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Dr. Bob
Dr. Bob, Neurologist (MD)
Category: Neurology
Satisfied Customers: 5118
Experience:  Neurology & Int Medicine (US Trained): 20 yrs experience
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BEFORE ANSWERING QUESTION, I WOULD LIKE YOUR FULL NEUROLOGIST

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BEFORE ANSWERING QUESTION, I WOULD LIKE YOUR FULL NEUROLOGIST FULL NAME, QUALIFICATION, BOARD.

I have brain injured daughter, since 1999 , she sustained severe brain damage in 1999 as a result of a car crash , sustaining subdural hematoma which was evacuated, She suffers from small seizures. She lost her speech and movement , sometimes she is aware and sometimes she is not aware.

Her name is XXXXX XXXXX is 37 , she does communicate with blinks and thumbs referring to "yes and no" , when she is not tired.

She is fed by a peg and also she is on a slow feeding liquid pump of 75ml an hour, For the past 14 years we have managed to maintain her stability.

But from now and then she gets chest infections and is put on an anti biotic, she does sometimes suffer from constipation and is prescribed medication for her stools.

My problems starts now, As of 8 months ago she has an episode of vomiting her own feces that was managed by the clinical team at the nursing home. Since that episode my daughter has been vomiting on and off and these past 2 months she is frequently vomiting, I am very worried about my daughter as she has a very poor swallowing reflex, my daughter has to be suctioned every 5 minutes, this is how severe her reflexes are.

My daughter has a one to one care with her throughout the day to suction her , and she is left on her own with the clinical team at night where by she does not have one to one care. My daughters vomiting is being constant for the past 2 months , i have spoken to her GP within the Unit and he keeps giving her anti sick drugs to stop her being sick, this stops her being sick at that moment but give or take another day she will then be sick again. I have asked the doctor to asses why my daughter is being sick and the cause for the past 6 months it is now average where by my daughter would now be sick 3 to 4 times a week and sometimes 4 times in 1 night.

The doctor has blamed it on her head injury , then he blamed it on her nutrition , we have spoken to the nutritionist and they stated that Tizzy has been on the feed for 7 years and if she was to be sick , she would of been sick from the first day.

On the basis of what i have mentioned could you please give me an opinionated assessment on what could be the cause of my daughters sickness and how you would diagnose it as a neurologist please ? what tests would you carry etc.... please.
Submitted: 3 years ago.
Category: Neurology
Expert:  Dr. Bob replied 3 years ago.

Doctor-Bob :

Hello. Welcome to JustAnswer. I'm Doctor-Bob, an internal medicine and neurology expert. I read your post and would like to ask for a little more information to help guide you. First, did your daughter suffer any injury to her spinal cord in the car crash? Second, are her vital signs stable (e.g. temperature, blood pressure, pulse, respirations)? Third, is she having regular bowel movements, and have these changed at all during the past 8 months? Thanks for the additional information.

JACUSTOMER-qmluotl5- :

Hi doctor, No my daughter did not suffer any spinal cord injury in the car crash, How ever her right lung collapsed at the time but now is ok.

JACUSTOMER-qmluotl5- :

secondly : her vital signs vary , since her accident she has suffered from low blood pressure , her respirations can go down to 90 , and her pulse is some times higher than normal when she has pain. Temperature is ok.

Her bowel movements have always been of type diarrhea , very loose because she is on medication for her bowells and always loose stools and sometimes watery. she has always been on the medication for her bowels for 9 years now.

Doctor-Bob :

Do you feel she has been having headaches or has been otherwise uncomfortable?

JACUSTOMER-qmluotl5- :

I cant tell weather my daughter has headaches as she is brain damaged , she can make facial expressions for example when she needs to go toilet, how ever never for headache very hard to tell. This is just very unusal that she has started being sick for 8 months , and she has been brain damaged for 14 years vegetative state.

Doctor-Bob :

I think there are 2 places to look for an answer as to why your daughter is vomiting so frequently. One would be to get an MRI of the brain if not done recently. This would be to check for a change that may be causing increased intracranial pressure, which often leads to vomiting.

Doctor-Bob :

Another would be to check her medications to make sure there are none causing slowing in her bowels (what we call "ileus") which can lead to constipation as well as delayed passage of food. When this occurs, the food tends to come up instead of going down.

Doctor-Bob :

If the MRI shows no change, and no signs of increased pressures, have her doctor go over all her meds with you to see if any of them may be contributing to an ileus. Be particularly wary of any meds that were started or increased around the time this problem with the vomiting began.

JACUSTOMER-qmluotl5- :

ok thank you doctor this is very helpful, Doctor im just worried that my daughter she has a poor reflex and cannot swallow properly i am just worried incase she chokes on her own vomit, in saying this doctor she has been on medication but nothing new .. these are anti Fit drugs , , shes also on Baclofen, sometimes on anti biotics when occured a chest infection.

also on antihistamine for her allergies. Nebuliser to losen her secretion 3 times a day followed by suctionining, the care home do give her regular paracetamol to dismiss any pain that is caused to her. Doctor please do you have number or anything i could call you on if possible even if international. .. she does not have no urine catheter or any foriegn body besides the feeding peg. Doctor how often should the feeding peg be changed because shes had the same peg for 3 years . And could that cause any infection ?

Doctor-Bob :

Your concerns are totally justified. The more she vomits the more risk of aspiration into the lungs. Her doc needs to get this under better control. Changing the PEG might help so this should be done. In the end, if no apparent cause can be found, ask her doc about a trial of reglan. This is a medication that helps the stomach to empty faster and helps propel food along the path so it is less likely to come back up the esophagus. It can cut down significantly on the number of vomiting episodes.

Doctor-Bob :

I must step away for a few minutes for a conference, but I will check back with you. You can follow up with me here anytime!

JACUSTOMER-qmluotl5- :

doctor i did keep asking her doctor too and he keeps saying that to please not judge his clinical judgement and his teams where by all i have ever asked or suggested to him was maybe to change a peg and check the medication just like you said, But he always takes it in the wrong mannor and states that "i am underestimating his clinical judgement" But as a mother all he has done is give her anti sickness drug which will not solve the problem, i feel that this is a regular quick fix to stable my daughter my daughters sickness but to solve it . Fair enough if this started from the get go but after 14 years of brain damage, and only these last 8 months this has started . it makes no sense and the doctor does not want to do any further tests. Would you recommend taking my daughter to a private test clinic to check her brain activity and root cause of this sickness ? .

JACUSTOMER-qmluotl5- :

but not to solve it ***

JACUSTOMER-qmluotl5- :

also her doctor is not a neurologist , He is a general practitioner. doctor lay it to me if her doctor doesnt want to help then how can i help my daughter and what full list of things should i check to find the root cause of this sickness. no matter how much money this would be this is my daughters life. Is there any more else i can do to check interms of tests etc... ?

Doctor-Bob :

Can you get a referral to a gastroenterologist or a physical medicine and rehab specialist? (called "physiatrists" in the US, these docs are the best trained to deal with those who have suffered from traumatic brain injury) This would be worthwhile because a specialist is more likely to start at the beginning and consider all possibilities. If the specialist wants to get an MRI or a gastric emptying test, he or she can do so. If they suspect a medication they can make recommendations about changing it. This may be less threatening to her GP. But at the end of the day, so to speak, you are her mother and her advocate and have a right to ask questions, request tests, and push for a referral. If her current doc is not willing to do more, you have a right to change doctors.

Doctor-Bob :

Are you still there? There is one other suggestion for you to consider.

JACUSTOMER-qmluotl5- :

I am still here it is 02:32 AM in the UK i will deffo research on what you said and recommendations for the best outcome for my daughter. Please go ahead with your other suggestion and any other further suggestions you may have ?

I will be back in the morning as i need to sleep, thanks doctor.

Doctor-Bob :

Yes. I hope you sleep well. I'll check back with you in the AM here (it is now 6:30 PM here).

Expert:  Dr. Bob replied 3 years ago.
Hello, Houria. How's your daughter doing today? Is she still having the frequent vomiting? Please let me know if you would like to continue our conversation. I hope it has been helpful so far.
...
Regards,
Doctor-Bob
Expert:  Dr. Bob replied 3 years ago.
Hi Houria. Do you still need assistance? There was another concern I wanted to go over with you if you are still there. Please let me know. If you feel all your questions have already been answered, please consider a positive rating as this is how we get credit for the time we spend helping you.

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