Question
My father is 73 yrs old. He has C5-6 quadriplegia since 1976. He now is having problems sleeping at night due to problems with Autonomic Dysreflexia. He requires most of his care during the night. We have not found the source of the irritation. His complaints of chest pain is new. We do know that he has a hiatal hernia. We do not have a medical doctor that is comfortable with quadriplegia. We try to sort his problems out with the help of a physical rehabilation physician. We do know at this time he probably has a urethral stricture and will need a cystoscopy and dilatation. Also it is suggested he have a gastroscopy to check for reflux as a source of the chest pain. We are not willing to undergo a cardiac cath procedure. He did have a echocardiogram at a senior citizens center that showed thickening of the left ventricle. We went to a cardiologist that told him we could not do anything, that kind of answer breaks my fathers spirit. We have concluded that the cardiologist was uncomfortable with the care required for a quadriplegic.We would like information to help us decide on what action to do next. Our rule of thumb is think twice and move ahead with caution. Do the least invasive exams.
Any Thoughts would be appreciated
Star Langley
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Answer
As a quadriplegic, I am in total agreement with your choice of least invasive exams first.  Since I am not a physician, I can't prescribe a course of action.  However, I believe that the first thing to do is to find a physician that is comfortable and knowledgeable about quadriplegia.  The Autonomic Dysreflexia needs to be addressed because it can be life-threatening.  About 80-85% of the time, episodes of AD are related to bladder issues.  The other key reasons are bowel problems and skin issues.  The chest pain needs to be checked into whether by a GI doctor to rule out reflux or by a second cardiologist that understands quadriplegia.

I believe that the urethral constriction may be causing the nightly episodes of autonomic dysreflexia by not allowing for adequate urine drainage which will overextend the bladder.  Quadriplegics with bladder problems typically have symptoms worsen when laying down flat.

My advice is to find physicians that are trained in the proper care of quadriplegics and get their first-hand advice on your father's condition.

Thank you for your question.  I hope that my answer points you toward some appropriate help.