Virtually Everywhere

The patient, a 6-year-old girl with celiac disease, had trouble controlling her symptoms*. That wasn’t initially why the family decided to try telehealth. They lived several hours from Children’s Hospital Colorado, which offers the most comprehensive celiac program in the region. Virtual visits were just easier.

But it was a virtual visit that helped Monique Germone, PhD, BCBA, a clinical psychologist who helps kids with celiac disease adhere to a strict gluten-free diet, figure out what was going on.

“I asked them to show me their kitchen,” Dr. Germone recalls. “Looking at the cabinets, everything at her level had gluten in it. So we talked about moving the snacks with gluten up high where she couldn’t reach them, and moving her gluten-free snacks down low where she’d have easy access.”

That was about two years ago, when Children’s Colorado’s #1-ranked Digestive Health Institute was just getting telehealth offerings up and running. Those offerings were the result of many more years of building the technology, infrastructure and logistics to support them. There was still a long way to go. Many insurance companies, for instance, were reluctant to cover care that didn’t take place in person.

Then COVID-19 came along.

Telehealth: breaking down barriers to care

“I think one silver lining of COVID-19 is the understanding that we can get rid of a lot of barriers to reaching patients,” says pediatric gastroenterologist Pooja Mehta, MD, MSCS. “As soon as everything shut down with social distancing, we were quick to transfer all of our in-person visits to virtual visits because we already had that infrastructure in place. Not a lot of other places had that.”

Children’s Colorado now offers virtual visits and telehealth programs for every specialty. Some are intuitive. Others are more surprising. One thing they all have in common: they offer kids and their families easier access to care, pandemic or no pandemic, no matter where they are.

“A lot of patients love it and want to keep doing it,” says Dr. Mehta.

These are just a few of them.

Driving the change to virtual visits

Arthur Helzberg, age 9, has spent a lot of time driving between the Denver Metro area and his home in Aspen, Colorado. Diagnosed at age 7, he needs to see a specialist frequently for his Crohn’s disease.

That’s especially important for keeping his symptoms and potential flare-ups in check. He needs blood work. His diet and medications need frequent adjustment. He also needs to come down for infusions of infliximab, which helps block inflammation, every five weeks.

It’s a lot of driving.

“And sometimes we can’t get there at all,” says Jamie Helzberg, Arthur’s mother. “I-70 is closed, airports are closed, we just can’t get there.”

Jamie and Arthur’s pediatric gastroenterologist, Thomas Walker, MD, had been talking for a while about telehealth. When COVID-19 hit, it was a good time to make the leap.

These days, Arthur checks in with Dr. Walker via video visit and is able to get bloodwork through a local hospital. He still has to come down for infusions ― but it’s a lot less often than it used to be.

“If I have to go to Denver it takes a whole day,” says Arthur. “But with telehealth it takes an hour or two.”

Which leaves Arthur with a lot more time to for biking, boxing, basketball or the million other things he likes to do. Which he now gets to share with Dr. Walker.

“He gets maybe even a better sense of me as a person,” says Arthur, “because he can see me in my house and me with my dogs.”

“Arthur shares more because he’s not in a clinic setting, he’s at home,” Jamie adds. “It’s been great for my husband and me, too, because in-person usually only one of us can be there. This has allowed us both to participate.”

The risk of not risking it

Keira Tsuo was born without the gene NKX2. It’s a tiny error in her code, but it affects everything in her body, particularly her lungs, her brain and her thyroid.

“It’s hard to find people who have even heard of it,” says Jessica Tsuo, her mother.

Keira needs a number of medications to keep her condition and symptoms in check. The balance is crucial. For example, Keira suffers from chorea, neurological tremors like those seen in Parkinson’s. The medication that buffers her symptoms can also contribute to osteoporosis, even shut down her adrenal glands in too high a dose; too little and her symptoms flare.

Her lungs, too, are prone to blockage, infection and pneumonia. That puts her at risk for respiratory infections ― like COVID-19.

Keira was due for a check-in back in March, which put her parents in a bind: they needed to get her in, but they weren’t going to risk it.

Telehealth proved an elegant solution. And it worked even better than expected. Over video, Keira’s neurologist was able to observe her chorea and could see it had gotten a little worse since their last-check in; she adjusted the medication accordingly. And Keira’s pulmonologist was able to listen to her breathe and determine her lungs were healthy.

In fact, the only thing the team wasn’t able to do was a blood draw to check Keira’s thyroid levels. But her levels had been stable for a while, so her endocrinologist felt good about waiting another six months.

“So even that was reassuring,” says Jessica. “She’s known them since she was 6 months old. They’ve seen her grow up. It’s like checking in with an old friend.”

A harbor from the storms

Strained relationships. A suicide attempt. Encounters with the police. Logan Wing landed in two different psychiatric facilities inside a month. He was in crisis.

Pending his release from the second facility, his mother, Christina Wing, had him waitlisted for Children’s Colorado’s Partial Hospitalization Program. She didn’t know what else to do. It was March, and the timing turned out to be a blessing. The waitlist had been long. It suddenly got a lot shorter. The intake was the last time they’d be onsite.

“They shut down the clinic,” Christina recalls. “By that time I’d tested positive for COVID-19 anyway.”

Logan wasn’t keen on the video program at first. He didn’t want to show his face to the group, for one thing, but it was a requirement to keep the camera on, so he did. It made him nervous. But it also helped him to see others where he was at.

“I could see other kids felt insecure, too,” he recalls. “That made me feel a little more comfortable.”

The program wasn’t easy. A two-week intensive for kids, teens and families struggling with mental health crises, it’s six hours of treatment, five days a week. Patients learn a new skill each day, and then the next day try to apply it. A couple of skills that stuck with Logan: identifying “fortune telling,” where the mind invents a disastrous future that may or may not actually come to pass, and what his therapists called “leaf in a stream,” where you mentally place a distressing thought on an imaginary leaf and let it float away.

“They never mentioned a waterfall, but in my mind I’d watch the leaf go over the waterfall,” he says.

The program helped. Logan found his way back to a better mental space and started rebuilding his relationship with his parents. His parents learned new skills for helping Logan stay on track without lapsing into old conflicts. Most of all, they felt less alone.

“I cried many, many times,” says Christina. “I was just ecstatic. You go through that too? It’s a level of relatability you can’t get over happy hour. This is what we’re going through. And we’re not the only ones.”

* Details changed to protect patient privacy