Life on Wheels (17 page)

Nausea

Blurred or spotty vision

Nasal congestion

Goosebumps

Slow pulse

Anxiety

Many people learn to recognize the signs of high blood pressure early and find they can manage episodes of AD. However, if signs persist, it is very important to get immediate medical attention. There might be a fracture you are unable to feel or a urinary infection of which you are unaware.

If symptoms appear, the first thing to do—after removing the offending stimulation, if possible—is to sit up. Elevating the body helps reduce blood pressure by encouraging pooling of blood in the lower extremities. Check if your leg or bedside urinary drainage bag is full. This could indicate a distended bladder that is backed up and causing the event. Empty your bladder if you can, but empty no more than 500 cc at a time, since this can cause spasms, which would exacerbate the situation.

If you need to go for medical attention, the first thing a physician should do is check your catheter or take measures to empty your bladder. You might need to be catheterized. The act of catheterization itself could increase stimulation to the nervous system. The treater might use an anesthetic jelly such as lidocaine to minimize sensory input and relax the urinary sphincter muscle to avoid exacerbating the problem. A physician should also check for fecal impaction. A physician might gently clear some stool at the opening of the rectum. Again, an anesthetic agent might be used. In some cases, the physician might give you an antihypertensive drug to quickly bring your blood pressure under control while he continues to work to identify the cause of the AD.

If you are being treated in a general emergency department or by your family physician, it might be necessary for you to educate the staff about AD, since they will probably not have treated AD very often.

During medical treatment, your blood pressure will be monitored closely, since it can change quite quickly during an episode of AD—as quickly as every two minutes. You might be watched for as long as two hours to ensure the episode does not recur. It is necessary to be certain that the cause is removed, rather than simply improved by short-term treatment. If the episode of AD is serious enough, you might be admitted to the hospital for closer observation.

A medical alert card for autonomic dysreflexia is available from the Paralyzed Veterans of America. The card includes instructions for how to help if someone needs to assist you in an emergency. Information on how to contact the Paralyzed Veterans of America is given in the Appendix.
²

Bladder cancer is not widely seen in the general population, but its incidence is slightly higher among people who rely on catheterization for bladder management. In a study of 2,660 records at Craig Hospital in Denver of people with SCIs, only 13 cases of bladder cancer were found, or less than 1%. Still, it is worth knowing what measures you can take to reduce the chances further.

Bladder cancer is more likely when there is repeated irritation to the bladder. Tumors have been seen inside the bladder at the point where a catheter makes regular contact. Indwelling catheters and suprapubic catheters are thought to be the greatest potential risk. People who use intermittent catheterization are less vulnerable. Infections are also an irritant— whether you are a catheter user or not—as are the presence of stones. Smoking is also thought to contribute—carcinogens from smoke can be carried in urine.

Some physicians feel the risks of bladder cancer are already lowered by the development of modern antibiotics and safer nonrubber materials now used for catheters. Anticholinergic drugs such as oxybutynin (Ditropan
^®
), propantheline (Pro-Banthine
^®
), or oxyphencyclimine (Daricon
^®
) are bladder relaxants that are sometimes prescribed to aid a bladder program and that can secondarily reduce bladder irritation.

The most common symptom of bladder cancer is blood in the urine. Blood in the urine does not mean that cancer is necessarily present. Blood can also be present with urinary tract infections (UTIs) or other causes. But take the symptom seriously and get examined soon by a urologist.

The urologist might suggest a cystoscopy, a diagnostic procedure in which a scope is inserted into the bladder allowing the physician to visually search for tumors. If a biopsy seems justified during the examination, the doctor will take a small amount of tissue for testing.

Some cystoscopic biopsy reports come back with a diagnosis of “squamous metaplasia,” a form of cellular change often seen in the bladder. Physicians do not widely agree that this is an indicator of cancer—many people, disabled and nondisabled, have squamous metaplasia but never develop cancer. Yet some doctors feel this change sometimes is a precursor to bladder cancer.

The strategy for preventing bladder cancer is to limit irritation to the bladder. Prevention measures include:

Controlling infections and stones by drinking enough fluids (see the discussion of bladder management later in this chapter)

If you have a suprapubic catheter, keeping the area around its insertion in the abdomen clean and shaved

Cleaning drainage bags and tubing with chlorine bleach and water