THE SUBDURAL HYGROMA IS GETTING WORSE AND I AM BEDRIDDEN

All indicators are my ventricle continues to over drain.  My brain surgeon's office is trying to get me in with a cancellation.  I was told if it gets worse to go back to the ER in San Antonio and the on-call brain neurosurgeon will assess the situation.  I am mostly bedridden. The VA wants me to go to the local ER first to get the referral to San Antonio.  I just got the last bill sent to the VA $14,000.  

The VA's claim they have no one locally who can do or read the lateral head shot, or properly read the CT scan is pure BS.

The VA  has an absolute policy of no emergency CT scans at the clinic.  If needed they will put you in an ambulance to cross the street to Valley Baptist.  The head CT scan is at most 2 minutes.  Only the VA can ask the neurosurgeon at the VA in San Antonio to read the CT scan.  But they will not agree to doing it at the VA Harlingen.  They also claim they have no one who can read the lateral headshop.  This is pure BS.  I can read it.  It is like a clock, and you look for a black notch associated with a time.  The online chart which is readily available tells them the setting.  I should be at 150.  I bet I am back down to 70.

My vision is in and out.  I have no control of my bladder. My gait is way off. The vertigo sensation makes it difficult to walk. In the last week I fell three times. 

My brain surgeon needs to have someone locally give him an assessment.  The only option is for the VA Harlingen to do the head CT scan and lateral headshot.  They will not.  I have verified they can ask the neurologist at the VA San Antonio to do the read and then notify my brain surgeon.

When I brought this entire mess to the worthless Congressman Vicente Gonzalez, he blew me off based on the VA lying that I can get care in Brownsville.  I cannot. 

I have since learned the brain shunt I have had been recalled in select patients.  It seems to over drain on its own without an intervening event.

A note, I changed the diagnosis from hematoma to hygroma.  The local radiologist misdiagnosed the problem.  He did nothing wrong.  There are so few patients with the problem it can happen.  But the subdural fluid buildup is obvious to a trained eye.

 

THIS IS FROM BRONSBIL ESTACION

Click for a great history about our airport.  All my regular readers know I am a huge fan of our airport and its long history of connecting us to Latin America.  Everyone also knows I have been pushing hard to bring Jet Blue which will open Brownsville to all of Mexico and Latin America via Mexico City, and San Antonio and all of Jet Blue's services out of San Antonio.

 

WE NEED A LOWER RIO GRANDE MEDICAL ADVISORY BOARD TO BRING BETTER CARE TO THE LRGV

Yesterday it came to my attention a local person fell and hit her head.  There was no care available, so she was medivac to MD Anderson in Houston.

Medicine is changing and our needs are changing.  No one hospital can fix the problem.  It has to be a community effort between Hidalgo and Cameron County through an advisory board.

My brain issue scares me more and more each day.  The VA doctor who treats my circadian rhythm disorder was dumbfounded the VA does not have a neurologist in San Antonio handle the read of my brain CT scan and lateral headshot.  She told me the local radiologist is to refer any read she cannot handle to specialists in San Antonio.

I am very happy with the ER help I received from Valley Regional.  The radiologist through no fault of his own could not properly read the CT scan or the lateral head shot.  On the latter it is about reading the setting on the shunt, not if the shunt is in place.  

That number will tell the ER doctor if my shunt is over draining or under draining.  This then gives context to the CT Scan read. We need to be fair.  An ER doctor and local radiologist can go their entire career and never see a patient with my problem. 

Both the radiologist here, and in San Antonio misread part of the CT scan.  Their reads got me the emergency care I needed- so thank you.  It really takes a brain neurologist to understand the subtle difference between a hematoma and a sac filled with brain fluid.  It was in fact the latter.  This is so rare it is impossible for almost any ER doctor or radiologist to get it right.  They need help and we should work together to help them.

The brain fluid sacs were even worse than a hematoma.  Mine were deemed severe requiring an immediate change of the pressure valve from 70 to 150.  That is a big change.  I can tell you based on how I feel, I am still in trouble.  

I have been sleeping 11 hours. It takes an hour to rehydrate me before I can get just a few hours work done.

THE SOLUTION

A medical advisory board can help all local hospitals to associate with specialists in San Antonio and Houston who can help with the advanced reads of MRI's, CT scans and basic x-rays. The need is there and we need a strong community-based Board to help the doctors.

The MAB also needs to work with all ER professionals to learn about rare conditions they are seeing in the ER.  We need PCP to also make such identifications.

With this data in hand the MAB can work with the hospitals to try and recruit specialists who can address these rare conditions. Our population is growing and changing.  

 

 THE SUPREME COURT EMERGENCY DOCKET IS FRONT AND CENTER WITH THE PRESS READING EACH FILING

My FRAP 8 Motion is about to be filed and will be read by the national press core. The issue is simple, are the three orders signed by the Texas Supreme Court while the case was squarely before federal judge Rolando Olvera void.  There is no dispute concerning the documents.  

I intentionally waited until after the end of the term to file my FRAP 8 motion, when there would be very little for the press to see, but with Trump filing FRAP 8 motion after motion.

It will take just one news source taking the story and the Texas Supreme Court will fall. 

"The Supreme Court's emergency docket has flared up in the thick of the justices' summer recess. 

President Trump is urging the justices to revive his mail ballot restrictions and allow White House ballroom construction to resume. It again puts the high court in the hot seat after its string of key rulings on other aspects of Trump's agenda.

And adding to the pileup this past week, a contempt fight from Apple, an execution and even an effort to save a "vicious" dog from euthanasia landed at the justices' feet."

 

GINA HINOJOSA IS CLUELESS ON THE GASOLINE ISSUE, OR WORSE IS SHE BOUGHT BY THE OIL AND GAS INDUSTRY?:  I DO NOT KNOW WHICH IS THE TRUTH BUT THERE IS A SOLUTION TO THE PRICE OF GASOLINE GINA IS NOT DISCUSSING

I am waiting on my body to rehydrate so I can try and get some legal work done.  The phone has been ringing all morning.  The concern for my safety and welfare is real. I think the key people now understand I have no real care options in the LRGV.

Gina Hinojosa needs to explain why she does not openly campaign with her father, Gilberto Hinojosa.  We all know the answer.  She is no more qualified to be governor than her father was qualified to be the Chair of the Texas Democratic Party.

Gina tried through paid bloggers to convince you she took the lead on Data Centers.  The record was clear.  Before Gina read in the paper they had become an issue, Governor Abbott has already called for additional regulation and a mandate they produce their own electricity.  Documented facts matter. 

HOW IS IT GOVERNOR ABBOTT AND THE LEGISLATURE CANNOT BETTER REGULATE THE COST OF GASOLINE?

Now pay attention, I am putting the blame on Abbott and the Republicans, but why is GINA not calling them out for doing nothing.  She has proposed nothing to address the issue of how Texas and the US can be net exporters of gasoline, and not find a way to cap the price of gasoline.

"The United States is the world’s largest exporter of motor gasoline (finished gasoline plus gasoline blending components), supplying over 16% of total global exports. U.S. motor gasoline exports in 2023 averaged 900,000 barrels per day (b/d), equivalent to about 10% of domestic consumption and enough to fill up the tanks of over 1.5 million SUVs per day,"

 WHAT TO UNDERSTAND

Our gasoline surplus is so large, we export the equivalent of 10% of our consumption.

Texas can control the price of gasoline coming from Texas fields.  There can be a higher price for exports.  But Texas can mandate a price range for Texas consumption, with the price going up after the needs of Texans are met.

So why is Gina Hinojosa not calling out Governor Abbott on the issue?  It is either ignorance, or she is bought by the oil and gas industry.  This is a very winning issue, and Gina is dead silent.  Why?

 

A VERY SLOW AND SCARY RECOVERY FROM MY SHUNT VALVE FAILURE

Walking around the house gives me the sensation of vertigo.  The ventricle over drained and leaves the brain without the proper cushioning.  It is estimated it will be the 28th before the ventricle recovers.  Then a week later I go back to my brain surgeon for a new CT Scan, to see if the subdural hematomas are decreasing in size.  It is simple, the full ventricle puts pressure on the subdural hematoma. 

This is the scary part and it is important people understand it is really no one's fault the proper care does not exist in the LRGV.  But the VA Harlingen can insure better care no ER doctor can ever provide, no matter how good they are.

Key to my care is coordination between the VA Harlingen and my brain surgeon.  I am going to have to do a second congressional complaint on the issue.  The VA's position is "we do not have anyone trained to care for the veteran so local services will not be provided.  The VA Harlingen is the only entity which can assure me proper care.

It is important everyone understand there are so few people with Normal Pressure Hydrocephalus an ER doctor can go their entire career never seeing NPH.  For sure they can go their entire life never seeing a failure in the valve.

Once you reach the point of subdural hematomas caused by a failure in the shunt valve, you are approaching stroke conditions.  The radiologist did find evidence of ischemia.  

The subdural hematoma by itself is a basis for an emergency referral to my brain surgeon.  But the actual data makes it easier to assess the patient.  Over drainage by itself is a basis for an emergency referral, but this is where local care is not available.

The radiology tech did a perfect lateral headshot as I requested.  But no one on staff knew how to read it.  I am being objective when I say it may have been the first lateral headshot the radiologist on duty had ever seen with a brain shunt.  There never would have ever been cause to train them into how to read the valve.

When I looked at it I estimated the valve was at 60, when it should have been at 90.

You have to look at it like a clock.  The setting is where you see the black notch.

If you view it as a clock, just shy of 6 o'clock, the setting is 90. That is where it should have been.  In fact it was between 4-5 o'clock, which is a setting of 60.  This meant I was overtraining.

The emergency referral to my brain surgeon would be the valve changed from 90 to 60, with evidence of subdural hematoma and ischemia.  With this my brain surgeon would have concurred in my emergency transfer to San Antonio.  

The repair requires use of a very expensive specialized ultrasound which ER's do not have, and no local surgeon would have.  It is very specific to the Codman shunt.

The potential malpractice issue is clear to me.  An ER doctor cannot diagnose a change in the value setting based on the patient's representation of the proper setting.  The VA can have this verified in my medical records, thereby making it possible for their radiologist to make the finding. 

So even if there are no subdural hematomas visible in the CT scan, the finding of  the valve setting failing becomes a basis to send the patient to the brain surgeon for an emergency correction before subdural hematomas develop.

This can only happen under the care of the VA.  I will try an meet with the Chief Medical officer to go over this, before I ask for Congressman Gonzalez to help.  

 

RECOVERING FROM EMEGENCY PROCEDURE TO CONTROL TWO SUBDURAL HEMATOMAS

This will cost Mayor John Cowen and City Attorney Will Treviño

Some history: I have a brain shunt to drain cerebral fluid from the ventricle. It was placed 7 years ago last April.

This is the second time it has failed.  My regular readers will remember I had to go to San Antonio last December for an adjustment to the internal valve.  It is not a big deal.  They use a form of ultrasound.

In December the valve sua sponte changed from 70, to 40.  This means the ventricle started to empty, which can cause a stroke.  My care was delayed because adult probation in Cameron County refused to change the date of an appointment. I am still working on getting that suit done.

This time for months problems got worse and worse until the point I could not function.  If you are not protected, judges have zero empathy for sick parties.  While in court with judge Terrell, he saw me dehydrating and told the lawyers to find water for me.  It is chronic.  It is so bad, on Wednesday and then Thursday it took 4 nurses to draw blood using an ultrasound to locate a vein.  Even then it was very difficult. 

The symptoms reached a critical level, and I went to Valley Regional ER.  The ER doctor gets an A+.  He may have saved my life by insisting I get to my brain surgeon in San Antonio. There were a variety of factors to include a CT scan showing two subdural hematoma.  There was also evidence of ischemic activity.  

This is where the problem develops. It is called Normal Pressure Hydrocephalus.  Key "Normal Pressure."  I was diagnosed in 1984.  At the time the DFW area had only 3 MRI's.  I had what today would be called a TIA.  The two neurosurgeons assigned to me could not agree on what they saw in the CT Scan.  I was sent for an MRI which did not show much more.  I eventually saw the head of neurosurgery at the VA Dallas, and he said there were so few MRI pictures of the brain it was best to just monitor it.

It does not manifest itself as pressure in any normal sense.  This is why doctors dismiss the finding.  The condition is so rare, few doctors have any experience with it.  The ER doctor in Brownsville saw I had the three W's.  It is a way of diagnosing NPH.  But then the CT scan showed the hematomas.  The mere presence of hematoma is enough for emergency care.

Even when I got to San Antonio, the ER doctor did not want to verify the CT finding of hematoma.  The on-call brain surgeon ordered the CT and found the hematomas.  

Another problem is, radiologists are not trained to read the lateral head scan which shows the value.  I can teach anyone in under a minute.  The radiologist does not even know they are to compare the official setting to the setting seen in the x-ray.  Again, this is so rare, I am willing to bet most ER doctors never see NPH or a failure in the valve. After the lateral head shot was done in Brownsville, they allowed me to see it.  The tech got it right the very first time.  It was picture perfect.  But I was the only one able to read it.  It showed a setting of 60, when it should have been at 90.  This meant again the valve was draining too much cerebral fluid, shrinking the ventricle.

THIS FINDING EXPLAINED THE SUBDURAL HEMATOMA

The ventricle this time shrunk so much that it pulled away from the skull.  This in turn caused the two subdural hematomas.  With there being evidence of some ischemia, I could have gone into a full-fledged stroke.  

THE TREATMENT WAS NOT COMPLEX

The treatment meant putting pressure on both subdural hematoma.  The surgeon changed the value setting from 60 to 150.  This means in about two weeks the ventricle will fill enough to allow it to put pressure on the hematomas.  The increased pressure will do two things.  It will prevent the hematoma's from getting bigger, and then through compression drain them. If they were larger, they would drain them through the skull.

This 150 setting is so intense I am to expect intense headaches.  But this is the best way to drain the hematomas through intense pressure.  In three weeks if the CT scan shows improvement, then they will reduce the pressure setting from 150, to maybe 130. 

MY REALITY

Not because of any individual reason related to Brownsville, there is no healthcare related to my situation which is available in Brownsville.  There are so few of us, I can imagine ER doctors going their entire career and never treating anyone with NPH, or post-surgical issues. 

Once you have a shunt, you have to have access to your surgeon.  My surgeon relies on local care to inform them of a problem.  This is not working.  I know I need to be in San Antonio, or Long Island.  As to the latter I am holding on two rental properties on Long Island so I can be close to a brain surgeon at the VA. A two-bedroom one bath duplex is $2750 a month.  I can afford the rent.  Once I am done with this lawsuit, I am gone.  Believe or not a mortgage on a house my size is about $6500 a month. One home because of its location on the North Shore of LI, has a mortgage of $12,000.  It is the same size as my home. 

SO, THE SCUMBAG JUDGE IN THE CITY CASE

He is very mad that I have doctor appointments.  In anticipation of yesterday's hearing, I cancelled two appointments.  They were important but not more important than appearing in court.  I am more than willing to reschedule appointments.  In fact, the one which only addresses how I am doing on a medicine which helps with my hypothalamic dysfunction, the nurse called me and asked the same questions the doctor would ask.  I am doing great on the medication.  So, I was rescheduled to November.

A side note, the NPH caused the damage to the hypothalamus.  40 plus years of doctors not knowing what to do resulted in significant damage to my hypothalamus. 

The VA based on my symptoms recommended I go to the ER.  The VA has no ER treatment.  Even if your doctor refers you for a CT scan, if it is an emergency you are sent to the hospital.  

So, I went to Valley Regional.  The ER doctor is the best (tied) ER doctor I have seen in Brownsville in nearly 21 years.  He took the cautious side and may have saved my life.  By all accounts when there are two subdural hematomas visible in a CT Scan, you need emergency care from your brain surgeon.

I filed the medical records to include the CT Scan and referral for emergency care in San Antonio.  I asked for a continuance.  You do not play games with subdural hematomas.

The judge through his actions actually denied the request for a continuance, and without notice and opportunity to respond just started in anger to rule on motions.

The order is so bizarre he states I complained he had not rule on the city's plea to the jurisdiction. He then granted the city's plea to the jurisdiction.  I have a mandamus and a federal TRO pending on judge Mark Woerner refusing to rule on my Plea to the Jurisdiction.

He then went on to deny the existence of the order he signed barring zoom hearings.  He called my claims to be fictitious. 

JOHN COWEN AND WILL TREVINO ARE PRICKS

I am as confident as the day is long, the Texas Supreme Court will void Judge Woerner's order which in effect denied a continuance based on a medical emergency.  The emergency was justified based on the emergency treatment I received.  I have the record.

Also based on everything I have learned the state will sanction Omar Ochoa for claiming code enforcement is discretionary.   Heather Scott counsel for the city has sealed Omar Ochoa's fate.

We are talking about the city enforcing the code, the same code against Texas Lone Star which the state of Texas sanctioned to the tune of $11,250.00.  This is all the city had to agree to avoid what has to be at this point well over $50,000 in attorney's fees. 

Compliance with the code is not discretionary. but John Cowen is a vindictive prick and will damage the reputation of Brownsville to avoid having to enforce the code.   If it were discretionary the state could not have sanctioned Texas Lone Star to the tune of $11,250.00.