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Wiggling Toes, C3-C4 Injury for Senior

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  • Wiggling Toes, C3-C4 Injury for Senior

    On Sept 30th, my Dad fell and damaged (compressed) his spinal cord at C3-C4.

    Just after his fall and prior to the surgery, he could wiggle his toes but no other feelings or movement below the nipple line. After the surgery (wherein he lost a lot of blood), he could nod, shake his head, shrug his shoulders and wiggle his toes, but was vent dependent. After about 12 days, my Dad became non-responsive (kept his eyes shut and was grimacing) and didn't seem to be able to wiggle his toes when asked, and even stopped shrugging his shoulders and moving his head.

    The doctors are saying that the toe-wiggling is merely "reflective" and that he is "complete" -- the focus was that he is quite elderly and one doctor (6 days after the surgery) even suggested ''pulling the plug" in consideration his age!

    However, in the past 2-3 days, I've been giving him foot massages and trying to move his limbs (he's swollen) -- and he shrugged for me and wiggled the toes on his left foot. He is still vent dependent but has shown some weak puffs of breaths. Any experiences out there regarding recovery?
    Last edited by SCI-Nurse; 10-20-2011, 02:29 AM.

  • #2
    Where is your father? How old is he? Have you obtained a second opinion about the extent of his injury (neurology)?

    Loss of consciousness is not associated with spinal cord injury, but could be due to brain injury that also occurred as the result of his injury/fall, or due to complications occurring during surgery.

    Is he sedated? Are you able to get him to repeat movements by verbal command (without touching him)?

    It is likely from what you say that he has some significant injury to the brain and/or spinal cord. Prognosis in an elderly person is much more difficult than in a young person. You should get him seen by an expert neurologist, and may need to move him to a different hospital if you are not getting cooperation in a more extensive evaluation of the severity of his disabilities and prognosis.

    (KLD)
    Last edited by SCI-Nurse; 10-25-2011, 01:22 AM.
    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


    • #3
      Wiggling Toes + Swelling Spinal Cord

      Yes – I’ve been able to get him to repeat the movements by verbal command (without touching him).


      My Dad is in California in the ICU. I had called in and they told me that he is getting physical therapy and is constantly being moved – but when I arrived it seemed that for weeks 1 and 2, since he wasn’t moving (except to change his position in bed and perhaps one minute of range of motion was the extent of the physical therapy), his body became completely bloated and the toe movements stopped.

      During week 3, I arrived and started to massage his feet (45-60 min per day) and to move his body a bit more (not much but perhaps, 50-100 circular motions per arm and leg). He could then move the left foot (only bending back the toes) or the right foot when I asked him to.

      Week 4 has begun -- the spasms have started. Now that I know that the toe movements are indicative of ‘incomplete’ status, I believe it’ll be difficult for me to show the doctors that he can move on command. I tell them but they don’t believe me - and have labelled him "complete."

      My Father has indicated to me that he can feel me massaging his feet – though he cannot feel my touching his arms.

      Since I have personally heard a doctor, while standing by my Father's bed, say that my Father will be in this condition for the rest of his life – I am fairly certain that for two weeks, my Father has heard many comments that his condition is permanent. The conclusion via a psychiatrist is that my Father has lost hope – hence the closed eyes and is refusing further care. Also, he is in pain from the vent tubes and perhaps his neck. There is no brain injury - thanks, they checked.

      I have read that 4-6 weeks is needed for the swelling to go down. A woman has told me that it took 3 months for her swelling to go down and to be able to move one elbow.

      My Dad is in his 70's - have you heard any stories of elderly persons who have regained movement after a wait period?

      Comment


      • #4
        Where is he in CA?? Is he being seen by experts in SCI?

        In elderly people, incomplete injuries are commonly central cord injuries, where there is more impairment of the arms than legs. Can you be at his bedside when the physicians make rounds so that you can help your father demonstrate his movement? Edema does take several weeks or months to subside in the cord. Is he on medication (steroids) to help with that? Spinal shock is even more important...until that has subsided, it is difficult to determine if the injury is complete or incomplete.

        Are they attempting to wean him from the ventilator?

        Are they talking about moving him to an acute specialty SCI rehabilitation center?

        Is your father by any chance a USA military veteran?

        (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


        • #5
          Doctors encourage seniors to terminate

          He is in San Francisco. I don’t know if his doctors are experts.

          The spasms have started, so it’s difficult to show the doctors anything.

          The doctors are encouraging him to choose not to live – I’m devastated! I’ve stated that I've read literature seems to indicate 4-6 weeks and sometimes more – I spoke to a woman who told me that it took three (3) months for the swelling to subside - but they're saying that he's complete and the best case scenario is to be like C Reeve and so, it's best that he choose not to live. He is not being given any medication to help with the swelling – he has only been given pain killers and blood thinners.

          One of the doctors initially spoke about moving him to an acute rehab center, but he also recommended that he choose not to live due to his age. Worse, the doctors are standing by his bedside and saying that he’ll be this way for the remainder of his life – and, now, my Father seems to want to die!

          No, he’s not a vet.

          Please give me your kind advice.

          Comment


          • #6
            What hospital? How old is he? Can you get him moved to Santa Clara Valley Medical Center's SCI unit? Personally, I would fire that doctor and get one with a less negative and ageist attitudes.

            (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


            • #7
              Your story has some eerie similarities to the one posted by momsurvive. Check out that thread for some other suggestions. I'm really sorry that you and your dad are having to go through this experience. Situations like these need to be handled with the utmost sensitivity and compassion and it seems as if you've received neither.

              Please keep us informed on your dad's condition.

              I'm sending all the compassion I can with this reply.

              Comment


              • #8
                My heart breaks for you as our family is currently in the same position as yours, except my mom's injury is on C1/C2 and brain injury. Doctors are very insensitive sometimes especially when they are older and say things are are way out of line. We don't discuss the topic of life support any more with anyone. If they start mentioning it, we tell them we aren't going to talk about this topic anymore and our decision is final.

                We also don't discuss her condition when we are next to her in case she can hear us.

                My mom has been conscious sometimes and answers with blinking her eyes, but never when the doctors come to see her. They come once a day for like 5 minutes, sometimes 2 if we are lucky. They seem to have given up on her, but our faith is strong.

                I will pray for your father.

                Gabriela

                Comment


                • #9
                  Apply to Rehab

                  Santa Clara rejected my Dad’s application. A hospital rep mentioned that he can reapply if any improvements are shown. The feedback is also that for persons over the age 70, they generally die in a year.


                  How can a person re-apply to a rehab center? Any advice on an appeal? Is it a written application or is it generally based on the patient’s condition?

                  When I massage his feet, I “knead” it – does it mean anything that he can feel sensation on his feet with a strong touch (a nurse mentioned that when she grabs his toes, he can feel it)? He was briefly given medication for the spasms, but no longer -- if I ask that he be given the medication for the spasms, will this be helpful? Or, does the medication have any side effect?


                  It seems that even when a Doctor comes to check his feelings in his neck and shoulder area… she doesn’t even check his feet – because my Dad has already been reclassified. She uses her finger and a sharp stick to check for feeling.

                  The insurance company has recommended a LT acute care facility in Marin – in reading what SCI-Nurse wrote, does this mean that he won’t get a lot of therapy?

                  His doctors had reclassified him as C1-C2 and complete – one doctor said that his situation is worse than Christopher Reeve - and that the most he can hope for is to be similar to Christopher Reeve. This doc's opinion is that the pulling of the plug is more desirable because in three months, my Dad will hate them for keeping him alive.


                  Does anyone know about or have tried electro stimulation? It seems that none of my Dad’s doctors are familiar with this. I heard that John Hopkins was doing something in this area and a clinic in Cleveland.


                  Thank you so much for your prayers.


                  Momsurvive, I will pray for your Mother – she is very fortunate to have a close-knit family who supports and loves her.

                  Comment


                  • #10
                    A friend of my family who was 80 went into the hospital with several different ailments. After a couple of days the docs came back and said he had advanced ALS. Everyone was like, he has ALS?

                    They put him on a ventilator and suggested that the family make final arrangements because there was nothing they could do for him. Three weeks later the family final decided to pull the plug. Getting serious rehab at that age seems almost impossible but I would keep trying until there are no options.
                    Last edited by Patton57; 11-03-2011, 04:52 PM.

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                    • #11
                      Home Care + Vent Dependent

                      I am trying to do an "analysis" on Home Care since my Dad really wants to go home - I'm worried since I know very little about medicine and health, but I'm doing as much research as possible. The Hospital doesn't recommend that I try it since my Dad is vent dependent and will require 24 hour care and registered nurses.

                      I'm trying to call the Medicare reps but have been waiting for over 2 weeks and each rep tells me something different.

                      Any advice? is there a good thread to read?

                      Comment


                      • #12
                        Your dad needs to go to an inpatient specialty SCI acute rehab center first. I would strongly recommend Santa Clara Valley Med center. They are expert in this, including training you & other caregivers and all the logistics. Call them.

                        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


                        • #13
                          Sensation in Arms - Wiggling Toe Senior

                          Thanks for the recommendation to call Santa Clara.

                          At about the end of week 5, my Dad indicated that he felt sensation - primarily in his arms and that he can feel it "sometimes." He has feelings on the bottom of his feet (when I do an amateur reflexology). Also, a nurse mentioned that his eyes "flew open" when she grabbed his toe and she told me that he had indicated to her that he could feel this. He also indicated that the medication is affecting his ability to feel. This encouraged him greatly -- I mentioned this to the Doctor who checks his feeling - she uses her latexed finger and a sharp point (little stick) -- but he failed the test -- he was exhausted at the time and after she left, he fell asleep.

                          Is the "sometimes" sensation normal or a good sign? Could a person feel kneading and not a sharp stick or finger? Would the pain medicine affect his ability to feel?

                          I am dismayed because I was able to cheer up my Dad, especially when I told him about the wait time for the swelling to go down -- and, he indicated that he wanted to recover. But, according to a nurse, a Doctor recently told him that he would never get off the vent and asked "do you want to be like this for the rest of your life?" My Dad has yet to get a peg -- so, according to the nurse, the Doctor told him "if you want to be like this for the rest of your life, choose to get the peg."

                          I saw my Dad after this conversation, and he was obviously in anguish.

                          At first, the Doctor told my family that they would know the first week if my Dad could move again -- now, they are saying that if he doesn't move within the first 3 weeks, it's definite.

                          dear SCI Nurse - you had mentioned a few weeks to months for the swelling to go down in the spinal cord... is there any document which I can download to show my Dad?

                          Comment


                          • #14
                            Originally posted by Joey_SF View Post
                            He is in San Francisco. I don’t know if his doctors are experts.

                            The spasms have started, so it’s difficult to show the doctors anything.

                            The doctors are encouraging him to choose not to live – I’m devastated! I’ve stated that I've read literature seems to indicate 4-6 weeks and sometimes more – I spoke to a woman who told me that it took three (3) months for the swelling to subside - but they're saying that he's complete and the best case scenario is to be like C Reeve and so, it's best that he choose not to live. He is not being given any medication to help with the swelling – he has only been given pain killers and blood thinners.

                            One of the doctors initially spoke about moving him to an acute rehab center, but he also recommended that he choose not to live due to his age. Worse, the doctors are standing by his bedside and saying that he’ll be this way for the remainder of his life – and, now, my Father seems to want to die!

                            No, he’s not a vet.

                            Please give me your kind advice.
                            Joey_SF,

                            I take offense to doctors stating the bold part above, that being in Christopher Reeve's condition is not worth living. I'm in that condition, though I'm much younger than your father.

                            I don't want to give you false hope, but life is NOT necessarily bad, just because someone has a high-level SCI and is vent-dependent (I'm not the only positive example). Granted, I don't know how age impacts things, but regarding his ability to potentially wean from the vent, typically that has much to do with the level of injury. At C3 or lower is technically where one needs to be in order to have the ability to regain spontaneous breathing. But perhaps if he's a C1-2 incomplete, the "incompleteness" could give him access to his diaphragm.

                            But even if it he cannot wean on his own, your father could be a good candidate for a diaphragmatic pacing system (DPS). I tried the DPS without success, but I'm truly complete and 14 years post SCI, and your father could be incomplete, based on the sensation in his feet (I have none). It is probably too early for weaning and/or DPS discussions, but here's an extensive thread about the DPS if you're interested:

                            https://www.carecure.net/forum/showthread.php?t=134394

                            God bless!

                            Bill Miller
                            Last edited by BillMiller823; 11-16-2011, 01:38 AM.
                            Wheelchair users -- even high-level quads... WANNA BOWL?

                            I'm a C1-2 with a legit 255 high bowling game.

                            Comment


                            • #15
                              Yes there are different tract and they are separate so you can have no movement or sensation to sharp touch but be able to feel temperature , deep pressure or vibrations.
                              CWO
                              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

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