Health care during COVID: Canceled screenings, postponed dental cleanings

In an attempt to maximize resources and keep patients safe, many elective procedures have been rescheduled or canceled. What does that mean for patients?

Vicki Simon at Point State Park in Pittsburgh. (Courtesy of Vicki Simon)

Vicki Simon at Point State Park in Pittsburgh. (Courtesy of Vicki Simon)

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Vicki Simon was having a rough year even before 2020 started.

“A hysterectomy was the first surgery that I had, and that was then followed a few months later when I had some issues,” she said. “I had a cholecystectomy in December.”

Her second surgery was actually two: the removal of her gallbladder and the removal of some scar tissue.

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But her health didn’t necessarily improve after the surgeries.

“I’ve had abdominal pain, and I had unexpected or unexplained weight loss of about 40 pounds in a short period of time,” said Simon, a preschool teacher.

To get to the root of the problem, her doctors suggested a colonoscopy and an endoscopy.

“Those were scheduled for the beginning of April, and they kind of held on and held on as all of this with the COVID-19 started to increase and stories started to come out. And then, of course, everything became so much worse. And so, at the end of March, my doctor finally called and they rescheduled for June 2,” she said.

Colonoscopies and endoscopies are among the list of medical procedures considered elective — procedures that are being widely canceled to keep people safe and preserve resources such as personal protective equipment and hospital space. Those are good reasons, and many patients agree with them.

“I had actually thought of postponing the procedure myself before I heard from my doctor, just because of everything that you were hearing,” Simon said. “I didn’t really want to use resources that could be used in more important ways, hospital resources, masks, PPE, all of that.”

But good reasons can’t provide answers to an individual’s medical problems. So what happens when your procedure is canceled? Where does that leave you?

There are some options, as Judd Hollander, senior vice president for health care delivery innovation at Jefferson Health and an emergency physician, has seen firsthand.

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Hollander’s father got some scary health news — the possibility he had bladder cancer — earlier this year, and had a consultation via telemedicine.

“He’s able to do a visit with his physician who can decide: ‘This is really tiny. We could wait three months past COVID, and we don’t think this is likely to have an impact on your survival or your quality of life, or we could do it now because this is large enough, and we’re concerned enough that it’s no longer an elective procedure. It’s something we need to do to keep you alive.’”

Telehealth visits are soaring during the COVID-19 crisis. Jefferson is doing close to 3,000 scheduled telehealth visits a day, coupled with the calls taken with its on-demand program, Hollander said. Part of that effort is to address patients that have had canceled procedures and are waiting for news.

“If you were seeing your oncologist and you were scheduled for a biopsy, or you were scheduled for an appointment with your oncologist to get biopsy results, or consider a biopsy, or decide the best way to approach your disease,” he said, ”you can still do your appointment with that same doctor who has the same medical records, who knows you, and they will see you via video and provide the best possible care.”

Simon and her doctor have been through a lot together, and she trusts things will be OK. She hasn’t used telemedicine, but she has other strategies.

“I’m just kind of putting those things off and writing down all of my questions so that when I finally go, my poor doctors will get the plethora of everything that I’ve been wondering about in these months in between,” she said.

The wait to see her doctor is long, however.

“This is a high-risk cancer screening,” Simon said. “So, of course, that gives me some pause, to wonder what is or what isn’t or might be and what the ramifications [are] of waiting.”

But not every elective procedure is a cancer screening. The Centers for Medicare and Medicaid Services issued guidelines and has a table that puts procedures into three tiers, each with two categories. In Tier 1 are procedures like endoscopies and cataract surgery; those should be postponed.

Tier 2 includes more serious things, such as newborn vaccinations and inpatient procedures. It’s also where low-risk cancer screenings fit in, among other procedures the agency recommends postponing after an initial telehealth evaluation. But it depends on your health, too. Healthy patients or patients who aren’t at high risk for COVID-19 might have different guidelines from patients who are high risk.

Tier 3 procedures are the really serious procedures, such as neurosurgery, transplants, and most cancers. Whether you’re healthy or sick, those procedures are likely to happen.

But what if this isn’t you? What if your canceled procedure was dental care? Most dental offices are closed under the directive of the American Dental Association.

What if you’ve got a killer toothache?

“The main factors are if you have a lot of pain, you know, something that can’t be relieved by say Tylenol or Advil,” said Charles Incalcaterra, president of the Pennsylvania Dental Association. “If you have a little minor toothache or sensitivity to cold, that’s not really a true dental emergency. But if you have a throbbing ache, or an ache that won’t go away and can’t be managed with over-the-counter pain relievers, then I would recommend calling your dentist.”

Dental emergencies also include infection, like swelling of the cheeks or gums. Or “if there’s any trauma. If you or a child falls at home, or you somehow smash your teeth on concrete or swinging a baseball bat, or whatever could happen, that’s definitely a dental emergency,” he said.

Teenagers and twentysomethings are in luck: Incalcaterra said wisdom-tooth surgery can probably wait — but again, if you’re in a lot of pain, it’s a different story. The same for orthodontics: Waiting is probably OK, but if you’re in a lot of pain call your orthodontist or, if they’re not available, a dentist.

If you need a dentist but don’t have one, Incalcaterra suggested contacting your state’s dental association, as there are some federally qualified health centers that offer dental care.

Even though dental health and biopsies don’t necessarily seem all that similar, the goal is the same.

“We want patients to stay out of the emergency rooms especially this time, with the other issues going on with COVID-19,” Incalcaterra said.

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