Spinal Cord Injury Information

I sincerely hope the information presented will be useful and help you and yours cope with this devastating injury.

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SCI INFORMATION, Changes

This important section is devoted to the changes that take place in the SCI body, and includes important information on the circulatory system, the respiratory system, the psychology and psychosocial adjustment of the SCI, even sexuality, sex after SCI.

The Circulatory System

  The circulatory system distributes nutrients from food and oxygen from your lungs throughout your body. Your circulatory system is made up of your heart, arteries, veins, and capillaries. Blood travels throughout your body by way of this system. Blood is made up of blood cells and fluid called plasma. There are different types of blood cells, and each serves a certain purpose in your body.

• RBCs (red blood cells) carry oxygen to the tissues of your body.

• WBCs (white blood cells) help fight infections and increase in number if you do have an infection.

• Platelets are cells that aid in blood clotting.

• Plasma is the clear fluid that keeps the cells floating. It allows them to flow through the blood vessels. Plasma also carries nutrients such as sugar, proteins, vitamins, and minerals to the tissues of the body.

  All of the things that are in the blood are necessary for the tissues in your body to survive.

  There are several specific changes that affect your circulation after SCI. After a quick look at the basics, we will describe these changes to help you recognize if there may be a problem.

  Getting blood to every cell in your body is the job of your heart. It acts as a pump, sending fluid through a system of tubes or blood vessels. Blood comes into the right side of your heart from your body and is pumped out to the tissues of the lungs, where it picks up oxygen. (Please note: Blood does not go into the air space of your lungs. Blood runs throughout the walls of your lungs like wiring in the walls of your house.)

  After leaving the lungs, it then returns to the left side of the heart and is pumped out into the arteries. The arteries carry it to the capillaries. These tiny blood vessels run throughout the tissues of your body. There they deliver oxygen, pick up waste products, and distribute nutrients as needed. The blood leaves the capillaries by way of the veins. Veins return blood to the right side of your heart, where the whole cycle begins again.

Blood Pressure and How it’s Regulated

  Blood pressure is a measure of the force with which your blood goes through your blood vessels, It is basically determined by two things:

• How well your heart can pump blood out.

• How much tension there is in your arteries.

  There is a wide range of blood pressures that are considered normal. A stable blood pressure is one that stays within a consistent range. Your nervous system controls the diameter of your blood vessels. The diameter is always adjusting in size depending on your body position and level of activity. This helps keep your blood pressure stable. For example, when you move from sitting to standing, the blood vessels in your legs narrow to stabilize blood pressure. If this did not occur, blood would stay in your legs rather than return to your heart. This pooling of blood in your legs would cause your blood pressure to lower.

  The major effects that your spinal cord injury has on your circulation are changes in your blood pressure and in how your blood moves from your body back to your heart. How well your heart pumps is not affected by SCI but the tension in your arteries is.

  As mentioned above, your nervous system plays a part in adjusting the diameter of your arteries. So, the arteries in the parts of your body affected by your injury will also be affected. A narrow artery raises blood pressure, while a wider artery lowers the pressure. Think in terms of a garden hose. At the tap, you turn on the water and let it flow at a steady rate. Depending on how you use the nozzle, you can close it down and increase the resistance, sending less water through in a high-powered, direct stream. You can also open the nozzle all the way and decrease the resistance, which will give you a lot of water in a relaxed spray with no strong power behind it.

  Increasing the blood pressure is like closing down the nozzle. Lowering the blood pressure is like opening up the nozzle so that the power behind the water is little more than what originally comes from the tap. By closing down the nozzle just enough, you can take the original power behind the water, force it through a smaller space and increase the power and speed at which it comes out.

  In the same way, a stable blood pressure is high enough to circulate nutrients and oxygen to your body quickly and efficiently but not so high as to cause you problems. After SCI, your arteries tend to stay wide (dilated). They can’t get as narrow (constricted) as they did before your SCI. The result is that your blood pressure stabilizes at a lower level than it was before your injury.

  Usually, the action of your muscles, flexing and relaxing either voluntarily or during spasticity, helps keep your blood moving. The muscles affected by your injury can’t do this any more, although spasticity can help somewhat.

These changes in your circulation after SCI tend to increase your risk for developing the following conditions:

• Edema (swelling).

• Thrombus / pulmonary embolus (blood clots).

• Orthostatic hypotension (low blood pressure when you sit up).

• Decreased heart rate.

  The following describes these problems and suggests how you can deal with them.

  Edema (swelling) - Depending on the level of your injury, your legs and perhaps your hands may swell. Swelling occurs when fluid leaves your blood vessels and goes into the spaces between tissue cells. This swelling is called "dependent edema." (Dependent refers to any area that is below the level of your heart.) This edema is caused by the loss of the use of the muscles in your legs or hands, because muscle action and movement help return blood to your heart.

  To prevent your legs from swelling, you can do the following:

• Wear compressive stockings routinely. These are tight elastic stockings and should generally come up to the top of your thigh. They help in returning blood to your heart.

• Do your range-of motion exercises every day, and make sure that you move your legs from one position to another every two to three hours.

  If the swelling is only in one of your legs, see the next section because you may have a blood clot in your leg! If both your legs swell, try these tips for decreasing edema:

• Do more range-of motion exercises and do them routinely or get someone else to do it for you.

  Elevate your legs to or above the level of your heart for 10 to 15 minutes. Do this four to five times a day. Here are some ways to do this:

• Lie down and place pillows under your feet and calves and/or under your hands and arms.

• Move your wheelchair close to your bed and place your feet and legs on the bed.

LOCK YOUR WHEELCHAIR FIRST!

• Sit on a couch or an overstuffed chair and place your feet and legs on your wheelchair.

  Make sure you wear your compressive stockings while you are awake and up in your chair.

  If the swelling continues in your legs for more than one week despite your efforts to treat it or if you notice a sudden increase in swelling, call your physician at the SCI center or in your community.

  Thrombus (blood clot) - Blood clots in either your legs or your lungs can be a serious medical problem. Blood has a tendency to clot when it does not move at its regular, steady pace. This is due to the same lack of muscle pumping action in your legs that causes swelling. A blood clot in the leg can break free and travel to other parts of your body. A clot that stays in one place is a thrombus. A clot that has broken free is called an embolus.

  One of the most common places for an embolus to lodge is the lung. This is called a "pulmonary embolus." Because this is an emergency, the staff will pay a lot of attention to you to help prevent this complication. You will need to learn how to decrease the chance of this happening

  To prevent blood clots, the same measures listed above to treat swelling are taken. Your doctor might also put you on medication that will decrease clot formation. These drugs are commonly known as "blood thinners" or anticoagulants.

Some common signs and symptoms of a clot in your leg include:

• One calf or thigh feels warmer than the other. It may also be red.

• One calf or thigh is more swollen than the other. A simple way to see if there might be swelling is to measure the size of both calves or thighs. A clot can develop and cause the leg to swell quickly. This is why, in the early stages after your injury, the nursing staff measure the size of your calves and thighs twice a day. You may wish to continue this practice on a weekly basis at home.

WHAT TO DO IF YOU THINK YOU HAVE A BLOOD CLOT

  If one calf or thigh becomes larger than the other:

• DO NOT increase your activity level.

• DO NOT do range-of-motion exercises.

• DO NOT move the leg. Increasing your activity may cause the clot to break loose.

  Put yourself to bed and call your physician or nurse at the spinal cord center to get further instructions. If you do have a clot in your leg, treatment will be geared toward preventing it from breaking free and moving to your lungs.

  Most people with a blood clot must take anticoagulants for three to six months after the clot is discovered.

HOW TO TELL IF YOU HAVE A PULMONARY EMBOLUS (BLOOD CLOT IN THE LUNG)

  You may feel one or all of the following:

• A sudden shortness of breath. It may be accompanied by a feeling of tightness in your chest.

• Pain in your side, chest, or back. The pain is usually worse when you breathe in and lets up when you breathe out.

• A sudden development of a new cough. This cough is often associated with sputum or phlegm that may be slightly pink or red.

PREVENTION

  Prevention is extremely important, because a pulmonary embolus can be life-threatening. Since most pulmonary emboli are caused by clots in the legs, the way to prevent them is to follow the prevention methods given to you under "prevention of blood clots."

WHAT TO DO IF YOU THINK YOU HAVE A PULMONARY EMBOLUS

• CALL 911. A pulmonary embolus is an emergency!

• Also call your health care provider or your local physician immediately.

• If you feel short of breath, sitting up in a chair sometimes helps.

• This problem needs to be treated in a hospital where further tests and treatments can be performed.

  Orthostatic Hypotension - Your blood pressure is lower after SCI because your blood vessels cannot constrict to help keep it at a higher level. When you sit up with your legs down or when you stand up, your blood pressure may drop even lower. This happens because blood tends to collect (pool) in the veins of your legs and feet instead of being pushed back to the heart. This is called orthostatic hypotension. Orthostatic means "changing positions," and hypotension refers to lower blood pressure. Lower blood pressure can decrease the amount of blood to your brain. This makes you feel lightheaded or dizzy when you change positions. This problem usually improves with time.

PREVENTING LIGHTHEADEDNESS OR DIZZINESS

  When you get up from a lying position, do it in steps:

• Sit up slowly.

• Rest for a few minutes.

• Move your legs to a lower position.

• Continue your activities.

  Do not change positions quickly. Take your time.

  Wear your compressive stockings and abdominal binder (if prescribed), because they help blood get back to your heart and help prevent blood from collecting in your legs.

  If you have a continuing problem with dizziness, you can try the following:

• Make sure that you are taking in enough fluids in your diet.

• If you continue to feel dizzy or lightheaded despite following all the tips outlined above, call your health care provider, physician or nurse. You may need to be put on medications to increase your blood pressure for a while.

  Your blood pressure can go so low that not enough blood gets to your brain and you pass out, or faint. Fainting should not cause problems if it happens once in a while. If it does occur more often, you need to be treated to prevent it.

IF YOU DO FAINT

• Your family or attendant should lie you down and elevate your legs to above the level of your heart.

• If you are in your wheelchair, someone can just tilt the wheelchair backwards about 45 degrees. Be sure to lock your brakes first.

Decreased Heart Rate

  After an injury to the spinal cord, your heart rate will tend to be slower. The same part of the nervous system that is responsible for your blood pressure is also responsible for increasing your heart rate. This ability may be lost if your injury is above the mid-thoracic level. If you cannot raise your heart rate when you need to, such as when exercising, you may have the same feelings of dizziness and lightheadedness that were mentioned in the section on orthostatic hypotension.

WHAT WILL YOU FEEL IF YOU HAVE DECREASED HEART RATE?

  Most people don’t feel any differently with decreased heart rate. Some people, though, may feel dizziness and lightheadedness if their heart rate drops below 50 beats per minute.

  If you feel lightheaded or dizzy, call your health care provider for further instructions.