[Gary Anderson]

Good Morning Forum

Could some of you kind folk out there be of some assistance to an old Doc?

I have a patient on my ward at the moment having plastic surgery done, however, more importantly they are L2 incomplete and not long diagnosed as such.

They are doing their level best to get back some form of quality life and have made enquiries about learning to sit ski.

However, they would like to go swimming again but they have a two pronged question:-

Q 1: How does an L2 incomplete para get into a swimming pool?

Q 2: They enjoyed swimming in the sea before the accident - how do you get into the sea.


What is putting my young patient off is the fact that they want to do things themselves without help. Which I can understand.

I am no help - me, I just launch myself off the edge of the pool but then, I am not paralysed. I have never been able to get the nerve up to go scuba diving - but then I could not do it prior to my accident.

My patient is L2 incomplete, has normal feeling above the knees, however, nothing below the knees. They will in the future be able to walk with calipers and sticks/elbow crutches.

Can anyone out there be of assistance before I make a right ass out myself and tell them something wrong? I would reckon that with such a low injury it may be possible to lower themselves from their chair down on to the edge of the pool. But perhaps not.

Any help/assistance you can give would be much appreciated.

Thanks folks.

[Lucydog]

Well it really depends on the design of the pool. I went to Centerparcs recently and the whole pool was totally acessible from changing area to poolside. I was able to take my chair right up to the poolside and then sort of slide in the water. But they also offered their own chairs so you could be wheeled in rather than thrown in as the pool was graduated, no steps. Getting out was more difficult so I sort of shuffled out on my backside and then got a hand from my husband. It was a lot of fun and the first time for me anyway!

The things you have to look out for are older public pools that have those funny foot baths you have to walk through. Sometimes there is no way to avaoid this, so the key I think is probably to see how easy it is to get to the poolside.
Ive never been tempted to use a hoist as they seem, well..... a bit cripply!!!!!!!

Since Centerparcs we now hire a local private pool for a hour or 2 at a time. Its private and we go as a family. I then have total faith in doing it myself and dont get embarrassed by people watching me.

Just a few suggestions, its worth perceivering with as he will Im sure find the right place and system that works for him

[Gary Anderson]

Hi Lucy

Thanks for that reply.

I know what you mean about hoists being cripply. It's 19 years now since my train crash and I dont like cripply things or things that highlight my inability.

The thing aggravating me just now is my lack of use in my arm. My colleagues laugh at me because I try to hide it at every opportunity. My reply is that I dont want a sign on my back saying "One Armed Doctor on the Loose."

I shall pass on your comments to my patient and I am sure that in time he will learn how to "adapt" as we all have (well, I dont think I have even after 19 years).

[lune14]

Hi Gary,

I have used the chair with the gradual ramp into the water as Lucy has described and found it very simple. I was nervous at first but found it a very independent experience as I could just swim out of the chair once I was in the water deep enough. The chair is supplied by my pool center, it's made of pvc piping with average front casters and rear hard wheels taken from a standard wheelchair. It's a bit difficult to wheel myself as it rolls wonky and there are no push rims but I always have a friend with me anyway. the seat & seat back are made from mesh fabric.

Other than this type of access my previous swim experiences were always a friend or PT lifting me to the water's edge, then doing a "hug" lift into the water (which is always nicer with a fella by the way )

[Tinbasher]

Hi Gary

Although I am told I am T12 incomplete I sound a bit like your patient. When I swim I tend to park my chair and slide down onto the floor (onto a towel) and then shuffle into the pool. If its a level pool where the water goes right up to the edge I can get myself out at a corner. I too hate those hoists affair you could sell tickets for the performance!

Oh an another thing tell him that those feet that keep popping up are his and not some drowning strangers

Tom

[Gary Anderson]

Cheers for the replies folks.

I shall remember about the feet Tinbasher.

Here are 2 more questions - a tad embarrassing but not too much I hope.

Now that we have got him into the pool,

Q1 - How do you swim without the use of legs?
Q2 - How do you disguise the leg back under swimming trunks?

I cannot answer these as (fortunately) I have the use of my legs and as for the leg bag, I only require a condom catheter for "security reasons" as my control is almost perfect.

Cheers folks. I know you will come up with the answers.

[edlee]

My plan for the bag is to fit a valve to the catheter and keep it off ( the valve) while in the water. Havn't got the chance to try it yet, as I haven't gotten an indwelling cath yet. Still using intermitent cathing. I guess , for me right now, it doesn't matter much. Who's gonna notice if I leak a little? I'll just stay out of the hot tub till I'm sure.

[russ1]

Quote

fit a valve to the catheter and keep it off ( the valve) while in the water

That's what I do, obviously with no bag attached. Most para's with indwelling caths of any sort should have a valve and use it regularly to maintain bladder tone and allow the flexibility to do this sort of thing.

[Tinbasher]

Well catheter valves are still a relativly new idea here in the UK I think.

When I did have cath I used to empty the leg bag roll it all up in a rubber glove with a rubber band around it and stash it in my roomy trunks. I have also disconnected the cath and clamped off the end (A plastic CLIPPIT bag closure does the job) but I was never really sure about that as I worried about getting pool water in the "system" as its never very clean. Any solution that breaks the integrity of the cath / bag system should probably be avoided.

Once he gets off the indwelling (as I hope he will) just empty the bladder before you get in, any leakage after that is going to be minimal and wont pollute the pool anymore than those cute kids in the shallow end!

Tom

[Dancingdolphin]

Q1 - How do you swim without the use of legs?


Hi! I was pleasantly surprised to be able to swim unaided while I was in rehab. At first, I'd a floatation thing around my neck and on both my arms, I discarded these one by one. Just have to work the arms a bit extra as no leg movements.......
I was also surprised to find that I could float on my back and the legs float to the surface with the toes breaking thro the surface!
I was a bit nervous at first but had a spports therapist by my side so I knew I wouldn't drown!!
Basically, just swim as normal without the leg movement..simple as that!

good luck!

[Tinbasher]

I forgot to say that one of the things that surprised me was how bouyant my legs were and how because you get set in a sort of sitting shape my bum seemed to stick way out of the water! I have since been told that the legs are more bouyant because fat is more bouyant than muscle ! Also as an incomplete I can stand and "walk" in water feels good.

Tom

[Apparelyzed]

Gary,

Does your friend use a legbag? Many people with a low injury at that level do Intermittent Catheterisation, so the legbag wouldn't be a problem.

If he is going for a swim for an hour, he could limit his fluid intake for two hours prior to swimming, and ensure his bladder is empty prior to getting into the pool. Then, once he is out of the pool, he could just rehydrate himself.

If he uses aa Indwelling Catheter, then he can just clip it off using a catheter clip, or by inserting a valve in the end. I have been using the valves mentioned above for 15 years whenever I have a shower. Another name for the valve is a catheter spigot.

If he has a bladder reflex which drains his bladder naturally when full, and uses a legbag, he could just restrict his fluid intake as above, empty his bladder using an intermittent catheter prior to getting into the pool, therefore no longer requiring the legbag whilst swimming.

For further info on catheter valves, see this post: http://www.apparelyz...?showtopic=3884

Regards

Simon.

[wheeliebear75]

I am L2 incomplete. We have a pool at our complex that is nice but has no adaptations for disabled. I park my chair at the side of the pool at the deep end & shove off. For getting out, I use my arms to hoistmyself out & sit next to my chair. Undo brakes....move chair a foot or so for safety and get back in. i think a para who can get from chair to ground and back again can go swimming at almost any pool. The pool z great because I can use a kickboard and excersize my leg muscles.

[WheelsWithAttitude]

I am a t10 complete so no sensation or movement from aprox a bit over navel.

I use public pools that are level with the water, meaning the water goes all the way up to the edge.

I roll up to the edge then get on the ground, move my legs into water and then the rest of my body.

Getting out I get up to the edge, then push my body up where I can lie on my stomach and then kinda pull myself completely out of the water.

I do have probs getting in my chair from the ground so I usually try to have someone lift me in or I to somehow get in it, by trying to hold unto something that will help me push my body up.

hard to explain, you'd have to see it.

Beaches and stuff I have not been to since accident, would like to try and see but I guess a beach chair would make sense or wooden planks into the water


As far as, how do i swim without the use of my legs?

I swim with my arms only,not as good not as long, very tiresome and not as fast, but I can stay afloat and swim.

I have spastic bladder, take meds to calm it, and have to cath every 4 hours.
So I go and do that to empty the bladder and then I can be ok for the next 4-5 hours, no prob.

This post has been edited by WheelsWithAttitude: 07 April 2007 - 01:49 AM

[Dan_H]

Mastering a floor to chair transfer has helped me do lots of things. It took a while to get it right myself but it was worth it. I'll transfer directly onto a folded towel or something similar.

I strap my leg-bag near my knee and wear 3/4 length shorts.

The swimming takes some effort just with the arms, but as said in some posts above, my legs float quite well. I find being relaxed and skulling on my back the easiest, except you need to keep turning around to see where you're going.

Dan H
T4/5 complete

[zzipzz]

I use the corner of the pool - turn my back and put my hands on the two sides and pull myself up.
reverse going in - way easier than going off the sides. Stick to the deep end. another pool I go to has a chair lift which is very easy. I've gone to the beach too but it messes up my front wheels (they make a horrible high pitch sound afterwards) but I have somebody else pull the chair up from the water.
I'm really curious if anybody has any swimming from a boat (kayak or motor etc) tips.

[cate]

Our local pool has one evening a week, which is for oldies and disable people, there is always somebody about to help, and they have a childrens area which is easier to get into, they also have chairs available.
With regard to using your legs, think of a swimmer training, they do length after length, arms only, and then legs only it can be done. I am sure he will enjoy and find it very good
Cate

[Elzeen]

How does an L2 incomplete para get into a swimming pool? I'll add my T12 method here: My husband and one of my grown children lift me out of the chair, move the chair aside, and throw me out into the middle of the pool. To get out, I sit and scootch myself backwards up the steps until I'm sitting on the rim of the pool. Then my team lifts me back into my chair. Not independent but well worth it!

Being in the water is a blast - it restores some "normalcy" to one's physical being. Swimming is no prob with just arms. I let the buoyancy of the water support me in whatever position happens and make up my own goofy swimming strokes.

I find that, unless the water is really warm, I lose body heat very quickly and cannot tolerate more than 20 minutes in the pool. By that time, I am shivering.

Q 2: They enjoyed swimming in the sea before the accident - how do you get into the sea.There are some rubbery-plasticy runner things that I have used at beach parks that are good for rolling over the sand. That - or one of those giant-wheeled chairs is a good way to get to the water.

And what a good doc you are to research this for your patient!

This post has been edited by Elzeen: 22 November 2007 - 03:29 AM