October 13, 2005
Preventing complications after spinal cord injuries
All over the world, researchers are trying to find the answer to making spinal cords whole again after they have been injured. Using stem cells and other new approaches, scientists have made some progress in animal studies and hope to find a breakthrough for humans before long.
But for people who are paralyzed with paraplegia (use of arms, but not legs) or quadriplegia (both legs and arms paralyzed), spinal cord injury is today’s problem. Even if hope for a future cure is a motivation for some, the issues of handling day-to-day living and staying healthy in spite of their injury are more immediate.
Dr. Diana Cardenas has spent much of her career working with people who have sustained spinal cord injuries. She is now a professor of rehabilitation medicine, chief of service at UW Medical Center for rehabilitation medicine, and director of the SCI Clinic at UWMC. She is also director of the Northwest Regional Spinal Cord Injury Model Care System, one of 16 model systems around the country that collaborate on research and treatment.
She has conducted research on many aspects of spinal cord injury, and now focuses particularly on studies of chronic pain and clinical trials on measures to prevent urinary tract infections (UTIs).
In the general population, she notes, UTIs are mostly a problem for women. But they are common among both men and women with spinal cord injuries, and, because of the loss of sensation, people often do not recognize that an infection is developing. Hospitalization for UTIs is common, and they often require intense antibiotic treatment.
“This kind of infection can be mild or more severe and require hospitalization, interfering with health and well-being,” she said. “After an SCI, as time passes, people should feel healthy and can get on with their lives, making necessary adjustments. But if they are sick with a urinary tract infection, their quality of life goes down.”
She has investigated several approaches to preventing urinary infections, including more intense education and training for patients learning how to use catheters, and is now conducting a study with a new type of catheter called “hydrophilic,” which has a surface that becomes slippery when exposed to water. She is looking at the change in the frequency of urinary tract infections using a hydrophilic catheter compared to using a non-hydrophilic catheter for a year.
“The idea,” she says, “is that this slippery surface will cut down on the number of tiny tissue injuries that people may get when they use the catheters several times a day to drain the bladder.” Although the bladder fills normally after a spinal cord injury, catheterization is often required to empty it. This is often done by the person with the SCI, using intermittent catheterization.
Early results of this study suggest that those who used the hydrophilic catheters were treated for urinary infections less often than others using the non-hydrophilic catheters.
Cardenas believes that clinical trials that actually measure the effectiveness of a new device or medication are essential. She did one of the first studies of an antidepressant that had been used to help with pain control for years among SCI patients, but never actually tested in that population.
Cardenas will talk about her research in the next Science in Medicine Lecture, “Clinical Trials After Spinal Cord Injury: Impacting Secondary Conditions,” at noon on Thursday, Oct. 27, in room T-625 of the Health Sciences Center. The lecture is free and open to everyone. It will be simulcast to Harborview’s R&T auditorium and the the Seattle VA, 518 Building 1.
Born in San Antonio, Cardenas earned a bachelor’s degree from the University of Texas in Austin and an M.D. from UT Southwestern Medical School in Dallas. She first came to the UW in 1973 and completed her internship and residency here. She earned a master’s degree at the same time. In 2001 she completed work for a master’s degree in health administration in the MHA for Medical Executives Program at the UW.
After her residency, she worked and taught at Emory University’s Department of Rehabilitation Medicine from 1976 to 1981, when she returned to the UW.
She has received numerous awards for her research and patient education programs, and has been a member of several national advisory groups. She chaired the research Advisory and Advocacy Committee for the American Academy of Physical Medicine and Rehabilitation Medicine from 1997 to 2001, and also chaired that organization’s Spinal Cord and Neurorehabilitation Special Interest Group.
She has been a member of three committees for the Institute of Medicine of the National Academy of Sciences and was elected a member of the Institute last year.
– Claire Dietz
