Re: It looks like the party of 'choice' is losing again!
By Robyn Shelton | Orlando Sentinel Medical Writer <br />Posted March 23, 2005 <br /><br /><br />One guest on a TV talk show demanded to know why Terri Schiavo had not had a brain scan recently. Surely a magnetic resonance imaging test, the guest said, would show if she were in a persistent vegetative state.<br /><br />A caller to a talk radio show demanded to know why Schiavo's husband, Michael, had prevented his wife from receiving rehabilitation therapy.<br /><br />The Schiavo case has created a level of hysteria and emotion that is not surprising, considering the life-and-death drama that's unfolding before the nation. But those emotions at times have clouded the facts -- or worse -- especially since Congress intervened last week.<br /><br />Here are the answers to some commonly asked questions about this complex case:<br /><br />Question: What is a "persistent vegetative state" and how is it diagnosed? Is it unusual for doctors to disagree?<br /><br />Answer: People in a persistent vegetative state have lost all higher brain function, including the ability to think, experience emotions and understand the world around them. However, they continue to sleep and wake; open their eyes; breathe on the their own; and even make noises and facial expressions.<br /><br />This is because their brain stems -- the portion of the brain that controls basic functions such as heartbeat and breathing -- continue to function.<br /><br />Those suffering from this condition do not track objects with their eyes, blink on command or respond consistently to cues in the environment. When a patient fails tests over a period of time, doctors consider the condition "persistent."<br /><br />There is no single test, such as a brain scan, that can peer inside the brain and absolutely determine a person's level of mental function. But doctors can diagnose the condition by testing a patient's ability to interact with his or her environment.<br /><br />Doctors who have been appointed by Terri Schiavo's husband and the courts have determined that she is in a persistent vegetative state with no chance of recovery. Her parents and their physicians do not agree, maintaining that she is not vegetative and can recover.<br /><br />Doctors who examine the same patient can reach different conclusions, but time is the best arbiter of diverging views, said Dr. Michael Pulley, an assistant professor of neurology at the University of Florida campus in Jacksonville.<br /><br />"The way to resolve it is to see if there is any change [in the patient's ability to interact] over time," Pulley said, adding that improvements would be expected within the first weeks or months of the injury.<br /><br />Terri Schiavo has been in this state for 15 years.<br /><br />Q: Terri Schiavo appears to respond to her mother in a video released by the family. Her father said that she smiled Monday when he told her that her feeding tube could be re-inserted. Doesn't this show that she is not in a persistent vegetative state?<br /><br />A: Terri Schiavo's parents say this is evidence that she is not in a vegetative state. Court-appointed physicians have not been able to document a consistent, predictable response from Terri that would indicate she is aware of her surroundings.<br /><br />Q: Isn't there new technology that could provide more insight into Terri's condition?<br /><br />A: There is a device called functional magnetic resonance imaging -- or fMRI -- that tracks blood flow to regions of the brain while a person is performing certain tasks. Doctors say this can be used to get more information about a person's brain function, but it is not a conclusive test.<br /><br />Terri Schiavo has undergone a series of diagnostic tests in the past, which showed her brain's electrical function to be flat, court records show. The outcome of those tests supports the diagnosis of "persistent vegetative state." Brain scans show that the area of the brain responsible for higher thinking, the cerebral cortex, has suffered severe atrophy and has been replaced by liquid.<br /><br />Q: Terri Schiavo's parents and a neurologist who examined her several years ago, Dr. William Hammesfahr, say the woman could get better with therapy. Would she be helped by rehabilitation?<br /><br />A: Other doctors have concluded that she will not improve with rehabilitation, and previous attempts with therapy had no effect.<br /><br />Terri underwent more than three years of rehabilitative therapy after her collapse in 1990, and her husband took her to a California center in late 1990 to have an experimental device implanted in her brain in hopes of stimulating activity.<br /><br />Jay Wolfson, who reported to the court in December 2003, wrote: "In recent months, individuals have come forward indicating that therapies and treatments can literally regrow Theresa's brain tissue, restoring all or part of her functions. There is no scientifically valid, medically recognized evidence that this has been done or is possible, even in rats."<br /><br />Q: Hammesfahr, the neurologist who examined Schiavo years ago at her parents' request, has said that Terri could eat and drink on her own if fed. Is this true?<br /><br />A: Doctors performed "swallowing tests" on Terri in 1991, 1992 and 1993 and concluded that she "was not able to swallow without the risk of aspiration," which occurs when fluid or food is inhaled into the lungs.<br /><br />Pulley, from the University of Florida, said that some patients in vegetative states can swallow, but this does not necessarily indicate higher thinking abilities because swallowing is a "reflexive" action
