Better Health - July 2020

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Better Health D

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PROSTATE HEALTH: Interview with Dr. Alexander Berry, D2 TRAVEL: Rome is ready for visitors, D3 LIVING: Jazz in July, D7

| SUNDAY, JULY 19, 2020

Preparing for a

new

school year

as COVID-19 precautions mean

‘no business as usual’

By Anne-Gerard Flynn

Special to The Republican

For Dr. John O’Reilly, chief of the division of general pediatrics at Baystate Medical Center, back-to-school physicals have always been about more than ensuring his young patients are current with year-to-year immunization requirements.

The long-time pediatrician uses these sessions to keep updated on patient lives, and especially so this summer as the many lifestyle disruptions and health care concerns ushered in this spring by the coronavirus disease 2019 pandemic continue until a safe vaccine can be developed and administered against the new respiratory virus first identified in China earlier this year and known as SARS-CoV-2.

“The pandemic has made it clear that there will be no ‘business as usual’ for the new school year,” said O’Reilly who sees patients at Baystate’s High Street Health Center.

Many of O’Reilly’s patients started with him as newborns and he was asked here what impact he sees from COVID-19 on them and their families as they prepare for a new academic year shaped by infection control precautions to reduce community spread of the novel virus.

How much are families talking to you about the impact of COVID-19 on their lives?

I bring up the topic in every patient encounter that I have, whether that be on the phone, on a video visit, or in person. COVID-19 has created great stress on many levels for everyone. Every patient and every family is unique, and it is important to understand how everyone in the family is dealing with that stress to begin to care for any individual patient.

How anxious are families to have their children back to attending school in the fall? Or, are they worried about exposure risks to their children and family?

Many parents are anxious about their children going back to school. Like many aspects of the pandemic, parents are trying to find the proper balance between their desire to see their children get a good education and their need to keep their children safe.

Parents know that for many school-aged children the last few months of webbased home schooling has not provided the educational, experiential and social experiences that children need to grow and thrive. Parents want their children to have the full experience of school, but they want to do that in a safe manner.

As a pediatrician do you feel it is better for children to be in school if community transmission appears to be low?

provide outreach to families, but food insecurity persists despite their best efforts.

With parental layoffs or furloughs family income decreased which increases food insecurity when money for food did not last all month.

The pandemic also had an impact on food banks and other community sources for food for our most vulnerable families. Community agencies are working hard to fill in the gaps, but it will take everyone’s advocacy and action.

Infants, children and adolescents need adequate nutrition to grow and develop.

Food insecurity has a delirious impact on the physical and psychological development of my patients and prevents them from reaching their full potential.

How have you been reaching out to parents to continue to bring in their children for checkups and vaccinations?

Are kids falling behind

in getting their checkups?

Children of all ages are falling behind on their immunizations.

COVID-19 has for the most part only produced mild illnesses in children. I fear that the drop off in well-child visits and vaccinations due to fears of COVID-19 will create a far more devastating outbreak of vaccine preventable illnesses such as measles, whooping cough (pertussis), and meningitis.

I have not seen any of my patients have severe cases of COVID-19, but I have seen over my career many children die and become permanently disabled from those vaccine preventable diseases.

To prevent such a catastrophe, we have been reaching out to our families to come into the office to get their child’s well child visits and vaccines. We have put in great efforts to reassure parents that it is safe to come into the office.

We have changed sched-

A good school experience provides the academic, social, and experiential, that is, band, theater, sports, art, that lead to maximal personal and brain development.

Our goal should be to create the conditions that will allow our children to go back to school safely.

What food insecurity are you seeing among your patients?

The COVID-19 pandemic has highlighted the great disparities in food access, especially in Springfield.

The majority of our patients qualified for subsidized or free meals at school, and that guaranteed them access to two nutritious meals a day.

I applaud the Springfield school and city’s efforts to

Dr. John O’Reilly, chief of the division of general pediatrics at Baystate Medical Center, sees patients at Baystate’s High Street Health Center. (PHOTO BY ANNE-GERARD FLYNN, SPECIAL TO THE REPUBLICAN)

ules and patient flow so that we can ensure social distancing and separation of patients coming in for sick or well visits.

We have enhanced cleaning protocols to ensure that all spaces within the clinic are safe.

We screen everyone prior to entering the clinic for fever and COVID symptoms, and require everyone in the clinic to wear masks and do frequent hand washing.

Many children have lost grandparents to COVID-19. Are you seeing the impact of this loss on your patients and their families?

Many of our families have lost friends and relatives to COVID-19, and that has had a traumatic impact on many of our patients.

The loss of grandparents may be particularly hard because they often played an integral part in a family’s daily life and had close connections to their grandchildren. The trauma is doubly compounded since both the parent and the children in that family have suffered a great loss and they may be experiencing grief differently.

Social distancing has prevented the usual community and ritual supports that we need to get through difficult times and that isolation only compounds distress and grief.

We have an integrated behavioral health team in our clinic who reaches out to families experiencing trauma and loss of any kind and helps arrange supports for both parents and children.

What is the biggest emotional impact the pandemic is having on children and does it differ by age group?

I think we all have experi-

enced some degree of stress and anxiety during the pandemic. The same way each adult may process his or her stress differently, individual children will experience their stress and anxiety differently based on their temperament, their environment and their developmental stage.

Younger children interact with the world in a more concrete manner, and may react to stress through their behaviors such as sleep difficulties, irritability, and tantrums.

Parents should treat those behaviors as a sign that their child is stressed and not as “being bad.”

Older children and adolescents have more abstract thinking and may have more existential concerns, that is, what will happen if...

For all parents the most important thing they can do is let their children know that they are safe and that they are loved. Parents who are concerned about their child’s behavior should contact their pediatrician’s office.

How are you trying to talk to them about coping with the academic year ahead?

Pediatricians are used to giving their “August speech” about getting kids ready for school. We always talk about getting kids into sleep and daytime routines that will get the kids ready for the school day schedules. Getting kids eyes off of screens and into books is always part of the speech.

Each age groups gets specific advice about how parents can prepare their student for the upcoming year. Now we will be incorporating pandemic safety routines such as frequent hand washing, social distancing, and mask wearing into the speech.

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Pediatricians have always made sure that the returning athletes have been getting their bodies ready for their fall sport. After a few months of lounging have they been doing their stretches and their daily exercise program to get ready for a successful season?

Prostate plays

important role

We will now need to be sure that after many months of a layoff do all our students have their brains and bodies ready to learn? Are they doing some reading and writing daily?

Have they used their YouTube time to look at any of the math or science videos for their grade?

The brain is the most important part of any student’s body, and it needs to get in shape for the school year ahead.

in men’s health

By Anne-Gerard Flynn

prostate cancer in a man with an elevated PSA. Typically Prostate cancer is among if a PSA is significantly elethe most common cancers in vated, I would recommend a men, along with skin, lung, prostate biopsy to check for and colorectal cancer. prostate cancer.

Would you explain the Dr. Alexander Berry, a For men with mild PSA pros and cons around PSA Holyoke Medical Center elevation a DNA urine test screening? urologist, was asked about will help guide a decision to All men with a prostate the role of the prostate gland get a biopsy. produce PSA. PSA can and what men should know Unfortunately, at this time increase in response to inabout being screened for there is no way to confirm if fection, changes in prostate Dr. Alexander Berry prostate cancer. size and cancer. As men age a man has prostate cancer the PSA typically will slowly without doing a prostate What is the role of the biopsy. rise as a result of the slow prostate gland in the male It is important to rememincrease in prostate size due ination. Doctors are lookreproductive system and to BPH. Because PSA can rise ber that prostate enlargeing to tell if there are any how important is this role due to reasons beside cancer ment is a benign reason for significant changes such as in terms of fertility as well this means it can be difficult elevated PSA. This is more increase in size or feeling a as overall health? to determine what the cause common amongst older The prostate plays an imchange in consistency. of a PSA rise is without doing men and so the majority of portant role in men’s health.

It’s important to underprostate biopsies that are a prostate biopsy.

The primary function is to stand that many men who PSA screening at an appro- performed will show BPH produce 95% of the fluid that have prostate cancer will priate interval can help your rather than cancer. occurs with ejaculation. This have a normal prostate on doctor decide if you have a fluid carries sperm to the examination.

Would you explain the normal pattern of PSA rise, cervix and provides energy in or if the rise may represent a approach of active surthe form of sugar that allows What is the Prostate-Speveillance for men with a cancer. the sperm to complete their cific Antigen (PSA) blood cancer considered slow What we do know is that “fantastic journey.” test designed to check and growing and whether you 95% of prostate cancers in The activity of the prostate what would be considered men aged 55 or older have a recommend it? is controlled by circulating a normal reading for the Active surveillance is a PSA of 4.0 ng/ml or greater. testosterone. presence of this protein in form of prostate cancer manThe difficulty is that many As a male ages the prostate the blood? agement that is commonly men with normal enlargebecomes more sensitive The Prostate Specific Antiment also have a PSA greater used. to testosterone and will gen (PSA) is a protein that is Based on the PSA level, than 4.0 ng/ml. keep growing. This is often released by the prostate and the type of prostate cancer, called BPH, benign prostate found in blood. and the volume of prostate What do you advise your hypertrophy, and can lead to The protein is continuously patients in terms of being cancer that an individual has common symptoms such as released at a low level by active surveillance might be screened for prostate weakness of stream, getting normal prostate tissue. If the an appropriate management cancer? up at night to void, and feelprostate tissue is infected, option.

My advice to men is that ings of incomplete emptying. inflamed or altered in other Men who have low risk, low you want to start to get your ways the level of PSA found volume prostate cancer can first PSA check around 45 in the blood is increased. years, then again at 50 years. be closely monitored with a When would a patient Cancer cells cause damBased on your family history combination of imaging, PSA begin to get a digital rectal age to the prostate and are and the pattern over time of testing and genetic evaluaexam as part of a wellness strongly associated with a tion rather than undergoing your PSA levels you should exam? What can such an rise in PSA. prostate cancer therapy. have your PSA checked at a exam detect?

For men aged 55 and under Active prostate cancer therregular interval between the Typically, prostate exams a normal PSA is considered apy carries a risk for erectile ages of 50 and 75 years. are recommended to all men to be 2.5 ng/ml, for those 55 In addition to a regular PSA dysfunction and changes aged 50 or older. There are years or older a normal PSA in urinary continence. For check your prostate should situations where a prostate is around 4.0 ng/ml. There this reason, many men with be examined with a digital exam would be recommendmay be concern at lower levrectal exam on a yearly basis. favorable prostate cancer ed in younger men. Most els of PSA if this represents a findings prefer active surveilcommonly these would be jump from a stable baseline lance.

Is a biopsy always men whose father or uncle trend. needed to confirm had prostate cancer at a Two years ago, the United When would surgery or cancer when there is younger age, and those men States Preventative Services other options be advised an elevated PSA level? who have prostate sympTask Force changed its for prostate cancer and There have been a numtoms. recommendations on who what risks do they carry? ber of new different urine A digital rectal exam is among men between 55 to 69 markers that are available Prostate cancer therapy a screening type of examshould have the PSA blood to help determine the risk of options include surgical removal and a variety of different forms of radiation therapy.

Surgery is typically offered as an option to younger men in the setting of higher volume or higher risk prostate cancer. Genetic evaluation of the prostate cancer biopsy and imaging findings on MRI can help determine if the prostate cancer is confined to the prostate itself.

In those situations, surgery can result in long term, durable control of the prostate cancer.

In the setting of older patients, those with prostate cancer that has just escaped the prostate or those with very high-risk disease, radiaIntroducing BHNTeleCare. tion treatment offers a better Connecting individuals and families with therapeutic supports balance of control versus by phone or through a secure internet connection. complications such as erectile dysfunction and changes to urinary performance.

Call today for information or to schedule a session: Special to The Republican

test, saying this is a decision between a man and his doctor based in part on family risk factors and preference.

We’re Here for You.

413-BHN-WORK (413-246-9675) 24-Hour Crisis Line: 413-733-6661 www.bhninc.org

In general, are most prostate cancers caught early today through screening and what are long-term survival rates?

Long-term survival with prostate cancers caught

through a screening program are generally very good.

For the majority of prostate cancers that are found at a relatively early stage treatment means there will not be a significant impact on life expectancy.

Do you see other tests being introduced any time soon in terms of screening for prostate cancer?

PSA testing and regular digital rectal exams remain the standard way to screen for prostate cancer.

Doctors are always trying to develop new ways to help screen for prostate cancer.

There are urine DNA tests that can help evaluate the risk for prostate cancer, and we know that MRI imaging can help increase the accuracy of prostate biopsy.

I incorporate both of these into my evaluation of a man for prostate biopsy, however neither technique is likely to be used in the primary care setting in the near future.

What are the most common conditions and their recommended treatments that affect a man’s prostate health besides cancer?

The two most common prostate issues that are seen are prostatitis and benign prostatic hypertrophy (BPH).

There is not very much a man can do to prevent BPH. This is determined by a combination of age and genetics. Prostatitis is an inflammation of the prostate that can occasionally occur.

We are uncertain as to how it happens but regular fluid intake and bladder emptying seem to reduce its frequency.

Overall prostate health is maximized when prostate irritants such as coffee are taken in moderation.

There are pros and cons around prostate massage.

Have you had many inquiries about it from patients?

What do you advise?

Prostate massage exists in two main forms therapeutic and stimulatory.

Therapeutic prostate massage is occasionally used for men with recurrent prostatitis and pelvic floor pain.

There are specially trained physical therapists in the region who will perform pelvic floor physical therapy and targeted prostate massage as part of a therapeutic program to treat chronic pelvic floor pain.

Every now and then patients do ask about stimulatory prostate massage.

There is a percentage of men for whom prostatic massage can be found to be stimulatory. The exact percentage is uncertain but appears to be around 10 to 15%. There appears to be minimum risk as long as this is performed in a gentle fashion.

How much do you talk with kids about wearing masks and social distancing? What do you say?

Again, it depends on their developmental stage. For the youngest kids their mask may be part of their superhero costume with magic hand sanitizer and force field social distancing.

For older kids we can add a little more of the science, but address the social issues that are important developmentally for someone finding their identity and their group.

I think finding ways for children to be involved in their precautions such as helping design or draw on their masks may help empower them and make it more likely they will comply with the pandemic precautions.

Are you seeing any unexpected increase in any certain health conditions in kids?

Quarantine and social distancing have really limited the usual range of other infections such as viral illnesses and strep throats that usually fill our office.

I think we are seeing an increased number of patients who are experiencing stress and anxiety that manifests as a wide range of behaviors. It runs the gamut from kids who won’t go to bed and kids who won’t get out of bed or out of their rooms.

Parents should reach out to pediatricians with their behavioral concerns just as they would their physical concerns about their children.

Behavioral health issues like most physical health issues are best treated when identifying issues early and getting the proper treatment as soon as possible.

What advice are you giving parents in terms of keeping up with their children’s medical needs?

Parents and pediatricians are partners in keeping children healthy and thriving.

Good communication and good teamwork are an important part of any partnership.

Each child has unique needs and parents should feel free to contact their pediatrician’s office if there are any concerns about either acute illnesses or chronic conditions such as asthma.

Pediatricians are ready to help keep children healthy with needed vaccines, medications, and either in person or virtual visits.

Are you screening for multisystem inflammatory syndrome in children?

Yes. We have been trying to educate parents about the symptoms of MISC-C, and we have been asking parents to call in with any concerns.

Our triage nurses are aware of the syndrome and ask about symptoms when they speak to parents. Luckily it is a rare complication of COVID-19 but we know early detection and treatment are key to successful treatment so we are on alert to detect it.