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.