Being too hot or too cold takes on a different and potentially dangerous meaning for wheelchair users who have a spinal-cord injury.
David Fowler’s wife and friends left the car and would be right back. He was just going to relax for a few minutes. Things wouldn’t be that simple.
“They got delayed, which ended up a 10- or 15-minute delay,” Fowler says. “I was getting into some serious troubles.”
Because of the sun. Even at an average distance of 93 million miles, that life-giving ball of nuclear fusion can become a real problem in minutes — especially for people with spinal-cord injuries and diseases (SCI/D).
Fortunately, Fowler’s companions returned in time to ice down the C4-5 complete quadriplegic to reverse the rapidly developing hyperthermia. Fowler survived just fine, thanks, and is now a multi-term national vice president of the Paralyzed Veterans of America (PVA).
Not True Anymore
Fowler remarks that when he hears or reads about dogs and children left alone in cars for just a few minutes needing major medical interventions, he gets it.
“I can relate,” he offers. “I went through (hyperthermia). It only took a few minutes.”
Back when he was injured in 1984, Fowler got all the warnings others with SCI do about body-temperature regulation issues. But, he sorta wrote them off.
Ken Lee, MD (right), works to help people such as David Fowler better understand thermoregulation.
“I had a pretty high tolerance to heat growing up in Texas,” Fowler remarks. “When I got hurt, I never really had the heat problems people said I would.”
Among Texans, heat was just another thing everyone lived with. Hot was just another way of knowing you’re alive.
“I worked in construction,” Fowler says. “I was in the sun every day. I was always able to say, ‘The heat doesn’t bother me.’ That’s not true now.”
Fowler says he’s been heat sensitive ever since that brush with hyperthermia and is getting more so as he ages.
Deregulation
Ken Lee, MD, chief of the SCI unit at the Clement J. Zablocki VA Medical Center in Milwaukee, says many people with SCI/D have bad experiences like Fowler’s before they appreciate just how sensitive they can be to temperature fluctuations.
“With (spinal-cord injuries and diseases) it is more important to watch temperature regulation,” Lee says. “The main reason is because SCI guys can’t regulate their temperatures like normal people do.”
Lee explains that thermoregulation happens through a series of autonomic and behavioral systems. For example, sweating and shivering are among the involuntary, autonomic actions the brain and nervous system produce to maintain a healthful average core body temperature, around the famous 98.6 degrees on the Fahrenheit scale.
With spinal-cord conditions, those systems are blocked to varying degrees. In some cases, the brain’s thermostat, the hypothalamus, just isn’t getting messages from or to the body about raising and lowering the core temperature.
“The electric wiring from the thermostat to the body’s heating and cooling is the spinal cord,” Lee says. “If the thermostat can’t get the signal down to the organs, or they have trouble getting to the thermostat, the person may not know what’s going on.”
Which can often turn dangerous quickly, the doctor offers.
Behavioral Thermoregulation
Lee says some of the voluntary behavioral temperature-regulation systems are obvious.
“I’m going to get an ice cream and go find a swimming pool and get in,” he illustrates.
But others are so subtle many don’t notice when they’re doing them.
For example, collecting that nice and chilly condensation from a soda can and rubbing it on one’s forehead or self-hugging to ward off cold. Those are part of behavioral thermoregulation, but it’s easy for the person doing them not to notice. And sometimes folks just can’t do them even if the thoughts cross their minds.
“(Someone with a spinal-cord injury or disease) can’t easily jump into a swimming pool,” Lee says. “Or maybe (he or she) can’t get to the shade, because there are steps.”
More Than a “Hair” Dryer
PVA member Paul Rodgers in Moline, Ill., says he’s made a big point of noticing the little things to keep his body temperature near normal.
The Vietnam veteran is a C5-6 incomplete quad who was injured in 1969. His attention to behavioral thermoregulation started when he had a brush with hypothermia, the opposite of Fowler’s experience. Rodgers’ hypothermia started with a routine shower.
“As soon as you start running shower water on your body, water on the part it’s not hitting starts to evaporate,” Rodgers explains. “I was in the shower for about a half hour, and it felt good. Then I got really cold.”
Without realizing it, Rodgers was going into hypothermia. Nurses put multiple blankets on him to conserve body heat and warm his core. Since then, he’s used hair dryers to ensure he’s completely dried after showers.
Rodgers says he also pays close attention to his heart rate, which can give early warnings of hyper- or hypothermia. According to medical experts, hypothermia can induce a reducing or increasing heart rate. Hyperthermia almost always induces an increasing heart rate.
Follow the Leader?
Lee says one of the best things people with SCI/D can do to prevent mild to severe hyperthermia or hypothermia is to take temperature cues from others.
If everyone is bundling up, consider doing the same. Likewise, if folks are doing things to cool down, it’s usually best to follow their leads.
“It’s a common sense thing,” he says. “There’s no reason to be special about it.”
Although, the doctor warns, don’t always associate feeling hot or cold with external temperatures starting hyperthermia or hypothermia. He says feeling overly hot or cold can easily be something else, too.
“If there’s heat involved, it may be a fever,” Lee adds. “Don’t just write it off as heat.”
For more information, contact your doctor or visit ncpad.org.
