New Beginnings: Health Check

Posted by Nurse Linda in Life After Paralysis on January 26, 2022 # Health

Doctor holding a stethoscope There are many ways to make new beginnings in a new year. These can be made at any time, but the change of the calendar to an entire new year is really a mark in time to think about changes or improvements. I hope you have been thinking about ways to improve your life-even if it is fantastic-there is always room for changes. Change does not and should not be made in huge leaps at one time, but small incremental steps toward bigger goals. Just a small switch can affect your life in a positive direction. Starting with complicated high-level goals can slow your progress if too much change and adaptation are required all at once.

An area of self-improvement from everyone is a health review. Looking at how your body is progressing is an important step to maintaining a strong sense of wellbeing. This includes both physical and mental health.

One of the changes in healthcare due to the pandemic is the use of telemedicine. Whereas it may have been difficult to make it to a checkup, the use of telehealth has increased the availability and comfort of checking in with your healthcare provider. A medical check-up in person for hands-on examination is essential; however, a check-up over the computer can also provide immense benefits. You can explain your health concerns in the privacy of your own home. I wonder how this will affect healthcare in general as it has been well researched that being in a physician’s office, often naked, prevents hearing and understanding health instructions. In your home, you are comfortable and could be less apt to miss important instructions. If needed, you can send a photo or show a live video of a point of concern such as a skin pigment change, demonstrate movement issues, and discuss personal concerns. The downside is the physician not being able to listen to your heart and lungs or feel areas of your body that need assessment.

Using telehealth is up to your preferences. A hands-on personal healthcare visit is necessary at least once a year, depending on your individual health condition. How you use telehealth should be to the benefit of you and your healthcare professional for your wellbeing. Perhaps an in-person, one time per year examination with telehealth follow-ups is a good plan. In-person visits with your primary physician and telehealth with your specialists may be the way to go for you. Or perhaps you need more in-person time with your specialists. If you live a distance from your healthcare provider or if going outside of your home is a challenge, as with COVID, telehealth is a viable alternative. Decide what is best for your health status.

There are appointments that you will want to keep through the years. These include vaccinations for flu, now COVID, pneumonia and shingles if that is recommended for you. The schedule should be maintained as the time between boosters is different. COVID vaccination time points are still evolving.

Some testing should also be maintained. This includes yearly bone density and urodynamic testing. These tests are necessary even if you have a history of normal results. Bone density and urological functioning are generally normal until one day; suddenly, it is not. Keeping up with normal tests is critical, so when there is a slight change, a correction can be made rather than waiting until the damage is done.

Coloscopy testing should be done every 10 years, starting at age 45 to every five years, depending on your results. Finding changes early allows for earlier treatment with better successes. Some payors will allow an overnight inpatient hospitalization for the bowel prep.

If you have issues with your respiratory system, pulmonary function testing may be needed on a regular schedule. Testing can keep further concerns at bay to help with successful treatment as needed.

Something to do annually is to review the big three, bowel, bladder, and skincare procedures. It is so easy to skip a step here and there as we are all rushing through the day. Review the procedures for bowel programs step by step. Compare to what you are doing. Check for hydration and roughage in your diet. Does your suppository or mini enema provide bowel stimulation without excessive mucous? Do you place it next to the bowel wall where your body heat will dissolve it in a timely manner? If you are performing digital stimulation, are you kind to your body by doing it gently? Aggressive stimulation triggers tone (spasms), which contracts the sphincters making the process slower as well as increasing the development of hemorrhoids. Is the overall time taken to perform your bowel program acceptable to you? Do you do the bowel program on schedule?

Bladder programs must be performed on a timely schedule to avoid kidney complications. Avoid stimulants that create excessive output, such as caffeine and alcohol. Drinks such as soda, alcohol, and many power drinks have sugar which creates an environment in your bladder for urinary tract infections. Typically, intermittent catheterization is done at a minimum of four hours to a maximum of six hours between catheterizations, depending on intake. Wash your hands thoroughly before and after catheterization. Use a generous amount of lubricant to create a smooth entry to the bladder. Change the dressing for a suprapubic catheter as directed by your healthcare professional. If you find your catheter is not working well for intermittent, indwelling, or suprapubic use, talk with your healthcare professional about a different style, size, or type of catheter.

Skincare often becomes a secondary issue for individuals with paralysis, but it should always be a primary concern. Check your skin frequently for pigment changes. Remember, a pressure injury begins deep inside your body where you cannot see it forming. By the time you see a pigment change, the damage inside your body is much more. Stay off any developing spots. Resolving a spot is much easier than healing an open area. Check your skin by looking at your naked body several times a day. Use a mirror or personal camera to look at difficult-to-see areas and to record your progress. Perform pressure relief maneuvers even if you have pressure dispersing equipment. The equipment can help prevent but cannot eliminate pressure injuries. Be sure your diet and hydration are healthy as nutrition is reflexed in your skin. Keep your skin hydrated with emollients as well. Reduce callouses over time to avoid cracking skin, allowing bacteria to enter.

Silent Autonomic Dysreflexia (AD) is a huge issue that is only now coming to the forefront. This is a miscommunication in the autonomic nervous system, the part of the nervous system that controls things that happen in the body automatically. Check your blood pressure periodically at random times of the day and night, especially with different activities, including self-care. Elevated blood pressure indicates silent AD or AD without symptoms. More information can be found here.

Mental health should also be evaluated at least once a year, if not more frequently. Assess your state of wellbeing. Are you happy? Are there things in your life that you would like to change? Are these things possible to change? If not, how can you adapt your living style to accommodate them? Many people are content in their own skin and circumstances. That is great. Often individual’s lives are disrupted by paralysis. You can help your body and your mind with movement. Your body craves movement. That is the way it is made. If you add moving the body parts that you can as well as you or someone moving your body parts that are challenging, your body will respond positively. It is a fascinating phenomenon that your physical body moving will improve your mental wellbeing because it is getting the input that it craves. This will not occur with one session of moving every joint in your body, but over time, you will notice a shift in your mental status.

This sounds like a lot of things to do, especially while reading one right after another. However, not all these activities need to happen in one day. I like to do many of my yearly healthcare prevention care around my birthday as I give myself the gift of health. The new year is also a good time to plan your healthcare activities for the year. How you like to organize your time should be on your own time plan, but these basic activities should be completely reviewed with a lot of thought and self-evaluation at least once a year. Of course, keeping up with them daily is important. Nurse Linda

Pediatric Consideration:

All the strategies used for adults can be used with developmental adaptions for children. Setting a good healthcare regimen in childhood will translate into a process for adulthood.

One strategy that should be included for children, and probably for adults as well, is the element of play. Making a game of doing the healthcare checks as well as in daily activities helps make the process more enjoyable. Nurse Linda

Linda Schultz is a leader, teacher, and provider of rehabilitation nursing for over 30 years. In fact, Nurse Linda worked closely with Christopher Reeve on his recovery and has been advocating for the Reeve Foundation ever since.

In our community, Nurse Linda is a blogger where she focuses on contributing functional advice, providing the "how-to" on integrating various healthcare improvements into daily life, and answering your specific questions. Read her blogs here.

And if you want more Nurse Linda, sign up for her monthly webinars here. Don’t worry, we archive her answers so you can refer back and sift through her advice. Consider it Nurse Linda on-demand!

The National Paralysis Resource Center website is supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $8,700,000 with 100 percent funding by ACL/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS, or the U.S. Government.