Rotator cuff surgery

Physician assistant Rosie Boschen helps Dr. Rafael Williams manage tools during a rotator cuff surgery at St. John’s Health in 2019. Elective surgeries, those defined as non-emergency, declined between 8% and 15% due to the pandemic, Chief Financial Officer John Kren said, but the hospital looks to be on an upswing now.

Terry Travis made sure to do one thing before going in for cataract surgery this spring: Get his COVID-19 vaccination shots.

“I wouldn’t have done it without that,” the Jackson resident said of his late-April procedure.

With a significant portion of the population jabbed, Jackson Hole doctors have been seeing clients return for routine checkups and procedures they had postponed, like cataract surgery, because they didn’t want to risk exposure to the novel coronavirus.

“We definitely have seen an uptick as people have been liberated, so to speak,” said Dr. Jamie Monroe of Teton Eye Clinic, who will perform Travis’ cataract surgery.

For the fiscal year that ended June 30, elective surgeries at St. John’s Health were down around 8% to 15%, estimated John Kren, chief financial officer and chief operating officer. But people’s confidence in the hospital’s COVID-19 protocols and the community’s handling of the pandemic, plus recent hospital awards and an influx of people who arrived in Jackson Hole looking for a pandemic sanctuary, are helping turn things around.

“We are currently on an upward trend across the board in the number of procedures and the number of visits to our clinics and people staying in the hospital,” Kren said.

That’s not to say that doctors didn’t feel the bite of pandemic lulls in traffic to their offices.

“At the height of COVID we had a sign: ‘If you’re sick don’t come in here,’’’ said Dr. Doug George, an OB/GYN with Women’s Health and Family Care. “That’s a little hard on business when you’re a doctor.”

Though George said he hasn’t exactly seen a surge in demand, patients don’t seem as hesitant about coming in, and the practice is busy.

“I’m sure people have put things off,” he said. “The surgery schedule has slowed down, for sure.”

Business aside, the possibility that people aren’t consulting doctors about potential problems or scheduling routine screenings is unsettling among medical pros.

“It worries me that someone might ignore something they shouldn’t,” George said.

During a St. John’s Health video discussion, “Colon Cancer Screening in the Time of COVID,” local surgeons talked about a “disturbing” nationwide decline in cancer screenings, including colonoscopies, during the pandemic. Disturbing because delays in detecting cancer mean more aggressive and invasive treatment will be required and the odds of dying are greater. With a colon cancer, for example, if they’re not looking for it they’re not finding it.

“By the time that you will identify the patient has cancer you’re going to identify it at a later stage, which is much worse for the patient,” said Dr. Eric Wieman, a general surgeon at St. John’s Health.

He and Dr. Jake Breeding, also a general surgeon, stressed that it’s critical for people to make up those delayed appointments.

“Even though COVID threw a big wrench into folks’ plans to do a colonoscopy a year ago, it’s super, super important not to let that slip by for another three years or five years or 10 years,” Breeding said. “It’s really important to get caught up now, not only on your colonoscopy but your mammogram too that you might have missed.”

Dr. C. Sean Haling, a specialist in radiology and diagnostic radiology with Jackson Hole Medical Imaging, said that by the end of the year the number of screening mammograms was down by a little over 400. Typically the department does around 3,800 screenings each year.

Thanks to the pandemic there was a period when screenings were put on hold. When screenings opened up, some women were reluctant to come in, and for those who did want to make an appointment it was more challenging to find a slot.

“When we reopened it was with limited numbers because we had to space out patients farther, so we couldn’t schedule as many throughout the day as we typically would,” Haling said.

Speaking in March, he said screenings were being scheduled in 30-minute blocks, rather than 20 minutes, with equipment thoroughly cleaned between patients.

“We are still under slightly limited capacity,” he said.

The COVID-19 vaccines added a twist, specifically by causing enlarged lymph nodes that could create an abnormal result on a mammogram. The national recommendation was for women to wait four to six weeks after their last shot to get a mammogram.

Asked about the risks associated with the pandemic lull in mammograms, Haling said, “If we are down 400 screening mammograms for 2020, statistically there’s one cancer there that we haven’t diagnosed yet — that is, in a patient that doesn’t have a palpable lump.”

But, he said, “we never stopped doing diagnostic work. Any women who showed up with symptoms — with palpable changes in the skin or anything like that — those women were getting in and getting evaluated.”

Judging by the numbers at Jackson Pediatrics, children are generally getting their routine medical evaluations.

During lockdown season in the spring of 2020, Jackson Pediatrics intentionally put some kinds of appointments on hold. Even so, from March 2020 through March 2021 “our number of checkup appointments was down only 10%,” said Dr. Travis Riddell. And “we are well caught up at this point.”

Sick visits were another story: They’re down 40% compared with expectations, he said, though that’s better than the drops of 50% or more he’s heard about elsewhere in the country.

“People just weren’t comfortable coming in for a relatively minor illnesses,” Riddell said. “The other thing is that kids just haven’t gotten nearly as sick over the last year.”

Respiratory syncytial virus, pneumonia, croup, common colds, ear infections, sinus infections … “All way down,” Riddell said. “I haven’t admitted a kid to the hospital for any kind of respiratory visit except for COVID this year.”

That’s good for kids and their families, though it’s not so good for the bottom line.

“We don’t want kids to get sick, but we have built our practice and hired our staff based on what we expect to be a normal year,” he said.

As for when that part of the practice will return to normal, “It’s hard to say for sure,” Riddell said. “I would wager that as soon as kids are back in school full time and not wearing masks and back to their normal activities we’ll probably see a return of all the usual crud we see in those age groups.”

Contact Jennifer Dorsey at jennifer@jhnewsandguide.com or 732-5908.

Jennifer Dorsey is chief copy editor and Business section coordinator. She worked in Washington, D.C., and Chicago before moving to the Tetons.

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