What life-threatening complications might a paralysis victim have, years later?

Factual Questions
1

Once upon a time that would have been a question about my novel. But that, for good or ill, is out of my hands for the moment. But I have been wondering idly what sort of illnesses or complications a person who was, say, confined to a wheelchair after an accident might suffer later.

Thanks in advance.

2

Mr. SCL is currently a home-care RN for a quadriplegic. They have to frequently use suction to make sure secretions don’t get into the lungs, because he can’t cough them up. They also have to be on guard against pressure sores, which he gets easily. Those are two that immediately come to mind. I’m sure there are more. Many, many more.

Oh yes - before Mr. SCL was on this case, while the patient was still in a nursing home, the staff there was trying to move him from a wheelchair to the bed without using a lift. They dropped him. On his face, breaking the bones around one eye.

3

Yeah, if you do not have Christopher Reeves’s money, paralysis even lower on the back can be life-threatening, sooner, due to issues with breathing.

Depending on the type of injury, circulation can also be an issue, raising the danger of gangrene, or, at least, necrosis. This is related to, but not identical to, the pressure sores mentioned by SnakesCatLady.

For particular issues, in the late 1990s it came to light that a lot of people who had survived childhood polio through heroic measures just before the vaccines became available began to suffer relapses (or the advent of a different but similar disease) just past middle age. Polio victims can suffer cruel relapse.

4

Complications can depend on the level of injury. As others have mentioned, pressure sores and respiratory problems are two big ones. I believe Christopher Reeve died from an infected pressure sore (or complications from the sore). Kidney problems are another possibility. Blood clots could be a problem. After being paralyzed in a car accident, Derrick Thomas died of an embolism.

5

Urinary tract infections are common when using catheters to urinate. The bugs can become resistant to antibotics over time and cause life-threatening infections.

Some stats

6

I had a cousin paralized by a motorcycle accident.

Six years later, he died from a stroke, caused by this accident.

Strokes are common, because without the muscle action in the legs, poor circulation can result in blood clots in the legs. Which can be dislodged, and travel thru the blood vessels until they get to smaller blood vessels in the brain, and block them, causing a stroke. (They can also end up in the blood vessels of the heart, causing a heart attack, or in the lungs, causing an embolism.)

7

autonomic dysreflexia.

“painful” stimulus below the injury such as constipation or a foot wedged under something triggers an adrenalin response, since you can’t feel it, you don’t fix it and the response increases. Severe headaches and life threatening hypertension ensue.

8

My sister-in-law is paralyzed from MS. Risks include the pressure sores mentioned above, as well as blood clots due to poor circulation. There is also a choking hazard, since she sometimes has trouble swallowing. There is also risk of infection from a pic line in her arm used to inject her with medication.

She had another MS-paralyzed friend who died suddenly a few years ago. He had apparently had a very severe ulcer in his stomach that was never detected because he couldn’t feel it, and one day it killed him (sadly, while he was on the phone with my SIL).

9

In Baltimore, we have quite a large collection of paras and quads, many from gunshot wounds. I trained at a place with a large VA hospital, and all of those have extensive SCI units (spinal cord injury).

What others have said is correct, but I’ll just add a few things:

  1. Pulmonary embolism is a killer, but all of these people should receive prophylaxis. As long as they take it, it greatly reduces the risk.
  2. Decubitus ulcers/pressure sores/skin breakdown are enormous problems. It is not uncommon for these to extend to bone and to lead to osteomyelitis. Osteo is not easily treated with antibiotics. If the osteo becomes chronic, then surgery is required to debride the infected/dead bone.
  3. In high cervical quadraplegics, specifically above the C3 level, they are ventilator dependent. This creates a huge risk for pneumonia, especially for bugs that are quite drug resistant (Pseudomonas, Stenotrophomonas).
  4. UTIs are an enormous problem. In fact, 3 of the 4 SCI admissions I’ve had this year so far were for UTIs. In these patients, every time you treat a UTI with antibiotics, you treat it incompletely – it is impossible to fully sterilize a bladder with an indwelling Foley or suprapubic catheter. The plastic also develops a biofilm around it not easily penetrated by antibiotics. Regular catheter changes haven’t been shown to help. So often, what we get are superbugs resistant to bunches of drugs (for instance ESBL Proteus or Klebsiella) and we dive right for a heavy-hitter antibiotic (usually a monobactam like meropenem). When diagnosing a UTI in a patient with an indwelling catheter, you can’t only look at most recent urine cultures – you should really look back over months of these results and treat all of the old bugs as well (since bets are that the bladder was not sterilized). When we are treating polymicrobial infections or two separate foci, for instance osteo + UTI, things become even more complicated.
  5. If these patients do become septic, because of the autonomic dysregulation and the constant low-level infections, it is sometimes difficult to tell. This makes things even more difficult, because we become unsure about when to pull the trigger on last-ditch antibiotic therapy. We start them too soon and we risk creating more superbugs. We start them too late and we’re behind the 8 ball sepsis-wise.
10

Depending on the extent of paralysis, and the age at which it occurs, you have the following to look forward to:

Dysphagia, apnea, pneumonia, constipation, dehydration, malnutrition, progressive diseases of the peripheral circulatory system, muscular atrophy, severe weight gain, or loss, either of which will have side effects, tissue necrosis from several sources, including bed sores, and loss of peripheral circulation, environmental deprivation, depression, anxiety, alienation, endocarditis, periacarditis. pneumo-cystosis, MRSA, drug sensitivity, drug reactions, congestive heart failure, hepatitis, renal insufficiency, and of course, the same old colds and such that you would have normally.

All of these can be ameliorated with extraordinary nursing care, which is, unfortunately very difficult to get, and very expensive. What you can get is people who don’t speak your language, and won’t be working for you for more than a year, most likely. It is the latter case that will prove fatal, of course. Since good caregivers come from all nations, as do mediocre ones.

Grim news, sorry. Some people overcome the odds. They, or the family surrogate that keeps the standards up are called “That old bitch” in the trade.

Tris

11

My SIL is only 40, but I may start calling her “that old bitch” just to keep her spirits up. :slight_smile:

12

Happily my question is only hypothetical. I hope no one thought otherwise.

13

I toast “the old bitch” with all honor.

:smiley:

Tris

14

Heh. I saw the subject line before I saw your name, and thought “Hm, I’ll bet that was Skald that posted that; it sounds like something he’d ask about for his novel”. Temporarily forgetting, of course, that it’s out of your hands now.

15

And REALLY frustrating, too. Ah well.