Terri Schavo is forgotten but she had anoxeria people believed it happened from within the hosptial - READ THIS BLOGGER INTERESTING"

CSI MEDBLOGS: FURTHER INVESTIGATION OF CT BRAINS TURNS UP NEW ASTOUNDING EVIDENCE


Terri Did Not Suffer Her Brain Damage Outside The Hospital--It Occurred While She Was Hospitalized


According to a time-line of physicians and therapists reports, posted on The Empire Journal, Terri's injury occurred on 2/25/90:


2/25/1990






Terri's Injury











2/25/1990



X-Ray Report Dr. Hameroff



Images taken of cervical spine, no acute bony pathology - straightening of normal cervical lordosis











2/25/1990




Neuro Consult Dr. DeSousa



Deeply comatose. No evidence of acute process in CT scan. Evidence of myoclonic seizures. Rule out acute myocardiac infarction, seizures as cause. Neck is somewhat stiff as is all of the muscles of the body. No jugular venous distension. WBC 26,300, drug screen negative










2/25/1990




CT Scan Report Dr. Hameroff


Normal










2/26/1990



EEG Report Dr. DeSousa




Abnormal EEG indicative of generalized suppression and slowing










2/27/1990



DeSousa Report



Brainstem Auditory Evoked Response shows no significant disruption of the brain stem acoustic pathway - study within normal limits










2/27/1990



CT Scan Report Dr. Greenberg



Normal CT Scan










2/28/1990




EEG Report Dr. DeSousa



Generalized diffuse slowing. Some fast frequency rhythms which were not obvious during previous recording. May have been slight improvement over last EEG.










3/19/1990



EEG Report Dr. DeSousa



Markedly abnormal EEG, no significant improvement from previous records










3/30/1990



CT Scan Report Dr. Abramson



CT Scan shows noncommunicating hydrocephalus, changes occurred since 2/27 exam


If you look carefully at this time line you will see that Terri had "NORMAL" CT's of the brain on 2/25 and 2/27.


STOP THE PRESSES


There is categorically and absolutely NO WAY Terri could have suffered MASSIVE ANOXIC INJURY TO THE BRAIN ON 2/25 AND HAVE NORMAL CT SCAN ON 2/27


NO WAY


Brain edema begins to occur about 20 minutes after infarction and by 24 hours her brain (if she HAD suffered a massive anoxic event) would have been MASSIVELY SWOLLEN -- something that could NEVER be missed and NEVER called normal.


NEVER.


If Terri's brain CT was NORMAL 2 days after she entered the hospital than there is NO POSSIBLE WAY she suffered a massive infarction or global ischemia on 2/25.


THIS IS ALL WRONG


Now look at 3/30. Suddenly she develops NONCOMMUNICATING HYDROCEPHALUS.


WHAT?


Did anyone ask HOW? How did she develop noncommunicating hydrocephalus suddenly on 3/30/90 with 2 normal CT scans on 2/235 and 2/27??


CONCLUSIONS?


1. IF this is an accurate report (normal CT brain on 2/27 -- injury on 2/25) then TERRI DID NOT suffer an event of massive ischemia on 2/25. tHERE IS NO RADIOLOGIST OR NEUROLOGIST OR NEUROSURGEON IN THE WORLD THAT WOULD DISPUTE THIS. it is impossible. tHE ct ON 2/27 WOULD HAVE BEEN grossly ABNORMAL.


2. IF TERRI DID NOT SUFFER ANOXIC DAMAGE ON 2/25 THEN THE REASON FOR HER BRAIN ATROPHY WAS CAUSED BY SOMETHING THAT OCCURRED after 2/25 namely in the hospital during February or march of 1990.


3. How does one develop NONCOMMUNICATING HYDROCEPHALUS in ONE MONTH? By a blood clot obstructing the CSF outflow from the brain at the Foramen of Magendie.


4. How does one get #3.


BY BEING HIT ON THE HEAD AND SUFFERING INTRACRANIAL HEMORRHAGE.


So Terri WAS HIT ON THE HEAD OR DROPPED ON HER HEAD DURING LATER FEBRUARY OR EARLY MARCH WHILE IN THAT HOSPITAL.


Posted by Doctor CBB on March 24, 2005 at 03:56 AM | Permalink
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Dr. CBB of Code Blue Blogs has an interesting take on the timeline of Terri's head injury as documented by the medical records available at this time. Read it here>/a> Dr. CBB also questions whether or not Terri has Hydrocephalus which is a treata... [Read More]


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Doctor Boyle, of the medical blog CodeBlueBlog, has an interesting set of conclusions based on the reported CT scan of Terri Schiavo's brain. He says: 1. IF this is an accurate report (normal CT brain on 2/27 -- injury on 2/25) then TERRI DID NOT... [Read More]


Tracked on March 29, 2005 04:10 PM
Comments


Global cerebral ischemia does not typically lead to massive cerebral edema. More often than not, the CT scan after this event is normal. Because imaging cannot demonstrate the extent of damage, physicians actually use the physical exam to evaluate brainstem reflexes to determine the extent of injury. Although this does not apply to Terri, the declaration of brain death relies on physical exam findings and does not involve any imaging studies.


Posted by: Alan Betensley | March 24, 2005 07:30 AM


Could someone else comment on this? I'm not a doc, but it appears to me that one person is saying swelling will happen within minutes, while another one is saying that that it may not happen at all. I'm confused!


Posted by: Ceci | March 24, 2005 09:33 AM


I think it is not a good idea for a doctor to be writing a diagnosis or interpretation based on what he reads from the interpretation by another doctor. I think this guy would lose his license if he did this in the field. This doc is all talk, and no experience in this case. If he gets these CT's to evaluate, then we should listen. But they way he has written this determination is just tabloid fodder.


Posted by: stacey | March 24, 2005 09:41 AM


If they (hospice) are ignoring Terri's basic needs--shouldn't they be shut-down or have the Federal gov. and run things until they are ship-shape.


Posted by: nerissa | March 24, 2005 10:31 AM


If they (hospice) are ignoring Terri's basic needs--shouldn't they be shut-down or have the Federal gov. and run things until they are ship-shape.


Posted by: nerissa | March 24, 2005 10:33 AM


RE: The Empire Journal
Do you think this is a valid summary of events, or a slanted/altered interpretation of events? It's not a real medical record, that seems obvious. What about the source? Lastly, any opinions about the 7/24/1990 MRI Report Dr. Pinkston
(Profound atrophy w/ very atrophic appearing cortex. Mild white matter disease, anoxic/hypoxic injury)? We all want to see that MRI, so why has everyone concluded that there isn't one? Contradictions ad infinitum!

Posted by: maximumbob | March 24, 2005 10:42 AM

Isn't that an abnormally high white blood cell count on admission? If you are going to speculate, at least include the possibility that she had an infection which produced incremental damage, perhaps? Or perhaps produced vasculitis, possibly causing a blood clot? The level of problems she quickly developed with her knees could be indicative of low level infection of some sort, perhaps not reliably showing on blood tests due to steroids used to control inflammation? The woman was in her 20's but she quickly developed arthritis in her knees (end of Feb admitted, beg. of May knee fusion - about 2 months). Her knees were treated with Keflex for at least once early in 1991 according to the records linked. Of course that WBC could have been totally unrelated and she could have picked up an infection in the hospital also.

There is no proof at all that Michael is responsible for all this. None. People shouldn't leap to these conclusions. We're never going to know exactly what happened. I'm not a doctor, but I've worked with vets to try to even get a good diagnosis on 2 different dogs with sudden onset of both extreme neuro symptoms that looked like some sort of stroke WITH arthritis and I have learned the limits of medical certainty. The one thing I know is that it was not due to the dogs being beaten, and the final best guess (after 2 good recoveries) was "disseminated infection".

This layman interpreted that as "God only knows, but antibiotics sure produced remarkable results". I'm not saying that this was Terri's problem - I'm just saying that medical mysteries abound. Whatever happened to her was unusual, but I doubt she was beaten up in the hospital while in the ICU.

Posted by: MaxedOutMama | March 24, 2005 10:51 AM

RE: Ceci - read the disclaimer for this blog. Blogs by definition are thoughts & opinions offered by the blogger. It's like the TV, if you are offended or have a problem with the content, TURN IT OFF!

Posted by: maximumbob | March 24, 2005 10:52 AM

Once again, WHAT IS THIS INFORMATION BASED ON?! I saw that the Empire Journal is cited, but they don't exactly 1) seem all that credible; and 2) note how or from where they obtained it.

Posted by: bioethics dude | March 24, 2005 10:55 AM

Maximumbob...

Huh? You must have me confused with someone else. I just said I was confused about the contradictory interpretation. I didn't say I was offended. I know there are people who post here that have medical experience, so I questioned the contradiction in the hopes that some of them would chime in and give me a little bit more data to chew on.

Posted by: Ceci | March 24, 2005 10:59 AM


Maximumbob,
Oh...I just figured it out...you must think I'm stacey. The names of the posters are below the post, not above.

Posted by: Ceci | March 24, 2005 11:01 AM

RE: Eating Disorders - Wouldn't Terry's reported eating disorder (I believe the principle misdiagnosis in the malpractice suit that supplied the million dollars - the proported impetus for the demise of Terry) provide clues about her strange bone scan?

Just in - Supreme Court rejects Schiavo case!

Posted by: maximumbob | March 24, 2005 11:03 AM

Ceci - Sorry, I'm new here.

Posted by: maximumbob | March 24, 2005 11:04 AM

Since I'm not a doc, I dont know the possibility of this, but if she had an long term intense diet bordering on anorexia/bulimia, can this eventually lead to seizures? The report of the incident stated that she fell in the bathroom doorway and was partially in the hall. If she had a seizure, that would be in a very confined space and could cause head injury and possible broken or damaged bones.

Just wondering.

Posted by: Ceci | March 24, 2005 11:07 AM

Terry's MI was probably caused by hypokalemia (or low potassium levels) due to an electrolye imbalance as a result of her eating disorder (anorexia/bulimia).

From http://www.nlm.nih.gov/medlineplus/ency/article/003484.htm

"Potassium (K+) is the major positive ion within cells and is particularly important for maintaining the electric charge on the cell membrane. This charge allows nerves and muscles to communicate and is necessary for transporting nutrients into cells and waste products out of the cell. The concentration of potassium inside cells is about 30 times that in the blood and other fluids outside of cells.

Potassium levels are mainly controlled by the steroid hormone aldosterone. (For more information see the aldosterone test.) Aldosterone is secreted from the adrenal gland when levels of potassium increase. Aldosterone, in turn, causes the body to rid itself of the excess potassium.

Metabolic acidosis (for example, caused by uncontrolled diabetes) or alkalosis (for example, caused by excess vomiting) can affect blood potassium.

Small changes in the potassium concentration outside cells can have substantial effects on the activity of nerves and muscles. This is particularly true of heart muscle. Low levels of potassium cause increased activity (which can lead to an irregular heartbeat), whereas high levels cause decreased activity. Either situation can lead to cardiac arrest in some circumstances.

In normal people, taking potassium supplements or potassium-containing drugs is of no consequences, because the kidneys efficiently dispose of excess potassium."

The irony is that Terry may very well die from a form of the disorder that put her in this situation originally.

On the Bone: Calcium leaching from bone to blood du to S/S of an eating disorder can lead to Osteoporosis, a possible explanation for such extensive bone damage if Terry was dropped (likely) or cracked on the head (unlikely)

Posted by: maximumbob | March 24, 2005 11:26 AM

Three out of four board-certified neurologists say Terri can't be PVS based on an audio recording. The fourth says he would want to see video as well.

http://www.dawneden.com/2005/03/neurologists-tape-proves-terris-not.html

Posted by: Ed Jordan | March 24, 2005 11:41 AM

If her injury was on the 25th, it's perfectly reasonable that her 25th CT would be normal. It takes several days for the global changes to occur. It takes 12-24 hours for the microscopic changes and 24-48 hours for the softening and edema of the brain. I don't know when that would begin to show on CT but I find in reasonable to assume it would take days for that to show---assuming a global hypoxic-ischemic insult.

Of course, I'm reading all this from my medical pathology book. And I'm not a doctor...yet. But I don't find it hard to believe that it took over 2 days for gross CT changes to occur--it takes time for tissue to atrophy/die/etc.


Unsure about the noncommunicating hydrocephalus.


Posted by: Jeremy | March 24, 2005 12:18 PM


RE: EEG-Scan,Schmam-The EEG is probably the acurate indicator of CNS function as indicated by neural electrical activity based on comparissons of archived EEG's for well over 75 years. Based on this, coupled with the Empire Journal Report (if accurate), wouldn't it be prudent to conclude that Terry has only sub-cortical function?(see EEG reports at the bottom) Also, if we introduce additional info. from the same report (7/24/1990 MRI Report Dr. Pinkston-Profound atrophy w/ very atrophic appearing cortex. Mild white matter disease, anoxic/hpoxic injury) can't we further conclude the same? This might satisfy one of Codeblue's criteria (* If Terri were actually brain dead (as opposed to brain damaged), or terminally ill, or mortally injured) to allow Terri Schiavo die. The only further test that would show conclusively whether or not cortical function is apparent would be a PET scan - showing uptake of radiotraced glucose as a function of active metabolism in active areas of the brain. I'm not sure that even this would suffice, as the bridge between objectivity & subjectivity has been crossed & burned!

From http://www.bio-medical.com/EEG.html

EEG History: The presence of electrical current in the brain was discovered by an English physician, Richard Caton, in 1875. It was not until 1924 that Hans Berger, a German neurologist, used his ordinary radio equipment to amplify the brain's electrical activity so that he could record it on graph paper. Berger noticed that rhythmic changes (brain waves) varied with the individual's state of consciousness.

The various regions of the brain do not emit the same brain wave frequency simultaneously. An EEG electrode placed on the scalp would pick up many waves with different characteristics. This has presented a great deal of difficulty to researchers trying to interpret the large amount of data they receive from even one EEG recording.Brain waves have been categorized into four basic groups: Alpha, Beta, Theta, & Delta waves. Although none of these waves is ever emitted alone, the state of consciousness of the individual may make one frequency more pronounced than the others.

2/26/1990
EEG Report Dr. DeSousa
Abnormal EEG indicative of generalized suppression and slowing

2/28/1990 EEG Report Dr. DeSousa
Generalized diffuse slowing. Some fast frequency rhythms which were not obvious during previous recording. May have been slight improvement over last EEG.

3/19/1990 EEG Report Dr. DeSousa
Markedly abnormal EEG, no significant improvement from previous records

4/4/1990 EEG Report Dr. DeSousa
No significant change since last EEG. Does not seem to indicate paroxsymal activity.

Posted by: maximumbob | March 24, 2005 12:39 PM

I hope y'all don't mind my asking this. It's more about methodology that this particular case.

Apparently Dr. Cranford felt an accurate diagnosis could be reached without MRI or PET scans. Will using CT scans, EEG, and physical examination allow one to conclude someone is vegetative? Does this hold true in all cases, or are there a few instances where more elaborate tests along with rehab are needed? Is there a *standard* methodology used in medicine to diagnose someone as PVS?

I think somewhere around 1999 Florida decided that feeding tubes were life support and could be withdrawn. Coupled with the guardianship laws of the state, it's perfectly legal to dehydrate someone to death with a diagnosis of vegetative.

Now, prior to this date, the diagnosis of vegetative may not have caused such an unalterable conclusion as death. Should the medical community be notified of legal changes such as those made in Florida so they can decide whether the standard of evidence for PVS should be raised due to a grossly different potential outcome?


Posted by: Ceci | March 24, 2005 12:58 PM

The Sun Sentinel has posted this Graphic of Terri's CT X-ray scan from her medical records, detailing their analysis of what it shows. http://www.sun-sentinel.com/news/local/southflorida/sfl-0324ctscan_graphic,0,6028609.graphic

Along with this article:
"Neurologists disagree with state specialist on Terri's brain damage

"Scans of Terri Schiavo's brain show that the great majority of her gray matter where thinking and feeling occur has died off and been replaced by watery fluid, with no chance of growing back, neurologists said.

About 70 percent to 90 percent of Schiavo's upper brain is gone, and there's also damage to her lower brain that controls instinctive functions such as breathing and swallowing, said three Florida neurologists who viewed 12 of her CT "computed tomography" X-ray scans Tuesday and Wednesday.

"This is as severe brain damage as I've ever seen," said Dr. Leon Prockop, a professor and former chairman of neurology at the University of South Florida College of Medicine in Tampa, upon viewing the scans.

Dr. Walter Bradley, chairman of neurology at the University of Miami's Miller School of Medicine, added: "I doubt there's any activity going on in the higher levels of her brain."

Read entire article here. http://www.sun-sentinel.com/news/local/southflorida/sfl-rxct24mar24,0,6305655.story

I have no experience in the medical field, so I can not comment on the doctor's opinions in the article. However I was wondering what you guys thought about their analysis. I also have some questions regarding these comments.

"Neurons do not grow back. The brain can rewire itself so that remaining healthy tissues take over functions that had been done by the cells that died. But if that were happening, it would have shown in Schiavo's behavior by now, said Dr. Michael T. Pulley, an assistant neurology professor at Shands Jacksonville Hospital, affiliated with the University of Florida medical school.

"The chance that this person is going to recover is about zero," Pulley said. "The longer a person goes on, the less likely it is they will recover."

Is this true, that the brain can "rewire" itself? And to what degree of certainty can they say that, this is not happening in Terry, if none of these doctors have observed her behavior over the last 15 years?

Elizabeth

Posted by: Elizabeth | March 24, 2005 01:36 PM

Here's Terry Schiavo's discharge summary from Humana Northside Hospital detailing her symptoms, changes in her condition, and results of tests run. I have no idea what any of this means, but I figured you guys may find it interesting.

http://www.zimp.org/stuff/Discharge Summary 050990.pdf

Posted by: Elizabeth | March 24, 2005 01:48 PM

Well, MaxBob, soon you'll get your wish. She'll be dead and then there will be no way to examine or test her. How nice for you.

Posted by: | March 24, 2005 03:17 PM

So your theory is that she developed noncommunicating hydrocephaus from a hemorrhage. Blood clotting up the foramen of Magendie any other blood in the ventricles? Without any evidence of subarrachnoid blood? Kinda curious, don't you think, the lack of any mention of blood on a study that's pretty good at detecting the presence of blood.

And all this from interpreting the one line summaries of other docs' interpretations as reported in a non-medical record. This is pretty insubstantial stuff for the kind of absolute claims made above. Authority and credibility on a subject is earned, and this is not the way to go about it.

Posted by: Craig H | March 24, 2005 03:33 PM

Jeez Craig, lighten up. I don't think the dude is trying to be an authority on anything. He just seems to be asking a lot of questions that noboby else seems to be asking. That, in itself, should be a positive thing.


Posted by: | March 24, 2005 04:12 PM


"THERE IS NO RADIOLOGIST OR NEUROLOGIST OR NEUROSURGEON IN THE WORLD THAT WOULD DISPUTE THIS." Hmm. Sounds pretty authoritative.


Don't get me wrong -- I think the question-asking is great. I'd just be way more careful about the certainty of the answers at a time when folks are looking hard for new information to hang their hopes on. I'll be glad to lighten up when the issue isn't as pressing.


Posted by: Craig H | March 24, 2005 04:31 PM

Do a CT scan and MRI-she doesn't need a PEG tube for those non-invasive procedures.Then when they confirm what we know-there is no "Terry" inside that poor creatures body,let's butt out.I'm sure the pretty young woman I've seen in photographs would have been apalled to know how she'd appear on our TVs 15 years later.Why is it so hard to believe she discussed her code status with her husband and not her parents-ask your married friends,co-workers,patients-who do they share the intimate details & desires of their lives with?As for Michael-probably no saint,but the attempts to villify the poor bastard are shameful-I hope my life never gets dissected by self righteous hypocrites like Tom Delay&Dr.Bill Frist.

Posted by: rs | March 24, 2005 04:43 PM

rs, read the court record. She made a casual remark about ventilators at a barbecue. There was no "discussion of her code status". Believe me, if there was no "Terri" there, I'd be first on Michael Schiavo's side. Unfortunately, this woman hasn't had any testing done since 2002. The fact that MS has refused testing, leads to suspicions and doubts of his sincerity in my mind. If there's reasonable doubt, don't pull the feeding tube out.

Posted by: | March 24, 2005 04:53 PM

Actually, lots and lots of people have been asking the questions for some time. And they've all been written off as Christian nutjob right-to-lifers and not worthy of attention. Nice to have a doctor with no apparent dog in the hunt weighing in.

Posted by: Scott Chaffin | March 24, 2005 05:00 PM

I'm so glad all you doctors and forensic experts have figured this all out. You ought to be ashamed of yourselves. That kind of "certainty" is nothing more than complete arrogance.

Posted by: joe bob | March 24, 2005 06:06 PM

Oh for petes sake, joe bob. Since when is it "arrogance", to examine information and question purported "facts". It's "ignorance" to assume that everything you read and hear through media sources is "true".

Posted by: | March 24, 2005 06:16 PM

Since I am neither a doctor or an American citizen I probably should not be saying anything. I can get as emotive on this subject as the next person.

I think that the doctor on this site has made a good case for what he is saying and for asking questions about what really happened.

I saw a comment that Terri was treated with Keflex for arthritis. That is not correct from my understanding of her medical record, and perhaps a little bit of a projection of my own background. An anti-inflammatory is used when someone is suffering an inflammation which can be caused by something other than arthritis. For example, when I fractured and dislocated my coccyx back in 1976 I was treated with an anti-inflammatory drug. I did not have arthritis at the time.


Second, I noticed the comment about the potassim level and the alleged bulimia. The medical record indicates that at the same time as Terri had a low potassium level she also had a high glucose level. I did a search relating to the potassium level, glucose level and bulimia. What I discovered made me doubt that Terri was in fact bulimic.


Third, this does not explain why, when Terri was admitted to hospital that she had a stiff neck. This is the aspect that needs immediate and further attention. What caused the stiff neck?


Based on the evidence that I have seen so far, and I am not an expert in this field, I have serious doubts about the bulimia aspect in this case. There is a possible reason to believe that someone attempted to strangle Terri on the night that she collapsed. We do not even know in what order the attempt might have happened. Being found on the bathroom floor is not an indication that she was bulimic. It could be an indication that she was so knocked about in an earlier fight that she felt sick and went to the bathroom and then fainted, or it could be that someone bashed her head against the bath.


For your information if someone's head has been smashed into the bath, then that person could in all likelihood suffer the kind of injuries that have shown up in Terri. Yes, I do know a medical person who was bashed by her ex-husband in this way and she continues to have a neck plus other problems.


This is all speculation on my part. I am putting it up for consideration.


Posted by: maggie4life | March 24, 2005 08:27 PM


Elizabeth, the concept that the brain can rewire itself is accurate. The analogy to electrical wiring can help you to understand. The brain cannot use material that has been destroyed and does not install new "wires" but can recruit areas of the brain that weren't damaged to replace some of the function of the part of the brain that was damaged.


However, as you would not choose to rewire part of your house that your were not using, the brain will not rewire to replace function that is not used. A newborn baby's brain is constantly adapting to the demands placed on it. For example, once the baby leaves the womb, it is functionally blind. It's been living in the dark and the brain hasn't made any significant investment in the optical center. However, when challenged by input from the optic nerves (the eyes) the brain rapidly adapts and "rewires" to see.


In the case of a stroke victim, for example, with loss of function of a muscle group, the brain may "rewire" to allow for use of those muscles, but only if challenged. All reports indicate that Michael would not allow Terri to participate in physical therapy. Without this therapy and the challenges it presents, it is almost impossible that Terri would have shown any improvement.


We don't know what improvement Terri may have made because her husband won't let anyone try.


Posted by: DrTony | March 24, 2005 08:58 PM

You are invited to read my additional posts on Terri at my blog. With credit to CBB, of course.


Posted by: DrTony | March 24, 2005 08:59 PM


RE: "Well, MaxBob, soon you'll get your wish. She'll be dead and then there will be no way to examine or test her. How nice for you."


WTF? I don't even know who I'm responding to, but I WISH for the death of no person. However, I do think this case has validated the fact that many, many people agree that this poor woman would not wish to be forced to be kept alive in such a condition. In as much as she stated the fact, not perfectly & not in writing (which I hope ALL people will do - maybe as part of their 18th birthday right of passage) that she wished Not to live in such a condition, she never stated the alternative. I do think starvation is a bit barbaric & I'd favor euthanising Terry as an act of compassion.


We afford this to the most heinous members of our society, not legally considered cruel & unusual punishment. I'm not a proponent of the death penalty. To the contrary, I believe government has absolutley no place in determining the death an individual. This is not a moral position, but one that recognizes the inherent danger of a bureaucratic institution making error when it comes to the life or death of an individual who may or may not be guilty of a capital crime (see The Innocence Project for specifics)


There is no error here. All legislative intervention was thwarted by the judicial rule of law, dispite executive over-reaching. That's called checks & balances & it's nice to see that it works.


My wish would be that all persons make a deliberate, and written decree as to how they would like to be treated in similar circumstances. Advanced Directives are filled out by only 25% of the population (I can't source it, but I read it somewhere today) Just take the guess work out of it. If you want to live in a PVS with a feeding tube, knock yourself out. But don't leave the decision to those who it might end up destroying.


Posted by: maximumbob | March 24, 2005 11:39 PM


"many, many people agree that this poor woman would not wish to be forced to be kept alive in such a condition."

4. The 3 Schiavos and Greer's opinion. The other rulings were just rubberstamps over Greer's ruling. Hardly think that qualifies as "many, many people".

Posted by: | March 24, 2005 11:52 PM

Well I am going to weigh in on the comment that to starve to death is Terri's wish. If you have a look at the transcript of the last interview with Larry King, Michael Schiavo finally admitted to the truth. He does not know what she would want, it is what "we (Felos/Schiavo/Greer) want." You can find several references to this transcript, including on the site of "LiberalsforTerri). Considering that I am a conservative Catholic in my thinking, I have a lot of admiration for the "liberals" and the investigative work that they have completed on this issue. THEY ROCK.

There are a lot of reasons for disregarding Michael Schiavo's testimony. One of the reasons happens to be that he is lying through his teeth in nearly everything that he has stated. Again, there is evidence that was not permitted in the court that indicates that Terri was in fact responding to treatment. There are medical notes that prove that she was responding to her treatment. You can find them on WWW.Terrisfight.org. The reference to this site is just as reliable as the reference to Matt C's "Abstract Appeal". Another reason for disregarding the evidence of Michael Schiavo is that he is living with his concubine and they have two children. He will not divorce Terri because he wants her dead.


I do not like the way that the unjust judge George Greer is claiming to have absolute power of whether Terri is allowed to live or die. Since there is no conclusive proof that she ever expressed a wish that she would rather die than be in her current state, I believe that the testimony that was accepted should be seen for what it is: TAINTED. It is the testimony of a very ruthless and violent man, who has been lying and has committed a fraud by suing for compensation relating to Terri's condition.


For example, I have not seen strong proof that she was in fact bulimic. The combination of a blood reading of low potassium level plus high glucose levels is one that does not necessarily mean that she was bulimic. The other evidence that this was true has not been fully verified. Since I am not a doctor I can only rely upon what I am reading on the Internet and from what I have read so far, I am not satisfied with the idea that she was bulimic. That blood test result could have also been an indicator that her system had begun to shut down when someone was attempting to strangle her (the most likely reason for the sore neck). This result could happen as she was deprived of oxygen.


Posted by: Maggie4life | March 25, 2005 01:09 AM


Last entry for this issue: Many, many people...
March 23, 2005 Gallop Poll http://www.gallup.com/poll/content/login.aspx?ci=15358
Majority Agrees With Judge's Decision in Schiavo Case
Few see hope for improvement in her condition if kept alive
by Jeffrey M. Jones

A slim majority of Americans agree with a federal judge's decision not to adjudicate the Terri Schiavo case -- denying her parents' request to re-insert the feeding tube helping to keep her alive, pending further legal action. Only a small percentage of Americans believe there is much of a chance for significant recovery for Schiavo if the feeding tube were permanently put in place. The public expresses sympathy for both Schiavo's parents and her husband, but is more sympathetic toward the parents. Americans take a negative view of actions of President Bush and the Republicans and Democrats in Congress in this case.


Definition of PVS & tube Vs Mouth


The ability to orally ingest food and water – to swallow substances other than saliva, is predicated on a level of cognitive capacity. Without cognitive capacity, the intentional act of oral nutrition and hydration is likely to lead to aspiration. Eating and drinking are not unconscious processes. Therefore, Theresa’s neurological status is directly linked to her ability to swallow.


The persistent vegetative state has been accepted as a formal diagnosis in modern American medical practice and it is recognized by American Academy of Neurology as:
The vegetative state is a clinical condition of complete unawareness of the self and the environment, accompanied by sleep-wake cycles, with either complete or partial preservation of hypothalmic and brain stem autonomic functions. In addition, patients in a vegetative state show no evidence of sustained, reproducible, purposeful, or voluntary behavioral responses to visual, auditory, tactile, or noxious stimuli; show no evidence of language comprehension or expression; have bowel and bladder incontinence; and have variably preserved cranial-nerve and spinal reflexes. We define persistent vegetative state as a vegetative state present one month after acute traumatic or nontraumatic brain injury, or lasting in least one month in patients with degenerative or metabolic disorders or developmental malformations.
The Multi-Society Task for on PVS, Medical Aspects of the Persistent Vegetative State, New England Journal of Medicine, 330:1499-1508, May 26, 1994.


In Re: Theresa Marie Schiavo, Incapacitated Report to Gov. Jeb Bush and the 6th Florida Judicial Circuit 1 December 2003 Jay Wolfson, as Guardian Ad Litem to Theresa Marie Schiavo Page 28 of 38


Posted by: maximumbob | March 25, 2005 01:12 AM


MaxBob, 3 Schiavos quoted a hearsay casual comment. A blind Judge agreed with them. Doesn't make it factual. It doesn't freakin' matter what the polls say. Get a clue. No one really knows what Terri wants now, or what she wanted then. Quit dodging the facts.


Do you really want public polls to decide the value of your life?


Posted by: | March 25, 2005 01:25 AM


"Do you really want public polls to decide the value of your life?

Posted by: | March 25, 2005 01:25 AM"


That's the reason we live in a republic and not a democracy. Mob rule can be deadly.


Posted by: | March 25, 2005 01:45 AM


The "domestic violence" [blame the man for everything under the sun] meme sure dies hard, doesn't it? Today on Court tv there was a trial shown in which a wife murdered her husband, who was trying to leave her, with a hatchet she had purchased within a day. Her defense was the "battered woman syndrome". She was the batterer.


Much b.s. was presented by some alleged "expert" who stated such whole cloth myths as, "one half of homeless women come from battering environments", as though they are virtually classic "battered women".[Lord, spare me, please!]


The term "domestic violence" is sexist via its propagandization through false statistics and fantasy mechanisms, perhaps drawn from some real anecdotal cases, but still anecdotal only, and always ignoring the acts of women. Real statistics show women are at least as physically aggressive as are men.


In addition the Violence Against Women Act is sexist, as much as a racist law is racist, in its presuppositions and spawn. It's due to sunset this year, and it should. It's supported by $3.5-5 billion in Federal money alone. No statistical benefit has ever been shown. Why would it be? Blaming males cannot work.


Posted by: Joe P. | March 25, 2005 01:56 AM


Joe P., what the heck are you blathering about? We don't know what happened to Terri, we are just examining whatever evidence there is on record. Chill.


Posted by: | March 25, 2005 02:00 AM


JoeP, the comments that you make have nothing at all to do with this case. That kind of comment is what is known as a diversionary tactic.


I agree that women do perpetrate violence in the home, and yes they also cause abuse in the workplace. However, that subject is not related to what happened to Theresa Schindler.


The facts of this particular case do point to the possibility that Theresa was abused by her husband on the night that she collapsed. What is worse than the physical abuse that she suffered is the mental torture of the last 15 years. Michael has refused to allow Theresa to have rehabilitation and therapy. There are reports available that indicate that Theresa was progressing prior to the court settlement. The setback came when Theresa did not win enough cash, and that seems to be the driving force behind Michael Schiavo and his Recovered Memory Syndrome.


There is a criminal desire to see Theresa dead, regardless of the method to achieve that objective. This woman's faithless husband wants her dead, and he is using a pro-euthanasia lawyer to push his agenda. The pro-euthanasia lawyer, George Felos, wants to win this case so that he can further his agenda to have generalized euthanasia recognized.


The unjust and blind judge who has been making these decisions with a possible underlying motive of having the fame of introducing generalized euthanasia into the USA. It is an effort to use the judiciary for activism.


When I look at the facts that have come to light, I see this in light of a plot between at least three players who have their own agenda. What they have done is use Theresa as the pawn in their game to get what they want by stealth. It is as if there has been some kind of private agreement that this woman must die so that these objectives will be achieved.


Most of all, what is shows is that the powers of the probate judge must be curbed in the future. He must not be allowed to preside over such unjust situations ever again. The elderly need to know that they are not going to be exploited by ruthless guardians. The same is true for those who have become physically or mentally incapacitated.


With regard to the evidence of Dr. Cranford, since he has an association with the Hemlock Society, he too has a clear cut goal of bringing in generalized euthanasia. It is in his interests, therefore to give the diagnosis that the client wants for the court case. Cranford has complied with the wishes of Felos and has testified that Theresa Schindler is PVS without an adequate consultation.

With regard to Jay Wolfson, I do not doubt his report at all. I am certain that whilst he was there, Terri was non-responsive. It is possible that someone interfered with Theresa prior to his visits so that she did in fact not have the ability to respond because of being heavily sedated. Keep in mind that it is Michael Schiavo who has been calling the shots concerning her medical treatment.

However, this still leaves the question open on what happened that night that she collapsed. Also it does not answer the question of what might have happened between the CT scans that showed no abnormality and the scan that indicated an abnormality.

I would like to propose that it is possible that her head was slammed into the edge of the bath as she struggled against her husband who was trying to strangle her. I would like to propose that this damage did not show up for a few days, thus leading to her deterioration into a coma. There are other possibilities but I wonder if it is possible for the injury to happen in the hospital, unless she was dropped off a gurney.

Posted by: Maggie4life | March 25, 2005 05:41 AM

Isn't it also the case with hyrdocephalus, that the pressure from the fluid can compress the grey matter to at least some extent, and when the pressure is removed, the tissue will expand? Not that this is necessarily the case here, and even if it was, I'd be very surprised if it was compressing everything we see missing here, but, again, wouldn't it be nice to know?

Posted by: LibraryGryffon | March 25, 2005 08:46 AM

Just because the comment is "hearsay" doesn't make it unreliable. It is likely admissible under an exception to the hearsay rule.

Using the "it's hearsay" argument is silly. It's like arguing the evidence is "all circumstantial."

Posted by: Curious JD | March 25, 2005 12:16 PM

Curious, your statement make no sense. Just because hearsay is admitted, doesn't make it reliable. For the past 15 years, Judge Greer has consistently ruled against Terri's parents. Even to the point at times where he violates the Florida constitution himself. Just because Greer is a Judge, doesn't mean he is unbiased or uncorrupted.

Posted by: | March 25, 2005 12:31 PM

Correct, but it doesn't make it unreliable either. But generally, the hearsay exceptions exist because in those situations there are some indicia of reliability.

And just because a judge rules against you or you disagree with his opinion, doesn't mean he is corrupt.

Posted by: Curious JD | March 25, 2005 12:42 PM

"And just because a judge rules against you or you disagree with his opinion, doesn't mean he is corrupt."

Read the court records of the case. The Shindlers got screwed for 15 years. Judge Greer is in the pocket of the Scientology lobby in Pinellas County. Another poor woman dehydrated to death in the care of her Scientology handlers. Greer did nothing.

http://lisamcpherson.org

Posted by: | March 25, 2005 12:54 PM

They got screwed because the judge ruled against them? Everyone who loses says that. Now you're talking about Scientology? You're getting out there with the innuendo.

You make a much better case on the medicine.

At least you've given up on that silly "hearsay" argument.

Posted by: Curious JD | March 25, 2005 01:03 PM

Curious, have fun with the kool-aid. It's grape today!

Posted by: | March 25, 2005 01:11 PM

When you can't come up with an intelligent response, put in a silly one.

Kudos to you.

Posted by: Matt | March 25, 2005 01:16 PM

Some people like the taste of kool-aid, impossible to talk them out of it so why waste the energy?

Posted by: | March 25, 2005 01:21 PM

I found her CT odd in that she has profound, global atrophy in her anterior circulation, but not her posterior circulation. The fore-parts of the brain look like the expected result of a global insult such as hypoxia or hypoglycemia: The metabolically more active gray matter - where the bodies of the brain cells reside - has died and only the connecting white matter remains.
But if she had suffered a cardiac arrest I would have expected the entire brain would be so affected. Instead, the territory supplied by the carotid arteries is injured but the territory covered by the posterior, vertebral arteries is not. What kind of injury would do this? Would strangulation do this? Has she ever had her hyoid bone XRayed?

Posted by: Neuromancer | March 25, 2005 01:28 PM

"Has she ever had her hyoid bone XRayed?"

Doubtful that she has. Michael Schiavo refuses most tests.

Posted by: | March 25, 2005 01:49 PM

Jeez, some of you should start looking into this Hospice that Terri is in. Greer's wife is on the BOD, Felos was on the BOD, Wolfson is connected to the hospice through USF, they are being litigated for medicare fraud for billing on non-terminal patients, Terri has been there for 5 years illegally, on Felos request.

If that doesn't give you some reasnable doubt about this case, I don't know what will.

Posted by: | March 25, 2005 07:05 PM

Jeez, some of you should start looking into this Hospice that Terri is in. Greer's wife is on the BOD, Felos was on the BOD, Wolfson is connected to the hospice through USF, they are being litigated for medicare fraud for billing on non-terminal patients, Terri has been there for 5 years illegally, on Felos request.

If that doesn't give you some reasnable doubt about this case, I don't know what will.

As the Australian observer here, I am indicating that as I have been reading up on all of the available information, this relationship with Woodside Hospice is to me a real problem.

Any judge worth his salt, and who is not corrupt should have had doubts about motivation in this case. I have worked through the wall of silence that has been thrown around any attempt to get an investigation happening. Wherever there is a connection to Greer and Felos, you will see that the investigations get stymied.

This should be a red flag folks that there is something very crooked going on here.

Even though I have no medical training, I have seen people in a coma, or in PVS, especially in recent years. The futility of treatment rule is a rule for those who are truly dying must be enforced in an ethical manner to prevent something like this case ever happening again.

From what I have read of the laws in Texas, there is a safeguard that allows the family to remove the patient within a 10 day window. One must not be too quick to jump down the throat of the President because one distraught mother is grieving over the death of her child, when in fact further treatment for the child would be futile.

From what I have seen of the medical records for Terri (the ones that Michael does not want us to read). There is sufficient evidence to suggest that she is awake and cognizant and that she is not PVS as claimed by Dr. Death Cranford. I saw my father not long after he had suffered his second stroke. He could not talk and he had suffered a lot of brain damage, but he could communicate with me. His condition would have been much worse that Theresa Schindler when Theresa was admitted to hospital.

As another aside, I am glad that Dr. Death Crandon was not around in 1959 when my sister was lying in hospital in a coma for two weeks because of brain damage. My sister came out of the coma and is alive and well today. It makes me shudder to think that a doctor could make such a diagnosis of Theresa without doing further tests and examinations. It bothers me a lot that a guardian is allowed to deny his ward proper rehabilitation as soon as he has gained a financial reward as a result of her collapse.

There are too many unanswered questions in this case. All eyes should remain on Michael Schiavo and his brother. (PS - the timing of the brother and sister in law coming forward with their hearsay evidence is also somewhat suspicious when it is observed on the time line. They did not emerge until after Pearse gave his report that slammed the motives of Michael. How convenient.) Has anyone checked the number of times that these other two might have changed important but small details of their evidence?


Posted by: Maggie4life | March 26, 2005 12:19 AM


Some thoughts on the subject (disclaimer, I am not a doctor but work on administrative side):


I worked for a year with a neo natal home healthcare group. One of the group of children that we did care for were compromised children in foster care. Some of these children were severely brain damaged due to shaken baby syndrome or SBS.

One of the things that keeps being commented on is the presentation of a "stiff neck" upon admittance to the hospital. Many people have speculated that she could have had some sort of neck injury and one commenter above asks about symptoms that seem similar to strangulation victims and asks if she had her hyoid bone x-rayed.

This got me thinking about children of SBS. Many children who suffer from SBS present with a "stiff neck", posturing, rigidity and a few other symptoms which I looked up to refresh myself on. In shaken baby syndrome, blunt force trauma does not have to be applied to cause injury to the brain and is often not present when children are first examined by physicians which often leads to misdiagnosis or completely missing the opportunity to examine the patient for signs of such an injury (in study data, children of middle class, caucasian parents are the most often misdiagnosed as opposed to children of minority parents; go figure).

I realize that Terri Schindler-SChiavo is not a baby and an adult's head and neck are much stronger and can withstand greater force. However (pure speculation on my part), couldn't a victim being 5 foot nothing and 115 lbs and their aggressor being 6 ft (appx) and 195 (appx) suffer a similar injury?

National Centers for Shaken Baby Syndrome

http://www.dontshake.com/Audience.aspx?categoryID=8&PageName=NonAccHeadInjury.htm

Head injuries account for the majority of the death and disability resulting from Shaken Baby or Shaken Impact Syndrome. These head injuries are typically identified in children less than two years of age and should be suspected when traumatic injuries are found in the absence of an adequate mechanistic explanation of their occurrence. Although the issue of shaking versus impact remains controversial to many, in our experience a history of shaking is rarely elicited, even when the perpetrator confesses. Moreover, evidence of impact is often found following careful correlation of physical and radiological data.(...)

On the other hand, multiple fractures, complex in-driven fractures, or fractures in which the margins are widely separated (diastatic fractures) are rarely the result of an accidental, simple fall. Further, we believe that it is the sudden stopping of the moving skull (the impact) which results in severe brain injury. If the head is stopped by something soft, (e.g., mattress, furnitureplain cushion, etc.) there may be no fractures but severe brain injury. Thus the absence of a skull fracture is perfectly compatible with an abusive injury.(...)
******************************************
Of course, we know a bone scan exists that indictes some sort of skull fractures which I believe the information addresses a little further on
*********************************************
Finally, the innermost layer is referred to as the pia mater (soft mother). It is intimately adherent to the surface of the brain. Under normal conditions, the arachnoid is closely apposed to the inner surface of the dura mater such that the two layers are separated by a potential space (the subdural space). On the other hand, the arachnoid and the pia are normally separated by a true space (the subarachnoid space) in which circulates the cerebrospinal fluid.

Traumatic injuries can result in separation of the arachnoid from the dura mater, enlarging the subdural space through the accumulation of blood or cerebrospinal fluid between these two layers. Such accumulations are referred to as subdural hematomas and subdural hygroma, respectively. Bleeding may also occur between the skull and dura mater (epidural hematoma) or into the space between the arachnoid and pia mater (subarachnoid hemorrhage).(..)

Non-accidental subdural hemorrhages typically are located posteriorly in the space between the two cerebral hemispheres or covering the outer surface of the cerebrum. These acute hemorrhages are usually of small volume and are rarely a cause of death. With time the blood comprising the hemorrhage will begin to degenerate and the hemorrhage will enlarge as water is drawn into it. This process of degeneration ultimately produces the chronic subdural hematoma and coincides with the aforementioned changes in the appearance of the hematoma on CT scan(...)


Parenchymal brain injuries include focal bruising (contusions), diffuse swelling and stroke. Multiple factors have been implicated in the genesis of these injuries including violent rotational forces, lack of oxygen supply to the brain (as a result of seizures, apnea or strangulation), and forceful impact injury. These primary injuries may result in a cascade of deleterious events occurring at the cellular level leading to the death of the neurons in the area of the injury(...)


A common misconception regarding non-accidental head injuries is that severe brain injury only develops if the victim is shaken "50 to 100 times". However, a single forceful impact is sufficient to produce very high deceleration forces in the infant's brain. It is these forces which result in bleeding to the eyes and brain. The injury is often the result of a single loss of control where the baby may be shaken but is also thrown down because the caretaker is still angry. It is probably this discard injury that causes damage. While the child's head can be struck violently against a chair or wall, it is important to understand that impact against a soft object (e.g., sofa, crib mattress, etc.) is sufficient to result in injury. Fatal injuries, therefore, can be caused by a single impact.

Whereas the identification of scalp, skull and meningeal injuries may be important as an indicator for the suspicion of a non-accidental injury, the identification of parenchymal brain injuries is most important because of its grave prognostic implications. Many of these injuries are associated with severe brain swelling, dangerous elevation of the intracranial pressure and death.
**********************************************

The teller, besides the stiff neck was the "stroke" along with rigidity, posturing, "seizures", the fractures of the skull on the bone scan and the type of brain damage Terri suffered. Patients who suffer strokes, if I'm not mistaken, often present with lowered potassium levels. I'm sure doctor Boykin can correct me if I'm wrong (or one of the other medical professionals commenting here).

There is no where that I know of an official diagnosis of "bulimia". This is totally speculation based on the findings of the malpractice suit which indicated that the doctor missed the lowered potassium level. Interestingly, this type of presentation of a 26 year old is fairly uncommon. How many do you know that dropped over from a stroke? The fact that the doctor did not take it into consideration is probably indicative of the case being fairly abnormal on presentation.


Also, I am presenting a completely separate hypothesis from Dr. Boykin. It is not uncommon for children suffering from SBS to not immediately show symptoms that would lead to that conclusion.


Typical symptoms include:


Less Serious Injury:
Lethargy / decreased muscle tone
Extreme irritability
Decreased appetite, poor feeding or vomiting for no apparent reason
Grab-type bruises on arm


http://www.angelfire.com/dragon/bdoornews/The_Oracle_of_The_Night.html