Darrell Rebouche (Host): When an illness, injury, stroke, or other medical condition changes what a person is able to do, recovery often involves much more than simply treating the underlying condition. It's about helping patients regain strength, mobility, independence, and confidence, and finding a path forward in everyday life.

Hello everyone, and welcome to Health on Point presented by Willis-Knighton Health. I'm your host, Darrell Rabouche, and the people who treat these kind of patients are joining us today. Dr. Wade Wyckoff, Dr. Katharine Balbuena from the Willis-Knighton Rehabilitation Institute. Doctors, thank you for being here.

Wade Wyckoff, MD: Thanks for having us.

Katharine Balbuena, MD: Thanks.

Host: Let's start with you, Dr. Balbuena. Please give us a broad definition of rehabilitation medicine. Some people may not realize what that is.

Katharine Balbuena, MD: Right. So, I would classify the type of medicine that we do as the medicine for people that have disabilities. That's how our specialty started back a very long time ago. And it continues today, because there are many people that do have chronic disease or have injuries that leave them with impairments that lead to disabilities in the way they function, not just in their home, but in their environment as well. So, that's how the whole specialty started. It's a very unique specialty, and it gives us a lot of opportunity to work with a broad base of patients.

Host: That may be its appeal, Dr. Wyckoff, as you never know what will bring someone to you. Just expand on what Dr. Balbuena said about the kind of patients you see and how you typically treat those patients.

Wade Wyckoff, MD: Right. It could be a wide range of diagnoses. Basically, anytime they have a change in their functional status from their baseline, that's when we're looking to basically help the rehabilitation process. Now, that could be a stroke, it could be a spinal cord injury, it could be an orthopedic condition. And the goal is basically to get patients safely back home. Also, we look at social factors, and we look at psychological issues as well. So, we kind of do like a whole body approach in order to safely get patients back home functionally.

Host: And the nice thing about the Willis-Knighton Rehabilitation Institute is you have inpatient, you have outpatient. You guys concentrate on inpatient settings. I mean, how does having an inpatient facility like this work to the advantage of the community and the patients who need it? Dr. Balbuena, let's go with you.

Katharine Balbuena, MD: Oh, having this facility is so important for our community. We specialize in the inpatient side of rehabilitation, which means it is a hospital setting. So, our patients come from the big hospitals to our hospital. They spend the night. But that is where we focus on treating them not only medically, but also physically, and we're able to focus on all aspects of their care and reintroduce them to the community.

Host: Dr. Wyckoff, I think people might not realize what all goes into it, or maybe some people don't even realize that a facility like this and physicians like you are available right here on what we like to call the hospital on the hill right there by I-20. It's such a beautiful building, inside and out with great care on the inside. Is it your sense that maybe people need to know more about this?

Wade Wyckoff, MD: Oh, absolutely. You know, I think a lot of people aren't aware of the difference between like an inpatient rehab versus a skilled nursing facility. Big difference is in inpatient rehab, you're going to have three hours of intense rehab a day. Now, it's not all at once, but it'll be spread out throughout the day, as opposed to a skilled nursing facility will be around one hour.

Also, at an inpatient rehab, you will be seen by a doctor each day, as opposed to a skilled nursing facility might not be a doctor seeing a patient every day. And, you know, here at Willis-Knighton, we actually have me and Dr. Balbuena, who are team PM&R physicians. So, we specialize in forming a rehab plan, and then we also have an internal medicine physician as well that will help us. But basically, the level of therapy and also the medical attention makes a big difference in helping to get these patients home.

Host: And Dr. Balbuena, you have a tremendous array of support staff, in addition to the physicians, who support you and help with the patients. Can you outline some of those for us, please?

Katharine Balbuena, MD: Oh, sure. So, Dr. Wyckoff and I are part of a tremendous team. It takes a mountain of people to accomplish what we do. But we work closely with obviously our rehab nurses, our physical therapists, our occupational therapists, our speech therapists. We have a dietician, we have social workers, and that's just to name a few.

But it takes a lot of effort and a lot of specialized care to help the patients, you know, regain their health and be able to take charge of getting healthy and improving what they need to do moving forward.

Host: Just chatting with the two of you. I mean, your enthusiasm for what you do, your belief in the efficacy of everything you do just leaps right out of your personalities. What inspired you, Dr. Wyckoff, to go into PM&R? And I'll define that one more time. PM&R, physical medicine and rehabilitation. What led you to this particular aspect of medicine?

Wade Wyckoff, MD: Yeah, thanks for asking. You know, it started early with me. I've always been active as a kid. I always was involved in sports. And, you know, for me, it was always important to just staying active. My mom was also a physical therapist. She actually worked at an inpatient rehab as a physical therapist. So, she stayed on top of us, you know, as far as staying active and, you know, being involved with sports, not just socially, but also physically.

And a big thing, you know, I noticed on my rotation as a med student is just how debilitated these patients can become in the hospital. I don't know if you know this, but every day that you're bedbound, you lose about 1% of muscle mass, which is very significant, and you can even lose more percentage in strength.

So for me, when I went to an inpatient rotation, inpatient rehab rotation as a med student, and I saw how much better these patients got, to me, I just loved it. I loved seeing the difference from when they first came in to when they left the rehab. And it inspired me. And for me to be able to help out and be involved in that process, I've loved it. You know, for me, it's kind of a dream job to be doing this.

Host: What about you, Dr. Balbuena? What led you to this? Because you seem to really, really be dedicated to it.

Katharine Balbuena, MD: Well, I had a similar story to Wade. I was an athlete myself, and I did get injured in college. And that was the first time that I ever had to do any sort of physical therapy. But I saw it personally help me through a tough time. And then, I loved medicine, always wanted to be a doctor. But when I did my first rotation in PM&R, not really knowing the specialty at all, I realized that I can help a lot more people than just athletes. And now seeing what we see every day, the types of patients that come into our building, we're treating patients from 18 years old up to 99 years old. And it's so rewarding, it's so fulfilling, just to give people some hope. They come in very scared and don't know what's going to happen, and you're part of that improvement, and you can give them confidence and hope and realize they're going to get better. And it's just a healing environment. It's literally the best part of medicine, I think, right now in our whole healthcare system, is inpatient rehab. There's just nothing better than being here in this building.

Host: I can tell you love it. Dr. Wyckoff, you've talked about this a little bit and Dr. Balbuena talked about the age range, but what about the kinds of patients you see? What is the preponderance, or can you pinpoint or just kind of lead to somebody you see more than anybody else, or is there just such a wide range it's hard to point a finger at anybody in particular?

Wade Wyckoff, MD: I'd say the most common diagnosis we see is a stroke. But we see a very wide range of diagnoses. A lot of different neurological diagnoses, spinal cord, something called Guillain-Barré syndrome, multiple sclerosis. Those diseases are basically when your body has an autoimmune reaction against your nerves. But we also get orthopedic conditions. We get patients after cardiac procedures such as a coronary artery bypass graft, which is like an open heart surgery. We get respiratory conditions. It's a very wide range of diagnoses. Basically, the whole idea is where they have a change from their prior level of function to where they're needing rehab in order to stay.

Host: Sometimes these patients come in into what you said, they're completely changed by a sudden medical event. And I know someone who comes to mind for you, you're particularly proud of her recovery, is a patient named Debra Mitchell. What do you remember about her?

Wade Wyckoff, MD: Oh, she was fantastic. But when she first came in, she was very low level. She had a brain bleed that brought her to the rehab. And, you know, she had very poor sitting balance. She couldn't even stand when she first came to the rehab. And to see how well she got was very inspiring. And I'd say it was such a great team approach with everyone involved in her care, and she was the biggest part of the team.

Host: No one can tell Debra Mitchell's story better than Debra Mitchell. So, let's hear from her right now.

Debra Mitchell: I had a stroke at my house, and I was found by neighbors.

Wade Wyckoff, MD: When I first saw her, she wasn't even able to sit upright on her own. She had very, very poor sitting balance. She didn't stand up at all.

Debra Mitchell: I spent, I think, about two weeks in ICU. And once I was able to be moved from there, I came to Willis-Knighton Rehabilitation Hospital.

Wade Wyckoff, MD: She was funny when she first came in. She used to drive a school bus, she told me, and motorcycles. And right away, she was like, "When am I going to be able to start riding a motorcycle?" You know, doing the revving motion with her hand and talking about wanting to drive. And I was just like, "Well, look, you just had a significant stroke. Let's just take one day at a time." The one of the things we had to work on first was just sitting her up, working on her sitting balance, and then eventually getting to stand her up.

Debra Mitchell: I was paralyzed all on the left side.

Wade Wyckoff, MD: And she was requiring a lot of assistance with therapy. But throughout the weeks of therapy, she really, really started to progress. Each week, we were amazed how much better she would get from the last week. And even each day, I would just notice the wins that were huge for her.

Debra Mitchell: Three hours a day, every day, five days a week for OT, PT, speech.

Wade Wyckoff, MD: During her whole stay, she was motivated. She was a team player. Our therapist did an amazing, amazing job from physical therapy to occupational therapy. Our nurses were fantastic. And her family was very involved as well. So, it was a huge team effort. But I will say I felt like she was the biggest part of the team. A lot of the therapy has to come from the patient. And she really was motivated to get better, and it was really an amazing rehabilitation stay for her.

Debra Mitchell: The level of care was outstanding. It was tremendous. And I always called them the A-team because that's what they were. In all areas that dealt with me, they were all the A-team. Very kind, very courteous and enthusiastic. They were my best cheerleaders.

Host: Dr. Wyckoff, the reaction to Debra's story was so huge on social media and on YouTube. She's beloved in her community. What was your takeaway from your relationship with her?

Wade Wyckoff, MD: You know, it was an amazing relationship. It almost felt like it was a family with her, with how the therapist treated her, the nurses. You know, it was bittersweet when she left, but it was amazing to see her walking out from where she was. And kind of like what I said before, you know, she was just so motivated. You know, she was like, "I'm going to get back to where I'm living a normal life again."

Host: Just one of so many success stories at Willis-Knighton Rehabilitation Institute. Dr. Balbuena, you know, people have a choice, and sometimes they don't know how to make that choice. They go maybe where a referring physician sends them, or maybe they've heard something from some friends and relatives. So, this is an opportunity to let everybody know what sets our facility apart from the others.

Katharine Balbuena, MD: Right. Well, you do have other facilities in Shreveport. However, what makes us stand apart is actually Dr. Wyckoff and myself to begin with, as we are PM&R physicians, we're trained. This is what we do every day. And, also just the environment that we provide for our patients. It's hard to put that in writing. But I would recommend that if you are in a situation and you need rehab or a family member needs rehab, to just pop in, come on by, and we'll take you around. You can see what it's like, and that'll give you the best impression of where you want your family member to be. But honestly, we take what we do every day very, very seriously. Dr. Wyckoff and I are full-time here at the hospital. We don't share our practice with outpatient right now. So, we're dedicated. We have such a wonderful team that's dedicated as well, and we take pride in what we do every day. So, come on by and check us out. And if you just talk to your case manager, your social worker, or your doctor, wherever you might find yourself, if you need rehab, we hope you consider Willis-Knighton.

Host: Okay, Dr. Wyckoff, let's say someone or many people take you up on that invitation that Dr. Balbuena so generously offered, what are the smart questions to ask about whether they're in the right place and what they should be looking for with, what you guys do?

Wade Wyckoff, MD: I think a big thing is, first, see if you know anyone that's been to an inpatient rehab, ask about their experience, you know, as far as getting word of mouth. And then, you know, some other things that make us stand out is that we're CARF accredited, which is basically an accreditation for rehabs that's very vigorous. And basically, we've been through a lot of standards that we've upheld that shows that we're, you know, very good and we're doing everything towards the standard of care. Dr. Balbuena can even discuss more about that, because she's been very involved in that process.

I also would look to see what the nurse to patient ratio is. Here, we usually have a five to one nurse to patient ratio. And also, one-on-one therapy. You know, you're going to want to have the therapist's full attention. So, the one-on-one therapy is very important and all of this stuff we provide here at Willis-Knighton Rehab.

Host: This is Health on Point, presented by Willis-Knighton Health. I'm Darrell Rebouche, and our guests are Wade Wyckoff and Katharine Balbuena, both physical medicine and rehabilitation physicians at the Willis-Knighton Rehabilitation Institute. Dr. Balbuena, let's talk about setting goals. Patients come in there, and I'm sure there's a wide variable in how long people stay. You can probably speak to an average length of stay, but what's typical, and how do you go about setting goals for these patients when they arrive?

Katharine Balbuena, MD: I would definitely say that the patients actually set their goals. They may not be the same goals we have for them, but we work closely with the patients to find out what it is that they are expecting to accomplish. The change that we've seen recently though is that when I was a younger doctor, we were able to keep patients for two to three months in rehab, so we were able to achieve some very lofty goals.

Now, our average length of stay is two weeks. And so, we've gone from two months to two weeks. So, we've had to speed up. Actually, what we're doing with the patients on a daily basis, but that also limits us, as to kind of the end point. But we do encourage that they do continue with their therapy when they go home. Just because they leave inpatient rehab doesn't mean they're finished. They'll still continue as an outpatient until they do reach their goals.

Host: Dr. Balbuena mentioned when she was a younger doctor. I don't know, you look great to me. But I think Dr. Wyckoff is, in fact, at this time, one of the younger doctors. So Dr. Wyckoff has Willis-Knighton and has your practice been everything you wanted it to be so far? And what are you looking forward to?

Wade Wyckoff, MD: Yeah. It has been awesome since coming here. I feel like Willis-Knighton has provided me with all the resources to provide awesome patient care here. I do feel like this place is a family. And, you know, it's been good having Dr. Balbuena here, who's also another PM&R doctor, almost as a mentor as well. So, so far since I've been here, I'm almost at one year now. It has been a fantastic experience.

Host: Based on your experience, Dr. Balbuena, what are the typical goals and strategies, if you can point to those at all, for the patients who come in?

Katharine Balbuena, MD: Well, I would say that for most patients, everyone wants to walk out of here. That's kind of the typical goal. That attainable a lot of the time. Sometimes they just don't want to walk with any device like a cane or a walker. We do have paraplegic patients come in where walking may not be a goal. But we do have advanced technologies such as exoskeletons to help them start working towards those goals. And, well, we never say never in rehab. That's one thing that I learned when I was a resident. Even the patients that can be very, very low level can improve, and we've seen it happen in front of our eyes. So, we try to maintain hope and support them in attaining their goals.

Host: Dr. B, do these patients still inspire you?

Katharine Balbuena, MD: Oh, every day. In fact, yesterday, a patient who has a significant brain injury, he walked for the first time and some of the other patients in the gym, we were all clapping, but some of the other patients in the gym were actually crying for him, and his wife was crying, and we were all crying, because he hadn't been able to do that before. So, there's just nothing that can beat that.

Host: Dr. Wyckoff, in the video we saw with Debra Mitchell, we saw that it's a cause for celebration when someone achieves milestones. Can you talk about the camaraderie you guys build among yourselves and the staff and the patients and their families that lead to those kinds of moments?

Wade Wyckoff, MD: Yeah, you're exactly right. And kind of like what Dr. Balbuena said, when these other patients watch other patients progress, you know, they feed off each other and they can all kind of relate to each other. So, it's a community, with the staff, with the patients, with us as the doctors. And I feel like we're all working towards the same goal here, which is really, you know, an awesome thing here. So, that's how I would describe it.

Host: Well, Dr. Balbuena, anything that we have not touched on that you'd like to bring up in closing?

Katharine Balbuena, MD: The only thing I'd just like to say, I would love to thank my team that work with us on a daily basis. Everyone just goes the extra mile to help everyone accomplish their job. Everyone has a smile on their face, every person that's in the building, and people notice that. I have patients tell me that every single day, "How did you find all these great people that seem so happy and are smiling all the time?" And I said, "It's just a happy place to be." But that means a lot. And that's just part of the healing atmosphere that we have at Willis-Knighton. And it's just great to be part of that.

Host: Thank you for your time, Dr. Balbuena, Dr. Wyckoff. Thank you for inspiring us with your tales of success and making people better and helping people get back to the lives that they once lived, or at least a better version of them if they can. And thank you all for joining us for Health on Point, presented by Willis-Knighton Health.