Workday of SCI doctor

[MrFlyGuy]

Hi all,

I was wondering what SCI doctors actually do for their patients. I looked up that the common conditions that they manage are neurogenic bladder, gi motility, sexual dysfunction, spasticity, bed sores, and pain. I also read that autonomic dysfunctions can manifest such as changes in blood pressure, heart rate, and pulmonary functions but would the SCI fellowship trained pm&r doctor manage this or would they refer them to other specialties?

Also is it mostly medication management or do you do certain procedures/evaluate them for rehabilitation? I know they have made large strides in SCI rehabilitation such as utilizing exoskeletons but are the pm&r docs involved in this or is it mostly physical therapists? All in all I think it would be a really rewarding specialty (I've actually worked with SCI patients before medical school) but I'm just confused about how they actually manage the conditions listed above. I'm MS3 btw.

MrFlyGuy

---

Members don't see this ad.

 

[RangerBob]

SCI physicians sort of act like PCPs for patients with SCI.

We (SCI and PM&R) manage autonomic dysreflexia. Most others don’t even know what it is. It’s only when we can’t get it controlled and it’s life threatening and the patient needs to be put on a drip that you’d transfer them. Most of the time the nurses (or patient if they’re at home) work through the AD protocol and they just tell you “oh, so and so had an episode of AD last night, it resolved with flushing the foley). But we would be the ones prescribing nifedipine/nitropaste, perhaps clonidine if it’s occurring often enough.

If the patient is a high tetra, typically they will follow with pulmonologist for vent management, but SCI physicians are the only doctors in the hospital aside from intensivists/pulmonologist who mange vents. We had them on our unit. But for long term follow up we usually had them follow with pulm as well.

For bladder/bowel/sexual stuff we do a lot of the management-ordering renal ultrasounds, counseling, prescribing whatever meds. But we refer to urology if they need a suprapubic tune or implant device, etc. But the patients are well served to be seeing uro on a once yearly basis or so.

Spasticity is all is unless you’re referring for tendon lengthening (typically in kids), dorsal rhizotomy (I’ve never seen one...). We do the Botox injections and while neurosurgery puts in the baclofen pump, we do all the management (refilling and trouble shooting-and there will be trouble-shooting!)

Pain is also totally within our domain, but for some patients with very severe and refractory pain we may refer to pain management. And I’d they need any axial injections we refer. But sometimes those pain docs are PM&R trained as well. But it’s rare for SCI physicians to do axial injections. Some don’t do their own peripheral injections (or Botox), depending on the culture of the institution, and may refer to general PM&R for those.

Exoskeletons are still fairly new. We’re getting one on my unit at some point. But it’s really PT that works with them. Typically we don’t have much, if anything, to do with them. Maybe when insurance covers them and they’re cheap enough we’ll prescribe them. Just like with wheelchairs, we should know how they work and how to prescribe them, but typically it is the therapist who is working closely with the patient that really customized the thing, teaches them how to use it, etc.

SCI is a very rewarding field. I found it most rewarding at the VA-you get a lot more time with the patients (and they do require a lot of time!), and you get just about all the support you need. And they can stay forever on rehab at the VA (and just about every VA SCI unit has one that does...). The patients can be very complicated, but they are often very grateful.

Sorry for any typos-using my iPhone to answer.

 

[MrFlyGuy]

SCI physicians sort of act like PCPs for patients with SCI.

We (SCI and PM&R) manage autonomic dysreflexia. Most others don’t even know what it is. It’s only when we can’t get it controlled and it’s life threatening and the patient needs to be put on a drip that you’d transfer them. Most of the time the nurses (or patient if they’re at home) work through the AD protocol and they just tell you “oh, so and so had an episode of AD last night, it resolved with flushing the foley). But we would be the ones prescribing nifedipine/nitropaste, perhaps clonidine if it’s occurring often enough.

If the patient is a high tetra, typically they will follow with pulmonologist for vent management, but SCI physicians are the only doctors in the hospital aside from intensivists/pulmonologist who mange vents. We had them on our unit. But for long term follow up we usually had them follow with pulm as well.

For bladder/bowel/sexual stuff we do a lot of the management-ordering renal ultrasounds, counseling, prescribing whatever meds. But we refer to urology if they need a suprapubic tune or implant device, etc. But the patients are well served to be seeing uro on a once yearly basis or so.

Spasticity is all is unless you’re referring for tendon lengthening (typically in kids), dorsal rhizotomy (I’ve never seen one...). We do the Botox injections and while neurosurgery puts in the baclofen pump, we do all the management (refilling and trouble shooting-and there will be trouble-shooting!)

Pain is also totally within our domain, but for some patients with very severe and refractory pain we may refer to pain management. And I’d they need any axial injections we refer. But sometimes those pain docs are PM&R trained as well. But it’s rare for SCI physicians to do axial injections. Some don’t do their own peripheral injections (or Botox), depending on the culture of the institution, and may refer to general PM&R for those.

Exoskeletons are still fairly new. We’re getting one on my unit at some point. But it’s really PT that works with them. Typically we don’t have much, if anything, to do with them. Maybe when insurance covers them and they’re cheap enough we’ll prescribe them. Just like with wheelchairs, we should know how they work and how to prescribe them, but typically it is the therapist who is working closely with the patient that really customized the thing, teaches them how to use it, etc.

SCI is a very rewarding field. I found it most rewarding at the VA-you get a lot more time with the patients (and they do require a lot of time!), and you get just about all the support you need. And they can stay forever on rehab at the VA (and just about every VA SCI unit has one that does...). The patients can be very complicated, but they are often very grateful.

Sorry for any typos-using my iPhone to answer.

Really great stuff. Part of me wishes I did a year in a military branch so that I could better relate to my patients. Do you think it would be important to have some military experience to work in the VA? I would have to get my vision corrected before I apply but I do think it would make a difference if I worked with this patient population.

MrFlyGuy

 

[RangerBob]

Really great stuff. Part of me wishes I did a year in a military branch so that I could better relate to my patients. Do you think it would be important to have some military experience to work in the VA? I would have to get my vision corrected before I apply but I do think it would make a difference if I worked with this patient population.

MrFlyGuy

I wish I had military experience as well.

I do think having that experience would help, but I would only pursue it if it’s something that truly interests you. You will still be able to connect to patients without the experience.

Most VA physicians do not have military experience.