How telemedicine improves in-person care: A vascular surgery patient’s story

July 22, 2020  //  FOUND IN: Michigan Medicine News,
David Wallace during one of his video visits. Photo courtesy of Wallace.

David Wallace prefers face-to-face visits with his doctors, but understands it’s not always possible or the safest option for him in a world with COVID-19.

So when the 63-year-old needed to consult with a doctor about surgery for carotid artery disease, he agreed to a video visit during the height of the pandemic, even though Wallace typically scheduled in-person appointments.

 While the trend toward telemedicine has been evolving in recent years, COVID-19 has definitely accelerated it, said Michigan Medicine vascular surgeon Peter Henke, M.D., noting that patients still have the option of in-person access to providers.

But, he said, “I think telemedicine will be the standard going forward. Patients can be imaged here via ultrasound or CT scan to provide basic information about their condition. Then, through telemedicine, the doctor can ask questions about symptoms safely and effectively, just as if the patient was being seen in clinic.”

The benefits can’t be overlooked, he said, pointing to Wallace’s experience.

Living with carotid artery disease

The Livonia, Michigan, resident had been diagnosed with carotid artery disease years earlier, a condition that didn’t significantly impact his day-to-day life.

Carotid artery disease, also known as carotid artery stenosis, involves a narrowing of the carotid arteries located on each side of the neck and responsible for carrying blood to the head, face and brain. The condition is typically caused by atherosclerosis, a buildup of plaque in the inner lining of the artery, which can lead to stroke. 

Symptoms of the disease include sudden loss of vision or difficulty seeing out of one or both eyes, weakness or numbness on one side of the face or body, sudden difficulty walking or speaking, sudden severe headache and memory problems.

Like Wallace, some individuals have no symptoms as plaque builds up slowly over time.

Important next steps

The retired truck driver discovered his condition had worsened after an ultrasound that was ordered by his primary care doctor, Christina Murphy, M.D.

The next step was further testing, including a CT scan that revealed 80 to 90% blockage in the right carotid artery, says Michigan Medicine nurse practitioner Ann Eschelbach, N.P.

“When blockage reaches 80 to 90%, surgery is considered,” she said. “If a patient is showing symptoms, surgery is typically scheduled within 4 to 6 weeks.”

Wallace, who was asymptomatic, had his first experience with telemedicine during a video visit with vascular surgeon Chandu Vemuri, M.D. The two connected over a telehealth video platform to discuss details of Wallace’s condition and timing for his procedure, a carotid endarterectomy of his right carotid artery, in the next few months.

But things changed for Wallace when he experienced sudden, temporary loss of sight in his left eye on April 8. He was rushed to Michigan Medicine’s emergency room where it was determined he had experienced an ocular stroke caused by the narrowing of his carotid artery. His providers say, even during the COVID-19 pandemic, calling 911 is still the best choice for the best possible outcome after stroke.

And because of Wallace’s earlier telemedicine consultation, the medical team had detailed, up-to-date information about his health history and were ready to get him into surgery sooner than originally planned.

During a carotid endarterectomy, an incision is made to the side of the neck over the affected carotid artery, says Henke, who performed Wallace’s procedure. “The artery is then dissected and the plaque is carefully removed. The patient is followed closely and is typically released the following day,” he said.

“I had surgery on April 10 and I was home the next day,” said Wallace. “The team did a great job.”

A viable alternative for some

Since his successful procedure, Wallace has been scheduled for video visits to discuss his progress as well as details for a three-month follow-up.

“A post-op appointment for this type of procedure is amenable to a telemedicine visit,” said Henke. “We can look at patients and assess a neurological exam to look at facial expressions and whether they can move their arms equally, just as we would during a clinic visit.”

Wallace admits he sees the benefits of participating in future video visits.

Originally intended for patients who had to travel long distances to their appointments, telemedicine is becoming preferred by a wider patient population, says Eschelbach. She points out additional benefits, including reduced spread of infection, improved access to care and overall patient convenience.

“In a typical environment, a patient would be here for testing, followed by a clinic appointment on the same day,” she said. “Now, they can get testing done at another Michigan Medicine location, with a video visit a few days later to discuss test results.”

Not every patient is eligible for a video visit, she points out. “Each patient is evaluated to determine if it’s right for them based on their diagnosis, where they live and whether they have access to telemedicine technology.”   

The new face of health care

The trend is here to stay, said Henke, noting the accelerated adoption of telemedicine at Michigan Medicine is guided by support teams to ensure its success. “In the past we may have had 20% of our patients accessing telemedicine over the course of a year. Now it’s more like 20% over a one-month period.”

In a world of social distancing, telemedicine has become an even more valuable and convenient option for patients, Henke said. “This is an upside to this awful pandemic — the acceleration of more patient-centric care.”

This story first appeared on the Michigan Health Blog.

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