VIRGINIA COMMONWEALTH UNIVERSITY

NATIONAL RESOURCE CENTER
FOR TRAUMATIC BRAIN INJURY

Neuropsychology and Rehabilitation Psychology Division Department of Physical Medicine and Rehabilitation.

Pat #15

DEAR PAT: My wife is currently in a coma resulting from a cardiac/respiratory arrest. She was not breathing for a minimum of 7 minutes, but the time could have been much longer. The doctors are telling me that she is only receiving the most basic of responses from the brain. She experienced seizures during the first 24 hours of her coma. She has been in this coma for 8 days now. Her critical care doctor is asking me to consider signing a "Do Not Resuscitate" form. I do not want to give up until I have exhausted all possible options. I want her back, but also want to adhere to her previously stated wish that she not be made to live in a "vegetative" state. Where or how can I receive information that will help me make this most crucial of decisions?



PAT’S ANSWER: This is one of the most agonizing decisions a person can make. A DNR form essentially means that CPR will not be performed if your wife’s heart stops. It does not mean that medical treatment will not continue and it does not mean that they will stop feeding her or assisting her to breathe. In other words, a DNR form does not constitute "giving up." Many terminally ill patients are asked early on in their illness to consider having a DNR form. I encourage you to meet with her physicians to discuss her prognosis. Consider getting second or third opinions from other experts. Talk with your family, your wife’s family, and clergy. If you and your wife ever discussed these issues, be sure to consider her wishes and values. Also, be sure that YOU talk to someone. Having a critically ill spouse is a terrible thing, and many people try to bear too much on their own.

For more information on coma, try the Coma Recovery Association’s website. Their address is: http://www.comarecovery.org

The following website has a nice list of links to resources about DNR forms – including information about legality, ethics etc.: http://www.npg.com/npg/legal/do.not.resuscitate.dnr.htm

DEAR PAT:I have a cousin that just had an accident that resulted in a brain injury. They discovered in doing x-rays that he has calcium deposits, which the doctor said it was not caused by current trauma-is this to be concerned with? What causes calcium deposits in the brain? Can it be reversed? I have been searching for answers on the web for 2 days and have not found anything. Can you help or lead me in the right direction for answers? Thanks.


PAT'S RESPONSE:Pat has a cousin who’s kind of hardheaded. I wonder if… No, actually calcification of the brain can occur from several problems. Most calcium that enters the body is deposited in bones and teeth. Sometimes, calcification can occur through aging. Calcification of the pineal gland for example, sometimes necessitates surgical removal. In other cases, calcification can occur because of brain cancer, vascular problems in the brain, some forms of infection (such as tuberculosis or toxoplasmosis), or a number of other metabolic disorders or problems with the kidneys. As for reversing the disorder, there are some techniques used for removing excess calcium deposits from tissues and joints – some involving diet, others involving medication. Your cousin’s physician should be consulted about treatment issues.

DEAR PAT:My Cousin was 28 years old when she was thrown from a car in an accident and suffered a brain stem injury. She was not expected to live. Yet, she made an almost complete recovery. We were rather happy about here recovery, when she began to fall down a lot. My aunt went with her to the hospital to do some tests, and they discovered numerous brain tumors. They were cancerous, and she has been undergoing chemotherapy for a while now. My whole family has been wondering whether or not the tumors were caused by the accident that happened almost 18 months prior.


PAT'S RESPONSE:Unless your cousin’s accident involved colliding with a truck carrying radioactive waste these are likely two independent events. Pat knows of absolutely no evidence that injury to the brain can later cause cancer in the brain - anymore than breaking a bone will cause cancer in the bone. Of course, anything is possible. However, as in most cases with cancer, there will likely be no way to trace it to a single "cause". Many things increase one’s chances of getting cancer and there are more likely suspects than brain injury. Genetic vulnerability and exposure to cancer causing agents in the environment are two big ones. Keep in mind that at this point, finding out what "caused" the cancer won’t help your cousin. What is important is giving her love and support so she can fight the cancer and hopefully win the battle.

DEAR PAT:Dear Pat: My son has a severe brain injury (he fell 35 ft). He postured a lot in the hospital and now he is in a rehab hospital. They had him on Haldol and also had him on Botox. It stopped the posturing, but now he is no longer on the Haldol and he is starting to posture again. Why would he posture? I am trying to get the Doctors to do something quick before it gets so they can't control it. My son is in a coma yet, he has been in one for 2 1/2 months and they think he is improving, but not while he is posturing. Also he fixes his eyes to the right at a certain time of the day some days. He tracks well and responds to sound. Can you give me any encouragement?


PAT'S RESPONSE:Abnormal posturing is usually a sign of serious Central Nervous System damage. Certainly, a 35-foot fall will cause serious damage. Normally when a muscle contracts, the muscles on the other side of the joint provide resistance to contraction. Abnormal posturing occurs when damage to the CNS prevents the muscles on the other side from acting in opposition. In the case of a prolonged coma, posturing can continue for a long period of time. Obviously, I can’t say anything specific about your son’s case – you should consult with his physician for a prognosis. In general, most people eventually "emerge" from comas. However, it is also true that your son sustained a very severe injury and has been in a coma for an extended period of time. You need to remain optimistic. You also need to be realistic – even if your son emerges from the coma, there will likely be a long rehabilitation process and many long-term changes.



Be sure to talk with your son’s physicians and try to understand the nature and extent of his injuries and get a realistic prognosis. Keep in mind, you also need to take care of yourself and your family. Consider talking to a counselor or clergy. We all need help to get through the bad times.

Pat thought the readers might enjoy this letter from a TBI survivor and an "Ask Pat" fan!

(P.S. Pat just loves fan mail!)
DEAR PAT:I understand that you know everything I need to know and what you don't know isn't worth knowing! My compliments to you for good advice couched in delightful banter. I am a survivor of a very severe TBI who has been blessed with considerable recovery. Persistence and integrity coupled with education and a sense of humor get me through. I also owe a tremendous debt to family, friends, and mentors (it took a while to find the right ones). Be an educated consumer; there are good doctors and there are not so good doctors, shop around for a genuine one - credentials are important, but not a substitute for compassion. Support groups can be an immense source of information and help; be sure it is well facilitated, focused, and viable. The BIA (Pat’s note: BIA = Brain Injury Association) is great! You/I/we are different, just like everybody else - TBI sequelae make you more unique, not diminished. In many cases, TBI doesn't affect IQ to the same degree as it does EQ (emotional intelligence); find alternative ways/coping skills to make up the difference (I'm still working hard on that one 35 years later). Be a skeptical optimist in exploring new information, therapies, and rehabilitation techniques - 1,000 years ago, everyone KNEW the earth was the center of the universe; 500 years ago, everyone KNEW the earth was flat; 100 years ago, the medical profession KNEW malaria was caused by vapors; imagine what they'll know tomorrow.

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