Vision

Part 1

While Damien was in a coma, we had no idea the condition of his vision. Here are a few experiences with determining and evaluating his ability to see after the crash.

Trauma Unit.

The first few days Damien was in the Trauma Unit; we noticed that he slept with his eyes partially open. With all his injuries, no one had been assigned to look after his eyes. About the 18th day, we noticed that he had a bright yellow substance covering the lower area of his eyes that were open - a 3-millimeter space between the eyelids of each eye. We mentioned this, but the staff was too busy to investigate. Finally, the lead nurse brought the yellow ooze to the attention of the doctor leading a group making rounds. The doctor notified the Ophthalmology Department. They visited Damien, took samples and cleaned the eyes. The samples proved that the bright yellow ooze was a bacterial colony (Staph). Studies also found that the exposed portion of Damien's eyes were becoming dehydrated. The doctors cleaned the eyes, placed an antibiotic in the eyes, placed an oily solution to protect the eye from water loss, and gently taped the eyes closed. This treatment regimen was completed after 2 or 3 weeks. They were very successful. Damien has never had eye infections again.  We asked the doctors how we could determine if Damien was able to see. They said that electrodes could be placed over the occipital lobe to determine any electrochemical activity. However, Damien's health rendered this test very low priority. It was not performed while Damien was in the trauma center.

We continue to use the recommended eye drops as a means to prevent water loss from his eyes. Damien still sleeps with his eyes partially closed. It is not all the time, but it is frequent.

Damien's attorney visited just before the nurse spoke with the doctor. His attorney was very upset about his eyes. Enough so that she wept and was agitated during her visit.

Hyperbaric Oxygen Treatment (HBOT)

By September of 1999, Damien had been moved from the trauma unit to a rehabilitation center in Austin, TX. A mother of one of Paula's students had a child who suffered a brain injury during birth (the birth took place in a hospital in another state). Her insurance was covering her child's treatment at the Neubauer Hyperbaric Clinic in Ft Lauderdale. The mother suggested we investigate HBOT as a treatment for Damien.  I called an HBOT center in San Antonio and spoke with the doctor. I asked if HBOT would benefit Damien's head injury. The doctor was very nice - but he said, "we do not know if HBOT will help a brain injury and we do not know if it will not help -so we will not do it."

  I did some research on HBOT on the internet and found a variety of opinions. AMA hates using  HBOT for all but a few very specific conditions. Many references refer to the benefits of using HBOT to treat optic lobe concerns, cerebral palsy, autism, and closed head injury. At the other end of the spectrum are the people who advocate using HBOT in a lassie faire manner: so-called oxygen bars where people can pay to breathe pure oxygen for a period of time. One must do the research, do the investigation and sift out the extremes.

During October of 1999, Paula and I visited the Neubauer Hyperbaric Center in Ft Lauderdale. Earlier, we had sent Dr Neubauer a video tape of Damien as requested. We interviewed Dr Neubauer and visited the center's facilities. We also discussed treatment with other parents in the room waiting for their child to complete that day's treatment. The parents were from several geographic locations: several states, London, Sydney, and Jerusalem.  Networking is very important. Our discussions with the parents gave us insight into which therapies worked, where the therapies were located, their observed results of the therapies, and finally the cost of the therapies.  During our last interview, Dr Neubauer stated "I cannot guarantee HBOT will help, but I can guarantee that it will not hurt."

Damien started HBOT on 29 Nov 1999. He received 100% oxygen at 1.5 atmospheres for one hour. He had 2 HBOT sessions daily: one early in the morning and the other late in the afternoon. We scheduled Damien to receive 40 treatments at that time.

I was very fortunate because my employer, The Psychological Corporation, permitted me to work from Ft Lauderdale. I leased a small apartment at Lauderdale Towers (the bed pulled out of the wall for use). I bought a fax machine, a laptop and a printer so I could communicate with the office in San Antonio. Damien was a resident at a very good convalescence home, Manor Pines. The staff was very good. He received great care and was able to get upright in a standing frame during physical therapy.

Dr Neubauer's theory was that during a head impaction, some brain cells are traumatized and stop absorbing oxygen. If oxygen can be added to these cells, then these cells will start to regain functioning.  One way to determine this is by taking a SPECT scan before and after a series of HBOT sessions. During this procedure, a dye with radioactive markers is injected into the patient's blood. After a period of time, a computer-controlled series of cortex  x-rays are recorded. Damien's first SPEC brain image had the appearance of Swiss cheese- several areas of the brain were not functioning and therefore did not absorb the dye. One of the largest areas of traumatized cells was in the occipital lobe.  We were very excited with Damien's second SPECT scan - none of the occipital cortex had blank areas (holes in the image). We continued HBOT until March 2000 when we returned home.

A Canadian study published in The Lancelet, vol. 357, 24 Feb 2001 [Hyperbaric Oxygenation for Children with Cerebral Palsy] was unprofessional and disappointing. The researchers were investigating the use of HBOT in treating cerebral palsy. It was a flawed design because their control group was not a true control group. A control group is exposed to ALL the conditions as the experimental group EXCEPT for the experimental variable. The experimental variable in their study was pressurized oxygen. The control group in this study was exposed to "compressed air" similar to that of scuba tanks. This air is partially pressurized. A true control group would be exposed to all the same chamber conditions as the experimental group but have the air at normal pressure.

The results showed that the experimental group made a significant level of improvement on the test administered before and after the treatment. Their control group (they even refer it to a "sham group") made improvements but to a lesser degree. Obviously, such results indicated that test results improved because both groups were subjected to pressurized oxygen. However, the government sponsored medical director ruled that the results indicate that the Hawthorne Effect was responsible for the outcome - therefore, the government would NOT continue to treat cerebral palsy patients with HBOT. This was devastating to the parents of cerebral palsy children in Canada. The state sponsored conclusion was more to benefit the budget of the governmental medical program than any wish to help cerebral palsy children.

By -the-way, The Hawthorne Effect means that the subjects made improvements only because they were participants in an experiment. As more support for my statements: while stationed in the Radiobiological Division at Brooks Air Force Base, TX, I was a member of a team investigating how protective certain drugs were against radiation. Our control groups were subject to the same conditions: mechanical, location, time, radiation levels, transportation, and housing as the experimental group. The only condition the control group did not receive was the drug.

Dr Neubauer submitted an answer to the article in The Lancet, vol. 357, No. 9273, 23 June 2001.The Canadian author failed to address Dr Neubauer's concerns in his reply. Rather, he just restated the government's conclusion.

One footnote about HBOT and the occipital lobe.

In September (about 2001), a Miami policeman was working in his wife's garden and was struck by lightning. This left the officer blind. Because it was an accident at home rather than job related, he had problems with insurance. Dr Neubauer interviewed the officer and suggested HBOT treatment. The officer was treated 2x a day with 100% oxygen at 1.5 atmospheres for an hour session. I was there for Damien's treatment in December of that year. The officer had regained his vision and they were holding a press conference. The officer explained the exact day he knew he could see again. He was in the chamber and became aware of a screw in the chamber top. By February, the officer was back at work - desk work at that time. If you see the newscast, I am at the back of the room reading a Jean Auel novel.

After getting Damien home from his first series of HBOT, we decided to see if his vision was really working. When sitting before a TV, he did appear to watch. but we did not know if he was seeing the images or responding to the sound. Therefore, we made an appointment with a vision specialist in San Antonio. That encounter will be the next blog.