anyone else. I was able to convince her to try it out again. She had many tests done, but refused to listen to their recommendations. She claimed the specialist was out to get her and made it very personal.” Munoz said she was at a loss with how she could help Sylvia, but refusing to give up, she reached out to Dr. Howe again. “He gave me some talking points, so when I called Sylvia back she said, ‘Okay fine, you convinced me,’” said Munoz. “She went to her specialist appointments and agreed to begin pulmonary rehab, which had been recommended for a long time.” Sylvia uses oxygen as part of her Chronic Obstructive Pulmonary Disease treatment, but she revealed to Munoz that insurance would not cover a portable oxygen concentrator, so she had to take an oxygen tank with her everywhere. Munoz reached out to Nebraska Total Care (NTC) to learn about Sylvia’s coverage options. After nearly six months and countless calls to pharmacies and NTC, she located a portable concentrator at a pharmacy that Sylvia could rent. “This was a huge victory not only because it made accessibility to her oxygen much easier, but also because she realized that I was committed to helping her and that she could trust me,” said Munoz. Over time, Munoz said Sylvia became more open with her. Through their conversations, Munoz listened to Sylvia’s concerns about her chest pain and other symptoms and offered education about the ER medical
Mariela Munoz and Jeremy Howe, MD, MPH discuss Sylvia’s care plan.
team’s suggestions for her care. “Eventually, Sylvia told me that she realized some of her symptoms were brought on by situational stressors,” said Munoz. “She didn’t want to go to therapy to discuss these stressors, so I suggested she reach out to someone in her community she trusted. She reached out to her pastor and set up regular visits with them and that helped her a lot.” By June 2022, Sylvia’s ER visits were reduced by nearly 50 percent. From June to December, she only went to the ER one time. “I continue to visit with Sylvia to ensure she has support,” said Munoz. “Her care has certainly benefitted from connections. We found the missing links, and I’m so grateful she was willing to trust me because now she is invested in her health.”
23 ANNUAL REPORT 2022
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