were other services that we were able to provide over the phone,” Riley said. “We’ve started seeing patients in the clinic, and then there were some services, like new family planning, that just required a face-to-face visit. Even when we were in crisis mode, there were some services — such as STD and family planning — that required faceto-face, and we continued those services.”

Moving forward into 2021, Riley said that she believes there could be modifications to the federal and state regulations for programs like WIC and HANDS. She said they have been able to provide those

programs through Telehealth due to the easing of federal and state regulations on receiving health care through Telehealth.

Therefore, due to the expanded use of Telehealth through the year of 2020, Riley said she believes regulations may modify long-term in order to allow the continued use of Telehealth in the future.

“I think what we’ll see is long-term modification in all likelihood. That’s my opinion, but we’ll only be able to continue those services in that manner if it’s allowed at the state and federal level,” Riley said, providing HANDS as an example.

“When you receive federal funding, you must meet the federal guidelines, and if you receive state funding, you must meet those guidelines. If those guidelines are re-

laxed due to a crisis, like a pandemic, then you’re allowed to make those changes. If the original guidelines are reinforced, then we will need to be required to follow those original guidelines. I’m as interested as anyone else to see where we might go in healthcare and where we could land with the ability to provide services in a modified manner.”

The Pike County Health Department provides many crucial health care services to the residents of Pike County. These services include breastfeeding counseling; cancer screening services; CDL school and sport physicals; dental hygiene; environmental health services; family planning; HIV and STD education and screenings; immunizations; syringe service program to reduce the number of dirty needles in parks, playgrounds and sidewalks; lead screenings; nutrition services; tuberculosis services; and a tobacco prevention program and smoking cessation classes, among others.

In addition, they have taken on a significant role throughout the COVID-19 pandemic by conducting contact tracing, administering COVID-19 vaccinations and tracking new cases and possible clusters, as well as meeting with other local health officials through its Coronavirus Task Force to discuss the county’s emergency preparedness plan.

As healthcare continues to move forward into 2021, Riley said she hopes to see long-term adjustments to the constraints that currently hinder some members of the community from accessing public health services.

“What I would like to see is permanent adjustments to regulatory constraints for public health to provide services to residents of the county,” Riley said. “I would like to see more of our Pike County residents have access to these wonderful services that we provide, and long-term or permanent relaxation of regulation, such as been seen during the pandemic, would go a long way in allowing increased participation.”

She added that she hopes the COVID-19 pandemic will help shed light on the importance of Public Health in the community, as well as the work that the Pike County Health Department does behind the scenes every day in order to “prevent, promote and protect” the community.

“I hope that the pandemic has shed light on the importance of what we do many times behind the scenes. Hopefully, moving forward, the community will be more aware of our role in population health and that, historically, Public Health has served the underserved,” Riley said.

“We continue to serve the underserved, but our role is larger than only serving those who are underserved. Our role is to prevent, protect and promote good practices for everyone, and our services are here for everyone in our community.”

The Pike County Health Department is located at 119 River Drive, and it can be reached at, (606) 437-5500. For more information, visit, www.pikecountyhealth. com.

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Staying Healthy During COVID-19

Maria Braman, MD, the chief medical officer at the Hazard Appalachian Regional Healthcare (ARH) Regional Medical Center, said that as we kick off 2021 while still in a pandemic, there is hope for a better year.

S TO RY B Y K AT I E K E L L E Y

For many people across the world the COVID-19 pandemic brought months of isolation. For some, this served as time to develop hobbies and enjoy the outdoors. For others, it resulted in a loss of social interaction, unwanted weight gain, and a decline in mental and physical health, presenting an opportunity of enlightenment in regards to overall health. With the recent distribution and administration of vaccinations, many people are looking forward to the months coming out of the pandemic and healthcare officials are encouraging people to focus on making healthier lifestyle choices in 2021.

Maria Braman, MD, the chief medical officer at the Hazard Appalachian Regional Healthcare (ARH) Regional Medical Center, said that as we kick off 2021 while still in a pandemic, there is hope for a better year because many people are making New Year’s resolutions to improve their health by taking the COVID-19 vaccine and planning to make changes that involve having a balanced sleep schedule and diet, participating in regular physical activity, monitoring your mental health, and continuing to practice routine maintenance by attending scheduled doctor’s visits.

“As we begin a new year, we all want a fresh start, especially 14 Health Guide 2021

now, and getting focused on our health is a great way to improve our well-being,” said Braman. Throughout the pandemic, said Braman, people would stop going to regularly scheduled doctor’s appointments due to a fear of exposure. This, she said, led to a lapse in the community taking advantage of available preventative services and screenings.

“What we have seen during this time is a lot of people are coming to us a lot sicker than they normally would have,” said Braman. “There are a number of ways – if we can have the opportunity as providers to see you early on then we have a lot better chance of curing things and getting rid of them before they become a problem,” she said, explaining that the sooner they can see patients, the sooner they can detect and treat their health conditions.

“We really encourage people to continue to do their maintenance, continue to keep up to date on visiting their doctor. We have options where people can do tele-health options if they don’t feel comfortable coming in, but I will also say to come into the doctor’s office I really feel is one of the safest places you can come, because we are practicing all of the precautions there so it’s one of your safest places to come in right now,” said Braman.

According to Braman, it is important to know if you have high blood pressure, cholesterol or glucose levels that need to be addressed before establishing a new exercise program or diet plan. These levels can be determined through a simple blood test, she said. While visiting a healthcare provider, she said, the provider may ask a series of questions about the patient’s overall health, such as what their quality of sleep is like, if they have any joint or muscle pain, or if they need specific vaccinations such as the COVID-19 and Flu vaccines. Braman said it is best for patients to take the opportunity during the appointment to discuss any health concerns and challenges including how to quit smoking, how to curb sugar intake, how to lose weight, or how to strengthen bones. One of the best things you can do to improve your health is to establish a relationship and good communication with your healthcare provider, said Braman.

“Often people think they only need to talk to their healthcare provider when they are sick, or when there’s something wrong,” said Braman. She continued, “Wellness is about preventing health problems before they occur through age-related health

screenings, vaccines and establishing a healthy lifestyle through diet and exercise.”

Having a balanced diet and sleep schedule, she said, play a large role in mental and physical health, as well as being physically active each day and maintaining a connection socially.

“It can make a real difference even if we don’t have to be some place at a scheduled time every day to maintain a routine, maintain a schedule. Those things are very important for our mental and psychological health. Sleep, getting at least eight hours a day and doing it on a consistent schedule, those things are really important. Sleep is so critically important for your mental state of mind,” said Braman. “Physical activity is another thing that is really important,” she said, explaining that just walking daily would be beneficial.

“Healthy food choices, that’s a big deal in our communities as well,” she said. “There are ways you can make healthier choices with fast food,” said Braman, adding that people just need to Continued on page 16

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put in the conscious effort and take small steps towards their Although the vaccine is available and is being distributed, goals. Some ways to do this, she said, are as simple as counting Braman said there are many people choosing not to get the vaccine calories, not ordering a super-size, and finding healthier alterna- because of fears or concerns. “I know a lot of people have some tive items to replace certain foods with. fears associated with it,” said Braman.

Braman said during the pandemic, it has been important to “In terms of long-term potential risks with the virus, the first find a way to connect to people even virtually, because humans honest answer is we don’t have all those answers for long-term are social beings and need interaction. Without the connection because this was developed within a year,” said Braman. “The scito others, she said, it is easy for some people to develop depres- ence they used has been in development for a long time, but a vacsion and other conditions. “I just know so many people are not cine has never been made this way so we can, through understandensuring that they stay connected,” said Braman. “This is hard, ing the science, know that there is minimal risk, but people are isolation is just really difficult. absolutely correct – we don’t know Depression and isolation at a for sure that there are no long-term time like this is really tough,” risks. Personally, I balance that she said. Utilizing Zoom and with knowing the current risks of social media, attending curbside COVID, with knowing the current events, and finding hobbies you risks for people who are elderly, for enjoy are all good ways to stay people who have co-morbid condiconnected, she said. If anyone tions,” Braman said. feels hopeless, said Braman,

“I haven’t seen my moththey should reach out to crisis er for a year because of COVID lines if necessary. and I don’t want to risk bringing In addition to maintaining COVID in on her. I saw her last a balanced diet, sleep schedule, Christmas (2019) and I’ve not exercise routine, and attending seen her since,” said Braman. regularly scheduled doctor’s ap“Those are the things I balance. pointments, Braman said getting I know right now that I could get the COVID-19 vaccine and consick and if I don’t get symptoms I tinuing to practice COVID-19 could pass them on to other peosafety guidelines such as wearple, I could hurt others, I could ing a mask, social distancing end up in a long-term situation from others, and frequently and that’s happening all around washing hands will be a vital us,” she said. She continued, statrole in being healthy in 2021. ing that to her, seeing the loss suf “In Appalachia, we unforfered throughout the pandemic has tunately reach almost number shown her the risks of not being one, two, or three on some of vaccinated. the most unhealthy categories

“I think most of us have in terms of colon cancer, lung now if not lost someone close to Maria Braman, MD, Chief Medical Officer Hazard ARH disease and lung cancer, obesity us, have lost someone we know to and diabetes. We really have a large population of people who COVID and it is real. It’s real now. I’m not willing personally to struggle with a lot of those co-morbidities and conditions, and wait five years because I don’t know that I’ll be here if I don’t get with COVID especially, they can make our folks at higher risk for the vaccine. For me, that risk is worth taking the vaccine now to developing either severe symptoms with COVID and symptoms try and save not only our local community, but our whole world that last for a long time or death,” said Braman.

“It’s especial- (which) has been put on pause, the whole globe,” said Braman. ly important in our communities that people take this opportunity “There may be some risks that we’re not aware of, we don’t to get the vaccine,” she said. know what those are, but we know what our current risks are and

Vaccinating a majority of the population, said Braman, will they’re scary.” achieve herd immunity, and will slow the spread of the virus, Braman said until a majority of the population is vaccinated, better protecting the community. healthcare officials will recommend that people still wear masks “You get to a point in the population where about 80 to in public, practice social distancing, wash hands frequently, avoid 85 percent of people are immune to the virus and that prevents mass gatherings, and follow other safety guidelines and precauspread, so that prevents people from getting sick and allows us to tions in relation to COVID-19. “We’re not in a position to be anyopen up and get back to life the way we knew it,” said Braman. where close to herd immunity, so that means COVID is still here “There are a couple ways you can get herd immunity. One, you and it’s present and it can spread,” said Braman. “We’re still going can wait for everyone to get the virus, but that takes time and we to have to mask, we’re still going to keep all those things in place lose lives. We’ve been losing lives, so that’s obviously not the until we can somehow convince other people to get vaccinated,” ideal way to do it,” she said. she said.

“The other way you can achieve herd immunity is with a vac- If anyone is looking for a healthcare provider or wanting to cination. We now have a vaccine for COVID-19,” Braman said. schedule a wellness appointment, they may visit www.arh.org and Braman said in the first two weeks that ARH had the vaccine they click on “find care” or call their local ARH hospital. To schedule an delivered more than 3,000 doses in their service area. “I’m excited appointment for COVID-19 vaccinations at ARH, call 1-855-274that we’re able to start getting people vaccinated,” she said.

2273 or visit www.ARHcovid19.com.

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COVID-19 has had far-reaching effects on patient treatment, medical community The stress on health care across the nation is showing the need for more rural hospitals.

S TO RY B Y T E R RY L . MAY

The COVID-19 pandemic has changed many things and has affected our daily lives from the way we work to how we shop and socialize. But there is another aspect of our lives that has been reshaped because of the pandemic. Like everything else, the changes in this aspect have both positive benefits along with its drawbacks.

According to Dr. Donovan “Dino” Beckett, physician and CEO of the Williamson Health and Wellness Center, the healthcare industry has undergone dramatic changes since March 2020 both in the way in which treatment is delivered and in the way that health care is perceived.

“A lot of the personal contact is now gone. I’ve been here since 2003 and my patients are like my family,” Beckett said.

“We used to hug each other and shake hands. We had a closeness that is now gone because of the new protocols. My staff takes all the recommended precautions. We wear more equipment (masks, gowns, gloves, face shields) that we didn’t have to for an office 20 Health Guide 2021

visit before.”

He said face-to-face appointments are, oftentimes, being replaced with telehealth conferences thereby reducing personal contact even more. However, Beckett said that being able to have the telehealth sessions provided a way for many patients to keep a continuity in their routine healthcare needs.

“Fourteen months ago, most people were not interested in telehealth. Now, patients are requesting telehealth conferences now because of the convenience,” Beckett said. “We do lose some of the interpersonal cues during a telehealth call that we would normally pick up with an office visit. But, we are also able to gain a lot of valuable input from family members we would not get normally.”

Beckett said despite the new COVID-19 vaccine that began rolling out in December, he believes there will be a litany of long-lasting effects caused by the dramatic lifestyles changes of the past year.

“

Because local hospitals are closing all over the country, patients are being admitted to larger hospitals (of which there are fewer).

Resources at these larger hospitals are being stretched treating patients that previously would have been sent to a smaller local hospital. This is especially crucial now because those hospitals are needed, more than ever, to be available for the higher number of critical patients caused by the pandemic. ~Dr. Donovan “Dino” Beckett, CEO of the Williamson Health and Wellness Center

Above: Photo by Terry L. May Dr. Donovan “Dino” Beckett said the COVID-19 pandemic has brought many changes to the healthcare industry. One of the most notable is the decrease in personal aspects of treating patients.

No longer are hugs, handshakes and other endearments allowed.

Here, Dr. Beckett wears a face mask as he sees a patient.

Opposite page: Photo by Bruce Justice Drive-through COVID-19 testing sites were used extensively during the summer and fall months of 2020. Dr. Donovan “Dino” Beckett said the Williamson Health and Wellness Center was the first in Mingo County to offer widespread drive-through testing.

“COVID has created fear and has forced people to remain in their homes and stay away from other people,” Beckett said.

“This isolation can lead to depression and stress which can create mental and behavioral health needs. I think we are going to learn that things like isolation and the devastation of our economy will have domino effects on emotional people’s wellbeing.”

Beckett said, on the other hand, the COVID-19 pandemic has created a national stage that allows lawmakers, funding sources and the general public to understand the need for rural healthcare across America.

“Our medical systems were overwhelmed when the pandemic hit,” Beckett said. “We found we had lots to learn when it comes to delivering quality medical treatments to the community and still maintain best practices.”

One of the biggest concerns the pandemic has brought to light is the need of more rural hospitals.

“Because local hospitals are closing all over the country, patients are being admitted to larger hospitals (of which there are fewer). Resources at these larger hospitals are being stretched treating patients that previously would have been sent to a smaller local hospital,” Beckett said. “This is especially crucial now because those hospitals are needed, more than ever, to be available for the higher number of critical patients caused by the pandemic.

“The stress on health care across the nation is showing the need for more rural hospitals,” he continued. “Cuts in funding for rural hospitals are now being seen with a new awareness. Hopefully, that message is clear.”

Beckett said he also thinks the pandemic is causing the medical profession to once again be a close-knit community.

“We used to have a strong medical society here in Mingo County, but that has kind of gone away,” he said. “The lines of communications are now being reopened between providers, hospitals, the health department and local pharmacies. We are all working together to fill a void. There is a unison.”

Beckett said because of state and federal guidelines, the county health department was limited in the beginning of the pandemic as to whom could be tested. However, as a private entity, the Williamson Health and Wellness Center was able to be the first drive-through testing site in Mingo County. As the protocols changed, the two groups conducted clinics in which they worked in tandem with each other.

Another example of unity Beckett cited is the distribution of COVID-19 vaccines. The Mingo County Health Department, the Williamson Health and Wellness Center, Logan-Mingo Mental Health and Hurley Drug are conducting joint vaccination clinics and assisting each other.

“Like any other virus, COVID will not disappear even with the vaccines,” Beckett said. “I think Mingo County and Eastern Kentucky have been hit really hard, and while COVID hasn’t relented, we may now be on the back end of it just because of a natural decline. However, it will continue to have spikes, but it will be better controlled with the vaccine. We now have hope that maybe we have turned the corner.

“COVID has changed the world and has had a cascading effect,” Beckett continued. “There are only few moments in time that has had this type of impact.”

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Health Guide

PMC at the Forefront:

Working to meet the challenge of COVID, Pikeville Medical Center also focused on the future of healthcare in the region

S TO RY B Y R U S S C A S S A D Y

Like most businesses and organizations in the region and beyond, COVID-19 has resulted in big changes and big challenges for Pikeville Medical Center.

However, according to hospital CEO and Vice President Donovan Blackburn, the hospital’s planning and actions both before and during the pandemic have laid not only a foundation for the hospital to be at the forefront of treating and fighting against COVID-19, but also for a future in which more and better quality services will be offered to people in the region closer to home for years to come.

Blackburn said that PMC was on a good track when COVID-19 first surfaced, then made a massive impact on the hospital’s bottom line, forcing it to close elective services throughout April and May. “Back in March, when we saw that COVID was starting to make its way through the U.S., we looked at our initial projections for April and realized what was getting ready to happen,” he said.

Blackburn said that, without the knowledge that a stimulus package, ultimately approved as the CARES Act, was coming, the hospital had to come to grips with the reality that it was going to have to shut down elective procedures — where the hospital makes its money — for a time.

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Blackburn said that it was the right thing to do at the time to protect the hospital’s patients, but it did have an impact on Pikeville Medical Center’s bottom line.

“When we looked at our projections, we had the possibility of losing multiple, multiple millions of dollars, not in a year, but in a month,” he said. “And, actually, that came to fruition.”

Despite questions about whether the hospital should continue with expansion projects during the pandemic, Blackburn said those programs are important to the region.

“The answer was really simple for me, it was because this was not going to last long-term,” he said, adding that there would ultimately be a pent-up demand for services after the shutdown. And, he said, with the approval of the CARES Act, and the reopening of elective services in June, staying the course was proven the right thing to do.

“We had our busiest June and July that we’ve ever had,” he said. “Our clinic business was up 25 percent because people were putting procedures off that were needed and that was dangerous.”

Blackburn said that aspect has led to a “lesson learned” scenario for the state and federal leaders, who are unlikely to insti-

tute another similar shutdown of hospital services because of the impacts it had on people’s health.

“We realized we can’t put others at jeopardy by protecting a segment of the population,” he said.

Blackburn said many services on which the hospital was working were able to be adapted and put in place quickly due to the groundwork already done.

An example he cited is telehealth services. PMC, he said, was already working on instituting a telehealth program with the Pike County Schools District, but the hospital was able to quickly pivot and put that out even more widespread, and was even able to institute aspects such as providing locations at which people without internet access could use the services.

He also pointed to the 24-hour drivethrough pharmacy and drive-through laboratory services, which have provided both safety and convenience for the public and staff during the course of the pandemic.

The drive-through lab services, he said, will continue even past the COVID epidemic.

“The public has really liked that service,” he said.

All that, he said, was in addition to the hospital instituted a number of policies and

Photo submitted Above: A staff member works with a child during a developmental exercise at the Appalachian Valley Autism Center. The AVA Center is the region’s leading facility to care for autistic children.

Opposite page: Orthopedic surgeon Dr. Kevin Pugh is shown in the operating room wearing person protection equipment. procedures to protect staff and the public and also to deal with the virus. Blackburn pointed to the opening of COVID-ready wards which proved to be the correct thing to do, taking into consideration the number of COVID cases the hospital ended up treating.

“Three different times we’ve used our surge plan to increase,” he said. “A surge a month ago, we had 85 patients total. Actually, at that time, it was more than any other hospital in the state of Kentucky.”

But, he said, the policies and procedures are working.

“So far, as of last week, we did not have one employee contract COVID who was working the COVID unit,” he said.

Acting quickly, instead of waiting and reacting, he said, provided the basis for the hospital to deal with the virus.

“We went urgent speed,” he said.

“We’ve been at the forefront … simply because we’ve been the aggressor. Instead of waiting for things to happen, we’ve been making suggestions.”

The hospital’s expansions, both those in progress and those announced during

2020, haven’t just focused on direct patient care. Blackburn pointed to the creation of a learning center at the former Summit Building which will allow the hospital to help in the training of new nurses and other specialized personnel.

“Big Sandy is expected to bring their first nursing cohort in by the end of January,” he said. “The first group will have about 35 students in it.”

Blackburn said the University of Pikeville’s nursing program has also expanded from 35 when he first began at the hospital to 90 students.

“Instead of hiring agency nurses … why not build a program here where we can put Eastern Kentucky people to work,” he said. “We’ll educate them here and they’ll stay here and take care of their friends and neighbors.”

Blackburn said the hospital is currently hiring approximately 95 percent of the students who graduate from the UPike nursing program. Those not hired, he said, are typically going outside the area.

The Pikeville Medical Center Heart Institute just completed a $35 million ex-

pansion, announced during the pandemic the continuation of the Drs. R.V. and Jyothi Mettu Children’s Hospital and opened the Appalachian Valley Autism Center, as well as received a grant to expand the hospital’s cancer center.

The AVA Center, which is named after Blackburn’s granddaughter, Ava, is already expanding and changing lives, he said.

“We’re working without about four different institutions to develop a Board Certified Behavioral Analyst program,” he said, which is a position needed in the AVA Center.

Blackburn said that for every BCBA the hospital adds, it can bring in another 10 to 12 “learners” — students — which also means the hospital will be able to bring on another 10 to 12 Registered Behavior Technicians.

“The goal is, within the next 18 months, to be up to about 100 learners,” he said. “If you look at the statistics in the area, right now the CDC says one out of 54 people is on the autism spectrum.”

More importantly than just offering a service or line of business, according to Blackburn, is that he and other officials with the hospital are hearing success stories from families in the community, including some families who are hearing their children speak for the first time. All of these things, he said, have led to the hospital being able to not only survive the pandemic, but also to thrive.

“We’re still a very stable hospital,” he said. “We’ve been actually been able to hire during the time of this pandemic due to not outsourcing to other countries and building those job bases here.”

The point of the growth is that there are multiple layers of benefit for the community. Not only does the targeted expansion of services provide more local jobs and more financial stability for the hospital, but the growth, he said, ensures that families and individuals throughout the region are able to receive a level of care that formerly required travel for hours.

“They’re not traveling at the point of their lives when they should be able to remain home,” he said.

And, he said, the job creation is not just impacting Pike County, but surrounding communities, as well.

“I’ve got 450 employees who live in Floyd County,” he said. “This isn’t just about Pike County.” And that growth and expansion is something that will continue into the future. “We’re providing better healthcare and we’re doing it at home and creating jobs,” he said.

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Health Guide

Skin Cancer Detection

Local nurse practitioner/dermatology specialist warns against ignoring skin health at anytime

STORY BY BRUCE J USTI CE

Healthcare professionals in all medical disciplines would likely agree that it is normal and even understandable for people these days to be focusing most of their attention on COVID-19.

However, these otherwise diversely specialized medical professionals are just as likely to agree that too much focus on even this persistent and often deadly illness can easily lead one blindly down a path just as hazardous and often just as deadly.

Thomas Hagerman is a nurse practitioner with Dermatology Associates and Surgery Center who specializes in dermatology. DASC is a physician owned dermatology practice with offices in eight West Virginia communities. He divides his time between the center’s Williamson and Logan offices.

As far as Hagerman is concerned, even during a pandemic there likely is no other area in medicine on which people tend to focus less, but towards which at all times should be directing far more of their attention, than dermatology.

“Generally, people tend to look at a spot or sore on their face or some other area of their body and dismiss it as being nothing, something that will eventually heal on its own and go away,” he said.

“But many, many times these spots and sores are some form of skin cancer, and some skin cancers are just as deadly as any other type of illness people can get. That’s why it is so important that we not get so caught up in COVID that we neglect what might be other serious medical issues. ”

Hagerman said the three typical types of skin cancer are basal cell, squamous cell, and melanoma, the latter being the most serious and having the highest mortality rate.

While squamous cell is very serious, and while basal cell can be serious if it becomes ulcerated, Hagerman said melanoma can and often does spread very rapidly to other parts of the body if it’s not detected early and successfully treated.

“If you can catch these cancers early 26 Health Guide 2021

Photo by Bruce Justice Though not as common among young children as they are adults, nurse practitioner and dermatology specialist Thomas Hagerman says children are not immune to skin

cancers and periodically should be examined for them while they’re small they can be removed and they usually don’t come back,” he said. “That’s why, regardless of what type of skin cancer it is, it needs to be caught and taken care of in its early stages.”

Hagerman said a relatively new cancer removal procedure being used more and more by dermatologists — one that is now commonly used at all DASC offices — is Mohs Microsurgery.

“Mohs Microsurgery is a tissue-sparing procedure where you go in and cut out the cancer,” he said. “It’s considered the gold standard in cancer removal surgery and typically has about a 99 percent cure rate.

“Sometimes the growth is deeper than it appears on the surface and more tissue has to be removed, but it is still the best and most effective and less invasive procedure going.”

Aside from cancers, Hagerman explained, there are other, typically even less regarded skin issues that indirectly can also lead to more serious health problems and eventual death.

One of these, psoriasis, is an issue for a great number of people that can increase the chances of an early death.

“Psoriasis is obviously very problematic for people who have the condition, and while it is problematic it’s not usual-

ly thought of as being life-threatening,” he said. “But the reality is it can lead to psoriatic arthritis, which can lead to other health problems, and can actually put a patient at a higher risk of developing more serious conditions like cancer. People who have psoriasis are more likely to die at a similar age as someone else who doesn’t have it.”

Hagerman said other skin issues people tend to neglect during normal times — far more during serious public health crises like COVID-19 — but also shouldn’t ignore are things like common eczema, acne, and other skin rashes predominantly experienced by children.

“The thing everyone needs to understand is the skin is one of our main protectors and when it’s compromised our entire immune system is compromised,” he said.

Hagerman said there are simple precautionary measures people can take to help mitigate serious skin problems.

“Anything that itches, burns, bleeds for no reason, won’t heal, or changes in any way, don’t ignore or neglect it,” he said. “Of course you have to follow all the recommended COVID measures and precautions, but you need to get it checked out right away because it’s your body’s way of telling you something is wrong and needs to be corrected.”

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Health Guide

6 tips for controlling your high blood pressure High blood pressure is called a silent killer, as it frequently shows no signs or symptoms. Uncontrolled high blood pressure puts people at higher risk for heart disease and stroke, which are leading causes of death in the U.S.

High blood pressure (hypertension) is a major risk factor for heart disease and stroke. According to the Centers for Disease Control and Prevention (CDC) and “The Surgeon General’s Call to Action to Control Hypertension,” nearly half of U.S. adults have high blood pressure, yet only 1 in 4 has their hypertension under control.

Who is at risk? The likelihood of suffering from high blood pressure increases with age, but all adults are at risk. African Americans are more likely than White Americans to have high blood pressure, develop it when younger, and have worse outcomes.

The good news? It is possible to control high blood pressure and reduce your risk of heart attack, stroke and other conditions.

“High blood pressure is dangerous, and unfortunately all too common,” said Janet Wright, M.D., acting director, Division for Heart Disease and Stroke Prevention at CDC. “Regularly checking your blood pressure and working with your healthcare team are vital first steps to help keep your high blood pressure under control.”

In honor of American Heart Month, here are tips for achieving lower blood pressure and supporting your heart health.

1. Get your checkups

If you’ve put off regular wellness exams, take time to catch up. Talk to your healthcare provider about hypertension, especially if you’ve had high blood pressure readings, high blood pressure associated with a pregnancy or family history of hypertension.

For checkups, use telemedicine if available, or communicate with your provider by phone or email.

If you must visit in-person, protect yourself and others.

* Before making an appointment, call your healthcare provider or check their website to see what measures they are taking to keep people safe during the COVID-19 pandemic. * Cover your mouth and nose with a mask when you must go out in public. * Do not touch your eyes, nose or mouth. * Stay at least six feet away from others. * Wash your hands with soap and water for at least 20 seconds when you get home.

2. Know your numbers

At your next checkup, ask your healthcare provider what your blood pressure numbers are, what they mean, and if you are at risk. If your blood pressure is high or borderline high, ask what actions can help lower your blood pres-

sure.

You can also ask your provider about using a home blood pressure monitor. Learn how to obtain one and use it. Ask your provider about electronic health record portals or other ways to track your numbers and how you can receive clinical advice to manage your hypertension.

3. Take medications as prescribed

Medications are often an important part of blood pressure control plans.

Follow your provider’s instructions carefully. If you experience problems getting or taking your medicines, talk with your healthcare team.

4. Make positive lifestyle changes

While medications may be prescribed to help control your high blood pressure, these lifestyle changes may also help: Continuned on page 30 Health Guide 2021 29

* Boost your physical activity - Start small, like adding a daily walk * Eat a heart-healthy diet - Include more vegetables, fruits and whole grains * Watch your salt intake - Read food labels and choose foods with less sodium (salt) 5. Reduce your stress Taking care of yourself is always important, especially during challenging times. Stress can contribute to health conditions like high blood pressure, heart disease, diabetes and other illnesses. How can you reduce your stress levels for better health? * Be aware of stress. Do you have headaches, muscle tension or other symptoms? Observing what causes you stress and how your body responds is the first step. * Move more. Physical activity can help reduce stress, whether intense exercise

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or a walk around the block.

* Lung and other cancers

* Try relaxation tools. Whether deep breathing, meditation or yoga - relaxation tools can help you let go of stress.

Find what works for you!

Ask your healthcare provider for support for quitting smoking.

* Talk to someone. Call a friend or

Visit CDC.gov/heartmonth for health tips, blood pressure logs and more.

mental health professional. Talking out a problem can help to reduce your tension.

6. Quit smoking

If you smoke, now is the perfect time to quit. According to the CDC, smoking increases your risk of: * High blood pressure * Heart disease * Heart attack * Stroke * COPD

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Health Guide

Resolve to manage your weight in 2021 Tips for following through with your weight loss goals. Small changes are key.

When you considered New Year’s resolutions this year, were getting healthier and more fit on your list? According to Statista, exercising and eating healthier are the top two resolutions for 2021. It’s not surprising that more people than ever are focused on their health and well-being, as a recent study published by the CDC found that about 74% of Americans are overweight.

The hard part is following through.

While many set lofty goals, it’s hard to keep the motivation past the first few months. The key is setting up small changes that are easy to keep going, plus using the latest medical tools at your disposal.

Losing weight is more like a marathon than a sprint. Having patience and reaffirming your reasons for setting these goals can help you go the distance.

Get support Weight-loss support can come from friends on a similar journey, your healthcare provider, a support group or online fitness and nutrition trackers. A personal support group can encourage you on down days and celebrate your wins.

ReShapeCare™ is a practical and easy-to-use virtual program to help achieve a healthy weight by changing your behavior, and is typically covered by insurance.

Be clear about your goals

Figure out what healthy goal you are trying to achieve. Talk to your doctor, or use a tool like the Body Mass Index (BMI) scale to help determine a healthy weight range for you. List your reasons for achieving this goal and post somewhere you can see every day as a reminder.

Start small - but keep going Habits are easier to establish if you start small but remain consistent. So even if you take a short walk, try to do it at the same time every day. Don’t use weather as an excuse - walk around your house or up and down your stairs if you can’t get outside. Walk a little more each week, then add other exercises like hand weights, cycling or yoga - whatever you enjoy.

The CDC offers tips about healthy 32 Health Guide 2021

eating and starting a fitness program. Always consult your healthcare provider before beginning an exercise program, especially if you have been inactive.

Think portion sizes

When you’re trying to lose weight, the hardest part is controlling your food intake. You probably already know you should eat more fruits and vegetables, along with lean proteins and whole grains, but portions also matter. Try serving meals on smaller plates to be more aware of how much you’re eating.

Consider weight-loss surgery

If you have a BMI of 30 of higher, the Lap-Band Adjustable Gastric Banding System can be a powerful tool to help you take control over your weight. The system features an adjustable gastric band placed around your upper stomach to help limit your food intake and promote your feeling of fullness. It can be tightened or loosened as your body or physical needs change over time, helping to provide sustainable weight loss over the long term. With regular adjustments that help you continue losing weight, Lap-Band is a long-term tool that gives you more power over your hunger and more control over your weight loss than ever before.

The Lap-Band gives you control over

your body too, because it is the least invasive and safest weight-loss surgery available. Unlike other more drastic weight loss surgeries, with the Lap-Band procedure you can continue to eat the healthy foods you love while maintaining portion control. The procedure also has the lowest risk for vitamin or mineral deficiencies. It is typically performed in under an hour, and you can usually return home the same day. If for any reason your Lap-Band needs to be removed, it is easily reversible.

Lap-Band is the only FDA-approved, laparoscopic weight-loss device for people with a BMI of 30 or higher that’s commercially available in the U.S. The procedure has been performed over 1,000,000 times since 1993 worldwide. It’s covered by most insurance companies, and is being backed by over 25 years of clinical evidence.

The Lap-Band program also includes customized counseling, coaching and nutritional education to help support the lifestyle changes you need to keep your weight off over time. Visit www.lapband. com to learn more.

Resolving to get control of your weight now is one of the best gifts you can give yourself. Let 2021 be the year you take important steps toward boosting your health and well-being.

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