Skin care after spinal cord injury | Guest Blogger Kate Willette

Posted by Reeve Staff in Daily Dose on April 26, 2017 # Health

The first time I heard about skin issues after spinal cord injury was in April of 2001 when my husband sustained his injury. When he was an inpatient at Harborview Medical Center in Seattle for about six weeks, we were required to watch an online video that was mostly about pressure sores. It completely freaked us out.

The rehab nurses told us over and over about doing pressure releases, and we knew bad things could happen if we forgot – but until we saw the video, we didn’t get it. We were more focused on learning to manage other aspects that came with his injury like his neuropathic pain, weak cough and spasms and, you know, being paralyzed.

One of the many things nobody guesses about paralysis is the sheer scope of what you’re up against. I’m not sure that even an obvious thing like lack of sensation would have come to mind. (I think this is called blissful ignorance.) Not being able to feel what’s touching your skin – or not perceiving it accurately – is a big deal. After SCI your skin might look normal, but it’s not going to function quite like it did before. You need to adjust the way you think about it and care for it.

One of the first times my husband Bruce had a skin infection, it started with a fever and chills that wouldn’t go away the way they normally would. We went to his doctor, who examined him and assured us he’d be fine. Lots of liquids and aspirin to keep the fever under control. A few days later he wasn’t better, so we went back . . . this time the doctor asked if it was possible he had an infection.

And then my husband took off his shoe and sock on the leg that has very little sensation. He rolled up the cuff of his jeans. And his foot and ankle were bright red, radiating heat, swollen, and obviously infected.

The doctor wrote a prescription for antibiotics and told us that if it got worse we should go to the emergency room. For a couple of days it seemed that the antibiotics were working. However, on the third day he was shaking with chills, and the fever had spiked again. I lifted the sheet he’d pulled over himself and the bad leg was now worse than before, which I wouldn’t have thought was possible.

Giant areas of what looked like water blisters were forming, and the skin underneath one had broken. The ankle was almost twice its normal size. Most frightening, there were red streaks aiming up his leg, and one of them was already high on his inner thigh.

We drove straight to the ER.

Fast forward a few years . . . Fever. Chills. This time we went right to the leg, and sure enough, it was already turning monstrous: bright red, warm to the touch, swollen. At the ER this time we ran into a little bad luck.

After checking in and seeing the intake nurse at 11pm, she took a few notes and went away. Every hour or so after that, I went out to ask why they hadn’t sent a doctor in to see him. At around 5 am, I finally succeeded in getting someone to send a doctor. By that time, the leg was again much, much worse. The red streaks were moving upwards from his knee. The doctor looked, spoke to us for all of two minutes, and suddenly we were signing papers to admit him.

Half an hour later I happened to be walking past the area of the ER where the overnight staff was having a meeting with our doctor, who was delivering an urgent lecture on how to recognize a serious skin infection and what to do when one came through the door. He sounded angry.

I was angry with myself for not pushing harder to get someone’s attention. Over the years we’ve run across more than a few medical professionals who lacked even basic knowledge of how the body works after a spinal cord injury. The difference between knowing for yourself what’s critical is often the difference between home and hospital.

My husband spent the next few days in the hospital and came home with the skin on that leg even more fragile than it had been. He examines it and uses lotion on it every single day now, and so far, so good.

This booklet is meant to make sure nobody lands in the ER, especially when understanding a few simple routines could have prevented it. Skin can repair itself, but only some of the time. After spinal cord injury, there are some problems with the system. Nothing that can’t be easily dealt with, though, if you know how.

For more information on the importance of skin care while living with paralysis please request or download the free booklet Pressure Injuries and Skin Management.