CSI MEDBLOGS: DOES TERRI SCHIAVO HAVE HYDROCEPHALUS?

THE FEEDING TUBE MUST BE REINSERTED IN ORDER TO GET A NEW CT OF THE BRAIN

I have offered the following proposition to Terri Schiavo's legal team today:

The single CT image I was able to access at the U of Miami's web sight raises the following ESSENTIAL questions/issues:

Issue: There is something in Terri's right ventricle (the image is reversed). I know she had thalamic implants, but on this one slice the "thing" in Terri's ventricle is not projected to the thalamus, it is projected within the ventricle. She needs a follow-up scan to  see what this is and where it is

 

Issue: If the "thing" in Terri's ventricle is a "shunt tip" -- who put it there and why is it there and was it removed? If she was shunted to relieve hydrocephalus then she must have follow-up exams and someone needs to postulate the most common mechanisms for hydrocephalus (which, I believe, is blood in the cranial vault)

 

Issue: Given this ONE image, NO ONE can exclude the possibility that Terri, at that time, had hydrocephalus.

I see all the classic signs: 

1. Enlarged ventricles
2. Rounded, bulbous front and back ventricle horns
3. "Pressure" effect on the occipital lobes of the brain (which, by the way, do not -- on this image -- demonstrate the atrophy seen everywhere else)

*People with untreated hydrocephalus OFTEN SHOW IMPROVED MENTATION WHEN THE OBSTRUCTION IS RELIEVED.*

So, if the other images bear out my impression from this one slice, then Terri MUST have a follow up CT or MRI or BOTH and if she is hydrocephalic she needs to be shunted, because there are possible positive therapeutic implications that no one can deny.

 
What if The State and Terri's Tube-Remover Ignore This ?

If she is NOT shunted it is my contention that there is no physician ANYWHERE who could say, in the future,  definitively, that Terri did not have hydrocephalus at the time of that particular CT slice.

What does this mean? Everything.

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); however, what I AM saying is that if they DON'T do a repeat CT scan NOW BEFORE TERRI DIES, the evidence will be on that scan forever. They will never be able to say it wasn't so.

Do they want to face their own carnivorous legal system when the dogs of war are let loose after Terri dies? I WILL BE THE FIRST TO TESTIFY. I will say that one cannot exclude hydrocephalus on that image. ONE MUST REPEAT THE SCAN. Basically, given THAT image the onus is on them to prove she is NOT hydrocephalic -- meaning she needs a repeat CT, and to do that they need to reinsert the feeding tube.

If they proceed as is, with that image out there on the internet, the person(s) who pulled that tube had better be aware that they are in jeopardy of actuating a death when there were standard medical procedural methods that had yet to be deployed.Here's what they can look forward to at the trial:

Dr. Boyle:             ONE MUST REPEAT THE CT SCAN

Tube-Puller:          Why?

Dr. Boyle:              BECAUSE SHE MAY HAVE HYDROCEPHALUS.

Tube-Puller:          O come on, that's ridiculous.

Dr. Boyle:             MAYBE. BUT SHE MAY HAVE HYROCEPHALUS.

Tube-Puller:          O come on. So what?

Dr. Boyle:             HYDROCEPHALICS CAN IMPROVE WITH SHUNTING.

Tube-Puller:         But she was brain dead. You're insane

Dr. Boyle:            MAYBE. JUST REPEAT THE CT SCAN AND PROVE ME CRAZY.

Tube-Puller:         we can't do that

Dr. Boyle:            WHY?

Tube-Puller:        She's dead. I pulled out her feeding tube.

Dr. Boyle:           DEAD? HOW DID SHE DIE?

Tube-Puller:       Dehydration. Starvation.

Dr. Boyle:           I'M SORRY FOR HER. I PITY YOU.

Tube-Puller:       Why?

<>

Dr. Boyle:   I CANNOT CHANGE WHAT IS ON THAT FILM. SHE MAY HAVE HAD HYDROCEPHALUS.   IF SHE DID, SHE MAY HAVE EXPERIENCED IMPROVEMENT WITH SHUNTING. 

Tube-Puller:        That's a lot of maybes.

Dr. Boyle:         THAT'S ALL TERRI HAD.
YOU SHOULD NOT HAVE PULLED THAT TUBE.  YOU ARE CULPABLE.  I'M AFRAID IT'S MURDER.

Tube-Puller:        that's idiotic. I only did what I was ordered by the courts to do.

Dr. Boyle:    

I'VE HEARD THAT BEFORE.
  IT DOESN'T FLY.

ONE MUST REPEAT THE SCAN. PUT THE TUBE BACK AND REPEAT THE CT SCAN.

Comments

[Jeremy]

Is this not just hydrocephalus ex vacuo which can occur with ischemic brain injury?

And have there been follow-up CT's that we just don't have access too? Do we know?

[Jeremy]

too=to ugh.

[marsha]

http://pekinprattles.blogspot.com/2005/03/dr-cranfords-complete-terri-schiavo.html

have you see this? I really have no idea about any of this.

Jeremy, Cranford stated on Hannity & Colmes yesterday that Terri hasn't had a CT since 1996. I heard it myself.

[Jeremy]

So perhaps this was the followup scan? And we'd need to see earlier ones? If this is the follow up then would there really need to be more?

Just curious.

[Jeremy]

Okay...actually that report you linked says she had a CT in 2002(and she's had multiple):

"The initial CT scan on the day of admission, February 25, 1990, was normal but further CT scans documented a progression of widespread cerebral hemisphere atrophy, eventually resulting in CT scans of 1996 and 2002 showing extreme atrophy (CT scans-1996, 2002: “diffuse encephalomalacia and infarction consistent with anoxia, hydrocephalus ex vacuo, neural stimulator present); prior to these most recent two CT scans, CT scans had been performed on February 25, 1990, February 27, 1990, and March 30, 1990, with an MRI scan on July 24, 1990.The two most recent EEG’s have demonstrated no electrical activity-on July 8, 2002: “no evidence of cerebral activity;” and October 4, 2002-“does not have any definite brain activity. However, most of the tracing is obscured by artifact from muscle and eye movement.” The clinical exams over the years were entirely consistent with diagnosis of permanent vegetative state secondary to hypoxic-ischemic encephalopathy. From the initial hospitalization in February, 1990, until the present time, there have been no significant changes in Terri’s neurological findings, and nothing in the medical records to suggest any disagreement whatsoever among Terri’s attending and consulting physicians about the underlying diagnosis and prognosis for recovery. A deep brain stimulator was placed in Terri’s brain on December 12, 1990 at request of the husband who flew with his wife to San Francisco for the procedure. This highly experimental form of medical treatment did not result in any clinical improvement in Terri’s condition."

I personally have my doubts in Dr. Cranfords ability to evaluate this case. He stated on National televison yesterday that the complete amount of time he has ever taken to evealute Ms. Schiavo is 45 minutes. He said yesterday that Terri hasn't had a CT since 1996, but in the above link to his email response, he suddenly remembers that she had a CT in 2002. I have my doubts that this is her actual CT.

[Jeremy]

No I think it's her actual CT. I'm 99.99999% positive of that.

I haven't seen Cranford talk...I'm just going on his full report here.

Abstractappeal.com confirms the 2002 CT:
http://abstractappeal.com/schiavo/trialctorder11-02.txt

[Kevin]

For ... the ... love ... of ... God ... can you all just please let the poor woman die? YOU all need counseling! YOU are trampling over HER rights! I hope the hell none of you ever find yourselves in her situation and are denied the right to choose what you want. Then you'll see how selfish you all are!

[Raquel]

This is supposedly an "accurate" timeline/history of the testing done to Terri (written by Dr. Cranford though...), although IF these additional tests were done, Greer has them sealed in the court records.

[The initial CT scan on the day of admission, February 25, 1990, was normal but further CT scans documented a progression of widespread cerebral hemisphere atrophy, eventually resulting in CT scans of 1996 and 2002 showing extreme atrophy (CT scans-1996, 2002: “diffuse encephalomalacia and infarction consistent with anoxia, hydrocephalus ex vacuo, neural stimulator present); prior to these most recent two CT scans, CT scans had been performed on February 25, 1990, February 27, 1990, and March 30, 1990, with an MRI scan on July 24, 1990.The two most recent EEG’s have demonstrated no electrical activity-on July 8, 2002: “no evidence of cerebral activity;” and October 4, 2002-“does not have any definite brain activity. However, most of the tracing is obscured by artifact from muscle and eye movement.” A deep brain stimulator was placed in Terri’s brain on December 12, 1990 at request of the husband who flew with his wife to San Francisco for the procedure.]

[JOMarley]

HEY...Check Dr Hammesfahrs Report. He also spoke about it on an interview with Ron Panzer at Highway2Health.net on 1/07/04
He tells that an experimental electrode was implanted in her brain,. Michael was told by the doctors that the electrode increased the risk of infection, encephalitis and a build up of excessive fluid. He was told that the electrode reqwuired ongoing medical monitoring. He removed Terri from the program and there was no medical monitoring from 1991-2 to now. The fluid is there and compressing the brain and diminishing her capabilities. It can be drained via a shunt and then the btrain would decompress and the diminished capabilties would return. Michael has refused all medical treatment. CRIMINAL ACT.

You can contact Dr Hammesfahr at Hammesfahr Neurological Institute HNI.com

Kevin, Terri made a casual remark, at a barbecue, that she would never want to be on a ventilator. Her husband is using this remark to starve her to death. There is evidence to suggest that she may not be PVS. Has it ever occured to you that Terri may not WANT to die this way?

[Jim]

Kevin, For the love of the same God, can't you let this poor woman LIVE? I can't believe you are serious in saying we are violating her right to death by starvation. I guess if wanting to let someone live is selfish, then count me in.

[GrenfellHunt]

Can we get some discussion of the no EEG in the last CT of 2002? To those of us non-medical readers, that sounds like no EEG=PVS or brain-dead.

[maggie]

Why is there so much inconsistency about the alleged CT scans? When did Cranford examine and do the scan on Terri in 2002? As far as I am aware he examined her only the once for about 45 minutes. He did not order any tests. Where is all this extra medical testing coming from?

Maggie, my point exactly. Frankly, I don't find any opinions (or information) from Cranford to be credible. He has his own agenda with Felos and that whole euthanasia crowd.

Dr. Cranford seems to have a knack for finding PVS. Cranford also diagnosed Robert Wendland as PVS. He did so in spite of the fact that Wendland could pick up specifically colored pegs or blocks and hand them to a therapy assistant on request. He did so in spite of the fact that Wendland could operate and maneuver an ordinary wheelchair with his left hand and foot, and an electric wheelchair with a joystick, of the kind that many disabled persons (most famously Dr. Stephen Hawking)use. Dr. Cranford dismissed these abilities as meaningless. Fortunately for Wendland, the California supreme court was not persuaded by Cranford's asessment.

Poor Mr. Wendland had a wife who wanted to remove his feeding tube. Thankfully for Mr. Wendland, he wasn't living in Pinellas County, Florida at the time.

[Delores]

Whats the harm in reinsurting the feeding tube and getting another cat scan. I think it is a sick day in America when we guickly kill criminals, or allow murders to spend a whole life time in prison, yet, we can starve the disabled or elderly. God have mercy on the husband and the judges, they are going to need it, they are nothing more than cold blooded killers.

[CodeBlueBlogMD]

Again, I only have the image on the website at u of Miami.

I have told Terri's legal team that I am willing/ would like to review any and all CT's and/or radiological examinations that have been done on Terri.

What may also be important here is the timeline of her cerebral atrophy as it relates to her cerebral atrophy.

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

[Anon]

This info needs to get to the Florida Governor's Office and/or the DCF in Florida in order to help them in thier claim and legal authority to take Terri Schiavo into protective custody.

[Jeremy]

Cranford didn't have to order the 2002 test for it to be read/interpreted by him. But the court acknowledges that it was done...and it was read by all the physicians involved in the 2002 case.

The CT was done and reviewed in 2002 by all parties involved...doesn't matter who ordered it.

[jack]

Again we are treated to this highly emotional and alarmist rhetoric--based on a single screen capture of a CT scan and a bone scan.

We have not been treated to the supposed hundreds of CT scans of functional seniors whose scans are as bad as or worse than Terri's.

Instead we are expected, on this paucity of evidence, to believe that a radiologist knows better that all the doctors--among them neurologists and neurosurgeons, at least one of which has actually operated on Terri's brain--all the investigators, judges and other people who have been dealing with this first hand for 15 years?

Jack, there's enough chicanery going on with Greer's court rulings (and these learned neurologists and Felos who have ties to pro-euthanasia groups) to give the situation an element of reasonable doubt. If you want to keep drinking the kool-aid and believing the propaganda, go ahead.

[Phil Calvert]

According to an article posted at the Captain's Quarters blog, Terri allegedly does have hydrocephaly:

"Terri had a CT scan done, which Morin says is analogous to a poorly-focused photograph. It only has use as a diagnostic tool when dealing with major acute trauma to the brain, not in determining chronic brain death, and does not reveal the hydrocephaly that Schiavo and his doctors claim Terri has."

See:
http://www.captainsquartersblog.com/mt/archives/004092.php

Just thought I'd pass that along...

Phil

[Maggie4life]

I am waiting to see what your next question will be because I have already found the questions that you are posing to be absolutely fascinating. I do not have any medical qualifications but that does not stop my interest.

I have seen some ill founded remarks about Terri's bone scan indicating arthritis. As someone who has undergone two bone scans, and the second one definitely showing signs of osteoarthritis, I feel that I can speak up about the use of Keflex as an anti-inflammatory for Theresa Schindler. I have been struggling with arthritic type pain for a period of more than 15 years. At age 28 I was the front seat passenger when our car was hit from behind. I received a whiplash injury from that accident. At the time it was diagnosed as a torn neck muscle as well as stretched ligaments. The situation in my neck was worsened when I began working for a government department here in Australia. Without giving all of the details of my own case, I just want to highlight that in dealing with my pain and inflammation I have been treated with a variety of the NSAIDS including Keflex, Celebrex and Orudis. This was well before any diagnosis of arthritis was viable.

If Terri's scan was showing signs of repair from injury, then the results do not indicate either the earliest forms of osteoporosis or arthritis. The activity on the scan is more than likely related to repair activity in her bones after she had suffered some form of severe trauma. To this I can add from experience that my last scan showed up a lot of activity in my feet and the doctor actually came and asked me if I had suffered recent trauma near my toes. I do fall a lot and I do mostly soft tissue damage. I would expect that doctors who are experienced with such scans would be able to state straight off if there was arthritis present. The doctor who interpreted the scan did not make any such comment.

Also, as a result of my own experience, especially with enthesitis, one's muscles and tendons attached to the joints can become severely atrophied when there is insufficient exercise taking place. Michael's denial of any form of rehabilitative therapy also precluded any effort to exercise Terri's arm and leg muscles, thus contributing to the worsening of her condition

Oh yes, I will be doing further research into the activities of Dr. Death Cranford and I will be writing a piece on my own blog with my findings.

This issue is about legalizing murder for those who are not able to look after themselves. There is a big scandal here involving guardianships in Pinellas County Florida. That scandal must be investigated.

(the Australian observer)

Would authorities be able to remove Terri from the hospice if she were admitted to the program fraudulently?

1. Hospice is for the terminally ill. *Was she certified as terminally ill by her physician and the hospice team?

2. Admission to a hospice program is done along the guidelines of specific criteria. *What criteria did they use to say that she was terminally ill?

3. Terminally ill is defined in hospice as a prognosis of 6 months or less. *How long has Terri been in hospice? What source is paying for her stay in the hospice? If her hospice funding is through medicare or medicaid, are we all paying to kill her?

4. The hospice she is residing in is a part of Hospice of the Florida SunCoast. *Are they fraudulently billing for Terri when she was not even appropriately admitted to the program?

5. Profiting from her death. *When will the husband's book deal be announced? Who is going to be writing the screenplay? What will they title the television mini-series?

Terminally ill is reserved for those who are dying or those who choose no treatment. If she felt something bad happening before her collapse and decided that it really sucked and wanted to live, but could not verbalize it.... as an American citizen, as a person, as an innocent victim, as a woman, doesn't she have the right to change her mind?

I've begun steps to get my wishes clearly stated in the event that I am unable to communicate them under my own power. I'll not leave it simply to an Advanced directive or to a Living Will. There will be more. Much more, including, but not limited to my writings, discussions with family and friends, a clearly appointed Health Care Representative, and personal hand written letters to people who love and care about me.. and one to a lock box at the bank!

Don't let them kill you without your expressed written request.