Hey everybody!

Being a wheelchair user, one is always concerned about developing skin, bowel or bladder issues. These are Living With A SCI 101. I am always on a constant vigil to ensure I remain free from any concerns involving these three priorities. However, there is a fourth overriding issue that concerns all three; an infection. Speaking of which, my ordeal started at around 7.30 a.m. on Sunday 13 August 2023 when I woke up. I was immediately welcomed with severe pain in my right shoulder and upper abdomen. My first thought was the possibility of a blocked bowel given that some of the pain was originating from my abdomen. As for the pain in my shoulder? That was a mystery.

Taking the severity of the pain I was experiencing; my partner activated my St. John alarm with an ambulance arrived within 45mins. Both paramedics showed concern as my temperature was 38C degrees – a red flag for them. They advised that my shoulder pain would be a referred symptom of my abdomen issue, an interesting fact. After prescribing fentanyl to ease my pain I was driven to North Shore Hospital in Auckland NZ. Upon arrival I was taken to Surgical Ward 4 and had x-rays of the chest and abdomen taken, followed by a CT scan of the same, and multiple blood tests. I was then placed in isolation as the doctors and nurses set about trying to diagnose my illness(es).

I was advised that afternoon that my chest x-ray was clear, as was my bladder. My temperature remained stubbornly high. After further investigation, it was determined I may have a possible subacute obstruction in my right interior abdomen. It couldn’t be appendicitis as my appendix had been removed in 2019 however, my temperature remained at 38C so there was a problem somewhere. I was placed on oxygen, through my nose to keep my oxygen saturation levels up.

By Monday morning I was starting to feel nauseous, so I was given anti-nausea medication, but this didn’t seem to make a difference as my nausea increased. My partner then started to demand that a doctor attend me as soon as possible. Her persistence paid off when a registrar finally arrived to assess me. My infection markers, normally between 3 – 10 were actually 361! The registrar called for a tube to be placed via my nose down into my stomach cavity. As they were fitting the tube I vomited a copious amount of dark green liquid. Once the tube was fitted I produced 1.7 litres of this liquid In 30 minutes. This signified a severe chest infection that also involved my lungs which explained why I couldn’t draw a deep breath without sustaining severe stomach spasms. 

By Tuesday, the next day it was determined not only did I have a severe lung infection, but I also had pneumonia. This was caused by a bacterial infection that I must have had before admittance to the hospital. It was explained to me that the persistent cough I had had for several weeks was the origin of this bacterial infection. I developed the cough while I was recovering in a care facility from my thumb joint fusion surgery. This infection also infected my bladder leading to a diagnosis of a UTI. The severity of this bacterial infection now in my chest, lungs and bladder led to my bowels ‘shutting down’. A condition known as ileus.

This meant antibiotics being fed intravenously through a drip for 8 days as the doctors fought to get the infection under control. I felt terrible throughout this time with a tube up my nose, a drip into my arm, and blood tests every day – which led to another complication; finding a usable vein with which to draw blood. Due to my general low blood pressure, and the fact I was probably dehydrated somewhat, despite consistently drinking liquids, suitable spots in my veins were difficult to locate leading to a multitude of patches on both arms and hands.

By Friday it was determined that I had developed sepsis. This was extremely serious which led doctors to prescribe an aggressive course of antibiotics, more aggressive than they would have preferred. This diagnosis really hit home as to the seriousness of my condition. I was on nil by mouth, only permitted to drink liquids and fortified custard. Yummy, not! Over the next week, I gradually started to feel better as my condition improved. It was then that a decision on my bowel movements, or lack thereof was addressed. It was decided to initiate an enema once daily to clear both my lower and upper bowel completely. This meant having to wear adult diapers as the evacuation could happen at any time post-enema, which it did.

By day 10 I had improved enough that the tube through my nose was removed, and I was able to start to eat solids and spend time out of bed and in my wheelchair. The drip for my antibiotics was removed as I was placed on oral antibiotics by then. I was also informed by a registrar that my infection markers had dropped from a high of 361 down to 3! He said I was remarkable in the way my body had fought and beaten the severe infections I had developed in the time it had. By day twelve it was determined that it was appropriate to discharge me to home, although I still had to take an oral course of antibiotics for an additional six days.

The learnings from this whole “adventure”, as someone who is living with a SCI, are these:

• If you develop a persistent phlegmy cough see your GP immediately. It may well be more than an irritant so be aware.
• Always be aware of how you feel, especially once in the hospital. If my partner hadn’t been so persistent in getting a doctor to see me the day after my admittance things could have been far more serious than they were.
• Keep an eye on your body’s temperature. My normal temperature is 36.4C. anything above 37C is cause for concern. Ensure you have a thermometer available for weekly checks at a minimum.
• Checking for bladder infections, and UTIs must be a constant vigilance. My partner had felt that my urine was cloudier and smellier than usual, but I had dismissed this as I was self-catheterising as normal.
• Bowel evacuations need to be monitored. How long does it take? What type of stool was it? 

• You must also try and ensure that your diet is conducive to assisting with ensuring bowel movements are promoted.

Finally, believe me when I say that ignoring or omitting any of the above suggestions/advice the risk of developing a bacterial infection that can develop into sepsis is most certainly not worth the symptoms suffered.

About the author

Ian Walker is a C6 Quadriplegic Incomplete. Ian lives in Christchurch, New Zealand and has survived 2 separate spinal cord injury-related accidents over the past 14 years. He is a Motivational Speaker who talks about - how to face adversity, cycle road safety, living with a disability, and being a 1 percenter . . .

Ian also enjoys life coaching which he utilises through his business BMotiv8d, to assist those with a disability, (or without), who lack motivation, direction and/or confidence, those who feel disorganised or unfulfilled, and/or those who need encouragement or need to set priorities, on how to realise their true potential.