Hi concerned221,
What a horrible thing to happen to such a young woman! How wonderful
that she is surrounded by such caring friends and family! Please
convey my wishes for a speedy recovery to your friend and her family.
Please keep in mind, as you read this answer, that no two patients,
brain injuries or recoveries are the same. Predicting when the young
woman in question can be self sufficient, is, I?m afraid, impossible.
Some things are unpredictable, and recovery/self-suffiency after a
coma is one of them. The doctors have said to you ?Wait?, and at this
point, other than being present for your friend, that is the best
advice. Waiting is terribly hard to do when you see someone you care
about lying in a hospital bed, attached to tubing and monitors.
As you can see exemplified by some of the personal stories below,
recovery time varies by patient and circumstances.
Your friend has several things in her favor however: her young age,
reactive pupils, and your statement that ?The doctors have indicated
that although her brain is going "slow" there are no signs of any
brain damage (clotting, etc.)?
Some members of the medical community may ?poo poo? the idea of
talking, massaging, playing music, showing pictures and offering
stimuli to your friend, but many studies have proved these to be
effective steps to recovery.
?Dimancescu said that some people are skeptical of coma stimulation
because they "believe that stimulation and therapy is recommended ad
infinitum, no matter what the person's progress is. That would be a
waste of resources and create false hopes in the family." In practice,
he said, intense care was "usually recommended for about three
months." He added that doctors? predictions were often wrong --
patients who did not seem badly injured might never recover, but
patients with greater injuries could awaken. Valko summed it up: "We
don't know as much as we think we do, doctors and nurses." ?
LifeIssues.net
http://www.lifeissues.net/writers/val/val_06_awakenings.html
Here is an inspirational story of a young man and the effect of music
on his recovery:
?'Music as Medicine" (Ensign) Last summer 18 year old Matt Tullis of
Sandy, Utah, had already received his mission call to Belgium when he
was in a violent car accident that killed two of his high school
buddies and sent him to the University of Utah Medical Center in a
serious coma due to massive head injuries. While his friends and
family hovered outside his room in a shaken silence, the doctors gave
him only a 25% chance to live. A bolt in his head monitored the
pressure as his brain swelled. "We were told," said Julie, Matt's
mother, "that if the pressure in his skull rose above 15 ICP's or got
as high as 30 for any length of time, it was very dangerous."
Medically, the doctors could get the pressure down to about 15, but
they couldn't do any better. So the lanky basketball player lay for
two days without the pressure dropping below 15. Then his younger
sister, Emily, and father, Howard, got an idea as they visited him for
a few moments in intensive care. Because Matt loves church music, they
started to sing "Because I Have Been Given Much." Immediately, the
monitor registered a dramatic drop in pressure, plunging from 15 down
to 4. With the family crying and the nurses amazed, they put a tape in
for him, Kenneth Cope's "Greater Than Us All", and his pressure
continued around 8 or 9 for the next few hours, which was the critical
time. "We felt that somewhere in his coma, he could hear that music
and know that we were there and the Lord was there for him," said
Julie. After nineteen days in a coma and three months in the hospital,
Matt is home recuperating, hoping he can go on that mission next year.
P.S. Matt is fulfilling a mission to San Bernardino, Riverside.
(according to the granddaughter of woman who wrote me said she saw two
men in white seated at his side as he spoke in a Stake meeting
there.)?
From the Utah Festival Opera Company
http://www.ufoc.org/michaelballam/medical.html
The information I am presenting is meant to inform and educate, and
is not intended as a medical diagnosis or treatment plan. I am pleased
to read that the medical community has come to realize there is hope
and possibility for coma patients!
About Comas:
A coma, simply put, is a state of prolonged unconsciousness, where one
is unable to respond and react to stimuli. There are several levels of
coma, each with different stages of alertness and function. You have
probably heard of a ?Deep Coma? before. This level of coma is when the
brain activity level is nearly shut down, and is often followed by
death. Amazingly however, some people have emerged from this level of
coma. In some stages of coma, a patient may be able to experience
awareness, but be unable to respond. It is because of this that I like
to see coma patients being spoken to as if they could hear and
understand your words, because they very well may! Since you don?t
know if this young woman can hear you, speaking to her as if she
could, playing her favorite music, and affectionate touches can be
nothing but beneficial.
Coma is brought on by injury inside the skull - intracranial (such as
a tumor, stroke, meningitis, abcess, and seizures) or injury outside
the skull - extracranial (such as cardiac arrest, diabetes, liver
disease, drug overdose, etc.).
Ecureme.com
http://www.ecureme.com/emyhealth/data/Coma.asp
A hypoxic (partial lack of oxygen) or possibly an anoxic (complete
lack of oxygen) coma, seems to be what the scenario in your question
describes. Both of these types of comas are called HAI, or
hypoxic-anoxic injury. A diminished oxygen supply can impair
cognitive thinking, physical movement and affect emotional stability.
Brain Injury Society
http://www.bisociety.org/neurology.cfm
Duration of a Coma:
Folks who are close to a coma patient, understandably, want to know
how long the loved one will be comatose. There are no remedies,
treatments, or therapies that can reliably ?wake? someone up from a
coma. An MRI may show if there is dead brain tissue present, and an
EEG may show electrical activity or lack of activity in the brain, but
neither is foolproof, and neither can predict how and when a person
will emerge form a coma, or how they will be affected.
?How Long Does Coma Last:
Coma can last from hours to days, depending on the severity of the
brain damage. It is possible for a person to remain in a comatose
state for months or even years.?
Brain Injury Association of Michigan
http://www.biausa.org/Michigan/whatis.htm#Life
?HOW LONG DOES IT USUALLY TAKE TO REGAIN FULL CONSCIOUSNESS?
It is important for the family to understand that not even the
physicians can tell when the patient will regain consciousness. The
family must be patient. Sometimes in the mildest cases, the coma lasts
a few hours, while with more severe injuries the coma may last for
months or years. In some rare cases, the injured person never fully
regains consciousness.?
Newfoundland Brain Injury Association
http://www.nbia.nf.ca/frequently_asked_questions.htm
Assessing Brain Injury
?Some patients are also given specific cognitive and
neuropsychological tests. These assessments sample many aspects of
brain functioning to see how the deficits caused by the brain injury
will influence everyday functioning. Such testing may be very relevant
later in assessing the injured persons capabilities for independent
living, employment, competence, driving and so on. These tests may be
repeated from time to time over several years. Therefore, the family
must understand that it may be several months or years before all of
the effects of the brain injury are known. Indeed, the head injured
person may continue to experience changes throughout his or her
lifetime.?
Newfoundland Brain Injury Association
http://www.nbia.nf.ca/frequently_asked_questions.htm
??an MRI scan can be used to assess the amount and location of brain
injury. This information is used to plan treatments and therapies,
and to predict recovery.
CT and MRI scans are powerful tools for assessing and treating brain
injury. The choice of scan depends upon the urgency of the
information needed and ability of the subject to participate in the
scanning procedure. For this reason, CT scans are often more used in
the early stages of recovery to assess for life threatening
conditions. MRI scans are most useful in assessing the amount and
location of brain injury for planning therapies and predicting
recovery.?
Brain Injury Resource Foundation
http://www.birf.info/mz/wala-hypoxic-coma-recovery-12386.html
?Imaging studies such as CT/ MRI are methods with which to visualize
the brain damage yet these methods alone cannot predict outcomes.
Other methods such as EEGs and evoked potentials are also used to
demonstrate brain activity which helps determine the severity of
event.?
http://www.meritcare.com/specialties/rehab/brain/abi/Anoxia/recovery.asp
?It should be remembered that sometimes, while a patient is in a coma,
they may exhibit behaviors which mimic conscious behaviors. For
instance, they may turn their head toward a sound. This may or may not
be a purposeful movement.?
http://www.waiting.com/injuryextent.html
A patient who is in what seems to be an awakened state, but exhibits
no responsiveness to his/her surroundings or to stimuli, is in a
persistent vegetative state (PVS). This indicates that the cerebral
cortex is not functioning properly.
?In the condition of locked-in syndrome, the patient appears
unresponsive without the ability to move or verbally communicate, yet
has full cognitive abilities. Such individuals are able to use an eye
blinking response to communicate.?
http://www.birf.info/mz/wala-hypoxic-coma-recovery-12386.html
A somewhat cruel trick can be played by Mother Nature when a coma
patient appears to be seeing or recognizing people or objects :
?Because the brain cannot tell that this part of the brain is damaged
or disconnected, a person may act as though he/she can see, even
though he/she shows no ability to identify or discriminate objects,
shapes, or colors.?
http://www.bisociety.org/neurology.cfm
One tool medical staff use to assess the severity of a brain injury is
the Glasgow Coma Scale (GCS).
A GCS score of 8 or less indicates a severe injury, a score of 9-13
indicates a moderate injury. A score of over 13 indicates a mild
injury, one that can generally heal without need of any rehab. As a
person?s score improves, it can indicate impending emergence form the
coma. You can see an explanatory chart on this page from the
Rehabilitation Institute of Chicago
http://lifecenter.ric.org/content/2162/?topic=1&subtopic=271
More about the Glasgow Coma Scale
http://www.birf.info/mz/wala-hypoxic-coma-recovery-12386.html
Here is a list of the various parts of the brain, with descriptions of
the effects an injury has on each section. Once the doctors have
discovered which part of your friend?s brain has been affected (if
any), you can better know what to expect.
Temporal lobes: These lobes contain auditory reception areas as well
as certain areas for the processing of visual information. Damage to
the temporal lobe may affect sound discrimination, recognition, and
comprehension; music appreciation; voice recognition; and auditory or
visual memory storage.
Occipital lobes: These lobes contain visual reception areas. Damage to
this area could result in blindness to all or part of the visual field
or deficits in object recognition, visual scanning, visual integration
of symbols into wholes, and recall of visual imagery.
Parietal lobes: These lobes contain reception areas for the sense of
touch and for the sense of bodily position. Damage to this area may
result in deficits in the sense of touch, disorganization, and
distorted self-perception.
Frontal lobes: These lobes are integrally involved in ordering
information and sorting out stimuli. Concentration and attention,
abstract-thinking ability, concept-formation ability, foresight,
problem-solving ability, speech, as well as gross and fine motor
ability may be affected by damage to the frontal lobes.
Thalamus: The thalamus is a kind of communications relay station for
all sensory information being transmitted to the cerebral cortex.
Damage to the thalamus may result in altered states of arousal, memory
defects, speech deficits, apathy and disorientation.
Hypothalamus: The hypothalamus is involved in the regulation or bodily
functions such as eating, drinking, body temperature, sexual
behaviour, and emotion. It is sensitive to changes in environment that
call for a "fight or flight" response from the organism. Damage to it
may elicit a variety of symptoms ranging from uncontrolled eating or
drinking to mild alterations of mood states.
Cerebellum: Together with the pons (another brain site in the area of
the brain referred to as the hindbrain), the cerebellum is involved in
the regulation of balance, breathing, and posture - among other
functions. Damage to the cerebellum may manifest itself as problems in
fine motor control and coordination.
Reticular formation: In the core of the brain stem, the reticular
formation contains fibers en route to and from the cortex. Because
stimulation to this area can cause a sleeping organism to awaken and
cause an awake organism to become even more alert, it is sometimes
referred to as the reticular activating system. Damage to this area
can cause the organism to sleep for long periods of time.
Limbic system: Composed of the amygdala, the cingulate cortex, the
hippocampus, and the septal areas of the brain, the limbic system
plays an integral part in the expression of emotions. Damage to this
area may profoundly affect emotional behaviour.
Spinal cord: Many reflexes necessary for survival (such as withdrawing
from a hot surface) are carded out at the level of the spinal cord. In
addition to its role in reflex activity, the spinal cord plays an
integral part in the coordination of motor movements. Spinal cord
injuries may result in various degrees of paralysis or other motor
difficulties.
Newfoundland Brain Injury Association
http://www.nbia.nf.ca/brain_injury_rating_scales.htm
Recovering After a Coma
A person?s recovery after a coma depends again, on a number of
factors, such as the age of the patient, the overall health of the
patient, and the severity of the brain injury. Your friend appears to
have suffered a hypoxic coma (from a lack of oxygen due to restricted
blood flow to the brain, during the 22 minutes from arrest to
resuscitation)
In a mild to moderate brain injury, neurons (brain cells) get bruised
and swollen, and may not necessarily be damaged. Once the swelling is
reduced and the bruising heals, the neuron can function again, or
other neurons take over. This takes time and the time varies from
patient to patient, depending on the severity of the injury.
Even though each patient?s recovery is different, some stages are
experienced by most coma patients. At first, the patient may be
completely unresponsive, but as the person begins to respond,
responses may be inconsistent. The patient may seem to respond even in
the absence of stimuli. The patient will begin to respond to hand
squeezing (as you indicated already!) and sounds. Often, the patient
may experience agitation with increased movement and activity. Speech
if any may be incoherent. Many coma patients will be prescribed
anti-depressants, which not be viewed as indicating psychiatric
problems, but as an aid to helping the patient cope with a strange and
abnormal condition.
Newfoundland Brain Injury Association
http://www.nbia.nf.ca/frequently_asked_questions.htm
According to the Rehab Institute of Chicago:
A person?s recovery after a brain injury goes through a series of
stages. After severe brain injury, the sequence is:
·Coma,
·coma emergence
·post-traumatic amnesia and
·resolution of post-traumatic amnesia.
·These stages represent only general categories.
·Sometimes, recovery can stop at one of these stages and not progress
to the next stage.
·The transition between stages is rarely abrupt; it is usually very gradual.
·Every person recovers at an individual pace, so it is difficult to
compare the experience of one person to another. ?
http://lifecenter.ric.org/content/2162/?topic=1&subtopic=271
As the patient improves, the Rancho Levels of Cognitive Functioning
are often used to monitor and rate the patient?s progress. Right now,
your friend appears to be in Level I, described as such: ?Complete
absence of observable change in behavior when presented visual,
auditory, tactile, proprioceptive, vestibular or painful stimuli.?
http://lifecenter.ric.org/content/2162/?topic=1&subtopic=271
More about the Rancho Levels:
http://www.birf.info/mz/wala-hypoxic-coma-recovery-12386.html
?It is important for the patient's limbs to be moved and ranged. Since
the patient is not mobile there are risks for the patient to lose
their range of motion in the extremities. Involuntary muscle tightness
called spasticity, is also common in brain injury and can affect the
use of muscles if not addressed. A physical therapist may be involved
to treat these problems. Another risk for the patient in coma is to
develop pressure sores or skin ulcers. Nursing staff and family
members can help prevent these ulcers by turning the patient?s
position in the bed every hour or two or as directed by therapy
staff.?
http://www.birf.info/mz/wala-hypoxic-coma-recovery-12386.html
From The Brain Injury Association of Michigan
Brain injury can be a catastrophic event which dramatically changes a
person and their family. A host of emotional responses may result.
Over time, people often find that they adjust to the changes created
by the brain injury. Adjustment doesn't mean that people are happy
about changes, rather, it means that they recognize that they cannot
be changed, and rather than struggle toward the impossible, begin to
set goals and make decisions based on the new self.
The person who has sustained the brain injury often must develop a new
sense of self, and the family must develop a new vision of who the
person is. This is a gradual evolutionary process which can be
different for each individual and family.
For the person with a brain injury, learning what a brain injury is,
identifying the changes the injury has caused, and ultimately,
adjusting to the new limitations resulting from the brain injury can
be a challenging and difficult, but often necessary process.
Family members often experience a similar process, and have the dual
challenges of changing their vision of the person with a brain injury
at the same time as the family is redefined and their role in it
changes, too.
Three general types of individuals and family intervention have been
identified and may be helpful at different stages of recovery:
Information and education; support, problem-solving, and
restructuring, and formal therapy.
Prognosis:
Still, there exists no completely accurate way to determine a patient?s prognosis.
?Pupillary reactivity--when both eyes have "fixed", or dilated pupils,
this points to a very poor prognosis? A promising sign is that you say
your friends pupils react when a light is shined into the eyes,
however you say her eyes dilate in reaction to light. Do you mean they
constrict? A normal papillary reaction would be for the pupils to
constrict (get smaller) in reaction to light.
?? an absence of pupillary light reflex at 48 hours after injury
predicted a poor neurologic outcome.?
PubMed Abstract
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10608544&dopt=Abstract
?Age--Some studies suggest that patients 25 years and younger have a
better rate of recovery than those who are older.?
http://www.bisociety.org/neurology.cfm
After 5 years of therapy and probably many prayers, this 18 year old
was able to say words and short sentences:
?Evidence that supports this claim is noted in the New England Journal
of Medicine in which a Texas doctor documents the slow return to
consciousness of one of her patients. The patient, age 18, sustained a
severe brain injury in a car crash in 1987. Although she opened her
eyes after a few weeks, she remained unresponsive and was treated
supportively for the next 15 months. At that time, nurses noticed that
she seemed to obey commands to move her leg and close her eyes when
they were tending to her. Despite the fact that her responses were
inconsistent and rarely seen by others, doctors agreed to administer
drugs intended to improve alertness.
She gradually began to improve and over time learned to answer
multiple choice questions and do simple math problems using eye
blinks. Three years post-injury she was communicating regularly with
eye blinks and recovering limited motor function. After five years,
she could mouth words and short phrases, although her attention span
was very short. Five years and two months after the injury she was
sent home. She is, as expected, severely disabled and dependent on
others for care. But her family is thrilled with the fact that they
can interact meaningfully with her and she appears to enjoy life. She
is noted for her playful teasing of her caregivers.?
http://www.biausa.org/Pages/related%20articles/article.coma.or.reduced.html
?Some studies have shown that patients with the best chance of
recovery after a hypoxic-ischemic event had intact brain stem function
and spontaneous roving eye movements on initial examination after
onset of coma and evidence of intact cortical function (pattern of
motor responses) at day 1 after the onset of coma. After several weeks
in a coma patients will invariably progress to a persistent vegetative
state. It is important to realize that "waking up" after coma does not
simply mean opening one's eyes or moving spontaneously but rather
meaningful response to stimuli such as following commands or
conversing intelligibly.?
Columbia University Medical Center
http://cpmcnet.columbia.edu/dept/neuro-icu/coping.html
From Columbia University medical Center: ?A familiar voice or touch
may have a calming or reassuring effect on the patient, and certainly
can't hurt. We encourage as much bedside contact between the patient
and family members as is possible, as long as it does not interfere
with medical care. Playing a patient's favorite music may also be
helpful. The main rule of thumb is to be sure that your contact at the
bedside does not lead to increased agitation, which can occur if the
patient is semi aware and frustrated by their inability to communicate
or express himself or herself. If this occurs, it is probably best to
leave the patient alone.?
http://cpmcnet.columbia.edu/dept/neuro-icu/coping.html
?Hypoxic-ischemic injury has a poor prognosis also. As a general rule,
patients with a nontraumatic cause of coma usually do not regain
consciousness if they have been comatose
http://www.postgradmed.com/issues/2002/02_02/malik.htmor in a
vegetative state for more than a month.?
?As recovery may take months to years, rapport and a good working
relationship with the rehabilitation specialists are very important.
Because of extended contact, both the person in rehabilitation and
his/her family may experience a variety of emotions as they learn to
cope and adapt to a constantly changing condition.
Because expectations may not always match the person's current level
of progress, the potential for disappointment and/or conflict may be
high. Therefore, it is important to discuss such issues both early in
the course of treatment as well as throughout the course of recovery.
Finally, predicting long-term recovery from hypoxic-anoxic brain
injury can be difficult. Full rehabilitation potential is not always
apparent early on. Often, depending on the nature and extent of the
injury, rehabilitation and improvement can continue over a period of
months or years. ?
http://www.bisociety.org/neurology.cfm
The likelihood for a good recovery after one month of coma is 8% for
hypoxic-ischemic coma, according to the Medical College of Georgia
Department of Neurology.
http://www.neuro.mcg.edu/amurro/coma/index.html#clinical
Patients with a hypoxic injury may have difficulty concentrating and
suffer long-term memory loss, upon recovery. The most frequent
change in people who have been in a coma are physical. Changes in
cognitive ability (thinking ability) are will also be evident. Changes
in social behavior and behavior with friends and family , can be
harder to detect. Therapy will concentrate on both physical and
cognitive rehabilitation, lasting months to years. ?A person's
physical and cognitive condition rarely worsens in the years after the
injury, but disturbances in social behavior can worsen over time if
they are not recognized or addressed.? ?Aside from the effects on
behaviour, head injury can, of course, affect physical abilities,
resulting in a loss of muscle control, headaches, and problems with
hearing, sight, speech and smell. A person may also experience
seizures and some degree of paralysis on one or both sides of the
body.?
Neurology Channel
http://www.neurologychannel.com/tbi/prognosis.shtml
and
Newfoundland Brain Injury Association
http://www.nbia.nf.ca/diagnostics_&_treatment_protocols.htm
?Many patients emerge from a vegetative state within a few weeks, but
those who do not recover within 30 days are said to be in a persistent
vegetative state (PVS) . The chances of recovery depend on the extent
of injury to the brain and the patient's age, with younger patients
having a better chance of recovery than older patients. Generally
adults have a 50 percent chance and children a 60 percent chance of
recovering consciousness from a PVS within the first 6 months. After a
year, the chances that a PVS patient will regain consciousness are
very low and most patients who do recover consciousness experience
significant disability. The longer a patient is in a PVS, the more
severe the resulting disabilities will be. Rehabilitation can
contribute to recovery, but many patients never progress to the point
of being able to take care of themselves?
http://catalog.nucleusinc.com/displaymonograph.php?MID=92
Some patients, upon emerging from a coma, may experience memory loss,
personality changes, and behavior problems. The patient may feel
depresses, irritable and angry, confused and have sleep problems.
Medication and therapy can usually minimize these kinds of post-coma
problems.
http://catalog.nucleusinc.com/displaymonograph.php?MID=92
If recovery appears unlikely:
This Weekly Planet article, about Terry Shiavo, says about coma
patients ? However, it is generally agreed that if a patient doesn't
become responsive before six months, his or her prognosis is extremely
poor.?
http://www.weeklyplanet.com/2003-11-20/cover2.html
When it appears that a patient may not recover, the family and
physicians will need to discuss delicate and sensitive issues about
quality of life. Resuscitation orders, ventilator and feeding
discontinuation plans will need to be planned.
http://www.ecureme.com/emyhealth/data/Coma.asp
?Another study showed that 21% of HAI patients who remained in coma
four weeks or less had a good recovery, and 79% had a poor recovery.
100% of those patients who remained in coma more than four weeks had a
poor recovery. Also, the patients whose coma durations were greater
than four weeks tended to show minimal recovery (functional gains)
after the first four months. If a person does not "wake up" from a
coma, then significant damage to the cerebral cortex, called laminar
necrosis may have occurred. Like wood-paneling, the cerebral cortex is
made up of a number of layers. If these cells die, the layers become
separated from each other. This results in neocortical death while
lower brain functions continue to operate (called a persistent
vegetative state).?
http://www.bisociety.org/neurology.cfm
This page on the eCureme site has some videos and article son end-of-life issues.
http://ecureme.healthology.com/search_new.asp?b=&searchText=Coma&search_help=&mySearch=2#
?Most people make the decision to withdraw life support when they
realize that further aggressive care will not alter the expected final
outcome (i.e. death), but will extend and prolong the patient's
suffering.
Discussions regarding the withholding or withdrawal of treatment are
raised only after there is clear clinical evidence that current
treatment has not resulted in desired outcomes and there is little or
no chance of meaningful patient recovery. These decisions are usually
made by family members based on the previously stated wishes of the
patient, or are based on a written advanced directive. Once it is
agreed aggressive medical management will cease, comfort care measures
are often instituted. Comfort care measures usually involve the
administration of sedatives (i.e.: morphine, fentanyl) to reduce any
potential patient pain and suffering once life-support interventions
are withheld or withdrawn.?
Columbia University Medical Center
http://cpmcnet.columbia.edu/dept/neuro-icu/coping.html
Additional Information:
Frequently, friends and family of a coma patient become so involved in
worrying about and caring for the loved one, they neglect to care for
themselves! In order to continue to support and care for the loved
one, you and the family need to meet your own needs as well. The
stress of coping with a coma patient, as well as a recovering coma
patient can exact a terrible toll on family members. Deal with your
own feelings, and look after your own physical and psychological well
being -fortifying your abilities to handle the stress and needs of the
patient. There may also be legal concerns, disability papers and other
matters that will need to be addressed.
It is perfectly normal for family members to feel denial, anger, and
even guilt over a situation such as one you have described. Sometimes
family will not believe what the doctors, nurses and therapists tell
them, and they may even direct anger towards the medical staff. This
is common, and perfectly normal. The medical staff is well aware of
this, and will handle it in stride.
?What can family and friends do for themselves??
It is not uncommon for family members to become unduly stressed as a
result of a tragic event. They may find themselves unable to sleep,
take proper care of themselves, or overcome feelings of complete
loneliness or hopelessness. They may tend to drink more alcohol than
usual.
Taking care of themselves simply involves using common sense:
1.They should eat properly, ensuring that they don't skip meals or
fill themselves with junk food. Only nutritious food gives them the
extra energy they require.
2.They should get enough sleep. You can only run on "nervous energy"
so long before you become exhausted. The family members should have
other people relieve them at the hospital so that they can get the
sleep they need.
3.They should stay away from alcohol or drugs, which will make them
ineffective in coping with their head-injured family member and their
family.
4.The family members should feel free to express their feelings to
someone close to them or to support people affiliated with the
hospital, their doctor, their minister, the social worker or a friend.
Discussing feelings is very important in relieving stress. One of the
most valuable forms of assistance comes from another parent or spouse
who has lived for some period of time with a head-injured family
member. The provincial head injury association will know of such
people, who are available either in support groups or on an individual
basis.
5.Families should be willing to let other people help. Too often,
family members are unwilling to let others be involved with meeting
the needs of the head-injured patient. A number of professionals and
organizations, such as the provincial head injury association, can
help, and the family should be prepared to call on them for
assistance. All of the responsibilities and support should not rest on
the shoulders of a few people.
6.Family members should not be afraid to ask questions. Much of the
anxiety they will experience is caused by the unknown. They should
write their questions down so that they do not forget them under
stress. Still, there may be no clear-cut answers to the questions they
have, especially in the early stages, so the family should also be
prepared to be patient and understanding. Many parents or spouses feel
intimidated by the medical profession or health care professionals,
but these professionals do care even though they may often be busy.
So, the family should not hesitate to ask questions! They must
remember this is their loved one and the situation has a profound
effect on their lives and their head-injured family member's future.
7.It is so important for the family to preserve its own health, sanity
and good morale. The family's ill health or low spirits may indeed
adversely affect the patient's recovery.?
Again from the Newfoundland Brain Injury Association (A wonderfully
done and informative web site, agreed?)
http://www.nbia.nf.ca/frequently_asked_questions.htm
It may help to read other?s accounts of dealing with the coma of a loved one.
Waiting.com
http://www.waiting.com/waitingbridge.html
The Coma Recovery Program that supported this page, is no longer in
operation. However, this site still offers plenty of information:
http://www.comarecovery.org/comaarousal.shtm
Evaluating the Comatose Patient
http://www.postgradmed.com/issues/2002/02_02/malik.htm
Someone else asks a similar question as yours on the Virginia
Commonwealth University?s National Resource Center for Traumatic
Brain Injury site:
?DEAR PAT: My father had heart failure and it took him 20 minutes to
bring him back. The doctor gave him medication and he was supposed to
wake up in about 10 hours. It has been over 72 hours and his is in a
coma. His heart and organs are functioning well and a brain scan
showed no signs of stroke. Can you tell me how long it takes to get
out of a coma?
PAT'S RESPONSE:Afraid I can?t answer that one. These things vary from
patient to patient and are always hard to predict. The physician
treating your father is the best source of information about his
particular case. It sounds like your father may have experienced what
is called a hypoxic coma. This means that there is oxygen deprivation
to the brain. A heart attack is one of the most common causes of
hypoxic coma. Because the brain does not store oxygen, the brain needs
a constant supply. If that supply is interrupted, brain cells begin to
die.
Generally, the longer in a coma the less likely there will be a good
outcome. However, if your father shows good brain function, there is a
good chance he will "emerge" from his coma. Sensory stimulation may
help him emerge from the coma, although there is some controversy over
the effectiveness of this intervention. After he is awake, he may need
a significant amount of rehabilitation therapy and may experience many
of the problems with attention, memory and behavior that are
experienced by other survivors of brain injury
http://www.neuro.pmr.vcu.edu/pat/pat12.htm.
It?s a little hard to see, due to the watermark, but this illustration
shows a lack of oxygen to the brain.
http://catalog.nucleusinc.com/enlargeexhibit.php?ID=802&TC=&A=2
Can Coma Patients Hear? This is an online weblog from friends and
family of coma patients:
http://www.comarecovery.org/discus/messages/3/58.html?SaturdayAugust1720020214am
The Brain Injury Association of Michigan offers support groups (if you
live in Michigan) and this toll free number (if you live anywhere) to
call for helpful information, (800) 772-4323
http://www.biausa.org/Michigan/support.htm
From the same Michigan site, research information
http://www.biausa.org/Michigan/research.htm
The Wyoming Brain Injury Association loans out 72 different videos on
Brain Injuries
http://63-126-124-136.hagenhosting.com/Wyoming/videos.htm
Different Levels of Hypoxic Coma
http://63-126-124-136.hagenhosting.com/Pages/types_of_brain_injury.html#hypoxic
Coma Recovery Association (This site says it is down for 30
hours-please try in a day or two. This site may have useful to you
information, but I can?t know for sure!)
http://www.comarecovery.org/artman/publish/ReportOnTheVegetativeState.shtml
An inspirational and informative account of a coma patient, Chelsie McManus
http://www.geocities.com/love4chelsie/coma.html
Stories of long-term comatose patients emerging:
http://www.comarecovery.org/discus/messages/3/164.html?TuesdayJuly820030328pm
Finally, family and social support is an important factor in a coma
patient?s recovery. Together with physicians, therapists, social
workers and mental health professionals family and friends can provide
a recovery support network that is critical to a coma patient,
especially after discharge.
There you go, concerned221. If any part of my answer is unclear, or
you need additional information, please request an Answer
Clarification, before rating. This will allow me to assist you
further, if possible. I wish your friend the best of luck!
Sincerely,
crabcakes
Search Terms
Hypoxic coma
Hypoxic coma recovery rate
Coma rehab |
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