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Coping with Coronoa Virus While in Recovery
Listen in as Bennet Davis, MD discusses the best ways to cope with Coronoa Virus while in recovery.
Featuring:
Bennet Davis, MD
Bennet E. Davis, MD, is the director of the Pain Recovery Program at Sierra Tucson. He is board certified in anesthesiology and pain medicine. Dr. Davis completed his undergraduate work at Stanford University in Stanford, CA, and received his medical degree from Case Western Reserve University in Cleveland, OH. He then trained in orthopedic surgery and anesthesiology at the University of New Mexico and University of California, Irvine. He completed his fellowship in Manchester, England, after finishing residency training. He is involved in organized medicine as past president of the Pima County Medical Society, and is active on a national level in teaching as medical director for CHC Pain ECHO, a telemedicine teaching program for primary care providers across the nation. He serves on numerous advisory boards for health policy. His latest article, “A New Paradigm for Pain?” was featured in The Journal of Family Practice and provides an updated definition of pain. Transcription:
Scott Webb: So for people in treatment from drug and alcohol addiction and behavioral health, what are the steps to now coping with Coronavirus while in recovery? Let's find out what Dr. Bennet Davis, Director of the Pain Recovery Program at Sierra Tucson. This is Let’s Talk: Mind, Body & Spirit by Sierra Tucson. Sierra Tucson- Ranked #1 Best Addiction Treatment Centers 2020 in Arizona by Newsweek. I'm Scott Webb. Dr. Davis, thanks so much for being on during this worldwide pandemic, can or how do people access the mental behavioral health care they need?
Dr. Davis: You know, there's a wide variety of people who access the system. There are people with no computer access, no transportation, no insurance. And for them it's been pretty tough. And the Public Health Departments in all the localities around the country, including Tucson area are working on that. For people that are in the system, what's happened is a really rapid transition to tele-health. Thank goodness. You know, and like in five days we saw the country transition to tell a behavioral health. And so people in the system are able to still by and large connect with their psychiatrist, psychologist, with the system I've been calling actually made some calls to New York to find out if the behavioral health providers that I know back there are able to connect with their patients. And by and large they're pretty happy with it. They still are. Since you bring up the issue of, you know, accessing, I'm going to make a pitch for two nonprofits that have really good websites, if that's all right. One is NAMI and that's the National Alliance on Mental Illness. If people just search that NAMI, on their browser, they'll pull up the very landing page now says resources during COVID. And there's another group that the ACEs Collaboratives around the country. And Arizona the website is azaces.org. But if you were to look up ACEs Collaborative or ACEs Coalition, you'll find your own States. Most States have this. In Arizona as in most of the other States, as soon as you get to that website again, here are, the landing page will have resources for dealing with COVID. And that website really focuses on kits on how to sort of trauma proof your kids about this whole thing, how to present it. They even have like little coloring booklets that you can download for kids to talk about COVID with a little virus character on the front. So those are really good resources for people that are struggling. And of course there are hotlines for each locality as well.
Host: Those are great resources and as you say, for people who are already in the system, they've got a little bit of an advantage there, but there are options available if this is the first time or if people are, you know, just trying to play catch up due to shelter in place. So are the residential facilities still open? And if so, why?
Dr. Davis: Yes. For people that aren't familiar, there are outpatient behavioral health clinics. You can go in and see a psychologist or a doctor, go to group therapy, that sort of thing and go home. Then there's another level of care that we call residential. Then above that there's care for people are really struggling, really acutely, suicidal, psychotic, that sort of thing. And that we would call inpatient care. So the residential facilities exist for the group of people that need daily observation, daily visits with healthcare providers. And a safe environment need to be watched pretty close but don't necessarily need that really high level of care. And it's kind of like the medical system, you know, there's people who still need to go to the emergency room of the hospital right now. We'd rather not. But if someone's having chest pain or they have appendicitis or a pneumonia or something like that, they're going to need to get into the hospital. So there's just like in medical healthcare and behavioral healthcare, there's a population of people that need to get into a higher level of care than we can deliver outpatient. So the situation really is no different before the virus or after.
Host: You know, just thinking about it, you know, of course a shelter in place and quarantining is you know, the mandate. If you will, but that doesn't change what people need. People have needs. People have, you know, physical and mental needs. And it's good to know that you're trying to, you know keep things as normal as possible for people business as usual.
Dr. Davis: Right, right. We can't close our hospitals, we just can't do that.
Host: Absolutely not. Right. So speaking, you know, just in general, how has your facility adapted to Coronavirus and COVID-19. What changes have you made?
Dr. Davis: So rapidly. Very rapidly. A lot. The bottom line is that in our facility, as in the others that I'm in touch with, you know, we follow the CDC and state health department guidelines. I know that our medical director and leadership are in contact with the State Health Department here in Arizona very frequently almost on a daily basis to make sure we're in lock step with what's going on with the State. The, you know, the most important thing is, is to understand a little bit about how infections get going. Infectious Diseases get into our population, not with people coming across borders. There's been a lot of focus on that. That's actually, not the most important thing. When people get sick with an infectious disease, what do they do? They go to the doctor. That is what we would call in Public Health, the usual portal of entry of an infectious illness into our communities. They go to the doctor and if the doctor's office or the facility isn't prepared to recognize and act appropriately, when someone comes in looking sick with an infectious disease, then it can spread. You know, the receptionist can catch it, the Doc can catch it if they're not careful. And then they spread it within the clinic and within their families. And so it goes. So it's really key that facilities, Doctors offices and facilities like residential behavioral healthcare, like where I work really are dotting their I's and crossing their T's.
So what we've done is we've limited access to our, we used to have family weeks. We do those virtually now. We don't have people coming in and getting tours, things like that. And we've decreased the size of the groups we have in group therapy. We've enforced social distancing, all that kind of thing. When new patients come in, they're screened. When our employees come into work every day, they're screened for a fever and so on. So we're looking for any evidence that it's spreading within the community so far. Thank goodness. None. And we're looking for anyone who might be bringing it in really, really carefully. We've done a lot of training of our staff who might come into contact with people who are in quarantine or isolation. Because that's also another really important thing to keep it from spreading, getting into the community and spreading. So some of those are kind of really basic. You've heard about with the CDC guidelines, and we've made a big transition to telehealth. Even our routine meetings where we used to get together and eat lunch and people would talk about their patients. The you know, the staffing meetings, we do those via telehealth, everyone's on their computers in their offices. So it's sort of a strange time to be going through this. But those are some of the things that we're doing.
Host: That's awesome. And so great that you guys, you know, were on it so early. So when we talk about follow-up, how are people following through or getting the follow-up they need, the support that they need with all that's going on right now.
Dr. Davis: Yeah, that's a big one, right? You can imagine people who are, have trauma, depression, anxiety, chronic pain issues, that sort of thing. And now we're all told to stay home and isolate and that's like the worst thing, right? Because it's the loss of connection that is really dangerous for people who are struggling with behavioral health issues and mental health issues. So the follow-up after they leave is going to be mostly telehealth in either what we call an intensive outpatient or PHP program. There are still programs that are running places, facilities where a person can go and stay in a modified environment, social distancing and so on. Stay say out of State, out of their town and then go back and forth to an IOP. But a lot of that back and forth isn't going to be for personal groups now. They're going to be staying where they're housed and they're going to be doing a lot of telemedicine, people who don't need that are going to go back and get connected with telehealth services and that sort of thing. And what we're noticing at my facility, I don't know how common this is around the country, but we have what we call connect 365.
So a full year, 365 days of following the patient outside and providing support to them if they're stuck and they can't make connections. And so we reach out and stay in touch with people and talking with the group of employees who run that program, they're seeing a lot more from people who have been discharged, either from their therapist, from the patient or from some folks that have helped coordinate their care from a care coordinator. We'll get calls about that and coordinate. So there's a need for a lot of aftercare support after they need residential and thank goodness we're able to provide that and it's being used. I wanted to find out recently about how busy that is and they're at least twice as busy now. So all those sort of things are critical to keep people connected after they leave. Ideally, when there's no virus around, people are in groups, it can meet, do their group therapy and that's very important. But that's just not possible now.
Host: Definitely not. And that sort of transitions into the next question cause you're talking about what people need and we know right now people need this type of stuff. So what advice can you share with our listeners to help them manage anxiety, Stress, for themselves for a loved one?
Dr. Davis: We've all seen this. We're getting an avalanche of information about how to do that out there. There are all kinds of good articles being written on what to do, staying connected. I kind of said this before. Staying connected as best you can on a regular basis with whatever technology you have, telephone, computer, that sort of thing is crucial for staying mentally and physically healthy. Obviously exercise, and sleep is going to be good. And you know, I'm going to say consuming news in moderation. That's pretty important. It's all day, every day, 24/7 COVID news and it's easy to get pulled into that. And I advise people to be careful about how often they're consuming it and in what circumstances, that it's not just on in the background all the time. It's good to stay caught up of course on what's going on, but not all the time. There are a number of companies that provide meditation advice, some free, some not through the internet that are excellent.
I mean, really just excellent. I mean, when I say a number, there are many. There are free YouTube courses on how to meditate and that's a really important thing to manage stress. I would sort of say, you know, in managing our lives there's a thing called the serenity prayer, which isn't it's agnostic really but they call it a prayer and that goes something like, you know, accepting the things we cannot change. Having the courage to change the things we can and the wisdom to know the difference. That applies a lot now. There's a lot we can't change. This is this a pandemic is a thing that, you know, it's here, we can modify it as we're hearing, but there's a lot about it we can't change, we can't change that we need the social distance now, and that people have stay at home orders and things like that. And learning how to accept that and using resources, whether it's meditation or talking with family about it, you have to sort of work through how we're going to just roll with that is really critical.
Host: So well said, Doctor, there's just so much that we can't control, but some of the things we can't control are, as you say, like we don't need to have the TV on in the background. If there's breaking COVID-19 news, we'll find out about it. Right. For those in treatment, what advice do you have for them during COVID-19 shelter in place, quarantine, whatever we want to call it. What's the best advice you have for them?
Dr. Davis: Well, for people who are in treatment, the same thing applies as to that last question. You know, you asked me about advice to listeners and on managing anxiety and stress. Those are in treatment. Focus on what's in front of you, what you're working on. And if you're looking for treatment, find a place that is really staying up to date on what's going on in their State, in their locality and according to the CDC. And so on. Vigilance is really important. So, you know, the key question is to any facility that's treating patients in groups is, you know, what's your vigilance profile? What are you doing to stay really day to day and several times a day on top of this? And our answer would be, well, we meet everyday. Leadership meets everyday to review what the news is and change our programming, that sort of thing. As we need to. People that are in treatment are actually kind of lucky if you think about it. If they're already set and they're going, and things are rolling along for them. That's great. Lucky for them.
Host: Definitely. So a doctor, anything else today? We've covered a lot of ground here and you've given some great advice and resources, you know, websites, and things online that people can do to meditate. What else can we tell people today?
Dr. Davis: Well, I would tell people that, you know, this isn't likely from my medical background to go away real fast. We're kind of running a long race here. You know, develop a patient's forbearance and stay as connected as you can using some of the things we talked about and what you can find out there. Pick up something new. Pick up a new exercise hobby, whether it's yoga or something else that you can learn. Learn to cook, that kind of thing while we're at home. One, patient was telling me their family is doing those giant crossword puzzles with thousands of pieces. That sounds frustrating to me, but whatever works.
Host: I think it's just really great advice that you gave people this, you know, do what they can do to stay connected, to stay mentally and physically well, to understand that this is a marathon, unfortunately not a sprint, and that there are services and people and facilities available to them like the ones we've talked about today. That's Dr. Bennett Davis, Director of the pain recovery program. For more information visit here at tucson.com. And if you found this podcast, please share it on your social channels and check out the full podcast library for topics of interest to you. This is Let’s Talk: Mind, Body & Spirit from Sierra Tucson. I'm Scott Webb. Thanks for listening.
Scott Webb: So for people in treatment from drug and alcohol addiction and behavioral health, what are the steps to now coping with Coronavirus while in recovery? Let's find out what Dr. Bennet Davis, Director of the Pain Recovery Program at Sierra Tucson. This is Let’s Talk: Mind, Body & Spirit by Sierra Tucson. Sierra Tucson- Ranked #1 Best Addiction Treatment Centers 2020 in Arizona by Newsweek. I'm Scott Webb. Dr. Davis, thanks so much for being on during this worldwide pandemic, can or how do people access the mental behavioral health care they need?
Dr. Davis: You know, there's a wide variety of people who access the system. There are people with no computer access, no transportation, no insurance. And for them it's been pretty tough. And the Public Health Departments in all the localities around the country, including Tucson area are working on that. For people that are in the system, what's happened is a really rapid transition to tele-health. Thank goodness. You know, and like in five days we saw the country transition to tell a behavioral health. And so people in the system are able to still by and large connect with their psychiatrist, psychologist, with the system I've been calling actually made some calls to New York to find out if the behavioral health providers that I know back there are able to connect with their patients. And by and large they're pretty happy with it. They still are. Since you bring up the issue of, you know, accessing, I'm going to make a pitch for two nonprofits that have really good websites, if that's all right. One is NAMI and that's the National Alliance on Mental Illness. If people just search that NAMI, on their browser, they'll pull up the very landing page now says resources during COVID. And there's another group that the ACEs Collaboratives around the country. And Arizona the website is azaces.org. But if you were to look up ACEs Collaborative or ACEs Coalition, you'll find your own States. Most States have this. In Arizona as in most of the other States, as soon as you get to that website again, here are, the landing page will have resources for dealing with COVID. And that website really focuses on kits on how to sort of trauma proof your kids about this whole thing, how to present it. They even have like little coloring booklets that you can download for kids to talk about COVID with a little virus character on the front. So those are really good resources for people that are struggling. And of course there are hotlines for each locality as well.
Host: Those are great resources and as you say, for people who are already in the system, they've got a little bit of an advantage there, but there are options available if this is the first time or if people are, you know, just trying to play catch up due to shelter in place. So are the residential facilities still open? And if so, why?
Dr. Davis: Yes. For people that aren't familiar, there are outpatient behavioral health clinics. You can go in and see a psychologist or a doctor, go to group therapy, that sort of thing and go home. Then there's another level of care that we call residential. Then above that there's care for people are really struggling, really acutely, suicidal, psychotic, that sort of thing. And that we would call inpatient care. So the residential facilities exist for the group of people that need daily observation, daily visits with healthcare providers. And a safe environment need to be watched pretty close but don't necessarily need that really high level of care. And it's kind of like the medical system, you know, there's people who still need to go to the emergency room of the hospital right now. We'd rather not. But if someone's having chest pain or they have appendicitis or a pneumonia or something like that, they're going to need to get into the hospital. So there's just like in medical healthcare and behavioral healthcare, there's a population of people that need to get into a higher level of care than we can deliver outpatient. So the situation really is no different before the virus or after.
Host: You know, just thinking about it, you know, of course a shelter in place and quarantining is you know, the mandate. If you will, but that doesn't change what people need. People have needs. People have, you know, physical and mental needs. And it's good to know that you're trying to, you know keep things as normal as possible for people business as usual.
Dr. Davis: Right, right. We can't close our hospitals, we just can't do that.
Host: Absolutely not. Right. So speaking, you know, just in general, how has your facility adapted to Coronavirus and COVID-19. What changes have you made?
Dr. Davis: So rapidly. Very rapidly. A lot. The bottom line is that in our facility, as in the others that I'm in touch with, you know, we follow the CDC and state health department guidelines. I know that our medical director and leadership are in contact with the State Health Department here in Arizona very frequently almost on a daily basis to make sure we're in lock step with what's going on with the State. The, you know, the most important thing is, is to understand a little bit about how infections get going. Infectious Diseases get into our population, not with people coming across borders. There's been a lot of focus on that. That's actually, not the most important thing. When people get sick with an infectious disease, what do they do? They go to the doctor. That is what we would call in Public Health, the usual portal of entry of an infectious illness into our communities. They go to the doctor and if the doctor's office or the facility isn't prepared to recognize and act appropriately, when someone comes in looking sick with an infectious disease, then it can spread. You know, the receptionist can catch it, the Doc can catch it if they're not careful. And then they spread it within the clinic and within their families. And so it goes. So it's really key that facilities, Doctors offices and facilities like residential behavioral healthcare, like where I work really are dotting their I's and crossing their T's.
So what we've done is we've limited access to our, we used to have family weeks. We do those virtually now. We don't have people coming in and getting tours, things like that. And we've decreased the size of the groups we have in group therapy. We've enforced social distancing, all that kind of thing. When new patients come in, they're screened. When our employees come into work every day, they're screened for a fever and so on. So we're looking for any evidence that it's spreading within the community so far. Thank goodness. None. And we're looking for anyone who might be bringing it in really, really carefully. We've done a lot of training of our staff who might come into contact with people who are in quarantine or isolation. Because that's also another really important thing to keep it from spreading, getting into the community and spreading. So some of those are kind of really basic. You've heard about with the CDC guidelines, and we've made a big transition to telehealth. Even our routine meetings where we used to get together and eat lunch and people would talk about their patients. The you know, the staffing meetings, we do those via telehealth, everyone's on their computers in their offices. So it's sort of a strange time to be going through this. But those are some of the things that we're doing.
Host: That's awesome. And so great that you guys, you know, were on it so early. So when we talk about follow-up, how are people following through or getting the follow-up they need, the support that they need with all that's going on right now.
Dr. Davis: Yeah, that's a big one, right? You can imagine people who are, have trauma, depression, anxiety, chronic pain issues, that sort of thing. And now we're all told to stay home and isolate and that's like the worst thing, right? Because it's the loss of connection that is really dangerous for people who are struggling with behavioral health issues and mental health issues. So the follow-up after they leave is going to be mostly telehealth in either what we call an intensive outpatient or PHP program. There are still programs that are running places, facilities where a person can go and stay in a modified environment, social distancing and so on. Stay say out of State, out of their town and then go back and forth to an IOP. But a lot of that back and forth isn't going to be for personal groups now. They're going to be staying where they're housed and they're going to be doing a lot of telemedicine, people who don't need that are going to go back and get connected with telehealth services and that sort of thing. And what we're noticing at my facility, I don't know how common this is around the country, but we have what we call connect 365.
So a full year, 365 days of following the patient outside and providing support to them if they're stuck and they can't make connections. And so we reach out and stay in touch with people and talking with the group of employees who run that program, they're seeing a lot more from people who have been discharged, either from their therapist, from the patient or from some folks that have helped coordinate their care from a care coordinator. We'll get calls about that and coordinate. So there's a need for a lot of aftercare support after they need residential and thank goodness we're able to provide that and it's being used. I wanted to find out recently about how busy that is and they're at least twice as busy now. So all those sort of things are critical to keep people connected after they leave. Ideally, when there's no virus around, people are in groups, it can meet, do their group therapy and that's very important. But that's just not possible now.
Host: Definitely not. And that sort of transitions into the next question cause you're talking about what people need and we know right now people need this type of stuff. So what advice can you share with our listeners to help them manage anxiety, Stress, for themselves for a loved one?
Dr. Davis: We've all seen this. We're getting an avalanche of information about how to do that out there. There are all kinds of good articles being written on what to do, staying connected. I kind of said this before. Staying connected as best you can on a regular basis with whatever technology you have, telephone, computer, that sort of thing is crucial for staying mentally and physically healthy. Obviously exercise, and sleep is going to be good. And you know, I'm going to say consuming news in moderation. That's pretty important. It's all day, every day, 24/7 COVID news and it's easy to get pulled into that. And I advise people to be careful about how often they're consuming it and in what circumstances, that it's not just on in the background all the time. It's good to stay caught up of course on what's going on, but not all the time. There are a number of companies that provide meditation advice, some free, some not through the internet that are excellent.
I mean, really just excellent. I mean, when I say a number, there are many. There are free YouTube courses on how to meditate and that's a really important thing to manage stress. I would sort of say, you know, in managing our lives there's a thing called the serenity prayer, which isn't it's agnostic really but they call it a prayer and that goes something like, you know, accepting the things we cannot change. Having the courage to change the things we can and the wisdom to know the difference. That applies a lot now. There's a lot we can't change. This is this a pandemic is a thing that, you know, it's here, we can modify it as we're hearing, but there's a lot about it we can't change, we can't change that we need the social distance now, and that people have stay at home orders and things like that. And learning how to accept that and using resources, whether it's meditation or talking with family about it, you have to sort of work through how we're going to just roll with that is really critical.
Host: So well said, Doctor, there's just so much that we can't control, but some of the things we can't control are, as you say, like we don't need to have the TV on in the background. If there's breaking COVID-19 news, we'll find out about it. Right. For those in treatment, what advice do you have for them during COVID-19 shelter in place, quarantine, whatever we want to call it. What's the best advice you have for them?
Dr. Davis: Well, for people who are in treatment, the same thing applies as to that last question. You know, you asked me about advice to listeners and on managing anxiety and stress. Those are in treatment. Focus on what's in front of you, what you're working on. And if you're looking for treatment, find a place that is really staying up to date on what's going on in their State, in their locality and according to the CDC. And so on. Vigilance is really important. So, you know, the key question is to any facility that's treating patients in groups is, you know, what's your vigilance profile? What are you doing to stay really day to day and several times a day on top of this? And our answer would be, well, we meet everyday. Leadership meets everyday to review what the news is and change our programming, that sort of thing. As we need to. People that are in treatment are actually kind of lucky if you think about it. If they're already set and they're going, and things are rolling along for them. That's great. Lucky for them.
Host: Definitely. So a doctor, anything else today? We've covered a lot of ground here and you've given some great advice and resources, you know, websites, and things online that people can do to meditate. What else can we tell people today?
Dr. Davis: Well, I would tell people that, you know, this isn't likely from my medical background to go away real fast. We're kind of running a long race here. You know, develop a patient's forbearance and stay as connected as you can using some of the things we talked about and what you can find out there. Pick up something new. Pick up a new exercise hobby, whether it's yoga or something else that you can learn. Learn to cook, that kind of thing while we're at home. One, patient was telling me their family is doing those giant crossword puzzles with thousands of pieces. That sounds frustrating to me, but whatever works.
Host: I think it's just really great advice that you gave people this, you know, do what they can do to stay connected, to stay mentally and physically well, to understand that this is a marathon, unfortunately not a sprint, and that there are services and people and facilities available to them like the ones we've talked about today. That's Dr. Bennett Davis, Director of the pain recovery program. For more information visit here at tucson.com. And if you found this podcast, please share it on your social channels and check out the full podcast library for topics of interest to you. This is Let’s Talk: Mind, Body & Spirit from Sierra Tucson. I'm Scott Webb. Thanks for listening.