Why a Physiatrist Offers the Best Rehabilitative Course

23 06 2011
Korean War Memorial Honors Korean Veterans

The practice of physiatry is approximately 50 years old.  So how is it many pain and immobility challenged patients have never heard of this medical specialty?

    Good question, I guess it’s possible this specialty could be considered the gold standard of rehabilitative medical treatment.  And available to pain and immobility suffers once other medical treatment has been exhausted.

    If you don’t already know about the discipline of physiatry, I will now fill you in on what this specialization can offer a chronic pain and immobility challenged patient that requires rehabilitative services.

   A physiatrist is a medical doctor that deals with muscular-skeletal, neurological, acute and chronic pain and rehabilitative therapy.  They are also referred to as a doctor of osteopathy who specializes in Physical Medicine and Rehabilitation (PM&R); using noninvasive diagnosis, treatment and management of disease through “physical” means (Physical therapy and medications).

    They can perform all types of specialized tests that range from nerve and spine imaging to determine severity of nerve damage (e.g. electromyography, nerve conduction) to evaluate various nerve disease/disorders, etc.  They also specialize and work with patients that have a history in degenerative back and neck disease problems.  To include, but not limited to:  Rehabilitative treatment with sports and work injuries; and those diagnosed with arthritis, tendonitis, osteoarthritis, rheumatoid arthritis, myofascial pain and spinal cord injuries.

    There are approximately 6000 physiatrists to date that specialize and focus on bad backs and the relationship to other parts of the body that also become affected.  For many patients that suffer from back pain and distal radiating pain to other body parts a direct connection to the pain origin can be substantiated and treated.  Radiating or distal pain from the origin pain source can take years to diagnose correctly and can be very challenging for many physicians.  In other words, so challenging primary physicians may take a subjective “shot in the dark” in referring a patient to a medical specialist that may, or may not be of immediate help.

    Sometimes these “shot in the dark” referrals may not pan out.  For me this was the case.  And I suspect there are many of you like me that had the same experience of visiting a lot of specialists and the end result was temporary physical therapy sessions, shots and more pills.  And only until a significant amount of time passed while working through a medical “status quo” policy driven health maintenance organization, did I finally get the treatment I needed.  And this occurred after I learned how to properly advocate and self refer to specialists that could treat me relative to my unique pain issues.

    It is my personal experience many of my medical referrals throughout the years to determine my pain origins were a waste of resources and time that lacked relative treatment.  I believe in my case, I should have been first referred to a physiatrist to determine the best rehabilitative course.  And it is also my belief that if this would have been the case, much of my pain and suffering would have been alleviated five years ago.  And to be honest, I’m not sure what the long-term impact will be on my health as a result of untimely and irrelevant treatment.

    Let’s now take a look at what the physiatrist’s educational requirements are so you can better understand their specialty background and how they as a “direct” referral source to other specialists may help you.

    Physiatrists go through 4 years of medical school and 4 years of residency training (1st year – internal medicine/general practice; next 3 years emphasize specialty training; fellowships for additional specialization in sports medicine, brain injury (stroke), spinal cord, pain management and pediatric medicine.

    Their patient goal is also to treat the whole person’s physical, emotional, psychosocial and vocational goals.  This discipline also falls in line with Mirror Athlete’s principled fit-healthy concepts.  Mirror Athlete is about “ill-health prevention for the encompassing being (mind, body and “soul-spirit”) and is our principled fitness life philosophy.

    For many pain sufferers with chronic pain that have not responded to previous pain management and rehabilitative treatments, access to highly trained physiatrist resources can make a significant difference in increasing mobility and/or alleviating pain. 

    It is true; most of us have access to highly trained medical specialists through our referring physicians.  And it is also true a primary care physician will “usually” not refer you first to a physiatrist “for pain and mobility challenges. 

    You ask why this is.  My answer to you, I honestly don’t know.  The only thing I can think… Maybe it has to do with higher costs of services.  And maybe if you are stabilized and appear to be tolerating your disability, and/or don’t understand, or know you can self refer to see a physiatrist, the HMO policy advices primary physicians to follow a cost effective services protocol otherwise.

    However, I can share with you, if you can get a referral to a neurologist; you’re really in line to get a referral to see a physiatrist from that point if your pain is substantiated and will help with your disability rehabilitative objectives.

    It is surprising to me in the last 7 years; I’ve been referred to at least a half dozen neurologists, none of which led me to a physiatrist for my chronic back/leg pain until recent.  And what is most perplexing, my pain-medical story had not changed significantly through the years.  If I had known about physiatry resources 5 years ago, I would have known to self-refer from a neurologist to a physiatrist knowing what I now know.  Why not 7 years ago?  In my case, I understand now it took two years to determine and substantiate my pain origins.  And I now realize I could have self referred to a physiatrist after I had my second neurologist visit.

    My lesson learned and now passed onto you:  The medical policy and practice “status quo” when dealing with “substantiated” pain and/or immobility, coupled with depression will include pharmaceuticals and other treatment until (a) you reach a certain age.  (b) The pills are now creating other medical health issues.  (c) The risk of other complications is high if continuing the same pain and/or depression management course.  (d) Something substantiated and significant has changed, or has been found through CAT, MRI, x-Ray results and/or lab work and is complicating your pain, or mobility story.  (e) You self refer to see a neurologist from your physician, and then ask for a referral to see a physiatrist from your neurologist.   The later sequence is the best course toward rehabilitative pain alleviation of chronic pain, including range-of-motion and rehabilitative, limited mobility challenges [My experience].

    To treat a patient without considering the entire being is to allow a part of the component being to become ill.  When relative and timely treatment is not balanced, part of our “being” becomes depressed.  And it is also a fact as one will age; without relative and timely treatment, quality living experiences are negatively impacted.

    With the assistance of a physiatrist the patient has access to a team of specialists to assist in customizing a rehabilitative treatment program that incorporates healing for the encompassing being.

    The team of specialist the physiatrist may access to assist your ill-health conditions are: Speech-language pathologists, social workers, nurses, and psychologists, neurologic (brain injury, stroke, and spinal cord injury), physical therapy, occupational and recreation therapists etc.  Other disabling conditions include amputations, complicated multiple trauma and pain, including burns rehabilitative therapy.

    Physiatrists also work with a whole team of specialists to restore independence in mobility, eating, dressing, and hygiene. The physiatrist also provides long-term continuity of care for functional problems that often persist after stroke.  Note: This is not simply a physical therapy program.

     In my opinion, a physiatrist is an encompassing-being, rehabilitative care provider.  And if you have not seen a physiatrist and if you’ve been suffering from chronic pain and/or are mobility challenged, also you have reached the end of your referral solutions; be sure to ask your primary care physician, or neurologist to see a physiatrist.

     A physiatrist referral sooner than later will provide most chronic pain and immobility sufferers pain relief and better quality care and living activity experiences.

 Internet Reference

http://www.spine-health.com/glossary/p/physiatrist

http://www.physiatry.org/Field_Section.cfm

http://www.umassmemorial.org/medicalcenterIP.cfm?id=3081

Marc T. Woodard, MBA, BS Exercise Science, USA Medical Services Officer, CPT, RET.  2011 Copyright, All rights reserved, Mirror Athlete Publishing @: http://www.mirrorathlete.com,  Sign up for your Free eNewsletter.





Why a Physiatrist Offers the Best Rehabilitative Course

23 06 2011
Korean Memorial, Washington DC

The practice of physiatry is approximately 50 years old.  So how is it many pain and immobility challenged patients have never heard of this medical specialty?

    Good question, I guess it’s possible this specialty could be considered the gold standard of rehabilitative medical treatment.  And available to pain and immobility suffers once other medical treatment has been exhausted.

    If you don’t already know about the discipline of physiatry, I will now fill you in on what this specialization can offer a chronic pain and immobility challenged patient that requires rehabilitative services.

   A physiatrist is a medical doctor that deals with muscular-skeletal, neurological, acute and chronic pain and rehabilitative therapy.  They are also referred to as a doctor of osteopathy who specializes in Physical Medicine and Rehabilitation (PM&R); using noninvasive diagnosis, treatment and management of disease through “physical” means (Physical therapy and medications).

    They can perform all types of specialized tests that range from nerve and spine imaging to determine severity of nerve damage (e.g. electromyography, nerve conduction) to evaluate various nerve disease/disorders, etc.  They also specialize and work with patients that have a history in degenerative back and neck disease problems.  To include, but not limited to:  Rehabilitative treatment with sports and work injuries; and those diagnosed with arthritis, tendonitis, osteoarthritis, rheumatoid arthritis, myofascial pain and spinal cord injuries.

    There are approximately 6000 physiatrists to date that specialize and focus on bad backs and the relationship to other parts of the body that also become affected.  For many patients that suffer from back pain and distal radiating pain to other body parts a direct connection to the pain origin can be substantiated and treated.  Radiating or distal pain from the origin pain source can take years to diagnose correctly and can be very challenging for many physicians.  In other words, so challenging primary physicians may take a subjective “shot in the dark” in referring a patient to a medical specialist that may, or may not be of immediate help.

    Sometimes these “shot in the dark” referrals may not pan out.  For me this was the case.  And I suspect there are many of you like me that had the same experience of visiting a lot of specialists and the end result was temporary physical therapy sessions, shots and more pills.  And only until a significant amount of time passed while working through a medical “status quo” policy driven health maintenance organization, did I finally get the treatment I needed.  And this occurred after I learned how to properly advocate and self refer to specialists that could treat me relative to my unique pain issues.

    It is my personal experience many of my medical referrals throughout the years to determine my pain origins were a waste of resources and time that lacked relative treatment.  I believe in my case, I should have been first referred to a physiatrist to determine the best rehabilitative course.  And it is also my belief that if this would have been the case, much of my pain and suffering would have been alleviated five years ago.  And to be honest, I’m not sure what the long-term impact will be on my health as a result of untimely and irrelevant treatment.

    Let’s now take a look at what the physiatrist’s educational requirements are so you can better understand their specialty background and how they as a “direct” referral source to other specialists may help you.

    Physiatrists go through 4 years of medical school and 4 years of residency training (1st year – internal medicine/general practice; next 3 years emphasize specialty training; fellowships for additional specialization in sports medicine, brain injury (stroke), spinal cord, pain management and pediatric medicine.

    Their patient goal is also to treat the whole person’s physical, emotional, psychosocial and vocational goals.  This discipline also falls in line with Mirror Athlete’s principled fit-healthy concepts.  Mirror Athlete is about “ill-health prevention for the encompassing being (mind, body and “soul-spirit”) and is our principled fitness life philosophy.

    For many pain sufferers with chronic pain that have not responded to previous pain management and rehabilitative treatments, access to highly trained physiatrist resources can make a significant difference in increasing mobility and/or alleviating pain. 

    It is true; most of us have access to highly trained medical specialists through our referring physicians.  And it is also true a primary care physician will “usually” not refer you first to a physiatrist “for pain and mobility challenges. 

    You ask why this is.  My answer to you, I honestly don’t know.  The only thing I can think… Maybe it has to do with higher costs of services.  And maybe if you are stabilized and appear to be tolerating your disability, and/or don’t understand, or know you can self refer to see a physiatrist, the HMO policy advices primary physicians to follow a cost effective services protocol otherwise.

    However, I can share with you, if you can get a referral to a neurologist; you’re really in line to get a referral to see a physiatrist from that point if your pain is substantiated and will help with your disability rehabilitative objectives.

    It is surprising to me in the last 7 years; I’ve been referred to at least a half dozen neurologists, none of which led me to a physiatrist for my chronic back/leg pain until recent.  And what is most perplexing, my pain-medical story had not changed significantly through the years.  If I had known about physiatry resources 5 years ago, I would have known to self-refer from a neurologist to a physiatrist knowing what I now know.  Why not 7 years ago?  In my case, I understand now it took two years to determine and substantiate my pain origins.  And I now realize I could have self referred to a physiatrist after I had my second neurologist visit.

    My lesson learned and now passed onto you:  The medical policy and practice “status quo” when dealing with “substantiated” pain and/or immobility, coupled with depression will include pharmaceuticals and other treatment until (a) you reach a certain age.  (b) The pills are now creating other medical health issues.  (c) The risk of other complications is high if continuing the same pain and/or depression management course.  (d) Something substantiated and significant has changed, or has been found through CAT, MRI, x-Ray results and/or lab work and is complicating your pain, or mobility story.  (e) You self refer to see a neurologist from your physician, and then ask for a referral to see a physiatrist from your neurologist.   The later sequence is the best course toward rehabilitative pain alleviation of chronic pain, including range-of-motion and rehabilitative, limited mobility challenges [My experience].

    To treat a patient without considering the entire being is to allow a part of the component being to become ill.  When relative and timely treatment is not balanced, part of our “being” becomes depressed.  And it is also a fact as one will age; without relative and timely treatment, quality living experiences are negatively impacted.

    With the assistance of a physiatrist the patient has access to a team of specialists to assist in customizing a rehabilitative treatment program that incorporates healing for the encompassing being.

    The team of specialist the physiatrist may access to assist your ill-health conditions are: Speech-language pathologists, social workers, nurses, and psychologists, neurologic (brain injury, stroke, and spinal cord injury), physical therapy, occupational and recreation therapists etc.  Other disabling conditions include amputations, complicated multiple trauma and pain, including burns rehabilitative therapy.

    Physiatrists also work with a whole team of specialists to restore independence in mobility, eating, dressing, and hygiene. The physiatrist also provides long-term continuity of care for functional problems that often persist after stroke.  Note: This is not simply a physical therapy program.

     In my opinion, a physiatrist is an encompassing-being, rehabilitative care provider.  And if you have not seen a physiatrist and if you’ve been suffering from chronic pain and/or are mobility challenged, also you have reached the end of your referral solutions; be sure to ask your primary care physician, or neurologist to see a physiatrist.

     A physiatrist referral sooner than later will provide most chronic pain and immobility sufferers pain relief and better quality care and living activity experiences.

 Internet Reference

http://www.spine-health.com/glossary/p/physiatrist

http://www.physiatry.org/Field_Section.cfm

http://www.umassmemorial.org/medicalcenterIP.cfm?id=3081

Marc T. Woodard, MBA, BS Exercise Science, USA Medical Services Officer, CPT, RET.  2011 Copyright, All rights reserved, Mirror Athlete Publishing @: www.mirrorathlete.com,  Sign up for your Free eNewsletter.





How to Work Around Chronic Pain?

25 06 2008
Q.   I was curious, how do you work around chronic pain.  After visiting your chronic pain center, I read your introduction.  You mention a pain management philosophy, or exercise application around pain.  I can’t find anywhere in your articles, or section that address this topic in detail.  Is there an article you have written on this topic?  If so, where can I go to read it?A.    This is a very good question.  The work outs, or fitness programs around chronic pain will be presented in some of the monthly excerpts from Mirror Athlete with Chronic Pain Chronicles.  Since you have seen the summary at our chronic pain center, you also understand most of this information will be released once the chronicles manuscript is published as a book.  Although I have not provided any detail on how Mirror Athletes that are-aren’t disabled work around chronic pain and specific techniques applied to stay relatively active & fit… I can say this is a work in progress (I will write some articles outside the chronic pain articles revolving around overall fitness and exercise program).   I can also tell you I can provide tidbits of information that you can use now to incorporate into a fitness exercise program to help you maintain a healthy lifestyle.  For example,A very important key to exercising, or performing activity if you have chronic pain, or are basically disabled because of your chronic pain, you first must understand what triggers your pain [I like to analyze the “what, when, where & how pain is triggered].  You need to learn to do the same thing.  This physical pain analysis prior to activity, or exercise work outs is critical.You also must have a good understanding of your medical & health condition, goals and activity risks by working with your primary care physicians and/or medical specialists ensuring you understand how a pain condition  could be aggravated to become more chronic.  Keep in mind what I’m presenting here is not a complete medical, health, or history audit checklist before exercise activity commences.   These general bullets are instead the basic rudimentary steps required to understand how you can stay active even with disabilities without risking further aggravation and harm to your body.  Since exercise and activity are key ingredients to my healthy life program, it is essential that all walks of life looking to improve their health condition apply an activity, exercise, pain management program that makes sense for their overall health management program.

In other words, if an activity creates pain beyond a manageable level of pain tolerance, I’d say relative to your pain and health management program this is not good for your body and could cause serious harm to a preexisting condition.

Also visit our site Wellness Company page.  We offer excellent “NATURAL” products scientifically formulated to remove chemical toxin allergies from your home.Thank You for your patronage, please subscribe to your free monthly eNewletter at our home site.

Marc T. Woodard, Health & Fitness Consultant, Publisher, Mirror Athlete Enterprises @  www.mirrorathlete.com
2007-2008 Copyright Mirror Athlete Enterprises, All rights reserved.
 

 

 





How Does One Deal With Osteoporosis Onset

25 01 2008

Question & Answer “Osteoporosis Onset”

Q.  Last year my mother was cleaning the house and slipped on a door mat and fell.  Unfortunately, she fractured her hip and had to be immobilized for awhile to allow healing.  The doctor diagnosed her with the beginning onset of osteoporosis.  Although I don’t consider my mother elderly at 64 years of age, I guess it is quite common for women to receive this type of diagnosis.  Is their anything my mother can do to strengthen her bone density so the condition does not worsen?

 A.  You are correct with your statement “quite common for women,” (women have a 1 in 4 chance of acquiring osteoporosis by age 60).  This is basically due to the fact women have 30% less bone density then their counter part.  Also, after a woman goes through menopause, estrogen levels drop drastically further contributing to bone density loss.  Nutritional experts highly recommend good sources of calcium, i.e., milk, yogurt, cheese, soy, almonds, etc.  Calcium supplements prescribed (1500-2000mg/day), may benefit  persons with osteoporosis.  Absorption is also an issue, as we age our bodies lack the ability to absorb the nutrients maximally.  Other nutrients vital to maintain strong and healthy bones…vitamin D, K, magnesium and zinc.

Highly recommended:  Physical exercise.  Loading up the bone structure with resistive workouts strengthens bone and builds bone density.  At a minimum, all adults should strive to go on walks every other day, make it a habit, your bones will love you for it.  Ask a doctor if supplementation, or exercise is right for you.  See our healthy home banner above.  The Wellness Wholesale Company has excellent “NATURAL” supplement scientifically formulated to assist osteoporosis prevention & maintenance.   Please feel free to read my personal testimonial on that web page with regard to the high absorption qualty of these premium wellness products

Author:  Marc T. Woodard, MBA, BS Exercise Science, USA Medical Services Officer, CPT, RET.  2008 Copyright, All rights reserved.  Mirror Athlete Enterprises Publishing @: www.mirrorathlete.com, Sign up for your free eNewsletter.