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Old 03-10-2010, 12:11 PM   #1
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brain injury due to lack of oxygen

I have a question. My brother in law suffered a heart attack 7+ weeks ago and has been hospitalized ever since. A number of issues have occurred. He is in kidney failure and on dialysis; he developed several infections pneumonia and a blood infection. He has been pretty much sedated and was intubated but recently they put in a trach for breathing.
He has not been responsive and appears may be due to the fact that he is sedated and on tons of medication.
the most recent report from sister is that they think he has brain damage due to lack of oxygen. Not sure how much lapse of time there was before the ambulance arrived at home. So there may have been some decreased oxygen at that point. Not sure if there was lack of oxygen while in the hospital.
An MRI is scheduled.
Can any one supply any information on brain damage due to lack of oxygen? Can there be some regeneration of cells in the brain? Especially cant cells regenerate shortly after injury. Long term regeneration I doubt.
Any input would be helpful Thanks for listening.

 
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Old 03-10-2010, 01:25 PM   #2
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Re: brain injury due to lack of oxygen

First, I am so sorry for your brother in laws condition...it must be terrifying for your family.. I am no expert, but I can share my experience as a person who has had many medical emergencies, heart attack, 4 strokes, kidney failure... to name a few.

The loss of oxygen can be devastating to your brain, and your other organs. It will be hard to tell the full scope of the damage while he is so heavily sedated, your BIL has some big issues to fight right now.

May I ask his age, and relative health before the heart attack? That can make a difference. Has he been able to respond to any stimuli so far? Has he opened his eyes, squeezed a hand...?

Again, I'm so sorry...

 
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Old 03-10-2010, 02:00 PM   #3
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Re: brain injury due to lack of oxygen

Thank you for the response. My BIL is 65. He has had prior health issues. First, he is diabetic and has been for about 24 years or so. He did have prior heart issues. Surgery was done. I'm trying to recall if a stent was done. I'm drawing somewhat of a blank on what was done.
With this current problem when he went in there was a question on how much function was left to the heart. A test was done. Initially they thought the heart was functioning at about 25%. But according to the test results they were slightly better and his heart function was at about 35%. Not great but better then initial thoughts.
After he was extubated and a trach was done they thought he was doing somewat better.
The problem that always seemed to delay further recovery was all the infections that he kept getting.
Part of the problem was that at times the doctors felt he wasn't responsive to commands etc. But with all the medication he was on what did they expect. He also was on Fetanyl for pain and appears there was a problem with the medication so they are weaning him off of that.
Not sure if the problem is all the meds he is on or if there is a chance of brain injury due to lack of oxygen. Not sure what else to say at this point. Again thanks for listening.

 
Old 03-10-2010, 02:31 PM   #4
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Re: brain injury due to lack of oxygen

That is what we are here for, and often times all we can really do...The added complications of infection and medication reactions are unfortunate but so prevalent in these kinds of situations...Seven weeks is a long time, so your BIL must be a real fighter. One thing I know for sure...even if he cannot express anything does not mean he cannot hear, and feel, so the comforting words of a loved one, and the touch possibly be felt.

As weird as this seems, even when I was unable to speak, or move, and appeared asleep, I did know when my family was near me.I had no sense of fear, just a floating feeling, no pain. I came out of it a long time later, re-learned to walk, talk, think, and after 6 years am still recovering little by little.

I don't know if you are nearby him or not, but please remind whoever is at his side to rest, eat well and remain hydrated. The caretakers can really become exhausted and overwhelmed, which doesn't helo anyone. Again I'm so sorry.

I'm going to be out for awhile, but I will be here to offer you as much support as you need...I am here everyday, and so are many others...Prayers for your BIL, and your entire family. Getting things off your chest is very helpful, and I understand.

Janet

 
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Old 03-10-2010, 03:42 PM   #5
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Re: brain injury due to lack of oxygen

Janet:

Thank you for your words and support. I agree with what you said about being aware of what is going on around you. I told my sister weeks ago that while he may not "appear" to be aware of what is going on at one level or another he is aware. I told her to talk to him and somehow he will understand what she is saying to him I told her as well if the doctors had anything negative to say "do not" say it in the room where he is. Leave the room to talk. While a person may be catatonic there is still a person inside there and I believe you can communicate with that person.

Anyway, I'll report back as I get more information. Thanks again for listening.

 
Old 03-10-2010, 10:07 PM   #6
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Re: brain injury due to lack of oxygen

I have heard accounts of people responding to music, recordings of their childrens voices. I could not say that I could interpret the words themselves, but more of the feelings of comfort and familiarity.

 
Old 03-11-2010, 07:04 AM   #7
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Re: brain injury due to lack of oxygen

I agree with you on a person being able to respond to some sort of stimuli. One of my nieces who is in college called while my sister was at the hospital and she put the phone next to his ear so he could hear his voice.
Also within the past few days my sister and another niece were at the hospital and they askd him how he was doing. They both felt that they got some sort of response. I don't recall if she said he nodded or looked at them but they both felt something.

More later.

 
Old 03-11-2010, 08:56 AM   #8
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Re: brain injury due to lack of oxygen

Bless his heart...it is truly amazing what the human spirit is capable of. It sounds like you have a loving supportive family, and that goes such a long way in recovery. I wish I could give you all a big hug!

 
Old 03-11-2010, 10:23 AM   #9
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Re: brain injury due to lack of oxygen

sorry for all you and your family have had to go thru. my heart truely goes out to you, but you have been getting some really gereat asvice here from WL.

what i wondering about is what types of real testing have they done specifically ON his brain itself besides that MRI? what were the actual MRI results, did they tell you anything? if not, you CAN obtain a copy of that report and any other medical records too(whatever member of his family who is in charge of the decision making IS the one who can also obtain this info too). an EEG just to actually check for ANY true brain activity and how one responds to actual provoked simuli whether it is questions, or sounds or even pain really also would helo to better define his level of real damage at this point. when they provoke stimuli, they are also looking at the brain wave activity to see if something changes.

also a full and in depth neuro exam, espescially looking at both puplis as far as response to light change is really crucial to even seeing how reactive that part of the brain that governs it is too. if he has a constriction of pupil when light is intoduced, thats a really great sign of good activity. also having the pupils be equal round and reactive are all also very crucial. what have his overall neuro reponses been like since this occured? even with pain meds he still should have the ability to respond neurologically, unless they have him on something that would just inhibit/supress that to a certain degree?

was he already on kidny dialysis when brought in or did the renal failure happen while hospitalized(i know he is a diabetic so thats why i am asking this)? knowing that answer is kinda important here. does anyone at all actually know what his real 'down time' was before 911 was called? you just have a very small wiindow of time(4-6 minutes give or take a possible minute either way) before the brain will start reacting to the lack of oxygenation(and the blood starts to change PH to be much more acidotic). BUT if anyone actually even compresses that chest at all during that window, you will have some O2 going to the brain and other vital organs. we actually have alot more real oxygenated blood in our bodies once we arrest than they used to think back when the 'getting those two breathes" in BEFORE starting CPR just was the american heart national standard. the more research and ongoing tracking of cardiac arrest patients has actually led to alot of real new discoveries about how our bodies just are during any full arrest event. thats why the standards for CPR keep on changing like year after year.

but knowing just what the true situation was wherever he arrested, how soon CPR was initiated really would dictate what could be occuring or has already been irrepairably damaged at this point. he also, as you mentioned was dealing with some real blockages in his heart that would also dectate just how much real O2 was even circulating in his blood during the course of any given normal day here too,that can matter as well.

i would think that at this point of it being at least 7 weeks here since this even occured that the docs would just already kind of know what his real true prognosis actually is by now? but they also have to be doing the right types of ongoing testing too in order to even know what that real prognosis actually is here too, ya know what i mean? when it comes to really defining any real brain damage it just really does take some good brain testing, any good contrasted MRIs done at this point i would think would show this far out certain areas of any real damage due to lack of O2 being the factor since it would tend to atrophy if it had actually died or lost some of its normal density as well? doing an actual angiogram on his brain would also show really well any arterial damage where blood has stopped flowing to. this test would ONLY show arteries that are functioning that simply 'light up' as the contrasting agent runs thru them. i had this done in order to better define my brain aneurysm in 05. is he actually breathing on his own or is he on a vent?

i would most definitely keep on talking to him, bringing in music to also help stimulate any real responses from him as well. BUT, you and the rest of your family really do need to meet with his treatment 'team' of docs here to really gain the very best understanding of his real true status and what they feel his prognosis actually is for his future. its just the mere fact that no one probably realistically even knows when his downtime actually even started and how long his brain simply went without the proper oxygenation. that usually tells alot when the docs actually know that part even.

i just think at 7 weeks, his docs have HAD to form some type of real impressions here based upon what they have already tested and the things that they may still need to do yet but have not yet done for him? but simply being his family, you all do deserve to be given some more solid info than you have been so far. only time and testing will really show the full impact of the extent of true brain damage. while some things in our brains we CAN actually live without, other more vital areas, well those simply are needed for 'normal' life sustation.

my youngest son suffered a very severe brain injury back in 06? and we went thru hell and back, believe me. he sustained a double skull fracture at the very back of his head(this is where he landed after his idiot friend thought it would be funny to drive off while my son was still sitting on the trunk of his car??) and the worst of the worst was an actual brain bleed right into the very crucial frontal lobe of his brain(this IS the cognitive function and executive decision making area). he was in varying levels of coma for about three weeks and inititally placed on a vent that they were able to remove only after a few days. the very scariest part was just listening to him talk but him not really 'being there' where WE were in time and place as his brain was trying to kind of put all the stored data within the far corners of his brain back into some kind of order again? very insane and scarey to see and hear. but with a ton of cognitive therepy, he has come a very very long way now. while alot of people cannot even tell he actually still has certain problems within that executive thinking process that just IS that frontal lobe area, i can see it since i just know what my son used to be?

his brain was just such a freaking mess at that time i did not think there was a chance in hell that we would EVER get "him' back? but to my wonderful suprise(and a ton of solid gratitide) and alot of ongoing therepy and help at home in reminding him of certain things along the way, we were very blessed in even getting what we did given the extent and that particular area of real damage done and what i heard at the beginning? so do NOT lose hope here. despite everything i told you hon, there is a much bigger person upstairs who is the person who truely 'decides" anyones fate. there is always HOPE. just keep on stimulating, you just never truely know what he is able to actually hear. but everyone really does NEED to truely know everything that is going on, how extensive things are really, and what the docs actually feel is even possible given just what they know or see or don't see so far at this point. just keep on hanging in there and doing what you have been. the rest is truely in gods hands along with your uncles here. please continue to keep us posted hon, good luck with this whole situation, marcia
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Old 03-11-2010, 10:41 AM   #10
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Re: brain injury due to lack of oxygen

I am not sure where to begin or if this will answer all your questions.

As to the response time from 911, I am not sure how much time elapsed. I don't think it was long but may have been long enough or more then just a few minutes. Just happens my nephew is an EMT and was home and able to take some action but I doubt that he was able to give oxygen until 911 responded. Even if they arrived right away it may have been not quick enough. Not trying to blame them just may have been too long in this matter.

As to kidney dialysis, yes he is diabetic, but was not on dialysis before entering the hospital. They ended up putting him on dialysis 24/7 then went to 4 hours sessions. I think he may have been put back on 24/7 dialsysi for some reason but not 100% sure on that one.

As to the neurological examination, not sure what the examination consisted of. Whether it was just a physical examination or not. To my knowledge the MRI was not done but was in the process of being scheduled and a 2nd opinion as well.

EEG is a good idea and worth considering. I'll mention it my sister as to whether the docs have done it or are considering it.

Thanks again for the support. Will keep you posted.

 
Old 03-11-2010, 02:00 PM   #11
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Re: brain injury due to lack of oxygen

Thank you Marcia...my experience does not cover so many of the diagnostic details...I am much more experienced in the emotional aspects of brain attack, (the new name for stroke). My recall of the details of anything have been severely compromised.

There are so many knowledgeable and experienced folks here, so eager to share and hopefully spare others from the overwhelming aspects of these life changing events...I am so proud of all that come here, whether it is to learn, or to share...we are all here to help one another, which proves the innate bond, and strength of the human spirit.

Hold your loved ones close.

 
Old 03-11-2010, 03:05 PM   #12
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Re: brain injury due to lack of oxygen

Update. I briefly spoke to my sister about whats going on with my brother in law.
First of all an EEG was done several weeks ago but she was never told about it and was apparantly "abnormal." The MRI was delayed in being done because of difficulty in doing it at the moment. I can't recall exactly what she said the problem was though for the delay.
There seems to be some question if the EEG was abnormal because of the medications he is. Some of the doctors didnt feel that the meds would affect the results of the EEG while my sister feels that the meds may affect the results. I "think" she said one of the doctors said the meds could affect the results while most of the docs said the meds didn't affect results.
It appears from what she is telling if the EEG is correct the results are "severe" damage.
I am besides myself in what to think at this point. I don't know what else to tell her and how to still remain positive in this situation.

Any suggestions? Thanks again all for your listening and your support.

 
Old 03-11-2010, 04:46 PM   #13
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Re: brain injury due to lack of oxygen

Again, terribly sorry for all this...there is no easy answer. If there is severe damage to the brain, little can be done except to wait. Does your BIL have children?

I would never suggest that hope is lost, because there are a million stories of people making miraculous recoveries from what seemed like impossible odds. But to create false hope is another thing. This is a time when you can only hope for the best, but prepare for the worst.

May I ask, is he in a major city hospital? Are there any further tests or treatments planned? Are there any improvements in his infection? Is he on life support? Even asking these questions is agonizing for me...
'
I imagine by now the family is completely exhausted, and worried sick. How do you think your sister is holding up? (It is your sisters husband, right?). Has she had any counsel, either grief or spriritual? This may be the time for her to seek help in dealing with the possibility that her husband might remain as he is...

 
Old 03-12-2010, 06:35 AM   #14
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Re: brain injury due to lack of oxygen

Yes, there are several children. My BIL has 2 children from a previous marriage and 4 childrn from this marriage to my sister.
I agree in that miracles can alway happen. But, I also agree you don't want to create false hope either. Where there is life there is hope. Yes, pray for the best but be prepared for the worst too.
We live in NJ and he is in a huge hospital which supposedly has a good repuatation. But from the stories from my sister I can't agree that it is a good hospital and my sister is not happy with them either. She had to fire one doctor. Due to his condition he could not be transported to another facitility.
Not sure at this point what the options are on further tests. No he is not on life support.
I suggested that she speak to someone for help in handling this....professionally. She is not handling this at all. Her response was for what? So from her response at the time, while I didnt agree with her, she didn't want to do it. I can't remember, I may have suggested it again, but this time in response to an e-mail from her. I don't think she addressed the suggestion this time from what I recall.
I'm not sure what she will do if it is severe brain damage.
Again to her the issue may be is there brain damage and is the EEG correct. Is the conclusion from the EEG correct or was it the result of him being on so many medications? I think I indicated in a prior email one doc felt the EEG result may be due to the medications thus the EEG may not be correct. I think they were going to change the medications he waa on to try a different approach on the meds.
Time will tell. Updates to come.

 
Old 03-12-2010, 09:18 AM   #15
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Re: brain injury due to lack of oxygen

I am so glad to hear he is not on life support, and that he is in a reputable hospital. Does your sister have a good re-pore with the current doctor? I know how frustrating it can be to try to get answers from doctors, and that is even the good ones.

I am assuming that you live some distance away? Does your sister have a strong network of family that is helping her keep vigil over her husband? Are the children old enough, and close enough to be helpful, take turns at the hospital and such?

I am sorry that your sister is taking this so badly...she must be devastated, it is the natural reaction. Hopefully in time, when there are some more definitive answers, that she will get some help to deal with all that might lay ahead...but like you said, time will tell. Everyday can seem like a week, I am sure.

Until then, I will be here.

 
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