Wednesday, February 7, 2007

Let's Get Physical

Apologies to Ms. Newton-John and unshod company, but I'm really thinking about physiatry, the practice of physical medicine and rehabilitation. This is not psychiatry, podiatry or psychosurgery. It's physiatry. Odds are good if someone in your life needs active care from you, they need a physiatrist too, but odds are better that unless you're a practicing physician yourself, you've never even heard of the specialty. This is a shame.

The Background:

Physiatry is really a pretty amazing specialty. Joining elements of orthopaedic medicine, physical therapy and neurology in a combo meal of medical goodness, physiatrists treat patients with everything from sports injuries to post-polio complications. I think of them as having a function analogous to an internist, but for the meat and structures rather than the squishy insides. By drawing on broad rehabilitation expertise from the entire range of physical and occupational and recreational therapists, speech pathologists, psychologists and nursing, physiatrists put people back together again, usually emphasizing a conservative non-surgical approach.

As medical specialties go, physiatry is relatively new. The first physical medicine department was formed at the Mayo Clinic in 1936, and the specialty became officially recognized in 1947. The development of the specialty is a direct result of improved survival from things that used to kill people, like major trauma, strokes and spinal cord injuries. People are living longer after body-destroying disease and injury, and physiatrists are uniquely qualified to treat these patients, often over many years.

What I really like most about physiatry is the emphasis on improving function in the face of pretty grim limitations. Aside from the sports medicine aspect (which is how I first learned the wonders of physiatry), most physiatric patients aren't going to be "cured" of their underlying conditions - the objective is to find interventions that improve their quality of life and restore as much function as possible. So if your loved one has lost a leg, a smattering of brain cells or crucial space between their vertebrae, you should probably get to know a physiatrist.

Things Our Physiatrist Has Helped Cal With:
  • Alzheimer's Disease Prevention (prescribing a high-dose folate/B6/B12 supplement - I'll post on this sometime soon)
  • Ataxia
  • Awkward End-Of-Life-Care Discussions
  • Chronic Lower Back Pain
  • Constipation (physiatrists are well-acquainted with the GI challenges of the disabled)
  • Exercise Programs
  • Gait Issues Caused By Quad Problems
  • "Mushy Hands" - mysterious hand numbness
  • Neurogenic Foot Pain
  • Normal Pressure Hydrocephalus rule-out
  • Osteoarthritis of the Knee
  • Pressure Ulcer
  • Really Gnarly Fall Down The Stairs That Gave Him A Big Collarbone Lump That Will Never Go Away
  • Rotator Cuff Tear #2
  • Sciatica
  • Shoulder Pain
  • Sleep Disturbances
  • Supraspinatus Tear
  • Suspected TIAs/Vascular Dementia
Thus, you can see that all sorts of problems from his initial brain injury and from being 84 and wearing out all get treated by the same expert. The suggestion has never been surgical intervention - it's conservative, well-tolerated treatment with his best interests in mind.

How To Get Physical:

The American Academy of Physical Medicine and Rehabilitation is the national group for physiatrists. They have a member locator and you can find one of these amazing professionals with just a click.

Our Physiatrist:

Cal's physiatrist will be referred to here as Saint Curlilocks. It's a long story; she has overcome adversity of her own while still providing exceptional care. She worries about me and Jon almost as much as she worries about Cal. She hasn't written him off as a brain-injured old guy who can't get better, and she's open to conventional, emerging and Eastern medicine. She works us in on no notice, she can make imaging happen at the speed of light and she is well-respected by all of the other care partners we work with.

I once thought she was impossible to unsettle, utterly unflappable, but it turns out, referring to the supraspinatus as the chuck roast really creeps her out. I also find that she does not consider "trigger point injection" synonymous with "deep basting". Nobody's perfect. Suffice to say, no doctor we have ever met is even close when it comes to compassion and caring and utter dedication, but it's not just that soft squishy kumbaya stuff that we love.

Ste. C is a brilliant diagnostician, able to accurately isolate where it hurts even when Cal is at his worst in terms of cognition and communication. It's this odd combo of veterinary medicine and advanced Vulcan nerve pinch delivery (seriously, I've seen her bring an old man to his knees with a well-placed index finger - it's really amazing) that has gotten to the bottom of some problems that were really making Cal miserable. (This is not unique to her - my physiatrist has this clever little poking technique for knee pain that had me on the road to being pain-free in about 10 minutes - I think they learn secret rituals in med school). She's been able to effectively treat this crate of problems even in the face of Cal not really being a surgical candidate, being intolerant of anything stronger than Tylenol for pain and having a drug list that looks like pharmaceutical Chex Mix. She works in concert with everybody - in fact, it's Ste. C who hooked us up with our psychiatrist, even going so far as to loan out her exam room and support staff to facilitate the initial meeting.

She is our go-to gal. When was the last time you and your loved one had an hour of a doctor's undivided attention at a routine appointment? She's pragmatic, too, which of course we find adorable.

Unfortunately, we are insanely protective of Ste. C and will not tell anyone a single nice thing about her in conjunction with her real name or location, for utter fear that she will get all concerned about them and start taking such excellent care of them too, diminishing our access. So far as we claim in public, she kicks puppies, refuses to buy cookies from Girl Scouts and takes two parkings in the hospital lot. Gospel truth.

The Bottom Line:

People who need long-term management of the physical challenges of injury, chronic illness or congenital defects would benefit from the care of a physiatrist. Maybe you'll be lucky to find one as incredible as Ste C.

No comments: