The Health Issue A conversation with:
COMPLIMENTARY
September/October 2020
NEW HAMPSHIRE
WOM E N MAGAZINE celebrating the women of New Hampshire
Laura Fry, MD Family Practice/ Obstetrics Amoskeag Health
Dawn Fernald Community Relations Director Wentworth-Douglass Hospital
Inside: Susan A. Reeves, EdD, RN Executive Vice President Dartmouth-Hitchcock Medical Center
Renew MediSpa Dr. Lisa Vuich
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New Hampshire Women Magazine’s print publication is published by Melissa DiOrio of Gracant Communications (melissa@nhwomenmagazine.com). The name ‘New Hampshire Women Magazine’ is registered as a trade name with the State of New Hampshire by SG Communications, LLC and is used herein with its permission. The term ‘New Hampshire Women’ is registered as a trademark with the State of New Hampshire by SG Communications, LLC and is used herein with its permission.
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NHWM COVER WOMEN | Inspiring Women
NH COVID CRISIS THREE WOMEN ON THE FRONT LINES Written by Crystal Ward Kent
In March 2020 the world as we know it changed due to the growing global spread of the virus known as COVID 19. While we all had to quickly adapt to a life of work and school shutdowns, of social distancing, remote learning and masks as daily attire, nowhere was the impact of COVID felt more searingly than in New Hampshire’s hospitals. There are many dedicated men and women on the front lines in the Granite State, and three women are interviewed here. Today, they share their thoughts on this continuing crisis and its impact.
parts, but focuses on several primary goals: 1) to maintain the highest quality and delivery of healthcare services, 2) to foster and expand the research and teaching mission of Dartmouth-Hitchcock Medical Center, and provide health professions students with a first-rate learning experience, 3) and to make sure that the large staff of physicians, nurses and other personnel are getting the support and materials they need to perform at the level their job requires. DartmouthHitchcock Medical Center
Sue Reeves: Sue Reeves is executive vice president for Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire. Her complex and multi-faceted job covers many moving
is also undergoing a major expansion, which requires additional oversight. Reeves notes that her job would have been “exciting and challenging” even in the “good old days” before
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COVID, but with the virus’s arrival, every aspect of work at Dartmouth-Hitchcock has been disrupted. “We have had to rethink every aspect of doing every job in order to provide appropriate personal protection materials, proper protocols and ways of remote communications. This has impacted our teaching, how staff work and interact, and where they work. Every detail has had to be considered and altered to make sure that we maintain an environment that is secure and safe.” Reeves is used to hands-on medical challenges. She began her career in the medical field as an oncology nurse, and in fact, did her nursing studies at Mary Hitchcock Memorial Hospital School of Nursing, the former nursing school for Dartmouth-Hitchcock Medical Center. “I loved it here and I just never left,” she smiles. For herself, Reeves says that nursing was a calling, and she feels that this is true of many others in her field. “Nurses care deeply. We want to do everything we can to help others. We want to keep people healthy and out of hospitals, but if they must go there, then we want to make sure that they get the best care possible. Nursing can be physically and spiritually demanding— people may need you 24/7, 365 days of the year, but nurses understand that. Ask
most nurses and they will tell you, it’s still the job they would choose.” This dedication (and endurance) has stood Reeves in good stead as she has helped DartmouthHitchcock navigate the challenges of COVID. “Our mantra has been personal responsibility,” she explains. “We are committed to doing everything humanly possible to prevent the spread of the virus. We are very attuned to infection control anyway, and now we are working at the highest level. We are hyper-focused on things like cleaning and disinfecting any common surfaces—where people sit while waiting for example; everyone wears masks; everyone stays six feet apart. There are really no waiting rooms—people wait outside and are called to come in. We’ve changed how people enter and exit the building, and there are regular temperature checks. It’s challenging, being at this level all the time, but it’s the way it is. And yes, socially, it can be draining. People miss gathering for meetings or in the break rooms, but it’s what we have to do.” Reeves feels the New Hampshire medical community has done many things right during this health crisis, but is especially proud of how quickly
organizations came together and worked as a team—and continue to do so. “The New Hampshire Hospital Association took a leadership role right away,” she notes. “They quickly worked to establish a strong connection between all of the entities and to get everyone synchronized. Any hospital that felt they were being inundated could call on the network to get immediate support. We had twice-daily briefings during the height of the outbreak and still have regular virtual meetings. There is very much a neighbor-to-neighbor feeling among the state’s hospitals—you feel that others have your back, and I’m proud of that.” Reeves has also been pleased with the way that the state’s businesses have stepped up during the crisis, often pivoting to help solve logistical and material needs for the medical community. “We had local companies switching to face shield production over night to help us meet our needs,” she says. “It was amazing. I’ve also been very proud of how DartmouthHitchcock has taken care of its team. Even if personnel couldn’t work due to the shutdown, Dartmouth-Hitchcock stood by everyone. There are all kinds of healthcare heroes in this crisis—not just doctors. People from all walks of life and in all kinds of roles have helped in any way that they can, but this is how we are in New Hampshire.” Looking forward, Reeves sees both positive and negative changes in a world forever altered by COVID. “On the downside, the stress on healthcare workers has been and continues to be significant and unrelenting. Not only are healthcare workers’ jobs stressful, but they are also coping with outside stresses as well, such as school issues, economic stresses and social isolation. It’s hard for them to find ways to decompress physically or emotionally. Most concerning, the end of the pandemic is not yet in site—this is the number one concern for healthcare workers. “Another concern is the financial strain that has been placed on healthcare organizations and which has threatened the viability of some of them— particularly those in rural areas. Some will not survive and even those that do may take years to recover. “Last, and also of great concern is that people have delayed seeking care out of fear of being exposed to infection. As a result, we are seeing people with
exacerbations of their chronic illnesses as well as those who may have delayed urgent or emergent care for potentially life-threatening illnesses such as heart disease and stroke. Hospitals and other healthcare providers continue to stress that it is SAFE to come for care and for people to NOT delay—especially in the face of urgent medical needs.” Nonetheless, Reeves does see many positives that have come from the COVID crisis. “There is a heightened focus on infection control in healthcare organizations. This is good for reasons that extend way beyond COVID and will help prevent the spread of other illnesses, such as influenza, as well as hospital-acquired infections. “In addition, to avoid people congregating in waiting rooms, we have taken a new approach with how we schedule patients, and are extending hours to spread out appointments through the day,” Reeves explains. “This is benefiting patients by providing early and late appointments, which appeal to working people. And, the need to be able to provide healthcare services through electronic and telephonic means has created more access to care. These types of modalities will continue to benefit patients who live far from care sites or who do not have transportation. “Last, the spirit of cooperation among hospitals and health organizations has been incredibly productive. Working on problems together and sharing information has benefited everyone.” Laura Fry: Laura Fry is a family physician and associate medical director at Amoskeag Health in Manchester, New Hampshire. Her clinic covers communities within a 30-minute radius of Manchester, but also as far as Concord and beyond. Before becoming a doctor, Fry was a nurse, primarily working in oncology. Rather than following the path to becoming a nurse practitioner, she decided to become a physician herself. “I saw the need
for there to be one person who understood all aspects of a patient’s care,” she explains. “In oncology, so many people are involved, but in Family Medicine, you see patients of all ages throughout their lives. You build relationships with patients and their families. It’s how I wanted to practice medicine, and I’ve been doing it now for 30 years.” When the COVID crisis hit, Fry saw her practice change overnight. “We switched to telemedicine in a significant way, which was a big adjustment for the medical team and for patients. We had to adapt to the technology, and they had to adapt to a new way of receiving healthcare. Some accepted the change, but others—we have a lot of elderly patients—wanted to wait to be seen in person. Because of the shut down, that meant that I was not in face-to-face contact with a number of patients for threeand-a-half months, and for those with chronic conditions or urgent conditions, that was troubling.” Among Fry’s biggest concerns was that during the shutdown, critical diagnostic tests could not be run. “We do a lot of women’s healthcare and things like Pap smears, which test for cervical cancer, could not be done. If someone has a cancer forming or a precancerous condition, it needs to be addressed immediately. Postponing that test for months is not ideal, although we followed guidelines for professional organizations on how to handle screening and treatment. We can see patients now but we are still playing catch-up. We don’t yet how many lives may have been impacted due to the delay.” Also worrisome is the forced delay in vital immunizations, for both children and adults. “We had to follow CDC (Centers for Disease Control) guidelines, and that meant partially shutting down—we were open for some urgent cases. However, having infants, children
Continued on Next Page NH Women Magazine / VOL 2 ISSUE 11
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and the elderly not getting key vaccines on schedule does carry it’s own set of risks, and many people did not feel safe going to medical offices. Again, we are catching up, but we’re not there yet.” Nonetheless, Fry is grateful for the healthcare access that telemedicine did provide. “It allowed us to stay in touch with patients, not just to provide diagnosis, but also to keep up with those with chronic conditions or the elderly. We knew that many of our patients needed someone to check in and make sure that they were taking their meds and taking care of themselves. We were especially concerned about those with diabetes or multiple conditions. Our practice did as much telemedicine outreach as we did scheduled appointments. Our patients knew that we hadn’t forgotten them and many were amazed that we took the time to seek them out.” Fry notes that normally, her clinic does a great deal of community health work, visiting patients in their homes. They see not only many elderly patients but also those with mental health issues. Within this outreach group are patients who need regular medication, so it was critical to get refills to them. “You don’t want someone getting worse because they could not get their meds,” she says. “You don’t want to create a new set of problems. Thankfully, by being proactive, we were able to make sure that no one fell through the cracks.” Fry also feels that New Hampshire has gotten a lot of things right during the COVID crisis and believes that Governor Chris Sununu deserves credit for taking the crisis seriously from the beginning. “He’s been very careful and cautious
and I think that’s played a big role in helping our state keep our numbers low. He listens to the medical community, and that is key.” Today, Fry is back seeing patients in the traditional way, and will soon be providing homecare again, but is also keeping up the telemedicine. “I think this is one of the benefits that has come out of the crisis,” she says. “The old model of patients having to come to the doctor is no longer the way things have to be; we have learned that healthcare can be provided in multiple ways, and remote access may serve the patient better in some circumstances. I think tomorrow’s healthcare will include office visits, home care and telemedicine.” Fry also sees areas of concern beyond the direct impact of COVID. “People are under incredible stress these days, both those in the medical field and the general public. There are concerns over COVID, which is understandable—it’s scary; people have gotten sick, people have died—and there is the isolation and the stress of not knowing when this will end. We all need to do a good job of checking in with each other to see how we are really doing—are we taking care of ourselves mentally and physically? It’s important that we find ways to decompress even though many of our normal outlets are not available to us. We can still talk on the phone or have visits in a sociallydistanced way. We can go outside and be active. I find going outside to be a wonderful de-stresser. We live in a beautiful state with lots of trails and places to walk. Being out in nature can be a great prescription for your mental and physical health until COVID is behind us.” Until that day, Fry urges people to continue to follow safety
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protocols, listen to science, and get their flu shots. “New Hampshire’s numbers are very low, but in order to keep them low, we have to continue to follow the CDC guidelines. We can’t resume ‘normal’ life, no matter how much we want to, until there is a vaccine,” she stresses. “Getting your flu shot is always important, but this year, you really must do so, as a COVID/flu combination could be deadly. If you are sick, having had a flu shot helps you get a speedier diagnosis, as it rules out one possibility. We can get through this if we stay positive and follow guidelines; I do believe that.” Dawn Fernald: Dawn Fernald is community relations director for Wentworth-Douglass Hospital in Dover, New Hampshire; Wentworth-Douglass is a Mass General community hospital and part of the Boston-based Massachusetts General Brigham system. Fernald directs all community relations activities for the hospital, including marketing, public relations, and guest relations. The “guests” include hospital greeters, volunteers and gift shop personnel as well as those who now
provide COVID screening for anyone entering the hospital. Fernald has worked in healthcare for the past 20 years, and chose the path as a way to help people. “I’m not a clinician, so it’s my way of serving,” she explains. “Hospitals play important roles in people’s lives and communities, and they have critical information
to share. I like knowing that I’m able to assist in getting that information to the public.” When the COVID crisis hit, the importance of communicating with multiple audiences was significantly magnified. Vital information needed to be shared internally and externally and Fernald’s department sprang into action. “We immediately starting having daily updates with staff so that everyone knew the status of the crisis and how that affected the hospital,” she says. “We held those daily meetings from March through the end of June. We now have them weekly, but we are able to switch to daily at a moment’s notice should there be another surge. We’ve learned that communication is key even if you don’t have all the answers.” When the crisis hit, the hospital formed a Command Center that quickly pulled together an emergency preparedness plan and outlined everyone’s role in that plan. Medical experts from essential areas took leadership positions in identifying how things needed to function, and Wentworth-Douglass also received valuable guidance from their system leadership at Mass General Brigham, which was in the thick of the crisis in Massachusetts. Fernald’s team also reached out to the public, pushing out lots of information through traditional media, social media and other hospital communication vehicles. “We talked about testing and safety protocols and tried, in general, to offer reassurance about the crisis and how to stay safe,” she says. Among the important groups that Fernald worked with were the hospital’s greeters— staff whose roles would now shift dramatically. “Before, our greeters would greet people and simply direct them to where they needed to go,” she notes. “Now, they were on the front lines and being asked to provide COVID screening. They would do temperature checks, make sure people wore masks, and ask
health questions. They also have had the sensitive and difficult task of having to tell people that visitors were not allowed. We know how hard this is on patients and families but it is an important part of containing the virus. Our volunteers stepped up and took on all of these roles, as they continue to do. They have been and are an essential part of our safety procedures.” Fernald also feels that the State of New Hampshire got many things right in terms of handling the COVID crisis, and she is very proud of how Wentworth-Douglass took action. “Being part of the Mass General family, we got a lot of critical insights into what it was like being in the middle of a major crisis and that helped us greatly in our preparations. Thankfully, New Hampshire has not seen the numbers that Massachusetts has, and since we live in a less densely populated state, we hope that remains true. However, credit also has to go to the State and the people. The governor’s stay-at-home order really helped us flatten the curve, and the fact that people took it to heart was so important. People have really been very attuned to doing the right thing and that makes a difference. “In terms of the hospital, the fact that we were able to assemble our
Command Center so quickly shows the diligence and teamwork of our staff,” she continues. “We quickly had people from all clinical areas, safety, infection control, building infrastructure, staffing, physician leadership and state liaisons in place and tackling key issues so that we were ready for whatever came our way. Like other hospitals, we initially had to shut down elective procedures and outpatient treatment because we did not have the proper protocols and protections in place, but now we do. If there is another surge, we will not have to shut down. We have also made a point of documenting everything we have done, and we are continuing to do so. In addition, we evaluate these documents periodically, noting what can be done better and how best to do so. This will enable us to quickly pivot to address any future outbreaks.” Fernald is not sure what our “new normal” will be like when the COVID crisis has passed, but hopes that we will achieve one, as people did after the Influenza Pandemic of 1918. In the meantime, she finds strength in the many positives that have come out of the crisis. “Our Infection Protection Protocols will benefit us in numerous ways as we go forward, long after COVID,” she says. “The hospital is functioning at a much
higher level and that is to everyone’s benefit. The advent of telemedicine will benefit patients of all ages from now on. It was something that we knew people wanted but we had not yet been able to implement due to infrastructure, technology and insurance payment issues, but now it’s hopefully a mainstay. “The crisis has also brought our clinical and non-clinical staff together in a way that we never thought possible,” Fernald notes. “Before, some of these people would never have worked together, and now they are spending time side by side in tents doing testing or in other roles. We have 3,000 employees but we have become a tight team, and that is priceless. “I’m also beyond words when it comes to thanking the community for all of the support that they have provided for the hospital,” she says. “Every time we had a need, someone from the community stepped up to help, whether it was PPE or any kind of materials, we got what we needed almost instantly. We had hundreds of donations of everything from snacks for key departments to dinner for the ER teams, to monetary help. We have felt so loved and appreciated by our community and that makes it all worthwhile.”
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EDUCATION COLUMN Helping Children Develop a Sense of Self Through Quality Early Childhood Education By Samantha Wingate, Director of Admissions and Advancement
P
reparing children properly for a seamless transition into primary school begins with quality Early Childhood Education. At this transformative stage, many think the benefit of an educational program is to help children familiarize themselves with pre-academic curriculum, but this isn’t the most significant impact it can have. A higher-level Early Childhood educational experience has the power to set children on a path towards understanding their own identities—and the identities of those around them. Supporting Pivotal Social Development Quality Early Education has a profound impact on children because their minds at this age are developing at an astounding rate. From birth to age 3, their brains are making over one million neural connections every second and will learn more than 80% of their lifetime knowledge and skills by the time they are five. That also means that every experience at this influential age, positive and negative, can have a lasting impact on the way their minds function. As they produce these crucial
connections, providing opportunities to interact with other children can pave the way for attaining sophisticated social skills, even at a young age. An early childhood education program is an effective way to grant children these impactful opportunities, offering the chance to make vital neurological connections in the context of playing, talking, and working with others. Constructing Self Identity Through Socialization Socializing regularly in a safe, supervised environment also gives children a chance to explore a valuable perspective other than their own: the perspective of their peers. It’s unlocking the ability to empathize and see oneself through another’s gaze that enables children to truly understand their own identity. Interacting with others, they recognize how their actions affect those around them, building an understanding of social cues that they’ll take with them as they continue to mature. The sooner they begin this social development process, the longer they’ll have to polish the socio-emotional and linguistic skills associated with these consistent interactions.
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Arriving Early & On The Right Track Conversely, depriving children of opportunities to learn about themselves and others can put them at a disadvantage—potentially delaying their pursuit of well-honed socialization skills and a sense of self. That’s why, at World Academy, we take great care in creating an enriching Early Childhood Education program where our youngest students flourish together. To learn more about what a high-quality Early Childhood Education can look like for your young one, please get in touch!
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NH Women Magazine / VOL 2 ISSUE 11
Written by Dr. Lisa Vuich, Owner of Renew Medi Spa
MEDICAL SPA | SPECIAL SECTION
TESTOSTERONE THERAPY FOR WOMEN -MYTHS AND MISCONCEPTIONSDr. Lisa Vuich is a graduate of Tufts University (1988) and Tufts University School of Medicine (1992). She opened Renew MediSpa in 2006 and has worked steadily since then to ensure that Renew MediSpa remains at the cutting edge of the latest advancements in nonsurgical aesthetics. She is a nationally recognized injector, a member of numerous aesthetic organizations, a Key Opinion Leader for several aesthetic companies, and a Master Clinical instructor for Specialty Med Training. She is board certified by the American Academy of Aesthetic Medicine and regularly instructs physicians and other providers on injection technique, platelet-rich plasma therapies and other aesthetic procedures through the Renew MediSpa Training Institute.
Most people when they hear the words testosterone supplementation will immediately associate it with the male physique, or with illegally obtained testosterone on the so called “black market” used by some in the fitness/ physique world to achieve greater than natural muscle gains. The reality is that testosterone is a vital hormone for not just men, but women as well and both men and women tend to be underdiagnosed when
it comes to testosterone deficiency. Most physicians, unless trained in Functional Medicine, won’t even check the level, and women don’t think to ask because they presume it is a male hormone or think that it is dangerous to take. So let’s review some of the Myths and Misconceptions surrounding Testosterone, abbreviated “T”: Bioidentical testosterone implants in the form of pellets have been used safely in women since 1938. In England and Australia, testosterone replacement has also been used in women for over 60 years. We have long-term data
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primary care physician first. If that person is not familiar enough with the science, you can contact us through our website (www.renewmedispa.com) or look for a functional medicine physician in your area. www. hormonebalance.org is another great resource.
showing the efficacy, safety and tolerability of doses of up to 225 mg in women, and even studies on higher doses used to for transgender patients have reported no increase in mortality, breast cancer, vascular disease or other major health problems. At Renew MediSpa, most of the women we treat with testosterone pellets are perimenopausal or menopausal. The most common benefits reported are improvements in mood and anxiety level, sleep quality, “brain fog” (mental clarity improves), hair quality, energy level, exercise tolerance, sex drive and vaginal lubrication. Placement of the pellets is into the fat pad at the top of the buttock in a 15 minute procedure repeated approximately every 3 to 4 months, and labs are checked twice a year. If you have questions about testosterone replacement, we encourage you to discuss them with your
Selected References: Glaser R, Dimitrakakis C. Testosterone and breast cancer prevention. Maturitas. 2015;82:291–5. Glaser, R., York, A.E. & Dimitrakakis, C. Incidence of invasive breast cancer in women treated with testosterone implants: a prospective 10-year cohort study. BMC Cancer 19, 1271 (2019) The Renew MediSpa Training Institute is in Derry, NH. For more information call 603-894-0070, or email lisa@renewmedispa.com
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NH Women Magazine / VOL 2 ISSUE 11
BALANCING WORK, HOME LIFE, HOMESCHOOLING & YOUR MENTAL HEALTH
DURING THE COVID-19
PANDEMIC
By Elyssa Ellis, Office of Strategic Communications, SolutionHealth Director of Behavioral Health at Southern New Hampshire Health, says, “For some women managing their behavioral health challenges has led to substance use. In some cases, overwhelming fear and worry about themselves and those around them can cause thoughts of suicide.” Symptoms of depression can include the following: • Feelings of sadness • Irritability • Hopelessness • Feeling worthless or guily • Withdrawal • Poor motivation • Trouble with focus • Suicidal ideation • Fatigue • Moving slower or quicker than usual • Appetite changes
The COVID-19 pandemic has redefined our daily lives. Our new normal involves juggling working at home (or putting in long hours on site for our essential workers), remote learning, and keeping up with our household routines, all while isolating from our social groups. How can parents do it all and still recharge their mental health? Experts at SolutionHealth, which includes Elliot Health System in Manchester and Southern New Hampshire
Health in Nashua, say it’s all about balance. Research from the Centers for Disease Control (CDC), show 1 in 10 women in the United States experience depression. Large national surveys found lifetime prevalence rates for anxiety disorders were 30.5% for women and 19.2% for men. Sarah Rocha, MD, a psychiatrist at Elliot Health System, says increased stress related to the COVID-19 pandemic may worsen an existing problem or precipitate new-onset mental health problems. “The pandemic and response to it have led to more
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Symptoms of anxiety can include the following: stress and worsening mental • Irritability health, as well as more respon• Avoidance sibilities for parents. There have • Worrying been some research studies • Restlessness published that indicate much of • Sleep disturbance the increased work is being done • Appetite changes disproportionately by women,” Dr. • Difficulty separating Rocha says. from caregivers • Moments of intense fear Women who are pregnant or • Trouble with focus postpartum are also facing unique • Fatigue challenges, as isolation from support may increase the risk Other symptoms include for postpartum depression, and headaches, gastrointestinal concerns about health and safety difficulties, excessive sweating, can be particularly debilitating increased urination, and muscle for women with anxiety in the tightness. postpartum period. To help women take care Michelle Gardner, RN, Unit of themselves and maintain
healthy behaviors during this pandemic, both experts agree women should manage expectations, practice saying “no,” and foster self-compassion. “How women managed their life before the pandemic may influence how they manage their new life during the pandemic. Having healthy coping skills is imperative to building resilience and caring for yourself,” Gardner explains. Women can do this by taking a break and letting go of guilt, celebrating all accomplishments, prioritizing and being creative in multi-tasking, creating a schedule, communicating and collaborating, and carving out time for themselves for both their physical and mental health.
“When working with families, I often reference those safety instructions on an airplane flight to put your own oxygen mask on first. You aren’t much help to anyone if you are unconscious! In order to care for others, your own needs must be met,” Dr. Rocha says.
and seek support when needed,” Gardner explains. Their biggest reminder to women: don’t wait if you need help. There are resources available through various means such as crisis lines, local providers, and emergency services.
Women should also recognize the signs and symptoms of behavioral health changes, know the facts about how to stay protected from COVID-19, and avoid excessive alcohol and drug use.
“If you are experiencing worsening symptoms of depression, anxiety, substance abuse, or any other mental health problem, reaching out to a health care provider is a sign of strength and may be the best thing you can do for yourself and for your family,” Dr. Rocha says.
“As a mother with school age children and an essential full-time employee, finding a ‘new’ balance has had its challenges and rewards. I think that it is important to remember that we are not in this alone—we are all in this together. This creates opportunities for people to draw on their strengths, find new coping skills,
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