AVM and equilibrium damage

[elizabeth-bradley]

  5 weeks ago, my 68 year old mother had a hemorrhage in her cerebellum, due to an AVM.  She had surgery to remove the malformed vessels, and to remove the excess blood, and we were told that all went well.  The major effects of the bleed were speech problems, and severe balance problems in her trunk.
  The biggest problem is this, for 23 days straight now mom has had constant feelings of nausea and vomiting.  A good day is having 2 vomiting spells a day ( of approximately 12-15 gags), and a bad day is many more than that.  She has had an NG tube for 15 days nourishing her.  They are putting in a PEG tube today.  They have tried a few different anti-nausea drugs, but none help, and some make her feel worse.  The one I can think of that they've tried is phenergin, and other one staring with a "p."  They tell us that the only thing that will get her better is time, as her brain "relearns" what it means to be in balance.  However, because she is so nauseated, she cannot sit up at all on some days, and only for an hour here or there on others.  It seems like a real Catch 22.
  I guess my question is this, is there any treatment that is available for this type of balance oriented vomiting?  I am desperate to help mom feel better.  They said they expected the problem to get better slowly over 10-12 days, and it has not improved a bit.  Can you recommend anyone for me to consult with, or for me to ask her doctors to call?  The doctors at the Patricia Neal Rehabilitation Center in Knoxville where mom is are very good, but I thought as long as I have the WWW as a resource, I'd ask for your expert opinion.
  I would appreciate any help you can offer me and mom.
  Thank you very much.
  Elizabeth Bradley
  Elizabeth Bradley, Ph.D.
  IQ Health of Virginia
  Health Promotion Program Analyst
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The problems your mother is suffering are basically due to extensive damage
to the cerebellum, specifically the vestibulo-cerebellum which has very
elaborate connections with the vestibular apparatus in the inner ear.
The damage is exactly like that of any stroke, and the nerve cells will not
re-grow, I would agree that this should subside in time but with the extensive
damage that has obviously taken place this will not happen rapidly.
The treatment is like that for any stroke, time and rehabilitation, there is
nothing which can be done to substantially speed the process.
I would agree with the use of vestibular sedatives to alleviate the symptoms
in the short term and the full rabnge of these medications should be tried,
you might also consider the specific newer anti-nausea medications like
ondansetron.
It is important that she have physical therapy, but this will have to wait
until symptom control is successful and some degree of recovery is achieved.
One possible resource would be to contact a physician who specializes in
palliative care, not because your mother is in the category of terminally
ill, but because these specialists have extensive experience in dealing with
refractory nausea in cancer patients.
Once this has been achieved the next step would be to start gentle physical
therapy, this will be a long slow proces, but the brain will eventually
learn to compenasate to some degree at least and some improvement should result.
I wish you and your mother the best of luch, I hope these ideas will be of some
use in this difficult situation.