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Physiatrist tomorrow

Kris-NYKKris-NY Posts: 2,207
edited 06/11/2012 - 8:46 AM in Pain Management
After months of reading posts by Ron about seeing a physiatrist my pain management practice recommended that I see one. They have one within their practice which is convienent for several reasons.

So tomorrow afternoon is my first visit with this doctor. Tomorrow morning I plan to spend some time detailing what I am taking now and what I am feeling now. I also want to put together a list of all of the "problem areas" that I know about.

Any other ideas?


  • Howdy Kris,

    Since it all goes with the package? How you're sleeping, stress, emotional up and downs you might have? Any appetite problems, or issues. Physiological changes? I hope the appointment goes well. *HUG*

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Thanks Brenda -- all great ideas that I will use. I am really hoping I connect with this guy. Since surgery is off the table for the forseeable future I need to get my act together. I'm hoping that he will be able to recommend a great GP and if it's not too much to hope for an epidemiologist and a surgeon to get rid of this gallbladder :) Oh and a dermatologist :) Might as well hope for the stars and be happy with an airplane ride.
  • Kris,

    I hope you can connect with him as well. Please let us know how it works out. I'll of course keep you in my thoughts and send bunches of positive energy your way woman!!! *HUGZ* :)

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Good luck! I am seeing a therapist 2moro for the first time too! Never saw one before so should be interesting! My doc specializes in pain, post op, dealing with meds, docs and disability. I hope it works well for us both! Be honest, open and have no shame! This how I am approaching. Also, I am everybodies everything, lots of preassure! This will be me being 100% me 100% selfish! No work, no kids, no husband, no pets, no bills.... u get my point, u should do the same HOLISTIC healing!
    Good luck!
  • Kris,

    While you might already have a file going in this practice, I would look at the website and see if you can't print out the new patient registration forms. While you are no a new patient to the practice you are a new patient to him or her. Lots of times the doctors are used to reading those forms and know what they are looking for. I also use a physiatrist and the relationship i have with him didn't happen over night. I have actually been with him three years this month. So it takes time to build those relationships. We had a rocky start, sense I am work comp i had to be there and couldn't leave. But in reality on our first appointment he was looking at everything and told me I would never be able to resume my job. So i was frustrated not what I wanted to hear, still wanted him to fix me and make me better. In the long run he was write and he can't fix it but can make it easier to live with. Because of the meds he prescribes I see him once a month for the work comp injury then a second time a month for non work related injuries, or what they say don't belong to them.

    I guess the point i am making is it takes time to build those relationships and for a doctor to take in the entire case and get it all down.
  • So Kris, what is does this physiatrist do? My PM doctor was a physiatrist, but I'm not sure what they do absent another label.
  • Since my last PM practice neglected me all weekend (and never even called yesterday to apologize), my NS will be referring me to a Physiatrist. Based upon what Ron has said, I'm hoping for the same type of experience as Kris.

    Interestingly, my PCP called me last night sort of out of the blue (I wonder if he caught wind of my formal complaint against the PM practice since they are in the same hospital?) to tell me about a genetic test result. He said very honestly that it is a difficult test to interpret and that sometimes a psychiatrist is the best trained to deal with complex neurological issues that relate to pain, anxiety, depression, etc., and he said he is going to see if anyone in that department specializes in treating pain patients.

    Either way, it seems like both avenues are worth exploring.


    P.S. Good luck, Kris!
  • My understanding is that the physiatrist is a doctor trained in the treatment of skelatal-muscular problems. So this guy has extensive knowledge about the spine and skeleton as well as the muscles, ligaments and tendons. Often the are called sports-rehab docs because many of the injuries come under this category.

    So this doctor is supposed to be able to look at my spine problems and the pain I am experiencing and then come up with a plan for pain relief. THis can include meds, PT in a facility, exercise or tens at home, acupuncture, aqua therapy, or anything else he can think of that might help. What really sold me was that if he thinks PT might help he designs the specific PT routine that I can take to my PT office around the corner. It's not just a script for PT for say a shoulder and then the therapist decides what to do.

    I'm also hoping that this doctor combined with the PM doc will be able to adjust or change the neurontin and maybe add something that will work better. If this happens then I can stop seeing the neurologist which will make him happy.

    Keep your fingers crossed. I have about 3 hours to get my records together for this appt.
  • I'm going to be really interested in hearing how things go for you, Kris. I had never heard this terminology, "physiatrist", before reading it here, but I think my PM doctor is acting in that sort of role as well. I'm seeing him on Friday and I'm going to ask him if he has that title too. We know that my pain is ultimately caused by an aggravated nerve, but that nerve now causes muscular issues and great pain. My SCS can really control most of the nerve pain, but doesn't touch the muscle irritation, obviously. So he is going to do trigger point injections into the muscles that are on either side of my cervical spine as well as those that run over to the shoulders and see if I can get relief. I am also supposed to be getting a tens unit to use at home. Physical therapy has not been an answer for me and a great deal of stretching is not encouraged because we don't wnat to risk disconnecting my leads.
    I didn't mean to go on and on about my situation, but it just made me start thinking about the role my PM doctor is taking. I have been so fortunate in the role my family doctor, neurosurgeon and PM have taken and they have worked so well together too to try and get me some relief. I know it doesn't happen that way for most.
    Good luck to you!
  • dilaurodilauro ConnecticutPosts: 9,877
    Kris, I hope everything worked out for you with the physiatrist. As you know, that type of doctor is what saved me.

    For those out there that are not familiar with a physiatrist, here is a web definition:
    ( From a Spine Universe technical writer )

    A physiatrist is a medical doctor who specializes in physical medicine, rehabilitation, and pain medicine. These spine specialists focus on the body's musculoskeletal system, which includes bones, joints, muscles, ligaments, tendons, and nerves. Physiatrists treat patients of all ages with diverse problems ranging from simple low back sprains to complex disorders, such as spinal cord injury. Their comprehensive approach includes treating the entire patient, not just symptoms.
    Physiatry is an aggressive, nonsurgical approach to treating musculoskeletal disease and injury, including different types of pain. Similar to other types of spine specialists, physiatrists take the patient's medical history, perform a physical and neurological examination, order X-rays or other imaging studies, prescribe medications, and perform spinal injections.
    Physical medicine and rehabilitation often includes physical therapy. Sometimes other physical medicine professionals are involved in the patient's care such as occupational therapists or athletic trainers. Physiatrists coordinate patient care with other doctors and specialists, such as orthopaedic surgeons and neurosurgeons.
    Physiatrists treat patients in different settings such as hospitals, outpatient clinics, rehabilitation centers, nursing homes, and private practice.
    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • I haven't had the priviledge of a great team. My PCP is totally disconnected. When I went to her she checked my cholesterol....did someone say drug company rep??? My neurologist did an emg and trigger pt injections which did nothing so he sent me on to the pm doc. I've been bouncing around to different surgeons for consults and most recently the neuro-opthamologist for the horners.

    The PM and this doc are working within a group called prohealth that is kind of an umbrella for all specialties. My gyn was there for a while and the organization is very professional. So far this day has gone very well so I have a good feeling...

    p.s. please never feel bad about talking about yourself or sidetracking any of my posts. I truly believe that we all learn so much more when the thread takes it's natural path.
  • Yes, my PM did really seem to know a lot about where pain comes from. I loved that about him. He did my injections as well, the facet ablation, the ESI, etc. and explained why he thought they'd help even though my injury wasn't related (for example, that my fracture would put stress on the facet joints below that point, and they were likely causing me pain).

    And he turned out to be right in most of the cases.

    Now that you have mentioned it, I'm going to switch to the other physiatrist in the practice. The doctor I saw last was an anesthesiologist. I'm wondering if that's part of the difference?
  • Dear Kris,

    I hope you have a good visit today with the Physiatrist. I will be anxious to hear how your appointment went.

    I have been really fortunate, in that my Neurosurgeon lined me up with a fantastic Physiatrist team after my spine surgery. The Physiatrist he initially set me up with, is my "primary" pain management doctor who I see once a month. This doctor prescribes the majority of my medications, works closely with my Physical Therapy team, orders the majority of my CT's and X-rays, and also tells me when I need to see my PCP (for a possible UTI, etc.) or any other specialty doctor for further examination (Cardiologist, for example).

    My primary Physiatrist does not do injections. I was sent to an Orthopedic Surgeon for evaluation of my dislocated tailbone fractures (discovered in January 2010), and during our consultation he recommended nerve blocks with coccyx injections as a form of pain relief for my chronic tailbone fractures. Because my primary Physiatrist does not perform injections, he referred me to another Physiatrist who specializes in giving injections. I am allowed 4 series of nerve blocks a year for my lumbar and tailbone pain and she gave me my first trochanteric (bursitis in hip area) injection in August. (All nerve blocks and injections are performed under fluoroscope guideance or ultrasound guideance for precise placement). This Physiatrist recently ordered me a TENS unit and also prescribed a specific anti-inflammatory medication to take for my osteoarthritis pain felt throughout my spine and joints. She phoned my primary Physiatrist to get the "okay" in prescribing me the Etodolac medication, prior to writing the script.

    What I find absolutely awesome, is that both of my Physiatrists communicate regularly regarding my overall pain management plan. My Physical Therapists also send monthly reports to these two doctors. They also send quarterly updates to my Neurosurgeon and my PCP and vice versa with my PCP reporting any blood tests taken or UTI infections I may have to my primary Physiatrist.

    I really hope you, Dave, HappyHB and everyone... can experience this kind of care. It really makes everything flow so smoothly between the doctors, when everyone is working together as a team.

    Best wishes, always...

    Tammy >:D<

    P.S. Just wanted to mention as a side note that I only use one pharmacy and one imaging center. I have a favorite radiologist that I request to read my images. All of my doctors look at the actual images themselves, but I like to read what the radiologist finds and puts down on the report. He is detailed and makes it easy for me to look-up any word I am not familiar with. I always get a copy of the imaging report, as I have to send any new reports I get to my LTD carrier and also my lawyer who is handling my SSD case.
  • When I read your post, I was in awe as to how you have everything so well integrated and running like a well-oiled machine.

    My PM machine is more like a wagon put together by some neighborhood kids... when it gets up a little speed, the wheels come off. #o
  • I would rate the visit as an 8 out of 10. He did a pretty good exam. He impressed me because he knew where my pain was before I told him. In his opinion the pain that is not being managed by the neurontin is from my posture and body mechanics being messed up since the surgery and with the new pain. He is sending me to PT but wants me to check back in 2 weeks. He also thinks he can do some trigger pt injections that will help. He prescribed Voltram gel as well.

    What I loved was that he had the same chart that the PM group uses. He came into the exam room after reviewing all my records so I didn't have to start at the beginning which was nice.

    I did feel a little rushed. Hopefully this will change when I go back. I wanted to talk to him about taking over the disability paperwork for me but never got the chance.

    So overall I was pretty happy. I am going to my PT which will help me know that what he says makes sense. I did like his short time line to review the PT results. And if it comes to trigger pt inj I think he will have more success since this is what he does all day as opposed to my neurologist who probably does 1 or 2 a week.

    Like all things there are good and bad. So far I'm finding this group to be good. Stay tuned for more...
  • Kris,

    Good to hear that all went well for you. Hopefully he is on to something and can get you back up to speed and feeling better. I have used the voltaren gel for my knees dislocating but for now I am off because of the fusion surgery. Don't ask me what is in it, but something that don't go along with my fusion.

    Anyway I happy you had a good visit and he is going to follow you so closely.
  • So glad to hear you are happy so far with your initial visit and exam. Hopefully you will start feeling less pain soon. Please let us know how it progresses. Good for you woman!! :)

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • dilaurodilauro ConnecticutPosts: 9,877
    I used Voltaren gel for several months before I had my shoulder surgery. I did help in reducing some of the pain.

    Its something to definitely try.
    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
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