(upbeat ambient music) - [Narrator] The region's premier medical information program, "Call the Doctor".

- [Female Narrator] The COVID-19 pandemic changed the way we lived and it produced a number of medical worries when it came to keeping the most vulnerable around us healthy and safe.

Unfortunately that may have exacerbated other issues that were already starting to pop, things like neck, back and eye strain from overusing screens, lack of proper dental care and a rise in substance abuse, we'll unpack some of those topics and explore the steps we need to take to start reversing some of the damage done now on Call the Doctor.

- Hello, and thank you so much for joining us for this episode of Call the Doctor.

I'm Julie Sidoni, I'm the News Director here at WVIA and I'll be the moderator for the series this season.

While the medical community was busy, and in so many cases, overwhelmingly busy, fighting the spread of COVID 19, there were other issues that health experts say were likely exacerbated by the pandemic.

We wanted explore a few of those issues here so we've gathered a panel of experts and really you're from all across the board here, which I find an interesting way to get into this.

Let's if you would just introduce yourself, tell people where they find you, who you are, what you do in a day's time, et cetera, go ahead with you Rosalyn.

- Hi, my name is Rosalyn Rowan.

I'm a physical therapist and I happen to be an outpatient administrator for Allied Services John Heins division.

We are involved in physical rehabilitation, physical therapy, occupational therapy, speech therapy for people with various different disabilities and disorders.

- Okay.

Dr. Yarnell.

- Okay.

I am Dr. Jennifer Yarnell and I am a clinical psychologist licensed in Pennsylvania, and I am in the Department of Psychiatry at Geisinger Medical Center in Danville, although Geisinger is all over the state of Pennsylvania.

So we have outpatient clinics.

That is where I am at in outpatient.

At the Medical Center, we have inpatient units, we're in primary care, we have substance abuse clinics.

So we treat every mental health disorder that seems to affect people in the state, so.

- All right, welcome.

- Thank you.

- We're glad to have you.

And Dr. McCarthy.

- Sure.

Hi, I'm Caitlin McCarthy.

I'm a general dentist with the Wright Center for Community Health.

I see patients of all ages and all procedures at our Scranton practice, but we also offer dental services at our Mid Valley practice as well.

And the Wright Center is, it's dedicated to providing affordable quality care to everybody, regardless of ability to pay.

- Well, I'm really glad you're all here.

Typically we do a panel and it's three experts from the same area.

So the reason we've gathered you is because we wanted to talk a little bit about what got worse essentially over those two years from the COVID-19 pandemic.

So I'm gonna start with you Rosalyn.

I'm interested in, because I'm watching, frankly everyone I know, my son's included.

They're constantly on screens, everybody's staring at their computers, it's the age of Zoom.

What kind of injuries or issues are you seeing right now when it comes to maybe neck and back strain?

- Well, postural issues are obviously at an increase.

We are spending more time sitting.

I myself have a 25 year old son who is no longer in the office, but is in a sitting room at screen.

So we do not, as we're in our, whether we are in our work, whether we are in the classroom, we're not gonna be paying attention to how we're sitting.

Do we have good posture?

Are we sitting in the right type of chair?

Do we change our position?

I mean, there are desks and things like that.

Now that do raise up, but most people don't have that.

So if you do have predisposition to musculoskeletal injuries in your neck, do you, if you have predisposition to back problems, they're gonna get worse.

I think beyond the school aged and beyond the middle aged people, we're also dealing with musculoskeletal injuries, or increase in the elderly, Their ability to get out to basically be mobile has decreased.

They continue to be frightened out in the community.

You are obviously dealing with some of the most vulnerable populations.

They're not being monitored, they're not functioning the way they normally do.

And they themselves are starting to have, not necessarily diagnosed issues, but back pain, back pain.

So we are seeing those people.

We do see patients that just have issues with general deconditioning.

- Just conditioning.

Yeah.

- That's an interesting word.

- The general deconditioning, and we can see patients with the deconditioning because deconditioning leads to decrease function.

I mean, you are not functioning normally when you're just in the realm of your home.

- You can't get those steps in walking around - Your living room.

- No, exactly.

That Fitbit is not gonna have the amount of steps you're supposed to be taking.

And things like being out in the community, that's activity, and people don't realize you don't necessarily have to go to a gym, especially as we age.

And people are complaining about increased falls, decreased ambulation.

Now that they're trying to get out, they don't have the endurance to.

- Hmm.

- So we get all those types of things pulling together.

We do see a lot of people that do have true diagnoses that maybe have history of stroke, have history of brain injury, that our contact is telling us, you know, hey, I'm worse.

It's not that they got had a new stroke, it's not that they had a new brain injury, it's just that these deficits have led to weakness because they're cooped up and now they can't function the way they normally did.

- Hmm.

- So they're circling back to us too.

But we are, it's very tentative because I do not believe that everyone who needs to be seen is necessarily comfortable coming out of the home yet.

- Not quite.

I mean, we'll never say over this or not over this, but certain people are starting to get back to activity.

- Yeah.

- And others are still very hesitant.

- And in our environment, unlike my esteem panelists here, based on what we do in physical rehabilitation, it's amongst other people.

I mean, we do maintain social distancing, we do mask, we do sanitize, but people are not necessarily comfortable being in the company of others, especially in the company of people that they don't know.

- Hmm.

- So, I don't think we're necessarily seeing everyone we should be seeing.

- We'll come back to you on that.

I'm interested Dr. McCarthy, dental care kind of fascinates me where COVID is concerned because it's not as though you can have a, you know, someone's looking at a skin condition or your joint, they right up in your face and your nose, tell me a little bit about how things changed for you really over the course of those two years.

- Yeah, the pandemic was really scary for us at first.

I remember when it began, we had employees who just didn't, they weren't comfortable working anymore because they didn't know what to expect.

It's a respiratory epidemic and you're literally in somebody's mouth.

So at first around March of 2020, the dental offices around the state actually closed down because the CDC recommended that all elective dental surgeries and procedures be put on hold and it took us a while to really get back into the swing of things.

And during that time, we were really only seeing emergency patients.

It's never a good idea to just wait until something becomes an emergency.

So people who would get their teeth every six months, their entire life stopped getting their teeth cleaned and are only are starting to come back to the dentist.

And now we're seeing the problems that they might have had in beginning stages at first are now much, much worse.

So for example, a cavity, it doesn't get better on its own.

It gets worse and worse.

Particularly in children, there were a lot of children, especially those from, I see a lot of low income, underprivileged, underserved children, and they had these unmet dental needs at first and now they're coming back in and their problems are much, much worse.

So we're very busy to say the least, I would say that we were strained before the pandemic, and now that we're sort of over that hill, we're even more overburdened trying get people in and get people back to tip top shape.

- You bring up pediatric dentistry, and I didn't even think about it until you said it.

That's a few years there where it seems as though it's very important to figure out what's going on in there, are the teeth coming in on time?

Do you need braces?

Are those issues that can be fixed down the line, or if you wait too long, have you missed a window?

- Oh, absolutely.

Anything can be fixed down the line, but getting at to it earlier is gonna be, it's gonna solve the problem in a much easier way, a tooth that might need a filling at first will need a root canal later on.

It can lead to pain, infection.

And so getting to these problems earlier is always, always the best route.

- And Dr. Yarnell, I think we could probably do an entire season just on what has gone on with mental health in these couple years alone.

- Yes, mm-hmm.

- But I asked earlier, is it safe to say that substance abuse has skyrocketed in the last few years?

- Absolutely.

And I don't think that we can really speak to how much it sky rocketed, because as we talked before, the data that we have in terms of the rates and the prevalence rates, they're not reflective of the impact of the past two years.

So it's starting to come out in terms of how bad it is.

Many people during the last two years were not able to get the care that they needed in terms of support for addiction, for example.

So, we could go into great lengths about the other mental health issues increasing, but with substance abuse, not being able to go to meetings or have a support system that they're able to access on a regular basis just led to more isolation.

If they were struggling with depression, anxiety, trauma, the triggering nature of COVID alone in terms of the feelings of helplessness and isolation and not knowing what's gonna happen.

Those are all triggers for people to lean on a substance or even technology, 'cause we were mentioning that is a form of self-medication.

So the nature, the dynamic of the triggers with substance use together is snowballing, and then you not having access to care, especially in the beginning of the pandemic is really catastrophic.

So in the beginning it was very crisis oriented, we have COVID, we have patients that are struggling.

How do we provide services without being able to see them in person?

And now we're making improvements, but there's a chain reaction.

There's so many more people who are in need and while we are improving in terms of how we deliver care through telemedicine, there's a lot of patients that need care.

- It's a very elementary question, I think.

But why, why would substance abuse kick up at a time like this?

I mean, you mentioned the stress and maybe the isolation, but in your experience, what makes someone go from, let's say routine, if there is such a thing, alcohol use.

- Yes.

- Into a problem area.

- Yes.

So what it tends to happen is, is when people are stressed, like outside of more severe mental health issues, when people are stressed or they're anxious or they're having a panic attack or an anxiety attack or they're feeling lonely or isolated, there's a natural inclination to do something to distract themselves from it.

So if I can't go out with my friends, then I can have a drink at home.

Or if I'm stressed, I can get a prescription for benzodiazepine.

Okay.

So there's a, or I can with technology, going into social media.

So we distract ourselves when we're feeling stressed.

But then over time, that distraction then turns into this is working and my mental health issues are increasing.

And then I want to now avoid.

So the distraction then turns into an avoidance and the addiction physiologically starts to develop even more.

So it's this recipe for more long term consequences in terms of their ability to handle it on their own and that not having access to the care and the help that they need.

And these could be individuals who never had a substance abuse problem, but given the situation that we have become, and the trigger is switched.

- Is switched.

- Yes.

- I've heard it described that way as a light switch.

- Yes, absolutely.

- And something happens and then suddenly, you're on a bad path.

- Yes.

Especially for people who are vulnerable or who are at risk for mental health issues that they really didn't think that they were before.

So which can be blind sighting for some individuals.

So I never had a panic attack before, I never had anxiety, so I'm going to have a drink to make myself feel better.

Oh, that works.

- [Julie] I'm gonna have another one.

- I'm gonna have another one.

Oh, and then now two's not quite cutting it.

- Yeah.

- I'm up to three and the bottle and then so forth.

So.

- I'm gonna go back to something you said a little bit earlier about people getting out just to go grocery shopping.

So we think of, I need to be active, I need to go to the gym, I need to, whatever the case may be, but is it as simple as if you're say an older adult, just to keep your mobility going, just as simple as getting some steps in, what's the recommendation that if people are starting to have issues from being too sedentary over the last couple of years, what now, where do you go from here?

- There's not probably a set answer for that.

However, there are studies that show that as we age, we develop, what's called sarcopenia, which is essentially the decrease in muscle mass.

that happens normally in the aging process.

It is worse with decreased mobility.

So the person, as they enter in their senior, even before their senior years can find themselves just with the lack of activity, with the lack of going out to the store, with lack of just walking around that they had previously finding themselves in, again, a snowball effect where I can't walk without being winded, therefore I will avoid going out now that I can.

And it becomes worse.

And where I could walk around the grocery store, I'm not able to now.

So now I'm going to use the convenience of my mobile app and a grocery delivery.

- Delivery.

- Delivery aid.

But I can still maybe walk down the block to see my friend.

Well, now that's becoming an issue.

So I regress and I regress and I regress, to the point that now I'm not functionally who I am, and there's that whole social isolation that comes with that too.

I think that leads to some of the other problems on this panel that we were talking about.

It isn't necessary for, when you go back to the original question, it isn't necessary for us to go out to the level of high fitness if that's not who we are as we age, but it is important to be mobile.

And it is important to maintain mobility and to maintain normal strength and normal range of motion for balance.

We hear tons of stories and it's the truth, of patients who have decreased balance and therefore have decreased safety in their homes, run the risk of true injury.

You know, as we age, the broken hip, the concussion, all kinds of injuries from being alone that can start us in the spiral basically downward.

So it's important to be out.

It's not necessarily just easy to do it on your own.

Some people really truly do need to get informal programs.

And I know it sounds like I'm a physical therapist, so of course I'm gonna be all pro PT, but there's something to that.

I mean, you don't have to have a diagnosis necessarily to know that I am not who I am normally.

And deconditioning leads to ambulation, dysfunction leads to functional mobility issues in other directions, leads to problems with stair climbing leads to problems with just handling your activities of daily living within your home, your duties in your household.

- You could be kind of on a cusp of a wave when, we might not even know the damage that is done so far.

- Exactly, exactly.

And again, usually people as they age have multiple conditions and multiple comorbidities and maybe frightened, we don't even know who they are necessarily.

These people can be in their homes right now.

- And we wouldn't know.

- And we wouldn't know.

- To that point, Dr. McCarthy, is it possible that, so I didn't go to the dentist for two years, but I'm gonna come back now, is it that we can make up this time or for some people is that, those are lost years, and if you didn't catch something right away, that can turn into a much bigger health issue.

- I don't think it's ever too late for anyone.

And I really would hope nobody would ever give up on their oral health.

So we can catch up, absolutely.

And if anybody's been waiting to go to the dentist, I would say that we've come up with a lot of safety measures that we didn't have in place before that are making dental care or just being at the dentist a much safer environment.

But yeah, I think that there's always a solution even in dentistry.

So if something's gotten worse, then we can fix it.

It's just, everybody is kind of playing that game at this point at point.

- All at once.

- Yeah, absolutely.

(chuckles) - We talked earlier about the, obviously there's sometimes drilling or your mouth is wide open and aerosol is everywhere.

You talked about.

- Yeah.

- Some things that you've done to protect yourself and protect the patient as well.

What are some of those things that people might expect if they go back to the dentist after a couple of years not being there?

- Sure.

Yeah, well, we always screen everybody at the door, first of all, because that's the most important thing is to catch any issues before they even come into the office.

And then when a patient's in the chair, they keep their mask on as long as possible, we're still a healthcare facility.

So we encourage mask clearing and we've improved things suction that we didn't have before, we spend more time just sterilizing rooms.

We're more mindful of social distancing, any precaution that we can we take.

- And Dr. Yarnell, what was going through my mind the last time you were talking was, how do we find them to even fix it if someone is isolated?

I mean, it's interesting that this is a little bit more of a connected panel that I had anticipated, how do you find those people who might need help and don't know where to start?

- Well at Geisinger, we're a medical facility.

So one of the benefits of having psychology, psychiatry, social work services as a part of that organization is that patients are coming to their primary care doctor and they're coming because they have physical pain.

- Mm-hmm.

- Okay.

So they go for physical pain and they're able to talk to their doctor, and the doctor is able to identify I think this individual has maybe a substance abuse problem or they're depressed, or they have PTSD, or there's some evidence of self harm or something like that, then they can send a referral to our department immediately.

So the ability to communicate with other providers, be it primary care, if it's through oncology or through neuropsych, neurology department through pediatrics.

So we all work as a network to be able to communicate and identify individuals that are high risk that might not necessarily seek psychiatric care or care for substance abuse, but we're getting the referrals through other medical departments and they will come to us.

So the ability for us to work as a team throughout the whole system has been so helpful to all providers, regardless of their discipline.

- What about a friend or a family member?

What can you tell people to look for if there are some signs, some red flags, maybe?

- You know, there are so many red flags.

I think if you see changes in behavior, if you see that people are back to work for the most part, if you see them not functioning well at work or not going to school, or there's behavioral problems, or there's a withdrawal, changes in mood, any of those changes that you see that is different from their normal behavior, not wanting to engage in like leisure activities that they used to before.

So when you see a distinct change and shift in someone, usually there is a problem.

- There's usually something happening.

- Yes, yes.

Something happening that would raise a concern.

It is hard when you see someone who you care about and they're struggling and you may encourage them to seek services and they may not want to, depending on where they're at in their life.

So it's a challenge.

And like you were saying, it's affecting all areas, all disciplines.

- All disciplines.

- All people from babies to the elderly population.

So I think we are all just trying to get back on the ship and try to figure out where to go and working together.

So I think that's one of the benefits of having different disciplines, being able to become familiar with the struggle so that we can work together.

- I really wish the show was maybe an hour and a half, 'cause I have that many more questions for you all, but that's gonna the wrap up our 25 minutes here.

If anybody has any questions, I would hope (tranquil ambient music) that they can get in touch with me and I will get them to you.

If there's something we can help with in particular, but that's gonna do it for this episode of Call the Doctor.

We're really glad you joined us.

And for all of us here at WVIA, we'll see you next time.