Health Maintenance Tips for the Wheelchair Bound

The amount of time that a person can sit up in a chair is different for everybody. Start sitting for short periods of time and check your skin. When you are confident you can sit for a period of time without skin irritation, then increase that time by a small amount and check your skin after that time. If you do get skin irritation, the best thing you can do is to stay off of it until it heals. Skin irritation can become a sore in just one day. So don't take any chances. A pressure sore can take months to heal and sometimes requires plastic surgery.

Periodically adjust your sitting position by reclining your wheelchair backrest or have someone reposition you in the wheelchair. People without disabilities can not sit in one position all day so don't think that you can. Mark periodically reclines the back of his wheelchair to relieve the pressure off his rear, stretch out his legs, and reduce the swelling in his feet. Also, Mark has a roommate raise and reposition him in his chair at lunch, dinner, and sometimes in the evening.

Always watch your body throughout the day. It will usually let you know if something is causing pain that you cannot sense. For instance, your arm or leg might continue to spasm in an unusual manner, or you might begin to have goosebumps and sweat. Don't ignore what your body is telling you. Get someone to check the things that might be causing your body to react in an unusual manner.

Just about anything that touches your body can cause a pressure sore.

• Wrinkles in clothing

• Shoes

• Compression stockings

• Wheelchair armrests

• Wheelchair foot plates

• Wheelchair sides

• Wrinkled bed sheets

• Abdominal binder

• Arm, knee, or ankle straps

Wrinkles in your clothing can cause skin irritation or even sores in just one day. When you first get up in your chair always check for wrinkles in your pants, shirt or any other piece of clothing that might pinch your skin. Mark likes to wear jeans, so to reduce the irritation of the pants, the back pockets are cut off by removing the stitches which hold them on.

Mark has tried to wear shoes to protect his feet but shoes have always caused him skin irritations. So Mark has chosen to wear knitted socks and is careful not to smash his toes into any objects. The compression stockings that Mark wears will cause skin irritation at the top of his legs. Mark prevents this by insert an unwrinkled tissue between the stocking and his skin where the irritation has occurred. Parts of Mark's wheelchair come in contact with his body. So Mark uses the foam from a life preserver to pad the areas around the point of impact to the skin. For instance, the top part of Mark's leg rest hits the side of his leg causing irritation. Mark places a thick and long pad below the point of contact to prevent his leg from touching the pressure point. The following picture shows the pad placement.

Mark does not have functioning back or abdominal muscles. Therefore, an abdominal binder is needed for his back support and to hold his internal organs in place. The binder must be placed in the correct position to keep the binder from irritating his skin. Mark also uses knee straps to hold him up in his chair.

As Mark slides down in his chair the knee straps can become tight. Mark has created knee pads that are placed underneath his pants that protect his knees from the knee straps. These knee pads are filled with a strip of foam from a life preserver. The foam is covered by a vinyl material and double-sided Velcro is attached to the material so that the knee pad can be attached to Mark's knee. The following picture shows one of Mark's knee pads.

Mark uses armrests to support his arms and to keep his shoulders from separating at the shoulder joint. These armrests can put a great deal of pressure on Mark's elbows. To prevent sores on Mark's elbows, two square pieces of egg crate foam are cut and placed under Mark's elbow.

Basic In-dwelling Foley Catheter Care

There are many methods used to maintain a paralyses persons urinary tract. You should find a urologist that has experience working with disabled patients. The physician you choose should be a doctor that will help you choose the best method of urinary care for your health and for your living situation. Mark and his urologist looked at several urinary care methods. Each method has varying degrees of medical risk. So Mark and his doctor weighed the medical risks of each method and chose a method that would maintain Mark's urinary tract but also fit Mark's living situation. They decided to use an indwelling foley catheter because Mark required a great deal of independence to go to college and an attendant would not be around to assist with urinary care methods that were high maintenance. The following paragraphs discuss the tasks required to maintain an in-dwelling foley catheter. Inserting and replacing a catheter is a medical procedure that is best taught by a medical professional and will not be covered in the following paragraphs.

Keeping your Catheter Clean

Keeping your catheter clean will reduce your chances of a urinary tract infection. Secretions build up on a catheter and can create an environment for bacteria to grow. This can give you a urinary tract infection. Mark's assistants clean his catheter every night as part of the routine of putting Mark to bed. To clean a catheter :

• Put peroxide on a cotton ball or a wash rag and use the cotton ball or wash rag to scrub off the secretions that have built up on the catheter during the day.

• Put an iodine based solution, such as Betadine, on a cotton ball and apply the solution to the catheter.

The peroxide is used because it is a very good cleaner and it easily removes secretions that have built up on a catheter. An iodine based solution is used to coat the catheter because it will kill bacteria though out the day.

Over time, an in-dwelling catheter will build up bacteria that can give you a urinary tract infection. To avoid this bacteria, periodically change your catheter. Mark changes his catheters at least every six weeks. But check with a urologist, they might have a different time schedule for catheter changes.

Leg Bag Configuration

Mark uses two leg bags to contain the urine that comes out of his catheter. Two-leg bags increase the amount of time Mark can go without requiring assistance to drain the bags. Quarter-inch latex surgical tubing is used to connect the two bags together and to connect the leg bags to his catheter. The following picture shows the leg bag configuration.

In the evening, when Mark is being put to bed, the leg bags are removed from Mark's leg and disconnected from the tube that is attached to Mark's catheter. Then, the tube from Mark's catheter is attached to a night drainage tube that is taped to a Clorox bottle. To keep Mark's tubing secure, the tubing near Mark's catheter is taped to his side near the bed so that urine coming out of his catheter flows down toward the bed and away from his bladder. This keeps urine from flowing back into the catheter and back into the bladder which can cause a urinary tract infection. When taping the tube to Mark's side, care is taken to tape the tube so that the catheter is not pulled taught. A catheter that is taped to taught can slowly work its way out of the bladder.

Leg bags should be changed every six to eight weeks because the plastic of the leg bags will become brittle and crack and the urine will begin to flow out of the cracks. Urine contains a lot of sediment that will clog connections and tubes. Clean the connections and replace the tubing periodically, hopefully before a blockage occurs.

Urine System Blockage

A urine blockage can be very serious and must be taken care of immediately. You could become urimic, which means your urine has backed up in your body long enough to begin poisoning you. Dizziness, nausea, and vomiting might ensue. Or Autonomic Dysreflexia, which is your bodies reaction to pain, might occur where you could have goose bumps, sweating, and your blood pressure could increase to a level that is very dangerous. If you have these symptoms, get help immediately. If no one is available to help you, then call 911 because you are in a dangerous situation.

A urine blockage can occur from many things.

• The catheter might be folded.

• The tubing of your leg bag system may be kinked or twisted.

• The connections or tubing of your leg bag system might have built up enough sediment to block the opening.

• The catheter may have built up enough sediment to block the opening.

• The catheter might have come out and must be replaced.

Urinary Tract Infections

If you think you have a urinary tract infection, call your doctor immediately. Usually, the bacteria that you are exposed to at home, are easy to kill with oral antibiotics if you catch the infection early. If you wait too long, the infection could become septic, which means the infection has spread throughout your body. Then treatment might require hospitalization and intravenous antibiotics. Be smart and get immediate treatment.

Some possible symptoms of a urinary tract infection are as follows.

• Bad smelling urine

• Dark colored urine

• Fever

• Achy muscles

• White discharge coming from around the catheter

• Fatigue

• Increased muscle spasms

Keep a few sterile urine specimin containers at home. Your doctor will want a urine sample taken to a diagnosic lab for testing so that he will know what type of antibiotic to give you. Take the urine sample directly from the catheter and do not touch the inside of the specimin container with anything but urine. If someone can not take the specimin to a lab immediately, then put the specimen in a refrigerator for a few hours until someone can. Do not take the sample from your leg bag or tubing. They are contaminated with all kinds of bacteria which will distort the diagnostic lab results.

The following items are the things you should do when you are being treated for a urinary tract infection.

• Drink as much water or cranberry juice as possible. The extra urine output will dilute the bacteria making it easier to kill.

• Drink cranberry juice or take cranberry pills. Cranberry will raise the acidity of urine which will make an unfavorable environment for bacteria to grow.

• If you are taking oral antibiotics read the information that comes with the prescription. Some antibiotics do not work well with dairy products and others can make you very sensitive to sunlight. Follow the directions and give the antibiotic the best environment to kill the bacteria. Always finish the entire prescription. If you do not, your infection might return or the bacteria could mutate and develop a new strain of bacteria that is resistance to the antibiotic. Some antibiotics will give you diarrhea. If this occurs, call your doctor and have him perscribe you another antibiotic. Let your doctor know that diarrhea is a big problem for the wheelchair bound.

• Rest... your body is expending energy to fight off the infection.

• Take your temperature several times a day until you are sure you no longer have a fever. If your fever persists for more than a few days or if your temperature gets above 102 degrees, then call your doctor. You might require intra-venous antibiotics. Take a fever reducer like aspirin or tylenol.

The following items are the things you should NOT do when you are being treated for a urinary tract infection.

• Do not drink any fluids containing diuretics: tea, soft drinks, coffee, beer, and even some bottled water. Read the label on anything that you drink and look for caffeine or alcohol.

• Do not exert yourself. Your body needs all the energy it can get to fight off the infection.

• If you feel cold or chilled for no good reason, your discomfort is probably because you have a fever. Do not wrap yourself in blankets or do anything that will raise your body temperature. You want to keep your temperature under control.

Basic Lung Care

Breathing is often taken for granted. When Mark was first injured, he was on a respirator for three months. Eventually, he was able to breathe on his own. He learned not to take his breathing for granted. If you are a high-evel quadriplegic with limited breathing, you should do breathing exercises. Devices exist to assist you with these exercises. An occupational therapist can help you find a breathing exercise device that is right for you. Mark exercises his lungs and diaphragm by playing harmonica with his fellow musicians for several hours a week. The breathing required to play harmonica is a very good aerobic workout, strengthens Mark's diaphragm, and increases his lung capacity.

What to Do When You are Congested With a Cold

If you have limited breathing ability, catching a chest cold will be a very difficult time for you because you will not be able to cough up the congestion in your lungs. There are a few things you can do to relieve your discomfort.

• Ask your doctor to prescribe you a bronchial dilator aerosol. When you have a cold, the congestion in your lungs can irritate and restrict your bronchial passages. This can make it very difficult for you to breathe. A bronchial dilator aerosol can give you immediate relief.

• Percussion is a manual technique used to break up congestion in your lungs. To administer percussion, lay in bed on your side and have an assistant cup their hands and slap them on your side, back, and chest so that the slap makes a popping noise. Then turn on your other side and have the procedure performed again. Make sure your assistant does not slap too hard and bruise you. When Mark has a cold, he has percussion done at night while he is being put in bed, and in the morning when he is getting out of bed.

• Have your assistant help you cough. This is done by having your assistant press under your diaphragm, just below your rib cage, while you are coughing. This takes some timing so counting to three and then coughing can help synchronize the coughing with the press under your diaphragm. Make sure your assistant doesn't press too hard and bruise you or possibly brake your ribs.

How to Recognize Pneumonia

Pneumonia is a bacterial infection of the lungs. If you think you have pneumonia, call your doctor immediately because pneumonia can be very serious and possibly fatal. As with any infection, the sooner you treat an infection the easier it will be to kill it with simple oral antibiotics. If you wait too long, the treatment might require hospitalization and intra-venous antibiotics. Pneumonia can have the following symptoms.

• High Fever

• Difficulty breathing

• Achy muscles

• Fatigue

• Increased muscle spasms

What to Do When You Have Pneumonia

The following items are the things you should do when you are being treated for pneumonia.

• Drink plenty of water. Fluids will help break up congestion in the lungs and antibiotics work better if you are not dehydrated.

• If you are taking oral antibiotics read the information that comes with the prescription. Some antibiotics do not work well with dairy products and others can make you very sensitive to sunlight. Follow the directions and give the antibiotic the best environment to kill the bacteria. Always finish the entire prescription. If you do not, your infection might return or the bacteria could mutate and develop a new strain of bacteria that is resistance to the antibiotic. Some antibiotics will give you diarrhea. If this occurs, call your doctor and have him prescribe you another antibiotic. Let your doctor know that diarrhea is a big problem for the wheelchair bound.

• Rest... your body is expending energy to fight off the infection.

• Take your temperature several times a day until you are sure you no longer have a fever. If your fever persists for more than a few days or if your temperature gets above 102 degrees, then call your doctor. You might require another oral antibiotic or possibly intra-venous antibiotics. Take a fever reducer like aspirin or Tylenol.

What to Do When You Have Pneumonia

• Do not exert yourself. Your body needs all the energy it can get to fight off the infection.

• If you feel cold or chilled for no good reason, your discomfort is probably because you have a fever. Do not wrap yourself in blankets or do anything that will raise your body temperature. You want to keep your temperature under control.

• Do not take an inspectorate. An inspectorate can solidify the mucous in your lungs and make it more difficult to cough up the mucous out of your lungs.

Basic Bowel Care

Many methods are used to evacuate the bowels of a paralyzed person. You and a rehabilitation doctor should discuss the different methods of bowel evacuation and decide on a method that is the best method for your health and for your living situation. The following is a list of a few methods that might be used.

• Bowel irritant suppositories can be used that stimulate the bowel wall enough to make the bowel muscles evacuate the material in the bowel. Ducalax suppositories are an example of such a suppository. This method keeps the bowel muscles tone but can take one to three hours to evacuate the bowel. Also, a suppository contains a chemical that your body may not tolerate well.

• An enema is the process of flushing out the bowels with fluid to evacuate the material in the bowels. This method evacuates the bowel quickly and might be used when a person is severely constipated. Note that an enema does not rely on the muscles of the bowel to evacuate the material. If this method is used on a regular basis, it can cause the bowel muscles to quickly loose their muscle tone and can become permanently useless.

Bowels should be evacuated on a schedule. Rehabilitation centers usually recommend that a bowel should be evacuated once every two days. Mark schedules his bowel movements once every three days because it gives him extra time in the evenings to work or play music. You should discuss a schedule with your doctor and decide what schedule will work best for you.

What Should You Eat and Drink

If you are wheelchair-bound, an unscheduled bowel movement can be a real mess to clean up. The food you eat and the fluids you drink can have a direct effect on the consistency of your bowel movements. So for the sake of the people taking care of you, watch what you eat and drink. Mark eats mostly meat and vegetables and sometimes bread at meals. He avoids starchy foods that can make him gain weight and he also avoids foods that will pass through his bowels quickly or act as a laxative, such as fruit, melons, grains, beans, corn, hot peppers, peanuts, and peanut butter. Mark drinks about three-quarters of a gallon of water a day. This gives Mark's body enough water to keep his stool soft and his urinary tract flushed. Do not use a stool softener unless you need one. Stool softeners can make your bowel programs inconsistent and you could have many unscheduled bowel programs. Instead of a stool softener, try drinking enough water to keep your stool soft. Everyone's system can react to foods and fluids in different ways. Pay attention to how your body reacts to what you ingest and act accordingly or consult with a dietitian for information on what would be a good diet for your health and your living situation.

Bowel Program Night

Mark uses a bed method to evacuate his bowels because it does not require a specially designed bathroom which can be very expensive. Another technique uses a chair on wheels that has a toilet seat attached to the chair. A person would sit on the chair over a toilet while bowel evacuation ocurrs. Mark finds this method very uncomfortable because it requires him to sit in an upright seat for up to three hours. An assistant might also find this method inconvenient because the assistant must perform a transfer to and from the toilet chair.

As mentioned earlier, Mark schedules a night every three days in which he evacuates his bowels. The following is a list describing the tasks that are performed on a night when Mark evacuates his bowels.

• Mark's hair is washed in a sink.

• Mark is transfered to bed, his clothing is removed, and he is placed on his left side. Note that Mark is placed on his left side because the end of the bowel comes to the rectal area from the right side of the body. This relieves the bowel from fighting against gravity to push out the material in the bowel.

• A large underpad is placed under Mark's butt and paper towels are placed on the underpad to catch the results.

• An assistant puts on a glove with lubricant and checks the colon area for obstructions. If there are obstructions in the bowel, they should be gently removed.

• A Ducolax suppository is inserted in Mark's colon.

• As results occur, the paper towels are removed and replaced with fresh paper towels.

• After Mark's bowels have been evacuated, a bed bath is performed. Mark's assistant knows when Mark's bowels are evacuated by keeping a rough estimate of the amount of results Mark has had. Also Mark's bowel programs are usually very consistent from one bowel program to another. His bowel programs usually have four to five bowel movements per bowel program and his last few movements are more liquid than the first few movements. Mark's assistant is familiar with this pattern and can judge when Mark's bowel has been evacuated.

• Normal preparation for bed is performed.

What Can Go Wrong During the Bowel Evacuation Process

• A suppository might have been put in incorrectly and the chemical in the suppository does not cause the bowel to push out the material. In this situation, Mark has his assistant re-read the directions on the suppository box and has his assistant re-try inserting another suppository correctly.

• The suppository might be evacuated before it has time to melt. Mark has his assistant put in another suppository.

• The bowel evacuation process might stop before the bowel is completely evacuated. Mark has an assistant perform digital stimulation. To perform digital stimulation, Mark has an assistant put on a glove with lubricant and gently rotate a finger around in the rectal area. This can stimulate the bowel causing the bowel muscles to evacuate the material. The assistant must perform digital stimulation gently or damage might occur to the rectal area. When digital stimulation does not get the bowel stimulated, Mark has his assistant put in another suppository.

• Hard dry stool might block the colon at the rectal area. This situation can cause a person to sweat and have goose bumps (autonomic dysreflexia) because the bowel is trying to push out the hard dry material but cannot accomplish the task. Mark resolves this situation by having an assistant gently remove the material. This is also a signal to Mark that he might be dehydrated and should drink more water.

Health Care Workers

One of the most important things to understand about your care is that you are ultimately responsible for your health care. If your health care worker performs a task improperly, you will suffer the consequences. It is your responsibility to make sure each task is performed properly. Mark has developed a system or a routine that his workers follow to ensure that nothing is forgotten and everything is double checked. You should develop a system for your health care that is appropriate for your situation.

Mark has three health care workers, usually college students, that are scheduled through out the week that come in at their scheduled times to get Mark out of bed in the morning and put Mark to bed at night. The following items list the reason Mark uses three worker for his health care.

• Avoid health care worker burn out. Do not depend on one person to take care of your health care needs. One person cannot possibly be there for you every night and morning. If you attempt to rely on one person for your health care needs, that person will very quickly become tired and irritable. Keep in mind that your workers have their own lives and they must have some free time to rest and enjoy themselves.

• Have "back up" health care workers. People can become ill, injured, or unavailable to work for you for a host of different reasons. If one of Mark's workers suddenly becomes unable to work, the two remaining workers can take over the extra work load until a third worker can be found and trained or until the worker can return to work. Mark also has his roommates trained to provide for his health care. So Mark actually has five sources of help for his health care.

• Communication works well between three people. Each worker should have the phone numbers of the other workers. If a situation should arise that prevents a worker from providing care to Mark, then the worker can call one of their fellow workers to take the shift.

• In an emergency, such as a catheter blockage, Mark has five potential sources of emergency help, two roommates and three healthcare providers.

Mark's Morning Routine

Mark has a system defined for the process of getting dressed and getting into his wheelchair. The following text describe the system he has developed.

• To start, healthcare providers wash their hands. Hands can carry many germs that can give you a cold, flu, or possibly even an infection.

• Range of motion is performed. Range of motion is the process of moving a person's arms and legs in positions that stretch muscles to keep them limber and maintain circulation. A trained physical therapist should show you this process.

• If Mark's feet are swollen, his feet are rubbed to push the fluid out of his feet.

• Anti-embolism stockings are slid on Mark's legs. During the day, these socks keep fluid from building up in Mark's legs. Anti-embolism socks work best when they are stretched tight.

• Knee pads are placed below Mark's knees so that his knee straps will not create sores on his legs.

• Leg bags are put on the lower part of Mark's leg.

• An abdominal binder is put on Mark's abdomine to support his back and stomach muscles.

• Mark's shirt and pants are put on. The pants are pulled high enough so that Mark is not sitting on the belt loops of his pants. The front pocket of Mark's pants are placed under the urine drainage tubing to keep the tubing from making blisters on his hip.

• Mark is tranferred to his chair and his pants are straightened to avoid wrinkles that might create sores. There are many different ways to transfer a paralyzed person. Consult a physical therapist for a method that works best for your situation.

• The tubing of Mark's urine containment system is checked for kinks.

• Knee straps and arm straps are strapped on Mark's arms and legs to hold them in place.

• Mark is raised in his chair and his shirt is straightened out to avoid wrinkles that might create sores.

• Mark's teeth are brushed and his hair is groomed.

• Mark's water is filled.

Mark's Evening Routine

The following text describes the system Mark has developed for being put to bed.

• To start, healthcare providers wash their hands. Hands can carry many germs that can give you a cold, flu, or possibly even an infection.

• Wrinkles are removed from Mark's bed sheet.

• Mark is transferred to his bed. There are many different ways to transfer a paralyzed person. Consult a physical therapist for a method that works best for your situation.

• Mark's shirt and pants are removed. When Mark's pants are removed at night, the pocket is pulled out from underneath the urine tubing before the pants are pulled off. This prevents his catheter from being pulled down with the pants. The pants are placed on Mark's chair where they can be found by the care provider that is working in the morning.

• The abdominal binder is removed.

• The knee pads are removed and placed where they can be found in the morning.

• Mark's urine leg bags are detached from his leg and placed by his shoulder away from the edge of the bed.

• Anti-embolism stockings are remove and are placed on Mark's chair where they can be found by the care provider that is working in the morning.

• Range of motion is performed. Range of motion is the process of moving a persons arms and legs in positions that strech muscles to keep them limber and to help circulation. A trained physical therapist should show you this process.

• Mark's urine leg bags are disconnected from his urine tubing and a night drainage tube is connected which is taped no more than two inches into a clorox bottle. The tubing attached to the catheter is taped to Mark's abdomine next to the bed so that the urine coming out of his catheter flows immediately down with gravity. This keeps urine from flowing back into the catheter and back into the bladder which can cause an infection. The catheter should not be pulled taught because it could pull out.

• Mark is turned on his side and pillows are propped behind his back to keep him in place.

• A pillow is placed between Mark's knees to keep his knees from laying together and forming a sore.

• Protective boots are placed on Mark's feet to prevent his heels and ankles from getting sore from lying on the bed all night.

• A sheet is placed on Mark so that, if he were to become too hot at night, he can easily pull the sheet off with his mouth.