Posted on 06/15/2005 12:27:19 PM PDT by veronica
(1st Add: Includes comments from George Felos, Michael Schiavo's attorney.)
(CNSNews.com) - Terri Schiavo's body did not show any signs of trauma or other criminal activity that would explain her brain injury, nor was there evidence to support previous diagnoses of a heart attack or an eating disorder, the Florida medical examiner who conducted her autopsy said Wednesday. A representative of Terri's family complimented the report, but said it still leaves many questions unanswered.
"She died of dehydration," Dr. Jon Thogmartin, the Florida medical examiner for Pinellas and Pasco counties said, noting that the official cause of death would be listed as "complications of anoxic encephalopathy."
"That's the only diagnosis that I know for sure, is that her brain went without oxygen," he added. "Why? That is undetermined."
George Felos - attorney for Terri's husband, Michael Schiavo - said the report confirms what he has argued all along.
"The courts have found that there was no abuse of Terri, no evidence of abuse, and that's what the medical examiner found," Felos said.
Terri Schiavo collapsed under unknown circumstances in 1990. Michael Schiavo was awarded nearly $2 million in judgments and settlements in a medical malpractice lawsuit claiming that the collapse was caused by a heart attack triggered by a potassium imbalance, caused by an undiagnosed eating disorder, bulimia nervosa. Thogmartin challenged that determination.
"No one observed Mrs. Schiavo taking diet pills, binging and purging or consuming laxatives and she apparently never confessed to her family or friends about having an eating disorder," Thogmartin found. "Furthermore, many other signs of bulimia nervosa were not reported to be present."
Terri was "heavy" as a teenager, according to Thogmartin, and had lost more than 100 pounds after graduation. The eating disorder diagnosis was based on that fact and a low potassium level measured during a blood test about an hour after Terri was first hospitalized.
"Her low potassium level appears to be the main piece of evidence purporting to show that she had an eating disorder," Thogmartin said. But he noted that she received numerous medical treatments when she arrived at the hospital that would have lowered that measurement.
"Thus the main piece of evidence supporting the diagnosis of bulimia nervosa is suspect," he concluded.
"Once you eliminate the potassium problem, which is known in bulimics, you end up with a 26-year-old who used to be healthy, who now lost the weight, is reveling in her thinness now, enjoying her life and doesn't want to gain the weight back," Thogmartin said. "If that's a bulimic, there's a lot of bulimics out there. It's just not enough."
Thogmartin said that because he cannot, "with reasonable medical certainty," ascertain why or how the blood and oxygen to Terri's brain were interrupted, he cannot rule on what started the chain of events that led to her death.
"The manner of death is different from the cause of death. Manner of death is the circumstances of death or how the death came about," Thogmartin said. "Since I don't know the circumstances or can't tell, actually, what the underlying cause is, the manner of death has to be 'undetermined.'"
Other allegations and theories addressed
Thogmartin dismissed the theory that the oxygen depravation to Terri's brain might have been the result of a myocardial infarction, the medical term for a "heart attack," or death of heart muscle from coronary artery disease.
"Mrs. Schiavo's heart was anatomically normal without any areas of recent or remote infarction," he explained.
In response to the allegations that Terri's collapse was the result of a physical assault, Thogmartin noted that she received nearly 30 X-rays, CAT scans and ultrasound examinations during the medical examination that followed her collapse.
"Any fractures - including rib fractures, leg fractures, ankle fractures, skull fractures, spine fractures - that occurred concurrent with her initial collapse would almost certainly have been diagnosed in 1990, especially with the number of physical exams, radiographs and other evaluations she received during her initial hospitalization," Thogmartin said. "No fractures or trauma were reported or recorded."
There was also, Thogmartin said, "no evidence to support or the evidence did not support," various allegations that Terri was abused or neglected after her initial brain injury.
Was Terri in a Persistent Vegetative State?
Thogmartin brought in Dr. Stephen Nelson, an expert in pathology of the brain and central nervous system, as a consultant during the autopsy. Nelson stressed numerous times that the diagnosis of a "Persistent Vegetative State," which was used to justify the removal of the feeding tube that kept Terri alive, "is a clinical diagnosis, it's not a pathologic diagnosis that has precision associated with it." But he did not dispute the finding.
"There is nothing in her autopsy report, in her autopsy that is inconsistent with Persistent Vegetative State," Nelson said, adding that there was evidence to support the finding.
"A normal brain weight for somebody who is approximately 41 years of age ought to be somewhere in the neighborhood of 1,200 to 1,300 grams," Nelson explained. "Her brain is 615 grams and is largely reduced to what is termed granular atrophy ... associated with the loss of blood flow that happened many years prior.
"Those all are consistent with what is reported in the literature for Persistent Vegetative State," Nelson added. "We found nothing that is contrary to what has previously been reported for Persistent Vegetative State."
Nelson compared the physical condition of Terri's brain to that of Karen Ann Quinlan, the New Jersey woman who died in 1985 -- nine years after her parents won a court battle to remove her from a respirator.
"Her brain, Karen Ann Quinlan's, weighed more than Terri Schiavo's brain weighed," Nelson said. "The findings here are, perhaps, worse, even, than Karen Ann Quinlan."
Thogmartin also concluded that Terri's brain injury was irreversible.
"Her brain was profoundly atrophied," the medical examiner concluded. "This damage was irreversible and no amount of therapy or treatment would have regenerated the massive loss of neurons."
Michael Schiavo relied on the diagnosis of a Persistent Vegetative State when he sought permission from the Florida courts to remove Terri's feeding tube. He and two of his relatives testified that Terri had said she would not want to be kept alive in such a condition. Thogmartin discussed the contention by many right-to-life advocates that Terri's family should have been allowed to offer her food and water by mouth after that feeding tube was removed.
"She would not have been able to consume sustenance safely or in sufficient quantity by mouth," Thogmartin said. "Mrs. Schiavo was dependent, therefore, on nutrition and hydration by her feeding tube and removal of her feeding tube would have resulted in her death whether she was fed by mouth or not."
In layman's terms
After a technical explanation of his findings, laden with medical language, Thogmartin was asked to summarize his findings in an exchange with one unidentified reporter:
REPORTER: "In layman's terms, did Terri Schiavo starve to death?"
THOGMARTIN: "No."
REPORTER: "Did she suffer any neglect or abuse?"
THOGMARTIN: "No."
REPORTER: "Will we ever know what caused her death?"
THOGMARTIN: "I don't know."
Pamela Hennessy, spokeswoman for the Terri Schindler Schiavo Foundation and Terri's parents, Bob and Mary Schindler, complimented Thogmartin on his report.
"However, it does seem that the conclusions of his report leave as many unanswered questions as there were previously," Hennessy said. "For instance, if Terri did not suffer bulimia and she had as healthy a heart as Dr. Thogmartin proclaimed, what caused her collapse?
"It doesn't really bring much in the way of closure to [the Schindlers] as far as what happened to their daughter, why this happened in the first place and what could have been done for her," Hennessy concluded.
Thogmartin said he is open to answering those questions.
"It is the policy of this office that no case is ever closed, and that all determinations are to be reconsidered upon receipt of credible new information," he explained.
"In addition to fading memories, the 15-year survival of Mrs. Schiavo after her collapse resulted in the creation of a voluminous number of documents, many of which were lost or discarded over those years," he continued. "Receipt of additional credible information that clarifies any outstanding issues may, or shall cause an amendment to her cause and manner of death."
Excellent post. Thank you.
The Effects of Dehydration on Brain Volume - Preliminary Results
J. M. Dickson1, H. M. Weavers2, N. Mitchell2, E. M. Winter2, I. D. Wilkinson3, E. J. R. Van Beek3, J. M. Wild3, P. D. Griffiths3
1 Department of Biomedical Science, The University of Sheffield, Sheffield, UK
2 Centre for Sport and Exercise Science, Sheffield Hallam University, Sheffield, UK
3 Unit of Academic Radiology, The University of Sheffield, Sheffield, UK
Abstract
In adults the cranium is a rigid bony vault of fixed size and therefore the intra-cranial volume is a constant which equals the sum of the volume of the brain, the intra-cranial volume of CSF and the intra-cranial volume of blood. There can be marked changes in the volumes of these three intra-cranial compartments which may influence susceptibility to brain damage after head injury. This is the first study to investigate the relationship between dehydration and changes in the volume of the brain and the cerebral ventricles. Six healthy control subjects underwent magnetic resonance imaging of the brain before and after a period of exercise in an environmental chamber. The subjects lost between 2.1 % and 2.6 % of their body mass due to water loss through sweating. We found a correlation between the degree of dehydration and the change in ventricular volume (r = 0.932, p = 0.007). The changes in ventricular volume caused by dehydration were much larger than those seen in day-to-day fluctuations in a normally hydrated healthy control subject.
This seems to support brain loss due to severe dehydration
It is not a mathematical inconsistency. Volume does not equate to weight.
You can pre-order on Amazon. I already have done so. It is suppose to be out June 28th, I believe.
Exactly what I wanted to know. Care to demonstrate?
Thank apackor2. I wonder what "the most severe dehydration case I have ever seen" would do to those figures?
You Michael Schiavo supporters are grossly unfair. MIchael Schiavo had things done just the way he wanted to - Judge Greer did everything he wanted. Schiavo didn't need any special expert - he had the Pinellas County ME. However, I certainly would not have objected then or now if he wanted another doctor there to witness the autopsy. That would have been fine with me. In fact, I would not have objected to any doctor requested by any of these parties witnessing the autopsy. The more the better. The only one who objected to having other parties present, whether they be requested by either the Schiavo faction, Schindler faction, or just an independent witness WAS the Pinellas County ME. So much for him and so much for you.
What you're saying doesn't even make sense. I am saying that there is a history of corruption throughout various departments and offices of Pinellas County and that as far as I know, it's still thoroughly corrupt. The ME prior to this one had to resign for allowing herself to be pressured by Scientologists into changing her analysis of an autopsy. Why, in a county noted for thorough corruption in department after department, and where this man's predecessor had to leave office because of faking reports - WHY - should I accept this man's sole opinion as definitive of ANYTHING without independent corroboration? That is RIDICULOUS.
Amazing that they didn't find evidence of starvation. /sarcasm
Of course, nothing about this autopsy surprises me. Some of the comments on this thread no longer surprise me, either.
I saw an autopsy pic of the Scientology starvation/dehydration victim, a while back. She was practically mummified. I wonder what HER brain weighed????????????
Yeah Terri wanted to die so bad, that she hung in there for 13 days :-(
"What doesn't change is that her parents wanted to care for her and keep her alive, whatever her state, while her husband wanted her to die. "
My thoughts exactly. It matters not at all that she was blind (but watch the videos of her and YOU decide for yourself).She left no wishes written and there wasn't enough to make a decision for a reasonable court. It had to be a Michael Schiavo approved court.
I hope you wouldn't call my spouse mean for making that same call as Mr. Schiavo. It's what I would want her to do.
Because dehydration did not lead to the anoxic encephalopathy.
And recall the testimony of the doctor who read the bone scan -- pretty much confirming that it wasn't reliable.
Dehydration caused her death, anoxic encephalopathy did not.
I think it was disgusting what was done to Terry. You knew the CYA effort would be stellar after her death. It's in God's hands now, but I don't have to be happy about it.
They should have weighed her with the autopsy. It is standard.
I wonder if they weighed her before the starvation/dehydration began.
Care to post it?
ClancyJ - you are 100% correct and I was thinking the same thing when I left posting this afternoon, although you put it far better than I probably wouuld. The autopsy doesn't change a damn thing. It's meaningless regardless of who issues it or what he says. It is pointless arguing about the size of her brain or what was in it. It doesn't change the fact that a women was starved and dehydrated to death by a court order and that is MORALLY WRONG and it will be wrong from now to doomsday regardless of how many autopsy reports are issued. The autopsy report is irrelevant, both because there is no independent corrobration of the review and analysis and because the bottom line is this:
Michael Schiavo should not have been allowed to maintain guardianship over his wife with such obvious conflicts of interest as a long term common law wife and 2 children by her, as well as the obvious financial issues. THAT WAS WRONG. Her family was willing to take care of her and as there were no indications WHATSOEVER of what her desires were prior to the accident except conflicting reports, the error should have been made on the side of LIFE. It was MORALLY WRONG for Judge Greer to issue an order dehydrating and starving this woman to death, regardless of what her alleged condition was. We have had an example recently of a man, a fireman I believe, who was in a coma - in a PVS some doctors said, for several years and who just came out of it right after Terri died and has been talking with his family and recovering.
This ME might be able to weigh a brain and discuss how it looks or what he thinks it means, but the bottom line is when we consider cases like that firefighter, we don't know how the brain operates or what a human being really is. Who are we to be so arrogant as to horribly kill another person because she disgusts or frightens us or because we think that WE would not want to live in such a way? What happened to Terri Schiavo was pure unadulterated evil and the truth will come out some day.
Now you death cultists - those of you who could not bear to see this woman alive and who seem so passionately attached to killing her, post until your fingers break. I don't give a damn what you think. You were wrong then, you're wrong now, and you will be wrong 500 years from now.
It was wrong to kill this woman and to kill her in such a brutal and vicious manner.
The Schindler's have stated that they would keep Terri alive even if the KNEW that was against her wishes. That is scary. For all she know she told them a million times not to keep her alive in that state. We can be about as sure of that as we can be about Michael causing her condition. (0=0)
Well, at least 500,000 times I'd say. : )
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