← Autodidact Archive · Original Dissent · Jack Cassidy
Thread ID: 17429 | Posts: 19 | Started: 2005-03-21
2005-03-21 04:56 | User Profile
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[font=Verdana][url="http://www.zimp.org/stuff/01%20-%20MICHAELSCHIAVOPROFILE.htm"][color=#800080]Michael Schiavo[/color][/url][/font][font=Verdana]
Background information on Michael Schiavo[/font][font=Arial]
[font=Arial]MICHAEL RICHARD SCHIAVO [/font]
[font=Arial]Born:[/font]<?xml:namespace prefix = st1 ns = "urn:schemas-microsoft-com:office:smarttags" />
[font=Arial]Married:[/font][font=Arial] November 1984 to Theresa Schindler, 20 yrs. of age. Michael Schiavo was 21 yrs. old. [/font]
[font=Arial]Physical Characteristics:[/font][font=Arial] Michael Schiavo is 6ââ¬â¢6" and weighs close to 250 lbs., compared to Terriââ¬â¢s 5ââ¬â¢3" height and 115 lbs. weight.[/font]
[font=Arial]Residence:[/font][font=Arial] Moved from [/font]
[font=Arial]Early Employment:[/font][font=Arial] Michael Schiavoââ¬â¢s initial employment in [/font]
[font=Arial]Michael Schiavoââ¬â¢s attitude was a major contributor to his chronic unemployment. He had a tendency to outspend Terriââ¬â¢s income, and his inability to retain employment created a serious financial problem, impacting their marriage. Also, it has been alleged that Michaelââ¬â¢s restaurant environment introduced him to drugs. [/font]
[font=Arial]Some Background Information:[/font][font=Arial] Most people, particularly Terri, were easily intimidated because of Michaelââ¬â¢s size. It has been documented that Michael had rages of anger and would use his physical stature to bully people, and as indicated in their attached personal experiences and affidavits, it was mostly women that were the subject of Michaelââ¬â¢s episodes of anger.[/font]
[font=Arial]In the early 1990ââ¬â¢s, Michael Schiavoââ¬â¢s treating psychiatrist, Dr. Peter Kaplan, stated in a phone conversation with Terriââ¬â¢s father, in regards to a violent episode occurring between Michael and Terriââ¬â¢s younger sister Suzanne, that Michael was potentially dangerous and should a situation re occur, to call the police. [/font]
[font=Arial]In a deposition from November 1992, that Michael admitted Dr. Kaplan prescribed Welbutron, Paneior, Elavil and Prozac medication to treat his condition.[/font]
[font=Arial]Additionally, contrary to everything Michael admittedly learned in his CPR training, he did not turn Terri over and clear her airway the night that she collapsed. His CPR training could have re-started her heart.[/font]
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[font=Verdana][url="http://www.zimp.org/stuff/06%20-%20CindyShookDepo.htm"][color=#800080]Cindy Shook, former girlfriend of Michael Schiavo[/color][/url][/font][font=Verdana]
2001 testimony regarding Michaelââ¬â¢s disturbing behavior. Ms. Shook was Michaelââ¬â¢s first girlfriend after Terriââ¬â¢s collapse
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[font=Arial]EXCERPTS FROM CYNTHIA SHOOK [/font]
[font=Arial]Backround:
[/font][font=Arial]In late 1991, 1ý years after Terriââ¬â¢s collapse, Michael Schiavo became involved in an intimate relationship with Cindy Shook. The romance continued for approximately one year. It can be documented that the two spent a weekend at the Don Caesar hotel in [/font]
[font=Arial]In May of 1992, at the apex of the romance, Schiavo had Terriââ¬â¢s 2 pet cats euthanized to clear the way for his moving in with Cindy and her pet dog. [/font]
[font=Arial]In the summer of 1992, Schiavo moved into his parentââ¬â¢s home. We can speculate with reasonable accuracy, it was at the instructions of his attorney, since the living arrangement would be contrary to Schiavoââ¬â¢s "loving husband" image they were projecting for the upcoming November 1992 malpractice trial.[/font]
[font=Arial]In April 2001, Cindy Shook (married name Brasher) was interviewed by an investigator working in Terriââ¬â¢s behalf. Unwilling to come forward because of her immense fear of Schiavo, Cindy had to be subpoenaed and was then subsequently deposed on [/font]
[font=Arial]Excerpts; [/font]
[font=Arial]Cindy Shook describing Schiavoââ¬â¢s possessiveness.[/font]
[font=Arial]"heââ¬â¢s very jealous. He stalked me at myââ¬Â¦at where I worked after I stopped datingââ¬Â¦when he would get mad at me he would tell me, I would rather be laying in bed in the nursing home with her than with you. I mean he can be the most incredibly mean person"[/font]
[font=Arial]When asked if she were afraid that Michael would physically harm her or if he would harm children. [/font]
[font=Arial]"I am concerned about retaliation because I have a child -I have children and a husband. I know him, I know what he told me I said he could be a very mean person."[/font]
[font=Arial]She spoke of how Schiavo stalked her for close to a year after the breakup and that she received repeated phone calls.[/font]
[font=Arial]"He came on the floor looking for me several times. I felt it was out of character for him to get a job as an orderly at the hospital That was concerning to me. When he would come up to the floor looking for her she was not scared the first time but later was scared.[/font]
[font=Arial]In town I would look up when I was drivingââ¬Â¦not at my work- she would look up in the rear view mirror and there would be Michael Schiavo. I would look up and he would be behind me in traffic. It continued for several months after he didnââ¬â¢t work at the hospital. She would change lanes, try to make a turn and he would do the same. He did this about ten times. [/font]
[font=Arial]One time he was behind me in traffic he got next to me in a two-lane going the same way, and he changed lanes basically right on top of where I was at, and I had to swerve not to be hit. I had to swerve off the road. Michael ran me off the road. I considered it as stalking, dangerous and guessed potentially life threatening."[/font]
[font=Arial]Cindy thought about getting a restraining order. She talked to an off duty police officer in her building [/font]
[font=Arial]They discussed marriage. She said Schiavo asked what would you do if I asked you to marry me. He never discussed getting a divorce. [/font]
[font=Arial]Cindy said Schiavo got angry when asked questions about Terri saying:[/font]
[font=Arial]"this had destroyed his life and he was being robed of a normal life."[/font]
[font=Arial]Regarding Terriââ¬â¢s care, according to Cindy Shook, Michael Schiavo said[/font]
[font=Arial]"How the hell should I know we never spoke about this, my God I was only 25 years old. How the hell should I know? We were young. We never spoke of this."
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[size=3][color=#800080]Cindy Shook, former girlfriend of Michael Schiavo
[/color]2001 phone conversation between Cindy Shook and Bobby Schindler discussing her paralyzing fear she has of Michael Schiavo
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[font=Arial][size=2] [/size][/font][font=Arial][size=2]I started by speaking with Investigator Kim. Kim informed me that she was presently with Cindy Shook at her home and has spoken to Cindy at length about events and conversation that occurred between her and Michael Schiavo when the two of them were dating.[/size][/font]
[font=Arial][size=2]I asked Kim if Cindy would speak to me. Kim informed me that Cindy would but that she is not going to come forward because of her existing fear she has for Michael.[/size][/font]
[font=Arial][size=2]Cindy then came to the phone. I initially thanked her for taking the time to speak with Kim. I asked if she would speak to our lawyers regarding this information. She told me absolutely not! I asked her why? She told me that Michael is insane and she is so scared that if she did speak about this, that he would cause harm to her husband and kids. I said to her, ââ¬ÅCindy, if you have information that will save my sisterââ¬â¢s life, then it is your responsibility to come forward.ââ¬Â She said that she understood why we were asking her to do this and understood our love for Terri but her childrenââ¬â¢s safety was more important than what would happen to Terri. [/size][/font]
[font=Arial][size=2]Cindy then went on to briefly tell me about their relationship when her and Michael were dating. ââ¬ÅHe was insane,ââ¬Â she told me. (Cindy stated this several times throughout our conversation) After we broke up, ââ¬ÅHe stalked me,ââ¬Â Cindy said. She had to get her husband (boyfriend at the time) involved so Michael would stop stalking her. She told me that Michael had tried to run her off the road on one occasion. She also included that at one time she thought the only way he was going to stop harassing her was by getting a restraining order against Michael.[/size][/font]
[font=Arial][size=2]I said to her that we would do anything we could so that Michael would not go near her and her family if she agreed to testify. She said that no one could ever guarantee that Michael, at some point, would not do something to her family, particularly her children. She continually stated that, ââ¬ËYou have no idea the person (Michael) youââ¬â¢re dealing with.ââ¬Â She explained to me that if she were single she would be there for my family but because of all the money involved, she was convinced, that Michael would retaliate against her family. [/size][/font]
[font=Arial][size=2]I asked Cindy, ââ¬Åwhat is it I could say that would convince you that you need to testify.ââ¬Â I tried to explain to her that by knowing what you know and letting him get away with it that she was essentially letting Michael get away with murdering my sister. She told me there was nothing that I can say that would ever convince her otherwise and she would not testify to any of this, no matter what my family did to try and get her to testify. In fact, she vowed to forget everything if we subpoenaed her. She apologized and said she felt awful but her family meant more to her than anything, even my sister dying. At that point I sensed Cindy was getting upset. I said that I hope she would change her mind and asked her to put Kim back on the phone.[/size][/font]
[font=Arial][/font] [font=Arial][/font][font=Arial][size=2]When I spoke to Kim, I told her that I could not believe how scared Cindy was of Michael. It was frightening. Kim agreed.[/size][/font]
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[font=Verdana][url="http://www.zimp.org/stuff/08%20-%20SuzanneExperience.htm"][color=#800080]Suzanne Vitadamo, Terriââ¬â¢s sister[/color][/url][/font][font=Verdana]
1992 encounter of violent episode with Michael Schiavo
[font=Arial]Terriââ¬â¢s sister, Suzanne Vitadamo, recalls her relationship with Michael Schaivo and one experience in particular[/font]
[font=Arial]My experiences with Michael Schiavo have always been unpleasant, and we never really were able to get along. I always remembered him as a mean and nasty person, but one instance stands out in my head that has made a lasting impression on me. Michael and my parents rented a home together in order to care for Terri within the first two years after Terriââ¬â¢s collapse. I lived with them for a short period of time. [/font]
[font=Arial]One day Michael and I got into an argument. I don't remember the specifics of what the argument was about, but I do remember that he went from 0 to 60 in a matter of seconds. Michael started to lunge toward me and I thought that he was going to punch me in the face. I'm 5'3" and Michael is 6'6". My father had to step between us before he got to me. I remember how terrified I was and began to run away from him. The house was very large so I had room to run. My parents and I were very disturbed and I was extremely frightened not ever having experienced that side of him.[/font]
[font=Arial]My father phoned his doctor after that and reported the incident to him. Michael was seeing a psychiatrist at the time. His doctor told my father that he was on medication, anti-depressants at the time, and that the next time he has that type of episode to call the police. [/font]
[font=Arial]From that day on, my father had me sleep with my bedroom door locked and a hammer under my pillow. Shortly thereafter, I moved out anxious and not wanting to ever experience Michaelââ¬â¢s extreme temper again.
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[font=Verdana][url="http://www.zimp.org/stuff/09%20-%20BobbyExperience84.htm"][color=#800080]Bobby Schindler, Terriââ¬â¢s brother[/color][/url][/font][font=Verdana]
1984 encounter of violent episode with Michael Schiavo[/font][font=Arial]
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[font=Arial]Terriââ¬â¢s brother, Bobby Schindler, recalls his relationship with Michael Schaivo [/font]
[font=Arial]Michael Schiavo and I never established a close relationship, we have always tolerated each other and I found that it was very difficult for anyone to build a close relationship with Michael because is always appeared to me that he walked around with a chip on his shoulder. My family would often wonder, before Michael and Terri would come for a visit, which Michael was going to show up.[/font]
[font=Arial]One experience that I had with Michael was at the beginning of his relationship with Terri, around 1984. I have no recollection what the details of the argument were, but do remember that we got into a very heated disagreement in the family room of our house while we were living in [/font]
[font=Arial]In hindsight this is something that I should have taken very seriously, and paid more attention to, but I remember that Terri asked me to please not tell our parents because it would upset them too much. [/font]
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[font=Verdana][url="http://www.zimp.org/stuff/10%20-%20DrHamilton.htm"][color=#800080]Dr. Hamilton, Orthopedic Surgeon[/color][/url][/font][font=Verdana]
1990, Dr. Hamilton consults Terri two months after collapse. Discovered in 2002[/font][font=Arial]
[font=Arial]Dr. Hamilton, Orthopedic Surgeon, consults Terri a short time after her collapse, on [/font]
[font=Arial]While Terri was a patient at [/font]
[font=Arial]Michael Schiavo, acting as Terriââ¬â¢s guardian and in control of what medical information was revealed, and also any medical decisions regarding Terriââ¬â¢s treatment, did not report this information to anyone in Terriââ¬â¢s family. Therefore, Terriââ¬â¢s family did not have any knowledge that Dr. Hamilton consulted Terri or what was disclosed as a result of Dr. Hamiltonââ¬â¢s examination of Terri.[/font]
[font=Arial]It was only a year later, on [/font]
[font=Arial]This bone scan taken of Terri on [/font]
[font=Arial]It wasnââ¬â¢t until November 2002 that Terriââ¬â¢s family discovered this information regarding the multiple fractures found throughout her body. [/font]
[font=Arial]Michael Schiavo never disclosed that Terri had a bone scan image taken just a year after her collapse to anyone in Terriââ¬â¢s family and, as mentioned, never disclosed that Terri was consulted by an Orthopedic Surgeon.
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[font=Verdana][url="http://www.zimp.org/stuff/16%20-%20DrCaroleLiebermanProfile.htm"][color=#800080]Dr. Carole Lieberman M.D., M.P.H.[/color][/url][/font][font=Verdana]
2004, Psychiatric Expert Witness profiles Michael Schiavo[/font][font=Arial]
[font=Arial]CAROLE LIEBERMAN, M.D., M.P.H., PSYCHIATRIST/EXPERT WITNESS[/font][font=Arial]
Diplomat, American Board of Psychiatry & Neurology Clinical Faculty, UCLA Department of Psychiatry 247 South Beverly Drive, Suite 202 Beverly Hills, CA 90212 (310) 278-5433 (310) 456-2458
July 12, 2004[/font]
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[center][u][font=Arial]PRELIMINARY THOUGHTS ON HOW TERRI SCHIAVOââ¬â¢S HUSBAND, MICHAEL, FITS THE PROFILE OF A WIFE ABUSER[/font][/u]
[font=Arial]Based upon my interviews of Terriââ¬â¢s father, Robert Schindler, and my research into media accounts of her case, I can provide the following preliminary opinions at this time:
--As the author of the book, [u]Bad Boys: Why We Love Them, How to Live with[/u] [u]Them and When to Leave Them[/u], I have studied men who exhibit pathology in their relationships with women. Profiles of the twelve different types of bad boys are explained. Michael Schiavo fits the profile, described in the book as the Prince of Darkness (see chapter 13). O.J. Simpson was cited as a classic example of this type, and there are indeed similarities between the two men. It is especially significant to note that O.J. flew into a homicidal rage when he realized that Nicole was totally abandoning him, as is characteristic of these impulsive men who most dread being abandoned by their woman. Similarly, Michael Schiavo was likely to have known that Terri had begun making plans to divorce him, since she had told a coworker and family member. Stalking is characteristic of this type of man, as well. And a girlfriend of Michaelââ¬â¢s, Cindy, accused him of stalking her in 2001.
--Terriââ¬â¢s personality fits that of a woman who would have been attracted (and attractive) to such a man. She was a loner as a child. In high school she was overweight and not popular with boys. She had low self-esteem. She was extremely compassionate, nurturing and subservient. They met when Terri was 20 years old, and married by the time she was 21. Such whirlwind courtships are typical of these men, who are able to spot a vulnerable woman they can dominate, and eager to seal her commitment to him.
Terri was frightened to object to Michaelââ¬â¢s pathologically controlling behavior. For example, he would monitor her odometer to control where she went. He tried to isolate her from her friends and family. She had to account for every penny, though they often lived on her income, since he would be fired, sometimes only after two weeks. He would splurge on $400 suits for himself, while she had to economize. He called her at work 3-4 times a day, often complaining of hating his job because no one appreciated him. He was often observed scolding her.
--Terriââ¬â¢s family observed black and blue marks on her before the incident that plunged her into her current state. Medical records and/or experts have revealed that her neck injury was consistent with strangulation. A bone scan revealed multiple fractures occurring within 1-2 months before or after the incident, which has been described as equivalent to her being ââ¬Åhit by a mack truckââ¬Â. Michael has given three different explanations of how he found Terri after the incident. [/font]
[font=Arial]--Michael has had Terriââ¬â¢s jewelry re-set into a ring for himself. Terri had two beloved cats that she adopted from an animal shelter, where theyââ¬â¢d landed after being mistreated. When he moved in with his girlfriend, Cindy, he had Terriââ¬â¢s cats euthanized. Psychologically, this is symbolic of what he is trying to do now to Terri.
--Michael has been under psychiatric care, including being prescribed several psychotropic medications. One of his treating therapists, Dr. Peter Kaplan, told Terriââ¬â¢s father that he should have called the police after Michael argued with Terriââ¬â¢s sister, Susanne, and Michael tried to attack her. This occurred right after Terriââ¬â¢s collapse, when they were all in a house together. Terriââ¬â¢s father told Susanne to lock her door and keep a hammer nearby.
--As a psychiatric expert witness, I have had experience performing psychiatric examinations of men like Michael Schiavo, and testifying in court about similar cases. The above is simply meant to illustrate some of the indications that Michael fits the profile of an abusive husband. He should most definitely be investigated as the perpetrator of the ââ¬Ëincidentââ¬â¢ that caused Terriââ¬â¢s collapse and her current condition. If Terri were to be allowed to die, as Michael has been desperately struggling to achieve for years, it could help him escape detection. This would be a grave miscarriage of justice.
For more information, you may contact Dr. Carole Lieberman at (310) 456-2458 or via email at [email="drcarole@drcarole.com"][color=#0000ff]drcarole@drcarole.com[/color][/email].
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[font=Verdana][url="http://www.zimp.org/stuff/14%20-%20TestimonyHammesfahrStragOnly.htm"][color=#800080]Dr. Hammesfahr, Neurologist[/color][/url][/font][font=Verdana]
2002 testimony regarding possible strangulation[font=Verdana]
[font=Arial]Dr. William Hammesfahr testimony possible strangulation[/font]
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[center][font=Courier New]PLACE: Pinellas County Courthouse[/font]
[center][font=Courier New]315 Court Street North[/font]
[center][font=Courier New]Clearwater, Florida[/font]
[center][font=Courier New]DATE: October 11, 2002[/font]
[center][font=Courier New]TIME: All day[/font]
[center][font=Courier New]REPORTED BY: TONYA H. MAGEE, RPR[/font]
[center][font=Courier New]Court Reporter and Notary Public[/font]
[center][font=Courier New]Sixth Judicial Circuit[/font]
[font=Courier New]REDIRECT EXAMINATION [/font]
[font=Courier New]17 BY MS. ANDERSON: [/font]
[font=Courier New]18 Q. You said that you had never felt a neck like [/font]
[font=Courier New]19 that except for one other patient, right? [/font]
[font=Courier New]20 A. Correct. [/font]
[font=Courier New]21 Q. What was the cause of injury in the other [/font]
[font=Courier New]22 patient? [/font]
[font=Courier New]23 [color=red]A. The person had an anoxic encephalous due to [/color][/font]
[font=Courier New]24 [color=red]attempted strangulation.
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[font=Verdana][url="http://www.zimp.org/stuff/15%20-%20DrBadenOntheRecord.htm"][color=#800080]Dr. Michael Baden, Forensic Pathologist [/color][/url][/font][font=Verdana]
2003 FOX NEWS interview troubled by Terriââ¬â¢s bone scan image from 1991[/font][color=#3f3f3f][font=Arial]
[color=black][font=Arial]ââ¬ÅOn the Recordââ¬Â with Greta van Susteren
Interview with Dr. Michael Baden, Forensic Pathologist, New York , October 24, 2003[/font][/color][color=black]
[font=Times New Roman][color=black]Greta[/color][color=black]: Dr. Baden, a potassium imbalance, letââ¬â¢s first talk about if you have a potassium deficiency, can that cause the condition that Terri Schiavo has?
[font=Times New Roman][color=black]Baden[/color][color=black]: Um, can, but unlikely. Potassium is very interesting. Itââ¬â¢s probably the most lethal poison we have when itââ¬â¢s injected rapidly, and thatââ¬â¢s why itââ¬â¢s the poison that kills people, capital punishment by lethal injection. And it stops the heart from beating properly ââ¬â too much of it. But also too little of it., hypo-potassium, can also cause the heart to stop beating properly and lead to lack of blood flow to the brain and death of brain cells by lack of oxygen. But thatââ¬â¢s very unusual, Greta, extremely unusual.
[font=Times New Roman][color=black]Greta[/color][color=black]: A normal healthy woman, I assume, would have no reason, for instance, to take potassium supplements unless, perhaps, sheââ¬â¢s on a diuretic or some other medication that would cause a potassium depletion. Is that right?
[font=Times New Roman][color=black]Baden[/color][color=black]: Thatââ¬â¢s correct. Thatââ¬â¢s right.
[font=Times New Roman][color=black]Greta[/color][color=black]: Is there any explanation then in your mind, and I realize you were not her team physician, but why would a woman at her age have a potassium imbalance?
[font=Times New Roman][color=black]Baden[/color][color=black]: Extremely unusual unless she had certain kinds of diseases, which she doesnââ¬â¢t have. She was in her twenties. The reason that sheââ¬â¢s in the state sheââ¬â¢s in is because there was a period of time, maybe 5 minutes or 8 minutes, when not enough oxygen was going to her brain. That can happen because the heart stops for 5 or 8 minutes, but she had a healthy heart, from what we can see. The other thing, though. . . Iââ¬â¢m sorry Greta?
[font=Times New Roman][color=black]Greta[/color][color=black]: No, go ahead.
[font=Times New Roman][color=black]Baden[/color][color=black]: Yeah, your staff has provided me with a bone scan that you guys obtained ah from her initial admission in 1991 to the hospital. And that bone scan describes her as having a head injury. Thatââ¬â¢s why sheââ¬â¢s there, thatââ¬â¢s why sheââ¬â¢s getting a bone scan. And a head injury can cause, lead to the vegetative state that Ms. Schiavo is in now, and it does show evidence that there are other injuries, other bone fractures, that on healing-stage, so that....
[font=Times New Roman][color=black]Greta[/color][color=black]: So, let me back up a second. Head injury. Could she have had, could she have passed out from a potassium imbalance causing a falling head injury? Is that what youââ¬â¢re talking about, or are you suggesting some pre-existing head injury to her passing out?
[font=Times New Roman][color=black]Baden[/color][color=black]: Something totally different. That itââ¬â¢s extremely rare for a 20-year-old to have a cardiac arrest from low potassium who has no other diseases. So the other issue is could it have been due to some other cause, which is raised by the family, has to be looked at.
[font=Times New Roman][color=black]Greta[/color][color=black]: Alright, other injuries and bone injuries, what does that suggest to you?
[font=Times New Roman][color=black]Baden[/color][color=black]: Some kind of trauma. The trauma can be from an auto accident, the trauma can be from a fall, or the trauma can be from some kind of beating that she obtained from somebody somewhere. Itââ¬â¢s something that should have been investigated in 1991 when these findings were found, andââ¬Â¦.
[font=Times New Roman][color=black]Greta[/color][color=black]: They were fresh.
[font=Times New Roman][color=black]Baden[/color][color=black]: Maybe there were, Maybe they were investigated by police at that time.
[font=Times New Roman][color=black]Greta[/color][color=black]: Alright. Dr. Michael Baden, thank you.
[font=Times New Roman][color=black]Baden[/color][color=black]: Thank you, Greta.
[font=Times New Roman][color=black][end transcript][/color][color=black]
2005-03-21 05:03 | User Profile
Apparently there are more than a few neurologists who have said Terri Schiavo's condition could be improved if given treatment. Michael Schiavo has prevented this from the get go. People who have seen Terri Schiavo said she definitely reacts to certain individuals (e.g., mom and dad and siblings) with smiles, yet grimaces and groans when Michael Schiavo enters the room. The only medical doctor Michael Schiavo has given permission to clinically assess Terri Schiavo's condition is an advocate for a pro-euthanasia group.
2005-03-21 05:08 | User Profile
I actually first heard about this controvesy; that she was possibly attacked, on the Savage Nation radio show. If the poor girl is a vegetable, she should be euthanized instead of being dehydrated and starved. There should definitely be a thorough investigation as to how she became incapacitated.
The House of Reps will vote any minute.
If only Congress would deal with the invasion from Mexico with similar urgency.
2005-03-21 05:25 | User Profile
[QUOTE=Snouter]I actually first heard about this controvesy; that she was possibly attacked, on the Savage Nation radio show. If the poor girl is a vegetable, she should be euthanized instead of being dehydrated and starved. There should definitely be a thorough investigation as to how she became incapacitated.
The House of Reps will vote any minute.
.[/QUOTE] Are you referring to his show on Friday night? LOL. I thought he was going to have a stroke. He was extremely worked up on this story. I do believe that as, Savage was saying, that how she got in that condition, is a little bit on the fishy side. I agree that she should be euthanized, but in a different manner then to starve her to death.
2005-03-21 05:33 | User Profile
[QUOTE=starr]Are you referring to his show on Friday night? LOL. I thought he was going to have a stroke. He was extremely worked up on this story. I do believe that as, Savage was saying, that how she got in that condition, is a little bit on the fishy side. I agree that she should be euthanized, but in a different manner then to starve her to death.[/QUOTE] Michael Schiavo has used shister lawyers from the get go to prevent any help for Terri Schiavo. Many top neurologists have said Terri Schiavo's condition could be improved with the treatment Michael Schiavo has prevented all along. Remember the case of the Tennessee police officer in a persistant coma for years until he came out of the coma and started talking one day?
2005-03-21 05:40 | User Profile
So far, the Coliseum consensus is THUMBS DOWN.
It truly boggles my mind Either/Or ended up hosting such a deathist site ... waxing every bit as pale as the Supremacist GOP without whose federally funded education efforts of the 60s we'd not have such Enlightened sorts as know who's fit to live or die.
What a sickening bunch of walking dead you are.
2005-03-21 05:49 | User Profile
[QUOTE=askel5]So far, the Coliseum consensus is THUMBS DOWN.
It truly boggles my mind Either/Or ended up hosting such a deathist site ... waxing every bit as pale as the Supremacist GOP without whose federally funded education efforts of the 60s we'd not have such Enlightened sorts as know who's fit to live or die.
What a sickening bunch of walking dead you are.[/QUOTE]You mean thumbs up, right? This whole thing has reminded me how infinitely preferable the Republicans are to the Democrats. I have to admit I had a bit of admiration for Dubya when I saw him arriving back at the White House from Crawford.
2005-03-21 06:01 | User Profile
[QUOTE=Jack Cassidy]You mean thumbs up, right?
For euthanasia, anyway. How much more humane are you than the Romans with their bread and circuses running with the blood of innocents deemed unfit to live but suitable for a spectacle (or shrouding biotech's being courted in Special Session from undue "pro-life" scrutiny).
This whole thing has reminded me how infinitely preferable the Republicans are to the Democrats. > Only because you're ignorant of the facts of the matter where Top Man of the deathists is concerned.
I have to admit I had a bit of admiration for Dubya when I saw him arriving back at the White House from Crawford.[/QUOTE]
I know my heart skips a beat when he bites his lip like Clinton.
What bullshit artists. Who buys this crap? Discerning fellow supremacists, appears.
2005-03-21 06:05 | User Profile
[QUOTE=Jack Cassidy]You mean thumbs up, right? This whole thing has reminded me how infinitely preferable the Republicans are to the Democrats. I have to admit I had a bit of admiration for Dubya when I saw him arriving back at the White House from Crawford.[/QUOTE] Speaking of the Bushes, Where is Jeb in this? I heard that a few years ago that he had created a bill called "terry's law" or something to that effect. This could be a great political move for him(at least with all the phony right-wing Republicans) if he wants to continue the Bush dynasty and run for president in the next election.
2005-03-21 06:05 | User Profile
[QUOTE=askel5]So far, the Coliseum consensus is THUMBS DOWN.
It truly boggles my mind Either/Or ended up hosting such a deathist site ... waxing every bit as pale as the Supremacist GOP without whose federally funded education efforts of the 60s we'd not have such Enlightened sorts as know who's fit to live or die.
What a sickening bunch of walking dead you are.[/QUOTE]Get off your soapbox. Terry's got a lot of support here, especially considering our site has been unencumbered by most of the conservative establishment, who prefer either to muddle through with JR or discuss losertarian arcania with John Deere or Neil McIver and Co. for quite a while.
2005-03-21 06:12 | User Profile
[QUOTE=askel5]For euthanasia, anyway. How much more humane are you than the Romans with their bread and circuses running with the blood of innocents deemed unfit to live but suitable for a spectacle (or shrouding biotech's being courted in Special Session from undue "pro-life" scrutiny).
This whole thing has reminded me how infinitely preferable the Republicans are to the Democrats. > Only because you're ignorant of the facts of the matter where Top Man of the deathists is concerned.
I know my heart skips a beat when he bites his lip like Clinton.
What bullshit artists. Who buys this crap? Discerning fellow supremacists, appears.[/QUOTE]I think we're on the same team here. I think we differ over the importance of making a show occasionally.
2005-03-21 12:32 | User Profile
[QUOTE=askel5]It truly boggles my mind Either/Or ended up hosting such a deathist site ... [/QUOTE]
Luke 5:27-32
2005-03-21 12:35 | User Profile
This case is intriguing, even from the other side of the world. Some stuff I found out while doing a bit of web browsing:
In 1999, while Governor of Texas, George W Bush signed into law a bill (The Texas Futile Care Law) that allows hospitals to withdraw life support from patients, over the objections of the family, if they consider the treatment to be non-beneficial.
It has already been used to withdraw life support from a fully conscious terminally ill 6-month-old baby boy, whose parents were unable to pay for alternative treatment:
[url]http://www.chron.com/cs/CDA/ssistory.mpl/metropolitan/3084934[/url]
[QUOTE]The baby wore a cute blue outfit with a teddy bear covering his bottom. The 17-pound, 6-month-old boy wiggled with eyes open and smacked his lips, according to his mother.
Then at 2 p.m. today, a medical staffer at Texas Children's Hospital gently removed the breathing tube that had kept Sun Hudson alive since his Sept. 25 birth. Cradled by his mother, he took a few breaths, and died.
"I talked to him, I told him that I loved him. Inside of me, my son is still alive," Wanda Hudson told reporters afterward. "This hospital was considered a miracle hospital. When it came to my son, they gave up in six months .... They made a terrible mistake."
Sun's death marks the first time a hospital has been allowed by a U.S. judge to discontinue an infant's life-sustaining care against a parent's wishes, according to bioethical experts.[/QUOTE]
And the family of a Texas man narrowly avoided having a similar fate befalling him:
[url]http://www.chron.com/cs/CDA/ssistory.mpl/metropolitan/3073295[/url]
[QUOTE]A patient's inability to pay for medical care combined with a prognosis that renders further care futile are two reasons a hospital might suggest cutting off life support, the chief medical officer at St. Luke's Episcopal Hospital said Monday.
Dr. David Pate's comments came as the family of Spiro Nikolouzos fights to keep St. Luke's from turning off the ventilator and artificial feedings keeping the 68-year-old grandfather alive.
St. Luke's notified Jannette Nikolouzos in a March 1 letter that it would withdraw life-sustaining care of her husband of 34 years in 10 days, which would be Friday. Mario Caba-llero, the attorney representing the family, said he is seeking a two-week extension, at minimum, to give the man more time to improve and to give his family more time to find an alternative facility.[/QUOTE]
A memo obtained by ABC shows that Republican senators are cynically using the Terri Schiavo case for political expediency:
[url]http://abcnews.go.com/GMA/print?id=595905[/url]
[QUOTE]ABC News obtained talking points circulated among Senate Republicans explaining why they should vote to intervene in the Schiavo case. Among them, that it is an important moral issue and the "pro-life base will be excited," and that it is a "great political issue -- this is a tough issue for Democrats."[/QUOTE]
2005-03-29 23:43 | User Profile
[IMG]http://a.abcnews.com/images/US/CHO10603291731.jpeg[/IMG][SIZE=2][FONT=Courier New]Terri Schiavo's father Bob Schindler, right, comforts Terri's mother Mary Schindler, center, as the Rev. Jesse Jackson looks on during a news conference Tuesday morning March 29, 2005 in Pinellas Park, Fla. The Reverend Jesse Jackson says Terri Schiavo is dying of hunger and dehydration, adding "That's inhumane." [/FONT] [/SIZE]
[IMG]http://graphics8.nytimes.com/images/2005/03/26/national/26families.1841.jpg[/IMG] [FONT=Courier New]Terri and Michael Schiavo in an undated picture. They met in the Philadelphia suburbs, where they had spent their childhoods and married in 1984. [/FONT]
2005-03-30 00:42 | User Profile
I'm definitely pro-Terri on this issue, and I don't doubt that Michael Schiavo is no poster boy for the Alan Alda Habitat.
But I'm somewhat disturbed by the post that opened this thread. Particularly how it relies on
[B]A [/B] family testimony - in a situation where acrimony not only exists but has steadily accrued over time, and
[B]B[/B] pop psychologists ("As the author of the book, [B]Bad Boys: Why We Love Them, How to Live with Them and When to Leave Them[/B], profiles of the twelve different types of bad boys are explained. Michael Schiavo fits the profile [of]...the Prince of Darkness (see chapter 13)") and tv talking heads indulging in speculation a decade after the fact.
In all likelihood, Michael Schiavo has things to answer for. But I can't help but think that if - God forbid - any of [B]us [/B] were to fall under this type of coast-to-coast, microscopic, everybody-step-up-to-the-plate-and-take-a-cut scrutiny, we would all be quickly tried and condemned in the court of public opinion.
Like it or not, people in their 20s are burning off their adolescent energy - yes, and assholishness - and over the course of living a life, you are going to have run-ins with people who will forever write you off as a Bad Guy, sometimes over the most trivial matters ( like "I never liked that guy's looks" or "he threatened to hit me once".)
God forbid your wife have a bad fall and, a year or two later, fall into a coma. It wouldn't take much, in a society evenly divided between judgmental holier-than-thou Christians and judgmental holier-than-thou liberals, to take a look at a decade-old x-ray, and crucify you as a wife-beater in the court of public opinion.
By no means should Terri Schiavo be benignly murdered as she is - she should be immediately remanded into her parents' custody. But if they genuinely thought that her husband was complicit in her condition, or in any other way violent and dangerous, they have had [B]fifteen years [/B] to contact law-enforcement with their suspicions.
Remember - [I]if they want to get you, they will. [/I] And if they can find something in your distant past to hang you with....ditto. I'm sure a similar 'case' could be built around every single member of this forum if they chose to sift throughevery grain of sand in our pasts.
2005-03-31 07:24 | User Profile
People who are in terminal conditions - e.g. will require extensive medical care just to survive - are usually not the healthiest of specimens. Let nature act.
2005-03-31 09:10 | User Profile
[QUOTE=neoclassical]People who are in terminal conditions - e.g. will require extensive medical care just to survive - are usually not the healthiest of specimens. Let nature act.[/QUOTE]She was physically quite healthy I think. Nature failed - it was up to the doctors. Unless you call a 44 to the temples or its equivalent - nature. Terminal - we're all terminal. And vegetative - well from your post I'm not sure you're entirely cognitively aware yourself - we've discussed all this several times.
Be glad I'm not Michael Schiavo holding your feeding tube :lol:
2005-03-31 12:00 | User Profile
"In his strongest comments yet on the Terri Schiavo case, Mel Gibson calls her killing "nothing more than state-sanctioned murder." The actor and director spoke out Wednesday night in a telephone interview with Fox News’ Sean Hannity.
"I heard their cry for help," Gibson explained his public comments. Gibson insisted that Terri Schiavo is not in a vegetative state.
Gibson said he decided to take a public stand because "it is completely wrong to deprive this poor woman of food and water."
He added that the court-ordered method of killing – depriving Terri Schiavo of basic sustenance – "is a prolonged and cruel execution."
Gibson said he is closely following the case and is astounded by the developments.
"I just sit here watching this whole scenario play out in front of me with my mouth wide open that our country has come to this," he said, adding, "I think it’s a really black day."
The actor offered little hope for Terri Schiavo at this point, describing the appeals as "too little too late."
"It’s nothing more than state-sanctioned murder," Gibson continued.
He was also disturbed that a local Florida judge was given the unquestioned power to sentence Schiavo to death.
"All the big guys, they’ve got their hands tied by some tinhorn judge down there," he said. "Come on. When they want to whip a judge, they got no problem getting Judge Moore in a heartbeat."
"It’s so wrong and I watch it, appalled and stunned, that we have gotten to this."
2005-03-31 12:04 | User Profile
Breaking News Supreme Court Rejects Request by Terri Schiavo's Parents
Top Neurologist's Report on Terri Released NewsMax.com Wires Wednesday, March 30, 2005 Here is a comprehensive report by Dr. William Hammesfahr, a world-reknowned neurologist, on Terri Schiavo's condition as of September 12, 2002:
Re: Terri Schiavo
I was asked to examine Terri Schiavo per the request of the Second District Court of Appeal. They requested that current information about her present medical condition be obtained. They also requested that an evaluation be performed to ascertain treatment options. HPI:
Ms Schiavo was in her usual state of good health until 2/25/90, when her husband reported that he was awakened from sleep approximately 6 Am by her falling. He reports that she was unresponsive.
Paramedics were called, and aggressive resuscitation was performed with 7 defibrillations en route.
In the Emergency Room, a possible diagnosis of heart attack was briefly entertained, but then dismissed after blood chemistries and serial EKG's did not show evidence of a heart attack. Similarly, a pulmonary or lung cause of the disorder was ruled out in the Emergency Room after normal blood gases and Chest X-Rays were obtained. The possibility of toxic shock syndrome was also entertained. The diagnosis of the cause of her condition was unknown. Her admission laboratory studies showed low potassium level, markedly elevated glucose level, and a normal toxic screen without evidence of diet pills or amphetamines.
The abnormal potassium level and sugar level were found on admission to the Emergency Room and were successfully corrected by the hospital staff over the next several days. The patient had a difficult hospital course with the development of poorly controlled seizures and prolonged coma state requiring, for a time, ventilator support. However, the staff noted improvement, and it was recommended by several physicians that she be discharged to an intensive rehabilitation center.
She was eventually transferred to Mediplex in Bradenton for intensive rehabilitation. She was poorly responsive. However, after a brain stimulator was placed in 11/90, the staff started to report greater interactions of the patient with her environment, including intermittently apparently following commands, turning her head to voice, tracking visually, etc.
This pattern continued even after discharge to a nursing home, although her course from that time on included multiple medical problems including recurrent urinary tract infections and hospitalizations, at times with severely low episodes of blood pressure due to a lack of treatment of urinary tract infections ordered by the husband and subsequent urinary sepsis requiring hospitalization.
During 1998, she was evaluated by Dr. James Barnhill, neurologist, who testified that he examined her for ten minutes and determined that she had no chance for recovery, and was in a persistent vegetative state. He also identified that her skull was filled with spinal fluid; there was no brain present on the scans. All responses he identified were reported as "reflexes." He obtained no blood pressure nor did anyone else, apparently, on the day of his exam, the closest documented blood pressures being obtained two days earlier and five days later. No tests including Urinary Tract infection evaluations, blood tests, EEGs, evoked potentials, or new CT/MRI exams were ordered.
One year later he again reconfirmed his earlier diagnosis. He felt no tests of any sort were needed for evaluation. In the spring of 2000, three physicians, including Dr. Jay Carpenter, who is a former Chief of Medicine at Morton Plant Hospital, filed affidavits after observing Ms. Schiavo. All three physicians stated that it is visually apparent that Ms Schiavo is able to swallow and, in fact, does swallow her own saliva.
The patient continued with no physical therapy, communication or speech therapy, or routine medical screening evaluations and treatment such as dental care, mammography, gynecological exams or pap smears during this time.
In May 2002, access to the patient was allowed for two physicians appointed by the family. At that time, my observation of Terri Schiavo in person occurred, having previously viewed videotape that was first shown at her first trial.
The examination
Medical examination and evaluations were performed on Ms Schiavo on September 3 and 4 with videographers present. Medical reviews of the charts provided were carried out, from which the above history is obtained.
On September 3, I spent from approximately 11AM until 4PM with Ms. Schiavo, returning the next day to also observe Dr. Maxfield and complete my portion of the exam (which duplicated that of Dr. Maxfield, so I observed without myself specifically repeating that part of the exam that same day).
The exam was videotaped at my request.
The exam started with the setting up of the video camera by the videographers, with Mr. Michael Schiavo present. I then came into the room and introduced myself to Ms. Schiavo. The patient was looking at the ceiling in a chair. She had a wide-eyed look to her. She appeared to be aware of my presence with slight facial changes and tone changes in her body, She did not look at me, or turn to look in the direction of my voice, continuing instead to look directly forward. Her mother then entered the room, coming toward her and speaking her name. The daughter immediately showed awareness of the presence of her mother, looking for her, then finding her visually when the mother was approximately 8 inches from her face. She then smiled and made sounds. Her father also entered the room with further apparent recognition by the daughter.
The first part of this exam included observing her interactions with her mother and her father. Here she clearly was aware of them and attempted to interact with them: the sounds, facial expressions, and searching out and tracking them. There are several previous reports by medical personnel and others of her responding to live piano music. Accordingly, I asked the mother to bring a tape of piano music. Two separate pieces were listened to. The first she appeared aware of the sound, but would not sing or interact significantly. The second she did interact making sounds with the music. She stopped making these sounds, when the music stopped.
During this time, she would move her head and track her head and eyes to the sound of music, or her mother's voice. I started my exam first on her right side, introducing myself and then examined her contracted right arm, the goal being to get a blood pressure, as neurological abilities are very sensitive to blood pressure. She looked at me and would track me with voluntary facial and upper torso movements. I later moved to the left arm and attempted to release contractures there. In order to get significant relaxation of the arm to a degree necessary to obtain a blood pressure, I worked for approximately 35 minutes to release the contractures enough to get arm extension to approximately 140 degrees. During this time, the patient would track the mother or the father, depending on who was interacting with her. Interestingly, she appeared to respond to her mother or father by tone of voice. At one time, after working on her arm for approximately 20 minutes, and no further extension of the elbow was to be had, the father walked up and started speaking reassuringly to his daughter. The elbow immediately extended approximately another 20 degrees. This was during a time period that I had been talking with Ms. Schiavo, and the music was also running. Yet with neither the addition of the music nor my voice did the elbow extend. With the father coming to his daughter and speaking, she immediately extended the arm further. At other times, he would speak more sharply to her, and she would immediately tighten, and appear to lose her spot of visual focusing, and her expressions would change. At times during and immediately after this part of the exam, she would also appear to voluntarily move her right upper extremity.
Multiple takes of her blood pressure were taken, and there were several readings of "error." During the reading of her blood pressure, I also palpated the median artery at the wrist. In general, the systolic readings on the blood pressure cuff correlated well with the wrist palpations. Thus, the systolic readings are probably fairly accurate, although the diastolic readings cannot be independently confirmed. Three readings were successfully obtained 96/65 pulses of 70, 107/78 pulse of 72, and 101/71 pulse of 70. The pulse was erratic by both machine and palpation. The blood pressure errors occurred due to spasticity in the arm being evaluated.
A general physical exam was also performed, although pelvic, breast, rectal, fundoscopic, sinus and ear exams were not performed. Technical difficulties prevented the fundoscopic exam from being performed.
The general physical examination and the neurological examination tended to be performed in an extremity-by-extremity fashion, as her cooperation was best by focusing on specific regions, and then not coming back to those regions at a later time. Moving rapidly and from side to side tended to result in apparent confusion and stress in the patient, manifested by increased tone and less facial interactions, eye contact, and less accessibility to her limbs due to the increased tone causing contractures to redevelop.
The general facial exam was significant for acne, probably due to a chronic stress induced steroid responses. No bruits were identified. Cranial nerves were intact, and the patient was able to swallow and handle all secretions.
The neck exam was abnormal. She had severe limitation of range of motion in the flexion, and to a lesser degree in extension. Indeed, I was able to pick up her entire torso and head and neck area with pressure on the back of her neck in the suboccipital region. These findings of cervical spasm and limitation of range of motion are consistent with a neck injury. No bruits were identified.
Lung exam showed scattered wheezes in the right lung fields. No rhonchi or rales were identified. Cardiac exam was normal to my exam. Interestingly, the significant arrhythmias identified by the electronic cuff, as well as my palpation of her wrist exam was not identified during this cardiac portion of the exam, suggesting the arrhythmia is intermittent.
Abdominal exam showed good GI sounds throughout, and was non-tender. No masses or aneurysms were palpated.
Extremities exam showed severe contractures in all four extremities. On the left upper extremity, she initially showed 4/4 on the Allen's spasticity scale about the wrist, fingers, and the elbow. However, with approximately 40 minutes of massage and release, the exam in this upper extremity showed spasticity on the Allen's scale, and at times, later in the exam, would show 2/4 on the Allen's exam.
The right upper extremity also showed 4/4 on the Allen's scale, and also improved with efforts at muscular tension release. However, time did not allow me the same degree of effort on her right upper extremity, and thus I am unsure of the degree of relaxation available in this area.
In the lower extremities, she has 2/4 about the hips and the knees, meaning full range of motion, but spasticity still present. However, about the ankles, she is 4/4 and I could obtain no improvement in the range of motion.
With levels of 3/4 and 4/4 spasticity, it is frequently difficult to determine the degree of voluntary control if any a patient has over an extremity. The internal spasticity and stiffness of the limb, makes gauging voluntary efforts very difficult.
Efforts that may be easily seen or felt in a patient with no spasticity may be completely missed or only able to be identified from sophisticated testing in a patient with 3/4 or 4/4 levels of spasticity.
Spasticity generally is due to neurological injuries, and is aggravated by lack of physical therapy and muscle stretching. To understand spasticity, it is important to understand what is normal with muscle activity
In a normal person, a leg, arm, or other part of the body moves because a muscle contracts and moves a nearby bone. However, muscles exist on both the front and the back of joints. When the muscles in the front of the joint move, the bone moves forward. When the muscles on the back of the joint move, the bone moves backwards. If the bone is your arm, then when the biceps contracts, the arm bends. When the triceps contracts, the arms straightens. Another characteristic of normal is that when one set of muscles contracts, the opposite muscles relax. Thus, when the biceps contracts, the triceps relaxes and vice versa.
In spasticity, that relaxation of opposing muscles does not occur. Thus, even if the biceps tries to contract to move a muscle, the opposing contractures of the triceps, prevents motion. In severe cases, like Ms. Schiavo, the contractures of the opposing muscles may be so severe, that voluntary motion appears very weak or non-existent. In fact, in some of her muscle groups, the severity of the contractures has grown so severe, that even an outsider cannot move the joint.
The Allen's scale is a 0-4 scale with 0 as normal or no spasticity. The scale is as follows:
0 Normal, no spasticity
1 Slight spasticity, palpated by the physician, but full range of motion of a joint.
2 Moderate spasticity, but full range of motion. Here the examiner may be allowed to use a great deal of his own muscle contraction to straighten a joint. If the joint can be straightened to its full range of motion, this is a 2.
3 Severe spasticity, but some motion can be identified. Full range of motion does not exist.
4 Severe spasticity, no range of motion.
Pulses in these extremities were symmetrical. Skin was intact in these areas.
The patient wore a diaper, and this was not removed for the exam.
Back exam was carried out and there were no evident areas of tenderness, masses, or other abnormalities seen.
The first two hours of the exam, focusing on cognitive awareness of her surroundings, was carried out in a chair. The last one hour on videotape was carried out in her bed. In neither position did she have difficulty handling any saliva or secretions. Only briefly, for a few minutes at a time, did she appear to tire and lose the ability to respond, track or interact with her surroundings.
She had no tube feedings or water during the entire time of the exam.
Alertness: The patient was alert throughout essentially the entire exam.
Responsiveness:
The patient would immediately respond to sound, tone of voice and to touch and pain. With respect to responding to those around her, she had limited responsiveness to me personally until approximately 45 minutes into the exam. She started to look at me, against her traditional right gaze preference, about the same time that we started getting significant relaxation in her contracted left arm (the arm that had been contracted for several years.) She appeared to identify the sound of my voice, with the relaxation of the arm. From that point, she would generally look toward the sound of my voice when heard, attempt to find me visually, then track the sound of my voice in its movements, or track me if I was within approximately one foot of her eyes. Prior to that time, she did not track me, or try to locate me visually. When playing music, she had a clear preference to the specific sound track played, and would listen to piano music, but change levels of listening depending on the track played. Her attention to the music would not wander during the track she preferred. She would pick out her mother's voice or her father's voice separate from the music or other voices or sounds in the room, and re-fix her gaze to those people. She would tend not to blink when watching those people. She ignored her husband's loud foot-tapping that went on for approximately five minutes at one point. She also ignored his voice and did not try to seek him out visually when he would at times interject comments during the exam or immediately afterwards.
During various portions of the exam, she would be moved or have her position readjusted. She continued to handle her saliva during this time, never being observed to choke on her saliva.
Following Commands: At various times during the exam, I asked her to close her eyes, or open her eyes widely, look towards her mother, or look towards me. At times, she appeared to properly follow these commands. Interestingly, some of the commands, such as close your eyes, open your eyes, etc. she tended to do several minutes after I gave her the command to do so. She had a delay in her processing of the action. However, when praised for the action, she would then continue to do the action repetitively for up to approximately 5 minutes. As we had moved on to other areas of the exam, at times she was continuing to do the previous command, then at inappropriate times since the focus of the exam had changed. During different portions of the exam, I would ask her to squeeze my hand on command, or, in the lower extremities, to pick up her right lower leg to command.
The upper extremities are contracted and weak. She appeared to squeeze my hand, and then relax her grip, in the upper right extremity, possibly in the upper left extremity. I am unsure if she was doing it to verbal command, or in response to body language; however, it was voluntary activity and not reflex. In the lower extremities, she showed these same abilities, marked on the right and to a lesser degree on the left (voluntary control over the ankles could not be determined due to the severity of the contractures there). However, in the right lower extremity, I again gave verbal commands, but also noted that she would oppose activity voluntarily. Thus, moving a hand against a thigh would elicit an equal and opposite reaction from her. She would gauge the degree of pressure, and counteract it equally. This is not a reflexive movement. With respect to her lower leg, we were able to clearly show that on videotape. I had her push her lower leg against my hand; my hand was on the top of her leg. Removing my hand suddenly, allowed her leg to suddenly continue voluntarily rising up and be seen on videotape. We had her do this repetitively on videotape.
Her right lower leg is quite strong. Other areas are either not as strong, or have such high spasticity brought on by neglect that voluntary activities are able to be felt, but difficult to show large degree of motion that are represented on videotape so well. The voluntary control is there, but does not show up well on videotape, as the range that the motion goes through is less.
Cranial Nerve Exam: Cranial nerve function is present and appears normal in all groups tested. The fundoscopic exam and ophthalmic nerve function could not be tested directly. She tracks well and voluntarily. She does not exhibit "Doll's Eye" motion, an abnormality seen in coma patients whose eyes move back and forth like a doll's when their head is moved.
Coma patients cannot direct their gaze to specific things and maintain their gaze on those things regardless of head motion or motion of the object.
She can do these things. She appears to see things best at approximately the.8-12 inch area. She was best able to track large reflective objects like aluminum balloons or sparkling lights (for which a focal length limitation is not an issue.)
This is a patient who has very poor language abilities. Her interactions with the world, as well as her ability to convey thought will depend in large part on her visual abilities and limitations. Thus a complete opthamological exam and evoked potential exam needs to be performed. This needs to be performed in comfortable situation and the patient needs to be comfortable with the examiner and the examinations. I would estimate that at least one day should be allotted for the exam and should be carried out her in room.
Sensory Exam: The patient was tested to light touch, pressure, and sharp touch and pain in all four extremities and on her face. The pain portion in the extremities was conducted by pinching the nail beds of her hands and feet. She clearly feels pain as the videotapes show.
On the face, noxious stimulation including cotton swab up the nose and gag sensation and papillary touch with cotton evidenced a pain response. These were more than just reflexes, as she appeared to be annoyed by these painful responses long after they had stopped, and would not smile at me again for the rest of the day.
She certainly feels pressure, as was discussed earlier, and opposes pressure with voluntary motor activity. When using a sharp piece of wood, which she found uncomfortable, and going over her entire body (except diapered areas and breast areas), we found that sensation is present everywhere. Sensation on the right side as evidenced by moaning or tightening up muscles or withdrawal and was more prevalent than on the left.
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.
Motor Exam: As discussed earlier, it is difficult to measure motor strength on the classical scales. The classical motor strength scale is a 0-5 scale and is described as patient's voluntary motor strength score /normal which is represented as a 5. Thus a person with no voluntary motion would be 0/5 and a person with normal voluntary motion is a 5/5. Normal motor strength requires relaxation of the muscles around the muscle being tested. Thus, if grip squeeze is being tested, the muscles that straighten the fingers must relax in order to have a good squeeze. Ifthose muscles don't relax, they tend to keep the fingers straight, and thus give a weaker squeeze than if they did relax. When the muscles near the area being tested don't relax, that is called spasticity, and makes the exam less accurate. At times the spasticity is so severe that a muscle tested may not be strong enough to overcome the opposing muscles, and no evidence of voluntary muscle movement is seen even though there is in fact voluntary control over those muscles.
This is the problem that we have with Ms. Schiavo. She clearly has voluntary control that is good control over her facial musculature. Formal testing of those cranial nerves showed no weakness or facial asymmetry.
In the upper and lower arms, however, the spasticity is severe. She at times would voluntarily move her right arm/ hand complex against gravity, which is considered a strength of 3/5 or greater by convention. When squeezing my hand and relaxing on the right side, she had approximately a 2-3 (-)/5 but range of
activity was severely limited by spasticity. On the left side, it appeared weaker. In the upper extremities, she would oppose pressure on her, or try to move her arms with approximately 3/5, but not to command (probably due to the aphasia). The right side was stronger than the left.
The leg motion on the right was generally approximately 2-3/5 in all groups except around the ankle. However, when opposing my hand in the lower leg, she was 3+ -4-/5 and the voluntary action caught on videotape was clearly a strong 3/5 or better. On the left side the strength appeared to be more of a 2/5 range in all groups, but due to the difficulty of the exam, may actually have been stronger than this.
The convention of the 0-5 scales for testing voluntary motor strength is as follows:
0 No voluntary movement
1 Trace movement able to be felt
2 Movement of an extremity if gravity is removed. Thus if movement of a leg occurs in a bed while a patient is lying down, but he cannot move that same area up off of the bed, this is considered 2/5.
3 Movement against gravity
4 Movements against examiner's actively resisting the patient's muscular activity
5 Normal
The scale has some additional aspects, in that a - or + sign may further allow an examiner to delineate a specific number into sub-gradations. Reflexes: Were 2+ throughout on the left side, and slightly brisker on the right side.
The reflexes to my exam were slightly brisker in the upper extremities than in the lower extremities. These reflex findings may be related in part to differing level of tone due to spasticity. No clonus was identified. The reflexes at the pectoralis muscles were 2++ and symmetrical. Reflexes at the ankles could not be obtained due to the severe contractures. Babinski exam did not show abnormal reflexes, probably due to the severity of the contractures in the feet. Both glabellar and palmomental reflexes were mildly abnormal.
Impression:
The patient is not in coma.
She is alert and responsive to her environment. She responds to specific people best.
She tries to please others by doing activities for which she gets verbal praise.
She responds negatively to poor tone of voice.
She responds to music.
She differentiates sounds from voices.
She differentiates specific people's voices from others.
She differentiates music from stray sound.
She attempts to verbalize.
She has voluntary control over multiple extremities
She can swallow.
She is partially blind
She is probably aphasic and has a degree of receptive aphasia.
She can feel pain.
On this last point, it is interesting to observe that the records from Hospice show frequent medication administered for pain by staff.
With respect to specifics and specific recommendations in order to carry out the instructions of the Second District Court of Appeal:
From a neurological standpoint: The patient appears to be partially blind.
She needs a full opthamological evaluation and visual evoked potentials done to flash and checkerboard patters. The opthamological examination is to evaluate her retina and her ophthalmic nerve to try to determine the cause of her visual limitations and if any treatment exists. The evoked potentials looks at the nerve between the eye and the visual centers in the brain, to see if there is treatable damage and the type of damage, if any in these areas. This is important, as for individuals to interact with her, and possibly teach her better ways of communicating with others, they must know what sort of limitations she has. This even extends to whether she can see people or objects in specific areas of her vision, and what size objects need to be to be accurately seen. Additionally, if one were to properly examine her, it would help if one knew the full extent of these test results.
Communication: She can communicate. She needs a Speech Therapist, Speech Pathologist, and a communications expert to evaluate how to best communicate with her and to allow her to communicate and for others to communicate with her. Also, a treatment plan for how to develop better communication needs to be done.
Rehabilitation Medicine: The patient has severe contractures. She needs a specialist to evaluate these and develop a treatment plan.
Endocrine: The patient has clinical evidence of an abnormally functioning endocrine system. Her blood pressure is abnormally low. Many patients with severe neurological injury have low blood pressure due to an abnormally functioning endocrine system. The reason for this should be determined and corrected, as with a more normal blood pressure, she is likely to have even better neurological functioning. She has facial acne consistent with hormonal abnormalities.
ENT: The patient can clearly swallow, and is able to swallow approximately 2 liters of water per day (the daily amount of saliva generated). Water is one of the most difficult things for people to swallow. It is unlikely that she currently needs the feeding tube. She should be evaluated by an Ear Nose and Throat specialist, and have a new swallowing exam.
Mammography needs to be performed.
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.
Interestingly, I have seen this pattern of mixed brain (cerebral) and spinal cord findings in a patient once before, a patient who was asphyxiated.
A urological consultation should be obtained: I disagree with Dr. Gambone's view that the patient's bacteria in the urine may be ignored. In my experience, colonization of the bladder can very distinctly affect the patient's neurological status and affect their rehabilitation. The patient needs a urological consultation both to examine the bladder issue, resolve if there are possibly colonized and kidney stones (that may be the source of recurring bladder infections). Also, one significant mechanism of diagnosing and finding and diagnosing spinal cord injuries is through sophisticated bladder EMG and other testing. This should be done.
The neurosurgeon who placed the implant should be contacted for recommendations. A neurological examination can only be carried out in the context of a complete understanding of the patient's physiology, including current blood tests. Thus the tests that Dr. Gambone did months ago, before we had access to the patient, should immediately be repeated.
EEG: I have reviewed the EEG recently obtained. The EEG has large amounts of artifact. The technician's attempted to remove artifact by filtering. Unfortunately, filtering also affects and reduces evident brain electronic activity. This EEG is not adequate and should be repeated. It should be repeated at the patient's bedside, with the patient in a non-agitated state.
SPECT scan: A SPECT scan prior to and after several days of Hyperbaric Trial should be obtained. Such a Hyperbaric Oxygen trial does not constitute treatment, as the length of time of such hyperbaric is inadequate to render any treatment. However, it is a useful technique to assess the likelihood of improvement using hyperbaric oxygen. I would defer to Dr. Maxfield on the specifics of testing, but believe that it is generally accepted by those in the field who have experience with hyperbaric treatment, that Dr. Maxfield's recommendations in this area are accurate.
William M. Hammesfahr, M.D."
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