October 6, 2022

What happens when a person with a host of medical problems gets Covid?

For 56-year old Brenda Bidwell of Waverly, NY, she became even more medically fragile.  Due to her several medical conditions, she had to move to a nursing home in 2018 for rehabilitation.
But when Covid hit the nursing home and she contracted it, her situation became worse. Nursing homes followed mandates to keep their residents in and visitors out. Add to that the critical staff shortages nursing homes experienced then, and continue to struggle with now.
“I felt so stuck,” Brenda recalled. In addition to being a diabetic, she is a double amputee, has a tear in her retina, is prone to blood clots and has lymphedema. She suffers from chronic pain, anxiety, and obstructive sleep apnea.  Previously, she had a stroke and ostomy surgery. 
If that wasn’t enough to manage, she could tell her oral health was declining during that time. She had been getting much needed dental treatment but the dental office she was going to closed during Covid. Eventually, she felt pain and swelling in her mouth.
“I could feel how much more my teeth were decaying,” Brenda said, who turned to eating only soft foods because of the pain and infections. Because of staff shortages and other more urgent needs, daily oral healthcare was not a priority.
Because of the multiple medical concerns, Brenda can only be seen by a dentist affiliated with and close to a hospital.  Eastman Institute for Oral Health’s Eastman Dental, part of the University of Rochester Medical Center, was the closest choice for her, even though it meant a three-hour one-way ambulance ride to transport her on a stretcher.
But Eastman Dental wasn’t new to Brenda, because Able2, a medical and dental clinic in Elmira that serves children with special needs, referred her two sons to Eastman for their braces.
“Able2 and Eastman Dental have been in my life for 20 years,” she said. “They’re both fabulous.”
After extensive x-rays were taken, the recommended treatment plan was presented to Brenda.
“Her oral health is in need of significant treatment,” explained Dr. Nadia Stephens, assistant director, EIOH’s Specialty Care Clinic. Dr. Stephens, who graduated from Eastman Institute for Oral Health’s specialty training program, is uniquely trained to treat patients with complex medical conditions. 
“Brenda had multiple missing teeth, and the teeth on her upper jaw were extremely sensitive because of severe rampant decay,” explained Dr. Stephens. “In addition, she also had decayed teeth on the bottom and had multiple abscessed roots.”
Because of Brenda’s complex medical issues, it’s hard for her body to fight infection, which could trigger a spike in her blood sugar resulting in swelling; and the pain affects her blood pressure, all which could have potentially very serious consequences. Unable to be put under general anesthesia or IV sedation, Brenda’s treatment must be done in stages, and therefore prioritized. The teeth causing the most pain would be removed during the first visit, followed by three more visits for more extractions of the unrestorably decayed teeth and infected retained roots.
After the long ride on the second visit, Brenda arrived at Eastman and her twin sister Bonnie helps her get settled. Bonnie moved back to New York from New Mexico to help care for her sister. A dental assistant comes in to take Brenda’s blood pressure and check her blood sugar level.
“It’s critical that her blood sugar and blood pressure are at levels where it is safe to proceed with treatment,” said Dr. Stephens, who works closely with patients’ medical providers to ensure quality, safe care is provided. “We see patients from throughout the region who have very challenging medical conditions. It’s an honor and privilege to help people when other dentists aren’t able to help them.”
When the Specialty Care Clinic was established in 2018, a large, spacious elevator specifically designed to accommodate stretchers was installed.  The treatment rooms are large enough for the stretchers, and have special equipment for patients who are morbidly obese, wheelchair bound, or who may have severe anxiety.
After it’s determined that it’s safe to proceed with treatment, Dr. Stephens comes in to see how she’s feeling from the extractions the previous week. She knows Brenda’s back hurts from laying on the stretcher and does what she can to help her be as comfortable as possible.
“Dr. Stephens is very competent and has a great technique,” Brenda said. “I can’t even feel the Novocain when it goes in.”
“She is very thorough, works quickly and effectively,” added Bonnie, who stays with Brenda during the procedures. It’s been a long road, and Brenda is happy her sister is around more.
“Brenda has literally been laying down for four years,” Bonnie explained. “But now, I’m happy to be there to help her get better and get stronger.”

Bonnie helps Brenda wash, attach her prosthetic legs, sit up, and do her physical therapy. She’s working toward being able to stand confidently and long enough to transfer to a wheelchair.
Two more visits to Eastman Dental and all the extractions will be completed and her gums restored and ready for the next step: full dentures on top and partial on bottom. In the meantime, Brenda looks forward to more normalcy with her daily routine and meals.
“I thank God Eastman is here and I’m able to get the care I need and get the dentures my insurance covers in a facility where I’m safe.”
For more information about the Specialty Care Clinic at Eastman Institute for Oral Health, visit specialtydental.urmc.edu or call (585) 341-6888.

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