Posted on 05/28/2007 9:33:12 AM PDT by wagglebee
Here is what Dr. Hammesfahr wrote:
"We found that she had two sensory levels. The first is the side-to-side asymmetry, where she feels more on the right than the left. The second is a major increase in pain approximately C4 and cephalic to the head. This is consistent with a spinal injury and spinal cord injury near this level."
And did I not report this right on the mark?
Here is the summary of his findings:
"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."
His statement, "Thus, there may be an injured disk or spinal cord..." is a far cry from your interpretation, and it is not a "lie."
Notice that in treatment options, he considers that the patient may not have a spinal cord injury: "...than one who just has a hypoxic encephalopathic."
What I said was, -- and I shouldn't have to repeat it, -- I don't have any problem with that; Dr. Hammesfahr also noted the obvious association with neurologic injury. It is a very ordinary, everyday opinion by both doctors. I added that I was going to look into the question further, however. Which I have been doing.
Terri's neck rigidity was noted immediately at Humana. Both the severity and the timing (onset) of such rigidity are associated with the severity of the injury. The worse the injury, the faster you see the rigidity and the worse it is. Anyone can understand that.
So, the early onset suggests some sort of severe neck injury, not necessarily vertebral or spinal cord. Some sort of whiplash could very well be involved, from a struggle. WADs show up in sports medicine and other situations, not just auto accidents. They are also associated with elder abuse, spousal abuse, child abuse and Shaken Baby Syndrome. From the Clinical Journal of Pain: "Whiplash-associated disorders (WADs) occur as a result of trauma and are often due to motor vehicle accidents and sports injuries. Cervical injury is attributed to rapid extension followed by neck flexion. The exact pathophysiology of WAD is uncertain but probably involves some degree of aberrant muscle spasms and may produce a wide range of symptoms."
We are certainly interested in a traumatic cause. Here is a source with a lot of basic information. It's a wide subject. There are many kinds of cervical strains and sprains. Whiplash injuries can occur in crashes in any direction, and are common in sports as well. Physical spousal abuses such as pushing and hair-pulling could certainly jerk the head around and cause neck injuries.
>> ..We had a person essentially here that has had brain injury and probably also a spinal cord injury.
Who ruled out a soft tissue injury? And who cares if it "goes with" Dr. Hammesfahr's finding? I do not represent Dr. Hammesfahr.
Dr. Hammesfahr did not "claim" a vertebral injury anyway. He suggested the possibility of one. According to the autopsy report years later, there was none. Question closed. That is exactly why we turn our attention to the possibility of a soft-tissue injury.
Colleagues in other circumstances, superior and assistant in this case. Dr. Thogmartin had full authority, Dr. Nelson assisted and served at Dr. Thogmartin's discretion. In that sense it was an employer-employee relationship.
This hardly seems worth arguing about.
In an early press conference, Dr. Nelson played to the press by comparing Terri's dehydrated brain with Karen Ann Quinlan's. That was unprofessional. However, I forgave him later when he said, kindly, that his findings did NOT rule out Terri interacting with her examiners or family, as we all observed in the videotapes.
> I have proposed some.
Two to be exact -- both against astronomical odds.
You brought up the "there is no known explanation" theory, aka SADS. That one calculated out at one in 2,500,000 for Terri's age cohort. Don't bet those odds, doc.
The other was Seldane interactions with any or all other contraindicated drugs. We don't know the number of Seldane users in order to calculate the odds, but again it's astronomical. There were many millions who used the drug safely and only 40 severe adverse reactions in 12 years. We also have reasonably strong information that Terri was not taking either Seldane or "the other" drug. Which makes the odds 0.00000%. Zero.
To suggest that either of these wildly improbable scenarios happened to Terri in the middle of a domestic dispute is abnegation of a medical professional's duty to look for abuse.
They are also an affront to Occam's razor, which tells us not to look beyond the obvious cause until it is eliminated. The obvious and statistically overwhelming cause is domestic violence. It has not been eliminated.
So he agreed with Dr. Hammesfahr, who said, "Spasticity generally is due to neurological injuries, and is aggravated by lack of physical therapy and muscle stretching."
The critical question is, what caused Terri's anoxic brain damage? We know that it is far more commonly caused in young women by auto accidents and intimate partner violence than by all other causes combined. Terri was not in an auto accident. Figure it out.
That's not actually totally true. I'll accept it as a general rule however. Yes, the neck rigidity, and the rigidity of other skeletal muscles was noted immediately. Dr. Shah describes it as the well known consequence of brain injury - decerebrate posturing.
So, the early onset suggests some sort of severe neck injury,
No. The Humana discharge summary clearly states that the Humana docs considered it part of decerebrate posturing, not a specific neck injury.
Examination showed decerebration and focal seizure activityand
PHYSICAL EXAM At the time of admission revealed an unresponsive decerebrating young white female on a ventilator.and
NECK Somewhat stiff. All other muscles of the body were also stiff.This doesn't mean there couldn't be a neck injury, but that there is no indication that she had one. The ED looked for verebral injury with a C-spine X-ray, and did not note any.
Some sort of whiplash could very well be involved, from a struggle. WADs show up in sports medicine and other situations, not just auto accidents. They are also associated with elder abuse, spousal abuse, child abuse and Shaken Baby Syndrome. From the Clinical Journal of Pain: "Whiplash-associated disorders (WADs) occur as a result of trauma and are often due to motor vehicle accidents and sports injuries.
WADs are considered to be acceleration deceleration injuries. There are several sports that can supply that sort of acceleration. I have never heard that wrestling or the corollary - struggle between two adults - is one of them. I'm not saying it's impossible, but please do show specific medical information. The article you linked does not say that, and deals with both whiplash and general cervical muscle strains. Also, as mentioned several times, you can't correlate injuries to infants and young children with healthy adults (maybe in certain cases with the elderly, but that's a different issue). So far, the material I've seen on abuse causing WAD is infants and young children. I can believe it for elders, but I'd have to see the material for healthy adults. Please link.
Physical spousal abuses such as pushing and hair-pulling could certainly jerk the head around and cause neck injuries.
I think you're lumping things together here, and I'd like to separate them. I can (and have) gotten a neck muscle spasm just from turning my head. It's well known that muscle spasms can occur with minimal trauma. So if you're asserting she could have had neck muscle spasms I have no problem with that. (In fact, we know she did, from her anoxic brain injury, which causes muscle spasticity.) On the other hand, if you're claiming hair pulling and pushing causes whiplash injury, I'd need your exact definition of whiplash injury, and link to authoritative medical information that correlates well.
In any case, what I originally called "utter bunk" and still maintain is utter bunk was this:
...We had a person essentially here that has had brain injury and probably also a spinal cord injury.Gone for the day, but I'll look at the rest of the posts later.
Q. Spinal cord or vertebral injury?
A. Vertebral injury, but I also suspect, from other parts of my examination, spinal cord injury along with it.
I know, sir. "A severe injury to the brain at the level of the brainstem is the usual cause of decerebrate posture." But didn't Terri retain good brainstem function? This all adds a few new puzzlements and leads for our plucky medical investigator, doesn't it?
>> This doesn't mean there couldn't be a neck injury,
Thank you, that was my point. We reexamine Terri's neck injuries in order to see if they shed more light on the causes.
>> There are several sports that can supply that sort of acceleration.
What is there that sport can do that personal violence can't? For instance, a man holding a woman by her head or by her hair and whipsawing her head forward and back. As in auto wrecks, we may assume that the severity of the damage sharply increases if the victim does not anticipate (steel herself against) the attack.
That is a statement. He says she did have a brain injury.
>> ... and probably also a spinal cord injury.
That is an opinion, not a statement. It's "probably" so. You can call it bunk -- which is a lot easier for someone holding the autopsy report than for someone examining a live patient. But you can't call it a lie.
Nah, we're not interested in small stuff. Whatever Terri had was severe and bothered her the rest of her life; and I think we can credit that pain focus around C4. Her neck was so rigid, she had practically no ROM. ... She also had severe contractures in all four extremities
Makes one wonder why Michael, the "loving husband," would not let her have any range of motion therapy after he got the malpractice therapy money (late 1992).
Would you mind describing “decerebrate posturing” for those of us who are too dense to figure it out on our own? I really appreciate your medical explanations and am learning a lot on this thread! Thanks!
Oh don't be silly, T'wit. Dr. Thogmartin hired the right guy to find anything around her neck. Ah, good old cremation.
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" But Dr. James Benz, who has fended off attacks on his own credibility, sidestepped the latest controversy to a certain extent after the associate medical examiner, Dr. Stephen Nelson, resigned recently to pursue other opportunities Nelson's resignation letter, effective May 15, is dated April 1 but wasn't sent to Assistant County Administrator Vince Bonvento until Wednesday, a few days after Bonvento told Benz of his concerns about Nelson's past"...
"Bonvento postponed the item for Tuesday's meeting when he learned for the first time of in Broward County...."
"Nelson joined Benz's staff in 1993 after he quit the Broward Medical Examiner's Office amid charges that he botched a cause-of-death ruling, saying an 82-year-old Sunrise woman committed suicide. The woman's husband later confessed to strangling her...."
" Other controversies swirled around the clouded past of one of Benz's associates, Stephen Nelson, defense attorneys began using the issues to request second autopsies. "
Snips are from Sun-Sentinel 1996
"Decerebrate posture is an abnormal body posture that involves rigid extension of the arms and legs, downward pointing of the toes, and backward arching of the head."
"A severe injury to the brain at the level of the brainstem is the usual cause of decerebrate posture."
On the Broward County medical examiner's staff, Dr. Nelson "botched a cause-of-death ruling." My goodness! He said an "82-year-old Sunrise woman committed suicide. The woman's husband later confessed to strangling her...." Mercy!
Our Dr. Nelson couldn't identify a strangulation victim? Called it suicide? A STRANGULATION VICTIM?!?
Hmm. This would be the one pathologist the "independent" Dr. Thogmartin DID trust to assist, after refusing to let anyone else observe the autopsy on behalf of the Schindlers. Heavens, what next! Since both men are local, Dr. Thogmartin had to know about Dr. Nelson's "clouded past," to quote the newspaper. Why would he refuse to let a famous pathologist observe, but choose a known incompetent to do the brainwork? This is weird! What sort of hanky-panky was going on??
It was Dr. Nelson who did the sample that led Dr. Thogmartin to declare that Terri was cortically blind -- a finding belied by earlier clinical tests. She had very poor vision, to be sure, but even Dr. Cranford (working for Michael) found that she was sighted and actually complimented her for it. Drs. Hammesfahr and Maxfield measured her sight at up to 18 inches, best in the range of 8-12 inches. She could see the big shiny balloons further away, when focus didn't matter.
Cortical blindness, like PVS, is a clinical diagnosis and cannot be determined post-mortem. That didn't keep every ideologue in the country from seizing Dr. Thogmartin's comment to declare that all the videotapes of Terri were false. Yes, sir, Dr. Nelson found that for them -- the way he "botched" a cause-of-death finding and declared that a murder victim had committed suicide. (The lawyers must love this guy.)
After the autopsy report was issued, Dr. Hammesfahr replied that the finding of cortical blindness was clearly wrong and had to be a "sampling error." Now we know which incompetent pathologist MADE the sampling error -- the one with a "clouded past" right there in Florida.
What was Thogmartin THINKING?
And that was a RECENT STRANGULATION VICTIM at the time. Didn't Dr. Hammesfahr say that it looked like a strangulation to him?
Yet, young women do not just keel over in the middle of the night for no known reason. Dr. Baden himself had called that "extremely rare." He should have trusted his earlier instincts.
Apparently so.
Yes he changed his mind. He seen the polls and read his mail.
He entertained the idea, as many did, but what he said on the record (in the document he present to court) was a little different:
"Interestingly, I have seen this pattern of mixed brain (cerebral) and spinal cord findings in a patient once before, a patient who was asphyxiated."
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