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CoLiamPet
07-14-2010, 09:15 AM
Searched the forums already and found some good info but need some clarification on a few points.

My MC (teen) has an accident while at a swim meet and takes a tumble off the starting block. She slams her back and then head against the block and suffers concussion & temporary paralysis of her legs. From what I've garnered in reading the other posts, one of the following might apply:
Possible L5/L4 injury (unstable fracture possible w/bone shards)
Spinal cord edema/inflammation
Compression of the cord

Need MC to have a temporary paralysis that can resolve. I have no aversion to having her undergo surgery but would prefer if she weren't significantly damaged long term. Would also need to know corresponding treatments.

Many, many thanks :)

sheadakota
07-14-2010, 05:54 PM
I'm sure someone will correct me if i am wrong- but i believe the scenario you describe- slamming her back against a wall- is not sufficient to give her a compression fracture-a least not one resulting in temporary paralysis- although stranger things have been known to happen-

I would think more of a twisting motion is needed and greater force than jumping off a starting block.

Having said that-if there are bone fragments in the canal- immediate surgery is required as would steroids to reduce the inflammation- if the cord itself is not compromised then movement could be returned in as little as 24 hours- if the cord was compressed without fracture and steroids reduce the inflammation- movement will return when the swelling reduces- again assuming no blood flow or neuro compromise has occurred- ( I am describing best case scenarios as that is what I think you want :) )

milly
07-14-2010, 06:11 PM
what you need is an injury that produces either significant impingment on the spinal cord, an impingement that will compress the cord to the point that paralysis results but that once the impingment is corrected, will allow the patient to gradually regain some of the feeling

or, there could be trauma and a hematoma could develop and the swelling associated with the blood volume could cause compression on the cord and result in the same damage...that might work better in your scenario...all that would need to be done would be an evacuation of the hematoma and then determine to what extent the patient is paralyzed....

like sheakdakota said, the length of time either condition is allowed to exists correlates to the recovery time if a recovery is made at all

:)

(PM me if you would like research specifics on this) :)

Drachen Jager
07-14-2010, 08:09 PM
I'm sure someone will correct me if i am wrong- but i believe the scenario you describe- slamming her back against a wall- is not sufficient to give her a compression fracture-a least not one resulting in temporary paralysis- although stranger things have been known to happen-

I would think more of a twisting motion is needed and greater force than jumping off a starting block.



He said concussion too, if she landed head first on those rubber mats they use, her spine could twist enough to do that kind of damage in the neck, the mats would keep her skull from cracking open.

It would have to be quite the accident though, like another swimmer pushing her rather than just falling by accident. I don't see how something like that could happen by accident.

sheadakota
07-14-2010, 09:13 PM
Ahh- I guess I misunderstood the OP- I thought the MC was poised on the starting block to jump into water- its a swim meet right? My assumption was made with the character in water-

Tsu Dho Nimh
07-14-2010, 10:57 PM
My MC (teen) has an accident while at a swim meet and takes a tumble off the starting block. She slams her back and then head against the block and suffers concussion & temporary paralysis of her legs.

It's possible for paralysis and numbness to happen just with bruising around the spine. What happens is there is some bleeding, tissue swelling and inflammation, and the pressure disrupts nerve signals. If the pressure lasts too long, there can be permanent damage to the nerves. Current therapy includes immediate administration of anti-inflammatory drugs to minimize swelling.

No bone shards (that's immediate surgery)

At the scene I assume she's complaining she can't feel her legs. That is an immediate call to 9-1-1 and nobody should move her in the interim. (good bit for a scene .. someone wants to cuddle and comfort her and the more medically educated ones are saying "don't move!" or body-checking the wannabee comforter).

EMTs arrive, she gets oxygen via a face mask, her neck and spine are immobilized after a brief exam, she is CAREFULLY moved to a backboard and strapped on it and off to the hospital. Backboards are NOT comfortable ... you can have her conscious and complaining the whole time.

In ER, she gets MRI of head and spine looking for damage - bleeding in the head, broken things in the spine. She is still strapped on the backboard until she's checked out and it's seen to be OK to take her off.

The EMTs and everyone else will spend a lot of time pinching her toes and asking which one it is. Also poking her with pins and tracing how far down the loss of feeling goes.

I have seen one young man recover from this in a dramatic fashion. He was admitted late one afternoon when a bad dive wrecked his spine. I walked into the ICU two days later (collecting blood samples early in the morning) and noticed he had tears streaming down his face. I didn't know then why he was there, and asked him if he was in pain. He say "yes ... it's like flames running up and down my legs and body." I asked if he wanted me to call the nurses to get something for the pain and he said, "No, it's the first thing I've felt since I dove off the pier Sunday and I just want to enjoy feeling the pain for a while."

I immediately boogied to the nurses station to report that the kid had a major change in his condition they needed to chart ... it looked like a SuperBowl winning touchdown celebration in the nurses station and around his bed. He walked out of the hospital a couple of months later, a bit weak and with a lot of PT ahead of him, but he was walking.

The severity can be anything from a few hours with fairly rapid recovery to days with long recovery ... the longer the numbness and paralysis lasts, the less likely full recovery is.

CoLiamPet
07-15-2010, 06:02 AM
It's definitely no accident and the force of impact is pretty hard... image a rug being pulled out from underneath you and having the weight of your body (plus velocity) all coming down in a surface no wider than your thumb.

Just as a follow up question. With respect to the whole bone shard scenario. What's the healing process like and what are the chances of recovery?

Many thanks for the super responses!

Tsu Dho Nimh
07-15-2010, 05:18 PM
the "bone shard scenario" ... how bad do you want her hurt? Tell me what the plot needs and I can tell you what damage to inflict.

CoLiamPet
07-16-2010, 05:18 AM
Hi Tsu,
The "accident", actually an intentional push off a starting block, involves a hard slam against her back. Looking for temporary paralysis, waist down, at least a few days, if not more. I'm not at all adverse to surgery. Basically, I'd prefer if she were disabled short term and recovers within time - if she has some minor permanent damage that's okay but I'd like her at around 90%. Would also like to add some P/T but that not an absolute requirement. Let me know if you need more info.
Many thanks :)

Kalyke
07-17-2010, 07:11 AM
Hi, I had offsetting of two vertebra causing temporary paralysis, yup, waist down.-- It is called Spinal Stenosis. It is like a slipped disk, and can be caused by any sort of random twisting movement (a push can do it because it is kind of like whip lash). The spinal cord is pinched by the offset vertebra, and for a few days (or months) you cannot walk, and yet none of your other body functions are disturbed. The pain is intense and never stops. Horrible pain like a flame thrower. Seriously, you have to drag yourself on the ground. You cry a lot. It is quite a terrifying thing when you first get it. I was in bed and woke up the next day and could not move my legs. I was totally paralyzed. Simply one day walking, and the next day, unable to walk, or function. I had to struggle to move and finally could roll off the bed to get to the telephone. Ah yes, I remember drinking milk from a gallon container while leaning against the wall of my apartment at the time, dragging myself to the bathroom ect.. not pleasant. I actually wrote a scene in a novel based on this. Coming back physically takes a few months as well. There is nothing that can be done but rest, limit movement, and take pain killers until you are able to do a bit of exercise. With me, It was caused by repetitive stress movements from my job. It could certainly be caused by a sudden accident. As far as coming back. I am completely better now, but it took about 6 months of physical therapy and drugs. Oxycodone or Hydrocodone-- I am amazed I am not addicted. I could walk with extreme pain after about a week. You can still go to the bathroom normally. Any questions, just PM

Tsu Dho Nimh
07-18-2010, 07:47 PM
Hi Tsu,
The "accident", actually an intentional push off a starting block, involves a hard slam against her back. Looking for temporary paralysis, waist down, at least a few days, if not more. I'm not at all adverse to surgery. Basically, I'd prefer if she were disabled short term and recovers within time - if she has some minor permanent damage that's okay but I'd like her at around 90%. Would also like to add some P/T but that not an absolute requirement. Let me know if you need more info.
Many thanks :)

You could get everything you need just from the impact of a not-quite graceful hard landing. Things start swelling, the nerves get compressed and it's all downhill from there. Just like if you slept awkwardly and you wake up and your hand doesn't work for a few minutes. That's nerve compression. Just apply it to the legs where the nerves exit the spine, and make it last longer.

The immediate treatment would be the same as always: backboard, transport, O2, and CAT or MRI to see what's going on. A big worry is bleeding into the spinal column causing even more compression - that can be carefully drained with a syringe, but it's serious complication.

If there's no breaks, she'll be immobilized in a well-padded bed, get injections of drugs to minimize inflammation and swelling, and what is called "watchful waiting" (fingernail chewing time) takes over. She can be scared, cranky, tearful, bored, angry ... all at the same time.

When the nerves start waking up, she'll feel all sorts of things going on, most of them unpleasant. Motor and sensory nerves may recover at different times ... she can have good feeling but poor motor control or vice versa. The 'zingers' from recovering sensory nerves can occur for months after she's mostly recovered, but they will get less and less frequent. Whe I was recovering from a compressed nerve it felt like I had my toes in a light socket occasionally. Pain pills do NOTHING for this.

She'd need some PT if only to recover from the bed rest, and is going to get testing to see how well she's recovering, a couple of repeat MRIs to make sure they didn't miss something because of the early swelling, and may get any cracked or busted projections (the part that sticks outward) super-glued back together.

http://en.wikipedia.org/wiki/Peripheral_nervous_system
http://en.wikipedia.org/wiki/File:Nervous_system_diagram.png

Look at where the nerves to the leg exit the spine - they come out of the Lumbar vertebrae, down by the hips where your spine curves forward.

Colliding with the deck and/or the starting block in that region or a bit above it is all it will take to get the swelling going ... think of how bruises swell, and imagine that happening near the nerve.