Dr. Ambekar Sudheer
Neurosurgery
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Patient's Query
Hi doctor,
My dad is without ventilator support since 40 days and his tracheostomy has also removed five days back. Without any life support system, he is currently breathing by himself for last 7-8 days with saturation level 100% on air. Past four days he is able to keep his eyes open for few minutes and moving his pupils and following the moving objects. My brother showed him pictures of family members and he is trying to look at the picture and recognize it. He is trying to hold hand or other objects with his left hand when asked. He has minor movement in his left leg as well. But there is no movement on right hand or leg and occasionally he moves his neck. I have attached a video showing his movements. Bedsore on side of the head and hip continues to be a point of concern. As per your advice I had requested the treating doctor for MRI (Magnetic Resonance Imaging) however they only did a CT (Computed Tomography) scan and the same is attached for your reference I am also sharing the two CT scans which they did two months back for comparison. Please advise on the below, his left hand and leg getting stiff and he was given Baclofen for the same. Is there other better medicine? Apart from changing position every 1-2 hours and applying Candid powder on the affected area, is there any medicine for curing bedsore? Do you see any chances of recovery from here? What needs to be done next for reasonable improvement? Do you see any chances of him speaking soon? Below are his vital statuses. Serum sodium- 129. Serum potassium- 4.8. Serum chloride- 98. Serum creatinine- 0.6. eGFR-103. Blood pressure-150/100. O2 saturation-100% maintaining without oxygen support for last 7-8 days. Pulse-75-90. Blood sugar 230 to 265 after taking insulin comes down to 140-160. I have attached the list of medicines which he is taking for the past one week. Kindly guide us.
Hi, Welcome to icliniq.com.
Thank you for the detailed information. I am happy to see your father improve gradually. Here is what I suggest. There is no other medicine for stiffness. However, physiotherapy should be carried out aggressively to prevent worsening of stiffness. One should rule out infection of the bed sore. If there is infection, antibiotics are needed and rarely surgical debridement might be indicated. If there is no infection, you can also apply Phenytoin powder on the bed sore. The powder helps to hasten the healing process. I do see that there are chances of improvement. But, I believe that he will not be able to do his daily activities independently and will remain dependent on others. In the latest scan, I see that there is hydrocephalus, also called post traumatic hydrocephalus. If the craniotomy flap is tense and there is increase in the water content in the brain, he will benefit from ventriculoperitoneal shunt surgery to relieve the water accumulation in the brain. This surgery can be done by the same neurosurgeon who performed the first surgery. I cannot comment whether he will be able to speak or not. All I can say is that he might improve in his sensorium (consciousness) some more.
Patient's Query
Hi doctor,
Thank you very much. I want your advice regarding the following. He is on liquid diet 2.5 L through rice tube which includes milk, barley, dal and rice. Any other diet plan or any addition to this can you suggest. His input 2500 ml and output is 3400 ml. Do you still believe that MRI (Magnetic Resonance Imaging) can help at this stage? What is the meaning of craniotomy flap is tense? And the surgery suggest by you have any chance of negative outcome? Is doing physiotherapy by myself thrice sufficient (30 minutes each time) is sufficient? Or have to do more? Does trained physio can help him much? Any other thing needs to take care of by me to help his recovery fast, like positioning of bed? What is your suggestion regarding acupressure treatment?
Hi, Welcome back to icliniq.com.
The diet which he is taking now is good. I would only add egg to it if your father does not mind having eggs. Egg has good amount of proteins and is good for health. If he is vegetarian, you may add crushed soybeans. As I had mentioned earlier, the MRI will help us to know how much recovery we can expect in him. It will not change the course of treatment. Craniotomy flap is tense means that the operated site is full or bulged and not lax or soft. The consulting neurosurgeon will be able to identify it. The surgery which I have mentioned usually does not have any major risk. The usual risks of infection and the shunt tube getting blocked are low but not zero. I suggest to get a physiotherapist to teach you how to do appropriate physiotherapy. You may make him listen to his favorite songs using headphones. Music therapy has not been proven to improve outcome, but, I have seen it worked. I will not be able to comment on any line of treatment other than allopathy as I am trained in only allopathy.
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Neurosurgery
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