Rep. Giffords remains critical, docs say 'no change is good'

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by Catherine Holland

azfamily.com

Posted on January 10, 2011 at 11:12 AM

Updated Tuesday, Jan 11 at 8:02 AM

TUCSON, Ariz. -- While Rep. Gabrielle Giffords remains in critical condition, doctors at University Medical Center in Tucson said they are relatively pleased with the progress of her recovery Tuesday morning.

Her condition remained unchanged overnight, which is positive news. An early more CT scan showed no increase in brain swelling, which is the biggest concern right now.

Doctors at UMC held a news conference Monday to go into more detail about Giffords' condition.

"At this phase in the game, no change is good, and we have no change," said Chief of Neurosurgery Dr. Michael Lemole during that news conference. "She is still following those basic commands."

Lemole said early on that the ability to follow those simple commands -- holding up a finger, wiggling toes, raising a hand -- indicates a high level of brain functioning.

"It implies that not only are the centers of the brain working, but they're communicating with one another," he elaborated Monday.

Lemole said while his team his optimistic, Giffords if not out of the woods yet. Brain swelling is still a concern although CT scans have shown no progression of the swelling. Lemole said that swelling usually peaks the third day after surgery, which will be Tuesday, but it can take longer to maximize.

"Every day that goes by that we don't see an increase, we’re slightly more optimistic," Lemole said. "We can breathe a collective sigh of relief after about the third or fourth day. We're getting close."

Surgeons removed a portion of Giffords' skull to help mitigate the swelling by easing the pressure in the cranial cavity.

In an earlier news conference, doctors said the bullet traversed the entire length of Giffords' brain, from back to front, on her left side, but did not cross over to the other hemisphere. The wound was "through and through," which means the bullet did not lodge in her brain. Former Surgeon General Dr. Richard Carmona on Saturday evening described Giffords' wound as "devastating," Giffords still has a breathing tube in place so she cannot talk and doctors are keeping her heavily sedated to allow her to rest more comfortably.

"At this point, we can't measure psychological function, nor would we try," Lemole said. "I think the important thing is to make sure the needs of the family are met and that we start to anticipate needs down the road."

Giffords' family is with her constantly and the UMC staff is doing everything they can for them.

Doctors still will not speculate on Giffords' long-term prognosis, saying only that there's a range of possibility.

"At this phase, things are going very well," Dr. Peter Rhee said.

Rhee said Giffords is one of two patients still in the ICU, but she is the only one in critical condition. Six more remain in the hospital; four of them are in serious condition. The other two are good and fair. In addition, two patients have been released.

Rhee said several patients still in the hospital will need to undergo further surgery.

Rhee said now that the emergency has passed, the care of most of the patients will transition from putting things back to together to looking at the patient as a whole, including the emotional issues that are virtually inevitable after such a traumatic event.

"We're accustomed to taking care of such things as PTSD [post-traumatic stress disorder] ... and there are also issues with depression that could take place," Rhee said. "Things are going to be things done with compassion.

"We have psychiatrists in house. Our social workers are the best in the country. But we also have city and county facilities and resources. ... That's the part we're really going to be concentrating on. It is vitally important to take care of these patients all the way through the spectrum of trauma care."

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