Spinal Cord Injury Information

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

If you do not find a subject shown here, please let me know and I will certainly try to research the information and present it on this website in continuing updates.

SCI INFORMATION, Hygiene

This important section is devoted to hygiene, and includes information and tips on daily and SCI specific hygiene, our skin and how to care for it, how to protect our skin from injury, suggestions for the alleviation and treatment of pressure sores, bladder and bowel programs.

Skin Injury and Hazards

  Before your spinal cord injury, your sensation warned you to move away from harm. Of course, accidents were always a possibility and will continue to be so.

  After your spinal cord injury, you have lost some or all of the ability to feel and/or move below your level of injury. This puts you at risk for injury to your skin.

Helpful Tips in Preventing Injury:

1. Always be aware of where and how your paralyzed body parts are located. Example: Are they too close to a heater or fireplace? After transfers to an overstuffed chair, are your feet squarely on the floor?

2. When transferring or moving around, be careful not to bump into things. Use your eyes to scope out distances and obstacles. Remember that when you turn around in your wheelchair your legs stick out farther than the rest of you.

3. Don’t do fancy or new maneuvers in your wheelchair until you have been trained.

4. Be aware that severe spasms can result in trauma to your skin.

Watch for these skin hazards

  Many people drink alcohol. Alcohol use may be a concern when you are taking other medications, are consistently drinking more than two or three drinks a day, or if you find you crave" a drink or need a drink to help you cope with daily hassles. Another indication that alcohol is a problem may be if your job and family are affected by your drinking.

  Alcohol and other drugs can damage many organs of the body, especially the liver, kidneys, and brain. When people are intoxicated, they forget to do pressure releases, so they are liable to get pressure sores. Also, alcohol and drugs may impair your judgment, which may lead to accidents or other activities that can injure your skin.

  You can control alcohol and drug usage by:

1. Drink alcohol during meals, and limit yourself to one or two drinks a day. (1 drink=12oz. of beer, 6 oz. of wine, 1 oz. hard liquor.)

2. If alcohol or drug use is difficult to control, consult your SCI clinic, a local mental health center, or a community alcohol treatment program.

  Anemia is the medical term to describe a decreased number of red blood cells (RBCs). Almost all (97%) of the oxygen that gets to your tissues is carried there by your RBCs. If your RBCs are low, you are anemic. If you do not have enough RBCs to carry oxygen to your cells, the cells can become sick and even die. When skin doesn’t get enough oxygen, it can break down and die. There are many causes of anemia, and it should probably be evaluated with lab tests. A common cause of anemia is the lack of iron in your diet. You might try eating more red meat or taking a vitamin with an iron supplement.

  Check the water temperature by putting a hand or other body part with feeling into the water and holding it there for five seconds. If you feel comfortable, the water temperature is safe. Beware of frozen foods on your lap. If using ice over an area for swelling, wrap it in a towel and keep it to a 10-minute limit.

  Depression is not the feeling we all get from time to time of being down, gloomy, teary, or just fed up. A depressed person is someone who does not eat much, has no appetite, cannot sleep at night, or sleeps all the time. Depressed people also generally are very inactive. Depression itself does not cause problems to the skin, but the side effects of poor eating, sleeping, and not being active tend to increase the likelihood of developing pressure sores from lack of movement. If you are just having a down day or two, don’t worry, it’s normal and will probably pass within a week or so. If it continues for longer than that, call your SCI center and ask to talk to the psychologist or your nurse or doctor. Get help if it continues, otherwise it can just get worse and worse.

  Diabetes damages blood vessels and nerves. When one has diabetes, wounds are more likely to become infected, and they heal much slower. Diabetes is a disease that requires insulin in most cases to get sugar into the cells for cell nutrition. When insulin is insufficient, sugar cannot get into the cells, and it builds up in the blood. That is why glucose, or blood sugar, is elevated in people who have diabetes. Do the following:

1. Control your blood sugar through diet and use of medication if prescribed.

2. Inspect your skin closely for reddened areas, blisters, or sores. Pay particular attention to your feet and legs.

3. Feet and toes are especially vulnerable to sores. Keep them clean, dry, and your toenails trimmed. A tiny cut can lead to serious problems, so be careful to prevent injury.

4. If you get a reddened area or sore, cover it to protect it from further injury, If the sore does not heal in one week, call your SCI center.

  Edema is when fluid collects in and around tissues. It is seen as swelling, usually of the feet and ankles, sometimes in the hands if you are a quadriplegic. If tissues swell too much, it is hard to get adequate oxygen and nutrients to the cells. That increases the likelihood of skin breakdown. If you do get a sore, it takes longer to heal because of the decreased oxygen and nutrients. You can:

1. Elevate your hands, legs, and feet frequently.

2. Wear your compressive stockings.

  Fever is an elevated temperature. Usually a "normal" temperature is considered to be 98.60 Fahrenheit (F) or 370 centigrade (C). However, it is common for some people to have their normal temperature slightly above or below 98.6⁰F. There is no absolute normal. Learn what yours is.

  Temperatures also normally run higher in the afternoon and early evening than in the morning. Your body may now be very sensitive to the air temperature, and you may not be able to automatically regulate your own temperature. After sitting in the hot sun for several hours, your body temperature may go up. You may actually have a fever if your temperature rises to over 100 ⁰F. An increased temperature is likely to make you sweat more, which can cause your skin to be more likely to break down. It also increases your tissue’s need for oxygen and nutrients, because your body is working harder to make you well again. If a fever does not go down after getting out of the heat and if it lasts for more than two days, call your SCI center. Take two Tylenol (650 mg) every four hours. Take a cool bath or sponge yourself with a cool rag, especially your head, neck, feet, hands, under your arms, and around your groin. Drink six to eight glasses of water a day.

  You can prevent frostbite by wearing warm socks and sturdy shoes when outside. Cover your head, ears, and hands when you go out. If your ears are becoming numb and tingling, your feet probably are too, so go inside!

Heat in General

• Do not use a heating pad.

• Beware of feet being too near the heater of a car.

• Do not use electric blankets.

• Do not move too close to fireplaces, radiators, or hot water pipes (especially, under sinks).

Hot Fluid or Food Spills

• Use cup holders on your wheelchair.

• Do not fill cups too full.

• When cooking, cover your lap and legs with a heavy plastic apron.

  You can have a low-oxygen problem when you don’t get enough oxygen to your body’s cells. It may be caused by a lung disease or, if you are a quadriplegic, by not being able to use your chest muscles to take deeper breaths. Tissues must have oxygen to live. When there is too little oxygen going to your skin, it is more likely to break down. If you smoke, STOP! Use your incentive spirometer and follow doctor’s orders closely.

  Moisture or anything that causes your skin to be wet or moist, including sweating, incontinence, diarrhea, etc. Prolonged moisture over any area tends to decrease the skin’s normal protective barrier. It can also cause the skin to become reddened and break down, thereby increasing the risk of infection. You can:

1. Keep your skin clean and dry.

2. Pay special attention to cleanliness in areas where you sweat.

3. If you have skin folds, clean and dry under them well.

4. Certain ointments or preparations like A&D Ointment serve as protection against moisture. If you develop a reddened area due to moisture, you might try one of these. Like any other reddened area, pay close attention to it, If it does not go away in a week, call your SCI center.

  Overweight is a relative term. Although there is a large range of weight that is acceptable, we will say that overweight is 10% or more over your ideal body weight. There are fewer blood vessels in fat tissue. Being overweight causes more pressure on your skin when you sit. This increased weight over pressure points increases the likelihood of skin breakdown. You can:

1. Go on a weight-control program. To do so, see or call your SCI dietitian. Read the section on general nutrition in this handbook.

2. Keep any areas between skin folds clean and dry. Inspect your skin frequently for reddened areas.

3. Change positions or do pressure releases frequently.

  Peripheral Vascular Disease (PVD) is a term that means atherosclerosis, or hardening of the arteries of the arms or legs (almost always the legs). This disease causes narrowing of blood vessels. It can be caused by diabetes, smoking, high blood pressure, and/or elevated cholesterol. If the blood vessels are narrow, it is hard to get enough blood to the tissues. This increases the chance of the skin’s breaking down by decreasing its oxygen and nutrient supplies.

1. If you smoke, STOP!

2. If you have diabetes, try to keep your blood sugar in control.

3. Keep your feet and legs warm. If your feet and legs are warm, the blood vessels will be as open as possible. If they are cold, the blood vessels will get smaller, which will make the problem worse.

4. Keep your feet and legs very clean. Inspect them often for sores or reddened areas. If you do get a sore that does not heal within a week, call your SCI clinic.

  Scar tissue is any area of your skin where there was a break in it and a scar has formed. All scar tissue has a decreased number of blood vessels when compared to normal skin. So, it cannot withstand the same amount of pressure and will be more likely to break down. You can:

1. Do special skin inspections over areas with scars.

2. If the scar area starts getting reddened or becomes whiter for a long period, try to stay off it. Not all scars will turn red as the first sign of a problem; they may get very white and feel hard to the touch.

If you must smoke, REMEMBER:

• Hot ashes can fall on your skin and bum you.

• Use cigarette holders if you have impaired use of your hands.

• Knock the ashes off into an ashtray frequently.

• Hold the cigarette away from your body.

• Do not smoke in bed.

  The nicotine in cigarettes causes the blood vessels to constrict (get small). Smaller blood vessels decrease the amount of blood, oxygen, and nutrients that get to the tissues of the body. This includes the skin. The lack of oxygen and nutrients increases the likelihood of skin breakdown. The only way to prevent the effects of nicotine is to stop smoking. There are stop-smoking classes available to help you.

  Stress is common in this day and time and it is common for many people to become tense, nervous, or worried by the demands of their daily activities. Muscle tension, increased blood pressure, irritability, and fatigue are common symptoms of stress. With constantly raised blood pressure and muscle tension, your body uses more energy, tires easily, and uses up the vitamins, minerals, and nutrients needed for healthy skin. You can:

1. Read articles that describes relaxation, time management, and stress reduction, and practice the principles.

2. Try to reduce your level of stress by taking time to relax daily.

  Sun can be very dangerous to a SCI person, so always try to:

• Use a #15 or #25 sunscreen.

• Develop a tan slowly.

• Check sun-heated plastic, vinyl, or metal surfaces before you put any part of your body on them.

  Underweight, which can be as bad as overweight, means being 10% under your ideal body weight. Some people who are underweight lack proteins, vitamins, and minerals. Low proteins or vitamins can prolong the time it takes to heal a sore if you do develop one. If you are underweight, you may have less muscle between your sitting bones and skin for protection. Take in extra calories. If you get full quickly, eat more often. Make sure you get plenty of protein food in your diet. You may also want to take a vitamin supplement.