Nothing could be more pressing on the minds of all of us than the Covid 19 pandemic. Our clinic has been closed to live visits since March 16. We are now doing all virtual visits for both new evaluations and follow up visits. There has been plenty of institutional IT support and direction in these efforts.
Working from home has certainly been different. I have a console like something out of Star Trek, using multiple devices: Iphone for the virtual visit software, Ipad for the secure VPN medical record, and my desktop for email communication. Apart from some technical glitches on the client’s end, it has been going pretty well. I made a little sign to show them that says “Let’s try again, I cannot hear you. Call back in”, which usually solves the problem.
Interviewing has been fairly straight forward, though I do spend some time talking to walls or window curtains! I can even do a partial neurologic exam, which makes us all laugh. Everyone seems happy to keep their appointments, to keep some normalcy during this very abnormal time.
There is definitely some anxiety in the community, expected under the circumstances. But there is less distress than I might have thought. Kids are just starting to get remote learning schoolwork and negotiating the system. Some teens who had missed a lot of school are using their time to get caught up under less stressful circumstances. They are also enjoying sleeping in later. Most of the kids and teenagers are managing fairly well, though often admit to being bored, missing their friends, just like we are experiencing.
The change in headache/migraine patterns is interesting and in some circumstances, diagnostic. Kids who had been having headaches every single school day and missing many days are now reporting few headaches. They may have more environmental stress around the pandemic, but no real school stress. That has lead to some interesting conversations with parents about the direction of care and interventions.
In addition to my usual visit topics, I have been focusing on the headache-healthy lifestyle during this disruption. Kids and teens with migraine especially need to keep to as normal a schedule as possible, with regards to meals and sleep. Hydration is something that falls off the radar, as the usual cues they use during a school day are gone. We focus on how to create a new way to achieve adequate hydration, a new visual or strategy to use. I have been suggesting filling an empty 2 Liter soda bottle with water (66oz), and drinking from it all day, as a way to stay on track. When it is empty, you have reached your goal.
I also talk about exercise and how to incorporate it into the day, with limited options. It is too easy to sit around, doing school work, watching Netflix or playing video games to pass the time. They can always go outside for a walk or run around the yard with the dog, use any home exercise equipment, create competitions within the family, anything to get moving. If the weather is bad, they can run up and down the stairs, do jumping jacks, or an exercise video on YouTube. It’s a great stress management tool for everybody.
Another stress management strategy I suggest is that they down load the WebMAP Mobile app for chronic pain for teens (see my review in the last blog post). They now have time to explore the app and do the CBT exercises, which many would benefit from but either did not have time or resources to make happen. Seems like a good use of this downtime.
I do have a group of patients who are a bit distressed though, and these are my patients who have been undergoing either occipital nerve and trigger point injections or Botox injections for their chronic headaches. Many of them are college students, who have had their year completely upended. I managed to get a number of them in before we closed to elective procedures but many are due in the next 1-2 months. They are quite worried about how they are going to manage if their migraines get bad again. (Speaks to the effectiveness of the interventions, especially Botox).
We talk about all the things they should be doing to mitigate not having the procedure, all the headache-healthy lifestyle habits we always talk about. Reinforcing the daily schedule, good sleep, diet and hydration and getting exercise. If they are feeling too stressed, we explore their stress management strategies, and any tweaks to make it better. I am thinking of my patient with anxiety, migraine and Lupus who is stuck out of state because a family member has tested positive, and she is at risk, scary situation.
Despite not being able to physically be with our patients, we can still offer support and guidance. They know we care about them. And always reinforce the personal safety guidelines, wash those hands, stay home, think positive thoughts for themselves and the community around them. Stay safe!
HeadFirst PNP 