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Ep. 125 - LiveWell Talk On...Rehabilitation Medicine (Dr. Stanley Mathew)

episode 125

Ep. 125 - LiveWell Talk On...Rehabilitation Medicine

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Host: Dr. Dustin Arnold, chief medical officer, UnityPoint Health - St. Luke's Hospital

Guest: Dr. Stanley Mathewmedical director, St. Luke's Physical Medicine & Rehabilitation

Dr. Arnold:
This is LiveWell Talk On…Rehabilitation Medicine. I'm Dr. Dustin Arnold, chief medical officer at UnityPoint Health - St. Luke's Hospital. Joining me today is Dr. Stanley Mathew, medical director at St. Luke's Physical Medicine and Rehabilitation, to discuss rehabilitation medicine, common injuries, treatments, and more. Also Dr. Mathew is well-known to be the best dressed man in medicine.

Dr. Mathew:
Too kind Dr. Arnold, too kind.

Dr. Arnold:
Hey Dr. Mathew, you know, I think people hear PM&R and they think polymyalgia rheumatica. They hear rehabilitation medicine and they think, oh my gosh, alcohol detox and substance abuse rehab, I'm going to rehab. But it's so much more than that. Can you tell us what rehabilitation medicine is?

Dr. Mathew:
I'd love to Dr. Arnold, thank you for your time today. And I just want to say a huge thank you for your service during the Corona pandemic and your leadership getting us through this as our chief medical officer, through a wild time in rehab medicine. Doc honestly, you deserve it all. Quick thought on rehab medicine. It is an amazing specialty that I was fortunate enough to fall into about 15 years ago. What is rehab medicine? We are actually doctors of function and quality of life. It sounds kind of trivial when you think about someone's heart stopping or their lungs needing ventilator support. But after these catastrophic events, these patients often are so debilitated and weak that they need a whole team of professionals to work with them, to get them back to their prior function. So we're kind of the doctors of restoring function. Think of it under the terms of, we get to be leaders of a team of wonderful professionals here at St. Luke's Hospital that gets to put the pieces of someone's life back together again after a major catastrophic illness.

Dr. Arnold:
So I'm going into my 15th year here in Cedar Rapids at St. Luke's. Been in practice since '96. But, you know, I definitely have seen the acuity of illness. The people up in rehab, they're ill. I mean, they have a lot of medical problems. I've seen that over the years. But what are some common injuries that are seen up on the ward?

Dr. Mathew:
Absolutely, absolutely. You know, I'd start with our bread and butter, which is major neurologic conditions, Dr. Arnold. We have everything from strokes to brain injuries, catastrophic spinal cord injuries, young men playing a little too hard on the trapeze. Flips and injures to the spinal cord end up being a new quadriplegic, all four of his limbs, his arms and legs aren't working. The neurosurgeon and neurology team stabilize the individual and now is where the rehab team in. We pick up from there. You'd come over, live with us for a couple of weeks to months, work on therapy in regards to dressing, bathing, simple things like getting out of bed now become a whole new challenge. For example, after a stroke, the right side of your body doesn't work anymore. And then we deal with more complex medical injuries that are not just neurological. You know, we talked a little bit about all of us surviving a wild pandemic we went through. But a lot of our patients that unfortunately required ventilator support after the viral pneumonia that they had, are very weak. We returned the phrase, severe deconditioning or critical illness myopathy. They've just been in the hospital for so long, that every organ system has been affected. Their brain, their heart, their muscles, their tendons. So every day after they get medically stabilized, they come up and live with us. We have a whole team of professionals pushing them, working hard. The amazing thing about rehab, Dr. Arnold, that was different than when I practiced medicine as a resident, is you have a whole team working on one person every day to get them to their next goal. So, Doc, I work with a team of rehab nurses, physical therapists, occupational therapists, speech therapists, psychologists, neuropsychologists, dietician, pharmacist. We have used pet therapy, music therapy. So you can imagine that at UnityPoint, we put all of these professionals in a room together, figuring out how to get this individual back to restore health and function.

Dr. Arnold:
I think a colloquialism or putatively, however you want to describe it. People say, oh, he got stuck and he had to learn to walk and talk again. You hear that, you know. That's kind of what your team's doing. You're teaching them to walk and talk again, obviously generalizing.

Dr. Mathew:
Yeah, absolutely. Absolutely. It's one of the pleasures, Doc. You know, when I occasionally do fill in for acute medicine, you get about a day or two with a patient and then it's time for them to either go home or move on to the next level of care. What's amazing about the rehab space is, as we're in this very dark place in their life where they can't walk, speak, talk, brush their hair, you get to be part of the team that helps get them going. And we get to spend a lot of time with them, Doc. So years later, I'll get a card from somebody saying, do you remember five years ago, you spent two weeks after my motorcycle accident, you know, multiple fractures. Well, now this is a picture of me, my wife, and my five-year-old after regaining function. So it's a really great part of the whole medical community,

Dr. Arnold:
Yeah. I won't mention the name, but there's a nurse that used to work on five east when I first came to town and then moved up to rehab probably two or three years later. So she'd been up there well over 10 years and I saw her one time and I said, you know, hey, how are things going? You know, she said, I really enjoy it because I get to see people get better. And that was a huge satisfaction for her. And I noticed that with your team. I mean, they're very passionate about this. They take tremendous ownership and pride in their work, and you can't teach that. You can't buy that. You cannot buy craftsmanship and pride. That's something people have to have, and your team definitely has it.

Dr. Mathew:
Hey, thanks Dr. Arnold. Great to hear, much appreciated.

Dr. Arnold:
And you know, back to that myopathy of an acute illness. I still tell patients, for every day you're in the hospital, it takes three days to get stronger. So if you're here 30 days, don't expect to feel back to your baseline until 90 days after you leave. In all honesty, I kind of made that number up over the years, but it rings true. You know, people have a pneumonia for seven days and they're totally sick. I mean, just really ill. They're going to—it's going to be 21 days before they feel back to their selves when they get out of the hospital.

Dr. Mathew:
Absolutely. Yeah. There's been some good data deconditioning that the geniuses in the rehab space have published that they say 10% of muscle mass and strength is what you're losing just by laying in bed daily in the hospital. You plateau somewhere around 70 or 80%, whatever that time is. What was interesting though, about some of our post-COVID debility patients, is it took them even longer. You know, there's something strange about this virus in some people, that it just made people not feel good for a much longer period of time than a normal virus.

Dr. Arnold:
You know, they're starting to define that long-hauler syndrome. Of these people that had COVID and they have residual discomfort that continues well after the acute illness. From the critical care side, Stan, it's only in the last five years that critical ICU medicine started to talk about range of motion, and early mobilization, early ambulation. You know, I've often said you take a 96 year old and you just tell them to lay in bed for 72 hours, they will be de-conditioned 72 hours later. You can't expect them just to jump out of bed and go on their way. Now my teenager, she can sleep for 72 hours and then be fine, but that's a different story. If St. Luke's was a church, certainly one of the stained glass windows would be the rehab facility. Can you kind of give us an overview of the rehab facility? I mean, I know your team is very proud of the facilities up on six floor. And could you just kind of give us an idea of what's up there and how it integrates in your treatment plans?

Dr. Mathew:
As far as Midwest standards, I'm a native New Yorker and looking at this rehab unit, this looks like something straight out of Harvard that they designed here on inpatient at St. Luke's. They didn't spare any expenses. Starting off with our inpatient rehab unit, we have huge, gorgeous rooms that have large bathrooms where therapy can be done. As well as large rooms where therapy equipment can be brought. Everything from overhead lifts to transfer benches can be used. Moving to our dining area, part of the rehab experience is reintegrating back into a community setting. For example, Dr. Arnold, someone from the University that has a catastrophic burn, for whatever reason, just being able to be in public around your peers, it's kind of an overwhelming experience. You know, I joke around and say me and Dr. Arnold have a bad haircut, we probably don't want to do too many in-person meetings. You get a catastrophic injury where now the left side of your face is weak, it's all part of the community reintegration. Fast forwarding to what a therapy day is like, where are you going to spend most of your time is in our state-of-the-art gym. The gym has everything from a vehicle, to a basketball court, to a kitchen, to a mini shopping grocery store. We spent a lot of finances and resources, thanks to awesome administration like yourself, on high-tech equipment. From a functional electrical stimulation bike, which is you know, $30,000/$40,000 piece of equipment. That's part of the cutting edge technology and reintegrating the peripheral nervous system and central nervous system. Fancy words for saying: if something's paralyzed, if we can stimulate some of these muscles and nerves correctly, there's some theories that we can help wake up these paralyzed muscles. The therapists, a lot of them are not just PTs. They have their doctorate in therapy. All the rehab nurses have done extra certifications to become rehab nurses. You know Dr. Arnold, like you said, it's not something you can force someone to do, but they're at a different caliber. You see therapy going on everywhere around the country, and then you meet a team of professionals that take their job extremely seriously and are going the extra mile, whether it be education. I have an administrative team that doesn't want to cut corners when it comes to costs. You know, if there's new equipment out there, we're going to try our best to try to get it. So you spend at least three hours of your day working out with a bunch of therapists. Dr. Arnold, me and you, even though we're running around working, I'll tell you if you spend three hours working with a therapist every day, you can imagine it's pretty fatiguing by the end of the day. So most of our patients sleep really hard when they're done.

Dr. Arnold:
You know, I think you are a modest individual to begin with. But you know, we don't do bone marrow transplants here at St. Luke's. We don't do organ transplants. We send that stuff to the University because they're specialized to do that. And I think people ought to know that the University sends their rehab patients to you and your team. I think that's something to be proud.

Dr. Mathew:
Hey, thanks for bringing that up. Absolutely. And they send their most complex patients here. So there are, you know, there's a difference between rehab after a joint replacement, for example, which might be considered a little more straightforward. Versus a 20 year old in a motorcycle accident, who's now paralyzed in their lower extremities. Those are considered high, complex rehab cases and the University sends, I'd say 75% of their complex patients, our way. So a great relationship, but also the team as you know, loves what they do.

Dr. Arnold:
Yeah. So Stan, why did you go into rehab medicine? How'd you land there?

Dr. Mathew:
I wish I had a great story for you. You know, it kind of fell into me. Not everything in life is your choosing. I was actually planning on being an anesthesiologist, Dr. Arnold. I thought I had a doctor that took great interest in me, a wise physician like Dr. Arnold, who was guiding me in the ways of anesthesiology. Life changed and I met in an amazing physiatrist, who told me if you had interest in pain, you should forget about anesthesia and think more about functional aspect of your patient. So I got offered a residency position, I took it, and now 15 years later best decision of my life, Dr. Arnold.

Dr. Arnold:
Well, you know, I wanted to be a football coach and I started dating a girl that was pre-med. She's long gone, and here I am. So life has a funny way of working itself out, doesn't it? Well, Dr. Mathew, thank you for joining me today. This has been great information. Once again, this was Dr. Stanley Mathew medical director at St. Luke's Physical Medicine and Rehabilitation. For more information, visit UnityPoint.org.

Dr. Mathew:
Thanks, Doc.

Dr. Arnold:
Thank you for listening to LiveWell Talk On. If you enjoyed this episode, don't forget to subscribe. And if you want to spread the word, please give us a five-star review and tell your family, friends, neighbors, strangers about our podcasts. We're available on Apple Podcast, Spotify, Pandora, or wherever you get your podcast. Until next time, be well.