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    Physiatrist? Neurologist? Pain Mgmt? What do they all do?

    Hi,

    I'm new to the SCI thing and finding out how most doctors know very little about SCI. So, I have questions.

    I have a pain management dr currently (altho may be switching from him)

    I have urologist (which also needs to change..he doesn't know SCI altho he claims he does)

    I have a GP that I see for general stuff. He's great and he listens to me when I explain SCI stuff to him,but when troubleshooting, we're at a loss if I don't know.

    So -

    Should I have a physiatrist also? I have found several around here that have good reviews, but not sure if they handle SCI,, They're PM&R docs. I left a message for one today to have the Dr call me back so I could interview him to make sure he is the right fit for me.. after having so many wasted trips and visits to other doctors.

    What all can the physiatrist do for an SCI patient? What purpose do they serve?

    I saw 1 neurologist who was useless. Looked me over and told me I had a re ason to be in pain, referred me to some quack pain clinic and told me to come back in 3 months.

    Do I need a neurologist? If so, what can they assist with? I want to make an appt with Emory's Department of Neurology if I need it. Emory is among the best, around here at least.

    Having said the above, should I also have a GP and Pain Mgmt Drs? Would the physiatrist handle what a GP would or just certain things?


    Basically, tell me what Doctors I should have in my arsenal and what purpose they each provide.

    Thanks very much!
    Jason

    #2
    Physiatrist (PMR) docs have a lot of training in SCI medicine and rehabilitation. That being said, you have to find one that has a practice that treat a lot of SCI. PMR docs treat pain and a lot have had extensive experience with SCI during their residency. They will work with your family doc if needed to make sure that you are getting the specialized care you deserve. If you are in Atlanta I would check out the PMR docs at the sheppard center. Best of luck...

    Comment


      #3
      Originally posted by PMR DOC View Post
      Physiatrist (PMR) docs have a lot of training in SCI medicine and rehabilitation. That being said, you have to find one that has a practice that treat a lot of SCI. PMR docs treat pain and a lot have had extensive experience with SCI during their residency. They will work with your family doc if needed to make sure that you are getting the specialized care you deserve. If you are in Atlanta I would check out the PMR docs at the sheppard center. Best of luck...
      Shepherd Center is not on my list. I did inpatient there, and everytime I've tried to make an appt, the appts are like a month or more out, and that's just to get the Nurse Practitioner. I went once, and discussed all my problems and she didn't really say much other than teling me to come back to see the Dr,,, 2 months away!

      Comment


        #4
        Originally posted by smashms
        If you go to Emory see dr Neil Lava if he is still there. He is great.
        He is still there, he Director of the MS Clinic also.

        What would I say to make an appointment.for the reason? As a follow up to make sure everything is OK, etc? Maybe mention the pain to them as well.

        Comment


          #5
          Originally posted by jbridges9 View Post
          Hi,

          I'm new to the SCI thing and finding out how most doctors know very little about SCI. So, I have questions.

          I have a pain management dr currently (altho may be switching from him)

          I have urologist (which also needs to change..he doesn't know SCI altho he claims he does)

          I have a GP that I see for general stuff. He's great and he listens to me when I explain SCI stuff to him,but when troubleshooting, we're at a loss if I don't know.

          So -

          Should I have a physiatrist also? I have found several around here that have good reviews, but not sure if they handle SCI,, They're PM&R docs. I left a message for one today to have the Dr call me back so I could interview him to make sure he is the right fit for me.. after having so many wasted trips and visits to other doctors.

          What all can the physiatrist do for an SCI patient? What purpose do they serve?

          I saw 1 neurologist who was useless. Looked me over and told me I had a re ason to be in pain, referred me to some quack pain clinic and told me to come back in 3 months.

          Do I need a neurologist? If so, what can they assist with? I want to make an appt with Emory's Department of Neurology if I need it. Emory is among the best, around here at least.

          Having said the above, should I also have a GP and Pain Mgmt Drs? Would the physiatrist handle what a GP would or just certain things?


          Basically, tell me what Doctors I should have in my arsenal and what purpose they each provide.

          Thanks very much!
          Jason
          Erik Shaw at Shepherd Center is the best for pain management. He will not over medicate like others.

          If you go to Shepherd's outpatient clinic, they will evaluate you and set up appointments with all the doctors you need. I didn't care for the physiatrist there but all the others were great. A physiatrist only evaluates your needs for SCI and refers you to specialties that you need. Unfortunately, you will have to have separate doctors because most don't do pain management. At Shepherd's they will send you to the clinic.

          The urology department is also excellent at Shepherd.

          In my experience, that is what a neurologist did for me too but some more complicated cases of pain and especially nerve pain need a neurologist.

          I know how you feel with wasted visits.
          T12-L2; Burst fracture L1: Incomplete walking with AFO's and cane since 1989

          My goal in life is to be as good of a person my dog already thinks I am. ~Author Unknown

          Comment


            #6
            I wish I could help.

            I have met at least two doctors with advanced specialties (one in neurology and one in physiatry) who knew amazingly little about SCI. Finding good, motivated specialists is very tough.
            Last edited by xsfxsf; 19 Dec 2012, 3:06 AM.

            Comment


              #7
              A physiatrist who doesn't know how to treat SCI general medical problems and has to refer out for pain on a regular basis is a crappy physiatrist IMHO.

              Comment


                #8
                An SCI specialist is a Physiatrist ( AKA rehab doctor, PM&R) who what an additional specialization.They can handle or assist with the pain, urological issues or direct the care. Definitely should have one several years after injury until stabilized and one you can see prn( whenever necessary). However, you will still need a primary provider etc.. and the others later one as PM& R may or may not handle.
                CWO
                The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

                Comment


                  #9
                  Originally posted by PMR DOC View Post
                  A physiatrist who doesn't know how to treat SCI general medical problems and has to refer out for pain on a regular basis is a crappy physiatrist IMHO.
                  In my recent experience, there are alot of physiatrists who will not treat pain. Then you get referred to pain management to go through the protocol just as someone with diabetic neuropathy or other truly different problem. I had about 5 useless appointments before pain was truly addressed and treatment improved. My GP finally said I will write your scrips for pain meds if you like, I got tired of worrying over all the appointments. I also had to go through cognitive behavior pain management therapy where they teach you to relax. At six visits and $40 a visit...there is alot of money to be made by having these requirements for pain management. Those are separate from the physiatrist appointment and the pain management doctor appointment. Also six visits of physical therapy even though I have had it numerous times before and exercise daily.

                  At $40 a copay, it gets expensive to have all these different doctors and not know why you may or may not need them. My first GP would NOT even write an order for me to be evaluated for AFO's. He required me to go to a physiatrist even though I have worn and require AFO's for 23 years. The physiatrist just wrote an order and scheduled a follow up visit. I don't know for what because I just cancelled it. Then when I had an issue like an ear infection or UTI, I could never get in to see the same GP.

                  Good luck Jason
                  T12-L2; Burst fracture L1: Incomplete walking with AFO's and cane since 1989

                  My goal in life is to be as good of a person my dog already thinks I am. ~Author Unknown

                  Comment


                    #10
                    You will most likely still need to see a pain management specialist based on rules and controlled substances. I have patients who try to schedule many of their appointments at the various clinics on the same day. However, that can be hard and some pain management doctors including myself require monthly visits and UA 's. Shepherd is a great facility and I have consulted for them over the years. A long wait for an appointment could be seen as a good thing.....That means they are in demand and good at what they do in my opinion.
                    Disclaimer: Answers, suggestions, and/or comments do not constitute medical advice expressed or implied. Please consult your attending physician for medical advise and treatment. In the event of a medical emergency please call 911.

                    Comment


                      #11
                      Pain can be managed by many MD specialties and neurology is one of them- and a darn good one as they understand the neuro component. The newst "pain " specialist is an anesthesiologist who does pain procedures etc...for the most part but again may manage all the pain. It can vary alot.


                      CWO
                      The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

                      Comment


                        #12
                        Originally posted by SCI-Nurse View Post
                        The newst "pain " specialist is an anesthesiologist who does pain procedures etc...for the most part but again may manage all the pain. It can vary alot.


                        CWO
                        You are so right! What is most frustrating is these newest pain specialists really don't get the neuro. I have seen two of these in the last year.

                        I also saw a pharmacist with a doctorate and he controlled the medications at one "pill mill".

                        It is really really hard to find a pain management practice that actually manages pain. I don't want to be over medicated but yet actually finding something that works just to make it tolerable is almost impossible.

                        The pharmacist just kept increasing narcotics. It really is frustrating.
                        T12-L2; Burst fracture L1: Incomplete walking with AFO's and cane since 1989

                        My goal in life is to be as good of a person my dog already thinks I am. ~Author Unknown

                        Comment


                          #13
                          I've given up on pain management, because no doctor has managed mine in 31+ years.
                          Alan

                          Proofread carefully to see if you any words out.

                          Comment


                            #14
                            Originally posted by darkeyed_daisy View Post
                            In my recent experience, there are alot of physiatrists who will not treat pain. Then you get referred to pain management to go through the protocol just as someone with diabetic neuropathy or other truly different problem. I had about 5 useless appointments before pain was truly addressed and treatment improved. My GP finally said I will write your scrips for pain meds if you like, I got tired of worrying over all the appointments. I also had to go through cognitive behavior pain management therapy where they teach you to relax. At six visits and $40 a visit...there is alot of money to be made by having these requirements for pain management. Those are separate from the physiatrist appointment and the pain management doctor appointment. Also six visits of physical therapy even though I have had it numerous times before and exercise daily.

                            At $40 a copay, it gets expensive to have all these different doctors and not know why you may or may not need them. My first GP would NOT even write an order for me to be evaluated for AFO's. He required me to go to a physiatrist even though I have worn and require AFO's for 23 years. The physiatrist just wrote an order and scheduled a follow up visit. I don't know for what because I just cancelled it. Then when I had an issue like an ear infection or UTI, I could never get in to see the same GP.

                            Good luck Jason
                            Thanks, Daisy. I just switched pain mgmt doctors and I think I will be pleased. I was seeing Dr. Shaw at Shepherd and He and I did not see eye to eye at all. I saw Dr. Musser today who is the other Dr. in the clinic and can already tell he's going to be a lot better.

                            I am going to look into making an appt with Emory's Dept of Neurology and stick with them and my pain dr for right now.

                            However, If I have general health issues (UTI, etc) that present themselves differently in SCI patient, would I see the physiatrist for this? My GP is happy to treat me but doesn't have much knowledge of SCI, so he relies on what I explain to him/tell him. I'd like to not have to go thru months of chasing symptoms. Want to be able to go to a dr that knows SCI, explain my symptoms, etc and have him/her know what I'm talking about.

                            Comment


                              #15
                              Originally posted by jbridges9 View Post
                              However, If I have general health issues (UTI, etc) that present themselves differently in SCI patient, would I see the physiatrist for this? My GP is happy to treat me but doesn't have much knowledge of SCI, so he relies on what I explain to him/tell him.
                              Your GP should handle things like colds, culturing UTI's, and other issues that your SCI does not complicate. You do need a urologist simply because a neurogenic bladder can cause kidney issues. You need routine testing that only a urologist does like urodynamics and kidney scans.

                              A physiatrist can look at your overall issues like wheelchair and recommend things to improve your life with SCI. They don't treat common things like UTI, headache, foot injury like a general practitioner. Your SCI does not complicate most things but your GP needs to be able to communicate with the other specialty physicians and not be afraid to send you to a specialist when you need it.

                              This is the best I can explain what a physiatrist is: Wiki has a good definition.

                              Physical medicine and rehabilitation (PM&R), physiatry /fɨˈzaɪ.ətri/ or rehabilitation medicine, is a branch of medicine that aims to enhance and restore functional ability and quality of life to those with physical impairments or disabilities. A physician having completed training in this field is referred to as a physiatrist or rehabilitation medicine specialist. Physiatrists specialize in restoring optimal function to people with injuries to the muscles, bones, tissues, and nervous system (such as stroke patients).

                              The major concern that PM&R deals with as a medical field is the ability of a person to function optimally within the limitations placed upon them by a disabling impairment or disease process for which there is no known cure. The emphasis is not on the full restoration to the premorbid level of function, but rather the optimization of the quality of life for those not able to achieve full restoration. A team approach to chronic conditions is emphasized to coordinate care of patients. Comprehensive Rehabilitation is provided by specialists in this field, who act as a facilitator, team leader, and medical expert for rehabilitation.
                              I hope this helps it make sense. I know you are overwhelmed by having to have all these different doctors for everything. No one doctor can do everything.

                              There was one physiatrist at Shepherd that I did not see eye to eye with either but I can't remember his name. It is good that you switched. It is important to be able to talk to your doctor and they have to be willing to respond to your needs.

                              Currently, I have the following:

                              GP
                              Urologist
                              Pain Management

                              Its really hard to find a GP with SCI experience unless you live in a big city and even then they tend to want to send you to specialists.
                              T12-L2; Burst fracture L1: Incomplete walking with AFO's and cane since 1989

                              My goal in life is to be as good of a person my dog already thinks I am. ~Author Unknown

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