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Ask the Doctor: Spinal Cord Injury and Summer Safety

By Sam Ho, MD, Spinal Cord Injury Medical Director

Participation in leisure interests and recreation provides multiple physical and psychological benefits, such as improved health, fitness, and mood. It also increases your social network by meeting new people. This is why we include recreation therapy as a component of our Spinal Cord Injury Program. I hope this also gives you ideas or encourages you to get involved in one of our adaptive sports clinics. Keep in mind the following safety tips so that you can spend more time having fun, and less time with the doctor - or one of the nurses!

Sunburn and Heat-Related Illness

Beware of "too much of a good thing." Lack of sensation can contribute to sunburn, and certain medications can cause increased sensitivity to the sun (see package insert or ask your pharmacist or doctor). Your spinal cord injury also affects your internal temperature regulation, and ability to tolerate heat. Lack of perspiration can lead to overheating. Apply sunscreen, dress in layers (lightweight, light-colored clothing that reflects the heat), wear a hat, and closely monitor time spent in the sun, especially on hot, humid days.

Keep Yourself Hydrated

Always carry water with you and balance fluid intake with bladder management. Adjust your cathing schedule as you increase fluids. Some people also like to use a spray water bottle to cool off. Avoid strenuous activity on very warm, humid days, and take regular rest breaks. Avoid caffeine and alcohol; they actually cause your body to lose more fluids which can lead to dehydration. If you do experience sunburn, apply cold compresses to skin for comfort; do NOT pop blisters – cover with a clean bandage. If you experience fever or chills, call your doctor.

Heat-related illness can be serious and can sneak up on you. Signs of heat exhaustion (not to be confused with autonomic dysreflexia) most commonly include cool, moist, pale, flushed or red skin; headache; dizziness, weakness, or exhaustion; or nausea. If you experience any of these symptoms, it’s important to quickly get cool and comfortable. Get out of the sun and find shade, or an air-conditioned location, drink cool water, and remove or loosen tight clothing. Wet towels can also be used to cool down.

Later stages of heat-related illness - called heat stroke - are very serious and include: vomiting; decreased alertness or loss of consciousness; high body temperature; rapid, weak pulse; or rapid, shallow breathing. The late stage of a heat-related illness is life threatening – call 911.

Skin Care and Injury Prevention

Nothing can ruin your summer like having to stay in bed to heal a pressure area or burn. Even if you’re on vacation, make sure you continue to do regular pressure relief (for 1 minute every 15 minutes) and daily skin inspections to look for red marks and unusual scrapes, burns, or insect bites that may become inflamed or need medical attention.

Use caution with unfamiliar or unusual transfers or positions. For example, be careful when using adaptive sports equipment or transferring to and riding on boats or amusement park rides. Try to minimize bumping, scraping, or shearing injuries. Even if you're able to transfer onto bleachers, benches, or boat seats, use your wheelchair cushion when sitting on these hard surfaces as it provides the best padding. When camping, use an air mattress or other padded surface and make sure you re-position or turn yourself during the night as you would at home.

Remember to be very cautious around summer heat sources, such as campfires and grills, to avoid burns. Surfaces that soak up the sun can cause serious burns to unprotected bare skin that lacks sensation. Watch out for beach sand, metal, and dark vinyl upholstery surfaces, such as car or boat seats, and even your wheelchair cushion if it's been sitting in the hot sun. For good skin care, it’s also important to change out of wet or sweaty clothing promptly.

Insect Stings and Bites

Again, prevention is the best medicine. When you’re outdoors, use insect repellent, and reapply as recommended. If stung by a bee, try to remove the stinger as quickly as possible. Scrape out the stinger with a blunt-edged object, such as a credit card or dull knife. Wash the area with soap and water two to three times daily until healed. Apply a cold pack such as an ice pack wrapped in a cloth or a cold, wet washcloth for several minutes. Take Tylenol or similar medication for pain.

A sting anywhere in the mouth warrants immediate medical attention; additionally, seek medical care if you notice a large skin rash, large area of swelling around the sting site, or if swelling or pain persists for more than 72 hours. Signs of a serious, or potential fatal allergic reaction include wheezing, or difficulty breathing, tightness in the throat or chest, swelling of the lips, dizziness or fainting, nausea or vomiting. If you experience any of these symptoms, call 911 immediately. If you have a known allergy to bee stings, talk with your doctor about having emergency medication on hand.

Spider bites can be addressed by similar steps as a bee string. Wash the bite with soap and water, apply cool compresses, and take Tylenol or similar medication for pain. However, if you suspect the bite is from a poisonous spider (black widow or brown recluse spider), apply ice and head for the emergency room. Symptoms include a deep blue or purple area around the bite surrounded by a whitish ring and a large outer red ring, body rash, muscle spasms, tightness or stiffness, abdominal pain, headache or fever, general feeling of sickness, lack of appetite, joint pain, and nausea, or vomiting.

Tick bites should be reported to your doctor as your doctor may want to save the tick after removal. Use tweezers to grasp the tick firmly at its head or mouth next to your skin. Pull firmly and steadily on the tick until it lets go, then swab the bite site with alcohol. Never use petroleum jelly, or a lit match to kill, or remove a tick!

Water Safety

When near or in the water, always have someone with you, and wear an approved flotation device. Never swim alone, and make sure you know the water’s temperature, depth, and currents before entering. Make sure you know your swimming abilities, and that you have enough energy, or capable assistance to safely reach and return to your destination. Our therapeutic recreation specialists are available to provide swim evaluations, teach adaptive swimming techniques, and provide suggestions regarding flotation devices.

Remember that alcohol and water do not mix. Alcohol impairs your judgment, affects your reaction time, and greatly increases the risk of accident and injury. Never swim, participate in water sports, or operate a water craft after drinking alcohol.

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