May 16: Gerry's progress. ... from Gina

5/16/04

Dear Family & Friends,

This week we were happy that they unwired Gerry's jaw. Speech therapy has begun with the use of a "pmv", a valve that enables us to hear Gerr make sounds, cough, and eventually talk. They begin using the pmv in small increments to get him used to it, as it is a bit more difficult to breath with it on. They will increase the time with the pmv as he is able to tolerate until he can handle it for 8 hours a day for about a week. They will then cap off the trach for 3-5 days to see how he does. It is our understanding that if all continues to go well, within approximately 3 weeks the doctors will be able to remove the trach entirely!
The doctors, nurses and therapists continue to be very hopeful about Gerry's progress, saying that he is trying to break through. Lori met with the neuro for the first time, and was encouraged. The neuro explained that Gerry is responding to some advanced commands, for example, when the nurses ask him to lift his head so they can put a pillow under it, he does! This is very good! He did explain that Gerry is exhibiting what they observe in some stroke patients, which is an effect of his brain injury. This is that when they scratch the bottom of one of his feet, his big toe lifts up. They have put him on the medicine they use for Parkinsons patients to try to stimulate him to emerge from the coma. We are very impressed with the agressive treatment Gerry is receiving from the doctors and therapists, and continue to pray for them as well. We have noticed in the past two days that Gerry has been much less active, and looking very tired. All his vitals are good, etc., but we are wondering if maybe this new regimin of medicines may possibly be making him more lethargic. If it continues, we'll ask the doctors if this is a possibility. Please pray for his continued progress, and for the strength he needs to fight.
We are so grateful for those of you who live locally who have been able to visit Gerry. We've gotten many questions from visitors and also through email about comas and Gerry's condition. I have cut and pasted some very helpful info I got from a wonderful coma recovery website (http://waiting.com) that my sister found online. It is for people who have loved ones in a coma. The info is following, and I hope it is helpful for those of you who are interested to read it. We deeply appreciate all of your interest, concern, prayers and support. And we thank you for your continued prayers that Gerry would emerge from the coma! God Bless!

Gina
O Sovereign LORD! You have made the heavens and earth by your great power. Nothing is too hard for you! Jeremiah 32:17



About Brain Injury:

Understanding Coma


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Coma is a prolonged period of unconsciousness. Unconsciousness is the lack of appreciation of (or reaction to) a stimulus. Coma differs from sleep in that one cannot be aroused from a coma.

Coma involves two different concepts:

1.) Reactivity: Reactivity refers to the innate (or inborn) functions of the brain, i.e., the telereceptors (eyes and ears), the nociceptors (responses to pain), the arousal reaction (wakefulness) and the orienting response (turning one's head toward the source of sound or movement). We could also refer to these as reflexive movements.

2.) Perceptivity: Perceptivity refers to the responses of the nervous system to stimuli, which have been learned or acquired, i.e., language, communication skills, individual methods of movement such as gestures, etc. Perceptivity also refers to less complex learned or acquired reactions such as flinching when threatened. We can also think of these as conscious movements.

A person in a coma does not exhibit reactivity or perceptivity. He/she can not be aroused by calling his/her name or in response to pain.

As a person begins to emerge from a coma, they may begin to react to certain stimuli. To regain "consciousness" however, reactivity and perceptivity must both be present. These two elements are necessary for a state of awareness. Often, many of the elements of perceptivity must be relearned, such as speech, self-care, etc.

Many people are surprised that all stages of coma do not resemble what we have been taught to expect; a deep sleep. The person in the coma may exhibit movement, make sounds, and experience agitation. It is important to keep in mind that the coma patient may exhibit reflex activities which mimic conscious activities. Coma patients may be restrained to keep them from removing tubes or dislodging IVs. The progress of coma is measured by the patient's increasing awareness of external stimuli. There are many levels of coma which the patient will pass through as functionality increases.

Sometimes a coma is induced by chemical means to aid in medical treatment and recovery.

It is very important to remember to speak positively to and in the presence of the person in a coma. Some patients remember very distinctly events while they were in a coma. Studies also show that a positive attitude may be beneficial to the recovery of the patient. Conversations about the possible negative outcomes with doctors, nurses, and family should be conducted with discretion.

When will we know the extent of the injury?

When the patient "wakes up."

"But 'waking up' is a slow process of what we call 'emerging.' The first part of the waking up process is when the eyes open and they have wake/sleep cycles, the sleep cycles being the longest. As the wake cycles get longer and longer, movement begins to occur; then speech; then purposeful movement; reaching for things, making things work -- purposeful speech -- asking questions.

Arms and legs are the first things to move; then the head, from side to side. Speech begins with moaning, then moves on to mumbling, and happens more often when lying in bed." ~ Martha

Remember: No two brain injuries are alike.

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.

I can not stress enough that coma is often not what we imagine. No two patients are the same. Some will display movement and sounds throughout the comatose period, some may need to be restrained to prevent injury to themselves or others. It is best to view these behaviors realistically. This is the hard truth about coma; we do not know if or how well any particular patient will recover. But coma is rarely like it is portrayed in movies and on television, where one day the patient opens their eyes, smiles, and is discharged the next day. Recovery from brain injury takes time.

The brain is very complex. Even in the event of a "mild" brain injury, when there is no loss of consciousness, people often experience long term problems with memory, fatigue, concentration, anger, dizziness, etc. These problems may never be resolved and may require lifetime coping strategies.

Even in the event that the patient recovers quickly, it may take years to fully understand the extent of the injuries. If they are able to return to work, they may do an adequate job until faced with a new task. They may have deficits that will not be obvious until faced with a new or different situation or environment. These "subtle" deficits may be harder to find help for than more obvious deficits.

That is why you must be informed about brain injury. And why it is important to develop support systems now. You must be prepared for an injury which is permanent, as hard as that sounds. Information is your best option for dealing with brain injury.