Anyone been to a Physiatrist ????

My physical therapist suggested I go to a Physical Medicine doc (I guess this is a Physiatris??) and gave me a name.

Anyone go to, or been to, one??   What can I expect?   What kind of testing will they do??  Has it been helpful?

TIA!  Pat :)

[santana8]

I don't know what kind of doctor this is, but I would like to know, maybe someone else will know!

~Santana~

[6-paq]

She suggested I go to one for a second opinion on my lumbar spine and leg/foot/back symptoms.    My l-spine MRI shows issues.  Physical therapist says symptoms all come from back stuff and no sign of MS stuff (yet), but neuro is thinking all symptoms are caused by MS.

I'm guessing this is a doc who can figure things out????

As much as I hate to think about additional doc appointments, I think I really need this for my sanity.  Hopefully, it can give me some answers to some of my symptoms.  I feel like a ping-pong ball going back-and-forth.

Pat    

[alastria]

I see a physiatrist and have been having a really good experience.  There has been a lot of confusion about my hip/leg/foot pain being MS related or spine related.  The MS specialist made a good case about it being MS related so I gave up the pain doc I was seeing and chose to see a physiatrist instead.

The physiatrist looked over all the MRIs and gave me a very good examination.  He was very careful to examine all the areas that were causing pain and palpated those areas deeply to sort out what was what.  I was very grateful for this because I knew part of my issue was that my weakness was causing hip bursitis that was excruciatingly painful.  So right away he injected my bursitis.  We discussed botox for my piriformis problems (buttock pain) but right now he thinks my spasticity is too widespread for it to be helpful.  So he's been seeing me every month to keep an eye on things.  The injection in my hip eliminated the most painful part of my problem.

Since I have MS and disc problems, it was very challenging to doctors to sort out the causes of my pain.  And I was feeling like each specialist sees too narrowly in their own specialty.  The physiatrist was honest about struggling to sort it out but at least he did a thorough enough exam to figure it out one piece at a time.  And as I am in the medical field, he was respectful of my knowledge and thinking out loud with me.

This of course will not be the happy experience of everyone who sees a physiatrist, but it is a very interesting specialty.  They can do pain managment, injections, epidurals, PT recommendations, sports medicine.  

I can also tell you that after all this, the MS specialist is right and my leg pain is from the MS but it has caused dysfunction in all the muscles and joints on my leg.  Since the neuro doesn't necessarily address all the symptoms, this doc is a nice option for relief.  

Any other questions about it?

[6-paq]

Thanks so much for your reply.  This has been *very* helpful as I also have those disc issues.   This sounds like it is EXACTLY what I need.  Someone who will honestly sort of what is what.  

I am so glad to see that your physiatrist is working well for and with you and is able to provide you some relief!!!

I totally understand what you mean about each specialist seeing too narrowly in their own specialty.   I have often felt that my neuro has "tunnel-vision" with regards to certain symptoms.  Once he found the 3 brain lesions, I believe that he has used "possible MS" to explain everything going on (I'm still un-dx).   He said he was looking for "one main cause" of all of my symptoms.   Well, we can have other stuff besides just MS.

I had been told by one person in the medical field that I should keep "mum" about the possible MS when I visit a new physician.  They feel that it is too easy for them to lump all of my symptoms under an MS label and not be objective about investigating other possible causes.   I'm assuming with a physiatrist, that I should lay it all out on the line?

Would you also suggest I have copies of all of my MRIs sent to her or just the lumbar-spine MRI?   Also, since I'm having problems with the bottom of my feet and both elbows/hands, should I mention those as well?  

About your experience... did you know that you were suffering from spasticity prior to seeing the physiatrist or did he determine that from examining you?   I don't feel that I have any spasticity at this point, but maybe I possibly am?    

Did you mind telling me what disc issues that you have and what symptoms you were having?

Thanks again for your response and telling me of your experience.   I appreciate it!

Take care, Pat :)

[6-paq]

Another quick question.   Should I get a copy of the Physical Therapists report to take (the one who worked on my back and thought everything is back/hip related)?

Thx, Pat :)

[alastria]

Hi Pat,

I just brought my lumbar and pelvic MRIs with me and reports of my cervical and thoracic MRIs.  I didn't bring my brain or offer it really.  By the time I was seeing this doctor, I had had enough opinions about my brain.  The line between probable MS and "sure this seems to be" MS is kind of blurry in my case, but since the neuro is treating the MS - I told the physiatrist I have MS and was newly diagnosed and receiving monthly IV steroids.  I did share that my leg symptoms have been disputed as disc related vs. MS related.  He looked at my MRIs before he spoke to me so he expected a particular presentation with me (if it was disc related) and didn't see that.  By the time I got to this guy, I felt like screaming from the rooftop -"MY HIP HURTS AND IT"S NOT RELATED TO MY LUMBAR SPINE" - and I was right - the worst pain was the bursitis.  I was very athletic so it took a while for my weakness and spasticity to really be obvious I think.  I had been struggling with hip pain for over a year when I saw him.  My hip flexors (the muscles that move your leg forward) are very weak so some other muscles were trying to compensate and hold me up and it put a lot of stress on my hip.  My hip joint is now surrounded my spastic muscles and is very unstable.  

I knew I had some neurological oddities for many years but they did not involve muscles or pain before this episode.  My symptoms started as hip pain.  Excruciating hip pain (9/10).  Then tingling in my lower leg.  Then pain in my calf and foot.  So the pain pattern eventually looked similar to S1 nerve root pain.  My lumbar MRI shows disc degeneration and some nerve root encroachment there - so it was easy to take the leap to say the leg pain was from that.  But I didn't respond to epidurals, PT, chiropractic, stretching, strengthening.  I think my whole story is in my journal too but long story short - when I went for nerve conduction/EMG the neuro ordered a new brain MRI.  I just have one lesion in the corpus collusum but I have a very abnormal neuro exam.  By the time I saw an MS specialist, I had lost much function in my leg and not in patterns that fit a disc problem.  And I have fasciculations, tremors, tingling, cramping hands and feet, fatigue.  The steroids have given me back a lot of quality to my life - less pain, less weakness.  The cortisone in my hip helped me so much - just being able to sit is huge for me.  I did not have any back pain at all.  

I would lay it all on the table - I have disc and brain issues - let them try to puzzle it out.  I would say that any good doc wants all the pieces of the puzzle and will examine you properly to assess it.  The physiatrist was the only doctor I saw who had me put a gown on and actually palpated the areas (the others were neurosurgeon, 2 pain specialists, 2 neurologists, primary care).  What a concept - actually looking at and feeling the area!  

If you are not properly examined, move on to another opinion.  It is very confusing when brain problems look like spine problems.  

Not sure about the PT's report.  The thing is - when you have MS - it effects the function of your muscles - to say your symptoms are one and not the other is a very complex process.  You may, like me, have a real hip problem that is actually caused by MS.  Both need treatment and you have to understand both to understand how to treat both.

I'm not sure if I'm rambling or answering your questions enough.  I have trouble staying linear and logical right now so feel free to ask more and I'll try to be more succinct.

[twopack]

Bumping this up so other people can read it and discover what a good option a physiatrist can be.  In my experience they are more often a D.O. than an M.D. and therefore have more training and experience in body position, body mechanics, and holistic care.


A physiatrist is a doctor with special training in physical medicine and rehabilitation. A Physiatrist treats people with disorders that alter function and performance with a focus on principles and methods that improve daily function.

Emphasis is on the combined use of medications, various forms of physical energy interventions, and experiential training approaches.