Sunday, March 27, 2005

What if the CT Brain Scan Isn't Terri's?

Online Medical Discussion Board Concludes 1996 CT Brain Scan Is Likely A Hoax

[This post will be updated to fix facts or update conclusions as needed with informed consensus. Assertions will be withdrawn as they are refuted.]

Analysis and discussion on the award-winning medical blog CodeBlueBlog are casting suspicion on the single 1996 CT scan that has provided the entire basis of evidence - apart from Dr. Cranford et al's since-discredited testimony - for Terri's diagnosis of PVS and the claims of massive cortical atrophy (the so-called "liquefying brain"). From Dr. Martin on CodeBlueBlog:
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I have seen many CT scans looking like ["Terri's"] as well ... The single image from this particular scan shows SEVERE loss of cortical tissue. The PATIENTS who go along with CT scans like that are for the most part in advanced demented states, nonverbal, often contracted into the fetal postition, unable to follow any instructions or engage in purposeful movements.
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The conclusion that the 1996 CT scan shows severe brain damage and almost no hope for meaningful recovery was echoed by Dr. Sanjay Gupta, CNN's medical correspondent and a trained neurosurgeon himself, who reportedly based his opinion on this scan and the (disputed) EEG report. Dr. Martin's assertion above - that this scan may not even be Terri's - is either a five-alarm scandal in the making or a fantasy driven by collective "false hope".

Yet the consensus building on the discussion thread's medical participants indicates: The 1996 CT scan is a hoax.

WHY A HOAX?

Why we reached this conclusion is an excellent question. There are several reasons to consider.

First: Like Dr. Martin, Dr. Bell at Wake Forest and other respected neurologists in the field have collectively concluded that the two different exhibits being used to justify Terri Schiavo's diagnosis of persistent vegetative state or PVS - the CT brain scan ("Exhibit A") and the 10- to 45-minute patient exams by 3 doctors ("Exhibit B") - point in two entirely different directions. To a large degree they may even contradict each other.

That does not address the question of whether or not Terri has PVS. What it means is, the two exhibits gathered to "diagnose" Terri contradict each other. It means that at least one of the exhibits - Exhibit A or Exhibit B - must be false.

Which is it (or is it both)? Competent neurologists believe it is both, for reasons that will become clear shortly.

EXHIBIT B - Testimony of Dr. Cranford et al

First: there is reason to doubt Exhibit B independently. Exhibit B consists of testimony from three doctors - two for Michael Schiavo and a tie-breaker - that all agree she has "PVS". This is ludicrous for the following reason: Every neurologist (besides Dr. Cranford et al) who has examined Terri in person has found immediate and solid evidence of her cognitive abilities. Though this evidence was swished away as "irrelevant" by Judge Greer on every occasion (for reasons known only to him), they have found Terri to be alert, conscious, able to feel pain, and trying to speak. That falsifies Exhibit B - testimony that has been discredited by the eyewitness reports and even her own medical records - on its face.

[Ed: There will be more credible and irrefutable problems and contradictions that will impeach Exhibit B in a future post.]

While they have noted some obvious disabilities in Terri - partial blindness is one of them - they all realize she continues to hear well and respond. Why this hasn't been entered into evidence in Judge Greer's court is a mystery he has yet to answer for.

EXHIBIT A - 1996 CT Brain Scan

And now to the question of the hoax. If the flimsy provenance of the Exhibit B diagnosis has not put you in doubt about the entire case, then this may not stand for much to you. But there is serious reason to doubt the origin of Exhibit A on at least three grounds:

1.  Dr. Austin's argument that a patient with this degree of hydrocephalus (fluid in the brain) and cortical atrophy (diminishing brain matter) would not correlate to the patient history seen here and here is a compelling one, and one shared by the eminent neurologists quoted by Robert Johansen.

2.  If Exhibit A is to be believed then we must also believe that the deterioration in her brain was unusually rapid from 1993 to 1996, yet so slow between 1996 and 2005 that not only did she not die, but she remained sufficiently cognitive to appear in these videos, recognize music and express her wish to live. Whether or not it is called "PVS", it is doubtful the physicians could provide a viable explanation as to how the brain managed to retain those abilities in the face of such massive brain injury.

3.  Most patients who have PVS have almost-normal CT brain scans. This CT brain scan is considered anything but normal. It is a patient with late-stage hydrocephalus (whether it shows an acute or congenital problem depends on the patient's medical history).


WHY EXHIBIT A AND EXHIBIT B CONTRADICT EACH OTHER

A word on brain scans and PVS: Their consensus opinion is that a CT brain scan of a typical PVS patient may not look much different from a scan of a healthy brain. That's one of the reasons why doctors assert a CT scan of the brain does not diagnose PVS (a point the judge failed to understand when he admitted it into evidence). They DO, however, diagnose hydrocephalus of this advanced stage quite easily. The diagnosis reached on the brain scan is late-stage acute hydrocephalus (an acronym which I'll call AHC until a doctor is disgusted with it ;) and does NOT have a normal-looking brain scan.

Exhibit A and Exhibit B contradict each other because they defend entirely different diagnoses, and those diagnoses contradict each other. Dr. Cranford succeeded in moving both diagnoses toward the middle, but for reasons I will post in a follow-up, that interpretation can't be sustained either.

People with the kind of massive brain evisceration shown on the CT Scan would look like the patient described at the top, and not like the PVS patient that they claim Terri to be. We know that Terri Schiavo is neither of those (for reasons that were never submitted into evidence): she is much healthier and more able than either of those diagnoses permit, as her medical chart clearly demonstrates. All protestations to the contrary from 3 doctors and ONE image of dubious provenance, it simply cannot be explained how EITHER exhibit can be linked to Terri Schiavo.

Realize that if:

(1) the "liquefied brain" claim is based ONLY on the scan and not the "PVS" diagnosis that used the famous "balloon" video;
(2) her "PVS" diagnosis is based ONLY on the testimony of the three doctors (which now appears to be in some doubt) and NOT the scan showing massive cortical atrophy;
(3) each diagnosis contradicts the other; and
(4) Terri is reported by witnesses not to have the classic symptoms of either one, then we can conclude only one of two things:

1. Every clinician who has reported Terri's real symptoms other than the three appointed by the Greer / Felos partnership - which includes:
are all incompetent, delusional or lying. OR:

2. Both chains of evidence are phony.

Note that to date NO clinician who has actually treated Terri - whether a nurse or a doctor - from 1993 to the present day - has believed she was in a persistent vegetative state. Nor a helpless state of the sort implied by the brain scan - an even more horrific diagnosis than the PVS.

And it's also absurd that a doctor would allow competing and contradictory evidence to form the basis of a single conclusion (that fits neither one of the diagnoses these exhibits actually represent). The responsibility for a travesty of this magnitude is shared by Dr. Cranford regardless of whether or not the obtained the fraudulent evidence himself.

[This is not a proof, it's an argument. I'm working on a proof. It's longer. Stay tuned!]

And one thing more about the alleged brain scans:

There is a shunt clearly visible on the scan, yet Terri never had one installed.

Either an unauthorized shunt was installed into Terri Schiavo's head and then removed - for no particular reason or benefit (which is highly doubtful since Michael Schiavo forbade all medical treatment from 1993 onward) - or else the brain shown on the CT scan is not Terri's.

That should raise alarm bells.


WISHFUL THINKING?

On the subject of the shunt, there are a couple of things to note:

1. There was initial disagreement on the board as to exactly what the CT scan reveals. Consensus appears to be established however.

2. There is a thalmic implant that was installed earlier in her recovery and not removed. A dissenter had this to say:

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It still seems far more likely that this is a thalamic implant.

"How could they gage serial brain degeneration without serial follow-up?"

Are you really suggesting that 1996 is the only time anyone did a CT?

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Perhaps there's never been one performed. And the rebuttals - and the consensus - are quite clear:
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That is the tip of a venticulatr shunt which we are only seeing on one scan slice (because that's all we have). It was placed there to relieve increased intraventicular pressure which can have 2 causes: overproduction of CSF or obstruction to CSF outflow (= "communicating" and "noncommunicating" hydrocephalus).
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Regarding the possible existence of a "thalamic shunt":
A shunt is a device employed to drain CSF out of the ventricles when the body's natural mechanism of doing so has failed. If somebody placed a shunt into the thalamus, he basically has bad aim. It's a no-no to put shunts into the thalamus. People get sued for putting shunts into the thalamus. Stimulators, on the other hand, have for many years been placed in the thalamus in an effort to treat movement disorders.

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There can be considerable debate about the meaning of these anomalies, but the total set of contradictions are too overwhelming to sustain. And for reasons to be clarified in a follow-up post, the brain scan was both the pivotal piece of evidence that put Terri away - and kept the media incurious - and introduced a trojan horse (more on that later) that may unravel the chain of evidence.

Now here's the entire excerpt from Dr. Martin on CodeBlueBlog:
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I have seen many CT scans looking like ["Terri's"] as well ... The single image from this particular scan shows SEVERE loss of cortical tissue. The PATIENTS who go along with CT scans like that are for the most part in advanced demented states, nonverbal, often contracted into the fetal postition, unable to follow any instructions or engage in purposeful movements. (There are exceptions to this of course, but based on reports of her condition Terry Schiavo is not one of them.)

In addition [to contributing a misleading and incorrect analysis], it is irresponsible to contribute to the debate based on a scan that is possibly and even probably not from her.

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I call "shenanigans" on the medical evidence being used to convict Terri to death.

More to follow. I will have both a more coherent point-by-point explanation, a detailed logical analysis of WHY the brain scan is a hoax (will need help from the CBB), why it may have been picked over another by the perpetrator, and what contradictions it buried into the chain of evidence. There might also be a trojan horse buried inside (that will unravel the chain) that even Judge Greer can't exclude because it's already been admitted into evidence.

19 Comments:

Blogger Maggie said...

RD,

I have been following the comments on the other discussion page and saw something that is startling and I believe is well worth the investigation. Since I am not involved in medicine etc. I reserve the right to be wrong.

Kat-Missouri has extensive experience (admin not medical) with children who have been abused, including shaken baby syndrome (SBS for short). She goes into a lot of detail about the prognosis and diagnosis of children that are affected. She remarked that it could be possible that the time of the first abnormal scan could indicate that Terri was shaken so hard that her brain was injured.

Then I looked at some of the testimony given in deposition and in court, sure enough Michael Schiavo stated that he shook Terri when he "discovered" her on the floor.

Since I have had the awful experience of a stiff neck caused by whiplash, I can relate to some of the information that has been provided. FYI my diagnosis was a torn neck muscle on my left side and stretched ligaments. My injury came about in the classic hit in the back traffic accident as the front seat passenger, and yes I did accelerate and decelerate very rapidly.

That "shaking" that Michael has actually admitted to, could be the reason why she has suffered brain damage after the attempt to strangle her.

I am convinced that Terri did not suffer a heart attack, although it is more than likely her heart stopped whilst she was being asphyxiated. From what I understand that would be a normal response in that situation. I do not think it can be denied that Terri's brain was deprived of oxygen for a short period of time. There is also no doubt that the paramedics did CPR on Terri, although her husband failed to commence these procedures before the paramedics arrived on the scene.

There are just too many inconsistencies in this case.

2:25 AM  
Blogger Concerned Citizen said...

Today I'm ashamed to be an American. I can no longer have allegiance to a country that can allow something of this magnitude to take place. I don't even want to live here anymore. I have even started researching other countries to find information about immigrating. It's really terrible what's going on. This decision proves that none of us are safe! I can't believe that a human being is being murdered in this way.
I am not a crazy right to lifer. I am not a particularly religious person. I do not even consider myself a particularly moral person beyond just knowing right from wrong. But I do know when something doesn't pass the smell test, and this case stinks of uncertainty and injustice.
I have been thinking about this case every waking hour trying to understand Michael's real motive in this case. For a while I thought it was for money. Then I thought it was because he was afraid that she would eventually be able to tell the truth - which might implicate him. Now I think his motives are even more base than that. I think he has such a hatred for the Schindler family that he wants to hurt them in the worst possible way. From interviews we can see he is a spiteful, stubborn, controlling person. He has made it clear that he dislikes the Schindler family. What better way to hurt someone than to murder their daughter?
I also can't believe that the courts would allow a stranger to have priority over blood relatives. Because the bottom line is: Michael Shiavo is not Terris blood and his having a 10 year common law wife and 2 bastards with that woman is proof that he's not really her husband.
Unfortunately, no matter what we do, or what we say, it's not going to change Judge Greer's mind. He has an agenda and has been a recipient of campaign money from Michael Schiavo's attorney. To me that stinks of a conflict of interest.
In the end, I wouldn't want to be Michael Schiavo. There's not a place in this country that he's going to be able to go without looking over his shoulder. Everywhere he goes people are going to view him as a murderer. Every evil is going to befall him and his family. The innocent always pay for the wicked. Joseph Kennedy is a case in point, and to my knowledge Joseph Kennedy never did anything as heinous as what Michael Shiavo is doing. Judge Greer and George Filos will not be immune from that evil either. All of them are going to have to answer to a higher power one day.
I have some questions in all this: What is the woman that Michael Schiavo is living with thinking about this case? Is she in total agreement with Michael or is she so controlled and afraid of Michael that she's too spineless to speak out against his decision? Doesn't she realize that it could be her laying there one day? Doesn't she have questions about his true motives? Shouldn't his utter determination to kill Terri raise some red flags?
I have a prediction for her. I'll bet anyone that one day Michael will dumps her. Maybe then, we'll find out what she knows about his true motives. Unfortunately, it will be too late and at Terri's expense.

1:47 PM  
Anonymous Anonymous said...

OT - but relevant to accurate documentation -

I believe that Terri was a licensed Florida driver - info gained from comments on various blogs regarding her husband's controlling nature - ie: checking of mileage on car after every trip she took independantly.

Point being: In 1989-90, did Florida offer a provision for organ donation on the reverse side of this license? I ask because - if Terri signed the organ donation portion of her license, removal of her feeding tube would contradict her expressed wishes - wouldn't it?
If she is dehydrated and starved, would her organs remain viable for transplant?

This is no time to withold ideas (regardless of how outlandish) which may save her life.

The above thought was offered simply as an idea to gain whatever obscure legal means remain for the reinsertion of her feeding tube.

6:11 PM  
Blogger RD said...

Great posts all! Thanks. I belive the organ donor issue (a GREAT point BTW!) was yet one more issue that the judge blurred. If I'm not mistaken he figured her fundamental "right to die" asserted by Michael was stronger than her "wish" expressed on her driver's license. The idea being, if she's decapitated in an auto accident, obviously they'd use her organs, but if she were a "vegetable", and "wouldn't want to live like that" - then the court would rule in favor of dehydrating and starving her in order to accomplish it.

There's really no way to win with Judge Greer. The whole fix has been in from start to finish. Technically speaking he's already disobeyed worse with no change in the status for Terri OR his incarceration.

9:52 PM  
Blogger RD said...

I predict Michael's days as a man with life, liberty and happiness are numbered. The thrill (over seeing his wife dessicated by the state against her will) will fade once the media turn on him like a pack of wolves, once it's politically irrelevant for the media to stonewall the objective data and the sworn affidavits implicating Mr. Schiavo.

Then there's the question of fraudulently misdiagnosing a Stage 3 palsy/dementia victim with a Stage 1 illness (advanced late-stage cortical atrophy and hydrocephalus) for the specific objective of being allowed to kill her. (Exactly who is wrapped up in this has yet to be discovered.) You realize this fiction was its own undoing. It worked only so long as the case wasn't dragged out. Now even TIME has falsified Exhibit A (not on objectivity, but provenance).

For that George Felos, Dr. Cranford, and undoubtedly other hospice board members are complicit as well. They ought to be investigated, the sooner the better.

I have a prediction for them too: Unlike Michael Schiavo, Felos will face charges but will beat them. George Felos will slip through the system, his reputation not harmed in the circles where he is most beloved. For some of them, realize, a Stage 3 patient is just as deserving of "death" with or without their consent as is a Stage 1 patient. Let's never forget that. THAT is the other battle we're fighting. (Actually two battles: the level of consent required by the victim, and the Stages of hope at which someone's "wishes" can be applied to them by force of the court.)

Dr. Cranford will be a joke in peer review circles, his testimony easily impeached and affirmed only by those judges willfully deciding to ignore the truth, as Greer did. He may get some easy work occasionally where the diagnosis truly is terminal and the conclusion obvious to anyone. (He may be right in the other cases - he is a doctor after all - he just won't be believed anymore.)

Hospice board members may indeed be fingered by all kinds of employees, past and present. The level of indignation may have already reached the tipping point. Once this happens people are going to jail.

Anyone who can do this ought to: contact the media, remind them there are nurses waiting to come forward before it's too late and testify on Terri's behalf and against Michael Schiavo. RECORD it. Get it on audiotape. Something like:

US: "Hello. Yes, did you know that there are nurses willing to testify that Michael Schiavo has tried to murder his "spouse" on several occasions while under his care? And many of the hospice workers are ready to break ranks and spill the beans? We'd like to get them on your TV station as soon as possible - it's literally a matter of life and death."

THEM: "Sorry, we don't do smear journalism."
US: "But this is testimony sworn under oath."
THEM: "Well, anyone can lie in court."
US: "Our witnesses would be willing to take a lie detector test. Is Mr. Schiavo?"
-click-

WE NEED THAT on tape. BEFORE it's too late.

AS TO THE JUDGE specifically: Judge Greer will be on his best behavior from now on and it may take investigators a while to get to the bottom of his involvement in this, which (for all we know) could have started out with the "best of intentions". (After all, if you look at the 1996 CT scan, you yourself may be forced to conclude that the person's days are truly numbered.)

I bet the person most surprised at how long she's lived is judge Greer himself, unless he was involved from the start or became so later on once he discovered what had happened in his courtroom. Either way there's no valid excuse - it was, and is, HIS decision what to do all the way up to the last minute.

OTHER NEWS: Maggie found a post on the Empire Journal that finds the ACLU may have been underwriting Michael's legal expenses. (!) Folks, we have a problem in this country right now and it's not going to fix itself this time.

Mandy - from you :)
I have a prediction for her. I'll bet anyone that one day Michael will dumps her. Maybe then, we'll find out what she knows about his true motives. Unfortunately, it will be too late and at Terri's expense.

Unfortunately we both know she's not safe if she decided to leave Michael Schiavo, OR Michael decided to leave her. Better she get it on tape BEFORE she even HINTS she's going to betray him and come clean. But otherwise I agree w/you. ;)

11:04 PM  
Blogger Maggie said...

I think that I have the right angle on the bulimia to prove that Michael Schiavo committed fraud with the malpractice suit. I need someone to check the record of the malpractice trial to see if it was mentioned that Terri had an enteric infection. She was treated with Flagyl and that is used to treat the parasite gardia. This parasite can make a person feel very ill, and yes it could cause the potassium level to drop.

This is a very relevant point in exposing Michael Schiavo and the fact that he wants to murder his wife with state sanction.

6:14 PM  
Blogger pc93 said...

The following was a challenge given out [Ed. note: which has now been slightly modified April 18, 2005] and also included below is a URL for our press release:

From your friendly neighborhood moderator/creator of terrisjustice. See below. We have been challenged and now I must issue my challenge to you.

Those in the pinnacles of authority [Jeb Bush and others] believe that we are going to melt away and give up seeking justice for Terri.

The famous motto of the Zapatistas is one response of ours in this regard: Ya Basta!

We will never surrender! We will never tire!

Challenge to you: go out and inform 10 other people what happened to Terri. Get them signed on terrisjustice. Ask them to do the same.

This is how the grassroots grows and is the only true means of getting a true geometrical progression realized.

If you are not for getting justice for Terri against those with blood on their hands do not join this list. If you are a spy or have mal-intents and you try to join or succeed in joining please leave the list or it may be that one day you will die a horrible death not at our hands but as a result of your disingenuous actions which resulted in karmic repercussions. This is a form of what is called felos-de-se (a senseless or purposeful act of self-murder).

NOTE:

A great deal of lee-way is necessary, given the scope of the work, and I am committed to freedom of expression. HOWEVER, it does sometimes become necessary to remind ourselves of our purpose and the basic rules of etiquette when communicating with others.

Flame wars and attacks on the character of others are not allowed on this list, and other members of the list not involved should not be subjected to emails containing such material - carry them on in private please if you must, or more adult behavior, don't indulge in them at all.

We will remind once in awhile if things get a little out of hand, and any continued offense will be dealt with by either a moderation of the posts of the offender(s) or, when all else fails, a complete ban on those posts, especially when several complaints have been received from offended list members.

We have never had to take action in some years of doing this, and we hope this will never be necessary. Thank you for your support, and may your experience on this list be as enjoyable as it is informative.

URL for press release [also contained in Yahoo! News]:

http://www.prweb.com/releases/2005/4/prweb229498.php

JS

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