Q. I am quadriplegic and have recently moved across town. I would like to locate a physician near my home who is familiar with my disability. Do you have any recommendations on how I might locate such a physician and questions I might want to ask a potential physician to determine how well he or she can meet my needs?
A. There are several steps you may want to take in selecting a new physician. You may wish to ask your previous physician to recommend a physician in your new location. Chances are he or she may know of someone qualified to deal with issues relating to quadriplegia.
If your physician cannot make such a referral, you may want to begin your search by contacting those medical facilities near you that are identified as rehabilitation centers. Ask if the facility’s staff is experienced in spinal cord injury care, both on an acute inpatient and a follow-up outpatient basis, and if they are specially accredited in rehabilitation of spinal cord injured individuals. This means the facility has been reviewed by an independent screening agency and met established standards of documentation, staff levels and skills, and have an ongoing quality assurance and outcome documentation process.
The Commission on Accreditation of Rehabilitation Facilities (CARF) is one of these review bodies. CARF has two specific rehabilitation program accreditation levels that relate to spinal cord injury. Facilities can receive accreditation for a comprehensive inpatient rehabilitation program and, specifically, for their spinal cord injury rehabilitation program. Although many rehabilitation facilities receive the comprehensive inpatient rehabilitation accreditation, only those who meet the tougher spinal cord injury standards relating to numbers of new injuries seen per year and total depth and quality of staff and program components, will be accredited for spinal cord injury rehabilitation. At present there are only two rehabilitation facilities in Minnesota with this double accreditation specific to spinal cord injury — St. Mary’s Hospital in Rochester and Sister Kenny Institute in Minneapolis.
You will also want to ask if the facility has specialty physicians or physiatrists with extensive experience in managing a spinal cord injured person on the staff of the facility. If you have a preference for a male or female physician or would feel most comfortable with a physician whose age closely matches yours, feel free to ask for the names of physicians who meet those requirements.
You may want to set up an appointment with, or at least phone, the physicians who most closely meet your basic requirements. Ask the physician any questions you feel will help you determine whether the two of you would be a good physician/patient match. Some questions to help you get started might be:
• What experience have you had working with individuals with spinal cord injury?
• Do you currently have patients who have had spinal cord injuries who would be willing to talk to me about the quality of care they are receiving?
• Throughout my rehabilitation I received information about spinal cord injury in general, as well as specifics as to how my own body now functions post-injury. In essence, I was encouraged to be, and have become, an expert in how my own body now works. Do you adhere to the belief that patients should take an active role in their own medical management?
• Are you familiar with specialists in the areas of urology, physical medicine and rehabilitation, reconstructive (plastic) surgery, internal medicine and dermatology, etc., who are experienced in working with persons with spinal cord injury?
• Are you and your staff familiar with the latest developments in spinal cord injury care, techniques and equipment?
• What insurance plans and other sources of payment do you accept?
Remember, you are the consumer. You have the right to be listened to and provided with the latest information in all associated areas of concerns relating to your total physical and mental functions.
John Schatzlein, Manager, Spinal Cord Injury Program
John Hanson, Social Worker
Sister Kenny Institute
Q. I was diagnosed with phlebitis two years ago and have been taking Coumadin since. I also have quadriplegia and am taking Baclofen for spasticity. Are there any negative side effects from long-term use of these drugs?
A. Baclofen can cause drowsiness when an individual first begins using this drug. However, this side effect diminishes as a person’s system becomes used to the medication. After long-term use, some individuals may experience occasional increases in blood sugar and some enzymes associated with the liver. These changes are very infrequent and usually are noted only as an abnormal level in the results of a laboratory test. The changes are not permanent and do not normally make it necessary to stop using the drug.
Coumadin is given to thin the blood and acts by depleting your body of certain blood-clotting factors. The most serious short or long-term side effect of Coumadin is bleeding. This side effect is directly related to an increase in the length of time it takes for your blood to coagulate (prothrombin time (PT)). Any Coumadin therapy requires close monitoring of the blood’s PT and adjusting the drug dose to achieve a desireable PT.
An infrequent side effect of Coumadin is gangrene of the skin or other tissues. This usually occurs within the first few days after a person begins using Coumadin and does require discontinuing use of the drug. Any drug given with Coumadin may effect its action. Individuals who begin using other medication while taking Coumadin should be tested to ensure the medication is not adversely affecting their PT. Otherwise there are no direction interactions between Baclofen and Coumadin.
Barbara Seizert, M.D.
Kenny Rehab Associates
To submit questions on medical or rehabilitative issues for future colums, write: Medical Issues and Disability,Sister Kenny Institute, Dept. 16601, 800 E. 28th St., Minneapolis, MN 55407-3799