Q. I was reading a thread on the quad-list discussion group about a guy who is a C7 quad and had appendicitis and his appendix burst. He says he had to have major surgery, almost died, and spent a long time in the hospital.
Since then I’ve heard stories of this happening to a couple other people with SCI, both paras and quads. It kind of freaks me out.
I’m a C7 quad as well. Does being paralyzed make somebody more prone to appendicitis? If I did have appendicitis, how would I be able to tell?
A. Curt, I’ve also heard about a few people with SCI who have ended up in the ER with a burst appendix, and I’ve wondered the same thing — how can you tell if you have appendicitis?
The appendix is a narrow tubular pouch, attached to the large intestine, located on the lower right side of the abdomen. Appendicitis is inflammation and swelling of the appendix. Journal articles say that approximately 7 percent of people in the United States will develop appendicitis in their lifetime, and that the most common causes are obstruction from food waste, a hard piece of stool or infection. PubMed Health says appendicitis is one of the most common causes of emergency abdominal surgery. The first symptom is usually pain in the lower right abdomen. Other symptoms include reduced appetite, feeling nauseous and a low fever.
Appendicitis is a go-to-the-ER type of situation. If an inflamed appendix isn’t removed, it can burst and quickly turn into a life-threatening situation. A burst appendix can lead to peritonitis (infection of the lining of the abdomen) and sepsis (bacteria in the bloodstream).
Diedre Bricker, R.N., of Craig Hospital’s Nurse Advice Line, explains that having SCI doesn’t make a person more or less likely to get appendicitis than the general population, but reduced — or lack of — sensation makes diagnosing appendicitis in somebody with SCI much more complicated. To further complicate matters, usual symptoms of appendicitis are similar to many SCI-related complications, like UTIs.
“Abdominal pain is the most difficult thing we deal with when people call us,” Bricker says. “The decreased sensation that goes with SCI makes it very hard to help pinpoint what we are dealing with. Because the abdomen is where all of your organs are, the pain could be anything from a UTI to bowel problems, gallstones, kidney stones or something wrong with the liver or pancreas.”
Bricker says the key to sensing when you might have appendicitis is being in tune with your body and paying attention to warning signs when something is wrong. “If you are breaking out in a sweat at night, or have a decreased appetite or are feeling nauseous, or have increased spasticity, or get dysreflexic — don’t just brush it off,” says Bricker. “These are signs that something is wrong, and it’s time to consult with your physician — or if the symptoms warrant it, go to the ER — and find out what is going on.”
The next step is for the physician to go through a checklist to find out what is causing the symptoms — check for UTI; make sure the bowel program is on track and there is no constipation or impaction; check for any swelling, redness, pressure ulcers; rule out kidney stones and gallbladder stones, etc. — until a diagnosis is made.
A 1999 study, Appendicitis in Patients With Previous Spinal Cord Injury, points out the difficulties in diagnosing appendicitis in people with SCI. The study looked at records of 26 people with SCI and appendicitis treated in VA hospitals between 1992 and 1997. Half were paraplegic, half quadriplegic. The average length of time since onset of SCI was 22 years, the average age was 55, and ages ranged from 27 to 79.
Many of the symptoms mimicked SCI-related complications, and there was no consistent pattern of presenting symptoms (reason to seek treatment). The most common symptoms upon physical exam were autonomic dysreflexia, fever and elevated white blood cell count.
Appendicitis was initially diagnosed in only one third of those seeking treatment. Other incorrect diagnoses included UTI, pyelonephritis (kidney infection from a UTI), intestinal obstruction, constipation and colon cancer. The average delay from being hospitalized to correctly diagnosing appendicitis was two days.
A CT scan was done on half of those studied and it correctly diagnosed appendicitis each time. By the time of surgery, 92 percent of them had a ruptured appendix.
The study concludes that when people with SCI have vague symptoms and/ or signs of autonomic dysreflexia and a specific cause can’t be found, a CT scan can lead to an earlier diagnosis of acute appendicitis. Other studies indicate an abdominal ultrasound can pinpoint acute appendicitis.
Jerry Donovan, 51, from Norwood, Mass., is in his 12th year as a T7 para. In 2009 Donovan came down with appen-dicitis. “I had some friends over watching a Celtics game and I knew something was wrong, I just didn’t feel that great. I had been feeling a bit off for a few days,” Donovan says. “At first I thought it might be a matter I could take care of in the bathroom. I made sure my bladder was empty, did a bowel program to make sure I wasn’t plugged up.”
Donovan admits he doesn’t run to the hospital unless he is really sick. “I didn’t have autonomic dysreflexia or any of that stuff,” he says. “I had a slight fever but not really high, I was just feeling really crappy.” Donovan finally went to the ER. He said the physicians knew something was wrong, but after 12 hours of tests they couldn’t figure out what it was. Finally they did a CT scan and it showed that Donovan’s appendix had burst.
“They said if I had sensation I would have been in lots of pain and would have come in much sooner.”
After the CT scan pinpointed the burst appendix, a surgeon was called in right away. At 11:30 at night the surgeon made a 5-inch incision and cleaned everything out.
“The surgeon said it could have killed me,” Donovan says. “I was in the hospital for five days and was being pumped full of IV antibiotics to kill off any infection. It really set me back. I’m in really good shape and I bounce back from stuff, but this really knocked me out. It took about two months to get my strength back to where I was feeling like myself again.
“If I would have waited another day,” Donovan says, “that could have been the death of me. If you think there is something wrong with you — go in and have it checked.”
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.