Hello. I am an Internist and a Neurologist and am here to answer your questions.
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
so this sounds like a very serious concussion and she is semi-comatose.
did she need brain surgery?
No, she had noe surgery. She remembers me, her kids and friends but like I said sometimes a bit delerious
would you have any MRI or CT scan results of her brain?
does she have any organ failure, like liver or kidney problems?
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
so she is going to make a steady functional improvement with time
Well that´s what we hope for, but nobody is telling us anything here
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
They don´t have that here. Its like a third country sometime, we were lucky the ct scan was working that day
there are other scans, but I do not think they have them in samoa, you would have to go to hawaii I think
I worked in Hawaii some time ago
but now I am in NYC, where we have all this technology
what about her C1 fracture?
is she in a halo?
Not sure if she is moveable anywhere yet, and it would be very expencive too
this will be testing you can consider once
she is ambulatory, but still having problems with speech
She had a neck brace, but they put her on a traction for 2 weeks and now she is back on the neck brace
so that is good news
hmm, what is ambulatory? Sorry I´m Norwegian
because it suggests there is a stable fracture, that did not need surgery
ambulatory means she can now walk around
get places without a wheelchair
Nope, just one leg moving. Seems to be some twitching in the other foot but thats it
it may come a time where she can get around, but still is not 100% mentally
and then you will have to make some decisions like is her brain getting enough blood supply in certain areas
we have scans for that now
this is going to be a long road I would guess from here
So when she´s off the neck brace she should go to another country and check?
but the important thing is that she improves every day
when she is well enough to travel
Well easier said than done when you only have a samoan passport
maybe easier if there is a medical problem though
well this will be a long road, one thing, can she get up in a chair?
We have not tried that yet
you want to prevent infection
that is the first step here
to get her out of bed so she doesn't get bedsores
and doesn't get blood clots
she may not be ready yet
but that is the first goal
she already has a wound on her head and butt cheek that does not look good
you get immunocompromized in bed all day
and in a hospital
you can get other peoples infections, that can kill you
that is really the biggest fear for her
I know and here they don´t know that except the nurses. Her mom that cleans her and change diapers does not wear gloves
right, that is really the big problem
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
do they have a speech pathologist and a physical therapist working with her?
there is physical therapist here
she may need a long term rehab facility eventually,
do they have anything like that in Samoa?
hardly, its a big mess
well how can I help?
If you can get her CT and want an explanation
you can upload her films to www.dropbox.com
and I can look at them for you
well you have in certain areas, but like I said taking her elswhere might not be coverd by her insurance
yes, I understand
do they have "no fault" insurance coverage in Samoa?
with the auto insurance people help?
I have no idea, but will check on monday
find out is she or the other driver of the car, if there was another car
companies like Allstate or State Farm here in the US cover everything
but I have no idea about
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
it was a rental car
I did not know them, she was not even supposed to be with them. i thought she was at work
well this is certainly something that the rental car company would have to cover
if she signed a policy for insurance coverage, actually not her, but the driver
Well, police thinks alcohol was involved
that really does not matter in terms of health coverage
its not like the us here, rental companies don´t even ask about insurance
I am sure
well the important thing that will improve outcome here is the right hospital, but that may not be possible now
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
and start some PT at the bedside, then cognitive rehabilitation
I agree, maybe i can get her moved to the new hospital they have built. At least its clean
in the states, we would move her to a rehab facility
that sounds good, do you know the name of i?
Its next door, at the moment they are tearing down the old one she is in
not much about it here online
probably not, they move slow here
well if you have any questions, come back here anytime. If she gets a test like an EEG???
I can help interpret the report,
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
Just let me know how I can help
sure, get back to me if you get that CT scan
or any studies, her lab work
Great, will get back to you then at some point
good luck to her and to you
Dr Frank T
take care, bye