Tashana Joyce helps a patient schedule a telehealth appointment.
Social distancing has changed the way we do everything, from food shopping and socializing to learning and even going to the doctor. To respond to these changes, Shore Physicians Group had to quickly find a way to minimize in-person contact in the offices while still serving the healthcare needs of its patients and the broader community.
To do that, SPG consolidated all of their outpatient providers and 11 offices into just three locations and introduced a new way of caring for their patients – through telehealth via their smartphone or computer. And with many offices closed, they had to create a new call center where a team of Patient Service Representatives fields calls from 8 to 4:30 p.m.
Lindsay Richter, Director of Operations for Shore Physicians Group, says she is impressed by how the team pulled together the call center in just one day.
“Typically, putting together a fully centralized call center in such a short period of time would be a massive challenge, especially with most people working remotely. But this team really came together to do whatever needed to be done to support our patients,” Richter said.
The call center was set up in SPG’s former pulmonary office in Somers Point and is staffed by 11 patient service representatives, one from each of its offices. They are fielding patient calls and scheduling their virtual and in-person appointments, while also teaching patients how to use the new telehealth technology. The team is spaced well enough apart, with most working out of their own office to abide by social distancing rules, but they’re able to communicate easily with one another as well when they have questions.
Jaime Allen is the onsite call center supervisor. She’s there to support them and keep everyone motivated. And it’s working.
“The other day, the team fielded nearly 1,000 calls in just 8.5 hours, but the average wait time was only two minutes. It’s really incredible,” Allen said.
Jennifer Servis, who is typically a patient service representative at SPG’s Bethel Road office, says while she misses the face-to-face interaction with patients, she enjoys helping them become familiar with telehealth.
“Some patients have a really hard time getting to an appointment, whether it’s because of mobility or transportation issues, or even if they simply don’t feel well enough to leave home. With telehealth, those barriers are eliminated. And sometimes they can get a virtual appointment not just that same day, but within the hour. It’s not appropriate in every case, of course, and in those instances, we’ll schedule them to come in,” Servis said.
Allen says she believes telehealth is here to stay.
“Patients have been surprisingly open to telehealth. It’s a great way to provide for our patients at point of care where they need it most. It’s awesome when used in an appropriate manner.”
Shore Physicians Group is caring for its current patient base, but they are also accepting new patients as well.
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A stealth-like silent bubble could be present in your brain, your abdomen or other blood vessels and you don’t even know it. That bubble is an aneurysm and it has the potential to wreak a great deal of damage. An aneurysm is defined as a weak spot in the wall of a blood vessel. According to the Brain Aneurysm Foundation, there is a brain aneurysm rupturing every 18 minutes with a sobering 40 percent mortality rate.
Neurosurgeon Dr. Francis Kralick of Shore Physicians Group likened an aneurysm to a bubble that forms a bulge on the outside wall of a tire, stretching and weakening that wall. “Higher than normal pressure on the walls of that tire can cause that bubble to burst, and an aneurysm acts much the same,” said Kralick.
Where an aneurysm may form An aneurysm can form anywhere along the blood vessels in the body, but statistically tend to form at the fork in the blood vessel where they branch off and may be weaker, , according to the American Heart Association (AHA). While aneurysms tend to most commonly be found at the base of the brain, they may also be found in the chest, known as a thoracic aortic aneurysm, which is an abnormal bulging or ballooning of the portion of the aorta that passes through the chest. They can also form behind the knee in the popliteal vessel as well, according to the National Institute of Health.
Dr. Kralick explained that small berry aneurysms may be present in an individual’s blood vessel but never pose a problem because they are very small and minus symptoms, so they will go undetected. The problem unfolds when an aneurysm grows larger and is still without symptoms until it begins to leak or burst.
Symptoms of an aneurysm The AHA indicates that a brain aneurysm that becomes enlarged presses on nerves in your brain and may cause signs and symptoms. These can include droopy eyelid, double vision or other changes in vision, pain above or behind the eye, a dilated pupil coupled with numbness or weakness on one side of the face or body.
Symptoms of an abdominal aneurysm include tenderness or a pain in the chest.
Thoracic aortic aneurysms often grow slowly and usually without symptoms, making them difficult to detect. Some will experience back pain, hoarseness, a cough and shortness of breath. Some aneurysms will never rupture. Many start small and stay small, although many expand over time. How quickly an aortic aneurysm may grow is difficult to predict.
For a person with a peripheral aneurysm that has formed behind the knee, the patient may notice significant discomfort with walking along with swelling of the extremity.
If the brain aneurysm ruptures, the symptoms include a sudden onset of a severe headache, nausea and vomiting along with a stiff neck, loss of consciousness and signs of a stroke. Dr. Kralick said any of these symptoms require immediate medical attention.
Treatment options for an aneurysm Dr. Kralick explained that treatment depends on the size and location of the aneurysm and whether it has ruptured. The former method to treat an aneurysm was surgical clipping, which, according to Dr. Kralick, had a longer recovery time. Because it involves general anesthesia and opening the skull, it is used dependent upon the needs and overall health of the patient. Doctors may use a coil method that keeps the aneurysm from rupturing. Or, they may opt for the more common and less invasive endovascular method of treatment.
The endovascular repair method calls for the physician to thread a thin catheter that guides a stent graft through small incisions in the groin. The graft is inserted into the aneurysm and seals it from within.
Imaging is an important diagnostic tool A CT scan will normally be used to see if the aneurysm has been bleeding, according to Dr. Kralick. Also used is an MRI to get 3-D slice pictures of the area. Cerebrospinal fluid will be drawn to see if there are any red blood cells present in the fluid that surrounds the spine. Dr. Kralick said if there is blood in spinal fluid that will tell the neuroradiologist that the aneurysm may be leaking or has possibly ruptured.
Risk factors for aneurysms Researchers are finding that like so many other health conditions, heredity plays a role in who may be at risk for an aneurysm. Other risk factors include smoking, drug use, high blood pressure or hypertension, polycystic kidney disease, and congenital abnormalities that have been present since birth in the artery wall. Women have an increased incidence of aneurysms and they are more common over the age of 40. Ruptures of aneurysms are twice as high in the African American population compared to whites.
Preventing an aneurysm
Make Healthy Diet Choices: Diets high in calories, saturated and trans fats, and sodium can lead to high blood pressure, high cholesterol, atherosclerosis and obesity, all risk factors for aneurysms. Modify eating habits to offset the risk of aneurysm; choose fresh, whole foods over processed, packaged snacks. Limit fatty cuts of meat, like brisket and steak. Eat fried and fast food only in moderation. Reach for the low-fat or fat-free dairy rather than full-fat dairy. Incorporate whole grains and complex carbohydrates, such as brown rice or whole-grain bread, rather than refined, white carbohydrates, like white rice or white bread. Limit sugar-sweetened beverages, including soda, fruit juice, and energy drinks. When cooking, reach for heart-healthy oil, like olive, over coconut, palm kernel, and palm oil.
Keep Blood Pressure Levels in Check: Hypertension is a risk factor for aneurysms, and in November 2017, the American Heart Association and the American College of Cardiology lowered the guidelines for the diagnosis of hypertension from 130/80 to 120/80. Those new numbers put nearly half of Americans in jeopardy of having high blood pressure. To manage hypertension, eat a healthy, low-sodium diet, exercise regularly, quit smoking, manage stress, and maintain a healthy weight. The AHA recommends men limit alcohol to one to two drinks a day and women limit it to one drink a day. Take any medication for high blood pressure as prescribed.
Lower High Cholesterol: Cholesterol is a waxy substance that your body needs to build cells, but high cholesterol can lead to arteriosclerosis, or hardening of the arteries. A modified diet lowers bad cholesterol and raises HDL or good cholesterol. To lower bad cholesterol, limit saturated and trans fats, and to help promote good cholesterol, eat more foods rich in omega-3 fatty acids.
Make Exercise Routine: A regular exercise program can lower blood pressure and triglycerides, raise good cholesterol, and, in combination with a healthy diet, promote weight loss. The U.S. Dept. of Health and Human Services recommends 150 minutes of moderate intensity or 75 minutes of vigorous activity weekly. For patients diagnosed with an aneurysm, vigorous exercise will likely not be recommended. Seek a low-impact program from a healthcare professional.
Take Steps to Reduce and Manage Stress: Stress and high blood pressure seem to go hand in hand. When a person is stressed, the body will release adrenaline which increases heart rate and blood pressure. Dr. Kralick said stress does not cause an aneurysm but that the surge of hormones when a person gets angry or upset is capable of raising a person’s blood pressure and in turn trigger an aneurysm to burst. “We cannot hide from daily stressors, it is how we react that can make a big difference,” added Dr. Kralick.
Treat Obstructive Sleep Apnea: Obstructive sleep apnea is associated with the progression of thoracic aortic and abdominal aortic aneurysms, and can lead to poor outcomes for those with brain aneurysms. A study published in March 2018 in the Journal of Neurosurgery found brain aneurysms that rupture or result in vasospasm are a result of uncontrolled obstructive sleep apnea.
Quit Smoking: Smoking is a significant risk factor for the formation and rupture of brain and aortic aneurysms, but quitting can go a long way to reducing the risk.
Avoid Certain Prescription Drugs and All Recreational Drugs: Blood thinners and certain prescription medication, such as ephedrine and amphetamines, can contribute to the formation of an aneurysm, according to the Brain Aneurysm Foundation. Recreational drugs like cocaine should also be avoided because they damage the blood vessels.
Talk to Your Doctor about Screening Tests: If there is a personal or family history of aneurysms, be sure to inform the primary care physician and report any symptoms immediately.
Know the Signs of an Aneurysm: Although aneurysms can occur without warning, it’s important to recognize the signs and symptoms. If you experience pain, sharp or dull, or unexplained symptoms, don’t chance it. Call the doctor or go to the nearest emergency room.
Stick with a Treatment Plan: If you have been diagnosed with an aneurysm or suffered a rupture or dissection, it’s important to stay up-to-date on screenings, take all medication as prescribed and work to lower risk factors.
To learn more or to make an appointment with Neurosurgeon Dr. Francis Kralick of Shore Physicians Group, located at 649 Shore Road in Somers Point, call 609-365-6239.