This week’s resource of note is Palliative care.

Palliative care is designed to compliment the treatment you are receiving for illness and injuries such as traumatic brain injuries (TBI) or spinal cord injuries (SCI). The goal is to relieve the patient of pain, stress, fatigue, loss of appetite, constipation, nausea and difficulty sleeping with will result in a better overall quality of life for the person in treatment.

Those who provide Palliative care typically are part of a team that can be comprised of nutritionists, doctors and social workers. Together they work to generate a plan that will alleviate the symptoms mentioned above while giving support to both the patient and his or her family.

These services are provided by numerous hospitals and care centers across the United States. For a directory, please click here.

For an excellent description of this form of care, visit Get Palliative Care’s Website.

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

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.

Rich Newsome with the Newsome Law Firm, along with Tom Harmon, Pete Newsome and Clancey Bounds will be participating in the Nov. 2nd 2008 Florida Ironman on behalf of the Christopher and Dana Reeve Foundation as “Team Reeve Ironman.” Team Reeve Ironman is raising money for the Reeve Foundation.

The Florida Ironman race will take place in Panama City, Fla. and is one of only seven official Ironman races held annually in the United States. Ironman Florida is also a qualifying event for the Ironman world championship in Kona, Hawaii. The Florida Ironman race includes a 2.4 mile swim, 110 mile bike race and a 26 mile run.

The athletes who are part of Team Reeve Florida hope to raise not just money, but also awareness about the Reeve Foundation and the vital work they are doing for the SCI community. The Reeve Foundation is focused on finding a cure for paralysis as well as giving spinal cord injury (SCI) survivors much needed direct aid.

Please help support this worthy cause.

For more information on how to support the Team Reeve Ironman, please visit their Web page.

According to a Washington Post article, scientists have figured out how to turn one type of adult stem cell into another. What makes this development even more interesting is that it wasn’t done in a petri dish - this change was created inside of a living animal.

This breakthrough will potentially lead to cures for currently un-fixable illnesses and injuries such as spinal cord injuries (SCI) while bypassing the ethical objections that are now hindering stem cell research.

Research on mice by Harvard Stem Cell Institute (HSCI) co-director Douglas A. Melton, and colleagues, found three molecular switches that were able to turn a common cell in the pancreas into one that can produce insulin. This has the potential to benefit people suffering from diabetes, heart disease and other illnesses.

Imagine being able to cure your illness or heal your body through the flip of a cell switch - a process that would save both time and money that is currently spent on drugs and other ongoing therapies.

“I see no moral problem in this basic technique,” said Richard Doerflinger of the U.S. Conference of Catholic Bishops, a leading opponent of embryonic stems cell research. “This is a ‘win-win’ situation for medicine and ethics.”

While researchers warn that “many years of research lay ahead” before they will be able to prove that this innovation will be of use for curing disease and injuries, it is another big step made by science towards creating health and longevity.

As of today this study hasn’t been posted on the HSCI Website, but for those interested, here is the HSCI list of research projects.

Click here for the original article.

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.

Indevus Pharmaceuticals has received a United States patent for it’s overactive bladder treatment, the drug Sanctura XR. Good until January 2025, this once-a-day treatment is, according to Indevus’s Website, the only approved quaternary amine compound for the treatment of overactive bladder.

This compound can relax the smooth muscle tissue in the bladder, decreasing the contractions that lead to over activity. As many spinal cord injury (SCI) patients know first hand, they are particularly prone to developing an overactive bladder due to the nerve pathways between the bladder and brain becoming interrupted.

With the use of dugs such as Sanctura XR, patients are hopefully able to avoid painful surgeries and extended recovery periods. Of course, as with all drugs, the degree of benefit depends on its interaction with each individual patient. We aren’t advocating for this particular drug, only sharing your latest options!

If you’d like more information, click here.

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.

A MedPage Today article references a study performed by Paul Little, M.D. at the University of Southampton that was reported in BMJ Online First that may be able to benefit those with chronic back pain, such as is often felt after a spinal cord injury (SCI).

The focus was on the Alexander technique, a one-on-one instruction method created to help individuals develop lifelong skills that will improve chronic back pain by looking at things that contribute to the pain, such as poor posture, and rectifying it.

With as little as six lessons in the Alexander technique of musculoskeletal use combined with exercise, patients were found to have significantly reduced chronic back pain long-term.

The measure of benefit used is the Roland disability score which measures how many activities a patient can do. The Alexander technique was found to improve the patients scores by three points, meaning an addition of three activities that were no longer limited by back pain

To learn more and see for yourself if this technique can help you, check out this Website.

Four men are “wheeling” across Canada with the use of hand cycles in order to bring awareness and generate donations to research for conditions such as concussive head injury and Alzheimer’s. They believe that a donation of 30 cents by each Canadian citizen for “breakthrough” research will allow them to walk again.

This research comes from a Canadian research team at McMaster University in Hamilton. Dr. Michel Rathbone and Dr. Shucui Jiang successfully regenerated nerves in the chronically damaged spinal cords of rats with the use of adult enteric glia cells. These cells are abundant in human and animal intestines and have been found to support the nervous system.

The enteric glia cells were grown in cell cultures and then transplanted into the rat’s spinal cords where they stimulated nerves to grow, reducing the damage in the spinal cord. These cells are not only stable, they have bypassed the problem of tissue rejection by the host. In addition, this team of scientists found that a naturally occurring molecule in the body, guanosine, stimulates stem cells already present in the spinal cord to grow and develop into cells that insulate the nerve processes.

Even more interesting, this medical approach and application can be used on other diseases as well, including those of the brain.

To progress beyond animal testing, the researchers need support. You don’t have to be Canadian to pitch it - visit Wheel to Walk for more information!