Podcast | Episode 21: Spinal Cord Injury Clinic with Dr. Brian Higdon

Podcast Episode

Podcast Transcript

Tracy Davis: Welcome to the Brooks Rehabilitation Podcast. My name is Tracy Davis. On this episode, we have Dr. Brian Higdon and his new spinal cord injury clinic that he has here in Jacksonville. And just overall, talking about spinal cord injury in patients and some of the difficulties that they deal with and some of the unique care that we offer here at Brooks for spinal cord injury patients. For any further information about Brooks Rehabilitation, make sure you go to BrooksRehab.org and also look for @BrooksRehab on all of your favorite social media platforms. Let’s get right into the episode.

Dr. Higdon, thanks for coming onto the podcast. I really appreciate it. Thanks for taking the time out.

Dr. Brian Higdon: Of course.

Tracy Davis: Let’s just start off by letting you introduce yourself and let people know who you are, what got you on this path, and we’ll go from there.

Dr. Brian Higdon: Sure. So my name is Brian Higdon. I’m a physical medicine rehabilitation doctor and a specialist in spinal cord injury medicine. So I started my medical training journey at the University of Illinois in Peoria, and then I did my physical medicine rehabilitation residency at University of South Florida in Tampa. There, I realized and I discovered how special of a population that spinal cord injury was, how I got to practice medicine in a very specialized way, but then also in a very holistic way because spinal cord injuries really affect the entire body in one way or another. Even the brain, which is above the spinal cord, is affected in some ways by spinal cord injuries. So it’s a very holistic medicine despite being a very specialized field.

Tracy Davis: Sure. And were you from where you went to college?

Dr. Brian Higdon: So I grew up in Iowa, but I was in state in Illinois by the time I came to go to medical school. My family had moved there. And my residency in Tampa, from there I went on to the University of Pittsburgh Medical Center in Pittsburgh, which is kind of one of those legacy programs for one of those model systems programs for spinal cord injury. So I did my fellowship there and then this is my first position out of training for my subspecialization in spinal cord injury medicine.

Tracy Davis: Wow. So you’re going all over the map there.

Dr. Brian Higdon: Yeah. Back and forth to the Midwest and then up to Pittsburgh.

Tracy Davis: So was getting into medicine something you had always dreamed about or did it kind of happen gradually as you started your education?

Dr. Brian Higdon: So this is an interesting story. So pretty typical for a high schooler thinking about medicine. I liked math and science and I liked interacting with people and helping people in a very direct way. And I’d actually first looked at physical therapy and was looking at other careers in the medical field. So I shadowed a dietician. I was very familiar with laboratory work because my mom works in a medical laboratory. And then there’s also a doctor working there on the floor and they’re like, “Let me get you to work with this doctor.” And the first doctor I ever shadowed as a student was a physiatrist, was a physical medicine and rehabilitation doctors. So the first exposure to real medicine was with physical medicine rehabilitation. And then from there, I kind of had it in the back of my head as a specialization when I eventually got into medical school and was looking for a career choice. I had that in the back of my head, hadn’t really explored that, and it really matched what I wanted to do with my career.

Tracy Davis: Wow, that’s great. That’s awesome. So tell everybody, well, let’s get into why’d you come to Brooks? What about Brooks stood out to you and how’d you hear about us?

Dr. Brian Higdon: So from being in Florida, from being in Tampa, it was very centric on the Veterans Affair Administration because that’s how my residency was based out of, and I got very good exposure to spinal cord injury medicine there. But looking around Florida, I wanted to stay in the state of Florida and wanted to work at a place that served a very complex population and I first heard hints about Brooks Rehab at a conference I went to and from an attending I had there that had worked here for a while. But I’d looked more and more about it and realized what a great hospital it was and also the type of patients they served. We take patients here locally from Jacksonville, but even across the state from Florida and in the region. We take really the most complex patients that are out there. So if I wanted to continue my career taking care of various specialized patients that needed intense care, this is a place to come to be able to serve those patients.

Tracy Davis: That’s great. That’s awesome. So for those that don’t know what a PM&R MD is, we have a whole episode on that. If anybody’s curious, you can go back and look at that episode. I think it was with Dr. Mar and Dr. Shaw. But could you just give people a little bit of a quick overview of that, PM&R?

Dr. Brian Higdon: Sure. So for physical medicine and rehabilitation, also code physiatry, like I just mentioned, it’s a medical subspecialty. So we’ve all gone through medical school and know the ins and outs of prescribed medications. But then during our residency, we learn more about the rehabilitation aspects of things. So learning some about what our therapist colleagues do, but then really learning what medications to use to treat patients with neurological conditions like spinal cord injuries or traumatic brain injuries and strokes. But then also the musculoskeletal aspects of what can go wrong with the body with sports injuries or with neurological injuries. There’s lots of muscle skeletal knowledge that we have. So with our therapist colleagues, we really are part of the team for rehabilitation.

Tracy Davis: That’s awesome. And it’s such an interesting career field and especially that you’re not just treating people acutely as soon as when they’re in the hospital, you’re helping them on their road to recovery, which is kind of our whole gig here. So let’s get into SCI, since that’s your role here, that’s your thing, and SCI patients continuum of care with you. So whenever you see an SCI patient, kind of talk about maybe where they’ve come from, where they’re going, just the whole continuum of where they’re at.

Dr. Brian Higdon: So when people suffer a spinal cord injury, it’s usually one of the biggest things that’s ever happened to them because it affects their ability to get around, to be able to do things that they want to be able to do. And after that injury, they are trying to figure out what their life is going to look like. Unfortunately, we don’t have any medications or treatments that we can do to make the injury go away, but there’s lots of things that we can do to improve their quality of life, and if they have some function, try to enhance that function as much as possible. But these injuries, it’s going to be something that patients have to deal with for the rest of their lifetime.

I see very different trajectory for patients who are able to get their symptoms under control and get back to the things that really interest them. If they’re kind of working age and career focused, trying to get back to their careers or getting back home to live with their family. If they get on the right trajectory with care, they can have very good quality of life and live very well. But if they don’t get the care they need, then they’re in and out of the hospital, they’re kind of suffering from their symptoms and it can be very rough for them.

Tracy Davis: So what does continued care after an SCI look like typically for a patient?

Dr. Brian Higdon: After patients get out of the rehabilitation hospital, they often still have more rehabilitation to go where they can work on getting more of their function and more of their strength back to be able to do things. Depending on their level and the severity of the injury, working on walking again or working on how to use their wheelchair more to their advantage. But then with their medical care, making sure that if they’re having bladder difficulties, making sure those symptoms are well managed and they’re not having recurrent urinary tract infections, which can make them feel miserable or land them in the hospital if it’s not well controlled.

One thing that really can bother patients’ quality of life is being able to control their bowels. People with spinal cord injuries knows them because they’re in a wheelchair, but one of the hidden things that they have to deal with is having control of their bowel movements, having it happen when they want it to happen and then not having accidents when they’re not ready for it. So there’s lots of tools that we can use to help them take control of their body’s functions and then when they’re not doing that, not have to worry about it as much.

Tracy Davis: Let’s talk about the clinic that you’re doing here. So talk a little bit about that and the specialized care that you’re offering there. So this is outside of the inpatient hospital.

Dr. Brian Higdon: So after patients get out of the hospital or if they’ve had an injury for a while, I see patients in my clinic and kind of go through anything that might be affecting them. So I have my own review system specific towards people that have spinal cord injuries and I can anticipate what problems they might be having and have an expectation for if this is going on, there might be a better way to do things. So some patients that have had a spinal cord injury for years, I ask them about for their bowel [inaudible], how long are you spending on the toilet? And some of them tell me two, three hours, multiple times a week just to sit on the toilet and kind of wait for things to happen. And for some other people it’s just like, well, that’s how life is for you but for me, that’s not acceptable. That’s not something that I’m just going to hear and move on. There’s lots of different strategies that we can do to shorten that time period and let them take back control of that.

Tracy Davis: So let’s contrast really quickly of whenever you’re rounding in the hospital versus being out in the clinic. Whenever you come in, what’s the difference in the game plan whenever you walk into the hospital versus the clinic?

Dr. Brian Higdon: Interesting question. In the hospital, after their injury, things are changing more rapidly because they’ve been sick for a while and there’s quick sicknesses going on that need to be addressed. So things have to happen much quicker in the hospital. But in the clinic, because they can only come into the clinic every so often, then I’m having to deal with more issues during a single visit in the clinic compared to the hospital. So hospital, I have to be quicker and address things right away, but in the clinic, it might not need to be that fast, but I’m covering more issues in a single visit in the clinic.

I talked to some degree about the bowel program, but other kind of points of emphasis I make with patients is urinary control, what symptoms they’re having, if they’re having frequent urinary tract infections. Soon, our clinic is going to be investing in a urodynamic suite, where we’ll be able to measure patients’ bladder pressures and their bladder volumes. And that is something that’s hard to do in the community because, because they have spinal cord injuries, it’s hard for them to get on and off the tables that they usually use to do this. But we’ll have the equipment to be able to help people with disabilities who also have bladder problem, which is spinal cord injury patients. So we’ll have our own urodynamic suite, so right after their injury, they’ll be able to see how their bladder is functioning more accurately and we’ll be able to offer that to all my patients that need it that come to my clinic.

Tracy Davis: Yeah. So whenever I was there with you doing some photos in the rooms with the patients, it does seem like they come in with a long laundry list. They’ve been waiting. They’re making a list of, okay, when I see Dr. Higdon again, I got to talk about this, this and this.

Dr. Brian Higdon: They have a list and I have a list and then we put the lists together.

Tracy Davis: Then you’re just tackling each one as you go. What’s some of the biggest stuff that you see that spinal cord injury patients are dealing with whenever they come in? It could even be psychological or anything like that. I know for a lot of our patients, that’s why adaptive sports is so great because the loneliness factor. And is it exercise? What are some of those kind of things that you notice?

Dr. Brian Higdon: So you only mentioned the exercise and then the psychological aspects. So for all our patients, we do screening for if they’re having symptoms of depression or anxiety. We have common screening questions so we’re identifying that early. And depression can be frequent with people with spinal cord injuries. But it’s really frequent with everybody, honestly, so it’s something that we try to identify. And we normalize it in the fact that we understand that it happens to a lot of people, but we don’t normalize it to the degree that we think, oh, you have a spinal cord injury, it makes sense that you’re depressed because it’s its own problem that we treat and then not just expect that, oh, you have a disability, of course you’re depressed.

Tracy Davis: Just deal with.

Dr. Brian Higdon: Yeah. No, we see that as a distinct issue that needs to be treated and can resolve with proper treatment.

Tracy Davis: Right. On the topic of preventing secondary problems after an SCI, how does that come up and how do you guys tackle that?

Dr. Brian Higdon: Yeah, so people with spinal cord injuries are really at risk for ending back in the hospital and having really serious health consequences. So people with spinal cord injuries are at high risk for infections, both with pneumonia and for urinary tract infections, for bladder infections. So if they’ve been having frequent infections, there’s certain changes in management that can be made to reduce the risk for infections. If they have a high level injury and have a weak cough, I review different preventative things for that and make sure they’ve gotten their yearly flu vaccine, if they’re up to date on their COVID vaccine. Some people with really weak cough, there’s a machine that can help them cough stronger and I can make sure that that’s ordered for them so that when they do get sick, they’re able to produce a strong cough and get all of that mucus out of their system and be able to heal better when they do get infections.

Tracy Davis: Okay. So there’s just a lot of things that people don’t really think about as far as the secondary stuff that comes up.

Dr. Brian Higdon: Yeah.

Tracy Davis: Okay. So if we talk about an acute versus a chronic SCI, what’s the difference?

Dr. Brian Higdon: So there’s no kind of solid demarcated line between acute and chronic. But acute is really right after their injury and when they’re still trying to learn how to function out in the community. So that’s really what we try to teach in the rehabilitation hospital is how to survive and try to get as much recovery as we can. But as far as when you become chronic, it’s kind of [inaudible]. Sometimes I would say six months, sometimes I would say a couple years, things have settled down and may have reached kind of a plateau with their neurological recovery. I really never say that you’re not going to have any recovery ever again because I don’t know what might happen with that individual patient and there may be new technologies in the future. So I never say that this is where you’re at, period. But there comes a time where people tend to plateau with their recovery. And as far as their functional recovery, as far as their strength and movement, that’s usually between six months and two years is where we see that plateau happen for a lot of our patients.

Tracy Davis: And is chronic pain a normal thing as well that SCI patients deal with or just some?

Dr. Brian Higdon: It can be really variable. There’s certain injury types that tend to be more painful. Patients who have been injured by more violence, so gunshot wounds, can tend to be more painful. Certain traumatic injuries can be more painful. But then I have some patients with very severe neurological injuries and I ask them whenever I see them, “Are you dealing with any pain?” And they’re not. So it can be really variable. But when it happens, it can be really disruptive to people’s lives. And there’s a couple medications that almost all doctors are comfortable prescribing, but it’s how you use those medications and then how you may combine different medications and try to mitigate any side effects that those might have to try to manage that pain as much as we can.

Tracy Davis: And then if we’re talking about unique care that we offer here for SCI patients and maybe a little bit of the sales pitch for your clinic and whatnot, since it’s something we kicked off here recently, what would you tell people for that? Whether they are maybe a SCI patient themselves listening or a family or friend of somebody listening, what would you tell them?

Dr. Brian Higdon: So I think for spinal cord injury patients, many of them, when they go to their primary care doctor, it’s either they’re the only spinal cord injury patient that that primary care doctor has, or maybe if they’re lucky, the doctor has experience with a handful of spinal cord injury patients. So from a patient’s perspective, really working with a physician that anticipates what problems they might be having, that is ready to deal with more than one problem at a time because we have a little bit more open scheduling where it’s not just one problem at a time, but it’s being able to deal with multiple issues at one time, kind of anticipating what problems might come with a spinal cord injury. Many spinal cord injury patients tell me that they have to go and explain to their doctor what autonomic dysreflexia is or explain to the doctor kind of what their issue is and then the doctor has to look things up and try to get back to them. But really, I’m that resource both for the patients and then for the physicians to have that expertise of knowing what’s normal look like and what’s abnormal look like with these patients and anticipating what other needs they might have that they may not even realize.

Tracy Davis: Yeah. I guess it’s like anything, there’s a reason why there’s specialists in medicine, so it makes sense for patients that have very unique needs and whatnot to come to someone who knows exactly what’s going on and can predict things that maybe could be prevented and stuff like that. So anything else that? I think that’s all I really had for you. Is there anything else you wanted to mention for anybody that might be listening? What are you excited for coming up with the clinic?

Dr. Brian Higdon: Yeah. So just yesterday I became the medical director for our spinal cord injury day program, and that’s something that is really special that Brooks has that it’s the only day program in the state, and even very large kind of legacy rehabilitation hospitals don’t even have a day program like we have. So I just became the medical director. I took over for Dr. Tonuzi, who really started the program along with Kat Cunningham, who’s the director of that program. So I’m really looking forward to working even closer with that team and seeing what new opportunities might be in the future for that program.

Tracy Davis: Yeah, it’s great that we’ve got quite a few of those day programs here at Brooks now. We have the peds one that just started and brain injury. So yeah, it’s amazing. Would you mind just giving everybody a quick overview of what the SCI day program is, what’s expected in that?

Dr. Brian Higdon: Yeah. So it’s a program where patients work closely with a physical therapist, occupational therapist, and a nurse specialized in spinal cord injury. And it’s a multi-week program, anywhere from four to sometimes 12 weeks, where they can really focus on their rehabilitation with improving their strength and doing kind of top tier functional progress for patients. So it’s a five days a week program. They live at home or elsewhere in the community and then come in for the entire day and get rehabilitation for the entire day to improve their function. And this is after they get out of the hospital to continue their progress during that intermediate zone where they’re trying to still make as much progress as they can make.

Tracy Davis: That’s one thing that I really, just as I get to spend time with these different programs around Brooks doing photo/video stuff and I’ve spent time with them at the SCI day, it’s just so great that Brooks is offering these, like you said, programs that are filling the gap of they’re not in the hospital anymore, they want to continue on with their recovery and getting stronger in whatever aspect they can, so we’re offering these kind of programs to where they can do that. That’s really powerful.

Well, I really thank you for coming on to the podcast.

Dr. Brian Higdon: Of course.

Tracy Davis: I’ll link in the description of the podcast below to the website and everything like that, so if they have any more questions, they can reach out.

Dr. Brian Higdon: Yep. Thanks for inviting me. I appreciate it.

Tracy Davis: Appreciate it. Thanks.