Prognosis of Capt Shakeel Mohbul Haque-25 batch

Date: Fri, 30 Apr 2010 22:05:28 -0400
To: “Dilwar Ali” <[email protected]>
From: Ghulam Suhrawardi <[email protected]>
Subject: Fwd: RE: A friend in Australia – in coma

My dear Dilwar:

Please take a note of the explanation as received from a young neurologist from USA.
She is the daughter of a friend of our family. Pue is same age as my middle daughter Saira.
They played and socialized together.

Her explanation seems to the point even though it may not yield much hope.

Best regards
GMS

Date: Fri, 30 Apr 2010 22:01:26 -0400
To: Pue Farooque <[email protected]>
From: Ghulam Suhrawardi <[email protected]>
Subject: RE: A friend in Australia – in coma

Dear Pue:

I don’t know how to thank you. It is such a pleasure to see that you have grown up to be a person advising us in such an eloquent language makes me so proud.
Your explanation definitely makes sense and the family must act accordingly.

On behalf of my friends and their families, I thank you for the advice or information.

You are someone I am proud of. God bless you and give you all the happiness.
All the best.

Your uncle
Suhrawatrdi

At 08:54 PM 4/30/2010, you wrote:

Hi Suhrawardi Uncle-

It was nice to see you last weekend as well.

Im sorry to hear about your friend.  After reading the letter, the best prognosis that I forsee for him at this stage would be persistent vegetative state which means that he will need to be mechanically ventilated(meaning he will need a surgical procedure called tracheostomy and ventilator in order to breathe) and a PEG tube(feeding tube).  He will have no consciousness or awareness of his surroundings, ability to communicate or any verbal or motor ability at this point.  The fact that he was found down, no one knows exactly how long his heart stopped pumping blood to his brain and then subsequently it took 20minutes to get a heart rhythm back, meaning he was not receiving blood/oxygen to his brain for over 20minutes.  After 5 minutes brain cells can not survive without oxygen.  He suffers now from severe hypoxic injury to his brain and for that there is no cure or return.  The cooling method mentioned in the letter is relatively new and still somewhat experimental in some of its stages, however it has been shown beneficial in patients that have suffered cardiac arrest that have been converted back to a normal rhythm rather quickly and in slowing down or stopping hypoxic injury in the brain, in cases where there is still viable tissue, meaning tissue that was not entirely deprived of oxygen for prolonged time.

At this point in time he is not brain dead as he has the most basic reflexes the brain stem possesses as well as extensor response or decorticate posturing to stimulation which is another basic reflex.  However if there is no purposeful motor movements seen within the first 24-48hrs after insult then the probability of that function returning is extremely low.  An EEG done is just a 20minute study, but as there was no evidence of active seizures or that there is excitability within the brain to produce seizures, suggests that an underlying condition such as seizures is not masking the exam and that he is functioning at a primitive level of the brainstem at this point.

The probability of him returning to his life prior to this event or even to his life with some deficits such as weakness or speech difficulties is almost nil.  In times like this it is the familys beliefs and decisions that dictate medical care.  If they wish to continue keeping him alive, then it will all be done mechanically with ventilator and being fed with a feeding tube.  There is potential from infection, and complications. However if they wish to withdraw care then he can pass away peacefully in a comatose state.  Everyones belief system is different and is their own, but if this were me or my family member I would choose to withdraw care; as it is more suffering to remain alive mechanically.  Also it is important to know his wishes for how he saw his life ending and what he wanted for himself.

I hope what I wrote was helpful and provides you and his family with some insight.  If you have anymore questions please feel free to email me again or you can call me at 732-995-1639.

Im sorry again about your friend, it is at these times you realize how precious and short lived life is.

All the best to you and I hope you are doing well.  I look forward to seeing you again.

Pue

Date: Fri, 30 Apr 2010 11:10:53 -0400
To: [email protected]
From: [email protected]
Subject: A friend in Australia – in coma

Dear Pue:

Greetings.
It was a pleasure seeing you that evening; even for a small moment. Hope
you are doing well.

A alumni of the Marine Academy has suffered a stroke. Attached please find
his diagnosis. They are trying to get
as much advice as possible from friends all over the world regarding his
neurological condition.

See if you can give some advice; if it falls under your expertise. It will
be just an advice. No one will hold you responsible for it.

It would be greatly appreciated.

All the best to you.

Best regards

Ghulam M. Suhrawardi, President & CEO
NMCI Group
National Marine Consultants, Inc.
236 Ernston Road, Parlin, NJ 08859, U.S.A.
Tel +1 732 553 9210 (ext 221), Fax +1 732 553 9215
Website: www.nmcigroup.com