Archive for June, 2010
Renee had a 2-hour phone call with a team of medical professionals helping Dustin recover. There was a LOT of ground covered. The only thing “missing” from these updates are the neurologists’ reports – those are to follow as Renee is meeting them in person in Regina.
WHO was on the call:
- The Unit Manager via proxy by the neuropsych nurse
- Occupational therapist
- Social worker
- Client rep
First, we have the medical report that was requisitioned from Calgary:
CALGARY CHART (what we were told was a work accident – this happened back in late Fall 2009. No work accident reports found on record.)
Dustin was admitted to ICU, unconscious and treated for POLYTRAUMA and diffuse brain injury.
List of injuries on admission:
- lacerated bowel from stab wounds
- lacerated liver from stab wounds
- blowout fracture of left cheek bone and frontal sinus
- bilateral multiple rib fractures
- collapsed lung with blood and fluid
- fractures of T-9, T-10, T-11 and T-12
- fractures of L-1 and L-2
- ligament damage and fractures to C-6 and C-7
- open wounds and lacerations
- acquired VRE in the hospital
- toxicology – not on the chart info to follow
- no damage to lips, teeth, mouth
Dustin was admitted to ICU semi-conscious (level 12) and then went into a coma.
List of injuries on admission:
- severe bilateral pneumonia
- fractures of right and left cheek bones over partly and badly healed fractures (since Calgary)
- fracture of C-6
- badly damaged thyroid cartilage
- multiple bilateral fractures of all ribs (over partly healed and old fractures since Calgary)
- acute brain injury over diffuse with bleeding and swelling
- severe malnutrition and dehydration
- heart arrhythmia
- damage to upper hard palate
- lower lip severed
- tongue cut
- blowout fracture of eye orbit and attached muscles
- bilateral bleeding, hematoma, scar tissue, swelling, cuts and damaged cartilage – both ears (new wounds over old wounds since Calgary)
- “2nd degree trauma” (?) to penis
- toxicology report: negative for Hep & HIV, no drugs or alcohol of any kind
- multiple wounds and lacerations in various stages of healing from new to scar tissue (since Calgary)
- No rape kit was done on admission
SURGERIES REQUIRED (eventually)
Facial reconstruction, ears, mouth and extensive dental work. Maybe more.
- Dustin will eventually need reconstructive surgery
- there is damage to the auditory canal in both ears
- there is some evidence of hearing loss but only in the higher ranges
- Dustin does not yet have the cognitive capacity to participate in the necessary tests to accurately determine the degree of hearing loss.
- the uneven and wandering eye is a result of the facial/orbital fractures and damage to the ligaments that connect the eye to the face
- Dustin does not yet have the cognitive capacity to participate in the necessary tests to accurately determine the degree of vision loss.
- he will need glasses
An application has been submitted by the Social Worker to Victim Services for Compensation. Dustin is pre-approved up to $1000 in dental work plus another $1000 if the actual costs exceed their limit.
The plastic surgeons noted in the chart that Dustin will require extensive reconstruction on his face, lips and inside his mouth before dental work can even be contemplated.
Dustin’s head trauma occurred over a long period of time so the ‘first 90 day rule’ does not apply. Dustin is still considered to be in the ACUTE phase. The inflammation of his brain is still evident although the bleeding has stopped. Progress has been slow but steady. Most of the severe deficits are in short term memory. There may be some retrograde amnesia. Dustin is in the repetitive stage. His agitation may be caused by the brain injury or by his inability to process PTSD.
- Once the swelling is reduced, some of the neurons may start firing again by themselves and Dustin may begin to remember, understand and retain new information.
- Dustin is ‘covering’ deficits. Apparently this is normal because Dustin does not understand the gravity of his injuries on any level. He probably knows that ’something’ is not right or normal.
- Dustin cannot transfer or generalize information. To accomplish this he must engage is stimulating and repetitive tasks. According to the Rehab people….life is rehab. Dustin must engage in ordinary activities over and over and over again so he can re-learn old skills.
- Progress will be slow. Dustin is still in the very early stages of ABI recovery. Dustin may never recover complete brain function but the end prognosis so far (subject to change): Mild ABI
- Dustin may never remember all the details, the sequence etc…It depends on the level of consciousness and unconsciousness at the times of the assaults. Partial Retrograde Amnesia is the rule, not the exception. It is very, very common.
- The ABI neuro team assessed Dustin with moderate ABI with the possibility of achieving MILD ABI after rehab….maybe.
- The hospital has put in a request for a specialized neuropsych consult.
- The physio therapist works with Dustin for at least two hours, Monday to Friday.
- Currently she and Dustin are working on ‘Stepping’, ‘Standing’, ‘Walking’, and ‘Balance’.
- Dustin cannot ‘balance’ his trunk and is very weak. He requires two person supports on either side to hold him up. The therapists have experimented with a walker but Dustin is too wobbly.
- Strengthening exercises and muscle building exercises are built into every activity or task.
- Dustin has a very positive attitude. He’s pleasant and cooperative most of the time. Dustin is also trying really hard to perform the exercises. He follows instructions but sometimes has a difficult time remembering.
- Dustin spends most of his day in the wheelchair. It is important to improve trunk balance and abdominal muscles.
- The Occupational Therapist works with Dustin for two hours every day from Monday to Friday.
- She administers cognitive assessments and provides Dustin with stimulating tasks and exercises.
- Dustin’s short term memory is severely impaired.
- He can repeat sentences and instructions immediately but not after one of five minutes.
- Dustin can choose between 3 options. This is consistent so she knows that the CHOICE is actually Dustin’s preference and not random.
- Dustin seems to be oriented in time and space.
- The Occupational Therapist administered a ‘Safety and Judgment’ test. Dustin’s answers were ‘vaguely’ correct.
- The therapist is noticing a very slow but steady improvement.
NURSING/HEALTH (no nurses, other than the psych nurse participated in the teleconference. He was there as a replacement for the Unit Mgr., not as a nurse)
- Dustin is able to focus on immediate needs and wants
- He is in hand restraints for impulsive behaviours (in bed or in the chair)
- Dustin receives multivitamins and T3s every 6 hours.
- Dustin ‘calls out’ frequently. This might be OCD, the brain injury or flashbacks.
- Dustin was scheduled for another swallowing test TODAY. If he passes, Dustin will be put on a very high calorie, dental soft diet.
- If Dustin passes the video test (thyroid cartilege damage plus brain injury responsible for the difficulty swallowing), we will be allowed to feed him (bring treats) pudding, ice cream, cream soups etc… (No pizza or hamburgers yet). It will take months of practice before Dustin can swallow properly and before he can chew more solid foods (damage to palate, teeth and tongue).
- C-diff swabs still negative
- VRE still positive. Dustin is not being treated. It is hoped that as he gets stronger, his body will be able to fight it off without more antibiotics.
- the nurses are applying topical cortisone ointment to Dustin’s wounds and lacerations. There is some improvement but it’s slow.
Dustin is still in Depends. He will be able (if he’s able) to go to the bathroom with assistance within 2 or 3 weeks. The problem right now is that he is too weak, cannot walk and cannot support his weight while standing, moving or sitting. Dustin knows when ‘he has to go’ but does not have sufficient control to ‘hold it’ until he can be physically transported to the bathroom. It takes 2 people.
Dustin moves limbs automatically (unconscious reflex which is normal at this stage of Brain injury) and independently on command. The left side works better than the right side.
PSYCHOLOGICAL AND EMOTIONAL
The Social Worker got ‘pre-approval’ for EMERGENCY PTSD counseling. It takes a minimum of 3 – 4 weeks of bureaucratic wrangling to have the emergency service implemented.
Ms. F from _____ Counseling has five (5) psychologists available, including herself, to provide URGENT support to Dustin….which will take at least 3 – 4 weeks. Victim Services has authorized the standard amount of $1000 or four appts to provide crime related support for PTSD which includes the initial assessment. The Social Worker is trying to arrange for Ms. F to come to the hospital to do the assessment. Four (4) of the five psychologists have agreed to go to the hospital to provide one-hour counseling sessions…after the assessment and when everything is set up in 3 – 4 weeks.
In the meantime, the Social Worker has been given permission by her supervisor to provide ‘listening and emotional’ support to Dustin if he discloses and requires assistance to process. The Social Worker said the she cannot help him process. The police have instructed everybody NOT to ask leading questions.
Dustin will not be given sedatives. The neurology department prefers not to administer certain drugs to patients with brain injuries. There is one compound approved to stop the repetitive loops which has sedative effects. This has already been prescribed and Dustin will continue to get it as necessary.
Dustin’s body will be okay. He will recover and with surgery(s), he will return to normal with normal function and abilities. It will take a long time. Dustin may walk with a slight limp (from spinal fractures).
Dustin’s brain injury is forever. With extensive rehab he may be able to ‘pass for normal’ but will always require some kind of practical and functional support. The hospital is very pleased with his progress, his personality and his attitude. It is too early to tell how far Dustin will go – but everyone seems optimistic.
|June 12, 2010|
|4:20 pm||to||9:20 pm|
Date: Saturday, June 12, 2010
Time: 4:20pm – 9:20pm
Location: Regina SK
Street: The Police department to the Regina General Hospital
City/Town: Regina, SK
Please show your support against the horrific crime committed against Dustin LaFortune. Show that this type of offense will not be tolerated in our communities, or our Country. This will be a peaceful walk from the The Regina PD to the Regina general hospital. We will be united against this outrage in a peaceful respectful manor. Show your support, citizens of Canada need to unite to take back our communities from brutal crimes and Police and Government inaction!
PLEASE INVITE YOUR FRIENDS AND THEIR FRIENDS, FRIENDS SO WE CAN SEE DEMOCRACY IN ACTION!