#pm&r

[dittohasadhd]

okay, let's try this again.

I make it to my apps even if I'm late. I do the exercises that they prescribe when I have the energy to. I use the tools and equipment that I can access and afford. I take the medicines that I can get my insurance to cover.

I eat more consistently imperfect nutrition is better than none. My sleep quality has improved even if the duration is inconsistent. I'm engaging less with my vices even though I resent it. I've put on weight and I've gotten taller even though I worry one is too much and the other is not enough.

My progress matters, even if it's slow.

I'm improving, right?

[schizoaffectively]

What to expect from a PM&R doctor/Physiatrist?

One thing that came from my recent annual rheumatologist appointment on Friday, was a referral to a PM&R (Physical Medicine and Rehabilitation) doctor. She suggested I see one, and I agreed to do so, so she made the referral.

I have no idea what to expect from a consult or seeing them in general! Like, I know it will be to help manage my symptoms and whatnot from physical disability.

So, for anyone who has experience with this type of physician: What should I possibly expect from a visit and future visits going forward?

For context, my main diagnoses are inflammatory arthritis, and also hypermobility. I deal with near constant chronic pain in most all of my joints, and struggle to stand/walk for prolonged periods of time unassisted (aka without my crutch or cane) without drastically increasing my pain level and affecting my mobility. So I'd imagine it'd be about managing and treating those things and other related symptoms/impairments.

[teachingrounds]

Did you know?

Men and women with spina bifida can still have satisfying sex lives and their own families.

The lower the spinal level of the lesion (especially T12 or lower), the more likely the person can orgasm. Men with a lesion between T11-L2 typically can have neither reflexive nor psychogenic erections, but they can still benefit from erectile dysfunction drugs, a vacuum devise, or an internal prosthesis.

Women are typically fertile, and they should take 4g of folic acid for 1-3 months before getting pregnant and at least through the first trimester. Men may be infertile due to repeat UTIs. Or they may have fertile sperm but need assisted reproduction.

If one parent has spina bifida, there is a 3-5% chance of a child having it as well.

[justinesattendingadventures]

Day 1

Today was really cool. This was technically my first day of my OMM rotation, but it turns out my attending is a PM&R doc who only does a little OMM. Because of this, I saw more procedures in one day than I had seen in my entire life. Joint injections, fluoroscopy guided injections, joint aspirations, basically if you could shove a needle in there they can do it. And by the end of the day I was carrying messages for patients and drawing up drugs. I’m still not completely sure what I’m supposed to be doing as a third year medical student, but I didn’t feel like a complete moron the entire time so I guess I’m not doing it totally wrong. Plus I only missed one pimping question! So... not so bad!

[teachingrounds]

Q. How is neurogenic bladder treated?

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A. The usual treatment for neurogenic bladder is clean intermittent catheterization (CIC, used by 90% of patients), typically four times a day. This may be augmented by anticholingeric medications to relax the detrusor muscle so it can hold more volume under less pressure and reduce urge incontinence; alpha-adrenergic agonists to tighten the sphincter muscle and reduce stress incontinence; and/or surgical procedures to increase the capacity of the bladder or to make catheterization easier.

Credit: J.F. Reybard, "Catheters," Credit: Wellcome Collection. Attribution 4.0 International (CC BY 4.0).

[teachingrounds]

Let's talk about bowel regimens. Individuals with high lesions tend to have better bowel function, which depends on an intact intestinal reflex; the lower the lesion, the more likely it will interrupt the lumbar and sacral plexus nerves required for gut peristalsis. For instance, anyone with lack of rectal tone will have trouble holding in an enema to make it maximally effective. So some people will get a stoma to do Mallone Anterograde Continence Enemas (MACE) from above. Or else they use a large-volume cone enema. Finally, consider using a "Squatty Potty" or similar "toilet stool" to encourage anatomical positioning and easier flow.

Pro-Tip: Did you know that the "Squatty Potty" is officially known as a "Defecation Posture Modification Device"?

Disclaimer: #TeachingRounds has not independently verified claims made about Squatty Potty or related products. We received no compensation of any kind for mentioning it and encourage you to do your own research

[teachingrounds]

Did you know? The number one predictor of unemployment among adults with spina bifida is stool incontinence. This week we're going to talk about bowel, bladder, and sexual function in individuals born with myelomeningocele and its related conditions.

Image: Holly Ann Roy and Alexander L. Green, "The Central Autonomic Network and Regulation of Bladder Function," Frontiers in Neuroscience (13 June 2019).

[e-reab]

A história da reabilitação no Brasil - Organização política (Final) - e-reab

Apesar, de um movimento internacional, o Brasil iniciou os preparativos para esse ano, tardiamente, através do grupo “Coalizão de Pessoas Deficientes”, em 1980. No mesmo ano ocorreu, como parte da história da reabilitação, em São Paulo o Segundo congresso brasileiro de Reabilitação Social e em 16 de julho de 1980, João Figueiredo, o então Presidente da República criou através de decreto a “Comissão Nacional do Ano Internacional das Pessoas Deficientes”, vinculada ao Ministério da Educação e Cultura. Posteriormente, inúmeros Comitês estaduais e municipais e outras iniciativas se fortaleceram, gerando assim uma maior consciência politica e de cidadania por parte da população deficiente.

Apesar, de um movimento internacional, o Brasil iniciou os preparativos para esse ano, tardiamente, através do grupo “Coalizão de Pessoas Deficientes”, em 1980. No mesmo ano ocorreu, como parte da história da reabilitação, em São Paulo o Segundo congresso brasileiro de Reabilitação Social e em 16 de julho de 1980, João Figueiredo, o então Presidente da República criou através de decreto a “Comissão Nacional do Ano Internacional das Pessoas Deficientes”, vinculada ao Ministério da Educação e Cultura. Posteriormente, inúmeros Comitês estaduais e municipais e outras iniciativas se fortaleceram, gerando assim uma maior consciência politica e de cidadania por parte da população deficiente.