Medical Affidavit
March 3, 2005
Richard Neubauer M.D. PA, Medical director of the Clinical Baromedical Center, Inc. dba Ocean Hyperbaric Neurologic Center Lauderdale-by-the-Sea, Florida. Largest Hyperbaric Neurologic center in the country.
I specialize only in neurologic problems. I deal with the recoverable brain. I have treated many cases of cerebral palsy, late manifestations of stroke, and traumatic brain injuries, as well as anoxic oncephalophy.
I have extensive experience dealing with cases like Ms. Schiavo. I have treated patients all over the world and shown substantial improvement in these patients. I once trated a patient who was in a coma for fourteen years. He became a unctioning member of society.
There have been many medical and technological advances in just the past few years in the evaluation and treatment of traumatic brain injury. I recommend that a Single Photon Emission Computerized Tomography scan be done on Ms. Schiavo to test the current status of blood flow and metabolism in the brain. This should be done as a baseline. She should then receive a trial of 20 and 40 hyperbaric oxygen treatments at 1.5 ATA and a repeat SPECT scan performed. Frequently, this will show areas of improved flow and metabolism, known as the Ischemic penumbra, and area of dormant idling meurons receiving enough oxygen to exist, but not enough to fire electrically. Should improved flow and metabolism be noted, a multi-disciplinary program would be mandatory consisting of hyperbaric oxygen in conjunction with PT, OT, speech, appropriate nutrition, neuro feedback, herbal medication, acupuncture etc. A SPECT scan is the ultimate form of brain death assessment. It far supersedes the flat EEG or actual blood flow study.
A neurologist (such as Dr. William Hammesfehr) should be consulted and could determine whether or not he would perhaps agree that the SPECT scan with trial of hyperbaric oxygenation would be indicated to ascertain viable and potentially recoverable brain tissue. PVS is not a manifestation or death. Please not the recent news release of a young woman who spontaneously fully awoke from a coma (PVS) and begaon talking and responding after 20 years in a vegetative state.
Medical Affidvit
March 3, 2005
Ricardo G. Senno, M.D., M.S., F.A.A.P.M.R., Medical Director Gentiva Health Services, Rehab Eithout Walls, which provides neurorehabilitation services. Resides in Evanston Illinois.
Former medical Director of the Rehabilitation Institute of Chicago’s Brain Injury Medicine and Rehabilitation Program.
I have, however, observed photographs of her on the Internet. Based on what I have seen, I believe that she is at least in a Minimally Conscious State (MCS); she does not appear to be in a Persistent Vegetative State (PVS)
Judging Ms. Schiavo based on the Rancho Los Amigos Scale, which has ten levels of cognitive functioning, with level one being representative of coma, I believe she is at worst a two, if not a three.
I recommend that Ms. Schiavo receive an fMRI. A standard MRI or CAT Scan is not a sufficient diagnostic tool to determine if she is or is not in a Persistent Vegetative State.
I believe that proper evaluation is a must on a patient that is at ms. Schiavo’s stge of recovery; regardless of if they are conscious, minimally conscious, or vegetative. I believe strongly that her treatment should include the disorders of conscious scale, which will help decide what other treatment is appropriate.
I recommend tht Ms. Schiavo also receive a full history and physical exam, including but not limited to looking at her past medical history, medical records, current medications, available imaging studies, and current and past laboratory results. For example, it could be that she is on a narcotic for pain control, and once this medicatin is removed, she would further progress. I say this because many medications cause decreased cognitive functioning.