Heat a danger for disabled

Those paralyzed can’t detect effects of high temperatures

Not quite a year after a surfing accident left him a quadriplegic, Robert “Buzz” Chmielewski was at Rocky Point Beach in Baltimore County with a girlfriend, working on his tan.

They spent an hour sunbathing, then decided it was time to leave. So he sat up and started reaching for his wheelchair. The next thing he remembered was his girlfriend and father struggling to lift his limp body off the sand.

“I was bumping over to the chair and out went the lights,” he said.

Seventeen years later, Chmielewski, 35, realizes that he was suffering from overexposure to the summer heat. Since then, he has learned how to prepare for hot weather. “I keep myself moist everywhere I go by spraying with a water bottle,” he said. “When I’m playing sports, I use more of a squirt bottle.”

Those may seem like precautions that anyone would take, especially this summer with temperatures soaring past 100 degrees, but sweltering climates are particularly dangerous for paraplegics and quadriplegics.

Paraplegics are paralyzed in the lower part of the body, while quadriplegics have lost the use of all four limbs.

It is difficult for them to feel any sensation below their spinal injury, which means that they are unable to feel the effects of extreme temperatures in the paralyzed parts of their body. There are also “incomplete” paraplegics and quadriplegics such as Chmielewski, who retain feeling in their limbs. However, like most of those with spinal injuries, he is no longer able to sweat.

“They have lost the ability to regulate their own body temperature because the spinal cord has functions that control those senses,” said Dr. Peter Gorman, director of the spinal cord injury program and chief of the division of Rehabilitation medicine at Kernan Hospital. Chmielewski is Gorman’s patient.

Gorman said that the Autonomic Nervous System, controlled by the spinal cord, enables people to sweat or shiver – signs of the weather’s effect on the body. Shivering keeps a person warm in cold temperatures by moving muscles, while sweating excretes moisture onto the body in hot temperatures, cooling through evaporation.

“They might, indeed, sweat above their head excessively, but there really are not that many signs, so they have to be proactive,” Gorman said of those who are paralyzed. “In some ways you can say they become cold-blooded, and the only way they can regulate is to change environments.”

Terence Moakley, director of special projects for the United Spinal Association, said that a stuffy nose and tingly fingers are the only symptoms telling him when it’s time to move into the shade.

Moakley, who has been quadriplegic for 39 years, has developed a few tricks over the years.

“I exercise early in the morning, which I think is preferable,” he said. He also drinks plenty of water.

He warns paralyzed wheelchair users to be careful about laying bare skin against metal parts of the chair, such as foot pedals and clips, when they are outside because the metal can become heated and burn desensitized limbs.

He recommends that people place additional cushioning around those parts for protection.

Chmielewski, on the other hand, sees no reason to allow his injury to alter his everyday activities. He remains an avid snow and water skier and plays tennis and rugby, often during the hottest hours of the day. He still tans as well.

“I’m kind of a sun worshiper,” he said.

Nevertheless, he strives to make sure that newly injured patients are aware of precautions that they should take in muggy weather.

“When you’re newly injured, it takes a little time to figure it all out,” he said.

By Stephanie Beasley
Sun reporter

Copyright © 2006, The Baltimore Sun

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