Round 3

So we once again find our self in the same position we have been in twice over the past year. Through the x-rays we found that Joey had somehow broken the rods placed in his back during the last round of surgeries. In the pics below the broken rods are circled in red.

Jo

We have no idea how this could have happened. Joey had not done anything other then basic daily things like getting dressed with my assistance, and getting in and out of bed also with my assistance. So back we go. Jefferson Hospital seemed to be our home away from home. By this time Joey was feeling a bit more comfortable at the hospital. Not happy, but not as bad as the first or even second round. We knew the drill, but this time there would be a bit of a twist. The surgeon took out the broken hardware, cleaned away any infection that was detected and began to rebuild his spine...again. Not only did the surgeon replace the rods that had broken, he also attached additional rods in between the two vertical rods to help with the stability of the entire thing.

Joey was ordered to spent the next 12 weeks laying flat in bed. On October 31, 2009 Joey was moved from Philly and place in a nursing home in Bethlehem Pennsylvania. What an experience that was for all of us. He was placed in a room with an much older man who was shot in the head several years earlier during a home invasion. This man also suffered from dementia. The things he would yell were terrible and funny at the same time. Here are a few examples: "fuck you, fuck you, fuck you" (repeatedly until he would fall asleep); "gimme somthin to eat" (during his meal); He had a plastic pumpkin on top of his TV and would say "What the fuck you smilin at, pumpkin"; and "Dear lord let my beard grow all around to the ground". We gave him a glow in the dark bracelet and would yell " hey look at my bracelet". But every now and then he would look over at Joey and say "hey Joey, hows your back?". He didn't have many visitors and really enjoyed the time we spent with him. We would always be sure to include him in on the conversation. It didn't seem like any of the nurses or aides understood or cared enough about his ability to interact every now and then. We would tell them that he just asked Joey how his back is and they would dismiss it like it wasn't a big deal. I thought it was a huge deal. So this older man helped us realize how lucky we are to have each other and our ability to be present in the moment at all times.

Joey's was in the nursing home for about a month. What a long month. The care was not as good as I feel it should have been. One night I came in to visit and he was not feeling well. As a part of Joey's paralysis he suffers from something called Autonomic Dysreflexia. What is Autonomic Dysreflexia you ask. Well here is an explanation:  

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What is "Autonomic Dysreflexia?"

Autonomic dysreflexia, also known as hyperreflexia, means an over-activity of the Autonomic Nervous System causing an abrupt onset of excessively high blood pressure. Persons at risk for this problem generally have injury levels above T-5. Autonomic dysreflexia can develop suddenly and is potentially life threatening and is considered a medical emergency. If not treated promptly and correctly, it may lead to seizures, stroke, and even death.
AD occurs when an irritating stimulus is introduced to the body below the level of spinal cord injury, such as an overfull bladder. The stimulus sends nerve impulses to the spinal cord, where they travel upward until they are blocked by the lesion at the level of injury. Since the impulses cannot reach the brain, a reflex is activated that increases activity of the sympathetic portion of autonomic nervous system. This results in spasms and a narrowing of the blood vessels, which causes a rise in the blood pressure.
 

Signs & Symptoms

• Pounding headache
  (caused by the elevation in blood pressure)
• Goose Pimples
• Sweating above the level of injury
• Nasal Congestion
• Slow Pulse
• Blotching of the Skin
• Restlessness
• Hypertension (blood pressure greater than 200/100)
• Flushed (reddened) face
• Red blotches on the skin above level of spinal injury
• Sweating above level of spinal injury
• Nausea
• Slow pulse (< 60 beats per minute)
• Cold, clammy skin below level of spinal injury
   

Causes

There can be many stimuli that cause autonomic dysreflexia. Anything that would have been painful, uncomfortable, or physically irritating before the injury may cause autonomic dysreflexia after the injury.
The most common cause seems to be overfilling of the bladder. This could be due to a blockage in the urinary drainage device, bladder infection (cystitis), inadequate bladder emptying, bladder spasms, or possibly stones in the bladder.
The second most common cause is a bowel that is full of stool or gas. Any stimulus to the rectum, such as digital stimulation, can trigger a reaction, leading to autonomic dysreflexia.
Other causes include skin irritations, wounds, pressure sores, burns, broken bones, pregnancy, ingrown toenails, appendicitis, and other medical complications.
In general, noxious stimuli (irritants, things which would ordinarily cause pain) to areas of body below the level of spinal injury. Things to consider include:

• Bladder (most common) - from overstretch or irritation of bladder wall
• Urinary tract infection
• Urinary retention
• Blocked catheter
• Overfilled collection bag
• Non-compliance with intermittent catheterization program
   
• Bowel - over distention or irritation
• Constipation / impaction
• Distention during bowel program (digital stimulation)
• Hemorrhoids or anal fissures
• Infection or irritation (eg. appendicitis)
   
• Skin-related Disorders
• Any direct irritant below the level of injury (eg. - prolonged pressure by object in shoe or chair, cut, bruise, abrasion)
• Pressure sores (decubitus ulcer)
• Ingrown toenails
• Burns (eg. - sunburn, burns from using hot water)
• Tight or restrictive clothing or pressure to skin from sitting on wrinkled clothing
   
• Sexual Activity
• Over stimulation during sexual activity [stimuli to the pelvic region which would ordinarily be painful if sensation were present]
• Menstrual cramps
• Labor and delivery
   
• Other
• Heterotopic ossification ("Myositis ossificans", "Heterotopic bone")
• Acute abdominal conditions (gastric ulcer, colitis, peritonitis)
• Skeletal fracture 

Now that you know what Autonomic Dysreflexia is I will continue with the story. I went in to visit Joey and when I arrived he was in a lot of pain and had a fever. He couldn't seem to figure out what the problem was. I lifted the covers and both of his legs were twisted from the knees down to the right. When I say twisted, I don't mean a little bit. I mean totally twisted. I immediately ran out of the room and made a nurse come and look at his legs. I informed them of his condition. It is so amazing how many medical professional don't know what Autonomic Dysreflexia is and don't know how serious this condition is.