An Exciting First Day of Holidays; autonomic dysreflexia

It had been a relaxing day, the first of a 10 day holiday with my parents and brothers and their families in Callala Bay, but as the sun started to set I began to feel uncomfortable. I have ongoing issues with my bladder, an almost permanent feeling something like a  urinary tract infection; that sense of wanting to go to the toilet but not being able to (since I wear a permanent catheter, it is an annoying sensation). This irritation increased but I could not find an obvious cause. I started to feel queasy and contemplated being put to bed early (it was 7 PM). All of a sudden I felt a sharp pain in my neck, as though I had inadvertently damaged my injured spine. The pain shot up to my head and I experienced an instant mind shattering migraine. No matter what I did I could not relieve the throbbing – lying back, sitting up, massaging the neck, nothing but increasing pain.

Realising something was wrong, my son Jacob went to get Elly, and the rest of the family came running.Elly realised almost straight away that I was probably experiencing autonomic dysreflexia (that it had not been immediately clear to me is a bit embarrassing, given the amount of training I had received on the topic in hospital). AD occurs when something goes wrong with body below the level of my spinal cord injury. For a “normal” person, the autonomic nervous system sends a signal to the brain – pain – to indicate the location and extent of an issue (extreme pain equals big problem). For an “abnormal” person with a spinal Cord injury, these pain signals are blocked, and instead a reflex is activated that causes a narrowing of the blood vessels and an increase in blood pressure (http://www.sci-info-pages.com/ad.html). This manifests itself in headaches, a rash on the face and chest as well is other symptoms. While this provides an important indication that an issue needs to be addressed, it does not locate the problem (it could be any number of things). More significantly, the increase in blood pressure creates a high risk of stroke. AD is thus considered a medical emergency.

Elly is cool under pressure and the first thing she did was to test my blood pressure, which reached a staggering 240/179 (an average blood pressure is 120/80 – an average blood pressure for a spinal patient is 100/65). Since this confirmed that what I had was more than a mere headache, she administered a dose of captopril, a tablet placed under the tongue intended to reduce the blood pressure. She then went hunting for the problem and discovered a small kink in my catheter line, which she repaired.

Mum called an ambulance, an apparently nerve racking exercise, since she seemed unable to remember her own telephone number. It has only three digits.

Dad offered me a pain reliever. He had some endone left over from my mother’s knee operation, but I don’t think morphine was the best solution.

My brother Troy went to direct the ambo’s, experiencing some frustration at the delay and at the flashing Christmas lights, which he confused with an ambulance siren.

Meanwhile, my blood pressure was on the way down. By the time the ambos arrived, things were heading toward normal. My head still throbbed, my face was still a beetroot red, but we all felt a little calmer. It was determined that Elly had fixed the problem and there was no need for me to spend a night in hospital. Thank God, I hate hospital food.

This had been our first experience of A.D. I had learnt a thing or two and will be able to react better next time – hopefully without the need to call an ambulance. It was something of a scary reminder of how vulnerable I am. But within 10 min of the ambulance leaving,  the family were sitting around having tea as if nothing had happened; except for the fact that our adrenaline levels were a little higher.

My boys, who had been concerned and loving throughout, kissed me good night. Thus ended our first day of holidays.9