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Spinal cord injured. Having UTI. Lower part of the body is paralyzed. Suggest treatment for complete cure

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Practicing since : 1980
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sir i am a spinal cord injured patient since 2007. at the time of injury (at c6 level) i was fully paralised except the upper part of my body (from shoulder). now i also get UTI. this days i get sense on every part of my body. luckily both my hands can perform 80% of its task (except tight grif), and about my legs, got sense, can move slowly, but cant control for walk or stand. sorry sir i forget to tell you about my spasm. please guide me for the best treatment , i will provide you all the requirements. sir please tell me i will be able to work or not.

With Regard
Posted Sun, 27 Oct 2013 in Back Pain
Answered by Dr. Rakesh Karanwal 43 minutes later
Brief Answer:
Functional recovery will take time

Detailed Answer:

Thanks for your query. I fully appreciate your concerns.

* Firstly, urinary bladder gets involved in long period. Under ideal circumstances, the catheter is changed after every few days. Repeated insertion of catheter into the bladder is the greatest risk for introducing infection into the bladder and may even involve kidney infection. Chances are that the organism causing urinary infection, may be resistant to most of the antibiotics.

* Nevertheless, please furnish additional information as follows :-

- Were you given steroids soon after injury? Are you still on steroids?
- Names of medicines that you are taking at present?
- Do you still have a catheter inserted into the bladder? Or do you mean you have a suprapubic cystotomy (SPC)?
- Can you now control yourself when you have an urge to pass urine?
- Do you have frequent urge to pass urine? Is there burning or pain while passing urine?
- Does the urine flows out without your knowledge, when the bladder is full?
- Please describe your spasms in detail

* Since your injury occurred 6 years back, I am afraid that the extent of recovery cannot be predicted. Nature of injury has two components : reversible and irreversible. Only the reversible component will recover almost completely. But complete recovery is unlikely.

* Regular physiotherapy under supervision will be of significant benefit.

* I will recommend that you :-

- Consult a qualified Neurologist, who will assess your neurological status, including your urinary bladder's functional status, thoroughly and advise accordingly.

- Get you urine examination and culture/sensitivity done. It will reveal the causative organism of UTI, as well as, give information about the most effective antibiotics for curing UTI. Your doctor knows what to prescribe for UTI.

Am eagerly awaiting further information.

Wish you a speedy recovery.

Dr. Karanwal
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Follow-up: Spinal cord injured. Having UTI. Lower part of the body is paralyzed. Suggest treatment for complete cure 2 hours later
1. Yes, some steroids had given after 4 hrs of my accident (actually i cant point out the name of that steroid).
2. Synaptol 150, Alprax-0.5,Oflox-200 and Limcee. (these were the present medicines)
3.Yes sir i have still suprapubic cystotomy (SPC).
4. I have the urge but i cant control myself to pass urine (sometime i can block urination for 4 or 5 sec). As the catheter goes directly into the bladder(SPC), urine comes out from my penis when catheter was block. during this sesion i feel all the sense and sometimes with pain and burning sensession.
5. about spasm- both my legs or sometimes only one leg shakes while touching when i got some long rest. specially in the morning or when i was ill.

Sir i will provide you some of my tested reports. Will you please take the responsibilities for my treatment/training as your patient. actually i want ur private treatment
Answered by Dr. Rakesh Karanwal 1 hour later
Brief Answer:
Recovery will take its own time

Detailed Answer:
Hi there,

I have gone through the additional information provided by you.

* As anticipated, prolonged SPC is the cause of chronic UTI.

* Given the high incidence of infections due to multi-drug resistant bacteria, the most effective antibiotics for UTI, can be short-listed through urine culture and sensitivity test. I would therefore recommend that you get the said investigation done AT THE EARLIEST. Your doctor will prescribe the most effective treatment (to replace Oflox-200) for UTI, on the basis of urine culture/sensitivity report.

* Restoration of bladder sensation is a good/favorable sign. I personally feel that the catheter should be removed AT THE EARLIEST POSSIBLE and, bladder training be started. Removal of catheter will minimize the risk of future UTI and septicemia- a XXXXXXX consequent complication. However, this decision can be taken only by your treating Neurologist, in consultation with a surgeon.

* Pain/burning sensation while passing urine though penis, are due to urinary infection itself.

* Further, for muscle spasms, the dose of Synaptol may require to be modified, and will be decided by your Neurologist .

* Lastly, but not the least- apart from re-assessment of neurological status by Neurologist; prompt, aggressive treatment of UTI; and, early removal/closure of SPC- your future course of action should be:-

1. Have a well-balanced, high Protein diet. Take lots of fluids daily.

2. Take adequate Vitamins particularly B12, Calcium and Vitamin D3 supplements daily.

3. If still bedridden, try to be mobile as much as possible; prevent development of bedsores, by changing sides every 2 hours, use of well-padded and soft mattress; keeping gluteal region and back dry; application of talcum powder frequently over these areas.

* However, may I emphasize again, that
-      significant recovery will take a long time;
-     there is no medicine which can facilitate early recovery;
-     Your Neurologist may consider prescription of Anabolic Steroids;
-     REGULAR PHYSIOTHERAPY- by a trained Physiotherapist- IS THE BEST OPTION for early recovery.

* Do send me all available reports.

* Lastly, I am highly optimistic that you will eventually, be able to become mobile- perhaps with mechanical support- to the extent that you will be able to perform routine work without anyone’s support.

It may not be possible for me to treat you without examining you. Regular consultation with your treating Neurologist is the need of the hour. However I will be obliged to support you towards proper treatment on this forum as and when you need it.

Hope I have addressed your query to your satisfaction. If you have any further questions, I will be more than happy to help you.

However, if you do not have any further clarifications, you can close the discussion and rate the answer.

Wish you a speedy recovery and good health.

With best wishes,

Dr. (Col) R Karanwal

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