Bowel Case Studies

DOI: 3/24/2010. The patient is a 55-year-old male machine shop lead who sustained back, neck, right shoulder and internal injuries due to repetitive work. As per medical report dated 04/27/16, the patient has a history of a spinal cord injury secondary to cervical stenosis. He underwent emergent decompressive cervical laminectomy on 3/26/10. The patient has ongoing neurogenic bowel, ongoing neurogenic bladder, severe depression and pain. He is eating, but he still has signs and symptoms consistent with depression. Based on the medical report on 5/2/16, the patient presented for follow-up for his sleep-disordered breathing. Impression includes severe obstructive sleep apnea with daytime hypersomnia and significant improvement with the use of

He is doing his exercises and trying to improve functionally. His bowel program is without any accident, and does go every other day. For his bladder program, he will have follow-up with cystoscopy. Spasticity is controlled at this time. He is sleepy, wakes up to turn at night and for bladder, otherwise, is not waken up much for pain. He has some skin issues on his left anterior shin. He has lymphedema which is worse on this visit and erythema is present bilaterally, with some induration. He requires 24-hour care and supervision because of the risk of suicidality. On examination, lower extremity spasticity is present, along with induration and erythema. Obesity is still present. Weight is 316 pounds. Current medications include Lotensin,multivitamins, D-Mannose, Colace, Coreg, Abilify, vitamin C, Lyrica, Doxepin, Robaxin, Flomax, Cymbalta, oxybutynin, Seroquel, testosterone injection, Amitiza and Nuedexta. Assessments include C7 spinal cord injury, ASIA-D (American Spinal Injury Association)-D, spastic tetraplegia; severe depression with history of suicide attempt; likely anoxia with anoxic injury; and neurogenic bowel/bladder; decreased balance; neurogenic erectile dysfunction and

With regards to functional community re-integration, it was noted that the client continues to use both “FWW” and wheelchair on community outings depending on pain level and fatigue, and outing duration. Safety issues with occupational therapy include fall risk when fatigued and ongoing suicidal ideation requiring 1:1 supervision. Neuropsychology section notes that at baseline, the patient continues to experience severe depression with chronic suicidal ideation (post-suicide attempt) and remains staffed as 1:1 for safety. Suicidal ideation is constant, and if given the opportunity and means to do so, the patient acknowledges that he would likely attempt suicide. Patient tends to respond to even relatively minor or day-to-day stressors with poor ability to cope and considers suicide as the first and best option for him. It was noted that pain continues to be a major limitation for the patient. It was mentioned that better control over pain and spasticity since Baclofen pump placement, he continues to be highly motivated to continue physical therapies and his mood is buoyed by his meeting of physical