COMMON COMPLICATIONS OF SPINAL CORD INJURY: LOW BLOOD PRESSURE AND DECUBITUS ULCERS
Low blood pressureNormal methods of maintaining blood pressure are sometimes damaged by spinal cord injury. Blood pressure may drop suddenly when moving from a lying to a sitting position, especially during the first few weeks after the injury. This phenomenon, called orthostatic hypotension, is what Franklin experienced when he got dizzy the first few times he tried to sit up.To prevent a substantial drop in blood pressure when sitting up, you may need to wrap your legs or use an elastic belt around your abdomen in order to eliminate pooling of blood. Rising slowly also helps. At first you may feel faint and may even pass out, but this will improve with practice. Often, as in Franklin’s case, the problem is eliminated spontaneously with regular sitting and activity. For those with severe problems sitting up, a tilt table is sometimes useful. Faintness and dizziness on sitting up can recur whenever you’ve had prolonged bed rest.
Decubitus UlcersPressure sores, or decubitus ulcers (also known as bed sores), develop on the skin in areas subjected to prolonged pressure that temporarily decreases the blood flow to that area. The skin can easily recover if the pressure is relieved, but when pressure persists, pain and eventually irreversible damage can result.Decubitus ulcers are a potential problem in the absence of normal sensation in the skin, because the individual does not feel discomfort after putting pressure on one area for too long. The first approach to preventing decubitus ulcers when you are confined to bed is to change position every two hours, turning onto the side or onto your back. Once you begin sitting up in a chair, regular pressure releases will get pressure off the sensitive areas. These will become part of your daily routine for the rest of your life. The several kinds of pressure releases relieve the pressure of body weight from particular areas of skin.A common type of pressure release for those who can use their arms is a wheelchair pushup, using both arms to lift your body above the seat for about a minute to relieve pressure on the buttocks. If you cannot use your arms, pressure can be relieved by using an electric wheelchair that automatically tilts back your upper body and thus shifts your weight. To prevent decubitus ulcers from forming while you sleep, you may need to change position every few hours. This may require assistance from another person.
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THE CANDIDA-ASTHMA CONNECTION: TRIALLING DIETSOver the past twenty years we have experimented with over one hundred different diets. There is no question that if an individual is on a poor diet and lives on junk foods and take aways, almost any diet will be an improvement and therefore the person will be healthier and probably feel better. But that is not the same as saying that this or that diet ‘cures’ Candida, asthma or an allergy. Some, like the ‘metabolism-balancing diet’ (also known as the ‘bio-balancing diet’, are inappropriate for many people. Others will be useful for some people but not for others. Unfortunately diets have to be tailored for the individual. If someone is unusually sensitive to nightshades, then tomatoes and potatoes may have to be excluded. Others will need to avoid foods containing natural salicylates and many, if not all, asthmatics tend to do better on a regime free of milk and sulphites. Many digestive problems are related to a gluten intolerance and gluten free diets can help to treat asthma and Candida by lowering the total load.Can Diet Alone Cure Candida?In some cases this may be possible. In the vast majority of people, however, Candida invasion can only be stopped if the focus of infection, the gut, is treated. And that almost invariably requires some form of anti-fungal medication. Your doctor should be able to advise you after judging the severity of your condition by interpreting the results of some of the many available laboratory tests. Sometimes people believe they have been cured because some or most of the symptoms disappear after they have followed an elimination or anti-candida diet for a while. When the appropriate tests are carried out, however, Candida is found to linger on inside cells. By testing antibody responses, we can judge whether the organism represents a threat to the patient and whether the body can defend itself. The symptoms of patients who respond well to diet alone may have gone simply because they did not have Candida in the first place, but were very allergic to some of the foods they stopped eating while on the Candida diet!There is no question that a trial elimination diet is a useful diagnostic procedure. Eliminating moulds, fungi, ferments and nutrients which contribute to Candida growth, such as sugars and refined carbohydrates, should improve the patient’s condition. If it does not, then either the Candida problem is more than just superficial and will need more vigorous treatment, or there are other reasons for the symptoms. If the diet is successful in eliminating the problems or at least making you feel a lot better, then you have achieved good results. Unfortunately though, you still don’t know if Candida was the problem or you were simply allergic to one of the foods avoided.*61\145\2*
DIABETES: TAKING ORAL HYPOGLYCEMIC DRUGS
If you are taking oral hypoglycemic pills and your blood or urine glucose levels become very high, consider increasing your dose. Naturally, whether you can do this, depends on whether you are already on the maximum dose or not. If you are not on the maximum dose, try taking another half pill a day or another whole pill if this does not take you over the maximum.One of the problems of being on pills is that they may not be absorbed if you have diarrhea or vomiting. Even if they are, they may not be sufficient to overcome the increased insulin resistance that can result from infection and other illnesses. If you have diarrhea and vomiting or if you cannot bring your blood glucose level down yourself, or if you feel very ill, contact your doctor immediately. Sometimes it may be necessary to have insulin injections to control your blood glucose level during a time of illness. This does not necessarily mean that the insulin will need to be continued when you have recovered.
Loss of glucose control on oral hypoglycemicsMany people with the form of diabetes that starts during middle age and the later years (maturity onset type) can control their blood glucose on diet and oral hypoglycemic treatment. Most people whose diabetes begins under the age of thirty years need insulin treatment but a few with maturity onset diabetes of youth (MODY) can be treated successfully with oral agents.Control of your weight through diet is especially important in maturity onset diabetes because obesity increases the body’s resistance to the action of insulin. However, if insulin production fails, whether in maturity onset diabetes or MODY, insulin injections will be needed for glucose control. This is not a disaster.Geoffrey, who is now fifty-eight years old and a production manager, had been taking chlorpropamide since his diabetes was diagnosed five years previously, gradually, increasing the dose to the maximum of 500 mg daily. Despite sticking carefully to his diet and remaining at the ideal weight for his age and height, his glucose levels began to rise. His doctor added metformin treatment and the dose of this was increased to its maximum, but to no avail. Geoffrey’s blood glucose levels continued to rise and he began to feel thirsty and had to get up to urinate several times each night. He felt tired and listless. I told him that he now needed insulin treatment but Geoffrey had a horror of injections and was convinced that he would never be able either to give his own insulin or allow anyone else to give it to him.’I would sooner die than go on to insulin,’ he said.Nothing I said could persuade him to change his mind. Over the succeeding weeks he became increasingly ill, was drinking large quantities of fluids daily, started to lose weight and was irritable with his wife and family. He developed an embarrassing soreness around his penis, a fungal condition called thrush, which men and women with diabetes can develop with poor glucose control. This was treated but it recurred. At each clinic visit I tried to persuade Geoffrey to change his mind about insulin treatment but he remained adamant. Then finally one day he came into the clinic in tears. He could no longer do his job properly, he felt awful and was badly depressed. His wife, who came with him, was very worried about him. I got out an insulin syringe and needle and demonstrated on myself how simple it is to insert the needle under the skin. After thirty minutes’ persuasion by me and his wife, Geoffrey stuck the needle into his arm.’It doesn’t hurt,’ he said, astonished.He is now on twice daily insulin injections with good glucose control, is back at work and says he feels marvelous. He wishes he had tried insulin sooner.
Call for helpEven the best informed and most efficient people have occasional Problems. It is not an admission of defeat to call for help -just common sense. Doctors greatly prefer being called when they can help prevent a problem from getting worse than when a disaster has occurred. Contact your doctor sooner rather than later.
Problems with glucose control• Hypoglycemia is preventable. Learn your warning signs – and learn from your mistakes.• Measure blood glucose levels frequently when you are ill.• Plan what to do if you become ill before it happens.• Take more insulin if your blood glucose level rises.• Check for ketones if your blood glucose level rises or you cannot eat.• Never stop taking your insulin.• Do not be afraid to call for help.
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