Wounded Cop Update
[From the Democrat and Chronicle; brain rendering from Gannett News Service]
When Rochester Police Officer Anthony DiPonzio was shot in the back of his head just more than three weeks ago the odds were stacked against him.
About 85 percent of people with that type of gunshot wound through the brain die within days. Those who live are usually on ventilators and unresponsive for weeks, many remain in the hospital for months, and all face long and difficult recoveries.
So when the 23-year-old officer was breathing on his own, squeezing hands and giving thumbs-up signs in less than a week, it astonished even Dr Paul Maurer [his doctor], a Rochester neurosurgeon who has treated thousands of gunshot-wound patients and served as a ballistics expert to Homeland Security. Within a week and a half, DiPonzio spoke for the first time, and last week, he was moved from Rochester General Hospital to a brain rehabilitation center at Unity Health System.
While the struggles that he continues to face come with more risks and no guarantees, the progress DiPonzio has already made might signal a recovery path that turns even further against the odds. To be sure, doctors know little about DiPonzio’s long-term prognosis, and the outlook can change at any time. Infections can pose a threat for months to come, and very few patients who suffer gunshot wounds to the brain ever regain lives similar to the ones they had.
But for the fortunate few, “at the end of nine to 12 months, sometimes the recoveries are impressive,” said Dr. Paul Maurer, the University of Rochester Medical Center neurosurgeon who operated on DiPonzio. “You’re never what nature made you, but some of those patients get back pretty close to where they were.”
No formula can determine whether patients survive or die, have lifelong disabilities or make incredible recoveries, but Maurer and others say several key factors can shape what happens after a shooting.
“There are an amazing number of cases where people will survive what you would think to be absolutely fatal injury, because some of the wounding impact doesn’t get to the patient, like when the bullet is coming from a long way away,” said Dr. Ross Bullock, director of neurotrauma at the University of Miami and a councilor of the National Neurotrauma Society.
Most people lose consciousness immediately from the initial impact of the bullet, and those who can continue to breathe and make it to the hospital quickly with at least a few motor responses have the best chances of surviving, Bullock said. Bleeding and injuries in the brain stem can be deadly.
The path the bullet follows permanently destroys the fibers in that part of the brain. Around the path, other parts of the brain swell from the impact, causing more damage and often leading to death. The amount the brain swells depends largely on the size and speed of the bullet.
This brain swelling poses the greatest immediate danger after the initial impact. When a patient arrives at a hospital, surgeons remove the top half of the skull to relieve pressure, and insert a tube down the middle of the brain that drains spinal fluid to help to reduce the swelling.
The first three to five days are the riskiest for swelling, and despite doctors’ efforts, most people die within the first two days from significant brain damage caused by the pressure, Maurer said. For those who make it through, swelling typically subsides within the first seven to 10 days, and the tube and a brain pressure monitor are removed.
But the skull is not replaced until at least six months later because infections still pose a constant threat and could require repeated procedures to clear up the bacteria. When a bullet enters, it carries bacteria, hair, fragments of the scalp and other debris into the brain. The risk of infection is greatest in the first two weeks, though the threat lasts for months.
“The outside world is now inside, and the brain has never seen the outside before,” Maurer said. When doctors remove the skull in the first operation after a shooting, they also surgically clean the first 2 inches of the bullet’s path and flush out the rest of the tract. Surgeons remove the bullet if it is accessible, but leave it in place if it’s lodged too deep.
Though the risk of infections is serious, aggressively tracking down the bullet and cleaning out its entire path can cause more life-threatening damage to the brain. Infections are treated instead with strong antibiotics, which also sterilize the bullet. The bullet typically doesn’t move in the brain once it’s lodged, and when the bullet is sterilized in about three to four weeks, antibiotics are no longer needed. People who survive gunshot wounds can live the rest of their lives with bullets in their heads.
The difficult fight in the first weeks after a shooting, from draining spinal fluid to warding off infections, is meant not only to save a life, but also to give the patient every chance to return to a good quality life, Maurer said.
“You can’t change what was lost the moment the bullet went through,” Maurer said. “But you start the battle to fight for every single brain cell you can save, because that’s what will determine the outcome.”
Where the bullet hits the brain can also make the difference between life or death, and how well victims recover. In general, people suffer the gravest injuries when hit on the left side of the brain, which controls much of thinking, reading, writing and speaking.
“All of these injuries are very severe and very life-threatening even in the best care. But given the choice, right brain injuries are always better than left brain injuries,” Maurer said. “That’s your best chance to do OK.” Doctors have reported that DiPonzio was hit in the back right side of his brain. That area, called the occipital lobe, controls functions related to vision, said Bullock, who did not treat DiPonzio. But the extent of the long-term damage caused by a gunshot wound is difficult to determine in the first few weeks. The bullet could have traveled through other lobes, or the pressure could have damaged other parts of the brain. Most bullets, other than those from high-powered rifles, also don’t have the speed to make it through the other side of the head and can ricochet inside the skull, causing additional damage.
“There’s an immense amount of energy that bullets impart to the brain,” said Ronald Hayes, co-founder and director of clinical studies at Banyan Biomarkers, a U.S. Department of Defense-funded biotechnology company that develops ways to detect traumatic brain injuries. “The pressure waves propagated by the movement from a bullet through the brain can cause very different patterns of injury.”
The different patterns of injury can direct the long process of recovery following the riskiest first few weeks. Most people with gunshot wounds in the brain begin rehabilitation after two to four weeks, and their long-term prognosis becomes clearer after about a week with therapists, said Dr. Mary Dombovy, who leads Unity’s Brain Injury Rehabilitation program. Some cognitive and behavioral issues, however, can take longer to show up, and many people shot in the brain can suffer seizures for up to a year.
“Every gunshot wound is going to be different,” she said. “It’s a very individual thing.”In rehabilitation, people who have suffered gunshot wounds often must relearn such basic functions as walking or talking. Those who have disabilities also work on finding other ways to do basic tasks; for example, using the left arm to pick up items if the right arm is paralyzed. Many take medications that help strengthen concentration, alertness and memory.
Often, the cognitive and behavioral effects of a gunshot wound to the brain are the most permanently debilitating, while physical disabilities are more easily overcome, Dombovy said. With all the disabilities, rehabilitation can take many months, but “it’s very critical to push the person to work on the things they’re having difficulty with,” she said. “The brain changes in a positive way in response.”
But as DiPonzio continues to progress every day, Maurer said cautiously that there are reasons to hope for a strong recovery. Despite the difficulties after a shooting, some people seem to go against all odds, he said. “And in those patients, it’s very gratifying.”
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The Daily Dose of “Bovine Feces”
[As my Ma use’ta say, this is “The pot calling the kettle black!” She didn’t have a prejudiced bone in her body…. so that WAS NOT a racial slur!! Sure “Dubya” left a deficit.. he was fightin’ a two-front war!! Nerobama displayed fiscal ineptitude in pushing, signing the Porkulus package!! Nerobama can’t lay all this housing rescue crap at Bush’s feet; we have Carter[DEMOCRAT], “Slick Willie” [DEMOCRAT] and Andrew Cuomo [DEMOCRAT] to thank for that. They’re the ones who purposely loosened the credit and earnings requirements to have more slugs OCCUPY homes; they weren’t homeowners-there was no way they could afford the houses they were in. They OCCUPIED them until they would be tossed out. Instead of giving the slugs a 15-17% welfare raise, he should have done the fiscally responsible thing and cut entitlement programs 15% across-the-board, IMMEDIATELY-and returned the mortgage requirements to PRE-Community Reinvestment Act of 1977 levels. But, given all that… in just ONE MONTH-when Nerobama gets his hands on the health care system…. ya might just as well bend over and “kiss your wallet goodbye!!” That’ll turn into just another entitlement program; everyone “has a right” to government-funded healthcare, courtesy of you and I. I hold a job that has a healthcare plan-don’t you?? In the last fifty years, all democrats have managed to do is create an ever increasing dependency class; those who also “have the right” to sit on their dead-asses spending our money, watching our TVs. Now, every time they get a “fart cross-ways,” we’ll pay for them to go to the emergency room at $12-1,400 “a pop!!” ….. and don’t believe the fecal matter opinion that entitlement reform HAS TO GO THROUGH health care!! Just another way for the federal government to get more and more control over the American way of life-that may not be a bad idea, tho’…. our way of life seems to have deteriorated to a “welfare state.” The entire population can go on the dole; with free health care to boot, we’ll want for nothing!! Wonder where he thinks the tax revenue’s gonna come from then??] As President Nerobama convened a high-level summit Monday pledging to set the country on a more responsible fiscal course, he blamed the government’s financial straits on his predecessor, President George W. Bush, and on gimmicks used to keep hundreds of billions of dollars in federal spending off the books.
“This administration has inherited a $1.3 trillion deficit — the largest in our nation’s history, and our investments to rescue the nation’s economy will add to that deficit,” Nerobama said as he convened a fiscal responsibility summit at the White House on Monday. “We cannot and will not sustain deficits like these without end. Contrary to the prevailing wisdom in Washington these past few years, we cannot simply spend as we please and defer the consequences to the next budget, the next administration or the next generation.”
Nerobama gave policy wonks pride of place in the East Room as he convened about 130 lawmakers, policy advocates and union and business leaders for a meeting to showcase his commitment to reining in the deficit and getting control of exploding federal entitlement programs.
“The long-term fiscal picture is unsustainable,” a liberal economist, Robert Greenstein of the Center on Budget and Policy Priorities, told the group. “We are on the path to the very debt explosion we must avoid. While holding the summit so close to passage of the $787 billion stimulus package jarred some, others said bold steps were necessary.
“Crises of the magnitude of the current one only end with overwhelming government action,” an adviser to Sen. John McCain’s presidential bid, Mark Zandi of Moody’s Economy.com, told the gathering.
Nerobama’s budget director, Peter Orszag, sounded one of the administration’s key themes: that the president’s health care reform plan is essential to getting programs such as Medicare and Medicaid under control.
“To my fellow budget hawks in this room and in the rest of the country, let me be very clear: Health care reform is entitlement reform,” he said. “The path to fiscal responsibility must run directly through health care.”
“We do ourselves no favors by hiding the truth about what we spend. In order to address our fiscal crisis, we’re going to have to be candid about its scope,” he said.
In a measure of the spending challenge, Nerobama lauded the Agriculture Department for saving $19 million in training and management costs — a figure that amounts to a rounding error on the trillion-dollar deficit.
As for a program with potentially grander impact, White House press secretary Robert Gibbs declined to confirm reports that Nerobama dropped plans to set up a Social Security commission after congressional leaders objected. But at a briefing Monday, Gibbs promised there would be few celebrating when Nerobama’s budget is released on Thursday. “Everybody has to be involved in the sharing of pain,” he said. After hearing from Nerobama in the East Room, summit participants headed to the nearby Eisenhower Executive Office Building to attend one of five “breakout sessions” that focused on narrow issues. Top administration officials were to shepherd the discussions, with Treasury Secretary Timothy Geithner leading one on taxes and White House economic adviser Lawrence Summers tackling Social Security.
Til Nex’Time….