Medically Speaking - The benefits of an annual check up
My articles, over the course of this year, have covered some of the common health complications that can occur in people with a spinal cord injury (SCI). Some, if not all these complications, can easily be avoided, by early detection. This applies, especially, to complications relating to pressure sores, spasticity (contractures), and urological problems. The old adage, “prevention is better than cure,” rings true in cases concerning the care of SCI individuals. The problem is that many patients do not schedule regular appointments, as several of these complications are asymptomatic. The opportunity for early detection is often missed and more treatment is required to fix the problem.
What does a check up entail?
A review of the patient’s urological status is vital. We need to look at what is happening with the bladder – the bladder is not a static organ and changes over time. The baseline tests include the basic bladder and kidney sonar or ultra sound. These tests give us a good idea of the state of the kidneys and the bladder as well as whether there are any obvious concerns regarding scarring or cysts. It also shows whether the bladder is emptying well, and if there are any signs of back pressure on the kidneys (hydronephrosis - an urodynamic test may be performed). The tests will also reveal any kidney, or bladder stones. If they are detected at an early stage, these stones are easy to treat. A small bladder stone can be removed in a doctor’s room, but if left untreated or missed, these stones can become the size of a golf ball, which requires an operation, where an incision is made in the bladder to remove them. Some blood tests are also performed to establish if the kidneys are functioning well.
Secondly, a good look at the patient’s skin is important. Are there any pressure areas of concern? Is the seating adequate, or is there a concern that poor posture may be putting a patient at danger of pressure sores? At this stage, you may be referred to a therapist to review this matter.
Your cushion or wheelchair may not be suitable anymore due to changes in your weight or posture. If scoliosis is suspected, a doctor may order X-rays to measure the curvature of the spine.
Your range of motion will also be monitored, if your motion has been reduced, it could be a result of boning (see the Sep/Oct issue of Rolling Inspiration) or contractures due to lack of stretches, or perhaps spasm. Contractures will affect your posture which may have an impact on pressure sores. Your doctor may refer you to a hand clinic (if the upper limb is involved) or an orthopedic surgeon.
All your medication will also be reviewed as not all medication needs to be taken for the rest of your life. Decreasing the amount of medication you take may improve your health. We review common drugs, such as antispasmodics – do you still need to take them or are there alternatives or a possibility of reducing dosages? Many patients take medication for neuropathic pain. The doctor will decide if these drugs are still required and whether the dosages are correct. Bladder medications (anticholinergics etc.), bowel medications and antidepressants should also be reviewed regularly.
Don’t forget that behind every spinal injury, is a human being, who is susceptible to any normal diseases. Doctors need to monitor your general health and practice preventative care. General tests include, an annual blood pressure check to exclude hypertension, a blood sugar test to exclude diabetes (especially if there is a family history) and routine screening for an inactive thyroid should be considered based on the patient’s history. Men over the age of 50, should undergo routine screening for prostate cancer (blood test) while a colonoscopy should be performed every 5 to 10 years after the age of 50, in all spinally injured people. Ladies, please don’t forget to visit your gynecologist for a breast exam and PAP smears.