Back in mid-2010, I was approached by NEW MOBILITY to write a column focused on providing information about managing the health challenges that often accompany spinal cord injury. And thus was born Para/Medic, a bimonthly column that first appeared in the January 2011 issue. Para/Medic was an extension of Bladder Matters, a column I started in 2008 about the unique challenges of, and different options for, bladder management with SCI.

Para/Medic has been a fun and challenging column. I enjoyed looking up peer-reviewed research articles on a subject, then adding in the firsthand knowledge of leading doctors, nurses, nurse practitioners and clinicians, as well as people with SCI.

By far, the most satisfying part of writing the column has been hearing from readers who have been helped by information they gleaned from it.

However, all good things run their course, and finding new topics has become more difficult. Rather than risk becoming repetitive, it is time to let Para/Medic fade away. I will continue to keep my eyes open for information that can help readers and myself, as I’m now in my 35th year as a T10 para. As always, if you have a question or idea for a column or article, please contact me at Rhvshark@mac.com.

Of the 42 Para/Medic columns I’ve written, here are excerpts from three that stand out for their breadth of appeal and relevance.

Strategies to Avoid Pressure Sores

As in many areas of medicine, researchers’ knowledge of how pressure sores occur continues to evolve. Until the early 2000s, known causes of tissue injury were pressure that reduces or stops blood flow to the tissue, along with heat and moisture. Research shows that additional causes are serious bumps and/or shear (pushing and pulling of tissue against bone), which can damage capillaries and deprive the surrounding tissue of blood. This happens below the skin surface and causes damage from the inside out. In 2007, the National Pressure Ulcer Advisory Panel added “suspected deep tissue injury” to its pressure injury staging scale and, a few years back, the word “suspected” was dropped, which led to the current term “deep tissue injury,” or DTI.

For more on deep tissue injury, I turned to Darren Hammond, a certified wound specialist and clinical support and education specialist for Motion Composites. “These days, many of the deep tissue injuries that clinicians are seeing, particularly with acute rehab stays that are so short [due to insurance guidelines], are caused by transfer failures where a person lands on a tire or something hard,” says Hammond. “This is where the research of Dr. Amit Gefen comes into play. Gefen has done important MRI studies that show deep tissue stresses and strains — and how these stresses lead to deep tissue injury.”

Hammond and Gefen worked together. Gefen had established that DTI can be caused not only by an acute incident but also by repetitive small traumas to deep tissues. “We had an ‘aha’ moment,” says Hammond. “I said that some people have poor transfer habits and bump a wheel or plop heavily on the surface they are transferring to. Even though this causes micro trauma, at the end of the day when doing a mirror-skin check, things look good.” The problem is that every healed micro trauma becomes scar tissue that is less resilient then regular tissue, thus more susceptible to injury.

Read the rest of the article: newmobility.com/2019/09/strategies-to-avoid-pressure-sores.

Bladder Irrigant Solutions for UTI Reduction

Saline is an irrigant that many of us were introduced to in rehab, where we were taught to add 30cc of saline after each cathing. Dr. Michael Kennelly, director of urology at Carolinas Rehab in Charlotte, explains that using saline should help dilute residual urine and sediment, and help prevent stones and stop bacteria from colonizing.

Another option is to add distilled white vinegar mixed with saline to the bladder. This supposedly creates an acidic environment that is hostile for bacteria. Kennelly emphasizes that it is important to have a discussion with your doctor before trying any irrigant solutions, and the vinegar-saline solution is a good case in point. He says the solution can irritate the bladder and cause inflammation, which weakens the bladder wall’s defense mechanism and makes the bladder more susceptible to infections.

The only FDA-approved solution for bladder irrigation is Neosporin G.U. irrigant, an antibiotic solution that is mixed with saline. I learned about the mixture from Paula Wagner, my urology nurse practitioner at U.C. Davis Medical Center in Sacramento, California. Wagner explained that although it is an antibiotic, Neosporin G.U. doesn’t get absorbed systemically, so I can use it as often as twice a day if my urine looks bad or once every couple of days when things are good. It reduced my UTIs from one every couple of months to less than one a year.

“You can be doing everything right and still have problematic infections,” says Wagner. “When this happens, it is important to talk with your urologist and ask them if an irrigant solution like Neosporin G.U., or gentamicin, is an option you should try. The bottom line is you need to do something to control UTIs, and different things work for different people.”

Read the rest of the article: newmobility.com/2015/12/bladder-irrigant-solutions.

Fracture Risk and Treatment Options with SCI

The average person with SCI loses 28 percent of their bone mineral density within the first 16 months of injury, according to Dr. Douglas Garland, an orthopedic surgeon and former director of neurotrauma at Rancho Los Amigos Rehab Center. Around that point, BMD loss slows down but continues at a rate of 1 percent per year. However, the good news is BMD in the lumbar spine rebuilds, reaching normal within 10 years of injury. In addition, for reasons unknown at this time, 30 percent of people with SCI gain back much of their BMD in other areas as well.

Osteoporosis is diagnosed when you’ve lost 32 percent BMD, which puts you in the “fracture threshold” (where a minor fall or missed transfer can cause a break). A 50 percent loss of BMD is considered the “fracture breakpoint,” where minor incidents like stretching or even getting a limb caught in the covers while rolling over in bed can cause a fracture.

It is important to have a basic knowledge of fracture management with SCI because this is an unfamiliar area for many doctors and orthopedists, says Garland. In the event of a fracture, referring the treating physician to the journal article “Pathologic Extremity Fracture Care in Spinal Cord Injury” is a good idea, he says.

Although every fracture is unique, Garland says most non-displaced fractures (when the bone is still lined up) can be treated non-operatively with pillow splints, immobilizers or careful bracing, sometimes custom made. Also, he says it is important to be sure they are well padded and can be opened for skin inspection: “In the case of femur and some tibial fractures, intramedullary nails can often surgically fix the fracture. This is preferred over screws and plates because screws can pull out of osteoporotic bone.”

Read the rest of the article: newmobility.com/2016/04/fracture-risk-treatment-options-sci

Para/Medic Topics

Here is a list of 42 health topics covered over the years of Para/Medic columns.  Additional columns on SCI, bladder and urinary tract can be found by searching for “Bladder Matters.”

General Health

• Appendicitis
• Autonomic Dysreflexia
• Cancer Screening
• Cardiovascular Disease
• Deep Vein Thrombosis (Blood Clot)
• Diabetes
• How to Find a Qualified Surgeon and/or Seek a Second Opinion
• Foot Care Tips
• Gluten Sensitivity, Celiac Disease
• Hospital Stay Survival Guide
• Managing Edema
• Spasticity Relief
• Winterizing an SCI Body

Osteoporosis, Bones and Fracture Management

• Bisphosphonates (medications for osteoporosis)
• Bone Growth Stimulator to Aid Fracture Healing
• Charcot’s Spine
• Girdlestone Surgery for Hip Complications
• Heterotopic Ossification
• Fracture Risk and Treatment Options with SCI
• Spinal Stenosis
• Syrinx

Bladder and Urinary Tract

• Anticholinergic Medications and Dementia
• Bladder Cancer: Increased Risk?
• Bladder Irrigant Solutions for UTI Reduction
• BioFlo, for Indwelling Catheter Users
• Guidelines and Options for Indwelling Catheter Users
• Options to Manage Bladder Spasms
• Using Antibiotics Responsibly
• UTI Antibiotics and Tendon Rupture (Fluoroquinolones)

Bowel Management

• Megacolon, Bowel Program Frequency
• Options For Dealing with Hemorrhoids
• Peristeen: New Option for Bowel Management
• Preparing for a Colonoscopy

Shoulders

• PRP: A Non-Surgical Option for Shoulder Repair
• Total Shoulder Replacement in Wheelchair Users

Skin

• Cellulitis
• Cushion Options for Severely Compromised Skin
• Deep Tissue Pressure Sores
• Strategies to Avoid Pressure Sores
• Summertime Skin Protection
• Unna Boot Compression Therapy for Wounds
• Winter Skin Protection