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New C4 70 year old male

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    New C4 70 year old male

    Hi Everyone!

    My sister (we are twins) and I have been reading during the little time we had in the past week. I am American and my sister is German (long story) and we both live in Germany.

    Our sweet and truly loving dad suffered a spinal infarct (as we've been told ) in the C4 region last Wednesday - July 1st. He simply started to sweat during Breakfast and then had a really sharp pain in his chest. My mom called the Ambulance and he was able to walk right up to it.

    In the hospital they though it was a heart attack at first, as he already had one and a quadruple bypass 8 years ago. He was only able to lift his arms at that point. They did a bunch of scans and tests to find out it wasn't the heart. They had suspected his spinal cord within a few hours and he was flown by copter to Hannover - a nearby bigger town where they have a specialty neurological ICU unit in a University Hospital.

    There they ran more tests (not sure which ones, I will try to find out more info). At that point he was still able to lift both of his arms - however no ability to move his hands. He couldn't move his legs. A day later he lost movement in his left arm as well. He has been fully awake all the time. We were able to talk to him and he was able to answer. On Saturday he started having breathing problems and then the spinal shock (we've been told this) got to his lungs. He is on a vent now and they will put in a trach today. He is also now completely unable to move anything below his neck. He can still understand everything we tell him but obviously he can't answer anymore. He has also gotten pneumonia, which we’ve been told is extremely critical at this point. He feels touch to all of his limbs, which I understand means nothing more than where the infarct was in the spinal cord area – I was told it was the upper part, not middle or back. Forgive me if I don’t have the correct medical terms for this and please correct me if I am wrong.

    Right now he's getting Cortisone for the swelling, and he's also getting anti-biotics for the lung infection. Additionally he has is also getting insulin (he was never a diabetic but this started day one in the hospital due to his glucose level being very high then and ever since).

    The doctors are being very helpful here and he has seen a number of neurologists. They answer all of our questions with the most care, which we are very happy about.

    To add to all of our problems, we also have a mom who’s been very ill for most of our life, she has suffers from disabling mental illness and we have to take care of her now as well in order to prevent a manic episode as this is extremely hard on her mental state as well. We try to do our best but can truly use some assistance in terms of what else we can do for my dad, what else we can ask and so on.

    Once our dad passes this critical phase we do know that they will start intensive rehab here in Germany, their rehab facilities are really excellent. Right now he's already getting rehab as much as he can in order to preserve his muscles and flexibility.

    Thank you so much for reading this and thanks in advance for your words of wisdom and support! My sister may also jump in (Angie) at some point as we are dividing time between ourselves to take care of my dad, my mom and do research. We will share this account if nobody minds.

    Chris & Angie

    i'm sure one of the sci nurses will post here. sorry i have no advice.


      Welcome to CC and sorry to hear about your situation.


        Welcome to CareCure.

        It certainly sounds like your father is getting the best possible care. I would just like to clarify one thing. He is having problems breathing not because of spinal shock (which causes other problems) but because he has nearly complete paralysis of his breathing muscles. At C4, this would include paralysis of his intercostal muscles (that move his rib cage), his abdominal muscles (which are critical for coughing and clearing secretions) and a weaker diaphragm. The diaphragm is innervated by C3, 4 and 5, with the C4 branch being critical to being able to breathe on your own. The pneumonia is due to his inability to cough, as well as his inability to take deep breaths, and this just makes it harder to breathe.

        Many people at C4 are able to wean off the ventilator slowly as they learn how to breathe with just their diaphragm (which is usually too weak to do this initially). Respiratory muscle fatigue often results in going onto the ventilator within 2-3 days of the injury. At his age, it is a bit more doubtful that he may be able to wean successfully. Regardless, as he recovers from the pneumonia, you should ask for assistance in finding a way for him to communicate with you. A speech pathologist may need to be consulted. It would be too early now to use a Passey-Muir valve, but this may eventually be possible. Until then, the usual is to teach him 1 eye blink for yes and 2 for no, so at least he can let you know his needs. A communication/spelliing board can be used for more complex communication but it does take time and practice to use.

        I am glad they are talking about intensive rehab for him. Too often in the USA elderly people are not offered this opportunity and I see many who are just sent to nursing homes without this chance to show they can benefit from this.

        I am afraid you may be in for a long haul in this. Down the road you need to start asking about in home attendant services that he may be eligible for in Germany. This would allow him to go home in spite of your mother's inability to really assist with his care.

        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.


          Thanks all for the nice welcome, and special thanks to KLD for the clarification. I've been away form Germany for so long that I am having a hard time understanding the docs "Medical German", that's for sure. Obviously this isn't good news at all what I am reading regarding the breathing.

          He had the tract put in FINALLY today, I am glad he can close his mouth again. I am hoping he will be able to talk somewhat later down the road with the PM valve. He does listed and so far we've been able to ask him questions. If he agrees etc (yes) he nods his head. If he doesn't then he also doesn't do anything. That's the one "good" thing right now. We are all so sad about this, we don't know what to tell him, other than that we love him with all of our hearts and that we are trying our best to help in any way possible.

          Today he seemed so, so sad though, it's really tearing me apart.

          Thanks for listening!


            Hi Chris and Angie,
            Welcome to CC and I am so sorry about your dad. I am glad that once he is stabilized Germany will provide him with rehab services. What you are going through IS very sad and difficult, but try to remember that no one knows what his ultimate progress might be at this point. Hopefully he will regain some motion and better respiratory function as time goes on. Meanwhile keep writing here, asking questions, and finding as much info as you can digest. Good luck to you all.


              Here is a sample communication board. You can make this up on your computer, and if it is printed on stiff paper or laminated, it makes it even easier to use. Point to rows to find the right one, then work across.

              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.


                I had a spinal cord stroke at C5 almost a year ago, a day after I had a cervical laminectomy. They put me on steroids to reduce the swelling. They then eliminated all sugar from my diet and began to test my blood sugar levels several times a day. I was told that sugar levels could potentially increase due to the steroids. Although my blood sugar numbers did go up, they never increased enough to require insulin.

                Perhaps this is why your dad is suddenly a diabetic. You might want to ask.

                I wish you and your family the best.