Q. I’m in my 10th year as a T4 complete para. As an avid mono-skier, winter is my favorite time of year. But it seems the cold winter months are increasingly taking their toll on my skin. My lower legs and feet get dry, flaky and red, and the tips of my fingers get deep cracks right at the edges of the fingernails. Is there anything I can do to help this?
Also, although I always get a flu shot, I’ve never had a pneumonia shot. I’ve read that it is recommended for people over 65 or with compromised immune systems — I’m healthy and my immune system is strong. Are there any recommendations in regards to SCI and getting a pneumonia shot?
A. Becca, for the average person, cold winter weather presents a myriad of health challenges, from trying to avoid colds and flu to dry, flaky skin, but adding spinal cord injury to the mix brings extra challenges and precautions. Here are some tips on “winterizing” a body with SCI.
A top priority should be keeping skin moist. When the temperature drops, so does the humidity. Cold dry air can cause skin to become parched. When cold air is heated, it becomes even drier, pulling more moisture from the skin. Cat Davis, RN, Craig Hospital SCI Nurse Advice Hotline, explains that the first line of defense for keeping skin moist and healthy — and for overall health — is to stay hydrated. One of the first signs of dehydration is dry, itchy skin, a condition that can lead to cracking and the beginning of skin breakdown.
Craig’s education module on hydration recommends drinking eight to 12 8-ounce glasses of water a day. Another method is to drink enough water to keep your urine in the clear to straw-colored range. As always, be sure to empty your bladder often enough — 450 cc (about two cups) is considered a full bladder. Proper hydration also helps avoid urinary tract infections and regulate body temperature. Dehydration can cause a feeling of being chronically cold, or a feeling of being overheated.
Even with proper hydration, dry air can cause dry, flaky skin, something a good moisturizing cream can help heal, says Davis, who also says to avoid products that have alcohol or perfumes in them because they can further irritate skin. When looking for a good moisturizing cream, a good place to start is to ask a local pharmacist to direct you to a cream specifically for dry skin that is free of alcohol and perfume.
Mark Wellman, big wall climber, adventurer and paraplegic, raves about Sween Cream, a moisturizer and skin protectant cream. “Ya gotta protect your butt with Sween Cream, brotha!’” Wellman would often say to me — something a therapist taught him decades ago. I would joke with him about this, until last winter when I developed dry, cracking, red skin on my butt. Remembering Wellman’s chant, I immediately bought a tube of Sween Cream, which costs about $12, and applied it morning and evening. Within days my skin returned to normal. I narrowly avoided skin breakdown and it is now part of my daily routine.
Additional advice for avoiding and/or healing dry skin comes from Cherisse Tebben, family nurse practitioner and certified wound care nurse at Craig Hospital:
• Limit bath or shower time to 15 minutes and avoid really hot showers because they dry out your skin’s natural oils.
• Avoid harsh drying soaps. Instead use gentle skin cleansers or bath gels with moisturizers; use mild soaps with oils, like Dove or Neutrogena.
• After a shower, don’t scrub skin completely dry, leave it moist and apply thick moisturizers (Eucerin or Cetaphil, for example) to act as a sealant and keep moisture from escaping.
• Use a humidifier, especially in drier climates.
• Choose natural fibers to wear, such as cotton.
• For laundry, use detergents without dyes or perfumes, which cause skin irritation.
Another winter wheeling pitfall is deep painful cracks that form on fingertips next to fingernails. The first line of defense to prevent these and/or help them heal is to wear gloves anytime you push your chair in the cold and/or snow, says Davis. I find that “Atlas Gloves,” available at hardware stores for about $8 a pair, are easy to don and doff, very tough, and keep hands dry even in the slushiest pushing conditions. In addition to wearing gloves, Davis advises regularly putting moisturizer on your hands and fingers.
When fingers do crack and split, Tebbin suggests soaking them in tepid water for five minutes, then applying a thick emollient, like Cetaphil hand cream. To heal cracked fingers fast, Matt Feeney, director and co-founder of Adaptive Adventures, suggests slathering a thick layer of Cetaphil on hands and fingers, then putting on disposable latex or vinyl gloves before bed and leaving them on overnight. Feeney reports the technique usually heals the cracks within one or two applications.
Cold dry winter air can also irritate the nose. Davis says over-the-counter saline nasal sprays squeezed into each nostril as needed provides a good option to soothe and moisten dry and irritated nasal passages, a condition that favors harmful cold viruses.
Craig’s guidelines state that to avoid colds and flu, people with SCI should get an annual flu vaccination, and if you have an injury at T6 and above, you should get a pneumonia vaccination. SCI at T6 and above affects the muscles in the torso —which assist in coughing — and compromises the ability for a strong cough that can fully clear out the lungs. As with all guidelines, Davis says it is important for people to consult with their own doctor in regards to vaccinations.
Arguably, the best way to avoid a cold or flu is by getting back to basics — hand washing with soap and water. Davis explains that cold and flu germs are often picked up on the hands, then enter the body when hands touch the mouth, nose or eyes. Frequent hand washing can help prevent this. Be sure to follow up washing with frequent moisturizing. Davis says hand sanitizers are a good solution if hand washing isn’t an option — but cautions they will dry out skin.
In cold weather it may be tempting to use an electric heating pad or blanket, but Davis says Craig’s position is very clear: “We don’t recommend them on any part of the body without sensation because there have been cases of heating pads and/or electric blankets burning skin.” A temperature of 111 degrees is hot enough to cause a burn, and 120 degrees is hot enough to cause a third degree burn in just 10 minutes. Another problem with electric blankets is their artificial heat dries the air and pulls moisture from large surface areas of the body, which can cause or exacerbate dry, itchy, cracked skin.
Becca, I hope this helps you stay healthy this winter. Wishing you a safe and healthy ski season with many first tracks!
Advice in this column is supported by Craig Hospital’s SCI Nurse Advice Line, a toll-free hotline for people living with SCI, a community service partially funded by grants from the PVA Education Foundation, Craig H. Nielsen Foundation and Caring for Colorado Foundation. For non-emergency nursing information about SCI health, call 800/247-0257 between 9 a.m. and 4 p.m. Mountain time. If you have a health question, contact Bob Vogel at firstname.lastname@example.org.