[Sanaullah]

Hello everyone,

My name is Dr. Ahsan M. Khan and I run a hospital of owned by my family in Lahore, Pakistan. On 12 March 2005, while working on a construction project for the hospital, a labrourer met an accident resulting in spinal cord transaction at D10-12 level.

We were able to perform a decompression leminectomy & transpedicular fixation at the hospital but he did end up with paraplegia. After recovery from the surgery, we tried to find rehab centers here as we are only an acute and chronic care facility with no arrangements for longterm rehab but could not find anyplace or anyone who could help him on long term.

We discharged him and he went home but came back a couple of weeks later with sacral bed sores and UTI which we treated and since then we have not been able to find the courage to let him go.

We know that he is in this condition because he clearly went against all safety precautions and was reminded to follow them even ten minutes before the actual accident by his supervising contractor. We however, also know that if we make him go back to his village, he is not going to survive more than a few months without any help. He is a totally illetrate man with no ability to read or write. It is impossible to give him written instructions to remember. No one in his family is literate to follow those instructions and they are extremely poor so it is but natural for them to have abandoned him to the hospital and work on their own survivals.

For months now we have been treating his sores and making him sit on the wheel chair to pass time but it is now becoming apparent that over the period we have not been able to develop a self esteem in him or to train him in any manner to become independent. Needless to say that free care for him is a burden on the hospital.

Since he is well enough now, we want to give him a desk job and for that some people at the hospital have also started trying teaching him how to read and write. Unfortunately, we have not been able to make him independent in his daily life. He cannot wash himself, clean himself, cook for himself or do laundry since most of that stuff is manual here. A person from the hospital staff has to be assigned for his daily cares constantly.

What I am looking for is guidance from all of you. I don't know how to help him further. I would want to know what kind of a residence to provide him with so I can shift him out of the hospital. Among other harms, staying in the hospital constantly exposes him to hospital infection risk. What kind of a toilet is convenient. How to make him shift himself independently from a wheel chair to a toilet seat. How to have him develop some control of his mid section so he can stay stable while bending on a wash basin to wash his face or brush his teeth.

Most of all I need to know how to motivate him. I am sure that if you can teach me things, I would be able to teach him all the stuff but his depression is the biggest hinderance. His belief that life for him is over and what ever is left he will have to spend at the mercy of others is killing his chances of ever becoming anyone worthwhile and killing our vigor to help him.

Please tell us what to do!

Sincerely
Ahsan M. Khan

[hillarymcarter]

Wow...it sounds like this guy is actually very lucky. I wish somebody had given my husband a job and care when he needed it. It sounds to me like this guy has got to stop feeling sorry for himself. Unfortunately, that is something that he will have to do by himself. His injury is still fairly new, so it may just take some time. On average, it takes people with a spinal cord injury about 2 years to adjust to their circumstances. Time will heal all (or most) wounds.

[Joed]

Hi Dr. Khan...

I read your post this morning, but was in a rush to an appt....I've been thinking about this practically all day.

There is a thread here that has links to videos showing various transferring methods. I'll try and find it and post the link here later.

As far as physical therapy, what they seemed to focus the most on while I was in rehab (I'm a para as well) was building arm and torso strength (for safer transfers).

A good excercise that builds arm strength as well as increased torso strength is to hold a weight in each hand and completely extend the arms horizontally to the sides, then bringing them straight up overhead...also from the same outstretched, horizontal position, bringing the arms (still extended and horizontal) to the front. Alternately curling the forearm in from an extended position, will also work the torso muscles.

"Thera-bands" are also good tools in building torso strength. Would something like this be available to him? They're basically hollow, rubber tubes that come in varying resistances...and can be easily tied to a doorknob or other stationary object, while the other end is pulled in a variety of positions. If you don't have these at your facility, I would be glad to send some to you.

The motivation issue is a tough one. If I could impart any one thing to your patient/friend at this point, it would be to say that although no one can know if he will realize any neuro return, I can say with certainty that his abilities will improve as his torso and arm strength improve. I think he'll be surprised at how much he will eventually be able to do on his own...and he hopefully will slowly come to realize that all joy and usefulness is not lost. It simply takes on another color.

It can be quite overwhelming at first, and there were times when I felt so defeated even before I began a task. Everything becomes so hard...even the simplest most mundane tasks can seem Herculean to overcome...but with practice and increased strength, there are little victories everyday. It is a slow process, and it's easy to become discouraged.

Please relay my encouragements to him, and let him know that now is the time to fight for his quality of life in the future. He has it much harder than most of us here...without the support of a therapy program...I know I take so much for granted...but I do believe that even with the obstacles he is now facing, if he puts forth his best fighting effort, he will be amazed at how much brighter his future will look. His resources are limited, but there is a lot that he can do on his own too.

I would also suggest perhaps printing out and reading to him some of the posts on this forum and other forums like this...relating the abilities of the members living their lives being paralyzed. I hope that would encourage him to see a possibly different outcome for himself than the one he's seeing now.

I wish I could 'fix' his situation. I was overwhelmed just reading your post. Please let us know how he is doing from time to time?

This post has been edited by Joed: 20 January 2006 - 11:36 PM

[Joed]

Here's that thread on trasnferring:

Tranferring

[Kaani]

Hi!
well i am a paraplegic from pakistan.. i live near lahore and i come to see this doc in lahore who is a paraplegic himself.. i think u should seek out his help as he really knows wht he is doing.. his name is Khalid Jamil and he is in Meo Hospital.. finding him wont be difficult do try it..

also i want to bring about the issue of lack of rehab centres in pakistan.. cant u docs do something about it?

[cartoon1]

Dr. Khan... my name is Ron can you please tell what part of the spine is D...?

I am seconed L for lumbar and that is really low.... and then you get the neck C1 base of the scull is as high as you can get. all of us with spinal cords that are severed.. it makes a big differance on how moble we will and can get.

To how much rehab he is going take to make him as moble he can posilbly be. I know it does not help you with trying to find rehab for him.

I am just trying to understand were the spinal cord was severed.

[Sanaullah]

Dear Ron,
Thanks for the query. You might be more familiar with the T for Thoracic. D is used for Dorsal and various parts of the world use T and D interchangeably. So Sanaullah has an injury at the Thoracic spine level