The Mystery of Terri Schiavo’s Sight Revisited

Thank you for the photo credit, Carrie Kae.

Google's ever-watchful 'Web Alert' caught this for me!

/:-)

I hope all is well.

MAIN: http://www.GordonWayneWatts.com

ALT: http://www.GordonWatts.com

Gordon,
You're welcome, I'm sure, but it was Bob Ellis who actually gave you the photo credit. :-)

Bob,

I think you have a misunderstanding of what happens to body tissue ( brain, kidney etc) when it is acutely deprived of blood or fluids. If ALL blood flow had been completely shut off to her brain and she died 12 days later, the brain would not shrink at all in that time period. We see that all the time when acute injuries occur like a heart attack when blood is completely blocked . The heart doesnt shrink in 12 days. Acute kidney vascular shutdown doesn't cause the kidney to shrink after 12 days and the brain doesnt shrink either in 12 days if it is deprived of blood or fluids.

If anything, you will see swelling with acute injury.

The shrinkage ( called atrophy) takes months to years to occur AFTER the initial insult and this can be seen on x-rays. Her brain scans revealed massive slowly progressing, atrophy which takes years. That would explain why there was a change between 2003 and 2005 in her sight.As her brain atrophy slowly progressed, you expect to slow deterioration of neurologic function, like sight,

So no , brain tissue doesn't shrink at all in 12 days. That is not what happens to tissue pathologically in acute injuries.

"The earlier false account of "liquification" of Terri's brain notwithstanding (hydrocephalus ex vacuo due to brain atrophy is the actual process in which the space previously occupied by the atrophied tissue is replaced by cerebrospinal fluid), the finding of decrease in the size of Terri's brain should come as no surprise given the fact that she was deprived of all liquids and food for the two week period immediately prior to her death.

The brain no less than the rest of the body is composed largely of water. Common sense dictates that there will be significant weight loss in all organs under circumstances of extreme longterm dehydration.

Recent research confirms what common sense suggests, demonstrating that even shortterm dehydration lasting merely hours can produce substantial decrease in brain volume and, we might expect by extension, brain weight. At this point it is impossible to determine to what degree Terri's presumed loss in brain weight is attributable to longterm cerebral atrophy vs. nearly two weeks of total dehydration. Even a basic standard of decency, integrity and respect for truth would surely suggest, however, that the ME should have exercised more caution rather than heedlessly contributing to the utterly predictable "shrunken brain," "shriveled brain" "withered brain" stories that completely dominated the reporting.

In an article published just this year in the leading journal, Neurology, Dr. Duning and colleagues report that even shortterm dehydration lasting 16 hours can produce a significant decrease in brain volume in excess of a half of a per cent. Not directly answered in this study is the question whether the rate of decrease in brain volume due to dehydration directly corresponds to the overall bodily loss of weight, though this is certainly likely. In any case, common sense suggests that much of the loss of weight in Terri's case might be explained as a consequence of longterm dehydration over the two week period after her feeding tube was disconnected and she was denied any hydration or sustenance of any kind. The ME omitted all data on overall weight loss as a result of dehydration from the Autopsy Report on Terri Schiavo, though the report does indicate Terri's weight at the time of death was 112 pounds, providing a basis for comparison if she was weighed prior to removing her feeding tube."

Tuesday, June 21, 2005
Terri Schiavo's Autopsy: The Blind Spot

by Sherry Eros, MD and Steven Eros
http://eroscoloredglasses.blogspot.com/2005/06/...

Dr. Rutledge, you are confusing the inflammatory response, which occurs in acute injury, with fluid loss. The latter does not result in atrophy but organ mass shrinks because of the fluid loss. Atrophy is a regression of tissue mass, dehydration is only the loss of water.

Mr. Ellis is absolutely correct in his understanding as he has stated above. I doubt the damage done to Terri's brain as she slowly died from dehydration ellicited much of the cardinal signs of inflammation as described by Celsus, save severe pain.

dr. theo--- I do understand the difference between the acute inflammatory response and tissue shrinkage due to volume depletion, but probably did a poor job of making my point. My only real question is does volume contraction cause pain ( and I guess we are talking about headache since we are specifically referring to brain shrinkage ).

The only study I could find on this was the one study trying to find the correlation between alcohol intake and 'hangover' headache and CT scans incidently found 2% brain shrinkage in some of those who had imbibed, related to dehydration, ADH etc. .It was then questioned whether that degree of shrinkage could cause the headache pain, but couldn't be determined because the biproducts of ETOH ingestion could have been the culprit and the shrinkage was could be an incidental finding related to dehydration.

Are you aware of any studies or proof that volume depletion in and of itself will cause severe headache pain. I personally have not witnessed that in my practice, although I admit after a person slips into a coma, it is impossible to know what they are or are not feeling. But really curious if there is objective data that supports 'volume depletion and severe head pain' or is it one of those ' well it just seems like common sense' arguments.

You and i both know those dont work too well when dealing with the human body.

I don't know whether shrinkage of the brain causes pain or not, Dr. Rutledge, but I can tell you with absolute certainty that the sensation of thirst during dehydration produces an agony unmatched by any pain I've ever experienced.

I'll try not to bore you with unnecessary detail, but I was hospitalized from July, '97 until April, 98 when I was discharged to rehab after receiving a heart transplant. It is a very long tale, but during part of this time I was in cardiac ICU in profound heart failure (they were trying to maintain an arterial pressure of 50 mmHg). I was being treated with all the common inotropes and was diuresed to reduce preload. I was also sedated with Propofol.

Brian, I can’t tell you how agonizing those two days were. The thirst I experienced was worse than any physical sensation I’d ever experienced. By the time I left the hospital I had had my chest opened four times, I’d had numerous IVs, PICs, and injections, six or eight cardiac catheterizations and biopsies, a trach, a J-tube and ,of course a Foley catheter. By far, the worst symptoms that I experienced the entire time in the hospital were that overwhelming thirst in ICU. (I was eventually treated with a HeartMate LVAD that maintained my cardio-vascular status until the allograft.)

I mean this very seriously, that I can think of nothing worse than dying of thirst. I can’t know what Terri Schiavo suffered in her last few days, but I truly hope that it wasn’t the kind of delirious thirst that I once experienced.

In my career I have many times decided (with the family) to allow nature to take its course and withhold specific treatments, but I refuse to withhold fluids. You know, Dr. Rutledge, that a patient in Terri’s condition is prone to urinary tract infections and pneumonia. I would not have had much of a problem with deciding not to treat her the next time an infection occurred. Why was it necessary to kill her by dehydration? I think there is a huge distinction between deciding not to treat a potentially fatal condition and acting in a positive fashion to cause the death of a patient, so called euthanasia. To do so by a method that may cause an agonizing slow death is inhumane.

(My apologies to readers unfamiliar with the medical jargon. It was used so as to be precise in communicating with a medical colleague not to impress or obfuscate.)

dr. theo--- I can only say that I am happy you are here to tell your unique story and it does give you insight that many of us will never understand. I also agree with not treating infections etc. in a terminal case like you mentioned and I also cant remember a case where I allowed or advocated stopping fluids. I think it is and causes great discomfort/pain.

My ' science' ears perk up when I hear something that I was unaware of and when it was suggested the brain shrinkage due to volume depletion caused severe pain/headaches, i was curious and questioned the reliability of it. Thats truly what I was curious and skeptical about.

Hope your health remains good and thanks for sharing your story. Brian

Thank you for your kind words, Dr. Rutledge. It's been over 11 years since my transplant and my heart has done great! The rest of this old body is falling apart, but I won't complain. God has been very good to me.

I understand your question about brain shrinkage and headache and I really don't know the answer to that. So many physiologic changes are going on when the body becomes dehydrated I don't think we can say with certainty what the effects would be in e very case. I am pleased to hear that you agree about withholding fluids.
When patients are facing their end what physicians can do is make them as comfortable as possible. Like I said, I do not think we are obliged to do everything possible to prolong life when death is imminent and certain. It saddens me when families cannot let go and insist I use all the technological means we have to keep someone alive when I know all I am accomplishing is to prolong suffering.

What is your specialty, Dr. Rutledge? May I ask how long you have been in practice?

I was pretty impressed. :-)

I'll await Dr. Theo's response to the more specific facets of your comments, but I'd like to address a more broad component.

It seems that you repeatedly get lost in the minutia and miss the "big picture" of an overriding truth. I didn't mention the reference to assertions that "the reason hangovers hurt is because alcohol causes dehydration and thus shrinkage and thus pain" because I wanted to examine that particular issue; I mentioned it because the contention has been repeatedly made that dehydration does not cause the brain--among other organs--to shrink.

This is an assertion that defies common sense (given the high percentage of the body made up of water), and the statements by some medical authorities that minor dehydration due to alcohol consumption causes brain shrinkage go to reinforce the common sense assertion that dehydration causes brain shrinkage.

And all of THIS goes to the supposition made by Carrie and others that some of the reduction in size of the brain and various parts of the brain may not necessarily have been present in Terri's brain before they dehydrated her to death.

And let us not forget the most compelling evidence that she was not brain dead and thus not a legitimate candidate to be euthanized: she experienced periods of cognizance, response, recognition and attempts to communicate.

A civilized people don't kill members of their society simply because they are disabled.

It doesn't matter what her brain function was, because she was alive and for that reason only, should not have have beeb euthanized. The minutia you are referring to are actually certain facts-suppositions that have been stated for which i am trying to validate. Sorry, but thats the way my brain works.

If one fact or supposition is false then one might look at the conclusion differently. I know you frequently take these as critiques of the main point you are trying to make, but usually are questions I have about how you arrived at your conclusion.

In this case i was asking dr. theo if he knew of a study or proof that dehydration-causing brain shrinkage-has definitely been shown to cause headache pain other than the alcohol study. I was curious and still am.

If there is objective evidence that is does, then I have learned something . If there is no objective evidence, that still doent change the fact that fluids and nutrition should have NEVER been removed from Mrs. Schiavo

Actually Carrie Hutchens wrote this piece.

But I agree with her that it seems to be common sense that if you deprive a human being of water for several days, all parts of the body--which is something like 60-75% water--would shrink as the body's reserve of water became depleted.

A variety of sources including CNN have reported that scientists strongly suspect the reason for hangover headaches is that the alcohol consumed dehydrates the body---including the brain. And that shrinkage of the brain is the cause of the headache.

Others including Dr. Neill's website state that even a 2% reduction in body water will result in brain shrinkage.

I'm not a doctor, but it defies common sense to claim that depriving someone of water for 13 days will not shrink the body tissues--including the brain--and that shrinkage is painful and damaging to biological functions.

Find a new topic. Terri Schiavo has been dead for over 4 years. You're like a broken record----over and over and over, it's like you're trying to convince yourself

Do you figure that if she's dead long enough, that'll somehow transform her murder into moral acceptability?

Sorry, the real world just doesn't work that way. A murder that has not been atoned for should never be forgotten.