Among the many restrictions in our daily lives resulting from the COVID-19 pandemic, there may be significant limitations in our access to medical services to which we have become accustomed. For persons without any acute or chronic health conditions, especially younger individuals, the restriction of services might not be apparent but, for those who may have such medical issues, these restrictions may affect their health.
We are aware of the limitations to our family physician visits for monitoring of chronic conditions such as hypertension, diabetes and heart disease. We have seen in the press the concerns which emergency room physicians have noted concerning the profound drop in the number of persons who should be seen early and have waited to seek attention, thereby risking their health and life. Some hospitals report an almost 50% drop in the number of visits. Patients with heart attacks, strokes, appendicitis and other serious conditions are often waiting for days before going to the emergency department for treatment. Patients are worried about their exposure to COVID-19 infection, but evidence shows that this risk is minimal as hospitals have been exceptionally successful in their prevention protocols. Operating rooms have been closed for many elective surgeries and access to diagnostic procedures has become limited in many cases. Even postponement of cancer surgeries has sometimes been necessary. Waiting times for hip surgeries and other elective cases are increasing.
For all of these well-recognized factors which may affect some of us, there are many ways to take charge of our health care more proactively. We are well aware of the health benefits of exercise, and walking for 30 minutes a day for seniors most days of the week (and when weather is suitable) has always been recommended for those who are able. Unfortunately, for snowbirds who may not be going south this winter, that won’t be as easy. With the sedentary life which many of us experience, our diet may have to be modified. With less activity, we will have to watch our calories and consumption of alcohol a little more closely.
The routine monitoring of certain chronic conditions performed by our health-care provider has been seriously impaired. As a result, we will have to take more responsibility in monitoring our conditions personally. Home self-monitoring of blood pressure has been recommended for years, but is not commonly practised. Doing this now is even more important than ever, inasmuch as monitoring in the doctor’s office has been curtailed and pharmacy machines for measuring blood pressure have been shut down for hygienic reasons. The American Heart Association and the American Medical Association have just released a joint major scientific analysis of self-measured BP monitoring and have concluded that it plays an important role in the detection and monitoring for proper treatment of hypertension. Among the risk factors for cardiovascular disease, hypertension is among the most important. In light of the limitations to regular office visits, those of us who have high blood pressure should be using a home monitor. Results can be saved on the machine or manually recorded and made available to your physician when routine visits are restored. Meanwhile, if unacceptable levels are found, urgent contact with your physician can be made.
One of the most recommended monitors is the Omron Wireless Upper Arm Blood Pressure Monitor. A good monitor should be priced at about $100 and should be a certified cuff. Consult your pharmacist. Wrist cuffs are more convenient, but the upper arm cuff is believed to be superior. Follow all of the recommendations for proper use of the monitor. If your pressures are commonly higher than 130/90 (or 120/80 if you are diabetic), consult your doctor by phone to see if medications have to be started or changed. Personally, my blood pressure readings are always normal on my home cuff and elevated when I visit my doctor, which convinces me that there is a white coat syndrome. I periodically take my cuff in to compare at the same time as the office recording is made.
Type 2 diabetes is another common chronic condition that requires regular monitoring, and accurate sugar levels can now be taken by the patient; consult the doctor by phone if advice is needed. Electronic blood sugar meters give an immediate result, allowing you to modify your diet or medication to achieve optimal results. For Type 1 diabetics or those with Type 2 using insulin, a device can be attached to the abdomen called a continuous glucose monitor, which constantly records sugar levels.
Patients with heart disease must be diligent in following medical advice and be certain to maintain their supply of needed drugs and not wait until they are out of medication before renewing. Any change in condition must be reported to the physician immediately and, if this is not achievable, a visit to the emergency room should occur. Any increased swelling of the legs or feet, any increased shortness of breath or any unexplained chest pain requires an immediate physician examination.
Another area of health care that could be compromised is the maintenance of appropriate immunizations. Currently, the most important one is influenza. In some provinces, regular vaccine as well as the more potent vaccine administered to persons over the age of 65 have been available, albeit with some interruptions, in pharmacies as well as public health clinics and doctors’ offices. All of us should be protected, especially during this pandemic.
Other vaccinations may not have been considered, but should not be forgotten. Since the vast majority of seniors had chicken pox as children, it is recommended that we all have our vaccination for shingles. This viral infection, which is associated with painful blisters, is more common in seniors and, in some cases, can result in a serious ongoing problem with pain that in some cases lasts for a lifetime. Shingrex, the vaccine, is more than 90% effective in preventing shingles in seniors and Health Canada recommends that we all receive this two-dose immunization after the age of 50, whether or not we know of a history of chicken pox.
Pneumovax, the ‘pneumonia vaccine’, is another immunization which is often forgotten. Strongly recommended for seniors, it is often one that is not discussed. Be sure to ask about this when doctor visits return to normal.
Since the pandemic, doctors in Canada are using the telephone, the computer and televised technology to communicate with patients more often, thereby being able to limit office visits to essential consultations only. Telemedicine has been in common use over the years, especially in more remote areas, but it is now being used extensively throughout Canada during the pandemic. In most provinces, doctors are compensated for their time using these modes of communication. Some doctors bill their respective provincial health insurance plan for these services, while many are paid on a capitation model, i.e. they are paid on a monthly basis for the individuals signed up with their practice. Some are on a mixture of these forms of payment and still others may be salaried. Whatever the method of payment, your doctor is compensated for all of these types of services and you should not hesitate if you need advice. For those who have had routine appointments for their chronic condition(s), virtual care has now become common and doctors’ offices will continue those needed visits by telephone or virtual encounters. Appointments will be given in the usual way and patients should write down any concerns or questions in advance, to review with the physician.
Skype, Zoom and e-mail have been utilized. Recently, my wife slipped on a step and peeled back a two-inch flap of skin on her shin. After three weeks of dressings, I was concerned that she might need a skin graft for a one-inch area that had not healed. After sending a picture of the wound by e-mail to our family doctor, he said that it was too small for a skin graft and to continue the dressings. As predicted, it was healed in eight weeks. My neighbour had a suspicious new spot on his forehead. I advised him to take a picture of it and e-mail it to his doctor to get advice. The doctor thought that it was not skin cancer, directed him to take another picture in one month and said that she would reassess the situation and advise further. You may not see your doctor in person, but do not hesitate to make contact when you are concerned with any issue.
Many of us have the need for routine laboratory testing for such things as cholesterol levels, blood-clotting times for those on anticoagulants, and kidney function tests, as well as followup chest X-rays, ECGs, mammography, colonoscopies and numerous other tests and examinations. Appointments for these may be overlooked when not seeing your doctor regularly. Be certain that you make inquiries about necessary followup tests that have been previously recommended and have your doctor’s office arrange necessary appointments. Most of these routine outpatient tests and procedures are being conducted as usual with appropriate protocols.
This year has exposed us to exceptional modifications in our daily lives. As seniors, we are at increased risk of serious illness from COVID-19 and must follow all of the recommended public health guidelines. This is especially important for those with chronic conditions such as heart disease, diabetes, lung disease and obesity. As well, our access to regular physician visits has been significantly jeopardized. All of this makes it important to take personal charge of our health issues and be certain that we not only follow all of the preventive measures being promoted, but also that we manage our health issues actively until life returns to normal. Now where is my mask? I’m going for a walk in the park with my wife.