(upbeat music) - Welcome back to Family Health Matters, I'm Shelley Irwin.

With me today are those guests, Dr. Phil Henderson, Primary Care at Division Chief at Spectrum Health, Jean Holthaus, Telehealth Clinic Manager, and Southwest Regional Director at Pine Rest Christian Mental Health Services and Adam Diver, Physical Therapist at Mary Free Bed Rehabilitation Hospital.

Appreciate you and the good work that you all do in this healthcare field, couldn't do it without you.

I always begin with the basics.

Jean, remind us of your good work at Pine Rest.

- Yeah, I'm a clinician there and I also oversee the telehealth clinic, which is a group of clinicians that only do telehealth work.

And I also oversee a number of the other clinics as well.

So enjoy getting to do a variety of roles.

- Thank you.

Dr. Henderson, what is your niche please?

- I've been with Spectrum Health for over 25 years working in both pediatrics and internal medicine.

Really, I do a lot of administrative work now with the primary care department and really glad to share what we're doing with the long haulers.

- All right, Adam, would you please brag about physical therapy please?

- Absolutely, as you stated, I'm a physical therapist at Mary Free Bed right here on our Outpatient Main Campus.

I'm one team member amongst an awesome comprehensive team of PTs, OTs, speech, nutritionist, social workers, nursing, the whole shebang, so pretty privileged to be here.

- Thank you, knowing you all have made your way through these last two years and we are still here talking specifically on the topic of post-acute COVID-19 syndrome, or of course in layman's term long COVID.

Let me have you set up our conversation, Dr. Henderson.

What is this long-term COVID?

- I don't know if there is a pure definition for long-term COVID long haulers.

It really is all of the symptoms that seem to have come up in a patient that occurred after having COVID-19 infection.

And they are very diffused, as probably all of our speakers are gonna be able to talk about today.

Many of them are life altering that we are really trying to help our patients through.

- Yes, and of course we're all in agreement that we're all still learning and dealing with this day by day.

Is there someone specifically at risk, I'll stay with you, Dr. Henderson for this well, long haul.

- That's some of the information we're still trying to gather.

As we see these patients in our clinic, we're trying to gather basic information to see why did a husband develop a long haul symptom when his wife had the same infection, same virus and did not.

So there's a lot to learn that we are still trying to gather that information on.

We get bits and pieces of information and we read about it every day, but we have to be very careful about some of these studies with very small end size.

So we really want to be able to share our information with others and learn from each other.

- Jean, bringing you into the conversation, now half a step back, obviously we'll zone in on the mental health in these times.

First of all, have you seen an increase in patient care needed in the last two years?

And where are we moving forward?

- Definitely seen an increase in both anxiety and depression, especially anxiety.

Anytime we're facing an external threat, our bodies move into fight, flight, freeze.

And so we've been living in that place for the last two years on some level.

And when you live in that place for long-term, it begins to affect the chemicals in your brain and it begins to affect your processing.

And so we've seen a lot of increase in need for services and people just dealing with anxiety and then dealing with the effects of having gotten COVID as well.

- What would be a sign or symptom, Jean that I would need to reach out for help?

- Sure, we talk about the difference between that normal anxiety that exists within a normal realm and when it gets outside of bounds, whether it's anxiety or depression.

And when we look at that we're looking at the impact upon your life.

If your symptoms are beginning to create a problem for you in functioning, they're interfering with your ability to live your life as you normally would, that's that place where you wanna reach out for help.

And I always tell people as sooner is better than later.

It's like if you hear that little clink in your car and you ignore it, by the time it's dead by the side of the road, it's gonna take a lot of work to take care of it there.

So if you can catch it when it's beginning to first create a problem in your world, and a lot of times people procrastinate and put off getting help, oh, it's not that bad, oh, it's not that bad and by the time they come in it's pretty significant in their world.

- Thank you for that.

We'll get back to again, that course of care and the caregiver as well.

Adam, take me to the world of physical therapy.

What are you seeing when it comes to long haulers?

- From the recent rehab side of things, we still have patients coming in with a lot of fatigue, weakness, occasionally shortness of breath, the rapid heart rates, even some dizziness.

COVID has been shown to cause some vestibular disorders or issues of the inner ear, from the cognitive side the brain fog, issues with speed of processing or word finding.

And as Jean discussed, the mental and emotional distress along with it.

So yeah, with Mary Free Bed we're addressing quite a few of those issues as well.

- What is your answer to the marathoner that comes in and says, I'm out of breath at mile two as perhaps a long hauler?

- Yeah, yeah, if you're a long hauler and you're able to train for marathon, I'd say you're doing pretty well.

But yeah, the shortness of breath, that's still an ongoing issue with COVID.

So we are working on the conditioning aspect of rehab certainly.

- Yes, Dr. Henderson, one of the symptoms for one who may be experiencing long haul symptoms is brain fog.

Can you spend some time here?

Why this brain fog?

- Brain fog is probably one of the more common one that we hear, but it's interpreted differently by different patients.

I've seen people who literally stop talking because they can't find the next word to say.

We're finding people who actually can't concentrate the way they used to.

I had a person the other day in the office who couldn't read anymore, the words didn't make sense to them.

And some of these are public speakers.

They've been doing this their entire lives.

So it's really life altering.

A lot of it is people just can't do their daily tasks that's taking so much energy, mental energy to be able to get through their day, it's affecting their work life.

They're struggling to be able to keep up with work.

And you can imagine even people who have jobs and occupations, where they have to be precise and be quick, this is really altering the way they process, it is a brain processing issue with the way we speak, the way we read and one of the more complicated things is mathematics.

When people do math, they can't balance their checkbook.

They're having really difficult times.

So things that we take for granted the way our brain operates and our body is just a magnificent the way it's put together, this has really changed the way that they have to go about life.

- Yes, is there a treatment for this particular niche of symptom?

- We're still looking for the optimal treatment.

There is no pill out there that makes people better.

And we have to be careful of what people read on the internet, what they think is good treatments.

But right now we're trying to utilize the services of our occupational and physical therapy and our speech therapy to reconnect the processes in the brain so that they can retrain the brain on how it works.

And our colleague from Mary Free Bed can probably really help us a lot on this and they're probably right in the thick of it right now 'cause I know we are, as we refer people to these places and these facilities, but the healing is not quick.

And it's one of the things we have to caution our patients with is, this isn't something that you can go to a couple therapy sessions and make it better right away.

It takes a long time and a commitment to really help in the healing process.

- Thank you for that.

Yes, Adam, I'll get to you in a minute for treatment plans.

Back to you, Jean, as far as the toll it takes on the patient and on the caregiver.

What would be your line of treatment that one is requested for your services?

- Well, obviously we wanna treat anxiety and depression.

That might be a part of that and that may involve medication to help manage those symptoms.

But also looking at it's very much like any other long-term illness that you would have.

Anytime you're stressing the body over time, you have to deal with the physical aspect of it.

And then you also have to deal with the emotional aspect of it.

There's a grieving that has to happen because you had an image of how your life was, you were able to do all of those things and you did them fairly effortlessly and now it takes all the energy you've got to maybe do something and you can't, or there are things you can't do.

So you have to grieve that loss and then you have to accept this new world that you're living in that wasn't one you wanted.

So how do you make friends with it and how do you find purpose and meaning in the midst of that and for people that are taking care of that individual, also how do they find a new balance to their world and how do they grieve that they now have a partner that they're having to care for and they didn't think that that would be that way.

They're maybe in their 40s and they thought that that would be something that happened in their 70s and that's radically altered their world.

Maybe they've gone from a two income family to a one income family, so there's lots of grief, lots of working to accept and then lots of, okay, and now how find purpose and meaning and move forward?

Given what I don't know, 'cause there's a lot of unknowns in this.

We don't know how long will it take?

What does recovery look like?

- Yes, hence your treatments including some talk therapy, medication as able and certainly perhaps the use of therapy exercise and more.

Yes, let me bring you back in, Adam.

Can you expand perhaps on Dr. Henderson's point and a treatment plan that you may present, everyone's different obviously.

- Correct, yeah, it's really a case by case approach.

We try to individualize our plans to each person based on their impairments, their needs, their goals.

But from the PT side of things, Mary Free Bed does a pretty good job of splitting up tasks between disciplines.

So PT will address large extremity, strength, conditioning, any issues with transfers, moving from bed to chair, for example.

OT will address upper body strengthening, conditioning and activities of daily living.

And then as you said, speech language pathology will address more of a cognitive side of things, that brain fog.

And additional team members, like I said we have nutrition on staff, so any diet needs, we have social work, psychology services here as well.

And recreational therapy, so leisure time activities and hobbies, recreational type things.

So we really try to address things from all aspects of care.

- Yes, Dr. Henderson, are we seeing this long haul in children of late?

- We're learning how it affects children more and more.

I think the preponderance of the focus has been on adults because of the way it's changed them.

And they can really vocalize what they feel and see differently.

But we definitely see the effects in our adolescents, we see it in our children.

It's just harder I think for us to categorize it in our children than we do in adults.

And somebody's brain is still developing, it's more plastic, what is the changes in the brain fog in a child, it's hard to distinguish that but we have been seeing the changes and we hopefully will find that their brains are still plastic enough to adapt more than an adult.

But another it's another area that we are really learning a tremendous amount about and it's gonna take us time to figure that out.

- Yes, Jean, now mental health services in general, you use telehealth as one of your specialties.

Maybe that's a silver lining that's come from all this, the use that this can be perhaps, I mean, there's nothing like face-to-face, but tell me how telehealth is happening working.

- Sure, COVID actually caused all of us to have to figure out how to navigate virtual visits.

And we had a telehealth team prior to COVID, but when COVID started, we switched all of our therapists and all of our services to being able to be online.

And we tried to that as much as we can because there are people that are severely immunocompromised that can't get out and get services in other ways.

And there's a whole group of people that have learned that this works and it's more convenient for them, they don't have to find childcare in the same way.

And so we are still providing the majority of our outpatient services are still being provided via telehealth.

We have in person visits as well, but a lot of people have found that they can actually access their mental health services.

And it overcomes some of the stigma of driving to an office, parking and walking in and sitting in a waiting room.

It makes it feel more accessible to them.

- And how important Jean is it, I mean, are we to the point where support groups are needed, bringing in the whole family to discuss whether it's long haul or another mental health challenge?

- I think support groups that help families are always important.

We have them that operate for different sorts of illnesses because we know that it affects not just the person that we're treating that has the illness, but everyone else involved with that person as well.

And so it's a team effort and we wanna take care of that whole team whenever we can.

- Well, Jean, I know you need to head back to work as you all will shortly, but I'm going to excuse you with your contact information, what's your resource for us?

- Sure, anybody that wants more information about Pine Rest can go to pinerest.org and you can access all of our information and all the contact numbers there.

And there are lots of blogs that people can just read about different aspects of mental health as well.

- Thank you for this conversation with you, Jean, take care to you.

Adam, continuing with you and your niche of physical therapy.

Do you have a success story for us?

- Yeah, absolutely, we've had many great success stories with our patients.

It's hard to think of one case specific example, but we've had great stories of patients, returning to family events, returning to social events, returning to work, just having that regularity back in their lives and just being very, very happy with their outcomes with it.

So that's the great part about my job is that rewarding feeling of helping patients achieve goals.

- Yes, Dr. Henderson, where do we stand with vaccines in general when it comes to this topic?

- We've been tracking our long haul patients.

Those that have been vaccinated is not vaccinated.

We don't have the final data out, but it looks like it's really an even split.

The vaccines, people have gotten COVID, it hasn't necessarily prevented them from having long COVID.

So if they've had a bad case of COVID or any COVID, they're at risk for developing long COVID but vaccines are still our greatest way of preventing us from catching COVID.

So any way that we can prevent the infection will help prevent long COVID.

So vaccines are our way of preventing the infection.

So they do prevent long COVID.

- Anything else you can add Dr. Henderson on prevention as far as if one has been diagnosed with COVID-19 to not have it turn into a long haul?

I imagine you want us to take care of ourselves as best possible, get our sleep, eat as well as we can.

- I wish I could tell you what that answer is, but I don't think we know it right now.

- Okay, yes, back to again, exercise, how much to push, how much not to push either with an exercise plan or just in general, Adam.

- That is a great question.

And that's the fine line we try to flirt with as therapists is trying to progress someone through exercise without completely exhausting them.

So we're always monitoring heart rates, oxygen levels, rate exertion that a patient is perceiving.

So we try to find that moderate amount of intensity when we're working with patients.

When they leave therapy, it's not just them going back to bed or sitting on the couch for the remainder of the day.

We want patients to be active and try to resume normal life as best as possible.

- Yes, and we know that is a tough question, but of oftentimes there's homework, there's home exercise, there's obviously ways to continue your programming at home.

How important is that for that patient to do their exercises and do what a physical therapist says?

- Oh, that's the most important thing you can do.

I always give the example with patients that, if they're coming here two days a week, three days a week, that's only two to three hours of therapy or exercise per week.

So really the magic happens outside of therapy.

Our job is to try to educate and coach patients on what they need to do at home and to establish a more health lifestyle to make those gains.

- Dr. Henderson, again, talking to Jean about the mental side, but what's your recommendation when a patient is looking for hope and we don't have the answers yet?

- Well, one of the things we try to do is one, we develop a trusting relationship with the patients, so we really have a good rapport and understanding, but you need to be really honest and upfront with people.

I mean, you tell them the likelihood of where they're at and how we're gonna try to get them there.

But part of it is affirmation, is really letting the patients know we understand what they're going through.

They're not the only ones and many people they haven't heard that, they haven't talked to someone who's had other people go through this.

So just knowing that they're not the only ones has been very important for the patients to hear and understand, we're gonna be with them, we're gonna walk them through this process, we're not gonna leave them or abandon them.

It's gonna going to be a long process.

And we are gonna be using all of our disciplines in healthcare to help people through this.

It isn't where one person's gonna be able to do everything for them.

So we will be using our mental health colleagues, our physical therapy colleagues, our occupational, it is really a multidisciplinary approach to taking care of these people, all of these people with the long haul symptoms.

- Yes, and perhaps should have addressed this in the beginning, but with a couple minutes that I do have left Dr. Henderson, what would be a symptom that I am moving into a long haul COVID?

One perhaps has been diagnosed, symptoms are minimal, but coming back, how do I know that I need to come see you for long haul addressing?

- Any persistent symptoms from long haul is really long haul symptoms, it's really persisting more than four to six weeks.

It's everything from loss of taste or smell, significant fatigue, weakness, the brain fog, we talked about, worsening depression or anxiety, first touch base with their primary care provider, make sure that the people know what's going on and we can keep track of it.

I forgot to mention just shortness of breath and persistent coughing.

We're seeing a lot of shortness of breath in patients who've had COVID and we have ways to help them through it.

But when it comes down to it, it's their own body that really has to heal what's happened to them.

And we can help them on that journey and use all of our other tools that we have in our tool bag to help them.

But it is a journey, it isn't a short one, it's gonna take time.

- Just in summary, more of what therapy can do to assist with long haulers and somewhat of a repetition here.

- Sure, so every discipline is addressing different needs and goals really.

So our goal is to just restore quality of life, get people back to doing what they did prior to being diagnosed with COVID or sustaining COVID.

So our services offer, we too have support groups, so we try to address all aspects of care.

- Dr. Henderson are there triggers say, do we see elevation and depression perhaps with long haul?

Would there be something that I should stay away from to trigger perhaps an event?

- Great question, we're assuming a lot of this has to do with just the inflammation that occurs within the body with this infection.

So just trying to stay as healthy as possible as people are recuperating, really watching a balanced diet, getting the rest that they need.

But also when it comes to things with our mental health, we have seen a lot of people who have had underlying anxiety or depression really worsen tremendously with this long haul.

Part of it, these people look perfectly normal.

They don't look like there's something, a sore or a cut or something where you can say, I can see that there's a problem.

So they're dealing with a lot of these issues with other individuals that they they had COVID and they don't have their symptoms, what's wrong with you?

So it's really hard for people to express to other people.

They almost feel ashamed at times or they're trying to hide it and they can't.

We have to be talking about this and sharing it.

This is gonna affect a very large portion of our population.

And we need to be able to deal with it as a society, as how we adapt to this.

A lot of people have had this infection and we need everyone to be able to understand it and help us through it.

- Adam, can you follow up on that?

- This is gonna be around for a while.

So just having the knowledge base and knowing what resources are there will help patients.

So if you're questioning whether you should seek help, you probably should.

It's like Jean mentioned earlier, trying to address things early on will be more helpful.

That way you are seeking those needs from medical professionals that can help you in addressing some needs that may be forthcoming.

- Where do I get started, Adam, with your services?

- You can reach us at maryfreebed.com, our general line is 616-840-8000.

We do have some short informational videos for COVID, just little tidbits we call them.

So you can find those a maryfreebed.com/fits so those provide a lot of information on how to address things as well.

- Great, keep doing what you're doing so well when it comes to this topic and physical therapy.

Dr. Henderson, give me a closing comment.

This has been a tough conversation because we have answers, but where are we 10 years from now?

Where are we six months from now?

What do you leave us with?

And then a resource or two please.

- Well, that page isn't written yet, we're still writing a book on this.

We have a lot of information to gather and there's a lot of people gathering it.

So we have a lot of our resources in healthcare working on this.

Right now it's really how do we support the people that have these symptoms?

How do we use the talents and skills that we have today the best way that we can?

Part of it is acknowledging the people that have it and making sure that they understand that they do have something and that we're here to help them through this and with those concerns that they have.

Some people have almost felt embarrassed to talk about it at times, and we have to be able to acknowledge it that it's real.

And how do we help them along this long journey.

10 years from now, hopefully we're gonna look back at this and it's a blip in the radar, we don't know what it's gonna be.

Will we still be getting vaccines 10 years from now?

I would bet we will be getting COVID vaccines 10 years from now to help prevent further outbreaks.

More to learn on that, I think we're gonna learn better therapies for what people have today.

We're gonna hopefully find ways to help prevent some of the inflammation and hopefully on the bright side of things, we may learn to advance medicine because of what we've gone through.

We're gonna learn new technologies, we've sped up the speed of the way we do things in the last two years in healthcare tremendously.

So we're gonna be able see how new therapies can be produced faster and help more people.

So I look at the bright side of that part while we're still dealing with some of the after effects of COVID-19.

- Dr. Philip Henderson, how do we find out more about your services?

- Really at spectrumhealth.com.org, our website.

Our long haul clinic is still in its early stages.

We've only been doing it now for several months.

We're expanding rapidly to really help our community and those who are afflicted by this condition.

- Great, gentlemen, thank you and Jean with her services as well.

Adam Diver, Dr. Phil Henderson, thanks for this conversation.

- You're welcome.

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