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Symptom Series: Showering

May 25, 2011

After much thought about which subject to start with for this little series, I settled on a topic that can present a wide range of problems and is something that most people do very frequently: showering.

Taking a shower can be extremely difficult depending on what you have available and what your current symptoms are. Not being able to take a shower because of your condition can deal a severe blow to your state of mind as well. So, I will start this entry out with listing my personal challenges with this routine task, how each challenge affects me, then move on to how I’ve dealt with these problems.

Challenge #1: Balance and vertigo
This one has proven to pose the most danger for me. I have fallen while taking a shower because of vertigo and poor balance, and I have accidentally cut myself several times with a razor because I lost balance or had a sudden bout of vertigo come on. Thankfully none of my falls have caused me to hit my head and while the cuts were sometimes quite long and bled profusely, they were not deep.So, lots of bruises and cuts but no major injuries so far. Poor balance and vertigo can make getting in and out of the shower a monumental task as well. I do not have a walk in shower (I imagine it would be much easier with one of those), just a tub with a detachable showerhead.

My solution: Grab bars, shower chair, nonslip mat, and detachable showerhead.
First I started using grab bars. There are two bars in my shower: one horizontal bar along the wall inside the shower and a vertical bar just outside of the shower. I hold on to the vertical bar to get in and out, and hold onto the horizontal bar while standing to keep my balance. This presented a few problems for me though. Attempting to shower while staying in a position that allowed me to hold onto the horizontal bar and being able to use only one arm to actually wash was tough (especially when washing my hair). After falling against the wall a few times, I ended up detaching the showerhead so I could lean against the wall while washing my hair, but when I close my eyes my balance gets worse so I would still end up slipping and falling (just with one less hand to grab onto something). So, I started leaving the showerhead attached and would keep using the bars. At this point I also got a nonslip mat with suction cups to put on the bottom of the tub to help stop slipping around (as long as it doesn’t get overly soapy and the suction cups are stuck on properly it works very well).

So, I would let go of the bar, wash my hair, then hold on again. This ended up causing my worst wall. When I turned my head to rinse out some shampoo, I had a very sudden intense bout of vertigo that made it feel like the entire room was spinning around and tilted backwards and forwards. I started to fall and reached out for the bar, but missed. I had been standing with my back angled slightly towards the bar so I had to try to spin around quickly to grab onto it. I ended up falling backwards and smashing my shoulder on the bar. After that, I decided to start using the showerchair. I did not want that type of fall to happen again, because if I had been angled just a little bit differently I easily could have knocked myself out on the bar. Since I live alone, if I did end up knocking myself out then I would have been laying there until I finally regained consciousness then would have to figure out how to get myself up on my own with a head injury.

There are plenty of different styles of showerchairs out there. There are stools, there are chairs with a back, there are boards that you can place in the shower to use as a bench (some even have clips attached to the legs so you can click the showerhead into it when you need both of your hands). I don’t recommend one style over another, whichever is most comfortable for you and fits in with your budget best (you may even be able to have the government help you pay for one depending on where you live and what your condition is).

The one that I use is a chair with a back, and I love it. At first it was very difficult for me mentally to use it. I was feeling a bit depressed already when I had to start using it and it definitely made me feel worse at first. After all, I am only 24 and had suddenly gone from helping other people onto these things and getting cleaned up to having to use one myself. But, I had to really force myself to think clearly about this (and if you’re reading this you may have to as well) and decide which is more important: clinging to a sliver of dignity or maintaining your independance and health? Without it, you could be running the risk of ending up in the hospital. I would rather be at home, uninjured, and sitting down to shower than getting a spongebath in a hospital bed by a stranger.

If balance, vertigo and fatigue are the only things I’m really having a problem with (more on fatigue in a moment), then I will sometimes stand with the chair right behind me while holding onto the bar. If I suddenly get too tired or disoriented to stay on my feet then at least then I can guide myself down to the chair quickly and safely. If I’m feeling really really good I still leave the chair in the shower and leave my various shower products on it (also kind of nice if I’m taking a bath when feeling good too, since I can push it down near my feet and use it as a table for a drink or something :P)

As for getting in and out of the shower: it’s really important that I move very slowly if my balance is impaired or I’m going through vertigo. Since my toilet is right next to my shower, if I move too fast and end up falling I could end up smacking my head on it. So I just pull myself up from the chair with the horizontal grab bar slowly, reach over to the vertical bar and hold onto it with both hands has I lift my legs out of the tub. Once I’m out, I can pivot while still holding onto the bar and lower myself onto the toilet (I usually leave a towel drapped over the seat, with the lid closed of course, so I don’t end up sitting on a cold surface. It also makes it much easier to dry off once I’m out).

Challenge #2: Tremors, spasms, and spasticity
This fun little group of symptoms make getting in and out of the shower incredibly difficult. With my fine motor skills shot thanks to tremors, just washing myself is a chore and requires an intense amount of concentration.

My solution: tranfers into and out of the tub in a seated position, plan out your shower
To get into the tub when my legs are tensed, I sit in my computer chair right next to the tub, lift myself with my arms onto the edge of the tub, then again onto the showerchair so I’m half in and half out of the tub. I then pick up my legs and left them over the edge of the tub with my hands (I try to get at the edge of the shower chair so I can lean back as I do this, as trying to force my legs to straighten out of a bit to get them over the edge is extremely painful). Then to get out I do everything in reverse after drying off every surface that I need to grab onto (very very important to dry them off, don’t want your grip to slip).
When my hands start to shake, it can be really hard to just get the wash cloth at the right spot. The best I can do to compensate for this is figure out which things I can avoid doing that day (ex: do I really need to wash my hair that day?) so I don’t end up getting more frustrated over the shaking and making fatigue worse. If my hands are shaking really badly I won’t use a washcloth on my face, just run water over it so I don’t accidentally poke myself in the eye. Shaving is pretty much out of the question when it’s at that point (bet that gave you a wonderful mental picture huh?)
As for the spasms, I keep my chair far enough back from the end of the tub that if I end up having a spasm that makes my leg kick out, I won’t end up kicking the tub and possibly breaking a few toes.

General tips
1 ) If you use a showerchair, try to get one that has a little clip on the side of the legs that you can attach the showerhead to. You’re going to need both hands for some things so you will need to put the showerhead down. Trying to hold the showerhead between your knees can be really hard if you’re having spasms or if your legs are locked up. Mine doesn’t have a clip (yet…) and there were a few times when I was holding the showerhead between my knees so I could lather my hair and ended up squeezing the showerhead so hard I got bruises.

2 ) Plug that tub. When you put the showerhead down and no longer have the water on you, you will get cold pretty quick. Having your legs and feet sitting in the warm water will help with that. You can also turn up the temperature in your bathroom before you take a shower or put a space heater (FAR FROM THE TUB) in there.

3 ) Speaking of water temperature: adjust the temperature on your water heater. If you get a lot of numbness (like I do) you won’t be able to tell how hot the water is and can end up burning yourself. I take lukewarm showers, so I don’t get too cold, but I don’t get so hot that I make my symptoms worse.

4 ) Rearrange your shower products so they are all in close reach. You should be able to reach everything you need without having to get up from the chair or lean to get them. Get a loofah on a stick so you don’t have to lean forward to wash your legs if you can’t lift them. Get suction cups with little hooks on them so you can hang washcloths or anything else you can on the wall right beside you.

5 ) If you don’t feel safe taking a shower on your own, then don’t. You can have your spouse help you if you have one, a particularly close and understanding friend, or you can get a home healthcare aide.

6 ) Don’t shower on days you don’t need to. If you haven’t been doing anything really physical and haven’t gotten warm enough to sweat, then just take a sponge bath in the sink instead. You won’t feel as clean but you will be a lot safer.

7 ) If you use grab bars, make sure they are installed properly. I can’t imagine having a grab bar come loose partway through a lift would be fun. Don’t use towel racks as a subtitute for grab bars.

8 ) If you tranfers into your tub from a wheelchair or computer chair, make sure the breaks are on.

If there is anything missing from this entry that you would like to see, please comment and I will be happy to edit the entry to add more.

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