Tuesday, February 3, 2009

Christy was very restless today.  She was very very active again with her arms and legs.  She was so restless, she didn't have enough energy to really settle and track.  We weren't sure if she was in pain, so she received two kinds of pain medicine a couple hours apart.  When that didn't settle her, Dr. Maher was called and he said to give her one dose of Seroquil.  Christy had been on this drug before but he had stopped it.  I'm guessing he stopped it because he wanted Christy to be more awake, and this drug can make you kinda out of it.  The drug is used to treat bipolar disease. This is not what Christy is getting it for.  I don't know what part of the brain is affected with bi-polar disease.  Those people have bouts of depression, then mania (they're kinda "high"-extremely elevated mood, energy, unusual thought patterns). I was reading and I think that there is some off-label usage for elderly patients with dementia-related psychosis (having lost touch with reality due to confusion and memory loss).  Treating Christy with Seroquil for this reason makes more sense than bipolar disorder.  I am not certain though. Some drugs are known to do other things, but the FDA has not approved them for that purpose.  A drug may be commonly used for more than one reason, and doctors feel it is safe. That's what I mean by off-label usage.  I have not had the pleasure of meeting this neurologist, and have not asked him reasons for meds, etc.  I can only guess.  Our own neurologist that we work with don't even communicate all that they're doing for patients who are under our care.  We, as nurses, often have to question the reasoning or read their notes to find clues to what they are thinking-- or try to look stuff up ourselves.  

Donald's been by Christy's side all day, trying to calm her with love and affection.  Dr. Maher did say at the start of Christy's violent movements that it was going to get worse before it got better.  It kinda stayed the same-ish, and then got better yesterday.  She was calmer and tracking.  Maybe she still needs to get worse before better.  Not sure how Dr. Maher feels.  All we can do is love her and pray and hope for some improvements tomorrow.  It's so hard to just stand by and watch Christy be so agitated.  We feel helpless and just want her better so bad.  She is doing different movements which may be good.  She is favoring the left side with her legs now, when she once only favored the right.  She's doing much much

 less "posturing" movements, and doing more arm movements.... movements simulating playing "junk ka na po!" If that's how you spell it (rock paper scissors)  I don't think I ever showed pictures of "posturing" these are two of the posturing positions that Christy was experiencing early on.  They are extremely bad signs-- signs of severe brain damage.  Since being upstairs she has started pulling her knees up all the way to her chest, and no longer keeps her feet pointed and inward.  Inward feet are also part of this posturing but isn't shown. Christy is able to lift her head of the pillow, and has lifted her arms up off the bed and even lift her arms over her head.  Christy kicks her legs, points her pointer finger and no longer moves her toes up to stimulation.  If someone tickled you feet, your reaction should be to point your toes downwards.  Christy started to do that too.  The tracking is her biggest accomplishment.  It's so encouraging that she can smile at a joke!!  We don't know what parts of the brain Christy is going to have problems controlling.  If she really is comprehending what's being said, she can still have problems talking or controlling her arms and legs and fingers to communicate.  We just have to give her time and love and let her body heal itself.  It's selfish, but we hope ASAP.  Every day Donald and the whole family are grateful for small accomplishments.  Christy has changed quite a bit from being in the ICU the first few days.  It's so so exciting to see her turn to someone when she hears a voice, to smile, or to focus in on you.  You feel her right at the edge of pure consciousness.  We try to find a balance between allowing her to listen to her music, talking to her, holding her and loving her but resting her brain and allowing her to sleep and replenish her energy.  May she have sweet dreams tonight.

Happy 31st birthday to the twins, Keli'i and Kaeo (Christy's identical twin brothers)... old futs! Hugs and love, gabby