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Dr. Frank
Dr. Frank, Board Certified Physician
Category: Medical
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Experience:  Neurologist/Internist with academic and clinical experience.
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I live in Samoa and my friend has been in a severe car accident

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I live in Samoa and my friend has been in a severe car accident almost 4 weeks ago. She can move her right leg mostly kicking with it and she can move her left arm. She has started to speak and recognize questions and people. Sometimes she does not make sense and think she is reliving the accidents cause she cries and screams. I have noticed that both her feet are very dry underneath and the toes. Is this due to lack of fluids? Also, when can we expect her to gain fully concienceness and will she start moving her other limbs. She also suffered head trauma and a fraction in C1
Submitted: 1 year ago.
Category: Medical
Expert:  Dr. Frank replied 1 year ago.

neuromd2012 :

Hello. I am an Internist and a Neurologist and am here to answer your questions.

Customer:

I live in Samoa and my friend has been in a severe car accident almost 4 weeks ago. She can move her right leg mostly kicking with it and she can move her left arm. She has started to speak and recognize questions and people. Sometimes she does not make sense and think she is reliving the accidents cause she cries and screams. I have noticed that both her feet are very dry underneath and the toes. Is this due to lack of fluids? Also, when can we expect her to gain fully concienceness and will she start moving her other limbs. She also suffered head trauma and a fraction in C1

neuromd2012 :

hello

neuromd2012 :

so this sounds like a very serious concussion and she is semi-comatose.

neuromd2012 :

did she need brain surgery?

Customer:

No, she had noe surgery. She remembers me, her kids and friends but like I said sometimes a bit delerious

neuromd2012 :

I see.

neuromd2012 :

would you have any MRI or CT scan results of her brain?

neuromd2012 :

does she have any organ failure, like liver or kidney problems?

Customer:

No, they took a CT scan and it showed her brain was swollen. hence they put her in an induced coma for a week, took her about a week and a half before she started speaking

neuromd2012 :

right

neuromd2012 :

so she is going to make a steady functional improvement with time

Customer:

Well that´s what we hope for, but nobody is telling us anything here

neuromd2012 :

she will probably need more testing. An MRI scan done now would be great as it would show the trauma to the brain better than the CT scan which was done early on

Customer:

They don´t have that here. Its like a third country sometime, we were lucky the ct scan was working that day

neuromd2012 :

there are other scans, but I do not think they have them in samoa, you would have to go to hawaii I think

neuromd2012 :

right

neuromd2012 :

I worked in Hawaii some time ago

neuromd2012 :

but now I am in NYC, where we have all this technology

neuromd2012 :

what about her C1 fracture?

neuromd2012 :

is she in a halo?

Customer:

Not sure if she is moveable anywhere yet, and it would be very expencive too

neuromd2012 :

sure

neuromd2012 :

this will be testing you can consider once

neuromd2012 :

she is ambulatory, but still having problems with speech

Customer:

She had a neck brace, but they put her on a traction for 2 weeks and now she is back on the neck brace

neuromd2012 :

or cognition

neuromd2012 :

I see

neuromd2012 :

so that is good news

Customer:

hmm, what is ambulatory? Sorry I´m Norwegian

neuromd2012 :

because it suggests there is a stable fracture, that did not need surgery

neuromd2012 :

ambulatory means she can now walk around

neuromd2012 :

get places without a wheelchair

Customer:

Nope, just one leg moving. Seems to be some twitching in the other foot but thats it

neuromd2012 :

it may come a time where she can get around, but still is not 100% mentally

neuromd2012 :

and then you will have to make some decisions like is her brain getting enough blood supply in certain areas

neuromd2012 :

etc

neuromd2012 :

we have scans for that now

neuromd2012 :

this is going to be a long road I would guess from here

Customer:

So when she´s off the neck brace she should go to another country and check?

neuromd2012 :

but the important thing is that she improves every day

neuromd2012 :

yes

neuromd2012 :

when she is well enough to travel

Customer:

Well easier said than done when you only have a samoan passport

neuromd2012 :

i see

Customer:

maybe easier if there is a medical problem though

neuromd2012 :

well this will be a long road, one thing, can she get up in a chair?

Customer:

We have not tried that yet

neuromd2012 :

you want to prevent infection

neuromd2012 :

that is the first step here

neuromd2012 :

to get her out of bed so she doesn't get bedsores

neuromd2012 :

and doesn't get blood clots

neuromd2012 :

she may not be ready yet

neuromd2012 :

but that is the first goal

Customer:

she already has a wound on her head and butt cheek that does not look good

neuromd2012 :

right

neuromd2012 :

you get immunocompromized in bed all day

neuromd2012 :

and in a hospital

neuromd2012 :

you can get other peoples infections, that can kill you

neuromd2012 :

that is really the biggest fear for her

neuromd2012 :

now

Customer:

I know and here they don´t know that except the nurses. Her mom that cleans her and change diapers does not wear gloves

neuromd2012 :

right, that is really the big problem

Customer:

we have to do everything ourselves, they don´t even have bed sheets so we need to bring our own and they are washed in cold water

neuromd2012 :

do they have a speech pathologist and a physical therapist working with her?

neuromd2012 :

wow

Customer:

there is physical therapist here

neuromd2012 :

she may need a long term rehab facility eventually,

neuromd2012 :

do they have anything like that in Samoa?

Customer:

hardly, its a big mess

neuromd2012 :

well how can I help?

neuromd2012 :

If you can get her CT and want an explanation

neuromd2012 :

you can upload her films to www.dropbox.com

neuromd2012 :

and I can look at them for you

Customer:

well you have in certain areas, but like I said taking her elswhere might not be coverd by her insurance

neuromd2012 :

yes, I understand

neuromd2012 :

do they have "no fault" insurance coverage in Samoa?

neuromd2012 :

with the auto insurance people help?

Customer:

I have no idea, but will check on monday

neuromd2012 :

es

neuromd2012 :

yes

neuromd2012 :

find out is she or the other driver of the car, if there was another car

neuromd2012 :

has insurance

neuromd2012 :

companies like Allstate or State Farm here in the US cover everything

neuromd2012 :

but I have no idea about

neuromd2012 :

samoa

Customer:

she was in the back of a van, 4 other people were in it and they all died. They ran head to head with a 10 wheeler truck

Customer:

it was a rental car

neuromd2012 :

oh sorry

Customer:

I did not know them, she was not even supposed to be with them. i thought she was at work

neuromd2012 :

I see

neuromd2012 :

well this is certainly something that the rental car company would have to cover

neuromd2012 :

if she signed a policy for insurance coverage, actually not her, but the driver

Customer:

Well, police thinks alcohol was involved

neuromd2012 :

I see

neuromd2012 :

that really does not matter in terms of health coverage

Customer:

its not like the us here, rental companies don´t even ask about insurance

neuromd2012 :

right

neuromd2012 :

I am sure

neuromd2012 :

well the important thing that will improve outcome here is the right hospital, but that may not be possible now

neuromd2012 :

so the key is for her to get past some of the acute problems, like the C1 fracture, to a point where she can get around

neuromd2012 :

and start some PT at the bedside, then cognitive rehabilitation

Customer:

I agree, maybe i can get her moved to the new hospital they have built. At least its clean

neuromd2012 :

in the states, we would move her to a rehab facility

neuromd2012 :

that sounds good, do you know the name of i?

neuromd2012 :

it

Customer:

Its next door, at the moment they are tearing down the old one she is in

neuromd2012 :

Tupua Tamasese?

neuromd2012 :

in Apia?

Customer:

Yes

neuromd2012 :

hang on

neuromd2012 :

not much about it here online

Customer:

probably not, they move slow here

neuromd2012 :

yes

neuromd2012 :

well if you have any questions, come back here anytime. If she gets a test like an EEG???

neuromd2012 :

I can help interpret the report,

Customer:

I´ll adress the wounds the best I can being a natural therapist and try to explain to her mom what needs to be done. She does not speak much english. I´ll see if I can get hold of these things

neuromd2012 :

Just let me know how I can help

neuromd2012 :

sure, get back to me if you get that CT scan

neuromd2012 :

or any studies, her lab work

Customer:

Great, will get back to you then at some point

neuromd2012 :

good luck to her and to you

neuromd2012 :

Dr Frank T

Customer:

Thank you

neuromd2012 :

take care, bye

neuromd2012 :

sure

neuromd2012 :

bye

Dr. Frank, Board Certified Physician
Category: Medical
Satisfied Customers: 7202
Experience: Neurologist/Internist with academic and clinical experience.
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