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Trying to understand C 7 Quad

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    #16
    Thanks "capecodsci". It's ironic you'd mention the situation at Spaulding. Apparently, they don't use anal tubes(?) there. He soiled the bed and was left laying in it. They are sympathetic to his situation. He has no movement, control, and feels like his dignity is gone and they're surprised that he gets angry when left sitting in poop.
    "Cass"...you have a point. I asked about the C7 again today. They're assuming he is a C4 now. He was a C7 upon admission, the day of the accident. At that point, he could feel his arms. I'm still waiting to hear if he was given the meth(?), though I assume he wasn't. As far as the family knows, Spaulding hasn't tested him since he arrived on Friday.

    Comment


      #17
      Originally posted by SCI-Nurse View Post
      The fracture levels do not determine the level of injury. The cord damage does, and that may be quite different from the fracture level. The ASIA exam, which should have already been done in the ICU, but will need periodic repeating when admitted to rehab and every few weeks thereafter, is what is important.

      You need to ask about both his actual level of injury and ASIA category from the ASIA exam. Please be sure you have read the article by Dr. Young on level of injury that I posted above so you can understand this better and ask better questions of his physicians.

      (KLD)
      I read the info in Wise' link again and understand better. The example sounds similar to our situation. It seems that Lahey ICU tested him at C4. Apparently, Spaulding hasn't tested him, yet. They are trying to start weaning him form the vent. They've also removed his anal tube(?). Is that normal? Feces just comes out.....

      Comment


        #18
        WTH is an anal tube?

        I don't think tehre is such a thing!

        There is a mechanism, at the outer end of the rectum but still inside, called the anal sphincter. This is what keeps feces in. Our sphincters are paralyzed. Usually they are stuck closed; likely your exes is. This situation is called a neurogenic bowel. There are ways around it, procedures we learn to do, or have someone do it for us. These procedures are called "bowel program". or "bowel care".

        It takes months, even years, to get all this fine-tuned. I suppose this process could be called bowel training, although I consider that a misnomer. There is no training the bowel. We just train ourselves to survive in these bodies.

        Meanwhile, should we shit ourselves, we need cleaned up.

        If, in fact, your ex-husband is lying in feces because this establishment considers that bowel training, that is neglect. He is not an infant that willfully soiled himself. He is a grown man that can no longer feel the sensations that used to send him to the toilet. If he can feel them, he can't go to the toilet anyway. If he were to miraculously transport himself there, he would not currently know the steps required to evacuate.

        Generally speaking...Once a day, the staff should undress him and cover his bed w/ protective pads called Chux, then lay him on those on his left side. They will insert a suppository. After 15 minutes or so, they will insert a finger into his rectum and sweep the rectal wall in a counter-clockwise motion (this is called "digital stimulation"). 30 secs of that, wait 5 minutes, repeat dig stim, wait, until the rectum is emptied.

        Some people choose a surgical procedure called a colostomy. Basically, a hole is cut under the left ribcage. Feces exit that hole into a bag and the colon/rectum is no longer used.

        So please tell your out-laws (LOL, the outlaws is what I call my husband's former in-laws) that there is no such thing as an anal tube!

        They have so much to learn and it seems like everyone is magooing around. I wish they would come here...it is scary to know they are so clueless!

        Meth, in this case = methylprednisolone, a steroid shown to reduce damage from post-sci swelling if given within 8 hrs of injury.
        Blog:
        Does This Wheelchair Make My Ass Look Fat?

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          #19
          I'm assuming the "tube" is something that was stuck in his rear to catch the poop. I've given different family members the website info and urged them to visit. They're so busy trying to juggle everything that they haven't had a chance. I mentioned calling and his sister thinks it's a good idea for me to. I just don't have the details on his condition know little. If I had more specifics, I would call right now. I have stressed the importance of getting him into a Model SCI System facility. If they don't want him far away, there is on right in Boston.

          Comment


            #20
            I think you are talking about a fecal containment system like the Zassi. These are only appropriately used for totally uncontrolled incontinence such as you see in patients with c. diff. or other serious illness. Many times they are restricted to the ICU. It is unsafe to sit with one of these in place, so the need to use one would nearly always preclude someone with a SCI going to or staying in a rehabilitation setting.

            If there is a suspicion that he has a c. diff. infection (which is common in hospitals, and highly infectious), with frequent loose or liquid stools, he needs to be tested and treated for this. It can cause serious side effects if not properly treated.

            This would not be appropriate to replace getting him onto a controlled traditional bowel program, and keeping one in place (they can stay in place up to 28 days) would not only prevent him from reaching that goal but also from benefiting otherwise from an aggressive acute rehabilitation program, which is what he needs right now.

            (KLD)
            The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

            Comment


              #21
              Originally posted by mckeownp View Post

              Steve Williams' Model SCI Rehab. at Boston Medical Center is very involved in the latest issues..
              This is where I went, and I was very pleased with the care and rehab I rec;d. Dr Williams is a great doctor.

              Re the morphine ..... If he is in pain, he needs to get this controlled. He cannot fully participate in his rehab if he is in severe pain. Morphine might not be the right choice, but there are other options that can be considered.

              Best wishes for him.
              T7-8 since Feb 2005

              Comment


                #22
                Originally posted by capecodsci View Post
                I rehab at Spaulding 6 years ago-- my advise is have the family members stay very involved- push him as much as possible--Spaulding was a very depressing place when I was there- they were understaffed and the majority of the nurses aids did not speak english-- my family would see me everyday and this helped tremendously- the Physical Therapists were OK--Dr. O'Connor was new then and was just OK-- If you could transfer him to Shepard in Georgia he might make out better. Make sure he gets as much PT as possible - this is a critical time in his recovery. My own opinion is I wouldn't send my dog to Spaulding. I hope it has changed over the years.
                Again, call Steve Williams at Boston Medical Centers Spinal Rehab. I would transfer asap. Case manager at Spaulding will give them his DIRECT phone #. Steve will review Lahey records and tell the family if your X got Meth-steroid. I bet he did. Leahy is 1st class trauma hospital. God bless.

                stevewilliams@bmc.org
                Last edited by mckeownp; 3 Jun 2009, 2:34 PM. Reason: e-mail

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                  #23
                  Thank you- mckeownp. I had been suggesting they try to get him into Boston Medical Center. My sister-in-law said she's looking into it. I have also forwarded her Steve WIlliams' name and email address, as provided by you. I was tempted to email him myself but, not sure if it's appropriate for me to do it. I'm not in charge of his medical care.

                  Comment


                    #24
                    my goodness, a lot going on. anal tube? well, KLD, imo, is our resident expert on daily care. sounds to me like this is not a great rehab

                    btw, the "meth" i referenced is not the street drug, sorry. i can never remember the entire name but it has been around for yrs, thx to wise young and company, to help minimize the loss of function in first 48 hrs or so. anyway, like me, immaterial if he didn't get it.

                    i was so bummed in rehab...it is tough.
                    Last edited by cass; 4 Jun 2009, 1:18 AM.

                    Comment


                      #25
                      Update

                      This week he was able to have his first drink and food. They started him slowly, with a donut. He told me his goal is pizza but, he has work to do before being allowed that. He wants to get in the gym. I'm glad to hear the ambition but, they need to continue weaning him form the vent as first priority.So far he can still only move his head. Still praying for him...

                      Comment


                        #26
                        Is he still unhappy with his care? Are you still looking into getting him moved?

                        Did they do his ASIA again? Is he actually C4? If so, then weaning from the vent is a critical and difficult goal.

                        (KLD)
                        The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

                        Comment


                          #27
                          I'm still worried about the anal tube, and he has his mind on pizza? LOL, he's doing ok. I think that there is some gym work that can be done even on a vent. Can he speak?
                          Blog:
                          Does This Wheelchair Make My Ass Look Fat?

                          Comment


                            #28
                            Originally posted by SCI-Nurse View Post
                            Is he still unhappy with his care? Are you still looking into getting him moved?

                            Did they do his ASIA again? Is he actually C4? If so, then weaning from the vent is a critical and difficult goal.

                            (KLD)

                            I'm still waiting to hear if they've done the ASIA again. The family still hasn't gotten to meet Dr O'Connor and he arrived at Spaulding 11 days ago. That seems strange to me. I would insist.
                            His sister is getting worried about the vent. He is up to being off for 4mins 3x a day. Seems like progress to me. Is that good progress for one week of work? They set him up with a portable vent, yesterday, so he could eat in the cafeteria with everyone.

                            Comment


                              #29
                              If the family isn't willing to push, I'm not sure what you can do. It is very good they are getting him up and to the cafeteria. I wonder if they are leaving him there (at Spaulding) until he is weaned? Not all rehabs take vent patients that need weaned, it is a specialty thing. But I hope they plan to get him to a real rehab when that is completed.

                              Sorry, I don't know much about the weaning. Here is a google page that will lead you to a lot of info re the process:

                              http://www.google.com/search?hl=en&q...=Google+Search

                              It looks like a lot of the weaning process depends on the patient's strength. Post-sci, I literally didn't have the strength to digest food! Your body uses every reserve to survive and heal at that stage. I can't even tell you how exhausting every little thing was. So I wonder if he is just tiring after 4 minutes. The only cure for that is nutrition, rest and exercise. It is hard to rest as a new sci, they turn you every 2 hours, cath you every 4. I never got any sleep until I requested sleep meds and got ambien. Then I started getting strong in a hurry. Roomie used to laugh, said I'd snore away while they did all this stuff to me (my nose was broken, the snoring never did go away.)

                              I worked really hard all day in rehab, and even after I was in bed. I needed my sleep. You might ask his family to be sure he is getting the rest he needs to get stronger. And the longer he is up, for instance going to the cafeteria, the quicker his strength will build.

                              It's weird...I never once was sent to the cafeteria to eat. They fed us in our rooms.
                              Blog:
                              Does This Wheelchair Make My Ass Look Fat?

                              Comment


                                #30
                                I think moving him is dependent on the weaning. That is the only therapy he's getting right now. I guess he was not cooperating with the weaning today and saying his stomach hurt and he couldn't do it. His family pushed him to try and he did 10 minutes! (out of anger). I think their having trouble being optimistic, as each day is so difficult and progress is so slow.
                                He did have a fever again this evening. They were icing him down. He's also starting to have strong spasms. Gues he has some light pressure soars, too.
                                Sister is still looking to get him into Boston Medical. She's supposed to let me know how that's going tomorrow.

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