Wednesday, March 23, 2005

By Special Request

I've been asked to cut and paste what I've written on other sites regarding Terri Schaivo. So here goes:

I'm not looking at this from a judicial, legislative, or executive angle. My reasons are purely medical. Sorry for the length, but it explains a lot. Believe me, there's much more.

I'm a bit concerned about the decisions of the doctors. I'll admit that I'm no expert yet, but based on what I've learned about radiographic imaging, an MRI and/or PET scan should be performed. A CT scan will basically differentiate for you tissue types and provide a 3D slice. I'm actually really interested in getting a PET scan. This would give us a better idea as to brain activity. Not whether or not there is fluid build up or not. To me, although fluid buildup is good information, if you look at neurological conditions like syringomyelia, you will see that the plasticity nature of nervous tissue is quite resilient. I've seen patients with syringomyelia who have come to our clinic with a 80-90% spinal cord compression from the fluid who were still walking! Does this apply to Terri? Who knows. But, it's worth looking into.

(Someone posted a link to Terri's CT scan) I saw a serious flaw with this link. Most importantly was the fact that the two images were not taken at the same level. You can clearly see the frontal sinus on Terri's CT scan (Look on the top part of the skull and you'll see the darkened air space) but not on the normal CT scan. Why is this important? Because at different levels of the brain, you have different anatomical structures which will look differently depending on the level of the slice of the CT scan. Differing structures such as numerous different nuclei and the ventricles (which can and do contain cerebrospinal fluid) can make 2 normal CT brain scans look completely different if they are not taken at the same level.

The problem with what everyone is arguing is whether or not Terri can feel pain. Lower brain functioning so far tells us that periacquectal gray and the reticular formation are areas that sense pain. Now, as far as pain cognition goes, that goes into the higher levels of the brain: The cortex. Now, we see from the CT scan that there is fluid buildup. This does not necessarily mean that Terri does not perceive pain. As I stated earlier, nervous tissue is very resilient. And, thanks to the CT scan, we still have quite a bit of cortex. It's possible that the fluid present could be due to a blockage of the acqueduct draining the 3rd ventricle to the 4th ventricle. Without further imaging or testing, we can't tell.

Recent research has shown that nervous tissue does, in fact regrow. It's an extremely slow process, but it does take place. Does this mean that Terri will regain congnition? We don't know. But, it is, in fact possible. This recent discovery may explain why some people take years to recover from comas, brain infarcts, etc. Neurology itself is a relatively new field. They are constantly learning more and more each and everyday. We keep discovering new things that tend to both prove and disprove past paradigms of brain functioning. So, rest assured that NOTHING is absolute. Is it possible for Terri to recover? Yes. Is it probable? Nobody knows. Should these other avenues (MRI/PET scans) be explored? Since it is possible that Terri perceives her environment but lacks the capacity to express it due to the areas affected by the fluid, I believe we should err on the side of caution. I'll need to double check this (sorry, my neurology course was last year), but if I'm right, the areas of higher cognition are in the frontal cortex, not the temporal or parietal cortex which appear to be the areas affected by the CT scan.

My basic opinion is that this case needs to be presented to a well educated medical ethics panel who utilize the most recent research and technology to perform whatever procedure they wish to determine a prognosis despite any opposition towards these tests. Since there is no living will, I believe this is the best course to take. If death is still chosen by the medical panel after all requested tests are run, then I vote death by lethal injection, morphine drip, etc. to make the death more humane.

When you take this to court, you are trying to explain medical science and technology to people who may not quite understand the complexity of the situation.