Spinal cord injury changes the body in ways that even people who are affected by it take years to understand its effects. Each and every person with spinal cord injury has to go through those uncertain times with fear and anxiety. I am no exception. It took me many years learn how a neurogenic bladder will cause urinary tract infection that if left untreated will lead to renal failure. I learnt that the hard way.

I was also ignorant of how a poor-fitting wheelchair will cause postural problems, why I should diligently go for scheduled medical check-ups and that people with spinal cod injury are prone to osteopenia that may eventually lead to osteoporosis. Those were the days when Internet was still a foreign word to many and resources in print for spinal cord injury were scarce and hard to come by.

Things have changed over the years. Information on complications, treatment and prevention for spinal cord injury are easily available through search engines such as Google and Yahoo. Many of such sites provide cold hard facts that may be difficult to comprehend with its extensive use of medical terms. Personally, I prefer to get my information from forums where people with similar conditions share their experiences and provide useful advice.

One site that I frequent for down-to-earth information is the CareCure Community. It has an extensive archive of all topics related to spinal cord injury where members with similar conditions share and discuss issues affecting them. What makes this forum unique is the sense of camaraderie by members from all over the world and the determination to part with whatever knowledge they have to people who need it.

During the Peer Counseling Workshop organised by the Jabatan Kebajikan Masyarakat Malaysia/Department of Social Welfare Malaysia (JKMM) and the Japan International Cooperation Agency (JICA) from June 25 - 28 at the Institut Latihan Majlis Kebajikan dan Pembangunan Masyarakat Kebangsaan Malaysia (MAKPEM), I conducted two training sessions. One of the was “How to Overcome Oppression and Change Society.” Below is an excerpt of my presentation:

What is disability? Is a person disabled because he is paralysed, blind or deaf? A more correct term to use in explaining these conditions is impairment – physical impairment or mobility impairment, visual impairment, hearing and speech impairment.

Being impaired in those ways do no necessarily make one a disabled person.

Lets look at the need of a wheelchair user. If there are buildings that wheelchair users can get into conveniently; if there are toilets that are accessible – large enough to accommodate wheelchairs; if there is public transport that wheelchair users can use.

If these conditions are fulfilled, the wheelchair user is no longer disabled.

Disability is not about us. Disability is not about us being physically paralysed, blind, deaf or learning impaired.

Disability is about society that creates barriers that disable us. Disability is about society with attitudes that disable us.

Society views us as people with extra needs that create problems that require extra cost and effort to resolve when in actual fact society is not doing enough to fulfil these needs to empower us – disabled persons – as a citizen and part of society.

We all have experienced oppression in one way or another, or in many ways. We have learnt about self oppression, familial oppression and societal oppression.

With the understanding that we are disabled through no fault of our own, we should find ways to communicate this to society that we can lead an equally fulfilling life just like anybody else given the opportunity.

The following is a paid review.

Doctors can only treat problems effectively if they have the correct information in hand. Diagnostic tools such as medical imaging play a significant role in modern medicine. The advancement in this field has taken the out the guesswork and trial and error of diagnosing problems of patients. Now, surgeons can determine with pinpoint accuracy anomalies that are not normally detected through external examination.

Gone are the days when one or two units of imaging equipment are shared among multiple specialties in a medical facility. Now there is available dedicated equipment for different specialties such as thoracic radiology and musculoskeletal radiology. These different units are built and tuned for the diagnosis of a particular anatomy and problem.

Medicexchange.com is one portal that provides imaging solutions to radiologists, technicians and allied health staff to discover, evaluate and purchase the latest medical imaging solutions has to offer. This content-rich site has a forum for exchanging experience and an extensive archive of clinical information and news.

There is a comprehensive list of solutions for various radiology modalities. From X-ray to MRI and PET, medical professionals are assured of a software or hardware that is suited to their needs. This one-stop site is a must-visit for medical professionals looking for total medical imaging solutions or just for upgrading their knowledge on the latest news and information.

The general perception of wheelchair users is that we are people with chronic medical conditions. In short, we are considered patients. That is furthest away from the truth. Wheelchair users are people who employ a different mode of mobility. Instead of using our legs to walk, we move around on wheelchairs. That is the only stark difference.

There have been cases where wheelchair users accompanying friends to hospitals were misconstrued by the nurses and doctors as people seeking medical attention. Likewise, I have experienced the same dilemma when accompanying my late mother to the hospital for her checkups.

While this is not a major issue, it is discomforting that society at large still sees wheelchair users with such mindsets. At a recent meeting regarding accessible public transport, there were suggestions to request for bus routes to specifically serve institutions for disabled persons and hospitals.

That is another misconception. Not all disabled persons live in institutions. Many live in the community. That is how it should be. At the same time, accessible buses should not only serve routes to hospitals. That should not be a priority but included as one of the routes.

True, many need to go to hospitals for regular checkups but that is not a major activity for disabled persons. It is more important that we are able to commute to work or school conveniently. Additionally, we also like to enjoy leisure activities such as trips to the malls or parks.

There are still a lot of misconceptions regarding disabilities and disabled persons. It is not totally the fault of society. Disabled persons themselves are the best advocate of change in such matters. By living in the community, we can gradually eliminate fallacies, build bridges and create an inclusive society where everyone is treated with respect and dignity.

*This entry first appeared in Monster Blog on October 3, 2006.

Does one become a person with disabilities after spinal cord injury? In reality, paralysis does not necessarily disable a person. Limbs may not function as they used to be but there is more than one way to skin a cat. Humans are adaptable creatures. For centuries, we have created ways and devices to simplify work. Likewise, in the present age, we have the innovation to invent assistive devices to substitute for the loss of limb functions.

Even the simplest everyday implements such as spoons and toothbrushes have been adapted for the use of people with limited hand function. On the other end, electronic technology has enabled a person who is completely paralysed to use the personal computer for work and leisure. Head-mounted pointing devices and voice recognition software has allowed people with severe physical impairments to perform all the tasks that a non-disabled person can do with a computer.

The built-environment is another area where people with physical impairments are disabled not by their own impairments but by facilities that are not accessible. To understand why this is so, there is a need to define the difference between impairment and disability. They may seem like two words with the same meaning. When we look closely there is a vast difference between the two.

Impairment describes the imperfect condition of the body such as paralysis of the limbs, blindness and deafness. Impairment does not and should not lead to disability. A person with impairment experiences disability when faced with environmental and attitudinal barriers.

A wheelchair user who is a person with impairment experiences disability when the only access into a building is via a flight of steps. A suitable ramp eliminates the disability and allows the wheelchair user to get into the building. He now no longer experiences disability. The ramp also provides an easy means of access into the building for people with temporary mobility impairments and the elderly.

Environmental barriers such as this are the result of attitudinal barriers. The lack of understanding of the needs of people with impairments, ignorance and discrimination leads to the construction of infrastructure that is disabling to certain groups of people. Just because things have been done the same way for thousands of years do not mean that it must continue to be done the same way now.

So, does one become a person with disabilities after spinal cord injury? It is evident that paraplegia and tetraplegia is not the sole cause of people being disabled. There are many other factors that restrict persons with physical impairments from achieving their full potential. There is a need to understand this and work on solutions to resolve it. Creating an environment that includes the needs of everyone is not difficult. All that are needed are a change of mindset and some creativity.

The term person with disabilities is universally accepted to mean person with impairments, be it physical, visual, auditory or intellectual. This term puts the burden of disability on the person when in reality environmental and attitudinal barriers are major disabling factors. Removing those barriers will result in removing the disability imposed upon persons with impairments. A better term, for the lack of a more suitable one, would be disabled person. It describes a person who is disabled by the environment and attitudes.

In the initial years after spinal cord injury, I was often stricken with urinary tract infections (UTI). This could be due to the indwelling catheter that was not properly maintained, insufficient intake of water, improper diet and low-resistance to infections. Urinary tract infection can lead to serious complications such as infection of the kidneys (acute pyelonephritis), inflammation of the bladder (cystitis) and inflammation of the urethra (urethritis) if not properly treated.

Early symptoms of urinary tract infection includes the urge to urinate often but only passing out small amounts of urine (cystitis), a burning sensation while urinating (urethritis), blood in urine (hematuria) and urine that is cloudy and strong-smelling. Advanced symptoms includes tremors, chills, high fever and symptoms related to high fever such as nausea, hallucination, poor appetite and vomiting.

Antibiotics were prescribed each time I had urinary tract infection. Little did I realise that over the years, I had to take stronger and stronger antibiotics because the infection-causing bacteria became progressively resistant to the more common antibiotics. It came to a stage where the urologist advised me to try to clear the infection by drinking more water because the urine culture and sensitivity (C & S) showed that nothing but the strongest antibiotics will work for me and some of the bacteria are already multi-drug resistant. In addition to that, I have to avoid antibiotics that are nephrotoxic to prevent further damage to my kidneys.

We all know that prevention is better than cure. Therefore it is important to take steps to reduce or even prevent the occurrences of urinary tract infections. Good practices include drinking sufficient water, replacing an indwelling catheter according to schedule, ensure cleanliness during intermittent catheterisation and bowel programmes, and emptying the bladder at predetermined intervals to prevent bacteria from multiplying.

If there is a need to take antibiotics for urinary tract infections, the full course must be completed. Stopping the course halfway when the symptoms have disappeared may not have fully eliminated all the bacteria and could even restart another infection. Taking partial courses can make the bacteria resistant to the same antibiotic later on. One should never self-medicate with antibiotics bought over the counter without proper medical diagnosis and advice. It is important not to abuse the use of antibiotics to prevent the occurrences of antibiotic resistant and multi-drug resistant bacteria as it will leave doctors with very few treatment choices and may result in the use of more expensive drugs.

Persons with spinal cord injury understand too well the perils of not drinking sufficient water. Constipation and urinary tract infections are two symptoms related to insufficient intake of water. Constipation can cause autonomic hyperreflexia while persistent urinary tract infection may damage the kidneys. To avert those problems, they are often advised to drink at least two litres of water. More often than not, many drink too much.

Drinking too much, known as hyperhydration, gives rise to another set health complications. Hyperhydration causes hyponatremia where sodium in the body is over-diluted and washed out from the body by the kidneys in the forum of urine. Sodium regulates fluid balance in the body, maintains blood pressure, helps transmit nerve impulses and is vital for muscle contraction. If sodium is not replaced, essential cellular functions will be disrupted.

Symptoms of hyponatremia include nausea, fatigue, dizziness, muscle cramps, disorientation and can lead to coma or even death. Minor hyponatremia can be treated by eating salty food and drinking sports drinks like 100Plus and Gatorade. Severe hyponatremia needs urgent medical attention. The problem of hyperhydration is apparent on hot days when too much water is drunk to quench thirst, especially by those who are taking Detrusitol which tends to cause dryness to the eyes, nose and mouth.

Therefore, it is important to pace the intake of water throughout the day. An adult needs to drink an average of two litres of water daily. A regulated intake of water not only reduces the likelihood of hyperhydration but also allows better bladder management by keeping the schedule for intermittent catheterisation and eliminating instances of a full bladder in between that.

The skin is the largest and heaviest organ in the body. In adults, it is approximately two square meters and makes up about 15% of the body’s weight. Skin is very pliable. Its major function is to protect the body from the environment. It acts as a layer to keep out micro-organisms and prevent infections. It is responsible for regulating body temperature. Many other important functions of the body are also dependent on healthy skin.

People with spinal cord injury and those with severe mobility impairments spend a lot of time in bed or wheelchair. The scapulas (shoulder blades), sacral region (tailbone), elbows, buttocks and heels are spots where the skin is constantly being pressed against the bed or wheelchair. Continuous pressure against those parts will result in pressure sores. Pain is a precursor to developing pressure sore and the loss of sensation or numbness after spinal cord injury exacerbates the condition.

The severity of a pressure sore is categorised into four stages. When one sits or lie down in the same position for too long, the skin around those pressure spots will become red, tender and warm to the tough. This is Stage I. The problem will go away as soon as the pressure is relieved. The tenderness can be reduced and soothed by gentle massaging with skin lotion.

In Stage II, skin loss occurs because the pressure is not relieved. Blood supply to the area is cut off causing tissue to die. It becomes an open sore. This skin loss is usually limited to the epidermis (outer layer of the skin) or includes some of the underlying tissue. It heals fairly quickly if treated promptly.

If continuously left untreated, the open sore becomes deep and crater-like. This is Stage III. All the layers of the skin from epidermis to the dermis (inner layer of the skin) are damaged. There will be muscles and tissue loss too. Even with proper care the sore may take a long time to heal.

By Stage IV, apart from damage of skin, muscle and tissue, bone loss occurs as well. Tendons and ligaments would have been irreparably damaged or destroyed. Pressure sore that has reached this stage will be difficult to treat and may result in fatality resulting from infection.

Pressure sore can be avoided by constantly relieving skin and tissue stress in the body commonly affected by this problem. Paraplegics who have good strength in the arms know the importance of periodically lifting their buttocks off the wheelchair. Quadriplegics should perform assisted pressure relief often with the help of caregivers for the same purpose.

Other factors that can cause pressure sores include the seams of pants, creases on cushion cover and wheelchair seat, skin damage from sliding on coarse surfaces and dampness of the skin from wearing diapers or leaked urine. It is easier and cheaper to prevent pressure sores than treating them. Therefore it is of utmost importance to do a thorough check of the pressure points every morning and before bed for potential signs of pressure sores.

Related Link: Spinal cord injury solicitor Brian Camp & Co. Solicitors, a UK based personal injury solicitors specialising in spinal injury claims.

Renal failure is the major cause of death in people with spinal cord injury (SCI). For those who are living with it, this adds an unwelcome burden to an already strained financial situation. Renal failure will eventually lead to a stage where hemodialysis is needed. Dialysis is a tedious and expensive process that many with SCI can ill afford.

The kidneys filter waste products from blood to form urine which is then stored in the bladder and discharged through the urethra. In some people with SCI, the bladder can go into uncontrolled contractions. These are called spasms. It causes urine to be pushed back into the kidneys. This is called a reflux. Spasms and reflux will eventually lead to irreparable damage to the kidneys and cause them to fail.

The other cause of kidney failure is urinary tract infection (UTI). This can occur in the bladder, kidneys or other parts of the urinary tract. If left untreated, it can also damage the kidneys. Among the factors contributing to UTI are poor hygiene around the genitals, sexual intercourse and diet.

There are several methods to reduce the occurrences of spasms and reflux. One is through medication. There are drugs to relax the bladder. The other is to empty the bladder at regular intervals, usually every four hourly, through intermittent catheterization.

In intermittent catheterization, a catheter, which is essentially a tube made from either PVC or latex, is inserted through the urethra into the bladder to drain the urine completely. The catheter is then removed, cleaned and stored for use later.

Unfortunately, intermittent catheterization is also a major cause of UTI by introducing bacteria into the bladder. Therefore, it is important that the catheter be kept as clean as possible and hands are properly washed prior to the procedure.

The act of drinking sufficient water throughout the day and emptying the bladder regularly reduces the opportunity for bacteria to multiply. A balanced diet is essential. However, the intake of coffee and carbonated drinks should be restricted as they are known to irritate the bladder and promote UTI.

Prevention is certainly better than cure when it comes to renal failure. The damage cannot be reversed. It can only get from bad to worse. The quality of life for people with renal failure is greatly reduced, more so when it occurs in those with severe physical impairments.

Medical and rehabilitation personnel must provide such information to people with SCI who are under their care to allow them to make informed decisions. I have known of cases where doctors were not in favour of good bladder management practices for whatever reasons best known to themselves. Pity those who regarded the doctors’ advice as the Gospel truth only to realise too late that they could have avoided renal failure had they been properly educated in these matters.

This entry first appeared in Monster Blog on August 22, 2006.

Related Link: Spinal cord injury solicitor Brian Camp & Co. Solicitors, a UK based personal injury solicitors specialising in spinal injury claims.

Over the past few years, my bowel management has to be changed. This could be due to the low-protein diet that I have to adhere to because of chronic renal failure. I can no longer eat as much food as I want because a lot of food contains protein. I believe that it is because of this that my bowel movement has been affected.

Chronic renal failure causes anemia. My anemia is slightly below the normal range. I have to make up for the reduction in red blood cells with iron supplements. Iron supplements cause constipation. That caused a lot of problems for me because I could not empty my bowel fully. To counter that, I started taking Lactulose in the middle of last year.

Lactulose is a form of liquid synthetic sugar. It tastes sweet just like sugar syrup. It is almost never absorbed in the stomach. It is instead metabolised by bacteria in the colon. This process draws water into the bowels and softens the stools. I am taking 15ml of Lactulose daily after lunch. It has greatly helped in my bowel management. I seldom, if never, get constipated after I started on it.

Lactulose alone will not solve the problems of constipation. Water intake should be sufficient too apart from a diet high in fibre. Currently, I am eating up to four portions of fruits, not only to prevent constipation but to vary the tastes in my meals because of the limited choice of food that I am allowed to eat.

Lactulose also draws ammonia from the blood. It is used to treat people with liver disease. Lactulose also causes gas. This could one of the reasons for the unpleasant putrid smell in the stool and when breaking wind. Overdosing on Lactulose may cause diarrhea, excessive gas and stomach upset. Therefore it is advisable to consult a doctor first before taking it.

Related Link: Personal injury claim solicitors Brian Camp & Co. Solicitors specialise in personal injury claims within the North West UK.