Senator Tim Johnson is in trouble and should be allowed to recover as the AVM induced Intracranial Hemoorhage appears to be catastrophic..

I'm very worried about Senator Tim Johnson's condition. It sounds like he has been stabilized but he has been under pharmacological sedation for an extremely long time. After 48 hours a Neurosurgeon will want the patient to start waking up on their own. The only reason to keep a person sedated is to try and avoid elevated Intracranial Pressure due to Cerebral Edema. Several days ago at Slate.com on the KausFiles: he quotes a Physician Professor Dr. Siller from NYU Medical Center. This physician is raising his eyebrows just like I am on Senator Tim Johnson's Condition and for the same reasons!:

Just Scroll down on this KausFiles link to the Friday December 29, 2006 post:
Sen. Tim Johnson is still under sedation, and AP's report contains this alarming quote (missing from the version now posted on WaPo): Dr. Keith Siller, director of the Comprehensive Stroke Care Center at NYU Medical Center and assistant professor at the NYU School of Medicine, said it is unusual for a patient to be sedated after brain surgery for more than a few days.

"The two-week period is longer than I would be happy with," he said

Unfortunately this Senator who has provided honorable service to our Country and represented his people of South Dakota is in big trouble . However, the New Minority Republican Party needs to fight and push for a constitutionally mandated complete contingent of Senators working on the immense clear and ever present Islamic Jihad danger facing our Country. Senator Tim Johnson is not qualified to work on these problems anymore. Senator Harry "Pinkie" Reid,the Majority leader from Nevada was not honest when he said the strickened Senator spoke and looked great during the initial post operative period following the Craniotomy on this man. This Senator is in big big trouble and will more likely than not never ever be the same as his Mental Status,and Cognition has been permanently been altered. It is unfortunately true that a hemorrhagic land mine has exploded in this patriotic American's mind. It is time to let the Constitution allow for the Governor of his South Dakota State pick a person to take Johnson's place so we can deal with the problems faced by our Country. We do not need a person whose brain has had a vascular bomb go off in it acting like a rubber stamp or automaton for his party's positions when he has lost insight, is no longer cognizant and has lost his mental faculties. Here's an article which is true but in my opinion as a Brain Injury Rehabilitation Specialist is very understated.

• from Ktiv Doctor Expects 'Long Recovery' For Sen. Johnson
• A Sioux Falls neurologist says U-S Senator Tim Johnson may be in for a long recovery period from brain surgery. Doctor William Rossing bases that belief on the length of time that the senator has been sedated.
  Prolonged sedation was used to minimize swelling after emergency surgery on Johnson for bleeding in the brain.
  Rossing says recovery for someone who's been sedated as long as Johnson is likely to be "significant and lengthy."
  
  That could mean the 60-year-old politician will be in recovery for months instead of weeks.
  Rossing says it usually takes just a few days to wean a patient from sedation. Johnson has been sedated since December 13th and is being gradually weaned.
  A New York University Medical Center official also says it's unusual for a patient to be sedated for more than a few days after brain surgery.

My assessment is better targeted than this one. I deal with people who have these problems on daily basis and am not willing to candy coat this issue because this man's grave medical situation needs to be addressed by Neurosurgeons, Neurologists, Physiatrists(PM&R), allied health professionals like those on a Rehabilitation Team(Occupational, Physical and Speech Therapists.

Here is a nice review which supports my contention that Senator Tim Johnson will not be up to the task of being a United States Senator. Only 45% of patients with an AVM return to normal. The key point to consider with Johnson is that he is almost a month out and now is being weaned from sedation to avoid Brain Swelling. This is a long time to keep a person with this condition in a Pharmacological state of Neurological Limbo(Neurologically on ICE)!

• Brain a Journal Of Neurology an Oxford Journal
• A systematic review of the frequency and prognosis of arteriovenous malformations of the brain in adults
  "in another Study only 45% made a recovery without a permanent deficit (Porter et al., 1998). These findings were, however, based on hospital-based survival cohorts, and are probably subject to their inherent biases, in particular that more severe cases may not have been ascertained at presentation. Whether recurrent bleeds carry a similar morbidity is even less certain (Hartmann et al., 1998; Porter et al., 1998)"
  

Wikipedia the free and co-opt wiki (or a collaborative website whose content can be edited by anyone who has access to it) of cyberspace doesn't provide info which cast a good light on Senator Johnson's condition. It has a good and accurate listing of the probable complications. As I've indicated before the Poor Man has been put on Pharmacological Ice(medicine induced coma/sedation) because of his brain swelling which further damages the Brain. In addition to the Orthopedic Practice I am Board Certified in Rehabilitation of Orthopedic and Neurological Problems so I know this stuff very well.

From Wikipedia, the free encyclopedia:

• Hemorrhagic strokes result in tissue injury by causing compression of tissue from an expanding hematoma or hematomas. This can distort and injure tissue. In addition, the pressure may lead to a loss of blood supply to affected tissue with resulting infarction, and the blood released by brain hemorrhage appears to have direct toxic effects on brain tissue and vasculature.
  "Hemorrhagic" Stroke as any type of Stroke Rehabilitation can last anywhere from a few days to several months. Most return of function is seen in the first few days and weeks, and then improvement falls off. However, patients may continue to improve for years, regaining and strengthening abilities like writing, walking, running, and talking. Complete Recovery is unusual but not impossible. Most patients will improve to some extent.
  Disability affects 75% of stroke survivors enough to decrease their employability. Stroke can affect patients physically, mentally, emotionally, or a combination of the three. The results of stroke vary widely depending on size and location of the lesion. Dysfunctions correspond to areas in the brain that have been damaged. Some of the physical disabilities that may result from stroke include
  paralysis, numbness,
  pressure sores,
  incontinence,
  apraxia (inability to perform learned movements), difficulties carrying out daily activities, appetite loss, vision loss, and pain.
  Emotional problems resulting from stroke can result from direct damage to emotional centers in the brain or from frustration and difficulty adapting to new limitations. Post-stroke emotional difficulties include
  anxiety,
  panic attacks,
  flat affect (failure to express emotions),
  mania,
  apathy, and
  psychosis.
  30 to 50% of stroke survivors suffer post stroke depression (Post stroke depression), which is characterized by lethargy, irritability, sleep disturbances, lowered self esteem, and withdrawal.
  Emotional lability, another consequence of stroke, causes the patient to switch quickly between emotional highs and lows and to express emotions inappropriately, for instance with an excess of laughing or crying with little or no provocation. While these expressions of emotion usually correspond to the patient's actual emotions, a more severe form of emotional lability causes patients to laugh and cry pathologically, without regard to context or emotion.
  

The Political issue of Senator Tim Johnson's Senatorial seat needs to be taken care of by the Political Institutions provided for by both the federal and South Dakota Constitutions. It is a travesty of the American Constitution that the Democratic Party will push for this poor man to be their rubber stamp! The Governor of South Dakota needs to replace the Senator ASAP as we now have a new Session of the US Legislature with its members sworn in. The concerns of the country need to come first for Politicians and Tim Johnson and his family needs to focus on the long and difficult road of Neurologic Recovery as make accessible by his Doctors and Rehabilitation Specialists. He Probably will never be the same that is just a fact for the odds at his age and the length of time he has been in Pharmacological induced sedation are not optimistic signs. Furthermore there is about a 18-33% chance of a re-bleed in the first year after a subarachnoid hemorrhage due to an AVM! Considering the stress and demands associated a seat in the US Senate I think it would be wise to let this man focus on his personal life and be spared the rigors of this demanding office which could increase the baseline high probability of an intracranial re-bleed in this patriotic American. Let a new Senator be appointed to conduct the affairs of our great country while this man's brain is given time to heal without Harry "Pinkie" Reid putting pressure on him to come came to early. God's Speed to the Good Senator from South Dakota, his family and to the New Congress and Senate in our great Nation's Capital. May the Governor of South Dakota follow through with what is Constitutionally mandated regarding his state's seat which is now figuratively vacant in the US Senate. I do not think that we, the American People whould be held hostage to the tragic incapacity of a seating US Seantor. The good Senator's family could make the decision if he is incompetent at the present time. ...
Thanks for reading

Dominus Vobiscum