Handicapped loved ones

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Handicapped loved ones

Post by FleshEatingZombie » Wed Oct 20, 2010 9:39 am

How does one prepare to help someone who does not have have the best motor skills?

What can be packed to help someone with difficulty walking or moving at a decent speed... or worse someone who is paralized in any way?

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Re: Handicapped loved ones

Post by Stercutus » Wed Oct 20, 2010 11:23 am

? this is more of a question for a doctor or physical therapist. It would depend upon a lot of things such as the nature of the disability and what it is you think you want them to do.
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Re: Handicapped loved ones

Post by Vicarious_Lee » Wed Oct 20, 2010 11:46 am

EDIT: I wil try to keep this on topic, it will be fairly long. The topic for this post will be "Mobility" and in terms of SHTF as in it's a normal Tuesday and you or your family is disabled. Or, the SHTF is that it's a normal Wednesday, and you have a job, and you have a disabled family member, or it's a mild SHTF and someone is disabled.

This post will not deal with a PAW or TEOTWAWKI. In those situations, most able-bodied people will die, and I can't adequately prep for those that need everything our modern society has to offer.

I'm going to call out any home aides, home nurses, therapists, tinkerers, etc. in this thread because I think ZS needs a "mobility impaired" thread not just for the PAW, but for right now, since disability and loss of mobility is one of the most common zombies that we face.

1. SETUP AND COSTS

So you or yours has been recently disabled and has impaired mobility. Unfortunately, things will get expensive, and common fixes to things that would come as a prescription are horrifyingly expensive. Your home must be set up to accommodate this disability. The more you rely on ingenuity, Home Depot, and internet message boards for people with the same problems the more you'll come out less poor here.

In addition, even if the disability is compensated through some entity with money to give you, you will need to fight. With the little things, with the little adaptations, save your energy and find a way around it yourself. Doesn't matter it your healthcare is private, public, or Federal (sort of). If you can do for yourself, you'll do faster and with a lot less headache.

Fight for a wheelchair, but if you try to fight for every shower head and grab bar, you're going to waste time, frustrate yourself, and come out bitter and ultimately less useful in the end. Forget that.

Instead, look to friends and family, and handiness. Ideally, you can get a certified Physical Therpist to do a "Home Evaluation" for you and tell you what needs to be done. Practically, hey: You're not stupid. This is ZS. Figure out the impairments to mobility yourself if you have to. It's not that hard sometimes. If you do get that therapist eval, and you're not shitting gold bricks, just look at what needs to be done and see if you can do the little parts yourself. For instance:

1. Remove rugs, transitions, floor texture changes, and minimize uneven surfaces in the home.

2. Any ramp into a home needs to have (optimally) 1" rise for 12" of run. They can be bought, or they can be built. They can be built cheaper.


2. BATHING

In our American Society, being clean is awesome. We have a love affair with soap, and I think that's sweet. I do not have studies that can prove this, but I have anecdotal evidence that being clean can literally reduce a persons pain levels, as well as making them feel more human. Some ideas for DIY adaptations:

Install grab bars (available at hardware stores). Put a non-stick mat in the tub. Get a shower seat from the local pharmacy.

Install something like this. It was 50 bucks, and went on in 10 minutes (my wife recently split her patella in half).

If there's a 2-story house (like I had) it's cheaper to figure out how to do a bath downstairs when their isn't one, instead of installing a lift, or having one installed. A sponge bath in the kitchen can be done, and approaches 75% of "cleanliness" of a shower. This helps in an acute mobility impairment as well as long-term.

In the hyperacute phase, I've leaned on these with good results. There are many other options out there for both short and long-term.


3. AIDES

Listen....this is the hard part with disability. The aide industry has cheapened itself and lowered wages to the point that it is extremely hard to find good help, and by "good" I mean someone that won't show up high, steal your loved-one's pain meds, and do not even a 1/3-assed job at taking care of them. This is the reality, and despite what anyone's heard it's not about to get better. At the best case scenario it's going to stay just as bad, and may get worse.

If you find one you like, HOLD ON TO THEM!!!!! Be nice. They drive door-to-door and wipe assholes. They make shit money, and almost without exception, in the best case scenario they are not with you for enough hours in their work-week to do all that's required. Get them to teach you. If they suck, this is one of the big-issue things to fight for. Don't give up on your aide if they're some crackhead. Start making phone calls and threats.


4. REHAB

Rehab is good, and I love it. Like everything else, it's severely limited (and will get moreso in the future). If your loved one is getting therapy, make every effort to get them to a therapy gym. All things being equal, you will receive higher quality rehab by virtue of the fact that a gym has superior equipment to what a home-based therapist can fit in their trunk. In reality, gym-based therapists tend to be better. Home care as a whole is not doing well these days, and isn't about to start doing better.

If you have a good therapist...PARTICIPATE!!!! In the best case scenario they will not be assigned enough hours to your family member, and they can teach you the things they do to fill in the wide time-gap in between. They will stop coming in a matter of weeks many times, and you need to learn and implement everything you can before then.


5. BACKUP

Once the healthcare dollars and visits runs out, the gap must be closed. This can be achieved through an INNUMERABLE number of churches, volunteer organizations, and charity groups as well as friends and family. Google is your friend, and advocacy is your new favorite hobby.


6. MEDS

I won't beleaguer a point that's prevalent on ZS already. Get backups. Like Chantrea mentions, if your family member has an implantable pump that dispenses medication systemically, then there needs to be oral backup in case that pump fails. Some meds cause horrible withdrawal, others can cause death if suddenly stopped.


7. BUGOUT

You need a prearranged place, pre-planned meds, and a way to get there. The short of it is that THERE IS NO BUGOUT WHEELCHAIR. The wheelchair is designed as a crappy replacement for mobility in the best of times. Find a way to get motorized transport, whatever that is. This is an excellent and powerful group that has some very good disaster information and pamphlets:

http://www.pva.org/site/PageServer?page ... ReliefFund" onclick="window.open(this.href);return false;



So, that's a start. Let's expand this thread, and TLRM and others can post up links to household fixes and websites that help people deal with this. The one common factor is that with a long-term disability and mobility impairment, you and your loved one will most likely be getting shortchanged. You and your loved one will not be getting all the help and healthcare that you are entitled to, and you will not be getting all that you need.

IMHO, this situation will not improve in the future, and will almost certainly worsen. So we must make-do.
Last edited by Vicarious_Lee on Tue Oct 26, 2010 12:04 am, edited 1 time in total.
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Re: Handicapped loved ones

Post by TacAir » Wed Oct 20, 2010 12:23 pm

Vicarious_Lee wrote:
Blacksmith wrote:? this is more of a question for a doctor or physical therapist. It would depend upon a lot of things such as the nature of the disability and what it is you think you want them to do.
Marked for EDIT.

Just the other day, I PMed TheLastRifleMan about this, since he's a DME repairman. I've got a long post brewing and was going to start a thread about it, but haven't gotten around to it.

I'm going to call out any home aides, home nurses, therapists, tinkerers, etc. in this thread because I think ZS needs a "mobility impaired" thread not just for the PAW, but for right now, since disability and loss of mobility is one of the most common zombies that we face.

So.....I'll see if I can't put something together.
A related thread would be the one now out there for carts. Let me see if I can fid it..

(edit) Got it

This basis for a single wheel cart is another possiblelity.

This shows a current Army 'rickshaw' two wheel cart. A rickshaw or even a 'bike rickshaw' could be an option, if you will be on the road, prepared trails or other firm surfaces.

The effort to carry an injured person any distance is - well, mind boggling. Strechers work, but are a temp measure. They are not an option if there is only two of you - think husband/wife team or small family group.

This should be an interesting thread.
Last edited by TacAir on Thu Oct 21, 2010 7:25 pm, edited 1 time in total.
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Re: Handicapped loved ones

Post by hotlead » Thu Oct 21, 2010 12:21 pm

I think any plans made should start with-

#1 What is the nature of the disability?

#2 What is the person capable of doing for themselves, either physically or mentally?

Some folks just need assistance with mobility but are otherwise 100%, while others are completely ambulatory but have significant mental imparements. Some are sharp and mobile, but have phobias or emotional issues.

It may be as simple as planning a route that avoids bridges for the guy who's phobic of bridges(a guy at my shop is deathly afraid of them and drives 80 miles around the bottom of the SF bay area to get accross the bay), or as complex as rigging a portable solar charging system for a rough terrain capable power chair and breathing apparatus.
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Re: Handicapped loved ones

Post by Vicarious_Lee » Thu Oct 21, 2010 3:58 pm

I'll make this about physical immobility. I know there are at least 2 posters that can also contribute.


Okay, I'll really try and work on this tonight.
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Re: Handicapped loved ones

Post by hotlead » Thu Oct 21, 2010 6:19 pm

I guess the problem with a discussion like this, is that no disabled person has the same limitations as another. Unfortunately it would have to start with a certain set of obstacles to overcome, in order to come to a complete and effective solution.

We can generalize about crutches, or chairs, or prothsetics, and come to a pretty close answer. That would help much more than not discussing it at all, at least folks would have a general idea of where to start.

I'm pretty motivated about this, it's the first time I've seen or heard a discussion about this topic ever, it seems most of the talk is about our own little incarnation of Rambo or the A-team. Right on !!!
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Re: Handicapped loved ones

Post by Chantrea » Fri Oct 22, 2010 11:38 am

I agree the mobility issues are on a huge spectrum.

On one end, you have folks like my ex, who may have a T4/5 spinal cord injury, but was also an athlete who modified/creating his own chairs to enable him to do what he wanted to do....and you can have someone else with the same level of injury who isn't even using a manual chair. You have folks who technically qualify as "paraplegic" BUT can walk with cane/crunch assistance (one of my ex's big beef with the paralympic games when he competed, esp. for sledge hockey--some teams had like one guy who needed to use a chair--the rest walked onto the ice carrying their sledges!) or not much at all. More extensive injuries more uniformly affect mobility, but even there there is a spectrum. Not all people who are "quadriplegic" need a respirator, for example. And then you have non-spinal cord mobility impairments like arthritis, MS, MD, diabetes, ect.

When I was with my ex, I didn't really worry about his mobility so much as how to deal with spastic muscles when the medications for his pump ran out. A lot of people don't realize that for some (most?) people, when there is a spinal cord injury it doesn't mean that the affected limbs hang limp. The muscles have spasms. Some people (like my ex) can even be pulled out of their chair by their leg movements if they don't have medication to control it or some way to immobilize them. Also, hygine is particularly important for folks with reduced or no sensation--sweaty, dirty skin gets pressure sores and injuries even faster than normal. If you can't change/launder your seat cushion as often, that puts you at risk. If you're stuck out with your crappy cushion, you're going to be in trouble quickly. We had wound care kits for each car and extras at home. My ex was meticulous about caring for himself, I've met plenty of folks with mobility impairments that were not--either because they had shitty rehab, weren's strong enough to keep up with it, or were depressed and struggled with it, or couldn't afford to have good protection gear (like good cushioning, plenty of hygene supplies, a chair that fit them, ect.)

To be honest though, folks like my ex would be a bigger asset to any team than a lot of "average" people (including myself). If someone is using a manual chair, esp. if they are an athlete, they've got awesome upper body strength. They will help people to remember (as everyone should do in a primitive shelter environment) to do body checks/wellness checks on a daily basis. Not having the use of your legs to the extent of other people doesn't preclude you from being a good shot (at least, not my ex and his friends!!) or using your brain. But obviously, everyone is different.

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Re: Handicapped loved ones

Post by Braxton » Fri Oct 22, 2010 4:59 pm

I am going to keep an eye on this thread for a few reasons, My ex had a very bad back. The slightest thing would render her unable to move for days at a time without extreme pain.

When I started to get into preping I went out and got a couple of nice BOB's and filled them with all the shit I thought we would need for a few weeks. The first time she put one on she collapsed into the floor screaming in pain. It was a serious O SHIT moment for me. I had not thought about this at all. How would I move her if we needed to get the hell out of dodge??

I found the answer on this forum, but I think she would be none to happy with my choice. Tactical Wheelbarrow. Seriously. It was the only thing that I had at the time and really the only answer that I could come up with at all.

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Re: Handicapped loved ones

Post by AZMedic » Fri Oct 22, 2010 5:51 pm

I'm a medic and used to work in the interfacility field of ambulance transports. Meaning we would go to the nursing homes or assisted care centers or whatever and get these people and transport them to the doctors appointment or hospital and such.

We used gurneys for this since we are well an ambulance. Makes it easy to move on even flat surface with two able bodied people. For those patients that weighed over 300 pounds its hard to move the gurney with two people.

Oh and this doesn't include my gear for if it was a full blown medical call.

For every non abled bodied person its going to take at least two to help that person move. Throw in gear and such and it may turn into three to four. Speed is not your friend here. It will be a slow process.

And don't think you can stack gear and stuff ontop of the gurney or the patients lap on the wheelchair. It will create wounds and skin tears and may break bones.

I'll add more later but with the mobility impaired in your group more is put onto the able bodied and overall speed is slowed a lot.
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Re: Handicapped loved ones

Post by DarkAxel » Fri Oct 22, 2010 7:46 pm

I'm not a doctor or any type of medical professional, but I do have experience helping my brother get about.

When my brother was released from the rehabilitation hospital after his injury, he walked with a cane and wore a belt around his waist so I could hold him up if he got wobbly. He was slow, but he could get around pretty good and pretty fast if I had ahold of his belt.

The docs put my bro on a walker after he had surgery on his feet, and I had to help him stand and sit down. After the surgery failed, my bro was wheelchair bound. He was able to help me get him in and out of his chair. He could still stand up by himself, but he couldn't turn around or walk without losing his balance, so I had to be there to make sure he didn't head over. He stayed in the wheelchair for many years, but eventually he relearned to walk, first with a cane, then unaided. After I moved to Lexington, Mom had my bro doing simple chores, like carrying in coal, making his bed, and fixing the morning coffee.

During my absence, Mom's mental illness go the best of her, and she relied on my bro to do a lot, like cooking, sweeping, feeding the fire (we heat with coal/wood), and some of the shopping (this still amazes me. My Bro had a right-frontal lobectomy and has serious problems with impulse control, short-term memory, and emotional control). Eventually he got tired of doing everything for Mom and refused to do any more. Then he had a stroke, and COULDN'T do any more (that's when I moved back home).

The stroke sent my bro straight into the bed. He can't sit up by himself. He can't help me get him into a wheelchair, and he can't keep himself upright in his chair. When he goes to the doctor, an ambulance must come out to get him. When he has seizures, he usually goes into staticus epilepticus(sp?), so we have to call an ambulance to get him to the hospital.

Conclusions and other random thoughts:

When dealing with the mobility impaired, everything takes at least double the amount of time it would take a healthy person. double your expected travel times, and double your pre-whatever prep time, at minimum

MAKE the impaired person help as much as possible if at all possible. There is a huge gulf between disabled and differently able. Pre-and-post SHTF, challenge your family member to improve their mobility situation. Keep their spirits up, and reassure them that they are not a burden, but that they are valued members of the team.

There have been a few times when I have had to move my brother unaided (he was either out cold from a seizure or in the middle of seizing during extreme weather). I have tried many methods, but the fastest has been to roll my bro onto a quilt, comforter, or sheets in layers, then drag him (face-up and head-first). As long as his head is between my hands as they grip the fabric, I can cradle his head in the blanket to protect from ground obstacles and still use my whole body mass to move him.

While moving my bro over uneven terrain in a wheelchair, I found that tipping the chair back on its biggest wheels helps immensely. Those small front-wheels on most modern wheelchairs will get hung on every tiny little gravel or dirt clod. Wheelchairs were designed for flat, smooth surfaces and even grades. Going off-road? Forget it, unless you plan on getting or already have an all-terrain capable wheelchair or a custom sports rig(both BIG $$$).

Be prepared to do a lot of heavy dead-lifting. Work on muscular strength and endurance along with your loved one. When you go to physical therapy with them, follow along, pay attention, and do some of the same things they do.

Even the disabled and differently-able have something to offer. My brother may have problems, but I can bet my life on his ability to keep a watch. He is the most observant person I know. If my bro can remember something, I know he will be able to recall it perfectly (getting through the short-term memory problems has been a trail-and-error process, but it has paid off handsomely) when he wants or needs to. He also has a very pragmatic outlook that has been invaluable when it comes to making choices. He's also the funniest motherfucker I know :lol: .

If you have a mobility impaired loved one in your home, make bugging in a priority, and tailor your bug-out plans around their speed of movement. As a caveat, if you have a MI (mobility-impaired) loved one in a mandatory evacuation area, GET THEM THE HELL OUT OF THERE AS SOON AS POSSIBLE!!! A MI group member = a slower reaction time = decreased ability to get them out of harm's way when the poo hits the wind-blades.

A lot of MI people take regular medication to maintain their standard of living or life expectancy. If a SHTF event turns into TEOTWAWKI and the PAW, the supply of meds will undoubtedly be disrupted or made non-existent. Standards of living and life expectancies will drop across the board, but people reliant on meds will suffer horribly. Look for alternatives to pharmaceuticals if at all possible. Consider the possibility that you will lose them: it will help in the long run. Do everything you can to give them an honest fighting chance. If you do that and they still perish, you will have the consolation that you did everything you could do for them, and loved them until the end.
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Re: Handicapped loved ones

Post by AZMedic » Fri Oct 22, 2010 8:44 pm

Oh if you do buy a wheelchair avoid the ones with plastic parts as much as possible they will break as soon as the terrain isn't so good. The metal ones do very well.

The standard wheelchair can last over smooth ground like dirt but is a pain to move.
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Re: Handicapped loved ones

Post by DarkAxel » Fri Oct 22, 2010 10:00 pm

I forgot:

Quad canes absolutely fail in uneven terrain as well. My bro had better luck with two single canes or crutches.
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Re: Handicapped loved ones

Post by SeerSavant » Fri Oct 22, 2010 10:13 pm

This thread is full of good ideas, sorry I can't add to them. Unless they area confined into a wheelchair, Simply focus on what they can provide, even if it's just knowledge, they can right shotgun... literally. Mobility may be solved by customizing a small all terrain vehicle. I had an uncle with legs that were pretty much useless, prostate issues, I think, it was a long while back... However, he had both a three wheeler (Preban/prequad wheelers) and a snowmobile, both were jury rigged to run with all hand controls, and the seat was given a back rest with side holders, so that the only way he could fall out was foward where his hands would keep him in.

Yeah, I know, pretty dodgy, and probably not gonna pass a safety inspection, but in a worst case scenario, I would rig up some kind of motorized or similar mobile platform for him/her to get around.

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Re: Handicapped loved ones

Post by AZMedic » Fri Oct 22, 2010 10:22 pm

One of the best things I can think of was someone mentioned earlier was to evac early with the mobile impeeded. Like before orders are given.
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Re: Handicapped loved ones

Post by Biggin » Sat Oct 23, 2010 12:00 am

Buy more ammo.

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Re: Handicapped loved ones

Post by hotlead » Sat Oct 23, 2010 2:35 pm

Biggin wrote:Buy more ammo.
Good advice for sure, and points out that most folks prepare for disasters by buying ammo instead of storing more food and gas, or oxygen cylinders for folks with COPDs and inhalers for those with asthma.

I'm certainly guilty of this myself to an extent, I definately have more cubic feet of ammo than food stacked up.
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Re: Handicapped loved ones

Post by Vicarious_Lee » Tue Oct 26, 2010 12:09 am

darkaxel wrote:I forgot:

Quad canes absolutely fail in uneven terrain as well. My bro had better luck with two single canes or crutches.
Absolutely agreed. Not a fan of the quad cane.

Another idea, if a person has a balance or neurological disorder that makes them unsteady on their feet (this could be due to a brain injury, or something like diabetic neuropathy) is something called an "NDT Pole".

It's basically a large, fairly heavy walking stick that comes to about shoulder height. It widens the center of balance, and gives tactile feedback through the hand via a weighty and long support straight to the ground. When properly employed, it can dramatically help a person's balance.

My original post has now been completed with a giant rambling response. :D
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Re: Handicapped loved ones

Post by DarkAxel » Tue Oct 26, 2010 8:58 am

I built my brother's wheelchair ramp out of two 10ft 2x6s and a pound of nails. Total cost? around $15. And that ramp is still there, 12 years later, as sturdy as ever. Total cost of a metal pre-built ramp that the home health supplier wanted to bring? $300 installed, and it would have been a fight to get my bro's insurance to pay for it.

Widening doorways can be quite a headache. In most cases you'll have to remove wall studs, and on structural walls, you'll have to build new headers as well. Not something for beginners (on structural walls).

All wheelchairs are not created equal. The type you see in hospitals is the same type that most home health providers default to when filling prescriptions. Quite frankly, they are junk, the cheapest thing the hospital corp. and home health corp. can find. Use one of those regularly, and you'll see what I mean. The tires slip off of the wheels too easily. The hand-grips on back come off. The wheels are made of plastic, and instead of bending like metal wheels, they will break. Invacare is the cheapest chair I've settled for.

If you or your loved one is large, they may need a larger, sturdier wheelchair. These chairs are wider (you can fit a normal chair in the seat), and require more room to maneuver.

Also, if you or your loved one is in a wheelchair, WATCH OUT FOR THOSE FOOTRESTS!!!! I'm convinced that those things were designed by enemy assassins to cripple the unwary and damage drywall. They also add at least two feet of room needed to turn the chair. I always took the damn things off and threw them in the closet, only bringing them out when absolutely needed (like after my bro's foot surgery).

Also, if you or a loved one must use a cane or crutches to get around, buy extra rubber tips. Those things WILL get loose and come off eventually. Those spares also come in handy if you break your cane. My former grandmother-in-law broke her hip, and when HH (home health) brought out her cane, she pulled the tip off of it and jammed it on a wooden broom-handle (her old cane broke, leading to her broken hip).

I'll post some more when I get back. Work calls.
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Re: Handicapped loved ones

Post by Vicarious_Lee » Tue Nov 09, 2010 1:00 am

Another very important topic:


PRESSURE ULCERS

These are also known as "bedsores". Most mobile people don't get them based on the combination of their nerves to a particular area of skin functioning well enough to tell them that they've been sitting or lying on that area and cutting off blood flow long enough (this is when your leg, ass, or balls if you've got them falls asleep), their muscles having adequate power to shift their position, and their brain having adequate power to recognize what needs to be done.

Any deficit in one area of that 3-part axis can create a pressure ulcer. Nerve injury, muscle deficit, or brain injury. This post will deal only with preventing them, and only when having to bug out.

The treatment, prevention, and management of pressure ulcers is a huge book that I'm not going to write here (unless ZS is willing to pay me a bunch and publish it for me), but there are at least 2 good threads concerning treatment of them in a PAW in the First Aid section.

The key truly is in prevention. Never has the concept of "An ounce of prevention beats a pound of cure" been more true. Think of pressure ulcers this way: "They take 6 hours to make, and 6 months to heal". That estimation may even be overly optimistic given your family members particular circumstances.

First order: Don't put your immobile family member on something hard. Not now, not to bug out. If you have to, then you need to shift their weight to areas of skin that can take the pressure every hour at least. Skinny disabled people get it worse. Give them a good cushion.

Common areas of pressure ulcers are (look them up, I can't just describe all of them here in this post) the Ischium on either side that you sit on, the Trochanters of your hips, the knees as they press together (with very little skin between them), the ankles, the toes and feet if you're standing, the elbows, the shoulder blades, and even the ears and back of the head in a sufficiently disabled patient, depending on their position.

Second order: Even if they're on a good cushion, change their position to relieve various "hot spots" every 2 hours. Your ass, right now, there are parts of it that you're sitting on where the skin is not getting blood flow. It's "ischemic". No worry. You'll just get up to get another drink, or make tea, or piss, or go to bed. When you go to bed, you'll toss and turn so that the areas of pressure that you're lying on will not be deprived of significant blood flow to become ischemic and form an ulcer.

You're lucky, but some family members are not so lucky.

Watch the skin. Protect the skin. When skin breaks down it takes a long time to heal, and a lot of dedication and more immobility to do so. I've seen pressure ulcers that'd make you faint.

I've known of more than one immobile person that was evacuated without adequate consideration for pressure ulcers during Hurricane Ike in September of 2008. At least one of them has died from it, and over a year later. The other still has a wound down to the exposed bone that will likely never heal, and that will likely take his life someday.
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Re: Handicapped loved ones

Post by SeerSavant » Wed Nov 10, 2010 12:18 am

Facts are, if your loved one, or someone who happened to fall in with your group has a disability then you work around it or find ways of utilizing them on a different level.
We are in fact humane, I know there are some who might take a pragmatic, even mercenary attitude towards the infirm or disabled....

I for one feel that a decision that cuts loose those that may not be an obvious asset to a group or a decision that makes alterations to a plan that didn't take into account a wheel chair, says as much about the value of them as it does about our own humanity.

Sorry to sound like a hippy, but I won't judge how much of an asset a person could be with a handicap anymore than I would judge a person by the color of his/her skin or the amount they weigh...

Cause that guy might not help as much, or he might be Stephen Hawkins.... But in reality, each decision you make says a whole lot mostly about you....

When I die, my personal sense of honor is all I get to take with me... And all that I am guaranteed to leave behind for those I love.

I'll do everything I can, not for some kind of pat on the back, or because it's how I would want to be treated, but because it's the right thing to do...


Shit, I sound like a lame Public Service Announcement......

I think I made sense, if not, well it wouldn't be the first time I babbled like an incoherent ten year old after ten bowls of fruity pebbles and a two liter of mountain dew......
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Re: Handicapped loved ones

Post by DarkAxel » Wed Nov 10, 2010 8:21 am

V_Lee, can you throw out a post about blood clots? Excellent post on Pressure Ulcers, btw!
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Re: Handicapped loved ones

Post by Vicarious_Lee » Sun Nov 14, 2010 12:40 am

darkaxel wrote:V_Lee, can you throw out a post about blood clots? Excellent post on Pressure Ulcers, btw!
This is difficult and somewhat nebulous. It's a valid subject, but it's absolutely HUGE in its scope. Like I laid out the 3 main factors for pressure ulcers (immobility, lack of sensation, lack of cognitive function to react to the sensation) that can be disrupted, there's an old meme that's still held in decent regard for blood clots. This is called Virchow's Triad:

http://en.wikipedia.org/wiki/Virchow's_triad" onclick="window.open(this.href);return false;

1. Hypercoagulability
2. Hemodynamic changes like stasis or turbulence.
3. Endothelial injury.

Lemme try to explain all 3 as briefly as possible.

1. Your blood clots too much, for whatever reason. Maybe it's genetic, maybe it's a myriad of other things. You either know this beforehand or you don't. There are a lot of reasons that this could happen.


2. This is the most common, and the most applicable to the immobile person. Let's just say we're talking about Deep Vein Thrombosis of the leg (DVT). There is such a thing as DVT of the arm, but as far as I know, no one's been able to show that it's really dangerous. Stasis happens when you don't move. For instance: The rate of people who have a complete spinal cord injury (no movement and no feeling below the level of injury) to develop DVTs without prevention is over 90% in the first 12 weeks. Your leg veins in particular require your muscles to pump your venous blood back up toward your heart. That's why those veins have little valves in them to catch the blood and prevent it from falling down. When these valves fail it causes varicose veins, right? Because the blood doesn't get stopped by the valve halfway up, and instead falls back down.

Now, your muscles (let's think of your calf muscle), when they contract, increases the pressure in that area and squeezes blood out of the area and upward, where it's caught by a valve, and your thigh muscles eventually do the same and send it on its merry way back to the heart.

In an immobile person, blood sticks around longer and tends to get stagnant and clot. Like pondscum. We don't want pondscum in our deep leg veins. Ever see a swiftly moving river? No pondscum.

The best and likely most common example of "turbulence" is in a common disorder called "Atrial Fibrillation".

http://en.wikipedia.org/wiki/Atrial_fibrillation" onclick="window.open(this.href);return false;

This is where your atria, the top two chambers of your heart, are stuck in an electric feedback loop that prevents them from providing a coordinated contraction to stuff your ventricles (the big ones at the bottom that do the pumping) with that little bit of extra blood to charge it before it gets sent to the rest of your body (on the left) or your lungs (on the right ventricle). They just sit there and jiggle uselessly. Usually they become big and stagnant. This can cause a clot to form in there that, on the right side can get put into your lungs, blocking off air/blood oxygenation for a significant part of your lung tissue (not that common actually), or if it's formed on the left, a clot can ping off down into your ventricle, and since it's after the natural "Filter" effect of the lungs it can get jetted right up into your carotid arteries and block off a large portion of your grey matter and cause an occlusive stroke that way.

The risk of a clot-based stroke in a person with atrial fibrillation who is not taking anti-coagulants is about 5% per year. In a fall-prone elderly person it may not be worth it to anticoagulate them if there's a big risk of them getting up too damn fast and hurting themselves in a way that being on anticoagulants would cause them to bleed out.


3. This is damage to the walls of the vein, which can be due to trauma, or it can be due to or worsened by things like diabetes or hardening of the vessels. When the wall of a vein is damaged it sends off chemical signals that activate the clotting cascade and produce a clot. This is a good thing if you get shot. If you're disabled, this can turn on you.



So I'll talk a little bit about treatment and prevention. First is treatment:

This can be treatment of either a clot itself, or a clotting disorder. Warfarin is beautiful, natural, common, and horrendously cheap to stock and produce. The downside is that it requires monitoring, and VERY closely at first until a good dose and steady-state level can be reached. Even then, eating a lot of leafy greens like spinach can increase your vitamin K levels (the area that warfarin fucks with most) to where it's less effective. The ideal situation is to be on warfarin, and have your diet and everything else stable enough that your INR (International Normalized Ratio)

http://en.wikipedia.org/wiki/Internatio ... ized_ratio" onclick="window.open(this.href);return false;

is stable, and you only need to get it checked a few times a year. In a PAW this will be impossible, and when SHTF this will be impossible for the duration of said SHTF.

Warfarin is absolutely NOT safe in pregnancy, but Lovenox is.

Lovenox (enoxaparin) is an injectable molecule that is well-standardised and requires basically no monitoring. Unlike Warfarin, it reaches peak efficacy in about 12 hours instead of 2-3 days. Also unlike Warfarin, it's very expensive, and it must be refrigerated. SHTF and it's a no-go.

Aspirin is great IF!!!! it's what you need. So just stock up on that if you have determined that it's medically appropriate and it's been prescribed to you.

Now....Prevention. In a bug-out.

1. If you're on Warfarin, have Warfarin. Take the same dose and try to eat the same things. Get your level checked as soon after your prescribed lab-draw as you can to be sure.

2. If you're on Lovenox, bring a cooler.

3. If you're on Aspirin, bring Aspirin.

4. If you're taking nothing, but are immobile and bugging out, then you need to work your leg muscles periodically and frequently to help prevent clots. "Foot Pumps" which is pumping your calf muscles intermittently show variable efficacy in the literature. But hell if that's all you have then you'd better do some foot pumps like your life depends on it, because it might.

Other than that, the topic is just to big for me to generally cover without knowing the specifics of each individual. Know your case, know your treatment, and know how to plan, prepare, and improvise as best you can (like using aspirin and having a family member mobilize a limb and pump muscles manually that otherwise would be paralyzed).

Strangely enough, after 12-16 weeks, the risk of a paralyzed person to develop a DVT will drop back to that of every other mobile person even without treatment. Illness (especially critical), injury, and medication can change this, but that's again too nebulous, poorly-standardized, and specific to each individual to get into here.

Hope that helps. DVT is a BFD.
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Re: Handicapped loved ones

Post by Trident » Sun Nov 14, 2010 1:41 am

Toileting will be major area of planning.
Craigs list and free cycle often has ads for adult diapers/bed pads and
cleaning products.
I found that my back was protected when I pre-made the bed with two to three layers of
linen and pad protectors.
Using a sheet draw cloth also helped move him from side to side as I changed his diaper and cleaned and dressed him.
I made his bed up by first laying a shower curtain down on the mattress,
then his cotton bed pad, then another shower curtain,
then his first bottom sheet,
a chux pad,
the draw sheet and the cloth "chux" pad I sewed up.
Then repeated the layers one more time.
I found that this system was great especially when he was having explosive leaky diapers and nausea and vomiting.
I also had pillow protectors under the pillow cases.
I kept his clean up gear in a plastic tote by his bed and made sure to use warm not hot flannel wash cloths to wipe and wash his bottom.
Getting the soiled and dirty linen out of his room quickly, made it more pleasant for him.
Getting a home health care textbook from your local community college book store can help you in learning how to care for disabled/ill family members at home.
And we also made adult sized "bibs" for him to keep him clean when he ate.

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