Q: I have been a C-5 quadriplegic for two years. My regular doctor is a neurologist, but recently another quad told me I should have a physiatrist as my primary physician. Why?
A: Physiatrists are physicians who specialize in the field of physical medicine and rehabilitation. To become a physiatrist, a doctor must complete medical school, three years of specialty training and a general internship. This training includes orthopedics, neurosurgery, neurology, rheumatology and internal medicine, plus all aspects of rehabilitation medicine. Physiatrists are routinely trained in the complex management issues of spinal cord-injured individuals.
Neurologists are trained in the early diagnosis and treatment of quadriplegia and paraplegia. Some neurologists develop special interest in post-acute spinal cord injury and take additional training courses in the subject. Therefore, it may be very appropriate to have a follow-up with a neurologist if he or she is interested and experienced in the medical management of persons with spinal cord injuries.
It is always wise to be an active participant in your own health care. This includes selecting a physician with whom you feel comfortable discussing your special concerns and who actively encourages your involvement in health care decisions. In some areas and in some cases, the unique issues of spinal cord injury follow-up are managed by orthopedists, urologists, and primary care physicians, as well as physiatrists and neurologists.
Q: I had polio thirty five years ago and have been diagnosed with post-polio syndrome. I recently heard that people who had polio react to anesthesia differently than those who did not. I’ve done a lot of reading on the subject of post-polio syndrome and have not seen anything regarding anesthesia problems. Have you any information in this area?
A: The question of response to anesthesia and other psychotropic agents by people who had polio years earlier has not been evaluated in any research study. I have found that the post-polio syndrome seems to be associated with a greater than expected sensitivity to sedative and muscle-relaxing agents. At a recent conference for people who have had polio, a number of people in the audience indicated that they thought they had experienced such an unusual sensitivity. This may be related to the polio envolvement of the lower portions of the brain (essentially a poliomyelitis encephalitis) which have to do with the central nervous system’s sleep and arousal functions. We are investigating the possibility of doing a research project on this very important question since it may help us understand some of the problems of fatigue, sleep disturbance, new weakness and pain related to the late effects of polio.
Richard R. Owen, M.D., Medical Director
Sister Kenny Institute
For more information on selecting a physician or post-polio syndrome, call Medformation at 874-4444.
To submit questions on medical or rehabilitative issues for future columns, write: Medical Issues and Disability, Sister Kenny Institute, Dept. 16601, 800 E. 28th St., Minneapolis, MN 55407-3799.
