June 5, 2006

I just wanted to let you know that we have some more good news!! I just spoke with Kelsey - Dirk had his angiogram early this afternoon which was "negative", meaning they were not able to find the AVM or other source of the bleed. This does not mean that it does not exist - commonly, when there is still a lot of blood in the brain, the blood compresses the abnormal vessel(s)=AVM and so you don't see it on the first angiogram. It is reassuring however that there is no brain tumor or other larger abnormality that is continually bleeding. The doctors hope that they will be able to take him off of the ventilator later today. Dirk was a bit sedated this morning, but when more alert he was able to move all of his limbs with very good (not 100%) strength. Once he is off the ventilator, they will need to make sure that he can swallow (as his brainstem controls this function) - in the interim they have been giving him "tube feeds" = nutrition through a tube from his mouth to his stomach. Dirk also has a pneumonia - which he likely got when he lost consciousness, and his stomach contents went into his lungs as he'd lost his able to "protect his airway" (i.e. gag if stomach contents tried to get into his airpipe). He is getting antibiotics since yesterday and a repeat chest xray shows that it has improved; it is not a bad pneumonia otherwise they would not be moving forward with getting him off the ventilator. They were also able to bathe him today (must've still had the ocean water and sweat on him!).

Moving forward...the next fews days will have him hopefully come off of the ventilator and working with the speech therapist and doing basic things like sitting up. The main issue is that he still has a drain in the ventricles - the next few days will be telling, i.e. will they be able to remove the drain? The hope is that as the brain swelling goes down and there is no more bleeding, the ventricles will no longer become overwhelmed and unable to drain properly. If they can handle the normal fluid, the docs can remove the drain. They will assess this by: dirk's alerness, repeat cat scans of the brain to look at the ventricles, and a pressure monitor in his brain (already in there). If they are not able to remove the drain b/c his ventricles get backed up again = hydrocephalus, then he may require a "VP shunt" = a shunt from the ventricle in his brain to his peritoneal cavity (the area of your abdomen that is fluid bathing your organs). This would entail another operation.

If they are able to remove the drain and he is stable from a neurological and blood pressure standpoint he would be able to fly back here!!!! He would then need acute rehab which Kels is thinking would be close to home in Marin.

The remaining issue is also how to prevent re-bleeding. Dirk will need another angiogram next week either in honolulu before he flies back or in san francisco when he gets home. This will localize the AVM and then he would still need treatment of this (as described in my past email). He will need close followup as soon as he gets back with a neurologist and neuro-surgeon which we are working on right now so that it's all set up when he gets home.

I am SO SO SO optimistic that he is truly on the path to a most remarkable recovery. Kels' first glimpse of hope and her happiness today were so so good...she kept saying how hopeful she is and how much all of everyone's thoughts, calls, cards, emails have helped her, dirk and her family.

xoxo Kiki

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