By Patty Kunze, RN, BSN and Roberta Palmer, RN
 
Now that spring is finally here and summer vacations soon will be upon us, the nurses at "The Rollin’ RNs" were talking about the response of our spinal cord injured bodies, in environments outside of our own safe havens. It’s a funny thing, we all expect our bodies will “mind their P’s and Q’s”, when actually they go into an odd state following time spent outside our usual environments, especially when traveling. It’s always helpful to discuss these offbeat occurrences with other mobileWOMEN and we discover we that are not alone. But a long car ride, a night of chilliness, and numerous conversations with able-bodied standers can cause a trifecta of disturbance, in our otherwise normal state. So, we decided to pen an article not only to the SCI population, but also to all mobileWOMEN who are unaware of this occurrence.

The first topic of the trifecta, is the extended car ride. Eight to nine hours in a car on a drive, is about the extent of our tolerance. Anything longer and we get squirmy. So, we try to keep our travels to 8-9 hours but sometimes they may stretch to 10 hours and that is exhausting on any body. Couple that with sitting in a foreign seat (other than usual wheelchair) for that time period and it all makes for an aggravated body, especially the back and neck.

That leads to part two, the neck pain. You all know the situation, you are sitting in your wheelchair at a wedding reception, gathering or get-together and someone enters to talk from the left or right side and begins a discussion over your shoulder. This action initiates a turn to the side and a view upward. An unbearably difficult position. But one we continue to perform, hoping the pleasantries will not last long but usually do. Afterwards, our necks are painful from muscle strain and we may feel some lightheadedness. Reason for lightheadedness, being the carotid artery runs up both sides of the head and looking to the side and up, causes some compression of the artery, decreasing blood supply to the brain.

And for some of us with higher-level spinal cord injuries, talking can slow down oxygen intake, increasing chances for lightheadedness. Common courtesy would be for that individual to sit down, eye to eye, in front of us. When we find ourselves in this awkward position, we should ask the talker to have a seat and since that individual isn’t aware of these concerns, here again is an opportunity for education.


The third in this trifecta, is the chilliness and the weather on our bodies. Face it, we are unable to feel temperature changes or tolerate cold or heat but when we are at a special occasion, we try to be cordial and not complain. How many of you all have said, “No, I’m fine,” when all along we are chilly or heated? Then it takes us forever to equate our body temperatures afterwards!

Why does this occur?? Inactivity can be one reason and for those with complete spinal cord injuries above the T-6 level, difficulty maintaining a normal core temperature in relationship to changes in environmental temperature, are referred to as being “partially poikilothermic.” Let us break down that last word, poikilothermic means having a body temperature that varies with the temperature of its surroundings. Consequently, persons with high-level spinal cord injuries are advised to avoid extremes in ambient temperature because they are susceptible to both hypothermia (body temperature below normal) and hyperthermia (body temperature above normal).


In addition, throw in some fast food during travel or unfamiliar cuisine at the special event along with missed opportunities to drink that water and our tummies jump right in, feet first of course, to assist the above occurrences. All this resulting in a state of upheaval and that we Rollin’ RNs, call the Travel Trifecta!

But never fear, usually a day or two of rest and getting back to a routine, will squelch the happenings and all will be right again in our special world.

It’s all good so roll on.

References:

Thermoregulation and Fever in Normal Persons and in Those with Spinal Cord Injuries. http://www.mayoclinicproceedings.org/article/S0025-6196(12)60394-2/fulltext.