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What Happens In Coma?

What Happens In Coma?

 We've all seen countless tv shows where a patient falls into a coma- the weeping family members try everything possible to resuscitate their loved one, from standing by their side and reading them stories to playing their favorite music, all in hopes of 'breaking through'.

 Unfortunately, comas are a medically complicated phenomenon with different causes and effects, and despite all our advances in modern medicine, we remain mostly in the dark about how to successfully treat one. But what exactly happens to your body when you're in a coma? First, we have to be clear that comas are very different from sleep, despite the fact that the origin of the word comes from the greek for Koma or deep sleep.

 Comas are not sleep however and are instead various forms of unconsciousness that render a person unable to respond to any external stimuli. You can play the loudest, heaviest death metal in the world right next to someone who's comatose and you won't succeed in doing anything except really annoying the neighbors. Likewise, you can even physically hurt people in a coma and they will remain completely oblivious and unresponsive- in times, not too distant past this was sometimes used as 'treatment', with doctors trying to shock their victims back into consciousness.

 Everything was tried from exposing parts of the body to open flames to severely dropping the body's temperature with ice, to even bloodletting from the head directly. One treatment even included wholly emptying the stomach, we guess because the doctors thought that if a patient got hungry enough the body would force them to wake up. Or maybe they really were just throwing everything including the kitchen sink at the problem, which we're sure was also tried.

 Comas can occur as a result of serious trauma or as a deliberate medical treatment by doctors. They are typically brought on by traumatic head injury, and it's believed that it's the brain's way of shutting down so it can focus on repairing itself. They can also however be brought on by a stroke,a brain tumor, drug or alcohol abuse, or an illness such as diabetes or an infection. Most of the time a coma only lasts a few weeks though, but past this period the patient can enter a persistent vegetative state that severely lessens their chances of ever coming back out of one.

 Sometimes people who recover may end up with major or minor disabilities as well, to include speech impediments, mental retardation, or problem coordinating body movements. Medically induced comas meanwhile are used when patients are at high risk of brain injury either due to physical trauma, drug overdoses, or diseases. The purpose is to protect and control the pressure dynamics of the brain, as during injury or disease the brain can swell up and push against the skull which can starve some parts of the brain of oxygen.

 A medically induced coma reduces the electrical activity and slows down the brain's metabolism, minimizing swelling and inflammation. There are several different types of comas, and they each differ from each other. A vegetative state means that a person's body can make physical movements such as grunts or yawns, but has no reaction to actual stimuli. The movements are purely involuntary, and sadly for loved ones seeing the body of someone you care about a sudden yawn can induce false hope.

 The truth is the brain remains shut down and operating only at the most basic levels. Catatonia on the other hand is a complete lack of any movement or response of any kind- this is exactly as it sounds. Brain death means that the higher brain functions are completely destroyed, and the brain only carries out autonomic functions such as breathing and swallowing which are hardwired into our brain's programming.

 A brain dead person has in effect no chance for recovery, and typically brain results from extreme physical trauma or severe illness. A stupor is technically not a form of a coma but is sometimes referred to as one. This is a case of one being able to be awakened, but only with considerable effort. People in stupors can often fall right back into a deep unconsciousness, but more often than not will recover on their own- the dangerous if they dip so deep into unconsciousness, that their autonomic functions are impaired.

 While in a coma your brain shows zero awareness or cognitive processing and is completely unable to respond to outside stimuli. It is in effect as if the brain has been completely turned off, or is being rebooted like a computer. Except for in the most severe cases, the body will continue to breathe and the heart will continue to pump, and if you block the airway patients can even cough as the body attempts to recover airflow. 

But that's about it, as the brain seems tobe unable to communicate between the brain stem and the cerebrum which controls cognitive consciousness through a process called the reticular activating system. Any doctor will admit that there's a great deal we simply don't know about the coma state, and in 2013 doctors treating an epileptic man in a coma were puzzled to find brain activity in the hippocampus- these ridges on the floor of each lateral ventricle of the brain are thought to be the center for emotion, memory, and the autonomic nervous system, meaning.

 It's quite possible that the unconscious person was experiencing memories but little else. The doctors replicated their findings in cats which were placed under general anesthetic, and the knowledge they gleamed may help make some comas reversible. While they don't believe that this means acoma patient which this type of mental activity, or any other, has any sort of awareness or ability to communicate about their condition.

 It is strong evidence for the fact that the brain does in fact take actions to try and repair or protect itself while in a comatose state. The rest of the body typically remains unaffected by the coma state though, with functions such as breathing and heart beating being so hardwired into our passive nervous system that we do these things literally without thought. 

People in a coma state though will require through which they are fed and kept hydrated, and are intubated with breathing tubes to maintain a clear airway- through some coma patients do retain the reflexes to swallow. The most common issue facing coma patients though is muscle atrophy, which comes from simply not using your muscles for prolonged periods of time. 

You don't need to be in a coma for this to happen though, if you've ever been a couch potato for a few weeks at a time then you'velikely experienced the severe weakness of muscles that have atrophied from a lack of exercise- even just getting up for a walk once a day can keep your muscles from wasting away. Bedsores are another serious concern for coma patients. Also known as pressure ulcers, these are common for people who are bedridden or immobile, or perhaps unable to sense pain.

 These happen in areas of the skin that are under pressure from lying in bed, sitting down, or wearing a tight cast for a very long time. They develop when the blood supply to the skin is cut off for more than two to three hours, and as the skin dies bedsore starts as a red, painful area which will eventually turn purple. If not treated the skin will split open and the area runs the risk of infection.

 They can also become very deep if undetected or untreated, extending into the muscle or even the bone, and they're very slow to heal. Sometimes bedsore can take years to heal and may require surgery. The most common places bedsores form are on the buttocks area, the heels of the feet, shoulder blades, back of the head, and backs and sides of the knees. If left untreated they can grow grotesquely large- if you have the stomach for it go ahead and do a google image search for untreated bedsores, we did, and we deeply regret it.

 The good news about comas is that despite what medical dramas may tell you most people recover within a few weeks to at least some level of their previous mental capacity. However new research and techniques is continually improving our knowledge of comas and how to treat them, and in 2017 a 35 year old man who'd been in a vegetative state since he was 20 was entered into state doctors called“minimal consciousness by stimulating the vagus nerve. 

This is one of the largest nerves in the body and goes directly to the heart, lungs, upper digestive tract and other organs. While not “awake”, doctors were able to have him follow objects with his eyes, and even prompted looks of surprise on his face.

 Doctors warn though that while it's a big step forward, it's far from a conclusive one because comas are as radically different from each other as those who suffer them, and what works on one individual may sadly not work on others. How long would you give your family because asking them to just pull the plug on you? 

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