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Dr. Sanjay Gupta: Still long road ahead for shark victim

Dr. Sanjay Gupta
Dr. Sanjay Gupta  


Jessie Arbogast, the 8-year-old Mississippi boy attacked by a shark last month, was released from the hospital Sunday and taken home. CNN Medical Correspondent Dr. Sanjay Gupta takes a look at what the move signifies.

Q. When the doctors decided to let Jessie Arbogast go home, did that mean he had made a dramatic improvement in his recovery? Did it mean he may be near a full recovery?

A. Oh no, not at all. What it meant is that he no longer needs the care that would require him to be in the hospital. Jessie has a long way to go to make a full neurological recovery. But his body has improved. His kidney function has improved, so he no longer needs dialysis. His breathing has improved, so he no longer needs a ventilator.

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What the doctors are saying is that the neurological care he needs he can get at home. What he will be getting at home is cognitive rehabilitation as well as physical rehabilitation. He is certainly going to need constant care. Luckily for him, his family is able and willing to provide it.

Q. The doctors refer to Jessie as being in a "light coma." Can you explain that?

A. Coma is a very general term. Doctors grade the degree on a numeric scale from 3 to 15. If you are a level three, you've shown up, you're alive, but that's it. Then the levels go up to 15, which is normal. When doctors calculate where you are on this scale, they look for three things: motor movements, verbal ability, and eye movements.

Doctors want to know if you are moving arms and legs to command. Jessie is moving his arms and legs but not on command. In terms of verbal skills, they want to see a patient speaking and making sense. Jessie speaks but he doesn't make sense. In terms of eye opening, Jessie does open his eyes and look around, but he can't do it on command.

If you are normal, you can get a command and act on it. Jessie can't receive a command and act on it. He is no where near being normal.

Q. How good are the chances he will get better?

A. His prognosis is moderate. It may be six months before we know if he is making significant progress. He may never get back to where he was.

Q. Jessie lost almost all of his blood in the shark attack. Do Jessie's neurological problems come from the fact that he lost so much blood?

A. Yes, that's a big factor in his condition. If you are normal, 15 percent of your blood flow goes to your brain. For 30 and 45 minutes following the attack, blood flow to Jessie's brain didn't happen. Doctors say after 5 or 6 minutes you have damage. When you had what he had there is certainly damage. To what extent it may take months to know, but there will at least be some.

Q. What about the arm that was bitten off by the shark and then reattached. How is it doing?

A. The arm is doing quite well. It has good blood flow, it is healing well, but what sort of function it will have will require an even longer recovery time -- 18 to 24 months. When doctors look at Jessie's arm they are trying to determine what kind of motor movements he will have. A normal person's arm, for example, understands the brain's commands to grasp with the fingers and toss the ball with the arm. The question is to what extent Jessie will be able to do any of that.

Q. Is the fact that Jessie is young work in his favor?

A. Yes, kids are lot more resilience than adults. He may have better recovery than someone who is 20 years older.






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RELATED SITES:
• Gulf Islands National Seashore
• International Shark Attack File
• Sacred Heart Children's Hospital

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