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Thread: Trying to understand C 7 Quad

  1. #11
    I think he is in major spinal shock right now but I think C7 should be moving arms, too, so I'm confused. Now they may feel really heavy at the moment. Perhaps he is too weakened by the pneumonia to pull it off? I remember being able to raise my arms over my head, but it was HARD. I groaned. Later I learned that move requires triceps, which I was blessed to retain although they still are weaker than my other arm muscles. I lay in the neuro icu, land of eternal boredom, and tried to lift my arms up. It felt like they had 50 pounds strapped to them. But I could feel the movement in there.

    With his arm placed at his sides, forearm up, can he bend his hand upward? That causes the fingers to flex in a move called tenodesis. I drive, talk on the phone, cook, drink coffee, all using tenodesis on one side. (The other side recovered better.)

    At 1 hour distant, your best contribution may be research and pushing for things like the next available bed at the best dang rehab in existence. Quality of rehab trumps proximity to family...it is THAT important.

    Pleas tell him I remember looking at my Dad and saying "Dad? What if I can't turn the pages?" But at C7, he WILL turn the pages. Fearing arm loss really is terrifying. I was starving b/c the hospital brought food I couldn't pick up. In desperation I grabbed the plate once, using my "clubs". Dumped a whole plate of fettucine alfredo down my c-collar! Then I was starving and STICKY!

    Things will get much better when he gets off the vent and off to rehab. Remind his ppl to turn him every 2 hours. Getting to rehab w/ a pressure sore is par for the course. Also dangerous, a hindrance and a permanent problem.

    He's in for the fight of his life but it sounds to me like he is asking the right questions. At 38, he is 2 yrs younger than I was. 9 years later, I take long road trips with my dog, am completely physically independent. I scuba dive. I rally on Capitol Hill for SCI cure research. I'll probably board 14 or so airplanes this year. This is a slower life than I had pre-SCI, but it is more of a life than many AB's have.

    I had an incomplete injury. That determines a lot and it is too early to tell for your dad.

    He has to determine to fight. The only guarantee is that no trying = no progress. And the family should prepare for the very very worst. No home was ever TOO accessible. I'm recovering from the stomach flu right now. As always, I'm cursing my own shortsightedness and wondering why my home has so many obstacles. I used to think that if I made things easier for myself it would make me weak. Now I know I would just waste less energy on unnecessary obstacles.

    Keep asking questions. We like to help!

  2. #12
    Quote Originally Posted by SCI-Nurse View Post
    Did you understand the doctors to say C7? If so, then he should already have the following arm muscles working:

    C5-Deltoids (shoulder)
    C5-Biceps (flex elbow)
    C6-Wrist extensors
    C7-Triceps (extend elbow)
    C7-Wrist flexors

    C8 gives you individual finger flexion and extension, and T1 the intrinsic muscles of the hand (spread the fingers), so if he is officially C7, he should already have a lot of arm movement. If not, then you need to question the physicians again.

    (KLD)
    I don 't understand why they're calling him C7 Quad. His injury was to the c4 and c5 vertebrae. He can only feel his shoulders and can move his head. At the first hospital, the day he was injured, he could feel down to his belly button and breath on his own. The third day he had to be put on the vent and has been on since(17 days post injury).
    It's so hard being the ex-wife who lives far away. The family is grateful that I'm looking things up for them, as they are busy trying to cope with this. I can't talk to the doctor to get details and I don't think things are being explained so the family really can understand.
    One plus is.... when I mentioned they should request Dr. Kevin O'Connor, his sister told me that he IS his doctor.

  3. #13
    The fracture levels do not determine the level of injury. The cord damage does, and that may be quite different from the fracture level. The ASIA exam, which should have already been done in the ICU, but will need periodic repeating when admitted to rehab and every few weeks thereafter, is what is important.

    You need to ask about both his actual level of injury and ASIA category from the ASIA exam. Please be sure you have read the article by Dr. Young on level of injury that I posted above so you can understand this better and ask better questions of his physicians.

    (KLD)

  4. #14
    ok, am gonna chime in. been a bit perplexed by this post but didn't want to say anything. i am c7, 100% c6 displacement with a lesion at c4. everybody is diff but i'm wondering why these docs are saying c7? i temporarily lost triceps in one arm, but never lost arm function. i did permanently lose finger function after 48 hours (no meth, ). i have no doubt, had they given me wise's meth, i'd still have my fingers. it is in my med records my fingers worked in first 48 hrs. i even remember doc asking me to take his hand and squeeze it and hearing his amazed response.

    don't stop hoping. you never know. best wishes.

  5. #15
    I rehab at Spaulding 6 years ago-- my advise is have the family members stay very involved- push him as much as possible--Spaulding was a very depressing place when I was there- they were understaffed and the majority of the nurses aids did not speak english-- my family would see me everyday and this helped tremendously- the Physical Therapists were OK--Dr. O'Connor was new then and was just OK-- If you could transfer him to Shepard in Georgia he might make out better. Make sure he gets as much PT as possible - this is a critical time in his recovery. My own opinion is I wouldn't send my dog to Spaulding. I hope it has changed over the years.

  6. #16
    Thanks "capecodsci". It's ironic you'd mention the situation at Spaulding. Apparently, they don't use anal tubes(?) there. He soiled the bed and was left laying in it. They are sympathetic to his situation. He has no movement, control, and feels like his dignity is gone and they're surprised that he gets angry when left sitting in poop.
    "Cass"...you have a point. I asked about the C7 again today. They're assuming he is a C4 now. He was a C7 upon admission, the day of the accident. At that point, he could feel his arms. I'm still waiting to hear if he was given the meth(?), though I assume he wasn't. As far as the family knows, Spaulding hasn't tested him since he arrived on Friday.

  7. #17
    Quote Originally Posted by SCI-Nurse View Post
    The fracture levels do not determine the level of injury. The cord damage does, and that may be quite different from the fracture level. The ASIA exam, which should have already been done in the ICU, but will need periodic repeating when admitted to rehab and every few weeks thereafter, is what is important.

    You need to ask about both his actual level of injury and ASIA category from the ASIA exam. Please be sure you have read the article by Dr. Young on level of injury that I posted above so you can understand this better and ask better questions of his physicians.

    (KLD)
    I read the info in Wise' link again and understand better. The example sounds similar to our situation. It seems that Lahey ICU tested him at C4. Apparently, Spaulding hasn't tested him, yet. They are trying to start weaning him form the vent. They've also removed his anal tube(?). Is that normal? Feces just comes out.....

  8. #18
    WTH is an anal tube?

    I don't think tehre is such a thing!

    There is a mechanism, at the outer end of the rectum but still inside, called the anal sphincter. This is what keeps feces in. Our sphincters are paralyzed. Usually they are stuck closed; likely your exes is. This situation is called a neurogenic bowel. There are ways around it, procedures we learn to do, or have someone do it for us. These procedures are called "bowel program". or "bowel care".

    It takes months, even years, to get all this fine-tuned. I suppose this process could be called bowel training, although I consider that a misnomer. There is no training the bowel. We just train ourselves to survive in these bodies.

    Meanwhile, should we shit ourselves, we need cleaned up.

    If, in fact, your ex-husband is lying in feces because this establishment considers that bowel training, that is neglect. He is not an infant that willfully soiled himself. He is a grown man that can no longer feel the sensations that used to send him to the toilet. If he can feel them, he can't go to the toilet anyway. If he were to miraculously transport himself there, he would not currently know the steps required to evacuate.

    Generally speaking...Once a day, the staff should undress him and cover his bed w/ protective pads called Chux, then lay him on those on his left side. They will insert a suppository. After 15 minutes or so, they will insert a finger into his rectum and sweep the rectal wall in a counter-clockwise motion (this is called "digital stimulation"). 30 secs of that, wait 5 minutes, repeat dig stim, wait, until the rectum is emptied.

    Some people choose a surgical procedure called a colostomy. Basically, a hole is cut under the left ribcage. Feces exit that hole into a bag and the colon/rectum is no longer used.

    So please tell your out-laws (LOL, the outlaws is what I call my husband's former in-laws) that there is no such thing as an anal tube!

    They have so much to learn and it seems like everyone is magooing around. I wish they would come here...it is scary to know they are so clueless!

    Meth, in this case = methylprednisolone, a steroid shown to reduce damage from post-sci swelling if given within 8 hrs of injury.

  9. #19
    I'm assuming the "tube" is something that was stuck in his rear to catch the poop. I've given different family members the website info and urged them to visit. They're so busy trying to juggle everything that they haven't had a chance. I mentioned calling and his sister thinks it's a good idea for me to. I just don't have the details on his condition know little. If I had more specifics, I would call right now. I have stressed the importance of getting him into a Model SCI System facility. If they don't want him far away, there is on right in Boston.

  10. #20
    I think you are talking about a fecal containment system like the Zassi. These are only appropriately used for totally uncontrolled incontinence such as you see in patients with c. diff. or other serious illness. Many times they are restricted to the ICU. It is unsafe to sit with one of these in place, so the need to use one would nearly always preclude someone with a SCI going to or staying in a rehabilitation setting.

    If there is a suspicion that he has a c. diff. infection (which is common in hospitals, and highly infectious), with frequent loose or liquid stools, he needs to be tested and treated for this. It can cause serious side effects if not properly treated.

    This would not be appropriate to replace getting him onto a controlled traditional bowel program, and keeping one in place (they can stay in place up to 28 days) would not only prevent him from reaching that goal but also from benefiting otherwise from an aggressive acute rehabilitation program, which is what he needs right now.

    (KLD)

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