Maintaining health and wellness during a pandemic is a struggle for virtually everyone, but those with chronic health conditions are particularly challenged. An overview of COVID 19 developments, the impact of COVID 19 on cancer patients and rising cancer rates, expanding telehealth access and methods of maintaining and fostering wellness were all covered at the Down East Living with Cancer Conference on November 4.

COVID 19 impact and developments
     Dr. James Jarvis opened the virtual conference with a primer on COVID 19 and its impact on the state and the country, noting significant developments in medical understanding and treatment.
     Coronaviruses have been around "since antiquity," Jarvis said, but were only identified and described in the modern era, unlike other viruses like influenza. When COVID 19 emerged, it was immediately clear that it was different. Much more contagious than SARS -- severe acute respiratory syndrome -- "it causes multisystem organ failure -- something we'd never seen before with respiratory illnesses on a large scale," Jarvis said.
     Since the outbreak began, 700,000 Americans have died. Life expectancy has decreased by 2.2 years for men and 1.65 years for women. Along with the acute effects, physicians are troubled by the long term effects COVID 19 leaves behind. "People continue to have cognizant deficiency for months, even years after infection," Jarvis said, adding "50% of patients are reporting fatigue for months on end afterwards."
     The development of the vaccine -- which Jarvis described as "a marvel of science" -- has been significant in slowing the rate of infection. New techniques such as employing monoclonal antibodies, high dose oxygen and precision steroid dosing are reducing the death rate from the virus.
     Even with the release of the vaccine, however, the rate of infection in Maine continues to climb. According to Jarvis, Maine is one of the few places where that's the case. As a result, the state's medical infrastructure -- including its capacity to care for patients with chronic illnesses such as cancer -- are under the threat of strain.
     "If you are not yet vaccinated, I implore you to get vaccinated," Jarvis said. "The three available vaccines in America are incredibly safe." He added, "There will always be one offs, but the chances are incredibly small, and the benefits of the vaccine are incredibly great."
     Jarvis said that he expects COVID 19 to become seasonal, like the flu, and that boosters will continue to be needed periodically as new strains mutate.

Managing cancer during COVID
     Even as COVID 19 is breaking new ground, a more familiar malady is strengthening its hold: cancer rates are rising in the state, and they're expected to go up even further next year. The American Cancer Society is predicting a rise from approximately 8,300 new cancer cases in the state in 2020 to more than 10,000 in 2021, or close to a 20% increase.
     Asked what can be done to decrease the rate moving forward, Jarvis emphasized, "Prevention is key." Avoiding behaviors, foods and substances that contribute to cancer reduces the occurrence of cancer, with up to 75% of all cancers being preventable. Once cancer has taken hold, "early detection is next," Jarvis said. Early detection improves survival rates for all cancers. Maine struggles with lung cancer in particular, with a 30% higher rate than the national average, according to Northern Light Health, and 75% of those cases are found too late, significantly reducing survival odds.
     COVID 19 has complicated the situation by causing people to cancel appointments, delay routine screenings and take up unhealthy behaviors, but that shouldn't stop people from being aware of the dangers of cancer. "We need to do our cancer screening," Jarvis said. "Doing those preventative services is incredibly important."

Improving digital connectivity
     For those who were contending with cancer prior to COVID 19 or developed it during the pandemic, the state's shift to telehealth has simplified some of the treatment and checkup process ? but it now faces a major hurdle. Susan Corbett of the National Digital Equity Center (NDEC) spoke of the advantages and ongoing challenges of getting Mainers connected.
     When the pandemic happened, the concern arose that many Mainers -- including a larger portion of the elderly population -- wouldn't have sufficient, safe access to their providers, and so the telehealth push began. Mainers have an approximately 50% "take rate" for broadband, Corbett said, explaining that half of the households in the state don't subscribe to it. "The number one reason they don't is affordability."
     To offset this barrier and help get more Mainers online, the NDEC connects residents with resources like the Emergency Broadband Benefit, which lowers the cost of broadband for low income households. In addition, the organization works with individual families to provide equipment -- from tablets to laptops to desktops -- to make telehealth visits possible. Lastly, classes in how to use the devices are provided at no cost, reaching residents in 320 of Maine's 457 towns thus far.
     The programs of the NDEC have been popular. More than 10,000 Mainers have taken a class, with more than 57% of participants being 55 and older -- and 8% are 80 or older, something Corbett is particularly happy with. "It just goes to show, if you want to learn, you can."
     Acknowledging the suffering and loss caused by COVID 19, Corbett said it served as an important catalyst for accelerating digital equity in the state. "Telehealth was one of the number one collateral benefits of the pandemic."
     Unfortunately, the state's telehealth programs are in jeopardy. While the outbreak of COVID 19 prompted Congress to make telehealth reimbursements a reality, the reimbursement rule has expired and clinics are now communicating with patients about the change. For cancer patient Donna Wiegel of Swan's Island, who has been able to do half-hour telehealth visits with her doctor in Skowhegan instead of having to travel and stay overnight, finding out that the program is stopping has been jarring. "We had moved to a place where telehealth was taking hold," Wiegel said, "and now we're taking a huge step backward in this."
     "It's a game changer for rural places like Maine," Corbett agreed. "It would be an absolute shame to not continue those services for all of our Mainers."
     Regardless of how Congress proceeds, Corbett is committed to helping to improve broadband access across Maine and the country. Communities looking to expand access are invited to email her at susan@digitalequitycenter.org, and individuals can learn more about available programs at digitalequitycenter.org.

Fostering resilience
     After addressing the medical challenges and successes of the past 20 months, the conference shifted to mental wellness and ways to improve resilience during the pandemic.
     Jen Harry of Infusion Mindfulness began by stating that COVID 19 has contributed to "unprecedented levels of anxiety, uncertainty and fear" in households across the country. Fortunately, there are "tools and practices that can really help us manage the intensity of all these emotions we're experiencing."
     Harry went on to describe the importance of resilience or response flexibility. People who have more emotional resilience are able to be more flexible, to get through stressful events without getting stuck. "What we want to be able to do is move flexibly in and out of our emotional states," she said.
     While "human beings are naturally resilient -- if you're sitting here you've made it through 100% of your bad days" -- resiliency is also a skill that can be learned, Harry said. Three minutes of practice a day can build permanent resilience in the brain. In the thick of difficult situations, pause and take one to three deep breaths, Harry advised. This will reset the nervous system and stop the fight or flight response. At that point, you can focus on your "seat, feet, hands and breath" and pay attention to the sensations at each part of the body to override the body's default mode network.
     Having compassion is key for wellness, Harry continued, especially including self compassion. A simple exercise is to "put your hand on your heart and acknowledge these are some hard times we're going through." The sensation of touch over the heart produces oxytocin, which can improve mood.
     Learning about wellness and building resilience are valuable skills that can improve health in the long and short term. For further reading, including about how the brain can be rewired from trauma and prewired against disaster, Harry recommends Resilience by author Linda Graham.

Exercise and nutrition guidance
     Samantha Williams of Bold Coast Yoga provided demonstrations and discussions of exercises that are valuable to those who are contending with cancer as well as the general public, while dietician Judy Donnelly of the Dempsey Center shared nutrition tips.
     Cancer patients going through treatment benefit from exercising in a number of ways, Williams said. "Exercise helps lower the chance of side effects and can lower the severity of those side effects when they occur," along with reducing depression and anxiety, preventing muscle loss and weight gain and even improving the effectiveness of treatment.
     Recognizing that the pandemic has a lot of people spending time indoors and in the home office, Williams said that sitting for a long duration has compounding negative health effects. To counteract them, simply stand up for one minute every 20-30 minutes, or take a break and exercise.
     Diversifying the type of exercise is important, Williams said, identifying the four primary types as cardiovascular or aerobic, strength building, stretching or mobility and balance. "Ideally, all four types should be integrated into a program to help build balance and help us feel our best."
     Nutritionally, the goal should be to "eat a colorful diet," Donnelly advised, particularly including spices as many have cancer reducing and health supporting properties. "Spices are the most concentrated sources of beneficial phytochemicals." Paprika and cumin were used in Donnelly's cooking demonstration, and turmeric got a special mention for its anti inflammatory properties -- with Donnelly noting to use it with black pepper to make it more digestible.
     When targeting specific foods, Donnelly said to "try to incorporate beta carotene rich foods three to four times a week because of the supportive nutrients they contain," noting carrots, sweet potatoes and cantaloupes as excellent options.

From surviving to thriving
     The conference closed with a powerful personal story from cancer survivor Brian Ross of Hampden, who, as Matt Dexter of the Christine B. Foundation put it, "wakes up every day choosing joy and hope."
     Ross described in a forthright way how he learned he had cancer -- "I couldn't poop." It was the day before Thanksgiving in 2017, and he soon discovered he was faced with stage 4 neuroendocrine cancer. A tumor had broken through the wall of his intestine and blocked it. Surgery removed a series of tumors along his neuroendocrine system, but Ross still required treatment every 28 days to keep symptoms at bay.
     Initially devastated, the experience opened Ross' eyes in new ways. He began cultivating practices to improve his physical and mental well-being to make his days bearable and extend his life.
     Unable to work at his job, Ross contacted Dexter, and the two formed a plan that developed into preparing meals for the cancer patients under the umbrella of the Christine B. Foundation. "I knew I had maybe a few years left," he said. "I wanted to do everything I could in that amount of time." He added, "I'm not a survivor, I'm a thriver."
     Over the past 20 months, Ross has had direct involvement in the preparation and disbursement of 150,000 meals to area cancer patients.
     With the one year anniversary of a second surgery now behind him, Ross proclaims, "I'm one year old. I've got many more years to come. And I certainly anticipate it to be a life giving back and loving."
     To see the Down East Living with Cancer Conference in full, visit the Christine B. Foundation page on Facebook at www.facebook.com/chrisbfund and find the November 4 video stream.