CARRIS HEALTH

Survivor calls long COVID experience surreal, scary

Linda Vanderwerf — Sun, 15 May 2022 15:00:00 GMT

WILLMAR, Minn. — Surreal is one of the words Mark Stier uses to describe his life now. Scary is another.

A year and a half after he contracted COVID-19, he struggles with lingering symptoms.

It’s scary, Stier said in April, because no one can tell him yet how long the occasional crushing fatigue, muddled thinking and other issues will be with him. He first fell ill on a hunting trip in October 2020.

Stier wonders, “What is this going to look like in two years, in 10 years?”

Stier, of Willmar, Minnesota, was quite ill but was able to stay out of the hospital.

David Hallberg wasn’t that lucky. He contracted COVID-19 in October and was hospitalized for nearly two months, including 17 days on a ventilator and weeks of inpatient rehab.

Six months later, he said, he feels he’s almost back to where he was before, but still gets tired standing or walking.

For people with long-haul COVID-19, there aren’t many answers yet, said Dr. Jayme Van Beek, a family practice physician for Carris Health in Willmar and Stier’s doctor.

“We’re only two years into this, so we really don’t know what long-term is,” Van Beeksaid.

Definitions of long COVID vary, and so do symptoms. As with the initial infection, symptoms vary widely from person to person and can affect different parts of the body.

Van Beek said someone whose symptoms linger for weeks should see a physician. The most common long-haul symptoms he sees are fatigue, shortness of breath, chest pain and “fogginess.”

Most information is anecdotal at this point. Studies into long COVID are going to take a long time, and a lot of money, Van Beek said.

There are a variety of other symptoms, and some people develop post-traumatic stress disorder, too. He knows of a person who hasn’t had any sense of smell since 2020. Some people spend six months or longer on oxygen.

While the illness may be recent, treatment involves “a lot of things we already know how to do,” he said, like pulmonary rehab for someone with trouble breathing or occupational therapy for someone with brain fog.

The brain fog does not appear to be dementia, which gets progressively worse, Van Beek said. The long-haul brain fog gets better over time, but it can take a long time.

When Stier first went back to work as dean of students at Atwater-Cosmos-Grove City secondary school, he carried a notebook everywhere, to aid his recall. Without it, he might forget a hallway conversation by the time he returned to his office.

That’s gotten better, and he’s developed more coping strategies, he said, but it’s still a problem some days.

Stier, who was an English major in college, is frustrated with his inability to find the right word in a conversation. That type of thing did not happen before he had COVID, said Lynn Stier, Mark’s wife.

When the couple, both 55, bought a new dehumidifier last year, he carried it to the front door before being hit by crushing fatigue. Lynn carried it to the basement.

Lifting the dehumidifier was not a big deal for her, she said, but his fatigue was worrisome.

The Stiers have always been an active family — walking, hiking, biking. They like walking through the woods looking for antler sheds. Mark has played basketball in a city league.

Now, he’s unsure what he can and can’t do. He asks himself if maybe he’s just getting older, too.

Sometimes, “I just feel yucky,” he said. “I would not wish it on anybody.”

For years, he taught his students how to use mindful breathing to settle down and be ready to learn. Now meditation helps him keep going.

When he was ill, he stayed in the lower level of their home, while Lynn stayed in the upper level. They were supposed to stay apart, but she said she did sneak down regularly to check on him.

At times he was so weak that he had to plan out where he’d stop to rest on his way to the bathroom.

Their goal was to keep him out of the hospital, because he might have been transferred to a hospital hours away. Nebulizer treatments, steroids and meditation helped him keep his blood oxygen levels up.

Questions about the future haunt him, though.

“Where’s the line,” he said. “What is COVID and what’s not? What’s old and what’s not?”

Hallberg’s struggles have been different.

At first, he thought he had the flu last fall. But after going back to work, he got sicker.

When he began having trouble breathing, Hallberg, 60, ended up at the Carris Health-Rice Memorial Hospital Emergency Department. He was sedated, put on a ventilator and transferred to Abbott Northwestern Hospital in Minneapolis.

After 17 days on a ventilator and several weeks at the Courage Kenny Rehabilitation Institute, he came home to be with his wife, Stephanie, and daughter Caroline on Dec. 21, still on oxygen and very weak.

“I don’t remember hardly anything in the month of November,” he said.

At first, he was so weak, “I couldn’t lift my feet off the ground,” he said.

When he returned home, he kept working on his recovery with respiratory therapist Kendra Sandmann at Carris Health Rehabilitation Center. With her guidance, he built up his stamina and gradually stopped using oxygen. He began a new job as a courier for Rice Hospital at the end of February.

In April, six months after he got sick, “I’m pretty close to where I was,” he said, but he’s still working on getting all the way back. He is carrying packages more easily at his job, but extended standing and walking still make him tired.

Hallberg counts himself lucky in some ways. “I never really felt any pain or discomfort,” he said. “I really never felt I had brain fog.”

Hallberg said he’s grateful for the care he received at the rehab center.

“I can’t say enough about how good the therapists are,” he said.

Sandmann returned the compliment and talked about how hard he worked to rebuild his strength.

“It’s very rewarding to see people like David,” she said. She called him an “ideal patient,” who always had a smile on his face.

“I was happy to be here,” Hallberg said.

They started slowly, first exercising while seated, then to a treadmill, starting slow and building from there.

Eventually, Hallberg was exercising 45 to 60 minutes at a time and working up a sweat. “He left here dripping,” Sandmann said.

Sandmann alternates her work schedule between the hospital and the rehab center. It helped her during the pandemic that she saw her hospital patients recovering in rehab, she said.

While Hallberg is a success story, she said, the past two years held a lot of sadness. Some people did not survive being taken off the ventilator, she said, and some haven’t been able to stop using oxygen.

The pandemic is not over yet, Van Beek said, and there are still things people can do to avoid becoming seriously ill.

“If you’ve thought about vaccination, I would do it,” he said. “If you have symptoms, talk to your doctor; we have things we can do.”

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Physicians, clinics working together to manage acute pain without opioids

Linda Vanderwerf — Sat, 26 Feb 2022 16:01:00 GMT

WILLMAR, Minn. — In years past, a patient might have gone home after surgery with a bottle of opioid pills, enough for a week or two.

If the patient didn’t take all the pills, they might sit in a medicine cabinet or a drawer, forgotten, until someone found them. And the pills could have ended up in the hands of an addict.

That has led to dramatic changes in how opioids are prescribed.

Dr. Nathaniel Slinkard, an orthopedic surgeon, says he almost never prescribes opioid medications for acute pain. Neither does internal medicine specialist Dr. Kendall Bos.

Slinkard said he explains to patients why he’s treating them the way he is. If the underlying issue isn’t treated, he tells them, “Your pain’s going to come right back as soon as that medicine wears off.”

Both doctors favor treatments that have less potential for harm or addiction, and also target the cause of pain. They practice at the Carris Health-Willmar Main Clinic in Willmar, Minnesota.

Slinkard and Bos are part of a rollout of new clinical practice guidelines for treating acute pain. That’s pain in the first couple days after an injury or surgery.

Dr. Kathryn Duevel led the development of the guidelines, which have been rolled out at Carris Health and throughout CentraCare, its parent organization. It was related to her work forming the Addiction Services program at the Willmar clinic.

CentraCare and Carris Health operate eight hospitals, more than 30 clinics, 10 senior housing facilities and seven long-term care facilities in central, west central and southwestern Minnesota.

The misuse of opioids grew from two things happening in the 1990s, Duevel said. Doctors were under pressure to treat their patients’ pain more effectively, and pharmaceutical companies assured them that opioid pain medications were not addictive.

The result was an epidemic of opioid abuse and overdoses that continues today. Over time, addicts’ use of synthetic opioids, heroin and fentanyl has overtaken prescription opioids.

Duevel said overdoses and overdose deaths jumped dramatically during the pandemic, and that led to the development of the local guidelines.

“To me, it’s a pretty compelling reason — we have people dying,” Duevel said. “It’s hard to get more compelling than that.”

Duevel and a working group condensed the highlights into a one-page document for physicians. Links to the state guidelines are included if needed for additional research or to double-check something as providers get used to the new guidelines.

The recommendations are based on dozens of pages of state regulations, condensed into a quick reference guide, she said.

There’s an accompanying handout for patients explaining the treatment of acute pain in the first days after surgery or an injury. It offers a list of first-line treatments, including over-the-counter pain relievers, heat or ice, massage and exercise.

Teresa Behm, Carris Health marketing and communications director, assisted in developing and packaging the new recommendations and patient information, Duevel said.

Carris Health Treating Acute Pain_Handout by West Central Tribune on Scribd

Acetaminophen, under the brand name Tylenol, and nonsteroidal anti-inflammatory drugs such as aspirin and ibuprofen are more effective for acute pain than many people think, Duevel said.

The system is in the process of reviewing the new guidelines with providers to gauge how they are working in practice. As it develops, doctors will be able to look at their own prescription record and compare themselves across their department and the entire organization, Duevel said.

Bos and Slinkard said they have been using the guidelines, and both like them. In both cases, the new recommendations reinforce what they were already doing.

“The way I treat pain is, pain is a symptom, and my job is not to cover up the symptom,” Slinkard said. “Instead of just treating the symptom, we try to treat the issue.”

Often, the pain is caused by inflammation, and anti-inflammatory drugs can help. Other medications can be used to address nerve pain.

“There’s all kinds of different ways to treat pain,” he added.

“We use a varied bunch of injections and medications to try to treat people’s pain that don't involve opioid narcotics,” Slinkard said.

Bos said he has reduced the opioids he prescribes over the 22 years he’s practiced in Willmar. “I’d say that’s probably true of most doctors,” he said. “There’s been a gradual movement over the last 20 years.”

Bos said he was in training in the 1990s, when pain was called the “fifth vital sign,” alongside temperature, pulse rate, blood pressure and respiration rate.

Rather than prescribing opioids, he now recommends patients take anti-inflammatory drugs or “good old-fashioned Tylenol.” The guidelines are flexible, and he may prescribe a day or two of opioids, if he feels the situation warrants it.

For the most part, patients are accepting of the recommendations, Slinkard and Bos said.

“In general more and more people are educated about it and are willing to follow these guidelines,” Bos said.

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12 Minnesota hospitals penalized for excess hospital-acquired conditions

Paul John Scott — Thu, 17 Feb 2022 13:31:00 GMT

ROCHESTER, Minn. — A dozen Minnesota hospitals have been penalized by the federal government for falling within the bottom 25% nationally at preventing hospital-acquired conditions. The penalties are detailed in a database released by the Kaiser Family Foundation.

Nationally, 764 hospitals were singled out for poor performance on hospital-acquired conditions — conditions the patient develops while in hospital being treated for something else — among patients discharged between July 2018 and the end of 2019. The adverse outcomes include blood clots, sepsis, bed sores, wound ruptures after surgery, and infections acquired after catheters, central lines and surgeries.

The hospitals named will receive a 1% reduction in their payments from Medicare for fiscal year 2022, according to the Centers for Medicaid Services. The Hospital Acquired Conditions (HAC) Reduction Program penalties have been levied annually since 2015 as a condition of the Affordable Care Act.

Minnesota providers on the new list included independent facilities as well as regional outposts operating under the banner of Essentia, Fairview, CentraCare and Mayo Clinic.

The full list of Minnesota hospitals penalized are:

Carris Health in Willmar Essentia Health St. Mary's in Detroit Lakes Essentia Health in Virginia Fairview Northland Regional Hospital in Princeton Grand Itasca Clinic and Hospital in Grand Rapids Mayo Clinic Health System Red Wing Ridgeview Medical Center in Waconia St. Cloud Hospital St. Luke's hospital in Duluth University Medical Center-Mesabi in Hibbing University of Minnesota Fairview Winona Health Services

Leading the state in consecutive years of under-performance on the metric was Carris Health in Willmar, according to a review of the KFF database filtered for hospitals in Minnesota. It faces a fifth straight year of docked Medicare payments for hospital-acquired conditions, its sixth designation over the eight years since the start of the penalty system.

Mayo Clinic Red Wing, Fairview Northland in Princeton, and University of Minnesota Fairview in Minneapolis have all now received the penalty for a fourth straight year — and in the case of Fairview, a seventh time overall. Mayo Clinic Phoenix in Arizona has been penalized for a third straight year, as has both Winona Health Services and University of Minnesota-Mesabi.

Many of the hospitals penalized by Medicare have paradoxically also earned its highest five-star rating for overall performance, including the Mayo hospitals in Red Wing and Phoenix.

The penalties are designed to elevate the quality of care in the United States, which had witnessed steady improvement on the problem of hospitalization leading to new illness, only to witness a stark worsening of the metric amid the crush of new patients and loss of personnel during the pandemic.

According to a new analysis in the New England Journal of Medicine, a 31% decrease over five years in central line-associated bloodstream infections since 2017 has been "almost totally reversed" during the pandemic. That same paper cites a study from August 2021 reporting that central line infections rose 60%, catheter infections 43%, and resistant staph infection 44% during the first six months of the pandemic.

Children's Hospitals, VA facilities, psychiatric and critical access hospitals are all excluded from the quality control review.

"Mayo Clinic is committed to the highest quality patient care, which is reflected in our top quality and safety rankings," Mayo spokesperson Jay Furst said in a statement. "The Centers for Medicare and Medicaid Services have recognized Mayo Clinic Health System in Red Wing and Mayo Clinic Hospital in Arizona as five-star hospitals, the top ranking, which is especially notable because of the complex and serious medical conditions for which patients come to Mayo Clinic for treatment. We are dedicated to continuous quality improvements that benefit all patients.”

“Patient safety is our highest priority and we continue to work toward zero preventable infections at all of our hospitals,” Fairview representative Aimee Jordan said in a statement.

Representatives for Carris did not return a request for comment in time for publication.

The results were first reported as part of a state-by-state database compiled by Kaiser Health News.

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