AboutHillarie Speziale Expertise I can answer general questions about ICU care, the frequently used medications, procedures, and life supports. I can also explain many of the diagnoses and supportive measures used for patients with that particular illness. I am familiar with the infectious, cardiac, pulmonary, renal, and gastric problems that can land you in the ICU. I can not tell you exactly how long the patient stay will be, diagnosis your symptoms, or tell you with any certainty that the care you (or your loved one) received was wrong. I can also answer career questions regarding RRT and RN fields. Please note: neurology is not a field I have a great deal of familiarity with..
Experience I have 17 yrs experience as a Respiratory Therapist, and 9 yrs as a critical care nurse. I am familiar with infectious, cardiac, respiratory, renal and gastric diagnoses that can land you in the ICU.
Education/Credentials Assoc. Degree in Respiratory Therapy, Bachelor of Science in Nursing, Master of science in psychiatric nurse practitioning.
Expert: Hillarie Speziale Date: 1/19/2008 Subject: Severe Hypothermia Recovery
Question QUESTION: A 57 year old male friend of mine was sick with flue and collapsed unclothed in his home from diabetic shock. He was discovered 5 days later. The temp of the house was 42F and his body temp was around 80F. He was in a coma for nearly a week and is now experiencing slight short term memory loss. The doctors have been very vague as to what long term effects this might have on him. He was found and hospitalized 10 days ago and still cannot urinate on his own, is in constant pain and has swelling in his feet. Prior to this "accident" he is a binge drinker, didn't know about his diabetes but had been throwing clots in his legs and feet, had prostrate troubles or erectile disfunction (undiagnosed) and was found with alcohol, cold medicine and prescription drugs in his system. Can you give me an idea of what long term effects we will be facing as he moves into recovery?
ANSWER: Hi Joanne, I'm afraid I don't have a lot of answers for you. I'm amazed he is as intact neurologically as he is. It would not have been surprising for him to have thrown emboli to his head as well. I have seen people with his issues recover completely, while others have never cleared neurologically.
I am unclear as to the nature of his pain. Is it secondary to neuropathy (nerve damage) of his legs from untreated diabetes? This is a very difficult pain to treat. Is it related to ischemia, poor circulation, in his legs? If that's the case they may elect to do surgery once he is more stable. Did he end up with pressure ulcers from his long stay on the floor and poor circulation? These can gradually improve with the proper hydration, position changes, and good skin care.
Separate from all of these, is the question of whether he will be able to remain sober if he does get home.
Often the reason physicians are vague is because there simply are no clear cut answers. There are so many individual factors for each and everyone of us, that it's very difficult to predict with any certainty how each of us would fare even if we were all struck with the exact same illness.
I realize this was a long time in coming. I apologize for that. I'm currently working 6 days out of 7 so it becomes difficult to find enough time.
Good luck to you. I hope your friend continues to make steady progress. Take care, Hillarie
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QUESTION: Thank you for taking the time to answer, I really appreciate it. I know the pain is in his legs and buttocks primarily but is also throughout the rest of his muscles. He is now experiencing some trouble with vision that he hadn't mentioned before. He is also having trouble with short-term memory loss. His heart is constantly monitored. We have been told he may have bladder atony? I'm not sure I spelled that right but they expect to move him in the next week or so to begin physical rehabilitation. I don't know most of the answers to the rest of your questions as the family is limiting his visits and information they give out to keep his employer from getting too much information. Thanks again for taking the time to answer.
Joanne
Answer Hello again Joanne,
It sounds as if the pain is related to the rhabdomyolysis he had initially. Although you don't mention it, he had significant risks for this and I have to believe he came in with it. A primary risk is a sustained period of immobilization, which would be the time he spent on the floor. In addition, diabetic coma related to type II diabetes, hypothermia, and alcohol abuse also increase the risk of developing this. It is a breakdown of the muscle cells and release of the cellular components into the body. It results, among other things, in muscle pain and renal failure. Depending on the severity of the muscle break down, fibrosis may occur, laying down scar tissue in the muscle. This is most likely the cause of his back and leg pain.
Bladder atony, a failure of the bladder to empty properly, can be a result of either obstruction of the bladder outlet or from problems with the bladder muscle itself. Prostate enlargement is a common cause of bladder outlet obstruction. Problems with the bladder muscle may be a result of diabetic neuropathy or Vitamin B deficiency. Alcoholism frequently leads to Vitamin B12 deficiency.
A good rehab facility can do amazing things. Hopefully they will be able to give him his life back and more. Especially if they can help him with his addiction. Continue pulling for him. I'm sure he can use all the friends he has right now.
Sincerely, Hillarie
