Duchess Jack Posted March 21, 2008 Share Posted March 21, 2008 No real changes, at least nothing positive. He is still in a deep coma and still fighting off pneumonia. The skin around the amputation seems to be holding up though – at least for now. They were finally able to take an MRI and it appears that he has pretty significant damage to his Hypothalamus (though it might be the corpus callosum) – it was a long phone call and the details are kind of hazy. The doctor said that – while rare – he has seen people come back from injuries similar to his. He also said that he has seen people who made no progress from where he is now. The doctor told my sister that she needs to stop looking at things on a day to day basis and instead look at things from a week to week or month to month basis. I can’t imagine the netherworld she must be living in. She just keeps on hoping that she will wake up from it all. She is holding on - but again - I worry what will happen when my mom leaves. In the meantime we found this… http://www.theleafchronicle.com/apps/pbcs..../803200335/1002 It basically explains how Prevention Magazine rated Clarksville, Tennessee as one of the 10 worst cities for pedestrians in the entire US. Now…. I had mentioned starting up a paypal account and I have the info on that. Being that it’s the Huddle and folk know me here by Duchess Jack, I decided it would be easiest to use my paypal account for Josh. Please don’t feel any pressure – but if you are blessed enough to have a little extra – please know that every little bit is appreciated. The guy who hit him was driving an ’89 Accord – so I can’t imagine that his insurance goes much beyond the typical $250K. Now – I don’t know how much his being in the trauma ward is costing my sister – but I am sure the costs will exceed (if they haven’t already) the $250K I figure he is covered for. If prayers are answered and he makes it through this – the hospital costs are likely to be dwarfed by the costs she will incur in taking care of him. But again – don’t feel any pressure. We’re just happy to have people praying and loving on him. The paypal address is - duchessjack@gmail.com If you are up to it – please put something in the comments area as I hope to send everything down to my sister in card with the kind words and prayers the folk here and others have been offering. Thanks everyone – whether you can help or not. Quote Link to comment Share on other sites More sharing options...
MikesVikes Posted March 21, 2008 Share Posted March 21, 2008 Hoping for the best to you and your family DJ. Quote Link to comment Share on other sites More sharing options...
Duchess Jack Posted March 21, 2008 Author Share Posted March 21, 2008 oh... I forgot to add... the guy who first jumped to help Josh... he was home from Afghanistan for only a week. He was expecting to go back in a couple days. He went to Walmart to grab some things and took a wrong turn out of the parking lot. It was that route that lead him to Josh. The first thing he did was put a tourniquet on Josh's leg. If he would have been a couple minutes later - Josh would have bled out. If the small chance that he'd end up there at just that time weren't enough - the soldier had given a class on tourniquets just the day before. Here is an article on the soldier... http://www.newschannel5.com/Global/story.asp?S=8012677 Soldiers Help Save Teen Struck By Car Posted: March 13, 2008 04:44 PM EDT Command Sgt. Major Stephen Blake CLARKSVILLE, Tenn. - A Fort Campbell soldier is being called a hero not just for serving the nation overseas, but also for saving a teenager. Command Sgt. Major Stephen Blake was driving down Purple Heart Parkway on Tuesday when he saw 15-year-old Joshua Castle lying on the ground. Joshua had been hit by a car near a bus stop. While running errands Tuesday morning, Blake saw Joshua Castle in the middle of the road. Blake and two other soldiers put a tourniquet on the teenager's injured leg. They also stayed with him until medics arrived. Blake, Major Daniel Runyan, Staff Sgt. Daniel Maple as well as Erica Landwehr were the first on the scene. Blake was in town from Afghanistan on a seven-day visit with his family. Their quick thinking may well have saved Joshua's life. "They tended to the most immediate of his injuries, keeping him alive long enough for the first responders to arrive," according to a statement released by the family Thursday afternoon. " Josh would not have survived if not for their calm and fast thinking." "At the time I just tried to help, but I feared for him," Blake said, adding that "Everyone deserves a chance and he's got a chance now." The Northwest High School sophomore was taken transported by medical helicopter to Vanderbilt University Medical Center in critical condition. He remains in the hospital. He is a coma and suffers from a multitude of broken bones and internal injuries. He has had a number of surgeries, including one to amputate his left leg, according to the statement released by the hospital on behalf of his family. Blake thought about his own four children including a son named Joshua, who is a year younger than the injured teenager. Police said they hope to hold a commendation ceremony for the three soldiers who helped save Joshua. Blake is returning to Afghanistan Friday Quote Link to comment Share on other sites More sharing options...
MikesVikes Posted March 21, 2008 Share Posted March 21, 2008 You have to believe in miracles after reading about things like that soldier. Quote Link to comment Share on other sites More sharing options...
whomper Posted March 21, 2008 Share Posted March 21, 2008 You have to believe in miracles after reading about things like that soldier. Well said. Prayers coming DJ Quote Link to comment Share on other sites More sharing options...
darin3 Posted March 21, 2008 Share Posted March 21, 2008 Well said. Prayers coming DJ +1 and Quote Link to comment Share on other sites More sharing options...
Randall Posted March 21, 2008 Share Posted March 21, 2008 You have to believe in miracles after reading about things like that soldier. No kidding. Quote Link to comment Share on other sites More sharing options...
Duchess Jack Posted March 21, 2008 Author Share Posted March 21, 2008 (edited) here's a picture of the surly little bugger Edited March 21, 2008 by Duchess Jack Quote Link to comment Share on other sites More sharing options...
rajncajn Posted March 21, 2008 Share Posted March 21, 2008 Prayers on the way DJ. Quote Link to comment Share on other sites More sharing options...
Duchess Jack Posted March 21, 2008 Author Share Posted March 21, 2008 I want to thank everyone who has helped out already. The post has only been up a couple hours now and the response has been really heart warming. I feel like a schmuk even mentioning it - but my pride is a small thing when compaired to the overall situation. Quote Link to comment Share on other sites More sharing options...
Big John Posted March 22, 2008 Share Posted March 22, 2008 You have to believe in miracles after reading about things like that soldier. absolutely. Quote Link to comment Share on other sites More sharing options...
polksalet Posted March 22, 2008 Share Posted March 22, 2008 Incredible story. Quote Link to comment Share on other sites More sharing options...
The Captains Wench Posted March 22, 2008 Share Posted March 22, 2008 I just wanted to jump in here and thank you all for being so supportive. The more prayers and good vibes we can send Joshua's way, the better. I just talked to DJ's mom and she gave me the list of brain injuries: multiple shear injuries to the corpus callosum high right frontal injury injury to the left frontoparietal region small contusion on the left temporal lobe a small amount of intraventricular hemorrhaging a subarachnoid hemorrhage in the interpeduncular fossa They are operating tomorrow on his leg and they said the skin looks pretty bad and if the muscle is infected they'll need to take his knee. Overall he hasn't changed much in the past few days. Quote Link to comment Share on other sites More sharing options...
jaxfactor Posted March 22, 2008 Share Posted March 22, 2008 (edited) Prayers and positive thoughts are still coming. Sent the $ I had in my Paypal account from Friday/Sat. night poker winnings. Also asked whomp and CD to send what they owe from last night to your Paypal addy instead of mine. If we have a game tonight and I'm fortunate enough to win, I will send that also. Hang in there! Edited March 22, 2008 by jaxfactor Quote Link to comment Share on other sites More sharing options...
Duchess Jack Posted March 22, 2008 Author Share Posted March 22, 2008 (edited) once again, thank you to everyone. I truly see the huddle as a second family. edited to add.... I've done some research at work today and the 'shearing' they speak of is also known as Diffuse axonal injury (DAI). Background Diffuse axonal injury (DAI) is a frequent result of traumatic deceleration injuries and a frequent cause of persistent vegetative state in patients. DAI is the most significant cause of morbidity in patients with traumatic brain injuries, which most commonly result from high-speed motor vehicle accidents. DAI is a significant medical problem because of the high level of debilitation that is suffered by the patient, the stress that must be endured by the patient's family when the patient is in a persistent vegetative state, and the staggering medical cost of sustaining the patient in this state. DAI typically consists of several focal white-matter lesions measuring 1-15 mm in a characteristic distribution (see below). Pathophysiology The pathophysiology of DAI first was described by Holbourn in 1943, using 2-dimensional gelatin molds.1 His work led to the understanding that shear injury is not induced by linear or translational forces but rather by rotational forces. Sudden acceleration-deceleration impact can produce rotational forces that affect the brain. The injury to tissue is the greatest in those areas where the density difference is the greatest. For this reason, approximately two thirds of DAI lesions occur at the gray-white matter junction. When shearing forces occur in areas of greater density differential, the axons suffer trauma; this results in edema and in axoplasmic leakage (which is most severe during the first 2 weeks following injury). The exact location of the shear-strain injury depends on the plane of rotation and is independent of the distance from the center of rotation. Conversely, the magnitude of injury depends on the following 3 factors: The distance from the center of rotation The arc of rotation The duration and intensity of the force The true extent of axonal injury typically is worse than that visualized using current imaging techniques. On the microscopic level, the axon may not be completely torn by the initial force, but the trauma still can produce focal alteration of the axoplasmic membrane, resulting in impairment of axoplasmic transport. This would lead to axoplasmic swelling, with the axon subsequently splitting into 2 pieces and a retraction ball—a pathologic hallmark of shearing injury—forming. The axon would then undergo wallerian degeneration. Dendritic restructuring might occur, with some regeneration possible in mild to moderate injury. Within the basal ganglia, the effect of DAI produces parenchymal atrophy brought on by shrinkage of astrocytes in the lateral and ventral nuclei, with sparing of the anterior and dorsomedial nuclei, the pulvinar, the centromedian nuclei, and the lateral geniculate bodies. Cholinergic neurons have been found to be slightly more susceptible to trauma than are neurons belonging to other neurotransmitters. Peripheral lesions usually are smaller than central lesions. The lesions typically are ovoid or elliptical, with the long axis parallel to the direction of the involved axonal tracts. A high association is seen between thalamic injury and DAI. Both silver staining and beta-amyloid precursor protein immunohistochemical staining have proven useful in the pathologic identification of DAI lesions. DAI was classically believed to represent a primary injury (occurring at the instant that the trauma occurred). It has become apparent, however, that the axoplasmic membrane alteration, transport impairment, and retraction ball formation may represent secondary (or delayed) components of the disease process. Frequency DAI represents approximately one half of all intra-axial traumatic lesions. Mortality/Morbidity DAI rarely results in death. As many as 90% of patients remain in a persistent vegetative state. Race No racial predilection exists. Sex No sex predilection exists. Age DAI can occur at any age. Some studies suggest that DAI may occur in utero if a pregnant woman is subjected to sufficient force. Anatomy Typically, the process is diffuse and bilateral, involving the lobar white matter at the gray-white matter interface. The corpus callosum frequently is involved, as is the dorsolateral rostral brainstem. The most commonly involved area is the frontal and temporal white matter, followed by the posterior body and splenium of the corpus callosum, as well as the caudate nuclei, thalamus, tegmentum, and internal capsule. Internal capsule lesions are associated more frequently with hemorrhage than are the other lesions and are secondary to the proximity of the lenticulostriate vessels. The following stages of involvement have been described by Adams and colleagues according to the anatomic location of the lesions4: Stage I - This involves the parasagittal regions of the frontal lobes, the periventricular temporal lobes, and, less likely, the parietal and occipital lobes, internal and external capsules, and cerebellum. Stage II - This involves the corpus callosum in addition to the white-matter areas of stage I. Stage II is observed in approximately 20% of patients. Most commonly, the posterior body and splenium are involved; however, the process is believed to advance anteriorly with increasing severity of disease. Both sides of the corpus callosum may be involved; however, involvement more frequently is unilateral and may be hemorrhagic. The involvement of the corpus callosum carries a poorer prognosis. Stage III - This involves the areas associated with stage II, with the addition of brainstem involvement. A predilection exists for the superior cerebellar peduncles, medial lemnisci, and corticospinal tracts. Clinical Details Classically, DAI has been considered a primary-type injury, with damage occurring at the time of the accident. Research has shown that another component of the injury comprises the secondary factors (or delayed component), since the axons are injured, secondary swelling occurs, and retraction bulbs form. Of patients with DAI, 80% demonstrate multiple areas of injury on computed tomography (CT) scans. The degree of microscopic injury usually is considered to be greater than that seen on diagnostic imaging, and the clinical findings reflect this point. DAI is suggested in any patient who demonstrates clinical symptoms disproportionate to his or her CT-scan findings. DAI results in instantaneous loss of consciousness, and most patients (>90%) remain in a persistent vegetative state, since brainstem function typically remains unaffected. DAI rarely causes death. Compared with patients who have an epidural hematoma, patients with DAI are less likely to have a lucid interval. There is little association between DAI and the presence of skull fractures; in addition, the existence of DAI has no bearing on whether a subarachnoid or subdural hemorrhage is present. The chance that a patient will remain in a persistent vegetative state is greater when lesions are observed in the supratentorial white matter, corpus callosum, and corona radiata. The prognosis also worsens as the number of lesions increases. For the almost 10% of patients who experience a return to any form of normal function, this improvement will be seen within the first year. DAI lesions can result in deficits in information transfer between the 2 sides of the corpus callosum, commonly resulting in auditory deficits. Preferred Examination Magnetic resonance imaging (MRI) is the preferred examination for DAI (particularly with gradient-echo sequences), although CT scanning may demonstrate findings suggestive of DAI and is more practical and available. Studies have indicated that MRI can play a role in predicting the length of coma in DAI patients. Limitations of Techniques MRI is contraindicated in patients with implanted pacemakers or certain types of metallic prostheses, as well as in patients who have metallic foreign bodies, such as bullet fragments, in their head or neck or near important vascular structures. In addition, MRI is difficult to perform on patients who have claustrophobia and on ventilator-dependent patients. Edited March 22, 2008 by Duchess Jack Quote Link to comment Share on other sites More sharing options...
rocknrobn26 Posted March 27, 2008 Share Posted March 27, 2008 PP sent. Prayers and best wishes still coming. Quote Link to comment Share on other sites More sharing options...
jaxfactor Posted March 28, 2008 Share Posted March 28, 2008 bump for Josh Quote Link to comment Share on other sites More sharing options...
seminoles Posted March 28, 2008 Share Posted March 28, 2008 They were finally able to take an MRI and it appears that he has pretty significant damage to his Hypothalamus (though it might be the corpus callosum) – it was a long phone call and the details are kind of hazy. I forget the effects by age on the hypothalamus but if it's the corpus callosum then things don't look so bright seeing as the kid is 15. My thoughts go out to him Quote Link to comment Share on other sites More sharing options...
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