A very full week in our return to Shirley Ryan.

Marcus remains medically stable following the placement of his baclofen pump. His vital signs are stable, and the medical team continues monitoring him while focusing on improving comfort, positioning, and participation in therapy.

Marcus’s current baclofen dose is approximately 236 micrograms per day delivered through the pump. Up from 198 yesterday. Doctors hope to gradually increase the dose to around 300 micrograms per day or higher, depending on how he responds.

Doctors reviewed medications previously used to stimulate Marcus’s wakefulness. They may conduct a one-time trial. Although it is normally a sleep medication, in some patients with brain injuries it can cause a paradoxical reaction, meaning the opposite of what is expected—sometimes temporarily increasing alertness.

requested a copy of Marcus MRI from Alaska. He said imaging has shown injury affecting several areas of his brain, including:

• Occipital lobe – affects vision

• Memory centers of the brain

• Cerebellum – involved in coordination

• Basal ganglia – deep brain structures that help regulate movement and muscle tone

He talked about damage to the basal ganglia can contribute to muscle stiffness and movement difficulties because these structures normally help control smooth, coordinated movement. He wants to perform additional imaging of his brain for comparison purposes.

They all said predicting recovery in disorders of consciousness is difficult.

Positive factors:

• Marcus is young

• He was healthy prior to the injury

Challenges:

• Hypoxic brain injuries often affect larger portions of the brain than traumatic injuries.

Doctors emphasized they cannot promise specific outcomes but will continue pursuing treatments and therapies that may help Marcus show increased responsiveness and functional progress. A tentative discharge date of the 21st of March has been discussed, but with the trials they want to do that will likely change.

The care team will continue adjusting Marcus’s treatments, including gradually increasing the baclofen dosage, evaluating medication trials, and pursuing rehabilitation opportunities. The focus remains on maximizing comfort, maintaining health, and exploring every reasonable option that could support Marcus’s recovery and responsiveness.

For the most part the transition has been smooth. The only complication arose when the records of what meds Marcus should be taking He was supposed to be weaned off one med that helps with seizures as he hasn’t had one in months. Somehow, the orders that were sent over showed Marcus receiving a full dose. Which would make him lethargic due o to the nature of the med. They all seemed a little disappointed with what they have seen from him thus far being tired and sleepy. They were promptly reminded that they doubled his Keppra intake when he was nearly weaned off and that the baclofen and the Keppra both cause drowsiness. They are doing an EEG based on the lowered dosage of keppra, just to make sure they don’t see anything. The goal is to finally have him done by the end of the week.