Hi, this is Dr Sathya. Thanks for your question and I will try my best to help you.
It is less likely that the stopping of the rehabilitation was the culprit for the reduction in the brain volume of your husband. While rehabilitation is important for the recovery from the brain injuries however it should not have such a big impact on the brain volume, in other words the loss in your husband's brain volume was not significantly related with stopping the rehabilitaional therapies.
It is known that after significant brain injuries like anoxic brain injury people do lose their brain volume. How much brain volume is lost depends upon the severity of the initial injury.
The reduction in the brain volume is not seen immediately and it takes long time even several months to be seen on the ct or mri brain scans to appreciate this volume loss. It is possible that the loss of brain volume seen in your husband's case just coincided with stopping the rehabilitaional therapy.
So the loss of brain volume in his case is not significantly contributed by the stopping of the therapy, rather it was just the time course taken by the shrinking process coincided with the stopping of the rehabilitation program.
Although the rehabilitaional therapy may not have much to do with the loss of brain volume however it is important for him to continue with it for longer time. The recovery process from the anoxic brain damage is a very long process and in some patients it may take even up to couple of years to see the maximal improvement so aggressive rehabilitational therapy needs to be continued for more time.
And unfortunately the rehabilitaional therapy is the only significant treatment available now that can help anoxic brain injury patients with recovery and there are no medication or any other treatments that can significantly help them from recovering from their brain injury. What ever improvement we see is either from the natural recovery that may take place in the due course of time, or from the rehabilitatonal therapy, or from the combination of above two, and that is the only hopes for these unfortunate anoxic brain injury patients until some major breakthrough takes place in this field of medicine.
The above are my opinions & recommendations regarding the concern you had related to the reason for the loss of the brain volume in your husband after his anoxic brain injury, and his prognosis, recovery time etc, and please ask me if there are any further questions.
Thanks for the waiting!
All the best!
Thank you Dr Sathya,
I would like to know if:
There is anything to stop the process of brain atrophy?
When can it be expected to stop?
He had his accident on Aug 5th 51/2 month ago.
He lost 1/3rd of the brain volume, will he lose more?
He was put in a shunt for Hydrocephalus, 6 weeks ago and that was the time he stopped receiving rehab. Could the Hydrocephalus cause or contribute to his atrophy?
I am his wife of 40 years. I want to help him, what can I do to maximize his chance of reasonable recovery?
I read about IV Vit C 50g a day-did help people in coma.
He is in Minimally Conscious State -could Vit C iv help? Or EFA, or B12 shot or HBOT or any neurotransmitter precursor? Or medicine?
He was just put in a custodial care place no rehab. Insurance is not paying for other care. I agree about the importance of rehab - how could he continue receiving rehab if he is in custodial care? I am told that he will receive rehab when he will respond reliably. But he is not improving since not getting rehab.
Should I take him home?
Best regardsDr Sathya.
(You may disregard the reply button unless you have any questions before my next post; and thanks for the waiting!)
Thanks for the waiting.
I have answered your questions point by point as below.
1) No, unfortunately there is nothing that can be done to prevent the brain atrophy. What ever atrophy going to develop it will develop, and it can not be prevented.
2) However probably the atrophy process might have stopped already. So I doubt he would have more atrophy now.
3) The atrophy will manifest within about 6 month or so, so I doubt there will be more atrophy now.
4) No, I do not think there will be more atrophy
5) If the shunt is working properly then the hydrocephalus should not contribute to the atrophy, otherwise it can contribute.
6) I fully understand your concerns, you are trying your best to help him, but please see that when it comes brain injuries we cannot do much. There is no medication or any special treatment that is available to help in these situations. Rehabilitation therapy is the only hopes.
7) I am not aware of vitamin C IV helping in these scenarios. You guys could try, nothing to lose much, but I doubt it will help.
And also none of the treatments you mentioned above will help. There is no evidence to show that these agents help in these situations. You guys could try them, nothing to lose because they are all safe treatments, but there is no sufficient scientific data to support that these agents really help.
8) Sorry to see that he is unable to get rehab therapy. If rehab therapy cannot be arranged while he is at custodial care then you may take him home and try rehab therapy and that would be great. Because at this moment rehab care is the mainstay of his treatment. It is not a guarantee that it will help, but if something is going to help then it would be only rehab therapy, along with whatever natural recovery will take place. So worth trying the rehab therapy.
You are welcome and please ask if there are any further questions.
(It is around midnight at my place and if any additional questions are there I will follow up on them in the morning, and at the earliest!)
Thank you! Thank you!
Can you recommend anyone in San Francisco who is expert on Hydrocephalus?
I think the pressure in his skull is high, he tends to through up, lately mostly after I massage his head. And he is not as alert as he was before.
When the shunt was placed right after he was much more alert.
And the neurosurgeon told us, that he had high pressure on his brain, he absolutely needed the shunt.
But after a few days he regressed.
We asked 7 radiologists before the shunt placement to check his MRI-s CT-s.
2 recommended it, 2 not recommended it, 3 not sure if it would help him.
Prior to his fall (or assault?) he was a brilliant pathologist.
Came home from work, went to get the mail in the lobby of our apartment building and was found down a minute later, noone saw what happened. Was on Coumadin, because of mitral valve repair surgery 2 years prior.
We are collegues and I thank you for your help.
No one had a good word for us this past 6 month.
I hope you know someone here, in San Francisco or nearby.
Thank you again,
You are welcome. Sorry I couldn't reply earlier as it has become morning at my area only just now and thanks for the waiting.
In SF area UCSF is the most prestigious medical institute and you guys may contact their neurosurgery dept to set up an appointment. Their web site & contact details are as below;
It is possible the pressure is building up inside and he may need a shunt revision etc. Shunt malfunction is not uncommon and requires revision sometimes, and once the proper CSF drainage is reestablished the pressure gets relieved.
So looks like there could have been an assault too, because this started suddenly and without any explanation.
Whatever caused this it is really a very sad incident, hope he recovers well. And sorry to hear that he was a pathologist too.
You guys may please contact neurosurgeons at UCSF and hopefully they will be able to tell whether the shunt is okay or not, and if not okay they will be able to fix it. In the meantime if possible he should receive rehabilitation treatment.
Thank you Dr Sathya,
I am very satisfied with the answers, but still have two questions.
After losing 1/3rd of the brain volume, is there any reasonable chance to recover?
Is that too much to lose?
How much is too much to lose? 30%? 50%?
Brain atrophy is irreversible as I know.
I am trying to save him, and if I can not achieve that, I will take care of him as long as he needs it.
Would stem cell therapy work? Dr Steenblock has good reputation in this area.
Thank you for the UCSF info, we will try to get someone from there.
Thank you for your time and expertise.
You are welcome. I have received these additional information. I am typing the answer now and I will follow up at the earliest.
While about 30% brain volume loss indicates that it is not a minor loss however when it comes to the recovery chances, I would say, yes, there are some hopes.
This is because brain has enormous ability to recover, even from serious injuries sometimes, and this ability of the brain is called as "plasticity". Plasticity in this context refers to the ability of the brain to create new connections and help in recovery of the lost brain functions due to the injury. It is a natural mechanism, and rehabilitation treatments will further facilitate this process.
However this recovery may not be seen in all individuals. Some patients do not recover at all, some recover little bit, and some other show significant improvement.
And there is no way to tell at this moment who will recover and to what extent, only time can tell.
But the recovery process is long, and may go on up to even couple of years in some patients so we need to give enough time. And as mentioned above rehabilitation therapy will help too.
Regarding the stem cell therapy; the truth is this mode of treatment is still an experimental level treatment for majority of the health conditions including the anoxic brain injury your husband is having. It sounds this mode of treatment has a very great potential and it can revolutionize the future of medical treatments, where a cure for myriad diseases can be a reality rather than just a dream, but for now it is just at an experimental stage.
Also at this moment it is not yet approved officially by FDA (the government health regulatory board related to drugs and new treatments). So we cannot comment much on these kinds of treatments, especially because its safety is not yet established.
That said, you may talk to Dr Steenblock and if you feel convinced that it is worth trying then you may go ahead with it. But I cannot make any official recommendation because FDA has not approved it - for the type of brain injury your husband is having.
If you wish to fetch more details on this treatment and also wish to contact Dr Steenblock then you may go through this web site;
http://www.stemcelltherapies.org/umresearch/brain-trauma.html (it is mentioned traumatic brain injury, but they may try this for anoxic injury too, but as I mentioned above FDA has not approved it).
Your husband is really lucky to have such a dedicated wife like you and I see you are putting such a tremendous amount of effort to help him. I genuinely hope he makes a wonderful recovery, All the best!
Please ask if there are any further questions.
Thank you Dr Sathya!
It is 2 AM here, I can go to sleep now with your answers in my heart.
I feel better, and thank you for your excellent answers.
Tomorrow I will contact Dr Steenblock and UCSF and also try to get more rehab for him.
I will let you know how it works out.
thank you again,
You are welcome.
Yes, it is a great idea to contact Dr Steenblock as well as UCSF neurosurgery services, and let us hope for the best.
Please keep me posted.
All the best!
It seems that the hospital and the insurance company categorically denies us from rehab. He is custodial care.
If we take him home, is it possible to still give him enough rehab that would be compatible with what he would get in a rehab hospital?
We know, how much difference it made the rehab prior to his surgery and placement to the custodial care.
Or should we focus on trying to find him a place with rehab, but because of the insurance problems we might not be able to find one.
We are struggling to figure out the logistics.
We can not pay out of pocket for these services. Not many people could.
But we want to do the best, XXXXX XXXXX make a difference.
You are welcome and thanks for the waiting.
Yes, ideally it would be great if he could have been admitted to a facility with excellent rehab care, some thing like a long term care center etc.
But because of the insurance reasons if that is difficult then you may try arranging the rehab care by taking him home. But in that case it should be either home rehab care (rehab people visiting home frequently) or taking him to the nearest rehab care frequently.
There are plus and minus in both these approaches. If rehab care is tried at home then it may not be the best possible care, because the rehab people may not be able to do everything at home. On the other hand if you are planning to take him to the nearest rehab care yourself then the transportation & travel issues etc will be a concern.
While he requires aggressive rehab care now, however the main concern is how this can be arranged, as above therapy at home or at a nearest rehab facility to your home with frequent traveling to that facility. And there are plus and minus with each of these options.
I agree the cost will be a major factor too, as you have put it appropriately majority of the people cannot afford for it.
But the best care would be continuing with aggressive rehab care now, however the concern is the cost and other logistics associated with it. I really hope you guys will be able to find out a solution at this really critical juncture. And I understand it is easier said than done. You are trying your best to provide your beloved husband the best possible care, but if the insurance doesn't help it will be really difficult task to arrange for a long term rehab care by yourself because it will be very expensive.
Meanwhile try to talk to the stem cell service as well as the UCSF neurosurgeons too. Hope they will have some good news for you!
Please ask me if there are any further questions.