*****************


April 2005

Sun Mon Tue Wed Thu Fri Sat
          1 2
3 4 5 6 7 8 9
10 11 12 13 14 15 16
17 18 19 20 21 22 23
24 25 26 27 28 29 30
Blog powered by Typepad

« The 131st Carnival of the Vanities | Main | CSI MEDBLOGS: FURTHER INVESTIGATION OF CT BRAINS TURNS UP NEW ASTOUNDING EVIDENCE »

Comments

Was Terri terminally ill BEFORE they pulled the TUBE???

NO.. they're all saying she could live on for years and years.

http://suebobsdiary.blogspot.com/2005/03/why-terri-schiavo-is-in-hospice.html

I apologize sincerely for posting again.

I am a hospice nurse, wishing I were better with computer tech.

Be well all.

Thanks Anon Hospice Nurse, we all have questions why Terri has been in a hospice for 5 years instead of a nursing home where the focus of care, and legal/medicare reporting requirements are very different.

CTM

Because I have another amazing question I am going to post on right this minute!

That was March 24, 3:34 on my computer. What happened to the question?

CTM, I'm sure CodeBlue is referring to the latest blog entry:

http://codeblueblog.blogs.com/codeblueblog/

RD

For the sake of argument I define these levels or "stages" of hope for a patient's rehabilitation:

Stage 1 - Beyond hope ("pull the plug")
Stage 2 - Hope ("let them live but don't rehabilitate them")
Stage 3 - No need to 'hope' ("rehabilitate")

We know from patient interviews that Terri is a Stage 3 patient. As pointed out on another thread here, this CT scan is clearly a Stage 1 patient. Therefore, it can't be Terri's brain scan.

It is my contention:

1. Whatever blood or other fluid entered Terri's brain from head trauma early on in her treatment was well-contained (though potentially causes her symptoms even now) and DID NOT lead to the CT scan we have been given.

2. The patient here in this scan is a very sick person indeed. Their cortical atrophy puts them in Stage 1 (no hope).

If we get our heads out of the weeds a minute and THINK, it's obvious this can't be Terri's CT scan.

RD

Come over & visit and I'll explain the whole thing. Am working on a follow-up PROOF for which I will need your help! I'll keep you posted.

Maggie4life

I think that there is grounds to follow through with the comments made by Kat-Missouri. Since I am not in the medical field, I will defer to the doctors on the matter of the CT scan and whether or not it belongs to Terri. I am already having doubts that this is the case. It sounds logical that those who want people to think that this is a scan of Terri's brain to prove that she is far gone have blundered.

The evidence that I have seen that makes any sense is the evidence that points to an argument followed by an attempt to strangle, followed by the shaking, which is admitted in evidence.

This is a clear cut case of insurance and medical fraud. (of course I am not a special investigator or a lawyer so I might be speaking out of turn - somehow I am not sure that I am speaking out of turn.

concerned citizen

Re: hospice. My mom has been receiving hospice care since September. Yes, you are correct that docs must certify that there is generally 6 months or less to live, and that there is no hope of recovery. Every 6 months, the doc must re-certify that the patient still is in this same status.

Also, amazingly enough, we have found out through my mom's supplemental insutance bills, that medicare does indeed reimburse hospice. How disgusting to think they ask for donations, then they are getting their pockets lined from medicare!!!!

Maggie4life

Since I have no medical background I have been clutching for information on the alleged Bulimia angle. Thanks to an off-hand comment, I think that I can now put it to rest that Theresa was Bulimic and that was the cause of her collapse.

If you check the hospital medical records as to what they found and how she was treated, you will find that she had a parasite in her stomach. If it was gardia that she had, then that poor girl would have been very sick with it, and yes she would have been vomiting (been there done that twice).

When I saw the off hand remark, I remembered that amongst the medication that she was given was Flagyl. Please correct me if I am wrong, is that the medication that is given for that kind of stomach upset?

If Terri had this particular parasite, she would have had extreme stomach pain and yes as it grew worse she would have been very nauseous, until she could no longer keep the nausea at bay.

I have been looking at this angle because it is probably something that I understand quite well. I have not been bulimic but I have for example suffered nausea throughout the whole of three pregnancies, to the point that I could not walk any distance without wanting to retch. I have also had two bouts of problems with gardia and there is a lot of vomiting. This could easily explain the loss of potassium.

Can one of the doctors please check into this aspect because I think that this is just another aspect of this case.

A.W.

I love this blog. interesting stuff. i am going to quote extensively from it on my blog, freespeech.com.

A dumb question, though. The husband now says he wants an autopsy. Is it safe to assume an autopsy would answer the same questions, if done right?

Mind you, i am not a medical guy, but i am bright enough to understand medical stuff if it is dumbed down a little.

Of course, to do it by autopsy is idiotic, when it can be done before death. i mean what if it turns out he is wrong. what is he going to say to the shindlers? "sorry, my bad"? But still i am curious on what an autopsy can be expected to show.

Tom

This is silly and bizarre. Putting a shunt in will not regrow her cortex. The lack of cortex is her major problem, not any pressure on it. You are a quack.

Steve

The "thing" in Terri's ventricle is NOT a "shunt tip"“ it is "thalamic stimulator implant” placed there Feb 1990 in California.

At that time it was considered an experimental procedure that Michael chased down in order to help his wife, they spent I believe 9 months in Calif working with the device and rehab.

Thalamic stimulatorsare now used tor the treatment of Parkensons tremors

CodeBlueBlogMD

Tom:

Watch what you say.

And look at what you are reading.

Did I say putting a shunt in would regrow TS's cortex? Did I say putting a shunt in would definitively help TS?

Here's what I said:

"As I said, nonshunted hydrocephalics can experience improved mental functioning after shunting. I am not saying this would be the case with Terri (because of how long this has gone on)"

Read it. If you atill need help interpreting what it means, let me know.

CodeBlueBlogMD

Steve:

On this single image (the only one I have) that "thing" projects within the ventricular fluid. Are you saying that it popped out of the thalamus and is now floating in the ventricle? These are two entirely separate anatomic areas.

I already said somewhere that it is possible that this could be the thalamic implant projected to the ventricle because of an extreme effect of "volume averaging" -- an artifact induced by the computer algorithms that "average" nearby pixels--and that might be possible if the anatomic distortion induced by her atrophy has juxtaposed the thalamic stimulator to the mid-ventricle and we just happen to be provided with the one image on which this artifact creates the illusion that there is something in the ventricle. However, that does not change the fact that on this one image, as of now, that "thing" is undefined, and the only other possibility is that it represents a shunt tip.

Steve

Kevins recount of events is pretty close.

Another blog has a well written piece

http://talesofawanderingmind.blogspot.com/2005/03/more-to-story.html

mod ervador

The Miami CT looks like it could be the section superior to the thalamus. The thalamus could be just below the section (it somewhat depends on the thickness of the sections). The "blotch" could be the thalamic implant partly in the focal plane in the region of the thalamic anterior nucleus. The body of the electrode could follow a trajectory similar to that of some types of shunt, which would put it in every section from the thalamus up to the area of the superior saggital sinus.

EEG only measures SURFACE brain activity. Someone could have the outer surface of brain tissue wasted, be flatline, and be have a conversation with you about nuclear physics.

Maggie4life

Why is it that the doctor who put in this implant has not ever made a statement about his treatment or his prognosis on Terri?
It seems really odd to me that perhaps the one person who could answer some of the questions that have been raised was not called upon to give any form of expert testimony in this particular case.

If this man worked with Terri why was he not called as a witness regarding his diagnosis of her state? Why was he not asked to review her status after say 3 to 12 months of the implant being in the brain?

Craig H

Ugh, indeed.

It doesn't take volume averaging to make that spot. The spot itself is part of the stimulator, the other part of which is stuck into or near the anterior thalamus. Thalamic stimulators have a long, stemlike, rodlike projection that runs FROM the thalamus up to the surface, either through medial parenchyma or sometimes, as in this case, through the ventricle. Here's an illustration: http://www.henryfordhealth.org/images/Activa.GIF
That's why you see it in the ventricle.

And NO to whoever posted that tripe about holding a conversation with a flat EEG. What part of the brain were you thinking of using to hear, reason and talk through the conversation? The cortex. That's where your language reception, comprehension and expression lives. It doesn't have to be functioning perfectly, but if it's electrically silent, you're not holding a conversation.

Maggie4life

Craig,

the only hole in your excellent explanation is that the EEG was not in fact flat. There was interference because of the high level of muscle activity, and when that was filtered out the EEG result was useless. The recommendation of other doctors happened to be that the test should be repeated at the bedside. That did not happen. Therefore we are back to square one with regard to a proper diagnosis in this particular case.

BTW thanks for the explanations that you have given, since I do not have a medical background I do not know if you are right or wrong. I will leave that to CBB.

Craig H

Thanks Maggie. I wasn't trying to make an inference about Ms. Schiavo's EEG. Sorry that wasn't clear.

mod ervador

I think there were several EEGs over the years. In his report, Hammesfahr chose to look at just one EEG, didn't like it for technical reasons (filtering of muscle activity), and discounted it. He doesn't comment on asking for previous EEGs to compare it to, or what those traces revealed to him. From what I could get of his testimony at trial in 2002, he was never asked about any EEG readings in trial, and his report was not entered into evidence.

Maggie4life

Mod ervador,

from what I have been reading, there had been no further EEGs after the one dismissed by Dr. Hammesfahr. This is the EEG that was used by Cranford to claim that Terri was PVS stage 1.

It was very wrong of George Greer to dismiss the testimony of Dr. Hammesfahr. I noticed that in his judgements he stated that he considered all evidence that claimed she was not PVS to be flawed. He was not willing to double check before issuing again his death sentence.

From what I can tell, this woman had severe brain injury and she had a spinal cord injury. Her neck remained somewhat stiff, as it was on the morning that she was taken to hospital. I am mystified as to why there was no follow-up on the cause of that stiff neck. There has been a wall of silence.

There are at least 3 doctors who have stated that they believe her injuries have come as a result of an attempted strangulation. This was ignored by George Greer. In fact the last doctor who gave that opinion was dismissed as not being credible. I wonder how Dr. McClane felt about his credibility being dismissed in that fashion.

So far no one has answered me as to why an attending neurologist at Bayfront wrote in his notes that Terri was in the neurological sense "awake". If that is what I think it means then descriptions of her being comatose are in error and perhaps even fraudulent, since those descriptions were used to hasten her death.

I have not seen any satisfactory answers to this type of question.

mod ervador

Cranford used more than one EEG to make his diagnosis. He may have illustrated his point with the latest one. Just because Hammesfahr dismissed it doesn't mean it was bad. It was inconsistent with Hammesfahr's "diagnosis" so I opine that he may have just wanted to make it go away, and he certainly didn't jump at the chance to explain the earlier EEGs because they would have posed the same problem.

Hammesfahr had no basis to claim strangulation. He saw a stiff neck in one strangulation victim. As if strangulation is the single cause of stiff neck? Her whole body was hypertonic on admission. Stiff neck is evident in most PVS patients regardless of what put them in that state. The stiff neck is basically a non-issue, if there's silence it's because it's already been said.

The allegation of neck or spinal cord injury by Hammesfahr was uncorroborated by other expert testimony or by any objective test. The 1991 bone scan (and Walker's 2003 deposition) and the Humana discharge papers mention no such injury.

Hammesfahr's testimony was dismissed with good reason. If you knew something about neurology you would cringe at his testimony in the 2002 trial. He was either incompetent or deliberately rigged the result. I've written more about his testimony on another page.

Unless I've missed something, Greer did not simply consider all testimony that TS was in PVS to be flawed. He considered Hammesfahr and Maxfield's testimony to be flawed. They just happened to be the only ones at the 2002 trial that said she was not PVS.

McClane's affadavit was educed by the Schindlers' legal team, based on information they presented to him. He said "the circumstances surrounding her initial anoxic episode and subsequent neurological status are consistent with a victim who has been strangled." That's true. The problem is, there are other causes consistent with the outcome. He did not say "the circumstances surrounding her initial anoxic episode and subsequent neurological status suggest strangulation to the reasonable exclusion of other causes."

McClane also said "a 'heart attack' precipitated by severe metabolic disease secondary to an eating disorder is inconsistent. Such a severly compromised heart would never continue to pump effectively for 15 more years." Notice how he used "heart attack" in quotes and not the condition that was actually diagnosed, cardiac arrest. He is strictly correct: a heart attack severe enough to lead to cerebral ischemia would also lead to a severely damaged heart. But nobody with a firm grasp of the details has said she had a heart attack, so he is disputing nothing of substance. It is a straw-man argument.

I've never seen any report attributed to the Bayfront neurologist that Terri was in the neurological sense "awake", only that she was awake in the sense that her eyes were open and therefore not in a coma.

I don't know if any of this satisfactory to you, but maybe it at least addresses the issues.

She had a broken neck. How is that for layman's terms.

The comments to this entry are closed.

My Photo

2004 WINNER: BEST CLINICAL SCIENCES MEDICAL WEBLOG

What People Are Saying

  • "Dr. Boyle is a man of strong views and good will...read the weblog."
    Brad DeLong-- Semi-Daily Journal
  • "My New Favorite Internet Obsession"
    cripes, suzette
  • "Marvelous Medical Blog"
    Ambivalog
  • "Entertaining and lluminating"
    Counterpunch Magazine
  • "Enjoyable Weblog"
    Alexander Cockburn
  • "I have found a new medical blog, and a blogging hero."
    Liz Ditz-- I Speak of Dreams
  • "Your Blog Rocks!"
    Allyson Dyar-- DyarStraights.Com
  • "A remarkable blog."
    Eric Scheie – Cultural Values
  • "Good thoughts"
    E. Moritz-- Life Liberty and the Pursuit of Happiness