June 3, 2006 (9:10pm)
The charge nurse told me the noise problem in Gary’s room had been solved: they had talked to the loud guy again, and he agreed to turn off his phone at 10 pm; also if anyone uses a TV after that time, they must use headphones. Yea! The first thing Gary said to me this (Sat) morning was that he had slept really good. Double yea!
This afternoon was filled with more classes for me. We spent three hours learning about the spinal cord, the respiratory system, and the skin, and how each is affected by SCI. The lecturer first labeled all the vertebrae and told us what is affected by each. I won’t go thru all that with you, but just mention a few things. One thing I hadn’t realized about Christopher Reeves’ injury is that he couldn’t hold his head up because of it – he could’ve used straps to do so, but apparently chose just to always be slightly reclined. Something else that we’ve noticed come into play is that with a injury above T8, there is a problem with balancing the trunk. In general, people with such injuries when sitting in their wheelchairs must use a chest strap as well as a lap belt so that they don’t fall forward, and must have lateral support so they don’t fall sideways.
One very significant change is that one doesn’t have the full use of abdominal muscles until T12, which means if one’s injury is above that, one can’t cough as one did before, which means one can’t get rid of secretions as well as before, which means bugs can grow, which means the risk of pneumonia is increased – in fact pneumonia is the number one killer of those with SCIs (sometimes I think I’d be happier not knowing this stuff).
The lecturer gave us the signs of pneumonia, and pointed out those which meant call the doctor immediately (mucus that is green or yellow or red; fever of 101 or more, no matter the reason for it). The lecturer gave us the treatment of it (in addition to calling the doctor): cough frequently, using the assistance of a family member if one can’t cough up the secretions on one’s own (the lecturer illustrated how to do this, and at some point we will each have “hands-on” classes where, under the supervision of a nurse, we practice on our family member this and other things we have learned); drink plenty of fluids; turn every two hours; try postural changes to help the drainage; percuss the chest. Prevention methods include getting pneumonia shots every five years and flu shots every year – not just the SCI person but all family members (I was not happy to hear this, as there is some controversy about CFS people getting flu shots – I haven’t gotten them in ages, avoiding the flu by just not being around other people, which brings us to – ); avoid people who are sick; dress for the weather (not as straightforward as before injury, which I’ll explain momentarily); eat a balanced diet; do not smoke and do not let others smoke around you – second-hand smoke kills off the cilia in the lungs, and the cilia are necessary to help pull “the bugs” out.
Oh, I just realized one of the Environmental Health shots I give myself is an antigen for flu (the antigen changes each year). So I think I don’t have to get a regular flu shot. I’ll have to look into this and also see if they offer some antigen corresponding to the pneumonia shot.
Back to the lecture. A few other of the potential changes after SCI that are governed by the spinal cord are changes in heart rate and blood pressure and temperature regulation. Heart rate tends to go down, and the body might do such unusual things as have the heart rate decrease when one exercises, which means it might take some time to get used to exercise. Blood pressure tends to be lower, and this reminds me of something I forgot to mention concerning dysreflexia. One needs to know what one’s normal blood pressure is now, because in dysreflexia it goes up, which could put it in the “normal” range for an adult, but be way too high for the one with SCI – for them 140 over 100 could be like an average person being at 180 over 120.
Another thing about the blood pressure is that since the blood will now collect in the legs since they aren’t being moved about, the person needs to wear a binder around their belly to keep the fluids from collecting there and ted hose on their legs to help the blood move back up and prevent clots; if that’s not enough, that is, the person still experiences dizziness, ace bandages are wrapped around the legs.
In terms of temperature regulation, the person may not be a good judge of how hot or cold they are, and it could change from moment to moment. So they should dress in layers, always have a jacket with them, etc. The best way to see what their temperature really is is to feel them. They may be able to do this themselves – touch themselves somewhere they still have sensation – and see if they feel too hot or too cold. But they may not be able to judge this for themselves, and so someone might have to do this for them. If they are too cold, more clothing is the obvious solution. If too hot, less clothing, misting them, or wiping them with wet cloths are solutions (they may not be able to sweat like they used to, but the misting or wiping with cloths will result in the evaporation process, which will cool them).
The last part of the lecture was on the skin, focusing on the horrors of “pressure ulcers” (bed sores), which of course we are all too familiar with. The guy pointed out that it was far easier to prevent them than to have to have the $130,000 flap surgery and then undergo the inconveniences that result from it. Don’t we know it. Some time ago we were bitching about the care at Birmingham to the skin nurse here, saying that you’d think hospital personnel would be aware of such things and take preventative measures. She said believe it or not, a significant number of patients arriving at Shepherd had the sores. She said Shepherd people go around and lecture other hospitals about it. Apparently other places don’t think of the possibility with those with SCIs, they think of it as a geriatric problem.
Anyway, back to the lecture. Other potential skin problems and how to deal with them were discussed, such as using a draw sheet to position a person in the bed instead of dragging them, which can cause shearing of the skin; avoiding burns by watching that one is not sitting too close to sources of heat and by keeping the water heater set at 120 degrees, etc.; avoiding yeast problems by not sitting around in wet bathing suits, drying oneself off properly after bathing, etc.; avoiding pressure sores by making sure the seat cushion on the wheelchair is properly inflated, by doing the weight shift program, by turning in bed on schedule, by being properly padded in bed (pillows must be placed in certain positions to keep the weight off bony areas), etc.
Etc.
The various problems are detected by doing skin checks twice a day, morning and evening. One looks over every inch of the skin to note any changes – color changes, bruises (figure out the source, e.g., did you get it because you are repeatedly hitting the wheel of your wheelchair when you are doing transfers?), swelling, cuts, scrapes, open sores, rashes. Figure out the cause for the change and treat it.
One must also touch every inch of the skin, looking for swollen areas, hard areas, warm areas. Those with SCIs are at increased risk of blood clots, because they aren’t moving their leg. Signs were given – usually one limb is larger than it mate. Call 911 immediately and don’t move the extremity or massage it. If they don’t find a clot at the hospital, the cause for the change may be heterotopic ossification - abnormal bone growth in tissue - usually a joint. Blood tests or x-rays can be done to determine if that is the problem.
The lecture finished with a demonstration on a model of how to turn and pad a person. Hands-on learning will come later for me.
Unfortunately sitting all that time through the lecture set off my sciatica-like symptoms. I tried to shift around and discreetly get the pressure off my left bun, but obviously I didn’t succeed. One of these days I’ll learn to just do what I have to do, even if that means kneeling on the floor during the lecture or standing in the back – it’s just that it’s hard to take notes that way.
Non sequiturs:
• Gary told me that he can tell that the hole in his trachea is almost healed, though he can still feel something internally in that area – he knows something went on there.
• They’ve removed one of the three drains in his back, so that is a sign of progress (I found out in the lecture that the reason for the drains is so that fluid doesn’t build up in the area of the incision – the increased pressure there could cause the incision to open).
• I was giving him a neck and upper back massage cuz he’s gotten sore there from his weight training. When I started to go down his back, he told me to stop. Evidently I’d hit the line between where he feels normal sensations, and where things start to “go weird” (before sensation stops completely). He doesn’t like being touched on the “weird” area, which of course is understandable.
Apparently the British use of “logorrhoea” does not suggest pathology. I will be editing that later blog entry where it was used. Be assured, I didn’t seriously think it was being suggested that I had a pathological condition. But the American definition of it fed into my fears: all along I have thought that if I had more time I would polish my entries more, that I am a little embarrassed by the raw, unrevised state they are in. But if I took the time to get the entries in the form I’d like to, there wouldn’t be many entries – just ask my critique group how long I go without showing them anything because I don’t feel it’s ready to be seen by anyone.
All for now.
The charge nurse told me the noise problem in Gary’s room had been solved: they had talked to the loud guy again, and he agreed to turn off his phone at 10 pm; also if anyone uses a TV after that time, they must use headphones. Yea! The first thing Gary said to me this (Sat) morning was that he had slept really good. Double yea!
This afternoon was filled with more classes for me. We spent three hours learning about the spinal cord, the respiratory system, and the skin, and how each is affected by SCI. The lecturer first labeled all the vertebrae and told us what is affected by each. I won’t go thru all that with you, but just mention a few things. One thing I hadn’t realized about Christopher Reeves’ injury is that he couldn’t hold his head up because of it – he could’ve used straps to do so, but apparently chose just to always be slightly reclined. Something else that we’ve noticed come into play is that with a injury above T8, there is a problem with balancing the trunk. In general, people with such injuries when sitting in their wheelchairs must use a chest strap as well as a lap belt so that they don’t fall forward, and must have lateral support so they don’t fall sideways.
One very significant change is that one doesn’t have the full use of abdominal muscles until T12, which means if one’s injury is above that, one can’t cough as one did before, which means one can’t get rid of secretions as well as before, which means bugs can grow, which means the risk of pneumonia is increased – in fact pneumonia is the number one killer of those with SCIs (sometimes I think I’d be happier not knowing this stuff).
The lecturer gave us the signs of pneumonia, and pointed out those which meant call the doctor immediately (mucus that is green or yellow or red; fever of 101 or more, no matter the reason for it). The lecturer gave us the treatment of it (in addition to calling the doctor): cough frequently, using the assistance of a family member if one can’t cough up the secretions on one’s own (the lecturer illustrated how to do this, and at some point we will each have “hands-on” classes where, under the supervision of a nurse, we practice on our family member this and other things we have learned); drink plenty of fluids; turn every two hours; try postural changes to help the drainage; percuss the chest. Prevention methods include getting pneumonia shots every five years and flu shots every year – not just the SCI person but all family members (I was not happy to hear this, as there is some controversy about CFS people getting flu shots – I haven’t gotten them in ages, avoiding the flu by just not being around other people, which brings us to – ); avoid people who are sick; dress for the weather (not as straightforward as before injury, which I’ll explain momentarily); eat a balanced diet; do not smoke and do not let others smoke around you – second-hand smoke kills off the cilia in the lungs, and the cilia are necessary to help pull “the bugs” out.
Oh, I just realized one of the Environmental Health shots I give myself is an antigen for flu (the antigen changes each year). So I think I don’t have to get a regular flu shot. I’ll have to look into this and also see if they offer some antigen corresponding to the pneumonia shot.
Back to the lecture. A few other of the potential changes after SCI that are governed by the spinal cord are changes in heart rate and blood pressure and temperature regulation. Heart rate tends to go down, and the body might do such unusual things as have the heart rate decrease when one exercises, which means it might take some time to get used to exercise. Blood pressure tends to be lower, and this reminds me of something I forgot to mention concerning dysreflexia. One needs to know what one’s normal blood pressure is now, because in dysreflexia it goes up, which could put it in the “normal” range for an adult, but be way too high for the one with SCI – for them 140 over 100 could be like an average person being at 180 over 120.
Another thing about the blood pressure is that since the blood will now collect in the legs since they aren’t being moved about, the person needs to wear a binder around their belly to keep the fluids from collecting there and ted hose on their legs to help the blood move back up and prevent clots; if that’s not enough, that is, the person still experiences dizziness, ace bandages are wrapped around the legs.
In terms of temperature regulation, the person may not be a good judge of how hot or cold they are, and it could change from moment to moment. So they should dress in layers, always have a jacket with them, etc. The best way to see what their temperature really is is to feel them. They may be able to do this themselves – touch themselves somewhere they still have sensation – and see if they feel too hot or too cold. But they may not be able to judge this for themselves, and so someone might have to do this for them. If they are too cold, more clothing is the obvious solution. If too hot, less clothing, misting them, or wiping them with wet cloths are solutions (they may not be able to sweat like they used to, but the misting or wiping with cloths will result in the evaporation process, which will cool them).
The last part of the lecture was on the skin, focusing on the horrors of “pressure ulcers” (bed sores), which of course we are all too familiar with. The guy pointed out that it was far easier to prevent them than to have to have the $130,000 flap surgery and then undergo the inconveniences that result from it. Don’t we know it. Some time ago we were bitching about the care at Birmingham to the skin nurse here, saying that you’d think hospital personnel would be aware of such things and take preventative measures. She said believe it or not, a significant number of patients arriving at Shepherd had the sores. She said Shepherd people go around and lecture other hospitals about it. Apparently other places don’t think of the possibility with those with SCIs, they think of it as a geriatric problem.
Anyway, back to the lecture. Other potential skin problems and how to deal with them were discussed, such as using a draw sheet to position a person in the bed instead of dragging them, which can cause shearing of the skin; avoiding burns by watching that one is not sitting too close to sources of heat and by keeping the water heater set at 120 degrees, etc.; avoiding yeast problems by not sitting around in wet bathing suits, drying oneself off properly after bathing, etc.; avoiding pressure sores by making sure the seat cushion on the wheelchair is properly inflated, by doing the weight shift program, by turning in bed on schedule, by being properly padded in bed (pillows must be placed in certain positions to keep the weight off bony areas), etc.
Etc.
The various problems are detected by doing skin checks twice a day, morning and evening. One looks over every inch of the skin to note any changes – color changes, bruises (figure out the source, e.g., did you get it because you are repeatedly hitting the wheel of your wheelchair when you are doing transfers?), swelling, cuts, scrapes, open sores, rashes. Figure out the cause for the change and treat it.
One must also touch every inch of the skin, looking for swollen areas, hard areas, warm areas. Those with SCIs are at increased risk of blood clots, because they aren’t moving their leg. Signs were given – usually one limb is larger than it mate. Call 911 immediately and don’t move the extremity or massage it. If they don’t find a clot at the hospital, the cause for the change may be heterotopic ossification - abnormal bone growth in tissue - usually a joint. Blood tests or x-rays can be done to determine if that is the problem.
The lecture finished with a demonstration on a model of how to turn and pad a person. Hands-on learning will come later for me.
Unfortunately sitting all that time through the lecture set off my sciatica-like symptoms. I tried to shift around and discreetly get the pressure off my left bun, but obviously I didn’t succeed. One of these days I’ll learn to just do what I have to do, even if that means kneeling on the floor during the lecture or standing in the back – it’s just that it’s hard to take notes that way.
Non sequiturs:
• Gary told me that he can tell that the hole in his trachea is almost healed, though he can still feel something internally in that area – he knows something went on there.
• They’ve removed one of the three drains in his back, so that is a sign of progress (I found out in the lecture that the reason for the drains is so that fluid doesn’t build up in the area of the incision – the increased pressure there could cause the incision to open).
• I was giving him a neck and upper back massage cuz he’s gotten sore there from his weight training. When I started to go down his back, he told me to stop. Evidently I’d hit the line between where he feels normal sensations, and where things start to “go weird” (before sensation stops completely). He doesn’t like being touched on the “weird” area, which of course is understandable.
Apparently the British use of “logorrhoea” does not suggest pathology. I will be editing that later blog entry where it was used. Be assured, I didn’t seriously think it was being suggested that I had a pathological condition. But the American definition of it fed into my fears: all along I have thought that if I had more time I would polish my entries more, that I am a little embarrassed by the raw, unrevised state they are in. But if I took the time to get the entries in the form I’d like to, there wouldn’t be many entries – just ask my critique group how long I go without showing them anything because I don’t feel it’s ready to be seen by anyone.
All for now.
posted by Peg Daniels at 7:51 AM
1 Comments:
I find your blog fascinating and entertaining, not to mention educational...I'm learning a lot of anatomy just by reading it. :) I've linked to your blog from mine.
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