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March 22, 2005

CSI MEDBLOGS: CODEBLUEBLOG ANALYZES TERRI SCHIAVO'S CT OF THE BRAIN

Topics: Medical Issues

THIS BRAIN IS NOT THAT BAD according to award-winning medical weblog "CodeBlueBlog."

From CodeBlueBlog comes some important and very interesting comments:

Thanks to reader "primer" I've been directed to the University of Miami Ethics program website where they posted this image from a CT scan of Terri Schiavo's brain in 1996. The sentence attached to the link for this scan on the site says:

HERE is the CT scan of Ms. Schiavo's brain, showing extensive cortical regions filled with spinal fluid.

A COURT OF MEDICAL LIGHTWEIGHTS WEIGH IN ON TERRI'S CT.

The Second District's first opinion in this case explained:

Since 1990, Theresa has lived in nursing homes with constant care. She is fed and hydrated by tubes. The staff changes her diapers regularly. She has had numerous health problems, but none have been life threatening.

Over the span of this last decade, Theresa's brain has deteriorated because of the lack of oxygen it suffered at the time of the heart attack. By mid 1996, the CAT scans of her brain showed a severely abnormal structure. At this point, much of her cerebral cortex is simply gone and has been replaced by cerebral spinal fluid. Medicine cannot cure this condition. Unless an act of God, a true miracle, were to recreate her brain, Theresa will always remain in an unconscious, reflexive state, totally dependent upon others to feed her and care for her most private needs.


First, I contest the theory that Terri's brain actively continues to degenerate as implied by the above statement. How could they gage serial brain degeneration without serial follow-up? And by what mechanism would her brain CONTINUE to atrophy? Second, Terri's cerebral cortex has not been replaced by fluid. That is inaccurate. The cortex is thinned and the sulci are enlarged. There is a difference.

Third, and most importantly, given the amount of atrophy on this image I disagree with the court's inadequately considered conclusion.

First of all, the University of Miami's appellation for this scan is inaccurate. "Cortical regions" are not and can not be filled with spinal fluid. The sulci (spaces between cortical ribbons) are enlarged secondary to cortical atrophy and these sulci are filled with cerbrospinal fluid.

The most alarming thing about this image, however, is that there certainly is cortex left. Granted, it is severely thinned, especially for Terri's age, but I would be nonplussed if you told me that this was a 75 year old female who was somewhat senile but fully functional, and I defy a radiologist anywhere to contest that.

I HAVE SEEN MANY WALKING, TALKING, FAIRLY COHERENT PEOPLE WITH WORSE CEREBRAL/CORTICAL ATROPHY. THEREFORE, THIS IS IN NO WAY PRIMA FACIE EVIDENCE THAT TERRI SCHIAVO'S MENTAL ABILITIES OR/OR CAPABILITIES ARE COMPLETELY ERADICATED. I CANNOT BELIEVE SUCH TESTIMONY HAS BEEN GIVEN ON THE BASIS OF THIS SCAN.

The worrisome, no alarming thing, for me, was that I heard a bioethicist and several important figures on the major media describe Terri's brain as MUCH WORSE. One "expert" said that she had a "bag of water" in her head. Several experts described her as a "brain stem preparation"

Continue reading the entire post .....

UPDATE: DO NOT FAIL TO READ THE COMMENTS AT CODEBLUEBLOG!

ALSO BE SURE TO READ THE POST ON CODEBLUEBLOG'S ANALYSIS OF TERRI'S BONE SCAN!

Cross posted at Hyscience

Posted by richard at March 22, 2005 9:52 PM


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Comments

I'm not surprised. Yet more evidence of how people are distorting the facts about Terri and her circumstances. With all of this ovewhelming evidence that Terri has gotten (to say the least) a raw deal, why is it taking so long for those three judges to order her torture to end? Somebody (who is not a troll) please tell me.

Posted by: powersthatblog at March 22, 2005 10:27 PM

ummm, there certainly is fluid in terri's brain. it is cerebrospinal fluid, not spinal fluid. All our brains sit in a bath of cerebrospinal fluid. When there is atrophy of brain tissue, the fluid fills in the space. What did you think the dark spaces are, air?

And parts of terri's brain are missing. For example, see the acne on terri's face in the video. She has hormonal imbalances because her hypothalamus is missing. It would normally be located in the dark area.

Posted by: amy at March 22, 2005 10:28 PM

What is the appeals court doing now??

Posted by: sujata at March 22, 2005 10:39 PM

> For example, see the acne on terri's face in the
> video. She has hormonal imbalances because her
> hypothalamus is missing. It would normally be
> located in the dark area.

Excuse me, I am barely older than Terri, and I often have some acne comperable to hers. My doctors have never even suggested any sort of "hormonal imbalance". And I certainly have my hypothalamus. You're fulla garbage.

Posted by: Suzanne. at March 22, 2005 10:57 PM

Suzanne, you're full of garbage, you hamsammich of a human being. Is that all you read of Amy's post? Did not the rest make sense? This is Science! Dont cloud it with your over-emotional crazyness.

Posted by: Truth at March 22, 2005 11:03 PM

Hey look, the 12-year-old troll "Truth" is back. Mommy went to sleep for the night? Stay away from the porn sites, K?

Posted by: JWL at March 22, 2005 11:13 PM

I have a problem with Amy'scomments too. I am older than Terri and I have a problem with hormonal imbalance. A lot of women have the same problem with hormonal imbalance.

Let's try to get the facts straight on this one.

Posted by: Maggie at March 22, 2005 11:36 PM

Why is evidence like this coming out every day (along with sworn affidavits etc), yet judge after judge fail to consider it? It just does not make any sense. Are these judges so out of touch with reality that they are no longer fit to judge, or is it a case or one judge messing up in the start and being too egotistical to admit his error, and all the following judges backing him up with an arrogant 'he's one of us, so we can't make him look bad, no matter what the evidence says' attitudes? Are the lawyers for Terri reading this site and getting this info, or are the judges just too arrogant and obtuse? The President of the US and the Vatican both are against this, millions of people over the world are against this, Terri's own parents are against this, so why is an allegedly abusive bigamist with blatantly obvious ulterior motives getting away with murder? Have some pity Michael Schiavo! You can have your divorce and walk away free of any responsibility to do what you want without killing Terri, and she will be looked after lovingly by her parents with all the rehabilitation and medication you apparently have denied her all these years, so stop this murderous crusade! There is only one apparent reason left that you'd want her dead - because you're scared the truth could come out if she recovers sufficiently to testify against you, or if in-depth tests reveal your complicity. Don't say you're doing it out of love - you have a fiance and children for fark sake! A loving husband does not get engaged to someone else and have children with them and deny his wife rehabilitation or medication and starves her to death! You've already admitted on the Larry King show that Terri did not tell you she'd want to die. Damn, it seems there's enough evidence to send you to death row if the judges weren't so inexplicably blind! Just walk away and let Terri live.

Posted by: demonsurfer at March 22, 2005 11:40 PM

OK, New England Journal of Medicine.
"Computed tomographic scans eventually showed severe atrophy of her cerebral hemispheres, and her electroencephalograms have been flat, indicating no functional activity of the cerebral cortex. Her neurological exams have been indicative of a persistant vegitative state, which includes periods of wakefulness alternating with sleep, some reflexive responses to light and noise, and some basic gag and swallowing responses, but no signs of emotion, willfull activity or cognition."
Link:
http://content.nejm.org/cgi/reprint/NEJMp058062v1.pdf
Terry Schiavo--A Tragedy Compounded
by Timothy E. Quill, MD
i dare you to read it. ;)

Posted by: amy at March 23, 2005 1:39 AM

Whatever, Amy, we've all seen what has been said elsewhere about the CT scans. Funny though, how others (I claim no expertise) say an MRI--or a PET, in her case--must be done to get an ACCURATE picture of the brain for a proper PVS diagnosis.
I think you're just taking that statement to support what you want to believe. Open your mind--many of the rest of us once thought the courts had sufficient medical information at one time, too.

Posted by: Beth at March 23, 2005 1:53 AM

demonsurfer

Only one judge refused to accept the sworn affidavits into court record and rather dismissed them as not credible or relevent..that was Judge Greer. However Each subsequent court just reviewed Greer's procedural protocols to see if they were correct. Found correct they agreed with Greer's rulings.
The merit of each of Judge Greer's decisions was considered for what was included , but it was not reviewed for what he dismssed of refused to consider. All of tht stuff is not considered relevent to his decisions. So what the Schindlers really want is a higher court that will completely RE hear the case so their affidavits and their side can be re presented and found credible. They also want to have Michael criminally investigated and so far Greer has called their information and alligations "interesting ' but not relevent" His opinion, not mine !

So if every higher court refuses to question the validity of Greer's decisons and rulings then The Schindlers are just able to present the case for review for procedural errors, not evidentuary errors.
That's the way I understand it anyway.

Posted by: JoMarley at March 23, 2005 2:02 AM

amy,

I accepted your dare and I read the article by Dr. Timothy E. Quill. You might like to know that the good doctor wrote a book called "The Case for Physician-Assisted Dying: The Case for Palliative Care and Patient Choice." (from http://www.stronghealth.com/services/palliative/quill.cfm ) I haven't read it, but it doesn't sound like he is unbiased.

Additionally, he ignores the medical evidence that suggests she did not have a heart attack (absence of elevated enzymes that accompany heart attacks, and Terri's weight at the time suggests bulimia was unlikely, etc.). Citing one of the very items in dispute as evidence hardly suggests that it is irrefutable or deterministic.

I encourage you to do the due diligence research necessary before you endorse the murder of an innocent woman, no matter how disabled she is.

Posted by: Joshua Dwyer at March 23, 2005 2:14 AM

Our battle is not with "flesh & blood" but rather with Powers and Princes in the spiritual realms.

Our weapons are not papers but prayers.

Posted by: d at March 23, 2005 2:30 AM

d, I agree, but we need prayers AND papers.

Great work, demonsurfer and JoMarley. God bless you, and all on this site who are helping Terry.

For the trolls, please read this site and Terris' Fight (http://terrisfight.net) and acquaint yourselves with the facts. And, God bless. We hope you will change your mind and help us fight for Terry.

I have been looking at a "kill Terry" site. They have many nasty, ugly words about Terry's "condition" on there. These things seem to be posted in order to assuage their own consciences. They are trying to ridicule and objectify Terry, so that they don't have to feel guilty about supporting her execution and torture. It's a lot like the stuff the trolls have posted here.

But, Terry's condition is not the point. The fact that she is a human being-----that's the point. She will always be a human being, no matter what any medical test says, or alleges to say or show.

In any event, these tests can pretty much be made to say anything. They're not really "hard science".

Like the brain itself, which is living and growing all the time, these tests are not fixed, either. They can change.

All parents know about the development of the connections in a growing baby's brain. It's dependent on stimulaton. Any baby who is not allowed the see the sunlight, or interact with others, will have some stunted development-------temporarily, until they get into a more stimulating environment.

It's an offense against the virtue of Hope, to say, "This is how things are now, and they can never change." Things are always changing every day, with every person.

We are not frozen in time. That would be the sin of Despair. While she is alive, we have a duty and an obligation to care for her. The corporal works of mercy tell us we are obliged to give water to the thirsty and food to the hungry.

It's just so simple, there's no way to deny it.

My son visited some friends in Arizona. He told me that there is a law in Arizona, that if a complete stranger knocks on your door, for a drink of water, you have to give them the water. Otherwise, you are criminally liable.

Because of this law, many people have a special drinking fountain set up outside their homes, for passersby.

I simply cannot believe these courts. I never would have thought this country was so low.

Each night I go to bed praying and hoping that I will awaken to the news that Terry has water now. This morning, at 5 a.m., I saw the horrible news.

By this afternoon, it will be about 120 hours for Terry.

My son was also deprived of water once, while he was in a psychiatric hospital. But, he was ambulatory, and could figure alternative ways to get himself some water. Terry can't do that. Of course, we also kept smuggling in bottles of water for him. But, staff kept removing them.

There was another man in the lunch room of the ward-------the psych patients don't get their meals brought to their room----------who asked me to get him a cup of coffee. This man was in a wheelchair, so of course, I got it for him.

A nurse came in and said, "He's not supposed to have any fluids". But, he had already drink some of the coffee, thank God. This man asked me to bring him envelopes, stamps and paper.

I brought those along on my next visit. But, this man did not recognize me. He was sitting there, like a wax figure. It was like he was dead or something, just staring fixedly, without even blinking.

God bless.

Keep saying your Rosary. The Blessed Mother said there is no problem that cannot be solved with the Rosary.

Posted by: Diana Goodavage at March 23, 2005 7:25 AM

look, both these articles are just published mar 22 in a reputable Journal Of Medicine, by doctors.
see also:
“Culture of Life” Politics at the Bedside —
The Case of Terri Schiavo
George J. Annas, J.D., M.P.H.
http://content.nejm.org/cgi/reprint/NEJMlim050643v3.pdf
If you read this, you can atleast understand why the coutrs are continuously ruling against the Schindlers. This article cites the Quinlan and Cruzon cases that established legal precedent.

Do you know what the alternative therapies proposed by the Schindler's nerologists were? hyperbaric chamber and vasodilators. unproven, the court ruled.

Beth, I'm familiar with fMRI, and it can only give more morphlogical detail. These people are DOCTORS. A flat enchephalogram can only mean one thing-- NO cortical activity. However much or little cortical tissue remains, a flat encephalogram is a flat encephalogram. fMRI is not going to give you the results you want.

That is not science. You don't get to keep testing ad infinatum. The same with the courts.
Jesus Mary and Joseph, read the article! Why do you think the Schindlers are turned down time after time? While their may have moral and ethical legs, they don't have a legal leg to stand on! We live under the rule of law. You can offer up a bunch of urban legends instant experts to contravene EVIDENCE.

I'm sorry, but the supremes have already turned down this case once. My prediction is that they will rule by refusing to rule.

All the stuff you are bringing up about Michael Schiavo has no bearing on the current case. Go ahead, try your luck, bring a civil suit against him, but that won't get the tube reinserted in the face of the FACTS.

Posted by: amy at March 23, 2005 8:03 AM

Amy - if you aren't supportive to Terri and her parents, then why are you posting here? We aren't going to change our mind about saving an innocent DISABLED person from dying from thirst. That would go against our morals. I suggest you either let us try to help Terri, or go elsewhere. Your arguing isn't helping anyone. There are other blogs you can post to in support of Michael, I'm sure...

Posted by: Sirena at March 23, 2005 10:33 AM

Not only that, but this case may be proving current medical theory wrong. If a flat enchephalogram can only mean no cortical activity, yet Terri is clearly demonstrating cognitive function, then the definition of brain-dead or PVS being no cortical activity is apparently not correct in all cases. It's called LEARNING; people used to think the earth was flat for fark sake! There is even a doctor who is a nobel-prize nominee saying that Terri is not PVS, but no Judge will hear it, and that is NOT just.

Posted by: demonsurfer at March 23, 2005 2:14 PM