Hi guys,

1. I am having problems with weight loss. I am c6/7,due to a car acident in december 05. Whilst in rehab i had no problems with eating, even to the point were my doc had referd me to a dietitan because i was eating to much junk! At that point i weighed around 150 lbs.I have always been quite thin.However, in october 06 when i was discharged, i began to drink quite heavily,and subsiquently lost all my appetite. I continued to drink for a further 6 months,then stoped totaly and have not drunk since.
Now 18 months on i still have no appetite whats so ever,its almost like i am forcing the food down. I have tried the milkshakes and am managing 1 a day,any more and i feel sick. I am managing to consume around 1500 calorys a day, which i now is not enough.I currently weigh 117 lbs and am 6.1 .Is there any kind of appetite stimulant available??

2. Blood presure.I am also suffering from low blood presure,i presume due to not eating.I have been given full lengh ted stockings and an abdo binder and still an average bp reading would be around 65/45,thats after being up in my wheelchair for a couple of hours.Now the major problem for me is that everytime i try to excercise, or even just propeling my wheelchair,i become very dizzy and if i dont stop what ime doing, i will faint. Its a vicious circle at the moment,i try to build up an appetite by ecxercising,then blood presure drops.

Does anyone have any sugestions as to what i can do?Any help would be much apreciated.

Many thanks for your time.

Oli.

Hello Oli,

As you are probably aware, dramatic weight changes can occur after significant trauma and sci. Of course, other causes should always be ruled out before proclaiming that a person's weight loss is entirely due to this. This is especially true if the weight loss is several years in for example.

weight loss
The thing is, there are a couple of reasons why weight loss may occur at certain points.....

Firstly, after SCI, the metabolism speeds up, this is because the body is directing more nutrients and blood flow to the muscles and more energy is required to maintain the body on an even keel.

Then, after a while, the decrease in muscle mass and atrophy can lead to further or the beginning of weight loss in some. The increased alcohol in the first year after SCI may have meant that your body was further stressed, obtaining only empty calories to help in the period of increased metabolism.

The difficulty is that a vicious cycle occurs as with a C level SCI, there is an interruption in the signals which tell you that you are hungry and this can shift and change over time: Meaning that as the metabolism shifts and you technically *need* more calories, you do not feel hungry accordingly.

What I would say is that after any significant trauma, the mechanisms which control the metabolism and the bodies automatic functions can be affected too as a sort of knock on effect. I have a Thyroid problem which is autoimmune and which was triggered by a traumatic delivery ( pre paralysis) but I also know that Thyroid issues ( HYPOthyroid and HYPERthyroidism) can be triggered in people who are susceptible ( such as those with autoimmune family history or high antibodies). So I would recommend that the dr tests for not only the thyroid hormones ( TSH, Free T4, Free T3 etc) but ALSO Thyroid antibodies ( TPO/peroxidase, TgAb etc). Also a simple test for Diabetes Mellitus and perhaps Pirtuitary markers may be useful as well as for Anaemia ( this is a very common cause).

It may be that you are simply not able to eat because you have no apatite due to the SCI, and the weight changes may be as outlined above, due to the trauma and metabolic changes, but simple test may be required if the weight loss is not slowing/leveling out.

As for Stimulants, I would suggest that opposed to those that you try to drink supplements such as ENSURE etc, the dietician will be able to prescribe a variety of different build up drinks...Alternnatively, if your dr gives them the ok, you may be able to take the drinks that body builders use. I say ask your dr first as many have a mis-balance of nutrients and may not be suitable if you are not undertaking sports etc..

Blood pressure

The BP issue is due to the low weight combined with the SCI level of injury. It is termed Orthostatic Hypotension and it affects people in varying degrees. OH is defined as when the systolic BP has a decrease of 20mmHg or more, or a reduction in diastolic blood pressure of 10mmHg or more, when the person's body position is changed from a supine (laying) position to an upright posture. In actuality, it is irrelevant if the person has any symptoms.
Quite a few studies have documented the presence of OH In people who have had a SCI, regardless of their level of injury. it can be so severe, that merely moving the person's head ( or the person moving their head) slightly can cause the Blood pressure and heart rate to drop. As time goes on, your body will very likely compensate so that OH is less troublesome especially to the heart rate and blood pressure.
Are you taking any Beta Blockers? or ace inhibitors as these can also affect heart rate and have an effect on BP, as can the use of Amiodarone®. Although these drugs may be required at present - it may be worth asking your dr about this. Also, after SCI, the body's ability to have the Vasoconstriction reflex (narrowing of blood vessels to keep blood in head and upper body) can be lost. This can be a major reason why OH happens. Also, having a SCI appears to be related to excessive pooling of blood in the abdominal viscera (internal organs) and lower extremities ( legs). Also due to lower limb inactivity, the pooling etc, there can be a lower stroke volume ( out put of the heart) so its more difficult for the person's body to compensate when they are first sat up. Even the 3rd, or 10th time. It actually can take a little while before the person can tolerate sitting. Even when their vital signs ( BP etc) are normal, you can still have the symptoms ( ie dizziness, syncope (fainting) etc).

Medications can be used to manage and lessen the symptoms of OH. However, the approach which is more successful is to use things such as abdominal 'binders'. However, as you have used these without effect, it may be that you find the medications useful. The body does OH in an attempt to preserve the Brain etc etc, so it is actually expected and very normal, but that doesn't help you when you are going through this. In many people, it does get a lot better as time passes..keeping hydrated and ensuring that you keep your legs elevated as much as possible can help. Also if you are using a Powered chair, you may be able to present a case to get a tilt in space feature on your chair...to help with keeping your legs above your heart as much as possible...

I hope that this helps and that you have some relief and find answers....sorry for the diatribe, I am not a dr, but am a qualified RN who before paralysis/chair worked in CCU specialising in cardiology..

HTH

Take care,

K

I am about the same height and build so think I may give you something to think about. I was in a car accident 14 years ago now and the first year after my accident I went through the same weight loss. I started at about 160 (with a hard on) 155 normal. Then I dropped all the way to 105 before I finally found out I had a pressure sore.

The wound was under the skin and not noticeable until it surfaced. By that time the wound had grown to 8cm x 5cm all the way to the bone. It took several skin graphs and months in the hospital to finally recover. I was told I was lucky again I guess because these wounds can be fatal.

So get your body checked for the possibility anyway. And try switching to beer there is a pork chop in every can.

Kewlcatz - do you happen to have a reference for this? It's just that I'd understood the opposite to be true and that the blood flow to the unused muscles was reduced and thus metabolism was reduced. Quite willing to be corrected though.

Having done a brief google this article here says



although it does also say



This is clearly a transitory effect and supports what knowthill was saying about looking for possible infection - I can't see that the initial effect would last as long as the OP describes especially as he put on weight initially.

To the OP i'm sorry I can't offer any help - it seems that the lack of appetite is the major issue. Only seen this with one of my friends who was a similar level to you. It was I'm afraid to say as much psycological as physical in his case. The docs didn't seem to be able to offer him any help either to improve his appetite although in the last year as his appetite for life has increased so has his appetite for food.

Have you spoken to the docs about having Ephadrine (migh be spelt wrong) - I used it in hospital in the early days to boost my blood pressure for a short while to assist me getting up without passing out from low blood pressure.

Cheers
Russ

Hi Russ1,

I didn't have a reference in mind per se -as such as I was drawing from what I was taught and experienced in people following trauma (sorry of I didn't eloquently get that across ), but there is info to support this and I have googled and found some info to support it including:


Source: spinalcord.uab.edu


Ultimately, I was *not* intending to suggest or say that this weight loss is the picture for the future. Indeed, it IS transitional and can be either weight loss or gain or periods of one followed by the other. I should have added that *eventually* the pendulum would probably swing the other way and cause weight gain due to the reasons you supplied and the loss of muscle mass and need for less calories....The 'need for extra calories' in the beginning and interim periods is due to infection, inflammation and blood flow to the area of injury ( and any subsequent areas/injuries) and unfortunately, no one can say how long this will last for sure. I would think that it is in someway dependent upon how much muscle bulk a person had in the beginning and how accelerated their metabolism ended up. That isn't an equation which is easy to work out. So I would think (based on what I have seen and been told) that it would take a significant chunk of time ( ie several months to a year +) for the body to recuperate and begin the sing the other way- for the metabolism to slow down again and the atrophied muscles to require much less than in the initial months.

Of course amount of spasms and pain affect muscle mass too so these factors may also effect the process?

I hope this clarifies things and sorry for any confusion, like I said, I am no dr, just sharing.. Please let me know if you wish me to find out some papers as I think I have some somewhere...

Take care,

K

Going slightly off topic here, but I found a bit more information on weight loss in acute spinal cord injuries, and how the stress factors put the body into a Catabolic State.


Although the above research was not primarily focused on spinal cord injuries, the principles are the same. I gave the above as an example as it is clearly written.

It took me about 4 years to get my weight back following my injury, and my weight stabalised between 96 - 05 (11st 7lb +/-2lb), however, as I'm getting older, the weight has started to creep upwards, 12st 5lb. I'm 6ft tall.

This is due to a number of factors, reduced exercise, increased calories, getting older etc.

You could try getting some of the bulk shakes that weight builders drink, but try not to eat foods which are high in saturated fat or hydrogenated fats.

It's difficult trying to get your appitite back, but try to eat a little and often if you can't stand large meals.

Keeping your fluid intake up should help with the low blood pressure. Try a couple of drinks before you get out of bed, and drink plenty throughout the day.

Regards

Simon

You can get a prescription from your Dr. for a steroid to increase your appetite