Help!

[Wise Young]

The following is an anonymous posting from the Cando SpinalNurse Forum
07/25/2001 3:58 PM:

"I just got a phone call from a friend in Puerto Rico with a C4 injury.He's complaining of an intense headache like none he's ever had before,shortness of breath and feeling lightheaded and sleepy.He also mentioned he's had diarrhea for 5 or 6 days now.He's trying to catch the 10pm flight here to NY to get checked out over here.My question is:Is there anything to help with the headache and shortness of breath until tom? He mentioned it could be hemorroids and that maybe someone did his BP wrong I just think the symptoms don't match but I could be wrong.I'm worried he's got an infection or something and just does'nt want to go to the hos.He is STUBBORN.Please help..."

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Anonymous, it sounds as if your friend needs to see a doctor quickly. He needs to go to the hospital quickly... The shortness of breath is of particular concern. The diarrhea may also be causing dehydration. Also, sometimes when people have an infection and their urine clearance goes down, the blood levels of drugs that they are taking (such as ditropan and baclofen) go up. He may need to be rehydrated intravenously and the cause of the problem, whether due to infection or otherwise, should be identified and treated.

Wise.e

[SCI-Nurse]

Here is what I also posted at Cando/SpinalNurse:

"I definately would not encourage your friend to be flying anywhere under such conditions without a physician's OK. His shortness of breath could get much worse on a plane, and if he has uncontrolled AD he could have a stroke. It sounds like he has bad AD. This could be caused by anything from an impaction to inflammed hemorroids to trauma during his bowel care. It is impossible to say without having more information.

Does he not have a SCI physician in PR? (KLD)"

[tnb]

Well,my friend made it to NY from PR.He went straight to Mt Sinaii's ER.They did a CAT scan,blood work,checked the fluid in his spine and found nothing that could be causing the headaches.They gave him a prescription for pain and for a UTI.A couple of days later he was back in ER with the same headaches.This time they said it might be sinus related.Still no clear sloution.In the meantime he keeps having the headaches that make him stay in bed all day long.He's scared he might pass out.He says his vision is blurry when he gets the pain and that the pain is so intense he can't even call out on anyone for a couple of seconds.I did notice he gets goosebumps and his forehead gets all sweaty.You don't know how helpless we feel...We defenetly want him to get better.I commented to his dr in the ER about AD and she did'nt even know what I was talking about.I hope I gave you more info so that you can give us your opinion.The only other thing I can see he has is hemorroids but he always seems to have those so I don't think it's that.Thank you for helping. http://sci.rutgers.edu/forum/images/smilies/confused.gif http://sci.rutgers.edu/forum/images/smilies/confused.gif

[SCI-Nurse]

It is unfortunate that your friend traveled all the way to NYC to see a physician who is expert in SCI, and then did not see one. Most physicians (and nurses) are only slightly acquainted with AD, and many do not know about it at all.

Now that your friend is back in PR, it sounds like totally classic autonomic dysreflexia. The cause must be found and treated. Untreated either the AD itself or the cause can be life threatening. Even mild AD over time will put a lot of stress on his heart that can have long term consequences.

Here is the name of a physician in PR who is a member of the American Spinal Injury Association.

Rafael Martinez-Cayer, M.D.
Santurce
Physical Medicine & Rehabilitation
Phone: (787)758-7575
Fax: (787) 766-652

If they do not treat patients, they should know who does. You can also call the medical director/chief at the VA SCI Center in PR, and they would be a good source of referral for your friend for a good SCI physician.

In addition, I urge you or your friend to download the clinical practice guidelines on the management of AD which can be found at this site:

http://www.pva.org/NEWPVASITE/publications/cpg_pubs/adt02.htm

This is the patient/layperson version:

http://www.pva.org/NEWPVASITE/publications/cpg_pubs/AutoDys.htm

Have your friend take these with them whenever they see a physician and be sure that the physician either knows about AD or reads these materials immediately. (KLD)

[tnb]

Thanks for the info.Do you by any chance have a dr in NY.He's still here because he gets most of his medical care here.And also do you have any suggestions on what can aliviate the pain whenever he gets it?

[SCI-Nurse]

The point of treating AD is to find the cause and treat that. If you just give the person medication for their headache, you are masking important symptoms of a serious medical problem. If the cause of the AD is found and treated, then the AD (and the headaches) should go away.

Here is one physician I know of in the NYC area:

Kristjan Ragnarsson, M.D.
New York
Physical Medicine & Rehabilitation
Phone: (212)241-9654
Fax: (212)348-5901

Dr. Young may also be able to provide some referrals. There is also a list of ASIA members at this URL which you can try:

http://www.asia-spinalinjury.org/membership/indexmembers.html#NewY

(KLD)

[Wise Young]

I highly recommend Steven Kirschblum, M.D. at the Kessler Rehabilitation Institute. He is the best spinal cord injury rehabilitation doctor that I know. He is experienced, practical, open-minded, and compassionate. I think that he is listed at http://njms.umdnj.edu/gme/residencyprograms.html