Tuesday, March 22, 2005

The Terri Schiavo Case

I have been researching the whole Terri Schiavo issue for a few days now. During my research I found some quite disturbing information that has me wondering why people want this woman to die.

A world-reknowned neurologist, Dr. William Hammesfahr, examined Terri Shiavo back in 2002.
In his report, Dr. Hammesfahr colcluded:


The patient is not in coma.

She is alert and responsive to her environment. She responds to specific people best.

She tries to please others by doing activities for which she gets verbal praise.

She responds negatively to poor tone of voice.

She responds to music.

She differentiates sounds from voices.

She differentiates specific people's voices from others.

She differentiates music from stray sound.

She attempts to verbalize.

She has voluntary control over multiple extremities

She can swallow.

She is partially blind

She is probably aphasic and has a degree of receptive aphasia.

She can feel pain.

On this last point, it is interesting to observe that the records from Hospice show frequent medication administered for pain by staff.

With respect to specifics and specific recommendations in order to carry out the instructions of the Second District Court of Appeal:

From a neurological standpoint: The patient appears to be partially blind.

She needs a full opthamological evaluation and visual evoked potentials done to flash and checkerboard patters. The opthamological examination is to evaluate her retina and her ophthalmic nerve to try to determine the cause of her visual limitations and if any treatment exists. The evoked potentials looks at the nerve between the eye and the visual centers in the brain, to see if there is treatable damage and the type of damage, if any in these areas. This is important, as for individuals to interact with her, and possibly teach her better ways of communicating with others, they must know what sort of limitations she has. This even extends to whether she can see people or objects in specific areas of her vision, and what size objects need to be to be accurately seen. Additionally, if one were to properly examine her, it would help if one knew the full extent of these test results.

Communication: She can communicate. She needs a Speech Therapist, Speech Pathologist, and a communications expert to evaluate how to best communicate with her and to allow her to communicate and for others to communicate with her. Also, a treatment plan for how to develop better communication needs to be done.

Rehabilitation Medicine: The patient has severe contractures. She needs a specialist to evaluate these and develop a treatment plan.

Endocrine: The patient has clinical evidence of an abnormally functioning endocrine system. Her blood pressure is abnormally low. Many patients with severe neurological injury have low blood pressure due to an abnormally functioning endocrine system. The reason for this should be determined and corrected, as with a more normal blood pressure, she is likely to have even better neurological functioning. She has facial acne consistent with hormonal abnormalities.

ENT: The patient can clearly swallow, and is able to swallow approximately 2 liters of water per day (the daily amount of saliva generated). Water is one of the most difficult things for people to swallow. It is unlikely that she currently needs the feeding tube. She should be evaluated by an Ear Nose and Throat specialist, and have a new swallowing exam.

Mammography needs to be performed.

Spinal Exam: The patient's exam from a spinal perspective is abnormal. The degree of limitation of range of motion, and of spasms in her neck, is consistent with a neck injury. The abnormal sensory exam, that shows evidence of her hypoxic encephalopathic strokes (right side sensory responses are different from left) also suggests a spinal cord injury at around the level of C4. Her physical exam and videotapes also suggest a spinal cord injury is also present, as she has much better control over he face, head, and neck, than over her arms and legs. This reminds one of a person with a spinal cord injury who has good facial control, but poor use of arms and legs. It is possible that a correctable spinal abnormality such as a herniated disk may be found that could be treated and result in better neurological functioning. This should be looked for, as may be treatable. Thus, there may be an injured disk or spinal cord; the disk injury is more treatable, the spinal cord injury, if present without a disk injury, may be more difficult to treat. A person with a spinal cord injury and hypoxic encephalopathy will need different treatment and rehab recommendations than one who just has a hypoxic encephalopathic.

Interestingly, I have seen this pattern of mixed brain (cerebral) and spinal cord findings in a patient once before, a patient who was asphyxiated.

A urological consultation should be obtained: I disagree with Dr. Gambone's view that the patient's bacteria in the urine may be ignored. In my experience, colonization of the bladder can very distinctly affect the patient's neurological status and affect their rehabilitation. The patient needs a urological consultation both to examine the bladder issue, resolve if there are possibly colonized and kidney stones (that may be the source of recurring bladder infections). Also, one significant mechanism of diagnosing and finding and diagnosing spinal cord injuries is through sophisticated bladder EMG and other testing. This should be done.

The neurosurgeon who placed the implant should be contacted for recommendations. A neurological examination can only be carried out in the context of a complete understanding of the patient's physiology, including current blood tests. Thus the tests that Dr. Gambone did months ago, before we had access to the patient, should immediately be repeated.

EEG: I have reviewed the EEG recently obtained. The EEG has large amounts of artifact. The technician's attempted to remove artifact by filtering. Unfortunately, filtering also affects and reduces evident brain electronic activity. This EEG is not adequate and should be repeated. It should be repeated at the patient's bedside, with the patient in a non-agitated state.

SPECT scan: A SPECT scan prior to and after several days of Hyperbaric Trial should be obtained. Such a Hyperbaric Oxygen trial does not constitute treatment, as the length of time of such hyperbaric is inadequate to render any treatment. However, it is a useful technique to assess the likelihood of improvement using hyperbaric oxygen. I would defer to Dr. Maxfield on the specifics of testing, but believe that it is generally accepted by those in the field who have experience with hyperbaric treatment, that Dr. Maxfield's recommendations in this area are accurate.
This does not sound like the hopeless case it has been presented as by many.

This evaluation was done back in 2002. Why has no action been taken, other then to starve Terri Schiavo? Dr. Hammesfahr was nominated for the Nobel Prize for Medicine in 1999 for his work with patients like Terri Shiavo. He is not some run of the mill doctor.

Seems to me that there are a good many people with political agendas involved in this case. The only consideration should be Terri Schiavo. If the therapies mentioned by Dr. Hammesfahr can help her, why have they not been tried? Why is the judge in this case, Greer, ignoring this and so quick to want to starve Terri Schiavo to death? Why did her husband not push to see his wife at least try these therapies? I know had this been my wife, or even my ex-wife, I would have been willing to try anything to see her get well. These questions need to be answered. I will have more on this over the next few days. - Sailor

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