Liesl Update

MOVING THE BLOG

2008-08-24T20:39:00.002-05:00

Dear Family and Friends,

We are moving Liesl's Updates to a site specially designed for our situation. I hope you will find it cool for several reasons:

(1) You can click on a box at the top of the Journal that makes it so that each time a Journal Entry is posted, you will receive an automatic email to let you know.

(2) You can sign the Guestbook without having to sign in to become a "blogger". Many, many people have email to tell me that they were frustrated at being unable to successfully post a blog comment. So I hope this is a good solution.

To see the new site, go here: http://www.caringbridge.org/visit/liesl

Note that I have copied and pasted all previous blog posts and everyone's comments directly into the Journal on the new site. (In the future, you can just post your comments in the Guestbook.)

A special THANK YOU to Brigette Schutzman who put me onto this new site.

Sun Aug 24 --7:30 PM

2008-08-24T19:22:00.003-05:00

The most recent CT scan showed nothing new. After the CT scan this morning, Liesl returned to her room and shortly thereafter, her left eye (the reactive one) returned to the condition is had been in all week (i.e, the dilation was not so great). Also, she stopped twitching so much. The doctors elevated her legs and she seems to be more comfortable.

Leigh reports that she looks peaceful and calm. He is letting her rest but will speak to hospital staff late tonight. If there are any changes, we'll post here again. If not, we'll post tomorrow.

I need to make a correction to the explanation of the Glasgow scale used to rate coma patients. Each of the three areas (eyes, verbal, motor) does not get equal weight. Eyes get 4 points, verbal gets 5 points, and motor skills get 6 points. See http://en.wikipedia.org/wiki/Glasgow_Coma_Scale for more information.

Sun Aug 24 --10:50 AM

2008-08-24T10:48:00.002-05:00

Several of you have asked about rating Liesl's coma on the Glasgow Scale, so Leigh asked the doctor yesterday about this. The scale goes from 3 to 15, with 3 being the lowest score. Note, you cannot get a "0", and a fully-functioning person would get a 15. It is broken into three ratings, each with a scale from 1 to 5. The areas are Auditory, Visual, and Motor Skills.

Liesl has a 1 on auditory and visual scales, and a 3 on motor skills, for a total of 5. She probably came to the hospital after the crash with a 3 or 4 total score.

This morning, Liesl's left eye is still reactive, but it is dilated. Also, she is twitching a bit. The doctor says there is no cause for concern but they did just take her for a cat scan about 15 minutes ago. S0 we are awaiting those results.

We continue to be full of gratitude for all of the prayers and other support that has poured in over these two weeks. Please don't stop those prayers now, as we need them as much as ever.

Sat Aug 23 --11:15 AM

2008-08-23T11:14:00.002-05:00

Leigh was thinking that all of her hand movements in recent days have been what we might call "purposeful movements" but talking with the nurses has clarified this. What they tell us is that she is not "extending" in her posturing, but she is realy still "posturing". What she has been doing in recent days is called "flexion posturing" or "decorticate posturing". (See http://www.nlm.nih.gov/medlineplus/ency/article/003300.htm) It is better than the extending she ws doing initially, but is not really considered "purposeful movement".

On the other hand, the nurse did say that while she was working with Liesl's head, Liesl moved her head away from the nurse. When the nurse moved to the other side, Liesl moved her head away agin. The nurse does consider this to be purposeful movement.

Her temperature is 99.8 – possibly urinary or yeast infection and they are working on that.

The nurse said today that clinically, Liesl seems worse than the actual injury would suggest she should be. That is, based on MRI’s, they would think that at this point, Liesl would be doing a bit better.

I wish I had more and better news to report. Her father will be with her every time he is allowed to visit today and we will post on this site again as soon as possible.

Fri Aug 22 --7:30 PM

2008-08-22T19:33:00.001-05:00

There are no changes to report tonight. Leigh will go see Liesl again in the morning.

Fri Aug 22 --1:30 PM

2008-08-22T13:26:00.002-05:00

While she is still unconscious, sometime between 9 and 10 this morning, Liesl opened her left eye completely. Since then, she has not done so again. However, her hands are moving more today than yesterday.

Her temperature is about 99.8 - 100. Her blood pressure is 88 - 135 BPM. The nurses noted that when her father eneters the room and speaks to her, her heart rate slows a bit, as if she is calmer when he is present.

She may be moved to another room today for neurological testing.

Leigh will visit her again and report back after 4 this afternoon. Meantime, I am working on this end to secure a place for Liesl here in Memphis as soon as possible.

Please keep those prayers coming!

Contact Information for Liesl

2008-08-21T11:46:00.003-05:00

Many of Liesl's friends from all over have been trying to call her cell phone and leave text or voice messages. I think her SIM card is completely full of messages at this point! Her phone is on my desk, but I want to respect her privacy and not fool with her phone. Her computer is also her at home, but again, it seems like an invasion of her privacy for me to turn it on.

So you can send email to her address or even to mine. Hopefully she will be up to reading them very soon. As an alternative, you might want to send your cards and messages for Liesl to our home address:

Liesl K Becker
c/o Leigh and Lynne Marie Becker
7250 Abercrombie Lane
Memphis TN 38119

I would anticipate that Liesl will be back in Memphis within the next week or two. As soon as she is able, we will be sure to give her all of the messages she has received by email or snail mail.

Should you need other information or need to talk to me, pop an email to lmbecker@brainiactutoring.net and I will get in touch with you as soon as I possibly can.

Thanks, everyone!

Lynne Marie (Liesl's Mom)

Thur Aug 21 --11:45 AM

2008-08-21T11:40:00.002-05:00

Liesl is still not awake. Her eyes are completely closed today, but she is still moving around quite a bit, as if she is trying to find a comfortable position. Both hands and both legs are moving.

Her basic stats are fine, although she still has a temperature around 100-101. Her heart rate is still up a bit, but she is young and strong and the doctors do not seem too concerned.

The tube to drain excess fluid from her brain has been removed completely and so they had to shave a little hair so that they could stich up the wound.

She is as beautiful as ever.

Her father read "Peter Pan" to her this morning.

Wed Aug 20 -- 9:45 PM

2008-08-20T21:39:00.002-05:00

Liesl's left eye is slightly open - perhaps a 16th of an inch. Her right eye is still dilated.

She is moving a bit tonight - her hands especially, but also her legs at times. The nurses said it sort of looks like she is moving to try to get comfortable.

Her ICP is fine; her heart rate fluctuates but the nurses are vigilant and make sure she is fine. She does not appear to be in pain or distress. This morning, her color was not as good in her face, but it has returned this evening.

The nurses are going to try to get her back into a circadian rhythm by turning out the lights at 10 PM (yeah - right - when is the last time LIESL WENT TO BED AT 10 PM? YOU SLU GIRLS AND MEMPHIS FRIENDS KNOW THAT'S JUST CRAZY!) In the morning they will turn on lights and a television a bit to try to get her into a good sleep pattern. Research indicates that this procedure does help patients.

Thank you all for the lovely emails, calls, and prayers for Liesl. Our family is sustained by your love, and I know Liesl will be strengthed when she awakens and sees all of your messages here on the blog and also those we have recieved by mail and email.

Wed Aug 20 --7 PM

2008-08-20T18:52:00.002-05:00

Leigh writes tonight:

During the visitation hours from 4:00PM to 4:30PM, I observed that the forefinger and thumb on Liesl's left hand were crossed and that the right hand seemed more relaxed. When I mentioned this to her nurse (Christi) today, she said that Liesl had been moving her arms a bit.

This morning when I visited her at 10:00 AM, Liesl had been removed from her bed and put in what I can best describe as a hospital version of a chaise longue for want of the correct term. She has been in this reclining chair all day. Christi said this is good for her since she has been in the bed since the accident of August 10.

Her temperature hovers around 100.2 degrees F. ICP varies from 15 to 26 mm Hg. Blood pressure: 127/78. The ECG registers around 110 bpm but there are times when it climbs to 152 bpm. Christi observed this happens when she starts moving.

At 2:00PM as I was telling her about an email I received from one of her many friends and how much her friend said she loves and misses her, Liesl's eyelids flickered several times.

Finally Dr. Raul Cardenas mentioned about possibly removing her EVD (external ventricular drain) soon. After seeing her around 3 PM, he happened to see me in the hallway and said, "Hang in there; it looks good."

Wed Aug 20 --12:30 PM

2008-08-20T12:20:00.003-05:00

Hello friends and family.

No real news to report.

Liesl is resting quietly and is pretty still this morning. Her vital statistics are good (temp 99.6, ICP 14, BP around 112/65). She continues to breathe on her own. No sedatives are being used.

Her father will visit with her again this afternoon as soon as they let him in to see her and we will write again later this evening.

Thank you for your continued prayers.

Tues Aug 19 --9:30 PM

2008-08-19T21:23:00.002-05:00

Leigh was just with Liesl a few moments ago. While he was there, he saw several signs of movement - including two big yawns and somewhat consistent movement of her left thumb.

Her temperature is around 100, and they have been working to keep her heart rate stable, as it has been bouncing between 111 and 152 throughout the day, perhaps due to being weaned from the sedatives.

From what we understand, it seems that he "intravascular fluids were low", so she was given a Bolus (from Wikipedia: "In medicine, a bolus (from Latin bolus, ball) is the administration of a medication, drug or other compound that is given to raise blood concentration to an effective level. The administration can be given intravenously, by intramuscular or subcutaneous injection.)

The timefrane on her move to Memphis is the question on everyone's mind, and to clarify, it appears that it will be at least 10 days before that move can happen. We sure look forward to that day!

Tues Aug 19 --5:45 PM

2008-08-19T17:38:00.004-05:00

More good news! Dr. Cardenas looked at Liesl's latest MRIs from various angles and concluded that the contusions are decreasing. He said he "expects her to come around".

The drains in her head that are in place to drain fluid in case of pressure bukld-up have been clamped. Her ICP is good, so they expect to be able to remove the drain altogether soon. At that point, Liesl can be moved to a facility in Memphis. This should happen fairly soon - perhaps in the next two weeks.

Color has returned to her cheeks!

She is moving her left hand and head spontaneously!

KEEP THOSE PRAYERS COMING! We are all ready to have our Liesl wake up for us!

Tues Aug 19 -- 2:15 PM

2008-08-19T14:16:00.002-05:00

The nurse today continues to provide some small signs of encouragement to us. Here is the news right now:

(1) Liesl is off of the ventilator entirely. This is great news. She is instead, on a t-piece. As in the previous blog post, this means that she has the trach tube in place, as a precaution. However, the nurse indicates that Liesl continues to initiate her owns breaths. Once in a while, they "push" a bit to open up her lungs. I asked if Liesl's initiation of the breathing is a neurological improvement over when she first came to the hospital and she said "Why, of course!".

(2) Another good sign is that her left side is now slightly responsive to the tests for "reaction". She had been "extending" but is now starting to try to "localize". (You nurses out there can add comments to clarify this if you like.)

(3) She is still not opening her eyes or making any spontaneous movements (for example, she does not scratch herself, etc) but they are continuing to wean from the light sedation, so hopefully, we can report improvement in coming days.

Tues Aug 19 -- 9:15 AM

2008-08-19T09:13:00.003-05:00

Erine (Leighton's father-in-law) just left the hospital with some positve news this morning. Liesl is breathing on her own. She is getting the lowest dose of oxygen going in via trach as a precaution. The doctors are weaning her off sedation to see how she will react. She does continue to have a low grade fever, but the doctor's seem to have this under control.

Although this is very good news, please remember to be cautiously optimistic. Liesl still needs your good thoughts and prayers. It has meant so much to the family to know that so many people know and love Liesl.

Mon Aug 18 -- 8 PM

2008-08-18T19:54:00.002-05:00

Sorry for this late posting. It has been a long and busy day here.

Liesl's condition is essentially unchanged since yesterday. The doctors decided however, that the breathing tube inserted via her throat needs to be removed because generally they like to have them out in 2 weeks or less. She has been coughing and gagging sometimes, and it is quite uncomfortable.

So they removed the breathing tube and instead inserted a Tracheotomy tube. Also, the doctors changed the method by which they are providing nutrition to her by inserted a feeding tube through her abdomin.

Regarding possible visits to Liesl - the visiting hours are extremely limited and the number of persons allowed at one time is limited to 2 people. Of course, an immediate family member should be present for each visit. Usually, two family members go in together. In addition, doctors want to limit Liesl's exposure to not only germs but also to potential excitement. She needs rest more than anything right now. So while the desire that many of you have expressed in wanting to visit Liesl is very deeply appreciated, please wait for now.

Liesl is likely to be moved to a new location soon (not sure when?), but once she is able to receive visitors, we promise to let you know right away!

Sun Aug 17 2008 - 9:30 PM

2008-08-17T21:25:00.002-05:00

While there is not much news to report tonight, we are pleased that Liesl has repeated the response to the nurse's tests of her reactions. The movements in her right arm are not big ones, but they are headed in the right direction.

Note the Gospel reading this morning was Matthew 15: 21-28, the last fews lines of which are:

Then Jesus said to her in reply: "Woman, great is your faith! Let it be done for you as you wish." And the woman's daughter was healed from that hour.

We all remain steadfast in belief that Liesl will be healed.

Sat Aug 16, 2008 - 8:45 PM

2008-08-16T20:42:00.006-05:00

Leighton just called and indicated that one side of Liesl's body appears to be looser and more relaxed than the other.

She is still posturing on one side - but the other side has shown a small sign of progress tonight. We have been cautioned not to get too excited, because this is indeed a small change. But of course, it is good news:

The nurse says that one time today when he pinched Liesl to check her reactions, her response was different. In the past when they tested her reactions, she "postured" (turned her arms outward and/or clenched her fists). In this case today, when they tested her one side, she exhibited a slight movement of her arm towards the point of pain. This is what she is supposed to do. This is good.

The other news of the evening is that she may have picked up a slight staph infection. They are treating it, and watching carefully, of course.

The medication for ICP (pressure on the brain) is being used a bit more tonight not because her ICP is high but because they want to keep her calm and relaxed.

Sat Aug 16 - Brief Family Update

2008-08-16T15:53:00.003-05:00

Leigh should be home in the next few hours so that he can be here for Lily's 4th Birthday Party tomorrow evening. Lily Catherine will be very excited to see her Daddy. Both little girls have missed their Papa terribly.

Leigh plans to return to Liesl's side on Monday. In the meantime, Leighton, Terra Leigh, and Ernie will continue to visit with her and tend to her.

More information will be posted as it becomes available.

We continue to thank God for all of your cards, notes, gifts, support, and prayers!

Sat Aug 16, 2008 --11 AM

2008-08-16T11:14:00.005-05:00

Overall, as we near the end of this week since this crash, Liesl's condition is essentially unchanged. Neurologically, she is the same today as she was when she arrived at the hospital.

When Leigh entered this morning, the ICP (which needs to be below 20) had spiked to 36. He called the nurse in, who indicated that it was ok because it would drop back into the teens, which it did.

Dr. Chittiboina came in and spoke to Leigh this morning. Here is what they talked about:

(1) Her left eye is still reactive (3 - 5 - maybe one of you nurses can tell us what that means exactly); but her right eye is still dilated (7-10). The right eye may have nerve damage or perhaps pressure on it. Not sure.

(2) There is a CPP number which should be above 60. It has to do with the flow of sucrose and blood in the brain. Liesl's CPP has been in the mid-60s and up to 70. So that seems good.

(3) Her temperature is about 99.5, still a slight fever. They got the results of a lung culture, and perhaps that is the cause of the temperature. Again, not sure. But she is on antibiotics.

(4) The basic stats (other than that pesky temperature) are all good - stuff like blood pressure, heart rate, etc.

(5) A drug called propofol is being used to lightly sedate her. If an uninjured person were on this drug at this dose, they would likely remain awake. (No need for such heavey sedation since she is no longer in need of the cooling blankets.)

(5) For clarification - the only structural damage appears to be at the brain stem (not the cortex), where there are two contusions. There appears to be no structural damage to Liesl's brain. But the function of the brain is an unknown. The best tool we have for monitoring her is the EEG, which shows no signs of seizures or other problems.

Several people have asked about the results of the most recent CAT Scan. I did not get any information so I assume there is nothing to report, but I will check with Leigh.

Fri Aug 15, 2008 --5 PM

2008-08-15T17:04:00.003-05:00

Feast of the Assumption of The Blessed Mother

There are no changes to report in Liesl's condition. It was a peaceful day for Liesl. Leigh describes her as looking like "a beautiful sleeping angel". Her ICP (pressure on her brain) is in the normal parameters, as are her temperature and blood pressure and other vital stats.

We received a copy of the Accident Report from the Bossier City Sheriff's Department today and one thing it indicates it that when the first responders first got to Liesl at the scene, she was still breathing. This is a relief for us to know that she has not had a stoppage of oxygen to her brain. It is indeed a miracle to us that when the crash occured, there were two off-duty detectives who witnessed the whole thing and who immediately responded to her and to the other driver.

By the way, the other driver is an elderly man named Oscar. We are unsure of the extent of his injuries, but had been told that he sustained broken bones (pelvic? hip?). Please add Oscar and his family to your prayers.

Leigh, Lexi, Lily and I want to thank the dozens of people who have prayed, written, called, brought food, and responded to all of our needs in these past few days. We have heard from our family in NC, TN, MO, AZ, FL, GA, WA, and others, as well as from friends and family from Sacred Heart Church, Holy Spirit Church, The Poor Clare Sisteers of Memphis and Guatamala, St Agnes Academy/St Dominic School, St Louis University (especially Liesl's Delta Gamma Sisters!), Kansas State University, the Bishop of Memphis, and Christian Brothers University. We are grateful and we are confident that God is hearing our chorus of voices. Thank you, all!

Thur Aug 14 --10 PM

2008-08-15T06:12:00.002-05:00

Leigh wrote this late on August 14 after visiting with Liesl:

Liesl had a new nurse tonight named Adam. Her temperature went up again starting about 3PM this afternoon. They put in new lines in case she was getting a bacteria infection from the old ones and had ordered antibiotics.

On the other hand, Adam says that in his experience some patients exhibit a circadian rhythm in temperature. When I left at 9 PM, the cooling blankets had brought her temperature back down to 100 deg.

Her ICP was around 12 mm Hg, which is good (above 20 is cause for concern). I asked Adam if she had started moving her limbs yet. The answer is still no. However he said she is heavily sedated while on the cooling blankets for otherwise she would feel as if she were on a block of
ice.

She had another CAT scan this morning but Adam did not have the result of that.

In a nutshell, Adam says her condition is unchanged since yesterday.

Thur Aug 14 --10 AM

2008-08-14T11:10:00.005-05:00

Liesl is making small progress this morning. The cooling blankets are completely removed and her temperature remains normal. She has reduced her "posturing", which is also a good sign. Her ICP is at 12 (normal). The physical therapist was sent to see her this morning. Not sure what that means, but it cannot be bad, right?

She is continuing to breathe ok with the vent; however, the doctor increased the quantity of pushes from the vent so as to help push CO2 out of her body.

More as soon as we have more information.

Wed Aug 13 --10 PM

2008-08-13T21:54:00.001-05:00

Leigh and Leighton (Liesl's father and brother) just returned from seeing Liesl. Good news, in general:

First, Liesl's temperature is down to 98.2. The cooling blanket underneath her is still in place, but the blanket on top is now pulled back.

Second, her inner cranial pressure (ICP) is also down within normal parameters. The medication is working.

Third, she is "breathing over the vent" meaning that Liesl is able to breath at least a little bit on her own. The ventilator is pushing perhaps 14 breaths per minute and she is breathing at more like 20 per minute, so some of that is her own work.

Her heart rate is good and blood pressure is normal at 126/73.

An area of concern is that although her left eye is reactive, her right eye is still dilated, as it has been since the crash.

Right now, she needs to remain calm. Many people have asked about visiting Liesl but right now she needs to have limited stimulation - and hospital rules would not permit visits at this time.

When her father discussed her situation in front of her, her heart rate went up. (So he will not do that again!) For now, he continues to whisper in her ear how much she is loved by her family, her DG sisters, and all of her friends - especially in Memphis and St Louis.

Keep praying. Keep praying, all. God will surely hear our prayers for our Dear Liesl.

Wed Aug 13 -- 3 PM

2008-08-13T15:00:00.001-05:00

Liesl is still unconscious. Today they were still trying to control her brain pressure; it was 26. It should be below 20. To control it, they give her a drug called Manitol and drain the CSF fluid from her brain.

Her EEG was good in that it was negative for seizures. But she had a temperature that started last night. They covered her with special blankets and had a fan on her to lower her temperature. When Leighton and I left at 1:00 AM, her temperature was decreasing but was still at 102. She is still posturing which is not good. Her nurse and one of her doctors (Dr. Wadhwa) are still uncertain whether she will recover or not. I heard from Graham (her nurse today) that Dr. Cardenas had found more contusions in her brain stem. Dr. Wadhwa says there is hope but that there is no way of knowing what will happen.