Blog at http://drpeg2003.blogspot.com/
May 31, 2006 (9:46pm)
Today was a class day for me. Unfortunately class began at the ridiculous time of 7:15 am. Which of course meant I shot awake at 3 am, heart pounding, worried I would wake up too early, not be able to go back to sleep, feel really lousy during the class (thus not taking full advantage of it), and then feel really lousy the rest of the day. So I laid there going through a progressive relaxation procedure. Forty-five minutes later, after going through the procedure three times, I gave up on that tack and meditated. Over an hour later I lay back down and drifted off into sleep for about an hour, then got up. I do not know why I react that way to first-thing-in-the-morning obligations, but I have since my college days. In fact, I considered not returning for a second quarter at Auburn when I started graduate school, because the pressure I put myself under in my coursework combined with the stress of having classes at 8 am (the only times the classes I was interested in were being offered) was so great. I know that I should just accept that this is the way I am, and then paradoxically, the problem would cease, but I haven’t managed to do that yet.
I didn’t have too bad of a day despite the inauspicious start. From 7:15 to 10:15 I learned about the bowel and the urinary tract; the programs those with SCI (spinal cord injury), possibly aided by their care givers, need to follow in order to keep these systems functioning as well as they can given the injury; the problems that can arise in these systems under the circumstances; and the symptoms and treatment of those problems. The problems can be quite serious, not simply the social embarrassment that can result because the signal no longer gets to the brain that bowel or bladder are full. For example, if one consistently allows the bladder to get too full, the urine can back up into the kidneys and cause kidney disease. In fact, the lecturer told us, as recently as ten years ago, kidney disease was the number one cause of death in those with SCI, because at that time it wasn’t understood how important it was to keep the bladder under 500 cc full. On the other hand, one doesn’t want to keep it constantly drained by using something like a Foley catheter (which is what is put in first in the emergency room) because a) there’s a high risk of infection because it is opened to the outside when emptied, thus allowing the possibility of germs getting in and b) the bladder shrinks to the size of the balloon at the end of the Foley (which is what anchors it in the bladder) and one ends up with hardly any capacity for the urine at all. The lecturer did a demonstration of how the catheterization is done (later we will learn hands on, as we will all the other things covered; someone will have to do these things for quadraplegics, and do them for paraplegics at least temporarily under certain circumstances – illness, as a result of surgical procedures, etc.). She asked the young male pharmacist who was sitting in on the class if he wanted to be the model, but he declined (turning a pretty shade of red in the process). So she used a plastic model of the male apparatus. At the end, she said, “And now we’re all done.” She then vigorously yanked the catheter tubing from out of the model. All the females in the class laughed uproariously. The pharmacist nearly fainted. The lecturer commented that one develops a certain twisted sense of humor when living with/working with people with SCI (and probably in being such a person too) – that it is necessary to deal with it. Her husband is a T12, her father a C4, by the way.
That reminds me. It’s interesting how everyone labels the patients here by the level their injury took place at. It starts with the medical staff, and then patients and their families pick it up. In the class I was in there were three T’s – paraplegics – and five C’s – quadraplegics. One of the quadarplegics is a fourteen-year-old boy.
We also learned about autonomic dysreflexia, which is a blood pressure disorder that *can* happen (but it won’t necessarily) to those with SCIs above the T6 level (and thus Gary is at risk, being a T4). Apparently it is a disorder unique to SCIs, that is, if you don’t have a spinal cord injury, you won’t suffer from the disorder. It is the reaction of the body caused by painful nerve signals trying to get to the brain. If not treated immediately it can lead to stroke or death – it is an emergency situation. There is a sequence of steps to go through in order to relieve the problem, and one knows it is relieved by an immediate cessation of the symptom or symptoms (only one of these need occur – sudden pounding headache, sudden heavy sweating or blotchy skin or goose bumps above the level of injury, sudden stuffy nose, sudden high blood pressure). One needn’t go through all the steps – stop when the symptom stops. The sequence is: sit straight up; loosen clothing; do the bladder program, even if that means catheterizing in the middle of a crowded concert – that’s preferred to dying there; do the bowel program; strip and check the skin for any changes (Were the shoes too tight? Was there a pebble in the shoe? Was something pressing into them somewhere? No patient at Shepherd’s wears jeans, and it is recommended that they no longer wear them “on the outside”: too many seams and pockets and rivets that can press into the body); check hands and feet for ingrown nails; if all the above has failed, go to the emergency room or call 911.
As you might surmise from the above, the number one cause of dysreflexia is a full bladder, number two (pardon that) is a full bowel; number three is a skin problem.
Another thing that was noted throughout the lecture is that in general, doctors, hospitals, etc., are not familiar with SCI, so anyone Gary needs to see will need to be educated. He will need to find a doctor willing to work with and become educated about SCI. He will need to go to a urologist every other year for an x-ray or something called an IVP because SCIs have increased risk of kidney stones. An interesting “little” thing, is that even though he might not feel the pain sensations, any procedure that is typically done using numbing (such as when a doctor removes an ingrown nail) will still require that he be numbed – otherwise those pain signals will still try to get to the brain and dysreflexia can result.
Throughout the three hours I kept thinking to myself, “God, I hope that doesn’t happen to Gary, God, I hope that doesn’t happen to Gary.” I know they wanted to present the serious consequences of not taking the care that is needed with these thing, and they certainly succeeded with me. I can just picture myself quizzing Gary daily on certain matters one would normally keep to oneself (“How’s your poop today, honey?”) We’ll (or should I say “I’ll”) have to find the balance between being concerned and neurotic (I’m sure my critique group can think of the other very appropriate adjective they’ve used to describe me). I think I tend to the latter. (“No,” you say in disbelief.)
Well, I took fourteen pages of notes, but I think I’ll spare you the rest of the details here. If anyone is interested in more details, the course is actually up on a website, www.myvitalconnections.org You’ll need a username and password, which you can get from me (if a lot of people request it, I’ll put it on the blog in the “my profile” section – I’ll let you know if I do this).
In the early afternoon the PT and OT came with housing recommendations based on the information about and pictures of our house that Jo had gotten. It appears that it won’t be as drastic a renovation project as we feared it might be. A few doorways need widening, screen doors and some inner doors need to be removed, roll-under sinks were recommended, and carpeted floors would be better changed to hardwood. Other things are furniture changes – remove some book shelves, get a smaller bed in the master bedroom and take out some of the other furniture in there so Gary can get around to the bathroom. Our entryways have only about a 2" step-up, so Gary should be able to roll right in, or at worst do wheelies over them, no ramp likely being needed.
The floor nurse came in and told Gary that they were going to make up a schedule for him so that he could still attend some of the classes he’d been scheduled to attend. They are going to find ones that don’t have many other people in them (the classes are offered regularly, and people are assigned to certain ones on certain days), and then they’re going to wheel his entire bed down to the classroom! I think it’s so great that they’re finding ways he can still participate in their program, rather than just lie there in that bed. I think it’s good he’ll get the little change of scenery and be able to do some interaction with others.
Other people came in and looked at his boots he’d been wearing. They decided they were too small and will come in next Tuesday to make casts for him (I had been under the impression they were going to do that today). Until then, they want him to keep his feet flexible by stretching them – so they will bring one of those belt loops he’d been using before for stretching his legs. I’ll put it around his feet and then he’ll pull on it to stretch his feet.
Gary mentioned he can still feel the rods and pins in his back. It’s not painful, he says, but can get quite uncomfortable.
It had been a long day for me. At the end, while turning off the light, I asked as always , “Anything more you want me to do before I go?” His roommate’s speaker phone went off. Gary looked at me. “Murder that guy on your way out,” he said. We laughed.
Aye, aye, sir.
May 31, 2006 (9:46pm)
Today was a class day for me. Unfortunately class began at the ridiculous time of 7:15 am. Which of course meant I shot awake at 3 am, heart pounding, worried I would wake up too early, not be able to go back to sleep, feel really lousy during the class (thus not taking full advantage of it), and then feel really lousy the rest of the day. So I laid there going through a progressive relaxation procedure. Forty-five minutes later, after going through the procedure three times, I gave up on that tack and meditated. Over an hour later I lay back down and drifted off into sleep for about an hour, then got up. I do not know why I react that way to first-thing-in-the-morning obligations, but I have since my college days. In fact, I considered not returning for a second quarter at Auburn when I started graduate school, because the pressure I put myself under in my coursework combined with the stress of having classes at 8 am (the only times the classes I was interested in were being offered) was so great. I know that I should just accept that this is the way I am, and then paradoxically, the problem would cease, but I haven’t managed to do that yet.
I didn’t have too bad of a day despite the inauspicious start. From 7:15 to 10:15 I learned about the bowel and the urinary tract; the programs those with SCI (spinal cord injury), possibly aided by their care givers, need to follow in order to keep these systems functioning as well as they can given the injury; the problems that can arise in these systems under the circumstances; and the symptoms and treatment of those problems. The problems can be quite serious, not simply the social embarrassment that can result because the signal no longer gets to the brain that bowel or bladder are full. For example, if one consistently allows the bladder to get too full, the urine can back up into the kidneys and cause kidney disease. In fact, the lecturer told us, as recently as ten years ago, kidney disease was the number one cause of death in those with SCI, because at that time it wasn’t understood how important it was to keep the bladder under 500 cc full. On the other hand, one doesn’t want to keep it constantly drained by using something like a Foley catheter (which is what is put in first in the emergency room) because a) there’s a high risk of infection because it is opened to the outside when emptied, thus allowing the possibility of germs getting in and b) the bladder shrinks to the size of the balloon at the end of the Foley (which is what anchors it in the bladder) and one ends up with hardly any capacity for the urine at all. The lecturer did a demonstration of how the catheterization is done (later we will learn hands on, as we will all the other things covered; someone will have to do these things for quadraplegics, and do them for paraplegics at least temporarily under certain circumstances – illness, as a result of surgical procedures, etc.). She asked the young male pharmacist who was sitting in on the class if he wanted to be the model, but he declined (turning a pretty shade of red in the process). So she used a plastic model of the male apparatus. At the end, she said, “And now we’re all done.” She then vigorously yanked the catheter tubing from out of the model. All the females in the class laughed uproariously. The pharmacist nearly fainted. The lecturer commented that one develops a certain twisted sense of humor when living with/working with people with SCI (and probably in being such a person too) – that it is necessary to deal with it. Her husband is a T12, her father a C4, by the way.
That reminds me. It’s interesting how everyone labels the patients here by the level their injury took place at. It starts with the medical staff, and then patients and their families pick it up. In the class I was in there were three T’s – paraplegics – and five C’s – quadraplegics. One of the quadarplegics is a fourteen-year-old boy.
We also learned about autonomic dysreflexia, which is a blood pressure disorder that *can* happen (but it won’t necessarily) to those with SCIs above the T6 level (and thus Gary is at risk, being a T4). Apparently it is a disorder unique to SCIs, that is, if you don’t have a spinal cord injury, you won’t suffer from the disorder. It is the reaction of the body caused by painful nerve signals trying to get to the brain. If not treated immediately it can lead to stroke or death – it is an emergency situation. There is a sequence of steps to go through in order to relieve the problem, and one knows it is relieved by an immediate cessation of the symptom or symptoms (only one of these need occur – sudden pounding headache, sudden heavy sweating or blotchy skin or goose bumps above the level of injury, sudden stuffy nose, sudden high blood pressure). One needn’t go through all the steps – stop when the symptom stops. The sequence is: sit straight up; loosen clothing; do the bladder program, even if that means catheterizing in the middle of a crowded concert – that’s preferred to dying there; do the bowel program; strip and check the skin for any changes (Were the shoes too tight? Was there a pebble in the shoe? Was something pressing into them somewhere? No patient at Shepherd’s wears jeans, and it is recommended that they no longer wear them “on the outside”: too many seams and pockets and rivets that can press into the body); check hands and feet for ingrown nails; if all the above has failed, go to the emergency room or call 911.
As you might surmise from the above, the number one cause of dysreflexia is a full bladder, number two (pardon that) is a full bowel; number three is a skin problem.
Another thing that was noted throughout the lecture is that in general, doctors, hospitals, etc., are not familiar with SCI, so anyone Gary needs to see will need to be educated. He will need to find a doctor willing to work with and become educated about SCI. He will need to go to a urologist every other year for an x-ray or something called an IVP because SCIs have increased risk of kidney stones. An interesting “little” thing, is that even though he might not feel the pain sensations, any procedure that is typically done using numbing (such as when a doctor removes an ingrown nail) will still require that he be numbed – otherwise those pain signals will still try to get to the brain and dysreflexia can result.
Throughout the three hours I kept thinking to myself, “God, I hope that doesn’t happen to Gary, God, I hope that doesn’t happen to Gary.” I know they wanted to present the serious consequences of not taking the care that is needed with these thing, and they certainly succeeded with me. I can just picture myself quizzing Gary daily on certain matters one would normally keep to oneself (“How’s your poop today, honey?”) We’ll (or should I say “I’ll”) have to find the balance between being concerned and neurotic (I’m sure my critique group can think of the other very appropriate adjective they’ve used to describe me). I think I tend to the latter. (“No,” you say in disbelief.)
Well, I took fourteen pages of notes, but I think I’ll spare you the rest of the details here. If anyone is interested in more details, the course is actually up on a website, www.myvitalconnections.org You’ll need a username and password, which you can get from me (if a lot of people request it, I’ll put it on the blog in the “my profile” section – I’ll let you know if I do this).
In the early afternoon the PT and OT came with housing recommendations based on the information about and pictures of our house that Jo had gotten. It appears that it won’t be as drastic a renovation project as we feared it might be. A few doorways need widening, screen doors and some inner doors need to be removed, roll-under sinks were recommended, and carpeted floors would be better changed to hardwood. Other things are furniture changes – remove some book shelves, get a smaller bed in the master bedroom and take out some of the other furniture in there so Gary can get around to the bathroom. Our entryways have only about a 2" step-up, so Gary should be able to roll right in, or at worst do wheelies over them, no ramp likely being needed.
The floor nurse came in and told Gary that they were going to make up a schedule for him so that he could still attend some of the classes he’d been scheduled to attend. They are going to find ones that don’t have many other people in them (the classes are offered regularly, and people are assigned to certain ones on certain days), and then they’re going to wheel his entire bed down to the classroom! I think it’s so great that they’re finding ways he can still participate in their program, rather than just lie there in that bed. I think it’s good he’ll get the little change of scenery and be able to do some interaction with others.
Other people came in and looked at his boots he’d been wearing. They decided they were too small and will come in next Tuesday to make casts for him (I had been under the impression they were going to do that today). Until then, they want him to keep his feet flexible by stretching them – so they will bring one of those belt loops he’d been using before for stretching his legs. I’ll put it around his feet and then he’ll pull on it to stretch his feet.
Gary mentioned he can still feel the rods and pins in his back. It’s not painful, he says, but can get quite uncomfortable.
It had been a long day for me. At the end, while turning off the light, I asked as always , “Anything more you want me to do before I go?” His roommate’s speaker phone went off. Gary looked at me. “Murder that guy on your way out,” he said. We laughed.
Aye, aye, sir.
posted by Peg Daniels at 7:57 AM
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