Why are respiratory infections so common in spinal cord injury (SCI) patients? We’ve mentioned the prevalence before, but want to share some data we recently found.

According to the University of Washington’s School of Medicine, respiratory infections such as pneumonia, are the leading cause of death in SCI patients. Compare this to heart disease, cancer and stroke which are the main causes of death in the general population.

SCI affect the respiratory system the muscles that are needed to pull air in and push it out of the lungs are often affected by a spine injury. Without the intercostal muscles working properly, the patient is unable to effectively cough up mucus which leads to an excess in the lungs that makes it harder to breath.

There are ways to make sure the lungs are kept clear such as with the use of suction or “quad coughing”, a process that involves a caregiver pushing down on the chest to force the air and mucus out. In addition, receiving a pneumonia vaccine called Penumovax prevents some forms. As SCI patients have such a high risk for these types of infections, it’s best to be prepared with as much prevention knowledge as is available!

Animal-assisted therapy (AAT) has been around for some time now, but we are only recently (in the last 10 years or so) seeing it branch out to document illnesses such as anxiety that are common after a traumatic brain injury (TBI) or spinal cord injury (SCI). This therapy involves the use of a trained animal to assist and comfort the patient. The most common animals used are dogs, but there have been cases of monkeys, cats, horses, fish, birds, dolphins and even cows.

Animal therapy trials have been done on patients with anxiety, paralysis, dementia, depression, hospice needs, in correction facilities and more. For those with a SCI that limits their mobility, animal interaction has been found to alleviate feelings of loneliness and isolation, both of which are often noted results if a SCI. According to a 2000 study in the Journal of Psychosomatic Research neurochemicals associated with a decrease in blood pressure increased after positive interactions between humans and dogs, another benefit in a situation that can cause a great deal of stress for the recovering patient. In addition, organizations such as the Delta Society have done their own research on the benefits of human/animal interaction as well as compiled a list of articles that substantiate this idea.

Another pet-positive article describes the link between coping with change and transition and having a pet. Learning to live with a disability such as caused by a TBI or SCI is a traumatic and often overwhelming process. The authors found that within six months of receiving a service dog participants demonstrated an increase in self-esteem, psychological well-being, community integration and also a 70 percent decrease in home aide needs. That’s a pretty significant finding.

Offering a counter-view, the Handbook on Animal-Assisted Therapy quotes a handful of studies (pg. 41) that speculate on other reasons for the benefits, such as increased exercise or socializing through walking a dog. Aubrey H. Fine, the author, goes on to point out how few of the studies performed can be concretely validated. To create a proper study, those receiving AAT would need to be taken off of any medication while a placebo group would have to be created. How can you manufacture a placebo for a pet’s affection? Fine makes a good point, but as many will attest to with or without studies offering proof, animals have added value to numerous lives. If you have pet therapy experiences to share, we would enjoy hearing about them!

Erectile problems after a spinal cord injury (SCI) has been an issue for countless patients. To better understand this problem, there have been numerous studies addressing the problem from a variety of angles such as specific dysfunctions and the neurophysiology of erections.

If erectile dysfunction is a problem that you or someone you know is experiencing, then we hope the following clinical research will be of help.

The Wikipedia defines a penile erection as an “increased penile blood flow resulting from the relaxation of penile arteries and the smooth muscle of the corpus cavernosum. This response is mediated by the release of nitric oxide (NO) from nerve terminals and endothelial cells, which stimulates the synthesis of cGMP in smooth muscle cells. Cyclic GMP relaxes smooth muscle and increases blood flow to the corpus cavernosum.” The simplified version is that blood flows to the penis causing a rigid state also known as an “erection”.

The Journal of the American Paraplegia Society states that “the majority of spinal cord injured (SCI) men with upper motor neuron lesions have reflex erections. However, these erections are often not adequately sustained making it difficult if not impossible to have intercourse.” They go on to say that the majority of those with lower neuron lesions are unable to have erections at all.

There are a few different approaches to this problem. Penile implants are one possibility, and for some, work very well. The drawback to the implant is that it increases the risk for infection and there is the chance that it will erode through the skin. You can choose between two types - inflatable and semirigid and the procedure is done in just a couple of hours under either general or spinal anesthetic. Inflatable implants operated with a pump have the benefit of allowing the penis to fully relax while the semirigid, as its name implies, keeps the penis continuously in a partially “aroused” state and is the lesser used version. Implants are a good option if medication fails to work, as is often the case with those who have a SCI.

Vacuum devices create an erection by drawing blood into the penis. This cylindrical device is placed over the penis to pull blood into the tissue and a ring is put around the base to hold the blood in place. Also called a penis pump, this tool has been used successfully for many.

Intracavernous injections of papaverine and phentolamine are other options that can lead to prolonged erections. Papaverine is an opiate and has some side effects such as constipation, somnolence and vertigo. Phentolamine causes blood vessels to expand which increases blood flow to the needed area and has few side effects. Both of these drugs are administered through injection and the patient can be taught how to do it himself assuming he is physically able.

Medications such as sildenafil (Viagra), vardenafil (Levitra) and Tadalafil (Cialis) are orally administered drugs that have shown positive results in a variety of studies. The recommended dosage is once a day, though Cialis is known for having a longer lasting effect - up to 36 hours. All of these pills have the potential for some uncomfortable side effects. Back pain, muscle aches, headache, indigestion and a runny nose are the primary ones, though some patients have reported experiencing hearing loss.

If your main concern is being able to father a child, Mitch Tepper at Sexualhealth.com lists two methods for obtaining sperm if manual ejaculation fails - electroejaculation stimulation (EES) and penile vibratory stimulation (PVS). EES requires anesthesia as an electric probe is inserted into the rectum. This procedure stimulates the nerves that control ejaculation. PVS is a less invasive process where you apply a vibrator to the penis and it has the added benefits of being a home procedure and pleasurable. It is common to first try PVS and if that fails to produce results, then try EES.

This topic is seldom an easy one to discuss and many are hesitant to do so. Keep in mind that this problem is not only widespread among those with SCIs, but among the general male population. You are not alone and with so many options to try, there is a good chance of finding one that works well for you!

A.J. Gross, D.H. Sauerwein, J. Kutzenberger, R.-H. Ringert. Penile prostheses in paraplegic men. British Journal of Urology

Male Urology and Sexuality After Spinal Cord Injury (SCI) Through a Narrative Book. Lombardi G.M.D., Macchiarella A. M.D, Celso M. M.D, Del Popolo G. M.D. Department of Neuro-urology Spinal Unit of Florence, Italy

Q: What factors need to be considered with an acute spinal cord injury (SCI)?

A: For acute spinal cord trauma, stabilization is the first priority. After an injury, according to Jack de la Torre MD PhD, there are biochemical, metabolic and physiological issues that arise such as reduced blood flow to the spinal column, the formation of free radicals, sodium channel activation, inflammation and energy substrate depletion.

To address these issues de la Torre suggests the use of fructose 1,6-diphosphate combined with dimethyl sulfoxide (DMSO) as when combined, the two stabilize the SCI and provide a high-energy substrate to the damaged tissue. Dr. de la Torre is a professor of neurosurgery and physiology at the University of New Mexico Medical School in Albuquerque who has been one of the main advocates for the use of DMSO, a controversial drug that has many healing properties.

Anders Holtz with the Department of Neurosurgery, University Hospital in Uppsala, Sweden emphasizes the need to consider secondary injuries that can result from surgery. He believes that the aim of surgery is to minimize neurological deterioration, stabilize and align the spinal cord, reduce pain and prevent secondary complications.

Immediately after a trauma to the spine, Holtz stresses the importance of monitoring the respiration system in order to time drug treatment so that the chosen medication is given at the most optimal time. In addition to the respiratory system playing an important role in medication administration, it also accounts for a high percentage of illnesses in SCI patients.

According to the Journal of Neuroscience Nursing in an article by Kathleen T. Lucke, “lung diseases and breathing complications cause significant illness in patients following spinal cord injuries. The mortality rate from pulmonary complications, such as pneumonia, lung collapse, respiratory failure, and infections, can be 40-80% in the first year after injury.”

As you can see, there are a variety of important factors that need to be addressed and closely monitored immediately and soon after a SCI. Awareness of the areas of special concern will help you to better understand what your doctor is focused on and why - not to mention that this knowledge will help you to determine if your doctor is competently approaching the treatment of the injury.

The majority of people who sustain SCIs will not have the medical knowledge to determine the best course of treatment, but even some awareness of the problems that can arise can add to you overall security that you are getting the best treatment available.

For further reading:
Essentials of Physical Medicine and Rehabilitation, Review and Self-assessment, Julie K. Silver & Walter R. Frontera, pp. 346, 2003. Price £28.99. ISBN: 1-56053-563-6. Hanley & Belfus, Philadelphia

Pulmonary management following acute SCI. (spinal cord injury) Journal of Neuroscience Nursing; Apr 1, 1998; Lucke, Kathleen T.

Anyone who experiences a traumatic brain or spinal cord injury is aware of how significantly his or her life can change within a matter of seconds. The two populations most at risk to sustain brain or spinal cord injuries are drivers and athletes. By being aware of certain information, both these groups can minimize their risk for brain and spinal cord injuries.

How Drivers Can Minimize Risk

There are several ways that drivers can minimize their risk of brain and spinal cord injury:
• Don’t multitask—turn off cell phones and put away anything that may distract you from the task at hand.
• Wear your safety belt.
• Drive defensively.
• Don’t drive under the influence of drugs or alcohol.
• Do not drive when you are fatigued.

How Athletes Can Minimize Risk

There are several ways that athletes can minimize their risk of brain and spinal cord injury:
• Always protective gear that is appropriate to your sport, such as a helmet or padding.
• Be safety conscious, and don’t attempt high-risk stunts or tricks.
• Prepare yourself by knowing what to do should a brain or spinal cord injury occur.

Seek Medical Attention

All the care in the world can’t prevent every brain and spinal cord injury. If you suspect that you or someone you know has sustained a brain or spinal cord injury, seek medical attention immediately. Remember, brain and spinal cord injuries can be caused without any direct impact to the area of injury, and sometimes do not show symptoms for several days or weeks.

Living with pain after a spinal cord injury (SCI) is something that many are familiar with, if not resigned to. There are a variety of ways in which to reduce or eliminate the pain, but what works for one person’s situation often fails to produce results for someone else.

An option we recently read about is the use of spinal cord stimulation (SCS) treatment - a therapy that is said to relieve neuropathic pain after a failed back surgery. (The original article can be found here.)

Patients in a prospective randomized controlled multi-center study (PROCESS) trial were rated on their level of pain before and after the use of SCS while a control group was given more traditional therapies such as nerve blocks and physical rehabilitation. Out of a 100 participants, 48 percent achieved at least a 50 percent reduction in pain. The control group experienced little or no relief.

SCS is not a cheap therapy, so you will definitely want to research your options and thoroughly consider the costs vs. the potential benefits. If you are interested, this Website has some good information on how SCS works.

Reference:
Manca A, Kumar K, Taylor RS, Jacques L, Eldabe S, Meglio M, et al. Quality of life, resource consumption and costs of spinal cord stimulation versus conventional medical management in neuropathic pain patients with failed back surgery syndrome (PROCESS trial). European Journal of Pain 2008.

One of the most common complications post SCI:

Kidney failure, according to SpinalInjury.net, used to be the leading cause of death for individuals with a spinal cord injury (SCI). Today with the improved bladder management methods, there are fewer and less severe kidney complications to be dealt with. More common these days are difficulties arising from urinary tract related issues.

The loss of normal bladder function after a SCI places a patient at an increased risk for contracting a urinary tract infection (UTI), regardless of the type of bladder management used. A UTI can occur in the bladder, the kidney, or other parts of the urinary tract. Urinary tract infection remains the most common secondary medical complication following a SCI and it is also one of the costliest.

Sci-Info-Pages, lists the common UTI symptoms as:
# Fever
# Chills
# Leakage
# Increased spasms of legs, abdomen, or bladder
# Feeling the need to catheterize more often (frequency) ( Intermittent)
# Feeling the need to catheterize immediately (urgency) ( Intermittent)
# Burning of the urethra, penis, or pubic area
# Nausea
# Headache
# Mild low back pain or other aches
# Feeling “lousy” or tired

If you experience any of these, please be sure to talk with your doctor to avoid further complications.

This week’s fact (or rather, facts) comes from the Care Cure Community’s Dr. Wise Young in response to the spinal cord injury question, “What can I do now to be ready for the cure?”

“The first and foremost concern of people with spinal cord injury should be to take care of their body and try to prevent muscle and bone atrophy and other changes that may prevent recovery of function. This is difficult but people need to engage in disciplined exercise that maintains their muscle and bone, take care of their skin, bladder, and bowels.

People should avoid procedures that cause irreversible loss of peripheral nerve and other functions. On the other hand, it is important to weigh the benefits of procedures such as tendon transfers which can provide greater functionality and independence for people with weak hands. Likewise, certain procedures such as Mitrofanoff and bladder augmentation to reduce bladder spasticity may provide greater independence but may not be easily reversible.

Finally, many studies have shown that people with the highest levels of education after injury are more likely to have better quality of life and health. It is important that people do not neglect their brain, the most important part of their body.”

Dr. Wise Young is the founding director of the W.M. Keck Center for Collaborative Neuroscience and a professor at Rutgers, The State University of New Jersey. He is recognized as one of the world’s top neuroscientists.

Q: What are the most common results of a spinal cord injury?

A: Depending on the particular injury sustained, there are a wide variety of primary and secondary complications that can result from a spinal cord injury.

Damage to the nerve fibers that carry motor signals to the brain through severing or compression can lead to muscle paralysis and loss of sensations such as those experienced through touch or pressure. Other potential effects are loss of bladder control, muscle contractions, decreased breathing capacity, exaggerated reflexes, over or under sensitivity to temperature changes, lasting pain, impaired sexual functioning and issues with bowel control.

Some of the most common secondary effects are increased blood pressure, sweating, pressure sores and an increased susceptibility to respiratory ailments.

Typically any of these functions that are lost will be regained within six months, if they are to return at all. After that point your chances of recuperation decreases greatly. This is why it is so important to make sure you receive proper care immediately after sustaining a spinal cord injury.

The time following a brain or spinal cord injury can be confusing, overwhelming, and extremely difficult to navigate. Quite commonly, a patient and his or her family are uncertain when it comes to what to expect or how to move forward. However, taking three simple steps will ensure that the patient and his or her friend and family deal with the situation as effectively as possible.

Step 1: Educate Yourself

Whether you are the patient or the friends and family of the patient, it’s extremely important to learn as much as possible about the injury, as well as potential treatment options and long-term outcomes. The medical team that is overseeing the patient’s care is an ideal resource, and should be able to give you the answers you need. They will also be able to steer you toward additional resources and support groups that will have all the information you need pertaining to the injury.

Step 2: Focus on the Present

While it’s tempting to think about the future, focusing on the present is very important during the initial time following the injury. It’s not uncommon for a patient to take one step back for every step her or she takes forward. It’s important, during this time, to understand that recovery will take place at its own pace. Patience and support are two things the survivor will need much of at this time. While the survivor should try to be as independent as possible, he or she should not be afraid to ask for help when it’s needed.

Step 3: Prepare for the Future

Life following a brain or spinal cord injury will be significantly different than life before the injury. Focusing on the future and what it holds is a very important part of the healing process. This stage should include goal setting, determining long-term care needs, researching treatment and clinical trials, and finding support groups.