Skin. It is the largest organ in the human body and also our first line of defense against disease. Yet it is all too easy to take for granted, especially areas of the skin that we can’t feel. For a wheeler that hasn’t had any skin issues it’s easy to become complacent about skin protection.
In my 28 years as a T10 complete paraplegic, I’ve heard way too many stories of wheelers that have gone years, sometimes decades, with no skin issues. Eventually they let their guard down, only to encounter months of hospital time with a major pressure sore. This is one of the reasons I still follow the skin protection practices I learned in rehab.
Skin protection is a subject that often comes up among the friends I roll with. What kind of cushion does so and so use? How do you protect your skin in this or that sport? We take pride in our health, and trading ideas on how to protect our skin. Encouraging others to do the same is part of this pride. Here are some of the skin protection tips I’ve learned along the way.
Skin Check With a Mirror!
Doing a mirror skin check of your butt and areas of skin you can’t see is by far the best way to protect your skin. Do this every morning and evening. This gives you the best chance of spotting potential trouble– an area of red, pink or otherwise discolored skin, or perhaps a scrape– before it becomes a pressure sore.
A mirror check is the best indicator of whether a cushion is doing its job. When I was released from SCI rehab, I was sent home with a memory foam cushion that looked great on a pressure map, but within a month my mirror showed the cushion was inadequate and causing more and more redness, despite constant weight shifts. By catching the problem early with a mirror-check and being aggressive about getting another seating eval (to a ROHO®), I was able to narrowly avoid a major pressure sore.
Last year a mirror check saved my butt again. I have slowly developed a curve in my spine, and my left ischium is starting to sit lower than my right. My evening mirror skin check revealed pinkness on my left ischium. After consulting with a seating specialist I switched from my 3-inch height ROHO QUADTRO SELECT® Cushion to a 4-inch height QUADTRO SELECT. A mirror check at the end of each day revealed that the added immersion I got from the extra one inch of depth in the cushion made the difference. The skin color returned to normal.
Skin Protection While Traveling
Because car seats aren’t designed with skin protection in mind, it is a good idea to sit on your cushion on the car. Better yet, when you replace your wheelchair cushion use your old one as a dedicated car seat cushion.
Another car seat safety tip: Be wary of car seat heaters. They have been known to malfunction and have caused severe burns in more than 60 cases reported by paraplegics. Be especially aware of whether a friend’s car or rental car has heated car seats, and where the control is so you don’t accidentally turn it on. See New Mobility Travel Matters: Hotel Hot Water and Rental Car Burn Dangers.
Hotel shower benches are usually rock hard, with added groves that are often cut through the middle, which can compromise skin. An easy solution is to ask the front desk for an extra towel or two that you can put on the bench for added cushioning. This is one of the many uses I get with the ROHO ADAPTOR Pad I bring when I travel.
In more than a few instances I’ve had to grab a last-minute, non-accessible hotel room with a walk-in shower. In a crunch, ordering a few extra towels for padding — one for the shower floor and one on the lip where the shower door closes– helps to protect your skin. This is another place where traveling with a ROHO ADAPTOR® Pad comes in handy.
Here’s another important skin safety tip for hotels and for staying with friends and family. Be sure to check the temperature of the hot water with an area of skin that has sensation, such as your wrist. The pain threshold is generally considered to be 112 degrees; any hotter and the water can cause severe burns. In a shower, always have part of the stream of water running on part of your skin that has sensation so you can feel if it gets too hot, something I learned the hard way when the shower water on my legs got too hot and turned the skin bright red. In that case I avoided a serious burn by immediately turning the water back to cold and left it running on my legs until they returned to their normal color.
I prefer a relaxing bath to a roll-in shower. But tubs present skin challenges of their own. Often the bottom and sides of tubs can be slippery, potentially leading to falls and broken bones. Ideally an extra bath mat for the side of the tub, plus one for the bottom of the tub, offers good protection. In a pinch, an extra towel or two — one for the side of the tub and one for the bottom of the tub — helps reduce chances of slipping. Another possible tub danger is non-skid surfaces on the tub base—I know of several wheelers that have gotten severe scrapes from these. Again, sitting on a bath mat or towel will help prevent this and a ROHO ADAPTOR Pad adds extra protection.
For me, transferring over the sword edge-like tracks of sliding shower doors presents the biggest bathtub danger. In a perfect world, a bath mat draped over the tracks with the suction cups engaged on each side of the tub offers the best protection. In a pinch, draping a towel over the tracks will do, but a word of caution—the towel can slip, leaving you sitting on the tracks. In a perfect world, a bath mat, covered by a towel, with a ROHO ADAPTOR Pad on top offers the best protection.
Toilet Seat Caution
Some toilet seats have sharp edges. I learned this the hard way when visiting my parents. I took care of business, then a bath just before bed and a mirror check, which revealed deep red marks left by the inside edges of the toilet seat. Fortunately my routine is very quick and I spent minimal time on the seat—the red marks were gone by morning. But it prompted me to get a ROHO Toilet Seat Cushion, something I now keep in my travel bag.
Another potential hazard to be wary of when staying with friends and family are floor-mounted heat vents, as vents can become hot enough to burn bare feet or other skin. I make it a point to put a towel over a heat vent if there is one in the bathroom.
In warm sunny climates it is a joy to take a relaxing swim. It is also another area to watch for burns. Dark surfaces, especially metal grates, can become extremely hot in the mid-day sun. I have a good friend, a T9 para, that hopped out of the pool after a swim and sat on a metal grate which caused a severe burn, hospital stay and skin flap. Always feel the temperature of someplace before you sit there—or better yet, sit on a towel or cushion.
I hope these tips help you to avoid skin problems. Please pass them forward.
Wishing you happy travels, adventure, and healthy skin.
Bob Vogel, 53, is a freelance writer for the ROHO Community blog. He is a dedicated dad, adventure athlete and journalist. Bob is in his 28th year as a T10 complete para. For the past two decades he has written for New Mobility magazine and is now their Senior Correspondent. He often seeks insight and perspective from his 12-year-old daughter, Sarah, and Schatzie, his 11-year-old German Shepherd service dog. The views and opinions expressed in this blog post are those of Bob Vogel and do not necessarily reflect the views of The ROHO Group. You can contact Bob Vogel by email at email@example.com.