astrocytoma Grade 2

[pedsmd]

Hi my father was diagnosed with Astrocytoma grade 2 3 weeks back. he is 73 yrs old. underwent a craniotomy, they did subtotal resection of the tumor which was around 5x7cm in size in the left temporal region.  He toleratedd the procedure well, came out of surgery well. But 4 days s/p surgery when we got him out of bed he kind of collapsed, 1-2 sec episode of ? seizure. Then he became very weak, though he was moving all his limbs well. We got him home last weeek, and he is very sleepy, he now does not even tell when he has to go to the bathroom. He sleeps all day, he eats, he has good strength he is moving all parts of his body but he is in this sedated state. he is on Dilantin 300mg qhs, they increased dexa to 4mg q8.They repeated CT this morning and it says the edema has reduced. But his mental status is unchanged...the doctors do not have an answer to how come he was fine 4 days s/p surgery then  slowly his mental status detiorated while his CT looks better. Please help!!!

[rumpled]

Depending on the doses... he may not feel so hot on those therapies so have patience with him.
Hang in there...

[pedsmd]

thanks for u r response rumpled...u r so good....I cannot thank u enough.
No he is not on sterroids. I think he is going through different phases, as if his brain is trying to reconnect. These days he has just gotten quiet...he maybe getting more depressed as he is getting more realization for what has happened!!!
He is due to start RT and temodar soon...I am scared whats going to happen then..does anybody has any idea how well that is tolerated?

[rumpled]

Is he still on the steroids? It could be that they are interfering with his sleep.  Is he getting enough sleep with the naps?
The best course could be to ask the doc for help for something to help for a while.

[pedsmd]

Question again...
My dad has been home now for almost 3 weeks. He is eating better. Now we have the reverse problem He is very restless and cannot sleep at night!!!! He is still very weak to walk though he can sit by himself and is getting a lttle bit stonger day by day. But he cannot make himself to go to sleep at night. he doea take short napes during the day. He has his follow up appt Monday, any experience with this..does he need somelittle sleeping aid in order for him to relax his brain? any input would be helpful. Thanks

[rumpled]

Hopefully the med will work and he will not require the shunt. Hopefully you will get some responses on the other thread and here from those with experience!

[pedsmd]

Again a roller coaster day today, doctors think there is a mild degree of hydrocephalus there, they started him on diamox.....any input about this from anyone. Its been already a month after surgery , could this happen after a month????His mental status was improving I felt as he was getting rid of the dilantin from his body..and now this comes up !!! i dont know what to do...they were suggesting to try diamox if that does not work would have to put VP shunt...awww anaesthesia again risks , risks,  dont know what to do...just praying for things to get better I think u get to the point that u leave it everything to the higher authority...

[pedsmd]

Thanks so much... I will keep u posted. u have been so helpful

[rumpled]

Talk to the doc and make sure you know all the steps so you feel more like you are in control.
Sedation can be healing - that can be why.
I hope he does better.

[pedsmd]

Thanks for your support. I really appreciate u r feedback.
Its so tough.....hard to take as the surgery went well and now we r struggling to manage the meds. Its taking forever..well as long as they get him better...he was so sedated yesterday I think it was the synergistic effect of dilantin and valproic acid. Now they have him off dilantin and started keppra hopefully he will tolerate that better and take valproic acid off

[rumpled]

Some people just have... sensitivities to meds...
I took keppra and it has effects too - all that class does - hang in there.

[pedsmd]

I am losing it!!!!! They lowered the dose to 200mg and the levels came back to >40. They have also started him on valproic acid. I am trying them to convince them to start Keppra as that is so much better tolerated and has less interactions!!!

[rumpled]

Are they going to lower his meds?

[pedsmd]

I thought u have to mantain less than 20

[rumpled]

Without a range - it is hard to say if that is good or bad?

[pedsmd]

his dilantin level came back as 40!!!!

[pedsmd]

They repeated his CT which is better. All bld work is fine. At least no fevers now. He is on anyti biotics until cultures come back. But still very drowsy...it is so frustrating and baffling....

[rumpled]

Steroids also can reduce his immune system - as can just the fact that he could has surgery and he is recovering.

He just had a major surgery, he is taking some major medications, and he has an infection - I would be tired too. I would keep talking to him, and let him fight but sleep is restorative.

Let us know how he is.

[pedsmd]

thanks for the reply. Could dilantin cause this state? This morning they diagnosed him with a UTI and he is back in th ICU. Could that had contributed to his sedated state?

[rumpled]

His mental status *could* (and this is just speculation on my part) could be due to the steroids.

While steroids are fantastic at reducing inflammation, they have a host of other effects on the body including making a person tired.

Some people do fine on large amounts of steroids while others cannot - if he had an existing hormonal issue that was undiagnosed, the corticosteroids would aggravate it. Plus his adrenals would be shut down on that dose. That is my theory. lt is not scientific in any way but based on that 4mg of dex is equal to 107mg of hydrocortisone (20mg HC will suppress the adrenals) and put him in a state of Cushing's syndrome. I used to have Cushing's and know the symptoms and what it can do to the body.