COVID-19 ‘overshadowing’ chronic pain, elective surgeries in NJ

As hospitals and medical teams have been uprooted from normal routines to meet the critical demands of COVID-19, elective surgeries have been postponed in New Jersey until further notice.

That leaves a good deal of patients stuck in a very difficult situation, according to Belinda Anderson, director of the Institute for Health and Wellness at Monmouth University.

The pandemic is "completely overshadowing what’s happening in the general healthcare arena, so other very serious issues, like the opioid crisis and other chronic conditions — heart disease, cancer — we're kind of no longer thinking about those; how serious they are, but also how people are managing those situations," Anderson said.

That's is not to minimize the urgency and pervasiveness of the novel coronavirus, which has reached more than 88,000 positive cases based on test results and more than 4,300 deaths since March 10 in New Jersey.

“Right now, my entire department of surgery is essentially redeployed to take care of COVID patients and other duties around this pandemic,” James Guarrera said. Guarrera is chair of the Department of Surgery for Rutgers New Jersey Medical School and also chief of Surgical Service for University Hospital in Newark.

Guarrera said the first clear signs of the pandemic, medical professionals have "worked very, very hard to come up with contingencies for patients."

He said his own department assessed their surgeries and anything emergent, considered to save life or limb, has not been impacted in terms of scheduling.

Guarrera said medical professionals have been working with roughly three subsets of care, with the last being "purely elective" — where a delay of over a month was unlikely to cause any major complications.

There has been concern, he noted, with the limited blood supply, as blood donors have not been following regular schedules, as well as nursing staff available to care for surgical patients in the Intensive Care Unit, in addition to the availability of ICU beds and equipment, such as ventilators and personal protective equipment.

Guarrera said sometimes, he doesn’t think patients know they are trying to advocate for them, as well.

“I’ve had patients that were frustrated that surgeries got canceled, and I feel like they didn’t really have the full understanding that during the pandemic we were canceling it not only because we had other things to do, but we were canceling it for their safety," Guarrera said.

Guarrera continued the reasoning is "we don’t have the capacity to do it safely and properly, so why would we want to provide a surgery that isn’t 100% up to our standards?"

He said he also "wouldn’t want a patient to have a perfect surgery but end up on a ventilator because they were exposed" to COVID-19 by another patient in the hall, as the virus is so infectious.

So what about patients dealing with chronic pain, now switching gears from an initial plan and waiting for surgeries to be rescheduled?

“Most people have a certain amount of fear around a surgery to begin," Anderson said, adding patients often get themselves "sort of psyched up" for a certain day that that’s going to happen. They look forward to having the problem rectified.

She continued that suddenly being derailed and then having to cope with their ongoing condition puts people under stress and likely causes some level of depression.

A lot of people are stuck not only managing their illness, but now also coping with the psycho emotional aspect of being delayed, as well as the uncertainty of knowing when it could potentially be rectified, Anderson said.

She said anyone dealing with such anxiety or depression, or such issues observed by a patient's family member, should consider the benefit of reaching out to a mental health professional for a telemedicine session to help.

Anderson said an added challenge for pain-related conditions is the ongoing opioid crisis and associated restrictions with prescriptions, which leave less choices for types of medications to manage chronic pain, as well as the issue of potential addiction or accidental overdosing by a patient.

Based on the backlog of elective cases from the past month, Guarrera said it’s anticipated that when they do start up, surgical teams will probably be "working 7 days a week and late into the night."

He said medical centers are now trying to arrange for contingency surgical staff to accommodate that.

Guarrera, who also heads up the liver transplant program, said he also has a number of patients who don't have the luxury of waiting another month to undergo their needed, life-saving surgery.

So, his team is working on how to best isolate such high-risk patients from the rest of the hospital amid the continued pandemic.

For patients dealing with the pain or anxiety of having an ongoing problem that they can’t yet resolve, Anderson said there are a whole range of activities made more accessible with modern technology to help manage those issues.

She said more organizations and individuals are making services available for guided mediations, yoga and breathing exercises to help people calm themselves and try to disconnect from the immediacy of their situation.

Anderson said the basics of a healthy lifestyle also are a lot more powerful than people think — so things like sleep, good diet and getting outside and even spending time with pets, can go a long way in boosting mood and help to feel more "balance" amid the chaos.