dysreflexia with a smile?

Whatup! Good enough day of therapy to warrant an update before I forget, but you'll have to dig in pretty far to get to the happy part.

The day actually started out not so great. I woke up around 4:30a and couldn't get back to sleep - that means maybe 3.5h of z time, slightly reminiscent of school... Then we started getting up at 7:00 to be on time for the typical Monday's bummer of a 9:00 session. Blah.

---[don't be worried in this part]---

Commence Giger. Pedal pedal pedal. After a little while - not even 1000 revs, as the resistance was up perhaps just a bit too high - I could feel my blood pressure creeping up. I was having a rather difficult and rather not fun time on the Giger already, so once the BP jump started, I wasn't sad to ask to get out of the machine. Good idea.

Feel free to e-mail me questions (thejlink at gmail dot com) or post in the comments if the following is incomplete, confusing, or flat out incorrect. For that matter, I'd appreciate confirmation that I have a clue what I'm talking about...

Quick medical lesson: Autonomic dysreflexia (AD) is a syndrome that troubles many spinal cord injury patients with higher injuries, including me. The deal with AD is that the brain/body (the "autonomic" part) misinterprets and therefore incorrectly responds to messages sent from stuff below the level of injury (the "dysreflexia" part). Common messed up signals are temperature extremity/irregularity, needing to go to the bathroom, and anything that should cause pain, among others. Common reactions are nausea, sweating, body temperature change, a dramatic increase in blood pressure, redness, headaches, dizziness, eye pain and more. Severe dysreflexia, not treated right away, can cause stroke and death and stuff. Don't be scared! It's not a big deal, and even useful on occasion, as long as everything is under control. Treatment involves (1) fixing the reaction and (2) removing the stimulus that is causing the problem. That wasn't a quick medical lesson at all!

In short, the patient has to go to the bathroom or whatever, but instead of communicating "I need to go!" with the normal recognizable feelings and signs, the brain cranks up the blood pressure knob, causing headaches and redness and such. To fix, the patient must be moved to as much of an upright position as possible, fetch ice packs, take the appropriate drogas if necessary, and do whatever else may be done; then, hopefully at the same time, the patient needs to empty the bladder, get off the pressure sore, find a cooler location, or stop whatever else is causing the dysreflexia.

Another note before we continue: The Giger is just about the worst position to be in when this happens. If you're lying on your back with appendages up in the air, your circulatory system doesn't really want to bother pumping blood up against gravity, so most of the blood just flows around in your head/torso. Throw in some distal vasoconstriction, and there is more fluid divided by the same volume equals higher pressure. Uh oh.

Yet another: I was prescribed an abdominal binder last week to help boost the BP, and I've actually been wearing it. As far as we're concerned, the binder is a medical corset.

So anyway, that's where I was, strapped into the inverse turtle equipment and starting to get dysreflexic. The therapists are of course very familiar with this stuff, so I was develcroed, debindered and upright at top speed. They even took my shoes off, a trick I had forgotten. To monitor pressure, I was equipped with the "angry nurse" automatic digital wrist sphygmomanometer. She loses some accuracy as pressure strays from 120/80, but this time she measured a ridiculous-but-dramatic 240/160 [corrected: thanks]! Eek! That's about four times my usual measurement, and even double that of the average human... There's no way my BP was that high, but it was ludicrous and temporarily frightening enough to evoke some therapeutic language from those around me.

No really, 240 systolic is a guaranteed stroke, and I'm still alive, my eyes didn't explode, and I'm, umm, as coherent as I get... The angry nurse is a sensationalist. Dysreflexia typically means catheter time for me, ooh yay, so that was taken care of and all was well. Game on, end scary.

---[stop not worrying]---

Here is where the rehab session was smiles. Getting back on the Giger would have been fear-provoking and a waste of time, so we moved on to mat work. Usually after the cath my BP drops back down to the point of nonfunctional dizziness... Not today. I went straight to sitting upright at the edge of the mat with no intermediate rest period, and I was able to stay upright and lean side to side with my arms on giant exercise balls [insert AC/DC song here] for about 15min without stopping to recline! This usually only lasts for 1-2min at a time before I get dizzy, with pretty heavy neck pain after two or three bouts of uprightness. Eeee! I ended up taking only two breaks total during my entire time on the mat, racking up about 30min of sitting without blood pressure loss or neck ouchness. :-)

Okay, that probably doesn't sound very exciting to you, but I felt slightly less abnormal, at least for those few minutes...

I also interrogated my main therapist about her trip to Alaska during the short sit, albeit not very well because it's a bit hard to breathe with the abdobinder. Then it was time for e-stim biking and Wii watching to round out the session. Last week someone Wii-bowled a 279. Wow.

The rest of the day was also pretty good. I even squeezed in a tiny nap.

I have no idea why this all worked out as such, but it was quite serendipitous. Hmm.