News Rep. Gabrielle Giffords, 6 YTBN Shot, Killed In Tuscon AZ

[mugaliens]

This is getting silly.

Perhaps. However, in the past your use of the term "silly" has been your excuse to close a thread.

Please don't. Really.

Lot's of good conversation still happening, here. :) It deserves it's continuence.

Thank you.

 

[Al68]

Perhaps. However, in the past your use of the term "silly" has been your excuse to close a thread.

Please don't. Really.

Times 2. Perhaps we need a thread about why so many threads are locked for no apparent reason. At least no obvious reason related to forum rules.

 

[alt]

That's pretty amazing if true. That's the kind of thing that only a parent would do for their child, and rarely in any other case.

Yes, I read a detailed news article about this. When you start to feel depressed that humanity is going down the tubes, it's acts like this that somewhat restore your faith in it.

 

[nismaratwork]

Yes, I read a detailed news article about this. When you start to feel depressed that humanity is going down the tubes, it's acts like this that somewhat restore your faith in it.

I'd add, it's pretty amazing that Giffords is recovering the way she is. I realize that people hear that she'll be months in rehab (to begin with), but she's able to respond to verbal commands, move her left side without apparent effort, and seems as alert and oriented as anyone can tell given her physical limitations at the moment.

 

[Evo]

Is she getting worse,? I couldn't find an update since this came out.

Brain fluid buildup might delay Giffords’ rehab in Texas

On Friday, Giffords was flown from Tuscon to the Texas Medical Center in Houston, where she had been scheduled to enter the Institute of Rehabilitation and Research. While the transfer went smoothly, Dr. John Holcomb, one of Giffords' doctors, told reporters that the trip had been medically "stressful" for the congresswoman, who was shot in the head at point blank range two weeks ago.

http://news.yahoo.com/s/yblog_theticket/20110123/ts_yblog_theticket/brain-fluid-buildup-might-delay-giffords-rehab-in-texas

Why was she moved so soon if there was risk involved?

Edit: The only update I could find is that the hospital has decided not to give updates until her condition improves and she can be moved.

Shortly after her arrival, doctors said she had been given a tube to drain a buildup of brain fluid that has kept the Arizona congresswoman in intensive care.

The Houston hospital treating Giffords gave no update Monday, and spokesman James Campbell said the next update would come when they are ready to move Giffords to the rehab hospital.

http://health.yahoo.net/news/s/ap/us_congresswoman_shot

 

[WhoWee]

Why was she moved so soon if there was risk involved?

I've been wondering the same?

 

[edward]

I've been wondering the same?

That has had me wondering from when it was first announced that she would be moved. They claimed the plane would fly at low altitude. But 28,000 ft still requires pressurization and depressurization of the plane.

EDIT: I just realized the Houston isn't much above sea level. Tucson is at 2,500ft

 

[nismaratwork]

No, she is in no way regressing based on public info (only info we have!). It's very common with massive head trauma to insert a probe and drain into the ventricle to drain fluid and relieve pressure.

From the report, this has been there from the beginning (which only makes sense), and while she CAN do some things, full rehab is out of the question. Assuming her intracranial pressure doesn't begin to rise for some reason, she should have this out within days to weeks.

Again... this takes a LOOOONG time to recover from: this woman have a significant amount of her brain traumautically destroyed... there won't be a linear improvement day to day. If, if in six months, she can walk and talk that would be AMAZING. Really, nothing about her recovery is short of amazing.

I'd add, you move because rehab needs to begin IMMEDIATELY if possible, and she needed to get to a TBI center, not a hospital. The reality of brain injury is that when people recover this way, it's great because there's real hope that the person they were might be intact. On the other hand, there's no more miracle "super-speed" that can happen: her brain has to establish new pathways to perform whatever tasks have been compromised. By all accounts she can understand verbal commands, which is FANTASTIC; where she was shot it's possible she could have lost the capacity to comprehend language.

It SOUNDS as though she has some aphasia related to expression, and hopefully recognition isn't an issue.

In the end, she's alive: if she can talk, understand words, maintain bilateral control of her face, and most important: if damage to her frontal lobe has changed her.

If she's in a wheelchair, but mentally intact and able to interact with the world, and stand with assistance, it may not sound like much, but that's fantastic. Anything more would be possible, but represents a low probability that we can hope for.

 

[Evo]

No, the new swelling is a new issue nismar, it was not expected. It's a setback.

 

[mugaliens]

I'd add, you move because rehab needs to begin IMMEDIATELY if possible, and she needed to get to a TBI center...

As I recall, there's some sort of chemical "cascade" response in the brain following trauma. It's designed to protect the brain overall, but often results in the death of neurons. From what I understand, it can also be interrupted, chemically, but the first hours are critical. I don't know how that's done, but perhaps someone who knows more can share with the rest of us.

 

[DevilsAvocado]

Why was she moved so soon if there was risk involved?

That has had me wondering from when it was first announced that she would be moved. They claimed the plane would fly at low altitude. But 28,000 ft still requires pressurization and depressurization of the plane.

EDIT: I just realized the Houston isn't much above sea level. Tucson is at 2,500ft

Very 'odd'...?? Pressurization, 'bad air', 'bacterial risk', different base altitude...?

 

[nismaratwork]

No, the new swelling is a new issue nismar, it was not expected. It's a setback.

A hydrocephalic reaction in the ventricles is never unexpected in a penetrating brain injury, and while it is technically a setback, it's statically nothing. You're correct that it's newly inserted, but setback?... delay maybe... although I can't say "setback" is wrong. When I think of a setback in this scenario, I think of infected CSF, runaway swelling, and herniation of the brain stem. Anything that doesn't kill or cause damage at this point should probably be placed under the rubric of "normal recovery".

Mugaliens: There are a bunch of "cascades" that occur after any traumatic injury, but the brain is really very much a closed box (with a tail), so they can become destructive very quickly. Apoptosis of damaged neurons is essential, but when they die, they release toxins (the real kind, not the "new age" variety) which in LARGE quantities over a short time... cause more self-induced cellular death (apoptosis). So, you end with a wound-track that, to protect itself from necrotic tissue... kills itself... UNLESS you're there early to dehydrate the brain (not needed in this case... which AMAZES me), or remove some skull to allow for swelling and natural (or artificial) drainage, it's trouble.

It's the neurological equivalent of massive blunt muscular trauma: the latter results the healthy response that dead and damaged muscle tissue is broken down. UNFORTUNATELY, if this happens as a result of MASSIVE trauma (faster than your body keeps up) you end with enough K in your blood to stop your heart; CaGluconate is usually a good way to treat that, but obviously the brain is more delicate and complex.

This is actually the SAME neurological process that occurs in the more common type of head injury: CLOSED head injury, not penetrating. We tend to call them, "concussions!

Remember, when a neuron dies, it doesn't just release its load of metabolic waste, then break-down further into more waste... it ALSO releases all of its neurotransmitter load! The LAST thing you want is for your heart to get the signal to beat in the wrong rhythm, or even worse, in massive trauma that dopamine, serotonin, and other good stuff causes... more cell death along the wound track for PBI. In a Concussion, it's diffuse, but this is why REPEATED concussion can drop someone as though you HAD shot them in the head.

In the end, neurons, and other cells die every day, and they need mechanisms to commit suicide and send signals to be cleaned away. Normally, this isn't a problem, but if you have a large number, especially in a small area, of this activity... trouble. This is a part of medicine for trauma... ALWAYS, but the brain and large muscles are generally the stand-outs.

edit: Whoops, I forgot the concussion animation! http://www.neuroskills.com/images/concussion.swf

 

[nismaratwork]

Very 'odd'...?? Pressurization, 'bad air', 'bacterial risk', different base altitude...?

She has a large hole in her head that wasn't there before... pressure changes make a DIFFERENCE. Bacteria in the brain make an even bigger difference: death!

 

[DevilsAvocado]

i don't know how that's done, but perhaps someone who knows more can share with the rest of us.

http://en.wikipedia.org/wiki/primary_and_secondary_brain_injury"

...

secondary injury is an indirect result of the insult. It results from processes initiated by the trauma.[5] it occurs in the hours and days following the primary injury[3][8] and plays a large role in the brain damage and death that results from tbi.[8] unlike in most forms of trauma a large percentage of the people killed by brain trauma do not die right away but rather days to weeks after the event.[9] in addition, rather than improving after being hospitalized as most patients with other types of injuries do, about 40% of people with tbi deteriorate.[10] this is often a result of secondary injury, which can damage even neurons that were unharmed in the primary injury. It occurs after a variety of brain insults including subarachnoid hemorrhage, stroke, and traumatic brain injury and involves metabolic cascades.[11]

secondary injury can result from complications of the injury.[1] these include ischemia (insufficient blood flow); cerebral hypoxia (insufficient oxygen in the brain); hypotension (low blood pressure); cerebral edema (swelling of the brain); changes in the blood flow to the brain; and raised intracranial pressure (the pressure within the skull).[1] if intracranial pressure gets too high, it can lead to deadly brain herniation, in which parts of the brain are squeezed past structures in the skull.

Other secondary insults include hypercapnia (excessive carbon dioxide levels in the blood), acidosis (excessively acidic blood),[12] meningitis, and brain abscess.[2] in addition, alterations in the release of neurotransmitters (the chemicals used by brain cells to communicate) can cause secondary injury. Imbalances in some neurotransmitters can lead to excitotoxicity, damage to brain cells that results from overactivation of biochemical receptors for excitatory neurotransmitters (those that increase the likelihood that a neuron will fire). Excitotoxicity can cause a variety of negative effects, including damage to cells by free radicals, potentially leading to neurodegeneration. Another factor in secondary injury is loss of cerebral autoregulation, the ability of the brain's blood vessels to regulate cerebral blood flow.[4] other factors in secondary damage are breakdown of the blood–brain barrier, edema, ischemia and hypoxia.[13] ischemia is one of the leading causes of secondary brain damage after head trauma.[3] similar mechanisms are involved in secondary injury after ischemia, trauma, and injuries resulting when a person does not get enough oxygen.[4] after stroke, an ischemic cascade, a set of biochemical cascades takes place.

. . .[/color]

 

[nismaratwork]

. . .[/color]

This is why that young intern is truly a hero for what he did, and why getting in the OR within 38 minutes did the rest. Remember: the first good sign was a lack of necrosis along the wound-track, and that indicates that... for better or worse, some of the cascades that normally occur did not because of the through-through nature of the injury.

Remember, TBI often = closed-head (bomb-blast, concussion, fall, *car accident)

*Most common

Example: Which actor... or Kennedy?... was it who hit a tree down a ski-slope? Anyway, she had bleeding in the vascular layer of her "brain-lining(s)", called the Arachnoid Tissue... an Arachnoid Hemorrhage. The warning you get there, other than the event itself, is possible LoC, and "Thunderclap Headache". If you ever have either, get to a hospital: you really can't know what's going on inside of your head, until it's close to "late". It's much easier to stop these cascades of cell death, swelling, herniation, metabolic crisis in the first hour, maybe a little more.

Repeated concussions... well, you can see why JUST the apoptosis could kill you... short circuit, get it? That's in addition to the lysis of cellular remains, and loss of viable tissue.

I'd also add: the toxicity experienced during methamphetamine abuse (over time of course) is nearly identical to the damage you see from dopamine releases after TBI, once you localize it. It's very spooky... I'd rather be dead than anhedonic.

 

[DevilsAvocado]

Miracles do happen. http://en.wikipedia.org/wiki/Phineas_Gage" (1823 – 1860), an American railroad construction foreman, got a large iron rod driven completely through his head!

It changed his personality (frontal lobe) and behavior, but he survived.

 

[DevilsAvocado]

She has a large hole in her head that wasn't there before... pressure changes make a DIFFERENCE. Bacteria in the brain make an even bigger difference: death!

Yes obviously... that’s why we all wonder – Why not moving the rehab team to Giffords, instead of vice versa...??

 

[nismaratwork]

Yes obviously... that’s why we all wonder – Why not moving the rehab team to Giffords, instead of instead of vice versa...??

Well, for one that team is going to work with more people than just Giffords, and it wouldn't be fair to do that. For another, this isn't just a team at a hospital, it's a TBI center that is MADE for rehab.

In the end, there is no benefit without risk here.Oh, and for Mr. Gage... a famous example, but also famously not himself... not just a change in behaviour. FORTUNATELY, Ms. Gifford's wound was NOT center-line through the prefrontal cortex, and was confined to one side of the brain.

In many cases where the forehead is damaged by impact (crush injuries often), or other more broad damage to the frontal lobe yields someone who has been robbed of impulse control, empathy... in short, you get an instant sociopath. It doesn't always happen, but of all the results, what's worse than a nearly full recovery except that now your beloved child no longer connects with people, steals on a whim, gets into fights... etc... and CANNOT be changed?

I think I'd rather die ME.

edit: It seems logical that infection would be more prevalent on a plane, than in an ICU, but in reality... not true. You're really no MORE likely to get a nasty infection than in your stay in the ICU. Part of it is the condition you're in, but part of it is the company: I'd add... this wasn't a standard plane.

 

[DevilsAvocado]

I'd add... this wasn't a standard plane.

What plane was it?


()

 

[DevilsAvocado]

Well, for one that team is going to work with more people than just Giffords, and it wouldn't be fair to do that. For another, this isn't just a team at a hospital, it's a TBI center that is MADE for rehab.

In the end, there is no benefit without risk here.

Strange... how many people do you need; 1, 2, >10?? She needs training of muscles, motor skills, and 'mental training' – not a complete 'computer lab'...

Can’t this be fixed 'on location' (until the condition is 'stable') in the wealthiest country in the world, for a woman who risked her life for democracy?


Many years ago when I was very ill, and hospitalized for 8 month, and lost basically all my muscles in my legs and weighted 50 kg – I got my personal trainer, 5 min walk from home, for free...

 

[WhoWee]

Strange... how many people do you need; 1, 2, >10?? She needs training of muscles, motor skills, and 'mental training' – not a complete 'computer lab'...

Can’t this be fixed 'on location' (until the condition is 'stable') in the wealthiest country in the world, for a woman who risked her life for democracy?


Many years ago when I was very ill, and hospitalized for 8 month, and lost basically all my muscles in my legs and weighted 50 kg – I got my personal trainer, 5 min walk from home, for free...

She must have better health insurance than you did?

 

[nismaratwork]

Strange... how many people do you need; 1, 2, >10?? She needs training of muscles, motor skills, and 'mental training' – not a complete 'computer lab'...

Actually... that's one of the many things that they need. I understand your view however... let's face it, most people aren't familiar with how someone recovers from a (usually) lethal injury!

Can’t this be fixed 'on location' (until the condition is 'stable') in the wealthiest country in the world, for a woman who risked her life for democracy?

First, yes, it could, but probably not with the same results you'd see where she is now. Remember, she's one of several hundred house members, not the president. Part of what she does for democracy is not to divert resources needlessly when she can and has safely arrived at her location.

Remember, there's nothing to be fixed... this is more about directed growth. Expecting a staff of people who have families and homes to uproot themselves when she was stable (for transport) is unreasonable. When we talk about stable for travel, that first means, "Are they hemodynamically stable?", which is not an issue here. She has a guaranteed airway, and probably some catheters or even a central line, and the rest was in the hands of her doctors and ultimately her surgeon. If that man was willing to risk his reputation, her life, and his future on moving her... I'd tend to trust that judgment given past performance.

Her brain is already beginning to re-wire itself, so to speak, and every day that work isn't guided during these early months of recovery have profound effects on her long-term outcome.

Many years ago when I was very ill, and hospitalized for 8 month, and lost basically all my muscles in my legs and weighted 50 kg – I got my personal trainer, 5 min walk from home, for free...

True, but that's EASY rehab to administer, we're talking about the brain here. Rehabilitation from atrophy and illness is something painful and hard for the patient, but easy from a technical perspective. Evaluating a PBI's progress, and re-LEARNING (literally) how to speak, walk... and who knows what else... is basically going to be her life for the next 4-6 months... and unless she truly is miraculous, the work of the rest of her life.

P.S. When you were sick, meningitis by any chance? Anyway, I'm sorry that you were ever so ill, and for the pain you must have experienced during rehab.

 

[DevilsAvocado]

She must have better health insurance than you did?

Maybe, maybe not, mine is the "communist type" that’s 'activated' form birth. It doesn’t matter if you’re in need of brain surgery, or help with a sprained ankle – it costs 30 bucks for the first visit to a doctor (non specialist $15), then it’s free.

But there are 'weak spots' in this system, as in any, but this is maybe for another thread.

 

[WhoWee]

Maybe, maybe not, mine is the "communist type" that’s 'activated' form birth. It doesn’t matter if you’re in need of brain surgery, or help with a sprained ankle – it costs 30 bucks for the first visit to a doctor (non specialist $15), then it’s free.

But there are 'weak spots' in this system, as in any, but this is maybe for another thread.

I'm fairly certain the Congressperson has above average health insurance - and will receive the best available care.

 

[DevilsAvocado]

First, yes, it could, but probably not with the same results you'd see where she is now.

Same results? I don’t get this... was there a setback, or not??

Remember, she's one of several hundred house members, not the president. Part of what she does for democracy is not to divert resources needlessly when she can and has safely arrived at her location.

To me, this looks 'weird'. Not that I say you should 'value' people for different status, occupation, etc (even if this exactly what normally happens) – we should be treated equal.

But, imagine if these "accidents" escalate... would you like someone related, that you care about, to be a politician? ...Fear is the worst enemy to democracy, ask the Germans...

This woman needs everything you’ve got over there – anything else would be a dangerous scandal!

Evaluating a PBI's progress, and re-LEARNING (literally) how to speak, walk... and who knows what else...

True, but don’t you think one or two professionals could do that for a couple of weeks, until she is more stable, without a complete "army of hardware"...?

P.S. When you were sick, meningitis by any chance? Anyway, I'm sorry that you were ever so ill, and for the pain you must have experienced during rehab.

Thanks man. Maybe I’m going awfully off-topic here... but if I can save one or more on PF from this veritable hell – I hope it’s okay... I love eating good food, and you just have to look at The Food Thread to know that this isn’t anything 'unusual' about me. Therefore:

*** When you eat grilled meat from pig or chicken - ALWAYS MAKE 100% SURE that it is well done! ***

I missed that one hot summer night many years ago, and it almost 'killed' me... There’s a bacteria called http://en.wikipedia.org/wiki/Yersinia" – you’re in BIG trouble. This antigen differs in different populations, in the USA/Alaska 11.5% are HLA-B27 positive.

If you are HLA-B27 positive you get very high fever and ESR + the hell called http://en.wikipedia.org/wiki/Reactive_arthritis" can be real bad and chronic for some... But I was 'lucky', it attacked almost every joint in my body, but didn’t 'demolished' it. The "only problem" for me was that I couldn’t open my jaw to eat properly...

But I made it and I’m extremely happy for that!

Take care out there and for goods sake THINK ABOUT WHAT YOU PUT IN YOUR MOUTH!


(Sorry for going terribly off-topic. )

 

[DevilsAvocado]

I'm fairly certain the Congressperson has above average health insurance - and will receive the best available care.

If "above average" means transporting a patient with a severe brain damage and an open skull at 28,000 ft with pressurization, I guess you’re right.

 

[WhoWee]

If "above average" means transporting a patient with a severe brain damage and an open skull at 28,000 ft with pressurization, I guess you’re right.

All I'm saying is that her insurance would probably pay for that service before most other insurances might - nothing else. Congress has very good insurance coverage.

 

[nismaratwork]

Same results? I don’t get this... was there a setback, or not??



To me, this looks 'weird'. Not that I say you should 'value' people for different status, occupation, etc (even if this exactly what normally happens) – we should be treated equal.

But, imagine if these "accidents" escalate... would you like someone related, that you care about, to be a politician? ...Fear is the worst enemy to democracy, ask the Germans...

This woman needs everything you’ve got over there – anything else would be a dangerous scandal!



True, but don’t you think one or two professionals could do that for a couple of weeks, until she is more stable, without a complete "army of hardware"...?






Thanks man. Maybe I’m going awfully off-topic here... but if I can save one or more on PF from this veritable hell – I hope it’s okay... I love eating good food, and you just have to look at The Food Thread to know that this isn’t anything 'unusual' about me. Therefore:

*** When you eat grilled meat from pig or chicken - ALWAYS MAKE 100% SURE that it is well done! ***

I missed that one hot summer night many years ago, and it almost 'killed' me... There’s a bacteria called http://en.wikipedia.org/wiki/Yersinia" – you’re in BIG trouble. This antigen differs in different populations, in the USA/Alaska 11.5% are HLA-B27 positive.

If you are HLA-B27 positive you get very high fever and ESR + the hell called http://en.wikipedia.org/wiki/Reactive_arthritis" can be real bad and chronic for some... But I was 'lucky', it attacked almost every joint in my body, but didn’t 'demolished' it. The "only problem" for me was that I couldn’t open my jaw to eat properly...

But I made it and I’m extremely happy for that!

Take care out there and for goods sake THINK ABOUT WHAT YOU PUT IN YOUR MOUTH!


(Sorry for going terribly off-topic. )

Wow... of everything you could contract that's common: Listeria, E. Coli, Trichinella!... and you get what... y. enterocolitica with reactive arthritis? I'm sorry for asking, but I've only ever read cases of y. enterocolitica contraction, never 'talked' to anyone who has had it. If I might: how did it manifest initially (besides the obvious), and besides the reactive arthritis?

Anyway... it may sound callous, but while we value our members of congress, it would be considered a scandal to essentially move a neuro-rehab team to AZ. I mean, you move the patient... not the hospital; that may sound rough, but it's the reality of care for everyone. As for the drain in her ventricle... it's not unusual, and obviously any time you need to relieve intracranial pressure you keep an eye open. On the other hand the actual brain tissue is not swelling or dying, the shunt is doing its job, and there's no infection.

I think people need to understand: she could recover over the next months to the point where she could live independently with here husband. She could also contract an infection that passes the BBB and downs her in hours. She was shot through-and-through the left side of her brain: anything other than her dropping dead or regressing neurologically is just... maintenance. It's possible she became sluggish (usual first sign) or had a small seizure, which prompted the placement of the drain. That kind of info is likely to remain private, and rightly so. I can only tell you that the USA is a VERY large country with a hell of a lot of members of the house of representatives. Of all the major elected officials, they spend the least time between re-elections, and so there is a greater turnover.

In short, they're public servants, and she's already getting six-digit medical care as we speak. There are veterans who never re-learned to swallow who would have loved her chances, but alas, this IS "premier" treatment. After all, you're less likely to commit a careless error with a member of congress shot in a famous incident... right? Beyond that, most insurance doesn't give you the choice of neurological rehab on demand... she's really doing very well.

Besides, there's very little that can be done now that isn't incremental, which I realize is still frustrating. The reality of neurology is that any injury is necessarily unpredictable, within that class of survivable injury. If you think of the long-term survival (5-10 years) for the patients that a neurosurgeon takes... phew. Of the percent that survive, most are elective surgeries (treatments for epilepsy for instance) or "normal" BFT.

The fact is... I don't think most doctors who haven't spent time in, or working for the military have seen too many gunshot wounds to the head where the person gave any signs of having a chance. This woman was absurdly lucky to have a surgeon with military experience, actually overseas. I can't imagine what a small municipal hospital would do on a normal basis if referral wasn't an option; in all likelihood, it would rapidly cease to be an issue.

 

[DevilsAvocado]

Man accused in Giffords shooting pleads not guilty

The 22-year-old man accused in a deadly Arizona rampage that critically wounded Rep. Gabrielle Giffords has made his first public statement regarding his role in the shooting: He's not guilty.

Jared Loughner smiled and nodded but said nothing as his attorney entered the plea Monday to federal charges of trying to assassinate Giffords and kill two of her aides. He also faces murder charges in the deaths of a federal judge and another Giffords aide killed in the Tucson shootings, and more charges were expected.

 

[nismaratwork]

Man accused in Giffords shooting pleads not guilty

In the context of our legal system, it's almost certain that an insanity plea wouldn't lead to acquittal, but it very well MAY be a mitigating factor when it comes to life in prison, or death.

 

[DevilsAvocado]

I mean, you move the patient... not the hospital;

Yes of course, that’s obvious even to me, if we are talking brain surgery, etc.

My personal experience of rehab is that all work is done by the patient, not the doctor/specialist, or advanced medical equipment. That’s why I’m surprised. And I’m very surprised that you have to move a patient 1,700 km for rehab, I repeat rehab – not the most advanced brain surgery ever performed in history.

But all this depends on whether you or Evo is right. If flying with an open skull at 28,000 ft with pressurization didn’t affect her at all, then there’s nothing to discuss.

http://news.yahoo.com/s/yblog_theticket/20110123/ts_yblog_theticket/brain-fluid-buildup-might-delay-giffords-rehab-in-texas

Two days Rep. Gabrielle Giffords was transferred from Tucson to a Houston rehabilitation center, she remains in intensive care because of a buildup of fluid in her brain.

The fluid, doctors said Saturday, doesn't appear to be infected, but the Houston Chronicle's Todd Ackerman reports, it will likely keep her Giffords from entering full-fledged rehabilitation until at least next week.
...
Dr. John Holcomb, one of Giffords' doctors, told reporters that the trip had been medically "stressful" for the congresswoman, who was shot in the head at point blank range two weeks ago.
...
"We just have to wait and see if the fluid buildup issue solves itself," Holcomb said.

I'm sorry for asking, but I've only ever read cases of y. enterocolitica contraction, never 'talked' to anyone who has had it. If I might: how did it manifest initially (besides the obvious), and besides the reactive arthritis?

No worries. Well, since you are the OP... I guess this is okay...

I’m normally a "healthy person", except for "youthful stupidity" = fractures, teeth, deep wounds, sepsis, etc, I always been healthy = no medicine. But this was totally weird from day one. I clearly remember how it started; I got a real "bad stomach" the week after "the summer party", and a few days thereafter – when the alarm clock rang and I was to get out of the bed – I was sure someone left a sharp knife on the floor, and that I had put my big toe on the knife. It hurt &%”¤#:(! Checked the toe for blood – nothing... I thought I had "nightmare" and put down the toe again – same thing.

Jumping on one foot (the "communist model" in work) I made it to the nearest medical center. The nurses (giggle giggle) were all convinced I had a VD and prescribe some weird (wrong) stuff (the "communist model" in work again).

Next day: Woke up and felt a strange 'sensation' in my left knee... removed the sheets and there it was! My knee had 'transformed' into a "soccer ball"! ... Confusion, high pulse – I was new in the "big town" and all friends I knew where already at work or school ... I made it down to the street, and into a cab straight to the "big hospital".

The Shining or The Exorcist doesn’t frighten me anymore, because I’ve done worse - without anesthesia.

The doctor walks up to me lying on the bench, and in his hand he held a loooong 'needle' with a diameter that looked close to a gun pipe... and a very sharp edge... I asked silently if "this going to hurt"...?

No worries, he said, and slammed that BIG NEEDLE straight into my knee and I SCREAMED STRAIGHT OUT! (the "communist model" in full action! ) It was good to get that "yellow slimy stuff" out though, ... almost half a bucket.

I can’t tell you all the details, only that I got worse from here... rashes, almost every joint (feet, knees, wrists, shoulders, jaw) swollen and hurting like h*ll and defunct, painkillers in every possible and "impossible hole", cortisone injections straight in the joints, crazy fever for months, insane weight loss, total 'weakness' = pure hell on earth.

But today I’m fit as a fiddle and have absolutely no problems from the 'nightmare'!

 

[DevilsAvocado]

CNN: State of the Union, Obama great speech, addressing Gabrielle Giffords.

 

[nismaratwork]

Yes of course, that’s obvious even to me, if we are talking brain surgery, etc.

My personal experience of rehab is that all work is done by the patient, not the doctor/specialist, or advanced medical equipment. That’s why I’m surprised. And I’m very surprised that you have to move a patient 1,700 km for rehab, I repeat rehab – not the most advanced brain surgery ever performed in history.

But all this depends on whether you or Evo is right. If flying with an open skull at 28,000 ft with pressurization didn’t affect her at all, then there’s nothing to discuss.

Wait now, I didn't say it didn't have an effect, I'm just saying that this an excess of fluid without concomitant swelling of the surrounding tissue or regression of the patient isn't a major concern. We're talking about a woman who still has a 'chunk' of her skull being kept for later, so sinking in a probe and drain isn't what it would be under emergent circumstances where you need to image and place on the fly, it's a new patient, and you have to crack the skull AND the BBB!

Otherwise, you're still right about rehab, it's just that muscular rehab requires much less assistance than major neurological rehab. The level of supervision, and the possibility for a sudden and fatal reversal is also not present in the former, but is there for the latter.

You had to build muscle, stretch connective tissue, regain balance, and more. She may need to re-learn how to read, talk, and almost anything else INCLUDING literally HOW to control the right side of her body. If the patient gives up, therapists can't MAKE them rehab... it's still about the patient being GUIDED, but the effort coming from that patient.

No worries. Well, since you are the OP... I guess this is okay...

Awwww, low blow! hit below the belt!

I’m normally a "healthy person", except for "youthful stupidity" = fractures, teeth, deep wounds, sepsis, etc,

Fracture... yep
Teeth... oh definitely
Deep wounds... hmmm, but yeah, I know what you mean
SEPSIS *car screeching to a halt* HUH!? I don't think that's part of the normal "childhood scrapes"! I like you man... please stay alive... so... no more playing with rusty nails covered in fecal matter... kay?

I always been healthy = no medicine. But this was totally weird from day one. I clearly remember how it started; I got a real "bad stomach" the week after "the summer party", and a few days thereafter – when the alarm clock rang and I was to get out of the bed – I was sure someone left a sharp knife on the floor, and that I had put my big toe on the knife. It hurt &%”¤#:(! Checked the toe for blood – nothing... I thought I had "nightmare" and put down the toe again – same thing.

Jumping on one foot (the "communist model" in work) I made it to the nearest medical center. The nurses (giggle giggle) were all convinced I had a VD and prescribe some weird (wrong) stuff (the "communist model" in work again).

Next day: Woke up and felt a strange 'sensation' in my left knee... removed the sheets and there it was! My knee had 'transformed' into a "soccer ball"! ... Confusion, high pulse – I was new in the "big town" and all friends I knew where already at work or school ... I made it down to the street, and into a cab straight to the "big hospital".

The Shining or The Exorcist doesn’t frighten me anymore, because I’ve done worse - without anesthesia.

Wow.. I can't express how sorry I am that you went through that. From the swelling in the knee I can fill in the rest... jesus. I'm glad that you didn't take a "wait and see" attitutde, and... really, what else can be said? I'm glad you're alive.

The doctor walks up to me lying on the bench, and in his hand he held a loooong 'needle' with a diameter that looked close to a gun pipe... and a very sharp edge... I asked silently if "this going to hurt"...?

No worries, he said, and slammed that BIG NEEDLE straight into my knee and I SCREAMED STRAIGHT OUT! (the "communist model" in full action! ) It was good to get that "yellow slimy stuff" out though, ... almost half a bucket.

He... placed a catheter or trocar... in your KNEE... without a block?! Oh.. and that's synovial fluid... joint-lube for the body... and my only question is if it hurt more to get the drain in, or felt BETTER to get the fuid OUT?

I can’t tell you all the details, only that I got worse from here... rashes, almost every joint (feet, knees, wrists, shoulders, jaw) swollen and hurting like h*ll and defunct, painkillers in every possible and "impossible hole", cortisone injections straight in the joints, crazy fever for months, insane weight loss, total 'weakness' = pure hell on earth.

I can guess the details... man, the hell of it is that it doesn't sound like your Yersinia infection was terrible, but the auto-immune reaction... I know that in all of this you were quite unlucky, but within that set, you're lucky that your joints recovered! Still... no wonder you have that sense of humor: you have or get that, or lose your mind.

But today I’m fit as a fiddle and have absolutely no problems from the 'nightmare'!

GOOD, and I can see why you feel the way you do about undercooked meat! I'd rather have trichinosis in my groin muscles.

 

[turbo]

Giffords' condition has been upgraded from serious to good, and she's scheduled to be moved to rehab later this morning.

 

[nismaratwork]

Giffords' condition has been upgraded from serious to good, and she's scheduled to be moved to rehab later this morning.

Wow... she is one tough lady, and must have been incredibly healthy going into this. edit: (i.e. before she was shot, not moved)

 

[DevilsAvocado]

Giffords' condition has been upgraded from serious to good, and she's scheduled to be moved to rehab later this morning.

Great!

 

[DevilsAvocado]

I like you man... please stay alive... so... no more playing with rusty nails covered in fecal matter... kay?

I was not me... it was my old man... he had that 10 year old "Yellow Miracle Powder" from the Army (and I think the Army had bought it from the remains of Columbus)...

He... placed a catheter or trocar... in your KNEE... without a block?!

Yup, definitely not a catheter, trocar looks more like it (this had a 'beveled' top), and no anesthesia or blocking. This was the 'shining' real thing!

and my only question is if it hurt more to get the drain in, or felt BETTER to get the fuid OUT?

Hard to tell... I had 'transcended' to the 5th dimension and the doctor looked very much alike Jack Nicholson at the moment... god knows what had happened if I had had a gun...

I can guess the details... man, the hell of it is that it doesn't sound like your Yersinia infection was terrible, but the auto-immune reaction...

Correct, the "stomach problem" (from the bacteria) was absolutely nothing. The real problem start with the auto-immune reaction – your body is attacking your body, so to speak, and there is no cure for that.

you're lucky that your joints recovered!

Absolutely right, there are a few very very unlucky people out there who never recover from this. The joints are permanently destroyed and I can hardly imagine the horrifying troubles they have to live with, thru out their lives.

What might one learn from this? Well, if you live in a developed country and are healthy – for god’s sake appreciate it! If you do get into trouble or get ill – be sure that there’s always someone that has 10 times your troubles (like Gabrielle Giffords). And generally; Time heals all wounds.

And of course – do not forget to be an 'accurate' cook!

 

[nismaratwork]

I was not me... it was my old man... he had that 10 year old "Yellow Miracle Powder" from the Army (and I think the Army had bought it from the remains of Columbus)...



Yup, definitely not a catheter, trocar looks more like it (this had a 'beveled' top), and no anesthesia or blocking. This was the 'shining' real thing!

Hard to tell... I had 'transcended' to the 5th dimension and the doctor looked very much alike Jack Nicholson at the moment... god knows what had happened if I had had a gun...

Correct, the "stomach problem" (from the bacteria) was absolutely nothing. The real problem start with the auto-immune reaction – your body is attacking your body, so to speak, and there is no cure for that.



Absolutely right, there are a few very very unlucky people out there who never recover from this. The joints are permanently destroyed and I can hardly imagine the horrifying troubles they have to live with, thru out their lives.

What might one learn from this? Well, if you live in a developed country and are healthy – for god’s sake appreciate it! If you do get into trouble or get ill – be sure that there’s always someone that has 10 times your troubles (like Gabrielle Giffords). And generally; Time heals all wounds.

And of course – do not forget to be an 'accurate' cook!

Yeah, a trocar... holy moley... and all of that infected synovial fluid without an agent. Well... you really don't have much to be afraid of from now on do you:... it definitely all gets better after 8 months and rehab. I think I can understand your attitude a little better now; good for you.

 

[lisab]

http://www.cnn.com/2011/HEALTH/02/09/giffords.recovery/index.html?hpt=T2

(Her spokesman) would not divulge what Giffords has said, other than saying she asked for toast.

Holy cow, she must *really* love toast...for crying out loud, someone give that woman some toast!11

 

[Lacy33]

http://www.cnn.com/2011/HEALTH/02/09/giffords.recovery/index.html?hpt=T2



Holy cow, she must *really* love toast...for crying out loud, someone give that woman some toast!11

So much to be happy about here.
Science in amazing.
Peoples attachment to Will is amazing.

 

[mugaliens]

I am as happy to hear she's doing well in her recovery as I am to hear that it's going well enough for Mark to complete his mission.

 

[nismaratwork]

Ha! She's talking... asked for toast. This is the greatest revenge anyone can have; survive, thrive, and watch as Loughner ends in prison or a hospital for the rest of his life... or dead. It's hard to hate the man, given that he seems so very psychotic, but on balance there's a grim satisfaction that his target did NOT die; she's beating the odds in a way that has my jaw on the floor. Her neurologists probably have a secret and deeply held desire to vivisect her brain and see just what the hell happened, and didn't happen.

We need to get with this, because we have a LOT of veterans with similar struggles, even if you can't see the damage that obviously. TBIs... we cannot let this create another post-Vietnam generation of walking wounded.

edit: Mug: I think he's doing the right thing as well. It takes some kind of brass knockers to go into space, but to do it with your wife recovering from a head-shot?... brave. I realize some will see it badly, but given the kind of power-couple they seemed to be, I can't think that anything other than this would be right.

 

[nismaratwork]

http://cnews.canoe.ca/CNEWS/World/2011/02/15/pf-17284046.html

Just over a week before Jared Loughner allegedly fired into a crowd of people near Tucson, Ariz., killing six people and seriously injuring U.S. Representative Gabrielle Giffords, the college that kicked him out was worried he'd return.

Hey, here's a thought for academia in its many forms: leave this to the REAL police. If you're worried, report, end of story.

I see a big ugly lawsuit coming there way, and I see (holds envelope to forehead)... a settlement. I'd hate to be a taxpayer in Pima County...

 

[nismaratwork]

http://www.cnn.com/2011/CRIME/03/09/arizona.loughner.case/index.html?hpt=T2

Hmmm... what a shock, the guy is psychotic, but he managed to shoot a bunch of people in the head.

Tucson, Arizona (CNN) -- A federal judge Wednesday entered "not guilty" pleas on behalf of Jared Lee Loughner, the Arizona man accused of fatally shooting six people and wounding 13 others, including U.S. Rep. Gabrielle Giffords.

Judge Larry Burns also scheduled a May 25 competency hearing for Loughner, and attorneys on both sides will be allowed to hire their own experts to evaluate Loughner's competency to stand trial.

Prosecutors sought the competency hearing, saying that Loughner had believed the FBI was bugging him, had extreme animosity toward the government, and was even hearing voices.

Loughner's public defenders didn't want such a hearing, saying it would be premature and could interfere with their ability to develop a relationship with Loughner.

But the judge said his review of materials relating to Loughner left him concerned.

"We can't do anything until I'm assured that Mr. Loughner is on board and able to assist" in his own defense, the judge ruled.

Last Thursday, a federal grand jury returned a new indictment against Jared Lee Loughner in which he is charged on 49 counts -- including murder and attempted murder -- related to the shooting outside a Tucson supermarket in January.

Loughner, 22, entered the courtroom with a slight grin, the first time he's appeared in a Tucson courtroom. His bald head is now showing growing hair.

When a clerk asked if his name was Jared Lee Loughner, he responded: "Yes it is."

In response to motions, the judge ordered prosecutors to release grand jury materials to the defense, but said Loughner's attorneys cannot reproduce the documents or leave copies of them with Loughner.

Burns also ordered the release of findings from authorities' search of Loughner's parents' home in Tucson, as requested by two Arizona media outlets. Last month, the judge sided with prosecutors in withholding the information because the investigation was ongoing and a grand jury was still preparing an indictment.

But with a new indictment now issued, the judge said it is time to unseal the documents relating to what was found in the Loughner family home.

"The active investigation is over," the judge said. "Ninety percent of the information in the warrant domain is already in the public light."

He added, "There is something mystic and suspicious in not releasing this type of information."

Burns said he will delay ruling on a motion filed by prosecutors Monday to force Loughner to submit a handwriting sample -- a request that he, thus far, has refused.

The government wants the sample to compare with handwritten notes found in Loughner's residence that include mentions of Giffords "as well as references to guns and bullets," according to a court document. It says he has resisted such requests to date, "arguing that the court lacks authority" to force him to provide a sample.

"There being no other avenue to obtain the defendant's handwriting exemplar, the government now seeks an order to compel," prosecutors wrote in the motion.

Burns said he wants to discuss some material collected by bureau of prisons on Loughner since he was arrested.

Prosecutors said they want the court to review the materials, to see if they should be able to see it. But Loughner's public defenders said they want time to review the matter and prepare arguments in writing.

As the hearing unfolded and the judge made his decisions, Loughner sat still.

The full courtroom included about 20 victim family members and seven people supporting Loughner, including a woman who dabbed her eyes with tissue. Among the spectators were Bill Badger, one of two men who jumped on Loughner and subdued him during the shooting, and shooting victim Susan Hileman.

Loughner's family members declined to comment as they left the courthouse.

Tucson attorney Michael Piccarreta, who appeared in court on behalf of slain federal Judge John Roll and his family, was asked by reporters afterward what he thought of seeing Loughner face-to-face.

Responded Piccarreta: "He's just another defendant."

Loughner was earlier indicted on three counts of attempted murder, including one alleging that he tried to kill Giffords with a Glock semiautomatic handgun during the event she was hosting for constituents.

Giffords, who was shot in the head, is undergoing rehabilitation at a medical facility in Houston.

The new indictment supersedes the earlier one. It adds murder charges connected to the deaths of Roll, a federal district judge, and Gabriel M. Zimmerman, a staff member for Giffords.

Loughner also faces charges in the deaths of Dorothy J. Morris, Phyllis C. Schneck, Dorwan C. Stoddard, and a child, referred to in the indictment as C-T G. Nine-year-old Christina-Taylor Green was among those killed in the shooting.

Autopsy reports released Monday showed that Zimmerman, Schneck and Stoddard suffered fatal head wounds, while the three others were shot in the chest.

If convicted, Loughner could face a death sentence, U.S. Attorney Dennis Burke said last week, although prosecutors have not said whether they will seek the death penalty.

 

[Proton Soup]

compelling a handwriting sample seems like a 5th violation

 

[nismaratwork]

compelling a handwriting sample seems like a 5th violation

It does, but then so does every compulsion, including a DNA sample... presumably they've been ruled to be something else. I'm no legal expert, or even particularly facile with the law so I'm not sure.

It's going to be irrelevant if he's as incompetant as I suspect he is... he's going to probably have to be compelled to undergo neuroleptic therapy as well.

 

[arildno]

First photos of Gabrielle!

Ms. Giffords is making steady progress, considering the extremely dangerous wound she received.

In this article, with a smiling, vibrant Gabrielle, we also learn about what particular achievements she has made towards self-reliance and functionality:

Since the shooting, Giffords has made remarkable strides, requesting her favorite foods, singing her favorite songs, and relearning how to walk and talk, although she struggles to string sentences together.

In an interview with The Arizona Republic published Thursday, Giffords' Chief of Staff Pia Carusone said Giffords' limited speaking ability has led her to rely primarily on facial expressions and hand gestures to communicate.

"She is borrowing upon other ways of communicating. Her words are back more and more now, but she's still using facial expressions as a way to express. Pointing. Gesturing," Carusone said. "Add it all together and she's able to express the basics of what she wants or needs. But, when it comes to a bigger and more complex thought that requires words, that's where she's had the trouble."

Carusone also said that if Giffords' recovery were to plateau now, "it would not be nearly the quality of life she had before."

"All that we can hope for is that she won't plateau today and that she'll keep going and that when she does plateau, it will be at a place far away from here," she said.

The fact that she is now fully able to communicate with the world around her IS remarkable.
And even if she should "plateau" now, to the chagrin of us all, she will still have a devoted husband and family that can see her needs and bring joy into her life.
And, perhaps even more important, she now knows she is able to reciprocate it for them.
For example by her winning smile.
http://www.huffingtonpost.com/2011/06/12/gabrielle-giffords-photos_n_875498.html

 

[lisab]

Today, Representative Giffords cast her first vote since being shot through her head in January. She voted for the debt agreement.

Congrats, Gabby!

http://www.npr.org/blogs/thetwo-way...rds-pays-house-a-surprise-visit-for-debt-vote

 

[Proton Soup]

wow, that's amazing.

 

[lisab]

wow, that's amazing.

I know! Who would have believed it, after hearing the details of the shooting that day?