Sunday, February 24, 2013

TING AND I, Home Medical Care



A major threat to quadriplegic patients like Tina is infection, especially respiratory infection and, secondarily, bedsores. If Tina gets the flu, certain antiviral medicines may help, but basically she is on her own—her immune system must create the antibodies that destroy the viruses.

Each fall, flu vaccinations are made available to combat the current version of flu, which is different every year. In 2009, a second version, H1N1, became a threat as well.

Tina and I each get vaccinated. For people in their 60s, as we are, it reduces our risk of catching the flu by roughly 50 percent. We require our nurses to get the shots as a condition of employment, made clear in the interviews we do in selecting new hires. This reduces their risk by 50 percent or a bit more, except that some of them are in contact with large populations of institutional patients who are more likely than most to catch the flu.

In 2010, there was controversy surrounding the safety of the H1N1 vaccine, which controversy seemed to me to be overblown. Regardless, we required this second flu shot, not for the benefit of the nurses, but for the benefit of Tina. Nursing means you take certain responsibilities and some added risks, for example, you drive to work when the roads are slippery. Four of our nurses strung us along several months, not indicating they would not get the H1N1 shots. When they did not get the shots after a month’s warning of our deadline, they were fired.


Your skin protects you from infection. Remove even a modest fraction of it and microbes will overwhelm your immune system and kill you. Antibiotics can wipe out some of these organisms, but some have evolved to be multiple-drug-resistant strains that we cannot yet defeat.

Lying in bed (or sitting) motionless keeps pressure on portions of the skin near the supporting bones. Blood to these areas is not supplied or removed in normal amounts, so cells begin to die. Altering the patient’s position frequently can prevent this. Urine and fecal matter can irritate the skin, making it more likely to fail. Sliding associated with being moved can exert shear forces that can tear the skin. Once such a sore, a bedsore, develops, the patient is at risk for systemic infection and death; thus, bed sores must be prevented, and treatment started at the first sign of a developing problem.

We had one such sore during Tina’s paraplegic period (1994-2004) and one during her current period of quadriplegia (post 2004). The first was due to inadequate attention by a home health aide and me. We should have changed her position more frequently and taken greater pains to keep her clean and dry. The second bed sore resulted during hospitalization, with unusual urinary and bowel incontinence as contributing factors.

At home we have taken many steps to prevent bedsores. We have an air mattress with a checkerboard pattern of air pockets: when the “black” squares are up, the “red” are down and vice-versa, thanks to the action of an air pump that every few minutes changes from inflating one air path and suctioning the other, to the reverse. We also put her on her side a total of a few hours each day. Being placed on her side is less than optimal for Tina, because she cannot rest as well or see the TV as well, but it works out, especially during daytime naps and some periods in the overnight shift.

Our staff has told me horror stories of fist-size bedsores down to the bone on nursing home patients who received inadequate care. By that stage the sores are deadly. Too many patients, too few staff, poor morale among the staff all can contribute. Once a bedsore starts to develop, it is admittedly a challenge to reverse.

Christopher Reeve was the well-known actor (Superman) rendered quadriplegic by the severing of his spinal cord in an equestrian accident in 1995, the year after Tina became bedridden. We closely followed developments in his case. Until 2004, he wrote and spoke as though he believed his spinal injury would someday be cured. That year he stated that he had lost that faith; bedsores recurred, despite presumably the best of care, and he died from the infection or from a reaction to the antibiotic given to treat it. Small, but deadly are bedsores.

We care for Tina’s skin very, very diligently.

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