Thoracic Park
A tale of spinal injury
If
you’re nearby when a head, neck, or back injury is sustained, treat it
very seriously and call for help. A simple lesson in common sense, or so
you may think, but the majority of the population wouldn't immediately
recognise the problem, never mind know how to react. Despite being a
nurse, even my own response to encountering a spinal injury
displayed little common sense.
Throughout
the 90's cycling had gradually replaced running as a way of keeping
fit and enjoying our beautiful countryside. After treading both the fells and
road for many years, knee damage and back injuries left few options for
replacing the sense of freedom offered by running. In those days I
trained for marathons, regularly covering more than 100 miles each week. I
enjoyed the challenge of competition, completing the Skiddaw fell
race in 80 minutes, and a marathon in 2hrs 40.
However,
running gradually became too uncomfortable and failed knee surgery finally put
paid to the addiction. So, to get a fix of adrenalin, I'd learned to
love both road and mountain bikes. It was a new way of life for which I
soon developed a passion.
We
lived in the fabulous wilds of Argyll: Minard, a tidy village on the shores of
Loch Fyne, lying midway between Inveraray and Lochgilphead. It's Sunday
morning - the glorious 12th of August - and I've been up since the crack of
dawn fitting new front suspension forks to my mountain bike. I've never used
suspension before and it feels great, although the handling is dramatically
different. That unfamiliarity with fork suspension before tackling a tough
ride may have been unwise, but I had good company following
my very fit son, James, along one of our regular routes.
It's
a calm day, the sun's shining over a glassy Loch Fyne and the world
looks more beautiful than ever. The boy's quick today. He's getting
quicker every time we ride together and I'm working hard to keep
up. Highly competitive, he races at junior national level and handles
the bike exceptionally well. Heading downhill toward the calm
loch on a deeply rutted stretch he begins to pull away. Catching him
seems beyond me, but despite gradually losing ground I'm determined not to
be beaten. I'm forcing myself, going ever quicker and taking risks to keep up,
but my lack of skill and the new suspension...
Suddenly,
on a narrow, steep chicane, the front wheel slips away. I
desperately try to hold the steering, but get thrown head-first into
thick undergrowth. It takes but a millisecond till I feel a searing pain
and hear an ominous crack in my neck. James rushes back to where
I lie, winded and concussed despite the bike helmet. Deeply concerned, he asks
if I’m okay. Pushing aside the dented pride, I tell him my left arm is near
useless. Getting to my feet, I manage to throw a leg over the crossbar and
cycle home.
Despite
being one-handed I try hard to ignore the injury and clean the car. Not content
with that, I also do some garden weeding. But the pain gradually becomes
excruciating. My wife pleads with me to call the doctor, but I'm
in denial and ignore her. She works in neurophysiology in Glasgow, and
fearing the worst, wraps a towel around my neck to restrict head movement and
prevent further injury. Although I don't realise it, I'm but a millimetre of
fractured vertebrae from severing my spinal cord and total paralysis. It'll
take just one wrong move.
After
an uncomfortable night, Allison pleads in desperation for me to get help,
before reluctantly leaving for work 70 miles distant in
Glasgow. After she's gone I think hard about the options. Trying not
to panic, I decide to let work know I'm not fit to travel
since my arm's useless and my neck has swollen making head movement impossible. Meanwhile,
a spinal injuries consultant with whom my wife works, tells her to phone home
and advise me to get immediate help. Now, living in rural Argyll has many
advantages, but one of those is not your proximity to emergency
medical care.
Checking
the time, I realise a bus is due that will take me to the
nearest medical help in Lochgilphead. With jarring pain firing through
every stride, I jog down the rough track from our hillside home to catch
the speeding brute before it leaves. As it leans through tight
bends I wince and hold tightly onto the seat. When it finally reaches the
town, I carefully walk up the hill to the cottage hospital
where I'm immobilised and catheterised. As I'm their Director of Nursing I
sense this is causing muted hilarity. No matter, within the hour one of
the local GP's has arranged an airlift to the Spinal Injuries Unit in the
Southern General Hospital in Glasgow.
The short
helicopter trip ends in my wife's place of work.
I'm grimacing sheepishly as she greets me on the helipad. Within a few
minutes an x-ray shows a fracture of the third cervical vertebra. Although
the spinal cord has been nipped, I'm relieved to hear it's not torn,
or the consequences could have been very serious. After three days in
hospital I’m sent home for a week to wait for the swelling to recede before a
scan can be done. When I finally return, the consultant shows me the print of
the scan. It looks like a star with fracture lines radiating out
from its cord-protecting core. I’m shocked at how close I am to total
paralysis. After discussing the options with the medical team,
I opt to wear a neck supporting body-brace. It's
like scaffolding and doesn't look pretty. Despite scaring some
children and fascinating others, it allows the fractured vertebra to heal
normally. Surgical pinning, the other option, would have solved the problem
immediately. Surgery, however, with the insertion of a supportive metal coil,
creates a greater risk of arthritic changes developing in later
years.
To
explain how serious this situation was, it may be helpful to outline the
potential damage such injuries can cause. Vertebral bones in the neck and back
(the spinal column) are easily fractured. It doesn’t
take a major trauma. A young guy in hospital had collided with the
ground when his kids' swing wasn’t strong enough and the
rope snapped. At first his children thought he was joking when he
told them he couldn't get up. Another patient in the spinal unit had fallen
back from the first - yes 1st - step of a ladder while
stacking shelves in his own shop. He'd felt a sharp pain on landing then tried
to get to his feet, but couldn't. Simple actions; devastating results.
Vertebrae
provide a conduit for, as well as protecting, the fragile and sensitive spinal
cord which transports vital messages from our brain to and from the limbs
and organs. Any break, tear, or distortion in the cord will prevent
the clear transmission of those important messages. Fracturing one of
the spinal bones and damaging the chord can therefore result in partial, or
total paralysis of the limbs. The most affected areas of the spine are
those of the upper cervical spine and mid-torso thoracic vertebrae. This is
possibly because they are smaller and more prone to extreme flexion due to
their exposed positions.
According
to recent figures, two people a day in Britain suffer a
spinal injury. Recent estimates put the total number of spinal cord
injured at between thirty-five and forty thousand people in Britain. The
level and severity of damage determines the degree of paralysis,
or loss of muscle controlled movement. 'Nipping' the chord between two
vertebrae can cause a loss of sensation in one limb. Minor injuries can
often be resolved with treatment. However, the other extreme - severing
the chord - leaves irreparable damage. In general terms, the closer to the
skull anyone's chord is affected, the more serious the impact on
the limb movement and a person's general physiology. In perhaps a
worst-case scenario, we can be left with tetraplegia - paralysed from the neck
down. This sometimes requires artificial support for respiration.
It
is reckoned that life expectancy is reduced by no more than ten per cent
following spinal injury. Many people, in fact, live long and active lives
regardless of the problems their injuries create. However, quality of life can
be more adversely affected by the psychological damage sometimes associated
with such injuries. Others are left with life-long, debilitating pain, yet
still pursue fulfilling, active lives.
A
fracture in the upper part of the cervical spine is, in layman’s terms, a
broken
neck. There are seven cervical vertebrae supporting the skull. If we
cut the spinal cord at this level the impact can be terminal,
although a complete shear usually results in tetraplegia, or
neck down paralysis. In such cases, life-long personal support is usually
required to maintain health and hygiene. However, a raft of adaptations is now
available to dramatically improve the quality of life.
In
relation to someone with ventilated (breathing assisted) tetraplegia, I had the
good fortune to meet a true survivor. He was a climber; a man who
loved mountains. After selling his business, he decided to fulfil a
lifelong ambition and tackle some of the more remote peaks in the Andes.
Following a hard days climbing, he'd returned to his hotel room without
meeting anyone before settling in a for a well-earned nights rest. Too
tired to be bothered eating, he decided to retire to bed. In
the early hours he got up to visit the toilet, but had forgotten
the small step between the ensuite and his bedroom. Missing his
footing, he'd tumbled over the step and struck the coffee table with
his head, breaking his neck and severing the cord. Unfortunately, no one
knew he'd returned. Paralysed and gasping for breath, he had lain
alone for nearly 24 hours before concerned hotel staff broke into the
room and discovered his plight. The German hotel owner tried to get help, but
the weather had closed in and no emergency flights could reach their remote
location. Taking matters into his own hands, he secured the paralysed climber to the floor of his long wheel-based Land Rover,
then drove some forty miles over tortuous tracks to the nearest town with
a hospital!
Once
repatriated to the UK, the injured climber spent more than a year in
Sheffield's Queen Elizabeth Spinal Injuries Unit until his
house could be adapted to meet his needs. During his prolonged stay,
the man taught himself to write using a breath-driven scribing tool for
his laptop and had an article about his injury published in the
local Sheffield newspaper.
Lower
level injuries can be caused by damaging one of the twelve thoracic vertebrae
helping support your torso down through your ribs to your waistline. The
outcome of fracturing these vertebrae is usually a degree of paraplegia, or
paralysis from the waist down. The lumber vertebrae lie below the
thoracic level, but don’t tend to cause quite so many problems. This may
be due to their safer and less flexible positioning on the spinal column,
possibly even aided by their larger size.
Dysfunction
following an accident can include a loss of bladder and bowel control. The
bladder is often left with its sphincter muscle in spasm, inhibiting the
free passage of urine. This can cause damage to the kidneys due to
back-pressure via the ureters, although the bladder is usually tested
thoroughly before leaving hospital. Due to staff changes this didn’t
happen in my case and I suffered renal damage before the situation was recognised
and corrected.
The
effects of spinal injuries on a man or woman’s relationships can also be
problematic. For some, living with the physiological effects of a spinal injury
on their partner can be difficult, if not impossible. This is true
for both the sufferer and their partner. Any life-changing injury often causes
personality problems. For many the change in body image and function is
difficult to come to terms with. These problems often take time to resolve. Before
leaving hospital, I was advised that it could take as long as five years to
adjust to the psychological changes brought about by an injury. From experience,
I cannot disagree with this timescale. Long-term psychological support,
however, is available both from within and out with the health service for
those who want, or need it.
An
individual's sexuality is also challenged. Male or female, there is a
change in body image to adapt to, as well as varying degrees of mobility loss.
It has to be said here, that there are now so many possible adaptations
available for daily living, that most of those suffering spinal injury can
survive admirably in any environment without assistance. In my case, this
included managing perfectly well on my own living in a small
caravan in France. During the two years it took to renovate and convert a
ruined barn into our home I also supervised the work to ensure it met
my needs.
For
men, there is often difficulty in achieving and sustaining erections; for
women, an absence of vaginal lubrication. Again, there are many different
ways, medicinal and mechanical, for overcoming sexual problems. Both sexes
may experience an absence of physical sexual sensations, but there are numerous
solutions to enhance and stimulate a partner during sex. Incidentally, there
is no reason why those with spinal injuries cannot have families. Many
well-known spinal injury cases, male and female, now live happily with growing
families thanks to IVF.
It
must be said, that surviving and thriving post spinal injury is a uniquely
individual experience. It is often dependent not only on the injury, it's
severity, and the supporting resources available, but the adaptability, courage
and determination of the injured person. Initially such serious injuries can
seem beyond even the strongest and most competitive of us, but where there's a
will, there's a way for most of us whose mobility and lifestyles are
compromised.
*This blog is a personal piece done as a broad layman's
overview. It in no way attempts to describe, from a clinical perspective, every
type of spinal injury, or disability and dysfunction caused by those
injuries.
Rob Brown is T4,5 PARAPLEGIC, having been struck by a car while
cycling in Sheffield. The injury occurred one year after accidentally breaking
his neck as described here. Lucky to be alive, he never forgets how good
fortune can shape your life.
His novels are available on Amazon.com & .co.uk
Paperback and Kindle!
Lamont - Moon's Rising by Rob Brown
Link: http://www.amazon.co.uk/dp/B00YZNE2JS
THE FACTOR - A Detective Lamont Novel by ROB BROWN
Link: http://www.amazon.co.uk/dp/B018YNIY66
