Pam Panchak, Post-Gazette

Dr. Richard Shannon, center, chief of medicine at Allegheny General Hospital, speaks to reporters yesterday on the status and treatment of miner Randal McCloy. Other physicians joining him for the news briefing were, from left, Dr. Stephen Sandroni, director of nephrology and hypertension; Dr. Antonios Zikos, director of FCCP pulmonary medicine; Dr. James Valeriano, vice chairman of neurology; and Dr. Brad Bellotte, director of neuro-trauma.

Physicians treating the survivor of the Sago mine explosion yesterday said it could be weeks before they know the full extent of the brain damage caused by oxygen deprivation and carbon monoxide.

His lungs are still inflamed and he remains on a ventilator, but doctors said other organ systems seemed to be functioning better yesterday.

A third treatment in the hyperbaric oxygen chamber would be postponed if his lung condition wasn't stable, said Dr. Richard Shannon, chief of medicine at Allegheny General Hospital.

"We're just going to try to hold the line," he told reporters after a news conference yesterday afternoon.

Doctors said they were keeping Randal McCloy, 26, in a drug-induced coma to rest his brain and give him a better chance to recover from his brain injuries. The sedation, however, makes it all but impossible to assess his neurological condition or to determine whether his brain injuries are permanent.

The latest CT scan showed that nothing had changed since the one preformed earlier in the day, meaning no further bleeding had occurred and there was no enlargement of existing lesions, Dr. Shannon said.

"It's very hard when all you're going on is pictures," said Dr. James Valeriano, vice chairman of neurology. MRI and CT scans indicate some injury and inflammation of the white matter -- the brain's cable network -- but how significant or permanent that damage might be is unknown. And the effects of carbon monoxide poisoning are always hard to predict, he added.

His relative youth and good physical condition, which may have played a role in his surviving the mine accident, are reasons to be optimistic about his chances of recovery now, the doctors agreed.

By early yesterday, Mr. McCloy had undergone two 90-minute treatments in the hospital's hyperbaric oxygen chamber. The miner had been transferred to Allegheny General from West Virginia University's Ruby Memorial Hospital Thursday for the pressurized-oxygen treatments.

Dr. Antonios Zikos, a pulmonary medicine specialist, cautioned that the oxygen treatments will have no effect on him immediately. The best that can be hoped is that they might prevent neuropsychiatric complications of carbon monoxide poisoning that can occur weeks or months later, such as swallowing disorders or suicidal thoughts.

In the here and now, Mr. McCloy seems to have overcome the threat of multi-organ failure, a consequence of the breakdown of muscle tissue that occurred while he was trapped in the mine.

Because of his long hours lying immobile in the mine and perhaps because of a lack of oxygen, some of his muscle cells had begun to break down, a condition called rhabdomyolysis. This released substances into his blood stream, which in turn triggered a cascade of problems throughout his body that caused his kidneys and other organs to begin to fail.

Blood tests yesterday showed the muscle breakdown has stopped and that some of the affected organs, principally the heart, are now functioning normally again.

Inflammation of his left lung remains a serious concern. In the mine, Mr. McCloy was lying on his left side, leading to the collapse of his left lung, said Dr. Shannon.

"Probably in the last hour or so in the mine, he was unable to really control his airway," Dr. Shannon said. "[He] lost his ability to sneeze and to cough, and began to accumulate a lot of dust and gases."

The irritation has inflamed his lung tissue, causing increased mucus production. It's like having the world's worst cold, the doctor said.

Mr. McCloy has remained on a ventilator and hemodialysis was performed yesterday afternoon to remove excess fluid from his lungs. A blood clot in his left lung does not appear significant, Dr. Zikos said.

How long Mr. McCloy might remain in Allegheny General is unclear. He came to the hospital for hyperbaric oxygen treatments, but Dr. Zikos said no consensus exists as to how many treatments are necessary to have long-range effects.

Research suggests that "anywhere between one and five treatments appears to be helpful," Dr. Shannon said. "He's received two, and he's tolerated them well."

Physicians from Ruby Memorial discussed Mr. McCloy's condition yesterday, but appeared in no rush to bring him back to West Virginia.

Some people have been encouraged that Mr. McCloy has on occasion chomped on his endotracheal tube and flickered his eyelids. Dr. Shannon cautioned against reading too much into such actions, which often occur when medications are being adjusted.

As long as he remains in a medically induced coma, those movements "are not a clear indication of the nature or the extent of his injury," he added.

Brain imaging showed some minor "pinpoint" bleeds typically caused by lack of oxygen. "They've very small," Dr. Valeriano emphasized, "and given his age, I don't think it will be a problem."

Of more concern is apparent damage to white matter in the posterior lobes of the brain, which are associated with vision and other sensory processing.

It's impossible to say how this damage might affect his senses or other functions because it all depends on which brain "cables" have sustained damage, Dr. Valeriano said.

Brain imaging from West Virginia was sent to Allegheny General yesterday and compared with subsequent images.

The comparison showed that brain swelling had progressed, he noted, but that's not surprising.

"It may be weeks before we get a better idea of what to expect," Dr. Valeriano said.

"What we're seeing is brain injury, but it may be transient injury."

Dr. Shannon said he has received many offers of special teams, advice and support from the medical community.

"No less than a dozen medical centers across the country that have contacted us," he said. "I have responded to as many of them as I can, but it's too early to invoke that."