The doctors say that, although there is no visible sign of seizure,
Barbara still has seizures according to the EEG. They have been
adding ativan to the keppra treatment. The ativan halts the seizures
but it is a temporary thing. After a while a seizure can cause brain
damage so they now want to give her phenobarbitol. But pheno carries
a risk of stopping breathing. Even though the dosage is less than for
a grand mal, there at her age a greater risk. If breathing stops,
they normally intubate and that carries a number of risks: damage to
vocal chords, to the throat, and worse. So they wanted my permission
to give her the pheno and ultimately to intubate if necessary. I asked
them to keep her on the ativan for the whole night and not start pheno
until the morning. I felt that, if something went wrong, there would be
better care in the daytime. (I know this may be a minor consideration
but that seemed the only way I could increase her odds.)
Yesterday, Dr. Gutin confidently said that she would be back in shape
very soon. Today, he supported the pheno treatment. On the other
hand, he is not in the seizure loop but really a bystander who knows
the players. (They have subgroups for everything there, including a
swallowing team.) So I had to make a decision on the spot and basically
followed the doctor's advice (after consulting Mimi).
I called Dr. Tao of the seizure group who is on tonight. She is hard to hear even when she is standing in front of you. She was talking about swallowing and so on but I did not get all
of her arguments. I think it is a matter of controlling the dosages and of
getting Barbara to follow the instructions for swallowing. They will follow
this closely and adjust dosages as needed. As of now, B is breathing well
and is talking better.
