Medical surprises that develop later in life

Medical surprises that develop later in life

Posted by AskNurseLinda on Mar 5, 2018 11:03 am

cd5eff9c360fd8a29f0a785a3dd5b804-huge-spChanges in your health status will appear throughout your life. These changes can be because of the evolution of your condition or due to aging.  They may or may not be due to your personal habits. Sometimes the greatest of care can still lead to complications due to the aging process or as a result of normal body changes. In either case complications might be reduced in intensity with care and vigilance.

Spasticity or tone is one of the major changes that can occur after discharge from the rehabilitation center. In medical terms spasticity is often called hypertonia or just tone. After an injury, spinal shock occurs. This is a period of time when there are no reflexes present. The body below the level of injury is flaccid. Spinal shock typically lasts from a few weeks to several months with some individuals not having return of reflexes for up to two years. When the reflexes do return, they are rather chaotic with spasms developing. The spasms will be rather mild but can build up to quite severe over time.

If you have spinal cord injury or paralysis from other disease processes, spasms can develop as your disease progresses. You might begin with no spasms which could increase over time. The development of spasticity or tone may or may not occur depending on your disease process. Spasms can be overtly noticeable or just slight contractions that are barely perceived.

If the source of spasticity or tone is from trauma or disease, the treatments are the same. Some individuals will be able to manage their spasticity without much effort. Range of motion exercises will calm the contracting muscle or muscles.  Frequent repositioning is helpful. As the spasms increase, some individuals will respond to warm or cool cloths being placed on the contracting muscles. Since your body area with the spasm might not have sensation, do not use heating pads and ice packs as you will not feel a burn or frostbite. Some will find relaxation of the muscles in a warm shower or bath.

Typically, spasms will increase as spinal shock resolves or as a disease increases. You might see the muscle contract under the skin or feel the sharp movement of a spasm. Some individuals have spasms that become so severe that they are literally tossed out of their chair or bed. Spasms can occur in the arms, hands, feet and legs but also in the trunk, bladder and bowel. Anywhere there is a muscle, there can be a spasm.

Spasms or tone can range from little pain to severe pain. The pain might not be felt in the contracting muscle but referred to the shoulder, chin or other area where you do have sensation. In severe spams, you might see clonus which is a rhythmic contracting and relaxing of the muscle or muscle group.

It is important not to overlook the basic treatments of repositioning and range of motion. If you have clonus and it bothers you, applying mild pressure to the opposite muscle group will stop the spasm. However, you might also want to include some medication to reduce spasm. There are a variety of options that range from muscle relaxers, to nerve medication to botox injections for severe spasms.

Oral medications will affect your entire body with a common side effect of drowsiness.  Nerve pain medication will also affect the entire body, some with complications of difficulty swallowing and lethargy for nine days which will resolve. Tolerance to oral medications can develop which requires a periodic increase in dosage to maintain effectiveness. Botox is an injected medication that lasts on average from three to six months before additional injections are required.

Not everyone has painful spasms. There are some individuals who use spasms to their advantage.  Although this is seen more often in those with spasms or tone from disease, individuals with spinal cord injury from trauma can take advantage as well.  Some spasms are triggered by movement. This stiffening of the muscle can be triggered to help turn in bed, transfer and even for walking for some. Many individuals will report they think they may have a bladder infection based on increased spasms prior to any other symptoms of urinary tract infection such as fever or fatigue. An increase in spasms can even indicate the development of a pressure injury.

Aging comes to everyone. It is unavoidable. Individuals with spinal cord injury might notice a slight decrease in function or abilities just from growing older. As we age, muscles can become weaker, skin can become more delicate and internal organs might become more susceptible to infection.

It is not uncommon to lose body mass especially in the muscles with aging. This can make transfers, movement and activities of daily living more challenging. What we take for granted at one age becomes more difficult with additional years. Getting around on uneven surfaces or up and, even, down hills requires more energy. This is true with or without spinal cord injury.

Skin that has remained perfectly clear suddenly develops a pressure injury without any change in routine. No infections suddenly turns into bladder and respiratory infections. Bowel programs take longer to accomplish. Joints start to ache. This is a tale for every human.

As you age, periodically, you will want to reevaluate your actions. Perhaps, it is time to increase your activity in exercise or begin range of motion exercises which did not seem as important when you were younger. Review your fluid intake and diet. You might want to consider adding a bulk former to your bowel routine. Don’t forget drinking warm fluids about 20 minutes prior to conducting your bowel program. Assess you bladder empting technique. Sometimes, we all can get a little sloppy in our routines as we economize time. Cough and deep breathe to keep your lungs clear. Perform excellent mouth hygiene to ensure anything that is accidently choked or swallowed does not affect your lungs.

Autonomic Dysreflexia (AD) can change with age as well. Perhaps you had experienced this earlier in your life but thought you had resolved the issue. As your body ages, it can sneak back up into your life. It might not appear as a full blown attack but can appear with even slight symptoms, sometimes silently, without symptoms at all. An AD episode might not appear for the first time until you are older, especially with SCI from disease. With advances in technology, AD episodes, especially due to computer or cell phone use, can be stimulated in those that did not have them before.

Symptoms of AD include all or just some of the following: pounding headache, hypertension, slow or fast heartbeat, apprehension, changes in vision, nasal stuffiness, sweating, flushed skin, goosebumps or tingling. When thinking about AD, most people cite the bounding headache as the main symptom, which is true but some individuals will only get a stuffy nose. Don’t let some of the more unusual symptoms pass by. There are wallet cards available from the Reeve Foundation Paralysis Resource Center that will help you communicate with your healthcare professional.

AD episodes that are full blown, presenting with minor symptoms or even silently without symptoms will affect your blood pressure which is not good for your cardiovascular health. Occasional monitoring of your blood pressure at different times of day can help detect changes with AD as you age. Know your average blood pressure. Blood pressure changes slightly every time you assess it, so beware of your normal range.

Another complication of spinal cord injury that appears early on and might show up late is Orthostatic Hypotension (OA).  This is a sudden drop in blood pressure when attempting to obtain a sitting or standing posture. It is due to a lack of coordination between the natural increase in heart rate and contraction of blood vessels in the legs and abdomen when raising your head. Our bodies typically contract the vessels in the lower half of the body which directs blood flow to the brain for standing and sitting. Without this action, we pass out.

Typically, OA occurs in the days and weeks after a traumatic injury. However, with spinal cord disease or with aging with SCI, the ability to regulate the blood vessels might become more difficult.  Increasing fluids slowly over time can help. Using some fresh elastic hose will provide some tension to the legs to assist with blood return to the body. It might even be time to obtain a new abdominal binder. Remember, elastic products lose their ability to contract after a while so using old products might not be effective.

One final thought about spinal cord injury is to think about your own mental health. People often overlook their own wellbeing. As you have changes in your condition or with aging, people sometimes isolate themselves. It comes over time, not just one day so isolation can slip up on you. It can become more difficult to get out. It easily becomes more convenient to sit at home and watch TV than to fight the elements and even the expense of being with others. Think of ways that you can become involved with others or how you would like to improve your quality of life. You may find you are content with the way things are or you might want to add some variety.

Nurse LindaI'm online in this community every Wednesday from 8-9 PM ET to answer your SCI and paralysis related questions.

Leave a comment any time by clicking the reply button. Let's get the discussion going!

Nurse Linda

Register for my next webchat!
Sign up here!

Subscribe to Topic

Would you like to be notified of updates to this Discussion Topic? Subscribe and you'll receive email updates of new posts.