Diabetes Forecast

A Checkup With Dr. Zabramski

Bret Michaels's brain surgeon talks about the rocker's health crisis

By Carolyn Butler , ,

Joseph Zabramski, MD—aka "Dr. Z"—is the chief of cerebrovascular surgery and director of clinical neurosurgical research at the Barrow Neurological Institute at St. Joseph's Hospital and Medical Center in Phoenix. Here's what he says about Michaels's health struggles and recovery.

There was a lot of confusion and conflicting media reports when Bret was said to be hospitalized for a "brain hemorrhage." What really happened?

I think there is a misconception about how serious this situation was at the time. When a patient first comes in, every subarachnoid hemorrhage is a life-threatening emergency.

How serious was it?

Well, around 20 percent of patients die as a result of the initial hemorrhage, 20 percent die while hospitalized, and only about half of those who survive have a good outcome, meaning they are capable of resuming their lives and returning to normal activities. How sick you are depends on how much blood is lost and escapes into the head.

In Bret's case, he had a pretty good-size hemorrhage and he was pretty sick—he had really bad headaches, requiring a lot of pain medications for a few days. Then he started feeling better.

But after [about 10 days] he started developing symptoms from the breakdown of blood in his brain . . . terrible headaches, back pain, stiff neck, nausea—all the symptoms you have initially with a subarachnoid hemorrhage start to come back again, and last for another seven to 10 days. We normally treat that with steroids, but, in Bret's case, because he's a diabetic we [didn't want to] give him steroid medications, which send glucose totally out of control. So we just had to treat the symptoms, as opposed to the cause, with pain meds, anti-nausea meds, and muscle relaxants.

When we're able to give steroids to people, their symptoms disappear over a few days' time. But he had to put up with this over another seven to 10 days.

How did he manage his diabetes on top of all this?

Bret takes remarkably good care of himself with his diabetes, being a lifelong diabetic. He does it the old-school way with needles and daily injections, and he's in good shape—he exercises daily and has no more than 10 percent body fat.

My experience with type 1 diabetics is that most of the time they do a lot better job adjusting their insulin than we can, and that was the case here, too.

Do you think his diabetes had anything to do with the hemorrhage?

It probably doesn't have anything to do with diabetes, though I don't know if anyone has specifically studied that. I feel sure that if there was a strong association between diabetes and subarachnoid hemorrhage, we would have recognized it by now. It seems that it's actually the opposite, that diabetes causes the hardening of arteries and more loss of blood vessels, rather than spontaneous bleeding. I think this was just a random event.

Did his relatively speedy return to the fast-paced world of rock and roll worry you at all?

I was very nervous. I told him when he did the The Oprah Show that I wouldn't let him fly to Chicago. It was all by satellite, and I was strongly recommending that he do [Celebrity Apprentice] by satellite. But I also realize what an intense person he is. He seems relaxed, he likes to joke around, but this is a guy who thrives on the travel, the shows—he just lives for it, it makes him feel better. It was obvious he was going to do these things, so I sat down with him and one of my colleagues, and we developed a plan to reduce his risks that included aspirin and daily injections of [a blood thinner]. We thought it was pretty safe he wouldn't have another stroke if we did those things, though not 100 percent because he is at higher risk than the average person.

He has jokingly said that I told him it wasn't such a good idea to do these things but that he said, "I'm not such a smart guy, Dr. Z, so I'm going to do 'em." So together, we said "let's figure out how to reduce the risks." As long as a patient understands what the risks are, you have to do your best to help them through it.

Where do things stand now?

I currently see him at least once a month to check his blood levels, discuss any kind of symptoms he's had, and adjust his medications, but he's really almost back to his old self. We've also monitored his glucose and hemoglobin A1Cs very closely, but he always keeps that under very good control.

From a neurosurgical perspective, I think he's doing extremely well, and the chance of him having another subarachnoid hemorrhage is no higher than anyone else's in his age group. If he wasn't on these medications for his heart, if we hadn't discovered the [hole in the heart], he would be released at this point. But he's on his way, and doing very, very well.

Check out our interview with Bret, here.



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