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Virus puts nonemergency health care on hold

If you need to see your primary care physician, his or her office should be up and running.

But if you were scheduled to have your teeth cleaned, your eyes checked, your spine adjusted, cataracts removed or were gearing up for a routine colonoscopy, you’re going to have to wait.

Many medical providers ranging from dentists to eye surgeons to chiropractors have been restricting their practices for the past three weeks in an attempt to avoid spreading the COVID-19 virus.

In some cases, certain procedures are banned for the next three months – unless delay would seriously affect the patient’s health – under an order issued Wednesday by Gov. Michelle Lujan Grisham designed to conserve supplies of protective gear.

Some providers have closed completely, while others have restricted clients to emergencies only.

Psychiatrists, psychologists and mental health counselors have started using teleconferencing to talk with patients rather than meeting face-to-face.

Physical and occupational therapists have been making individual decisions on how to treat patients, in some cases using online video calls.

And patients themselves are weighing whether they want to be in close contact with providers based on their own health and health risks if they caught the COVID-19 virus.

The governor’s “stay-at-home” order is scheduled to expire April 10. There has been no word on whether an extension is under consideration.

Restricted procedures

Therapists, chiropractors, acupuncturists and optometrists are not covered by the governor’s latest order, but many have restricted their practices until the pandemic runs out of steam.

State licensing boards have advised providers to follow protocols from the Centers for Disease Control and Prevention when treating patients in their individual specialties.

But dentists and doctors performing surgeries, including joint replacements or eye surgeries, are faced with a new set of restrictions designed to preserve stockpiles of personal protective gear – masks, gowns and gloves – used by doctors, nurses and medical technicians working with people who have caught the virus or testing people who may have contracted it.

Lujan Grisham’s order shuts down all but essential surgeries for the next three months.

It dovetails with her “stay-at-home” order and school closures implemented in an attempt to limit the spread of coronavirus and overwhelming New Mexico’s hospitals.

It applies to hospitals, ambulatory surgical facilities, dental, orthodontic and endodontic offices statewide.

Dr. Mary Rose Twohig

The order bans “nonessential surgeries” and other procedures for the next three months except in cases in which a delay would put a patient’s health at risk.

The impact on patients and providers is far reaching.

“Under the Governor’s edict, we do not do any dentistry since so much of it is elective and invasive,” said Dr. Mary Rose Twohig, president of the Albuquerque Dental Association.

Dentists have been dealing only with emergencies and will continue to do so. An abscessed tooth would be considered an emergency. Getting your teeth cleaned isn’t.

“People should call your dentist and talk about the problem to determine if it is an emergency,” said Twohig, who has closed her office. “Dental offices have an emergency telephone number. We’re trying to keep people out of the emergency room, they are overrun as it is.”

Many dental offices had already canceled routine visits prior to Wednesday’s order in order to reduce the potential exposure and spread of COVID-19 to patients, dentists and staff following the recommendations of the American Dental Association.

Primary care

If you step on a nail, you can and should see your family or primary care doctor for a tetanus shot.

None of the state orders or advisories from the CDC restricts primary care physicians.

They are seeing patients, although many are putting more time between patients to keep visiting rooms less crowded.

“But if you want a nose job, you’re going to have to wait,” said Annie Jung, executive director of the Greater Albuquerque Medical Society. “Unless you need your nose reconstructed because of an automobile accident; that will get done.”

People who believe they have symptoms of COVID-19 should call ahead before going to their doctor’s office. Many primary care physicians have the ability to triage a patient for the virus in their parking lot to keep them from coming in contact with other patients.

But patients with other medical problems should be able to see their doctors.

“Doctors understand this is about keeping stockpiles of PPE (personal protective gear) as high as possible for the duration of the COVID pandemic,” Jung said. “The order is about not filling up hospital beds and keeping them open and available for COVID patients.”

A routine colonoscopy will be postponed, she said, but a heart patient in need of a stent or other procedure will get it.

Eye care

Dr. Rachel Davis

 

Ophthalmologists are medical doctors who perform a number of procedures, including surgery.

Dr. Rachel Davis, president of the New Mexico Academy of Ophthalmology, said most eye surgeons started putting nonessential procedures on hold two weeks before Lujan Grisham’s latest order based on the advice of their national academy and the CDC.

“In a normal week, I might do 10 to 12 surgeries for glaucoma. This week, I did one,” said Davis, who is director of Glaucoma Service at the University of New

Mexico Health Sciences Center.

Patients whose conditions are stable using medication can have their prescriptions renewed by telephone or online without an office visit, while doctors will still be able to operate on patients who are in danger of losing their sight because of conditions like glaucoma, detached retinas or other eye traumas.

“Patients with glaucoma and cataracts tend to be older and higher risk for the virus, so there is no need for them to come into a waiting room unless it is absolutely necessary,” Davis said.

Patients who have had recent surgeries do need to come into the office for a checkup.

“Glaucoma patients have to have the pressure in their eye measured,” Davis said. “That requires a close examination, but we’ve added safety shields to the equipment. It has changed the way we practice.”

Most cataract removal surgery falls under the governor’s order, although it had already been cut back.

The normally bustling Albuquerque Ambulatory Eye Surgery Center in Northeast Albuquerque had a sign dated March 19 that said it was closed to implement additional protocols for safety of patients and staff. Next door at Eye Associates of New Mexico, a sign on the door said services were being limited to “retina injections, pre-operative visits, post-operative visits and urgent eye issues.”

Chiropractors

Optometrists perform eye exams and other vision tests, treat some vision problems and prescribe eyeglasses and contact lenses. All that requires close contact by optometrists and staff with patients, who are in close contact with equipment used in exams.

“Some doctors have closed in some cases due to the doctor’s own underlying health issues or out of caution for family, staff and patients,” said Richard Montoya, executive director of the New Mexico Optometric Association.

“Some are seeing patients for emergencies, such as the patient gets a piece of metal in their eye or conjunctivitis (commonly called red eye),” Montoya said. “We need to keep the emergency rooms clear for COVID-19 patients.”

Chiropractors are not covered by the latest order from the state, although some use protective gear.

But the COVID-19 virus is closing many offices and restricting care for many offices that are open as chiropractors follow advisories from the CDC and the World Health Organization.

“I’ve had five calls today from people who made decisions to close their practice,” said Ryan Rouse of Farmington, president of the New Mexico Chiropractic Association. “They are very tough calls that put them, their family and their staff in a financially precarious position.”

Rouse said the association didn’t have numbers on closures, but that many have or restricted their practices to emergencies. Some of those decisions to close offices are based on the health and age of the chiropractor, Rouse said.

Rouse, of Farmington, has reduced his practice by 75% over the last few weeks and is only seeing emergency patients.

Rouse said he is handling only emergencies and has been wearing protective gear. He advises other practitioners to do the same, because “you don’t want to become a vector for the virus.”

Rouse said his last emergency patient “got rammed and trampled by a steer.”

“My office can take X-rays,” Rouse said, “so we made sure nothing was broken so he didn’t have to go to the emergency room.”

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