Immunosuppression

Posted by Nurse Linda in Life After Paralysis on May 15, 2020 # COVID-19, Health

The immune system consists of parts of the body that destroy invaders that may cause us to feel ill or even harm us. These include pathogens such as bacteria, viruses and parasites. Neurological disease or injury can affect the immune system.

Parts of the Immune System

The main organ of the immune system is the spleen, which is located on the left side of the body, just under the lower ribs. The spleen acts as a reservoir to hold white blood cells. It will release the stored white blood cells when they are needed.

White blood cells or leukocytes are created in bone marrow. That is the soft substance inside the center of the bones of your body. There are six different types of white blood cells. Each type of white blood cell fights different kinds of infections. White blood cells will produce natural antibodies which will attach to the pathogen to destroy it. Your body makes antibodies from white blood cells but sometimes that is not enough to fight off some rapidly multiplying or difficult to rid pathogens. Then laboratory made (prescription antibiotics) must be taken to resolve the infection.

The lymphatic system is present throughout the entire body. At any point in time, some white blood cells and natural antibodies are circulating through the lymphatic system at the ready to destroy pathogens when encountered. Lymph nodes are located at various positions within the body. Pathogens are trapped and destroyed in these nodes which will swell when many pathogens are collected there. You might notice a swelling in a lymph node when you have an infection. When you have a cold or sore throat, you might feel a swollen lymph node in your neck. Depending on where your infection is located, lymph nodes might be felt in places such as under your arms or in your abdomen.

The Interaction Between the Nervous System and the Immune System

Like all actions of the body, simple functions such as a white blood cell encountering and neutralizing a pathogen can happen spontaneously. However, when a larger attack to an infection needs to be made, a signal is sent to the brain that will respond with the release of activity to counteract the invader. This can be releasing the stored white blood cells stored in the spleen, producing fever to elevate the body’s temperature to a point where the pathogen is less able to survive, increasing the production of natural antibodies, vomiting, diarrhea, coughing to expel the pathogen, changing hormonal production to alter the body’s ability to host the pathogen or any combination of these activities.

The brain’s response to an invading pathogen occurs in the part of the nervous system that is called the autonomic nervous system (ANS). The autonomic nervous system controls body activity that happens without you making a conscious decision, in other words, automatically. Body functions that are autonomic are things like your heart pumping, kidneys filtering, breathing, all action that keep you alive. Automatic control of the immune system is an automatic function.

After spinal cord injury, your autonomic system is affected. This can be a lot or just a bit depending on the level and degree of your injury. Since the autonomic nervous system is affected, the ability to respond to the needs of the immune system can be slowed as the messages to fight a pathogen may not be correctly or urgently sent to the brain for a quick response. Those with injury to the cervical and thoracic spinal cord have the greatest effect of immunosuppression.

The most complex system of the body is the nervous system. The second most complex system is the immune system. When one part or all the immune system is not working or slow in working, the system is compromised. A diagnosis of immunocompromised is made.

This is an oversimplified version of why individuals with spinal cord injury have immunosuppression. Other systems must be working effectively, efficiently and in balance to keep the body healthy. This includes production of hormones, brain responses, blood cell formation and function among many other delicate systems of the body that need to keep the immune system functioning at a top level.

Other Factors Affecting the Immune System

Individuals with spinal cord injury can develop secondary complications such as pneumonia in the respiratory system, urinary tract infections and open areas on the body from pressure injury. These situations can come with an increased risk of infection. The autonomic nervous system may not be able to respond in a timely fashion to defeat the pathogen from multiplying. Or the pathogen may be able to multiply before an effective response can be made by the body.

Keep Yourself Healthy, Take Extra Precautions.Washing hands

Wash your hands with soap and warm water for 20 seconds, frequently throughout the day. If soap and warm running water are not available, use hand sanitizer. Be particularly vigilant with this activity especially before and after suctioning, catheterizing, performing a bowel program or changing a wound redressing. Also, wash your hands before and after going outside.

Wash your face when you have been with other people, especially in crowds. If you are seated as your usual form of mobility, remember you are below the respiratory droplets of others. Standing does not resolve the need to keep the open areas of your face clean as respiratory droplets float around in air currents. However, seated is below everyone else where the droplets will eventually be brought to the ground by gravity.

Avoid touching your face with your hands. A pathogen can stick to your hands which then will enter your body if you rub your eyes, touch your mouth, nose or ears. Pathogens can also enter your bladder or bowel during toileting activities. If you have a cut in your skin, the pathogen can enter directly into your body.

Dispose of tissue immediately after you cough or sneeze. Do not keep it for a second use. The pathogen will stay on the tissue and be ready to enter your body on the second use. Have tissues at the ready for a sneeze. Carry bags for disposal of tissue if you will not be close to a disposal site. A self-closing bag works well. Wash your hands or use hand sanitizer immediately after disposal of your tissue.

Eat a well-balanced diet. A consultation with a dietician is generally covered by most health care payors. They can direct you with information about the diet that is right for your specific healthcare needs. That will include calorie intake for your metabolism. With a well-balanced diet, you might not need extra vitamins but discuss this with your healthcare provider to be sure you are not taking vitamins that will store in your body leading to toxicity or other health concerns. Also, discuss any medication, supplement, inhalant or lotion to ensure it is not counteracting with your regular medication regimen.

Drink fluid as your individual health care plan allows to keep well hydrated. This includes water. Avoid alcohol and caffeine which can dehydrate your body. Water helps flush pathogens out of your body.

Stop smoking, vaping or inhaling any other substance which can result in pathogens in your lungs as well as robbing your body of oxygen.

Keep up with vaccinations including an annual flu shot, every decade pneumonia shot. Discuss your need for a shingles shot with your healthcare professional. These will provide you with immunities that your body might not produce on its own.

Allow time for sleep so your body and mind can rest and reset. Natural sleep is a great healer and refresher.

Exercise daily. Your body functions below the level of injury, it is just not getting the message from the brain to do so. All our body’s crave movement. Provide movement either actively or passively. Your body will like it. The benefits will greatly affect all your body systems, including the immune system.

Report infections early so treatment can begin. Waiting allows time for the infection to grow and possibly overwhelm your body. Early treatment for an infection creates the best outcome especially when your immune system is compromised. Nurse Linda

Pediatric Consideration: Vaccinations have become a significant issue for parents. There is a lot of misinformation that surrounds them. The people that have spread this misinformation have been discredited. One researcher went so far as publishing fabricated data indicating a false connection between vaccination and autism. His response was that he felt so strongly about the connection that he created a fake data set that demonstrated a relationship. It was not until others could not confirm his research that he admitted his actions. There is no scientific connection between vaccinations and autism.

At six months, it is time to start the flu shot. Each year, strains of flu are identified as those that are thought to be in the community. As the years go by, your child’s immunity will become stronger as they have a different vaccination every year. Allergy to eggs is a contraindication for the flu shot. Discuss with your child’s healthcare provider to ensure your child is eligible for the flu shot. Nurse Linda

Linda Schultz, Ph.D., CRRN, a leader and provider of rehabilitation nursing for over 30 years, and a friend of the Christopher & Dana Reeve Foundation for close to two decades. Within our online community, she writes about and answers your SCI-related healthcare questions in our Heath & Wellness discussion.