By Patty Kunze, RN, BSN and Roberta Palmer, RN

It’s important for all of us to have a health care provider to help manage our health care needs.  For most people, that means having a local family doctor that we trust to care for us.  This provider may also be known as your Primary Care Physician. However, life with a Spinal Cord Injury (SCI) changes the scope of care many of us may need to care for our new bodies, especially early on.  I never gave this topic a thought after my injury, as there were so many other things that seemed more important to focus on when I got home from the hospital.  Yet, getting the ball rolling to find the right types of health care providers is just as important.  We need to learn what to expect from our bodies and who can help us to care for them so we can stay healthy.   Following is a list of types of specialty physicians that you may encounter or call upon to keep you in good health when living with a SCI.

PRIMARY CARE PHYSICIAN:   A primary care physician can be thought of as your medical home. He or she is the first healthcare professional you contact when you have a question or need. This is the doctor who can handle a variety of medical problems, who provides preventive care and advice, who maintains your medical history and can refer you to specialists when needed.  

 
ORTHOPEDIC SURGEON/NEUROSURGEON: Most people with a SCI have dealt with one of these important providers, the orthopedic surgeon or neurosurgeon.   This is the doctor that operated on the spine and most likely diagnosed the spinal cord injury.  The difference between the two is that a neurosurgeon is a physician who specializes in the diagnosis and surgical treatment of disorders of the central and peripheral nervous system including congenital anomalies, trauma, tumors, vascular disorders, infections of the brain or spine, stroke, or degenerative diseases of the spine.  While orthopedic surgeons examine, diagnose and treat diseases and injuries of the musculoskeletal system with surgery and corrective mechanical devices. They take care of bones, joints, ligaments, tendons, muscles and nerves -- everything that allows you to move, work and be active.  They are your go-to doctors for anything involving the spinal column/cord that might need to be addressed post injury.

PHYSICAL MEDICINE AND REHAB PHYSICIAN, PHYSIATRIST: Another doctor very important in the care of people with a SCI is the Physical Medicine and Rehabilitation (PM&R) physician, also known as a physiatrist.  This is the type of doctor that cares for you in the Rehab setting and works with a team of medical professionals, which may include physical and occupational therapists.  Because all spinal cord injuries are different, a unique plan is designed to help the person function and succeed in everyday life. The plan often includes:

•    Helping the person understand his or her injuries
•    Helping the person understand the details regarding his or her care
•    Helping the person become as independent as possible in everyday activities such as bathing, eating, dressing, grooming, and wheelchair use
•    Helping the person learn to accept a new lifestyle, especially pertaining to sexual, recreational, and housing options
•    Helping the person learn how to instruct caregivers in how to assist them
•    Preparing them for vocational rehabilitation

Many people continue to follow up with their Rehab doctor long after leaving the rehab setting as this doctor is familiar with the original rehab plan and can continue to oversee and guide your progress as you get stronger and more independent.
UROLOGIST:   An urologist is another doctor people with SCI would benefit from knowing.  This type of doctor specializes in the treatment of disorders of the urinary system.  A SCI may cause an interruption in bladder function resulting in loss of bladder control, an inability to empty the bladder, urinary frequency and urinary tract infections.  Many people with a SCI have to deal with at least one of these issues from time to time, especially urinary tract infections since many have to use catheters to empty their bladder.  A good urologist can help to identify and treat these types of problems, as there are so many options both old and new to make life with a dysfunctional bladder easier and healthier.
PODIATRIST:   People with a SCI lack sensation that can lead to scrapes, bumps and pressure sores of the feet.  Swelling in the feet makes skin even more vulnerable.  Athlete’s foot can become a problem if feet aren’t completely dried after bathing or there’s chronic moisture between the toes.  People with SCI are at risk for developing ingrown toenails that can become infected and can cause Autonomic Dysreflexia*.   Additionally, slow wound healing in the lower extremities can quickly lead to a nasty infection.  A podiatrist, a doctor that diagnosis and treats conditions of the feet, can provide professional foot care for conditions such as these.

WOUND CARE SPECIALIST: After a SCI, our nerves that normally signal discomfort and alert you to relieve pressure by changing position may no longer work. This can cause pressure sores, which are injuries to the skin and the tissue under the skin. They often develop on skin that covers bony areas such as the hips, heels, or tailbone. Pressure sores can also occur in places where the skin folds over on itself. They are described in four stages that range from mild reddening of the skin to severe complications, such as infection of the bone or blood. They can be difficult to treat and slow to heal.  If you develop a pressure sore it’s important to be evaluated and treated by a wound care specialist.  This person may be a doctor, nurse or other health care professional with special training in wound care. 
PHYSICAL THERAPIST/OCCUPATIONAL THERAPIST:  Almost immediately following the incident that led to your SCI, you were most likely introduced to both a physical therapist and an occupational therapist.  Physical therapists (PT) can teach patients how to prevent or manage their condition so that they will achieve long-term health benefits. PTs examine each individual and develop a plan, using treatment techniques to promote the ability to move, reduce pain, restore function, and prevent disability.  Occupational therapists (OT) treat injured, ill, or disabled patients through the therapeutic use of everyday activities. They help these patients develop, recover, and improve the skills needed for daily living and working.
As explained in their job descriptions, these therapists are very important in assessing your level of injury and identifying a treatment plan to get you to your optimal best in your every day activities of living. For example, a PT might work with someone to learn to transfer from a wheelchair to the bed while an OT might help someone manage the task of brushing his or her teeth.  The treatment plans are as unique as the individuals they are made for.  And the time frame to complete the plans might be short or may be ongoing as an individual continues to improve and new goals are identified. 

RHEUMATOLOGIST:  A Rheumatologist is a specialist physician who has expertise in diagnosing and treating musculoskeletal conditions such as osteoporosis.   People living with SCI have a much greater chance of developing osteoporosis, which is a disease in which the bones lose density, become weak and brittle, and are more likely to break.  Why this occurs is another separate topic of discussion too vast to go into detail at this time.  However, a rheumatologist is commonly the specialist who is referred for this condition.  (For more information regarding bone density, click here.)

These types of providers are some of the most common specialty providers you may encounter living with a SCI.  Your family doctor or primary care physician may be able to handle your specialized health care needs, but if not, they will most likely direct you to one of these providers.  Regardless, once you identify the doctors who give you care; make a list with their names and numbers so you and/or your caregiver have quick and easy access to your doctors as needed, especially in the event of an emergency.   See the example below:

June 29, 2017
Mary Jones’ List of Physicians
DOB: 2/2/60
Date of injury: 5/6/2014
Level of injury: T3-4 complete paraplegic
Allergies: Sulfa (rash)
Advanced Directives signed and on record at Mercy Medical Hospital

Physician	Phone number
Primary care: Dr. John  Smith Closed on Wednesdays	234-555-1060
Urologist: Dr. Tom Black Open M-F 8am-4pm, Wednesdays 8-12pm	234-555-3622
Podiatrist: Dr. Jerry Foot Closed on Fridays	234-555-8891

Roberta RN

References:

* Autonomic Dysreflexia (AD), also known as Hyperreflexia, is a potentially dangerous complication of spinal cord injury (SCI). In AD, an individual's blood pressure may rise to dangerous levels and if not treated can lead to stroke and possibly death. Individuals with SCI at the T-6 level or above are at greater risk. AD usually occurs because of a noxious (irritating) stimulus below the level of the injury. Symptoms include headache, facial flush, perspiration, and a stuffy nose.

What is a primary care physician?
http://baptisthealthfloyd.com/healthscope/which-doctors-are-considered-primary-care-physicians/

What does an orthopedic surgeon do?  https://www1.cfnc.org/Plan/For_A_Career/Career_Profile/Career_Profile.aspx?id=Pg7ZfV6tqbkJKexMcuHHpAXAP3DPAXXAP3DPAX

What does a neurosurgeon do?  https://www.urmc.rochester.edu/highland/departments-centers/neurosurgery/what-is-a-neurosurgeon.aspx

What does a physiatrist do?  
http://www.aapmr.org/about-physiatry/about-physical-medicine-rehabilitation/what-is-physiatry

The Rehabilitation Phase
http://www.brainandspinalcord.org/spinal-cord-injury-rehabilitation/

What does an occupational therapist do?
https://www.bls.gov/ooh/healthcare/occupational-therapists.htm

What does physical therapist do?
http://www.apta.org/AboutPTs/

What is Autonomic Dysreflexia?
http://www.spinalcord.org/resource-center/askus/index.php?pg=kb.page&id=248

What does a rheumatologist do?
https://rheumatology.org.au/patients/what-is-a-rheumatologist.asp

What is osteoporosis?
http://www.spinalcord.org/resource-center/askus/index.php?pg=kb.page&id=1581

About the Authors:
Patty Kunze has been a Registered Nurse since 1983.  She holds a Bachelor’s of Science Degree in Nursing and worked several years in a Spinal Cord Injury Unit at the local Veterans Administration Medical Center as a new graduate.  She has been a flight transport nurse for Neonatal Intensive Care, an assistant manager of Labor and Delivery, and an instructor of nursing students. In 2009, she was involved in an auto accident which left her paralyzed (T3-4 complete paraplegic) from chest down.  But she continues her nursing career while sitting in her wheelchair as a nurse paralegal and writing articles for others with spinal cord injuries as The Rollin RN ™.




Roberta Palmer has been a Registered Nurse for 20 years.  She has knowledge in Family Practice, Allery and Immunology, Special Pharmacy Medication and Counseling, and she is a RN Health Coach. In 2014, she was involved in an ATV accident which also left her paralyzed (T3-4 complete paraplegic) from chest down.