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All that You Need to Know About Physiatry

Physiatry, a comparatively new medical discipline, is gaining importance day by day. Originating from two different domains, namely, physical medicine and rehabilitation, physiatry mainly deals by addressing the functional disability in patients and assisting in the general improvement of the individual's health condition.

The term physiatrist evolved between the late 1930s and the beginning of 1940s from the doctors known as physical therapy physicians, who treated arthritis using microwaves or ultrasound. These healthcare providers were recognized as a medical specialty by the American Board of Medical Specialties in 1947.

An Introduction to Physiatry

Physiatry, also known as physical medicine and rehabilitation (PM&R), or rehabilitation medicine, aims to improve and restore body functioning and quality of life for patients with physical disabilities. Such physical impairments can damage the brain, nerves, spinal cord, joints, bones, ligaments, tendons, and muscles. A physician, who has undergone a complete training in this domain of medical field, is termed as a physiatrist. When other medical specialties emphasize on providing medical treatment and curing a health disorder, this discipline focuses on the patient's complete personal care and aims to minimize the patients' dependability upon others for carrying out daily activities and improve the quality of life.

Physiatrists are specialists, who carry out comprehensive and patient-based treatment procedures and are a fundamental part of the patient-care team. They provide medical care for patients of any age group and employ innovative and proven treatment methods to restore maximum health and function.

Training and Education of Physiatrists

After graduating from medical school, rehabilitation physicians have to complete 4 additional years of postdoctoral residency training. While undergoing this residency training, they devote 1 year on fundamental clinical skills and the next 3 years on studying physical medicine and rehabilitation. They also undergo training on the techniques of diagnosing and treating pain issues.

Completing residency training, this physician must sit for and pass a written and oral exam to become a board-certified physiatrist.

Practice Settings For Physiatrists

PM&R doctors practice in various clinical backgrounds, such as inpatient, outpatient and consulting areas. They have a good knowledge of musculoskeletal, rheumatological, neurological, and cardiovascular systems.

Inpatient physiatrists commonly undertake diagnosis for spinal cord damage, stroke, brain damage in both traumatic and non-traumatic cases, polio, multiple sclerosis, pediatric and musculoskeletal rehabilitation, and burn care.

Outpatient physiatrists take care of non-surgical health conditions, such as orthopedic impairment, spinal cord pain and disabilities, occupational wounds and overuse injury symptoms, pressure sore management, neurogenic bladder or bowel, chronic pain, and spasticity management. Outpatient physiatrists work within an interdisciplinary team, which includes orthopedic surgeons, other physiatrists, and neurosurgeons.

Role of a Physiatrist in Patients' Treatment and Recovery

Physiatrists undertake different modes of treatment to ensure the recovery of patients from musculoskeletal, spinal, and sports injuries or impairments. They suggest a comprehensive evaluation of the patient and then plan for a non-operative treatment customized specifically keeping in mind the patient's health condition. This requires rehabilitation programs and outside therapy, like occupational therapy and physical therapy.

Rehabilitation physicians also perform various minimally invasive medical procedures that help in easing the pain and improving mobility and function. The non-operative treatment procedures undertaken by physiatrists have been listed below.

EMG or Nerve Conduction Studies

Fluoroscopy-guided procedures

Ultrasound-guided procedures

Injections of spine

Injections of joints

Nerve Stimulators, Blocks, and Ablation techniques – Peripheral and Spinal

Discography, Disc Decomposition, and Vertebroplasty or Kyphoplasty

Prolotherapy

Spasticity Treatment

Manual Medicine or Osteopathic Treatment

Nerve and Muscle Biopsy

Prosthetics and Orthotics

Disability or Impairment assessment

Complementary – alternative medicine, like acupuncture, and others

Medicolegal consulting

When to See a Physiatrist?

Patients having the following health conditions must consult a physiatrist after getting a recommendation from the primary physician.

Chronic and acute back pain

Chronic and acute joint pain

Sports injuries

Degenerative joint conditions

Tendonitis or tendinopathy

Tennis elbow, golfer's elbow, and other overuse syndromes

Nerve entrapments, like cubital tunnel syndromes or carpal tunnel

In Conclusion

If you are facing any health issues due to sports wound or suffering from any orthopedic condition, then immediately consult a physiatrist for the betterment of your health issues. It is also recommended to see the specialist if you are in a condition which immediately requires musculoskeletal surgery. As physiatry focuses mainly on non-operative rehabilitation techniques and treatment procedures, your physical issue and quality of life can be restored without the need for any painful surgeries.  

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Understanding the Role of General Surgeon in the Healthcare Sector

General surgery has been considered as an indispensable part of the medical field since time immemorial. This medical specialty involves different types of surgical procedures for treating a wide range of health issues and ailments. 

Specialists trained and qualified in this medical discipline are termed as general surgeons. They are responsible for the management of preoperative, operative, and postoperative problems of patients having different health issues and diseases. Additionally, nonoperative, emergency surgery, and elective surgical treatment are also taken care of by these medical specialists.

Significant Roles of A Certified General Surgeon

Here is a detailed illustration of the role of a certified general surgeon for better understanding.

Examine and diagnose patients with the help of physical tests to determine if surgery is required to counter the patient's health condition.

Analyze the medical history of the patient and make the best treatment plan.

Make an assessment and suggest patients about the risk involved in undergoing surgery.

Carry out surgery to rectify or prevent disease, injury, any deformities, and patient's body function while complying with ethical and regulatory protocols.

Perform surgery according to accepted surgical techniques.

Take care of preoperative and postoperative issues and prescribe treatment accordingly.

Check if the operating room and all the surgical equipment are sterile and clean before the surgery.

Ensure proper patient care by coordinating and directing activities of the hospital workforce.

Supervise pre-surgery and post-surgery treatment and also determine risks related to it.

Follow the guidelines of the American Hospital Association's Bill of Rights related to patients and help maintain a patient's dignity.

Plan and arrange illness or disease prevention and health promotion programs.

Check post-treatment or post-operative health condition of patients, and arrange follow-up meetings with them.

Stay abreast with the latest information with regards to general surgery so as to provide the best treatment and care to the patients.

Components of General Surgery

General surgery includes nine primary units of surgery, something that all general surgeons must be aware of. Here are the body parts and systems that general surgeons commonly operate on.

1. Abdomen and associated organs,

2. Digestive tract,

3. Skin, breast, and any kind of soft tissue,

4. Endocrine, congenital, vascular, and oncologic disorder, specifically tumors of the salivary glands, skin, thyroid, parathyroid, as well as the oral cavity.

5. Vascular system, except the heart and the intracranial vessels.

6. The endocrine system including thyroid, parathyroid, endocrine pancreas, and adrenal gland.

7. Surgical oncology, which includes multimodality management of the patient suffering from cancer in a systematic way by surveillance, screening, rehabilitation, surgical adjunctive therapy, and follow-up.

8. Trauma management, including musculoskeletal, head, and hand injuries. General surgery encompasses the responsibility of all care phases of the injured person.

9. Complete surgical care of critically ill inside the intensive care unit, emergency room, and trauma/burn units.

Furthermore, this surgical specialist must have a sound knowledge of physiology, anatomy, epidemiology,  immunology, and pathology as well to carry out the surgery. They should also have a good grip on clinical care domains, like shock and resuscitation, infection, wound healing, antibiotic usage, neoplasia, metabolism, nutrition, intensive care, and pain management that are a part of all surgical disciplines.

Additionally, a certified general surgeon must be able to meet with the clinical requirements of terminally ill patients like their palliative care, pain management, nutritional inadequacy, chronic and malignant conditions of cachexia patients, and also provide support through counseling for end-of-life care and decisions.

A certified general surgeon also provides health care in some diseased conditions given below. However, additional training is required to have a comprehensive knowledge of these health conditions.

Pediatric surgery

Vascular surgery

Thoracic surgery

Solid organ transplantation

Burns

While providing healthcare, a general surgeon may also have to deal with the problems in other fields, such as gynecology, obstetrics, hand surgery, and urology.

In Conclusion

The role of a certified general surgeon is a broad spectrum and is not an airtight role. In many instances, general surgeons are required to intervene and assist surgeons of other medical specialties like oncology, cardiac surgeons and many more. Your primary care physician will be the one to determine if you need the help of a general surgeon or not.

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How Does A Pediatric Orthopaedic Surgeon Provide Specialty Care for Children?

When health issues arise in children, a doctor needs to be consulted who is especially trained in pediatrics. This is due to the fact that children's physiology is different from that of adults, and as they are gradually developing, their organs are also in the growing stage. The specialty in medical field that deals with the heath conditions of infants, children, and adolescents is known as pediatrics. A doctor who specializes in this area is called a pediatrician.

Here, we are going to focus on the medical specialist known as pediatric orthopaedic surgeon.

An Introduction to Pediatric Orthopedic Surgeon

A pediatric orthopedic surgeon is a medical specialist, who offers medical care to children with musculoskeletal problems, which include ailments of the bones, back, joints, or muscles. They provide treatment to infants, teenagers, and everything in-between. They can also treat children with health issues such as spine curvatures, limb deformities, broken bones, limping, or infection in the bone or joints.

Training Undergone by Pediatric Orthopedic Surgeons

Pediatric orthopedic surgeons focus on the treatment and diagnosis of children. For children's health care, a unique procedure of medical and operative care needs to be learned through advanced training. So future pediatric orthopedic surgeons undergo the following training and education:

Graduation from a recognized medical school for a duration of four years

Completion of a five-year orthopedic surgery residency program

A one-year additional sub-specialty training in orthopedics and spinal deformity in children

Which Health Conditions do Pediatric Orthopedic Surgeons Deal With?

The musculoskeletal issues of a child are distinct from that of an adult. As children are at the growing stage, the way their bodies respond to injuries, deformities, and infection may differ from the way that an adult's body reacts.

Some heath problems in children are simply an alteration experienced during growth which get rectified with time. For example, intoeing condition in an infant, which is common in childhood but is usually outgrown naturally as the child grows older. Children experience health issues with regards to their bones and joints, which typically occur during the period of development, and are not seen in adults. Moreover, the treatment and evaluation procedures followed for children are quite dissimilar than that of adults for similar heath issues.

The complicated pediatric problems in children are skillfully treated by a skilled medical and surgical team. The diagnosis, treatment, and management done by pediatric orthopedic surgeons for musculoskeletal problems of children have been mentioned below.

Malformation of the spine and limb, like Scoliosis, Clubfoot, Limb length differences, etc.

Scoliosis – This is a condition in which the spine of a child curves sideways, that usually occurs during the growing stage just before puberty. In case of mild scoliosis, pediatric orthopedics suggest a close monitoring with X-rays, to examine whether the curve is getting worse or not. Children suffering from this ailment may sometimes require the use of a brace to prevent the curve from getting worse. Whereas some children need surgery to keep the curvature of the spine under control, and also to straighten it in extreme cases of scoliosis.

Clubfoot – This is one of the most common congenital foot deformities seen in infants, in which the foot is turned inward. In a few cases, the defect is so severe that the bottom of the foot faces sideways or upward. If left untreated, it may impair a child's normal movement well into adulthood. While treating this condition, nonsurgical methods are also employed that include a combination of stretching, bracing, and casting.

Limb Length Discrepancy – This occurs due to the difference between the lengths of the legs and the arms. For many such deformities, the functions of the limbs are not affected. However, sometimes, injury or illness causes a difference in size that develops over time. For some children with limb length differences, the deformation can be adjusted by wearing a lift in one shoe. Whereas a child with extreme difference in the length of his or her limbs may have to undergo surgery to elongate the defective leg.

Broken Bones – Also known as fractures, this is one of the frequently occurring injuries in children. At their delicate age, their bones have a different quality and density, almost like fresh wood, which is soft in comparison to the older varieties, which are more brittle and dried-out. At their growing age, children need distinct treatment and evaluation that is different from that offered to adults. Treatment is done by the pediatric orthopedic surgeons with casting or splinting for broken hands, wrists, and fingers. Sometimes, there is the need for manual manipulation by a doctor to set or reduce the bone. Furthermore, in case of severe fractures, a surgeon may need to place metal plate, pins, screws, or rods to set the bone in the right position when it is getting healed.

Gait Abnormalities (limping) – Gait refers to the way a person walks. Abnormalities in a person's gait, such as limping, is caused when there is malfunction in the physiological system that controls the posture of a person. Generally, this occurs because of illness, genetic factors, injury, or abnormalities in the legs or feet. For children, pediatric orthopedic surgeons conduct a surgery or suggest physical therapy to help return the gait to normal. The specialist may also suggest the use of assistant devices, such as leg braces, crutches, walkers, and canes in case of long-term gait abnormalities.

Infection and Tumors in the Bone or Joint – Bone infection, called osteomyelitis, and joint infection, known as septic arthritis, start when the bacteria carrying the disease goes inside the body, after a trauma or a surgery. It is spread in the bones and joints through the bloodstream. Children who are affected by these infections, may face problems in walking as a result of intense pain in the legs.

When abnormal and uncontrollable multiplication of cells occurs in the leg bones, arm or rib bones, then it is called bone tumor. When this bone tumor is malignant, it is known as sarcoma. Osteosarcoma and Ewing's sarcoma are the most commonly occurring malignancies of bone tissues in children. Osteosarcoma is caused in bones around the knee, whereas Ewing's sarcoma affects bones of the thigh, pelvis, ribs, or upper arms. Both the malignancies can be treated with the help of surgery and chemotherapy with multi-agencies. The tumor is removed through a special surgical procedure.

Conclusion

When it is about the health issues of children, then it should be remembered that the earlier the treatment is done, the better. It will help resolve the health conditions of your little ones as quickly as possible and save them from having to face long-term adversity. For any kind of musculoskeletal problems affecting your children, consult a reputed pediatric orthopedic surgeon immediately and give your child a healthy life.

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