Good news for Johnson

By Bill Harlan, Journal Staff Writer | Thursday, January 04, 2007

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An angiogram Wednesday morning showed no sign of the blood-vessel defect that felled Sen. Tim Johnson three weeks ago, and a neurosurgeon said the senator is being weaned off the ventilator that has helped him breathe since his emergency brain surgery.

“His breathing has steadily improved, and now, he only requires ventilator assistance at night,” Dr. Vivek Deshmukh said in a written statement released by Johnson’s office.

The ventilator was necessary because fluid had developed in Johnson’s lungs as a result of a leaking arteriovenous malformation.

Doctors describe AVMs as tangles of blood vessels that are often present from birth. The condition can go undetected for decades. But they also can leak, causing an intracranial hemorrhage that results in stroke-like symptoms.

Johnson’s symptoms were first noticed when he had difficulty speaking during a conference call with reporters Dec. 13. He also had weakness on the right side of his body.

Johnson was sedated for more than two weeks after the surgery, but Julianne Fisher, a spokeswoman for the senator, said doctors had discontinued the sedation.

Dr. Alan Kelts, a Rapid City neurologist, said the continuing use of a ventilator and more than two weeks of sedation were signs of a serious injury to the brain.

“Insults” to the brain often result in fluid on the lungs, Kelts said, and a ventilator keeps oxygen flowing to the brain, even at night, when natural respiration can slow down. Sedation can be used to lower the metabolic rate to improve healing in the brain, he said.

But Kelts also called Johnson’s angiogram results encouraging. “That news is really excellent,” he said. “If the angiogram shows the AVM is gone, that’s a very good sign.”

Kelts said the next step for such a patient would be a move from intensive care to acute care, where physical therapy can begin.

The senator’s wife, Barb Johnson, said Wednesday that the family was pleased with the angiogram results. “Tim has had some challenging days since surgery, but step by step, he’s been making great progress,” she said in a written statement. “We know there is a long road in front of us, but Tim’s determination will make all the difference and he’ll be back at work as soon as he can be.”

Deshmukh said Johnson continues to respond to his family and to doctors. He follows commands and squeezes his wife’s hand.

Johnson also understands speech, Fisher said, but he has not spoken. The ventilator — a mechanical device that aids breathing through an incision in the neck and a tube down the throat — prevents him from talking. Doctors hope to take Johnson off the ventilator within a week, she said. Then, they will test his speech.

Fisher said Johnson’s condition has steadily improved in the past three weeks but that his recovery is expected to take “several months.” Treatment will include physical therapy.

Johnson remains in intensive care at George Washington University Hospital. He’s still listed in critical condition, Fisher said, mainly because he’s in intensive care and because he’s still using the ventilator.

Contact Bill Harlan at 394-8424 or bill.harlan@rapidcityjournal.com