Wednesday, June 29, 2005

Brain atrophy and dehydration

When the autopsy for Terri Schiavo was revealed earlier this month, among the questions I received, many people asked whether dehydration leads to brain atrophy. In addition, it is important to understand if there is an effect brain atrophy on function, and whether brain function determines whether a person qualifies for basic care.

An article in the journal of the American Academy of Neurology suggests that dehydration is associated with brain atrophy. From the abstract of an article called, “Dehydration confounds the assessment of brain atrophy,” we read the following.

“Computerized brain volumetry has potential value for diagnosis and the follow-up evaluation of degenerative disorders. A potential pitfall of this method is the extent of physiologic variations in brain volume. The authors show that dehydration and rehydration can significantly change brain volume: lack of fluid intake for 16 hours decreased brain volume by 0.55% (SD, ±0.69), and after rehydration total cerebral volume increased by 0.72% (SD, ±0.21)” (NEUROLOGY 2005;64:548-550).

Other reports show that brain atrophy can happen in as little as 16 hours without hydration. It would only be logical that a person would die quickly from dehydration because her brain was so atrophied by dehydration that it ceased to function. The autopsy itself stated the following.

“Brain weight is an important index of its pathological state. Brain weight is coorelated with beight, weight, age and sex. The decedent’s [Terri’s] brain was grossly abnormal and weighed only 615 grams (1.35 lbs.). That weight is less than half of the expected tubular weight for a decedent of her adult age of 41 years 3 months 28 days. By way of comparison, the brain of Karen Ann Quinlan weighed 835 grams at the time of her death, after 10 years in a similar persistent vegetative state.”

(PLEASE SEE JUNE 30 POST. IT IS A CORRECTION OF THE ERROR THAT WAS HERE.)

Thirdly, does her condition warrant her unqualified for receiving nutrition and hydration through a tube? No. It doesn’t. Severely disabled children and adults, including brain injury patients have been fed through tubes for many years. I remember seeing the kids at Holy Angels fed through a tube about 20 years ago. In addition, Pope John Paul II gives the following advice on artificial nutrition and hydration.

“The sick person in a vegetative state, awaiting recovery or a natural end, still has the right to basic health care (nutrition, hydration, cleanliness, warmth, etc.), and to the prevention of complications related to his confinement to bed. He also has the right to appropriate rehabilitative care and to be monitored for clinical signs of eventual recovery.

“I should like particularly to underline how the administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act. Its use, furthermore, should be considered, in principle, ordinary and proportionate, and as such morally obligatory, insofar as and until it is seen to have attained its proper finality, which in the present case consists in providing nourishment to the patient and alleviation of his suffering.”

With that said, today I was able to meet Suzanne and Michael Vitadamo, the sister and brother-in-law of Terri Schiavo. They are in New York City on a whirlwind media tour with Mark Fuhrman, investigator for the OJ Simpson case, to promote his new book Silent Witness: The Untold Story of Terri Schiavo’s Death. Read about their appearance on CBS’s The Early Show.

Though Michael did not say much, Suzanne spent a great deal of time talking about what Terri was like before her accident, what the goals of the Terri Foundation will be, and thanking all of us for our hard work to promote Terri’s cause. One of the goals of the Terri Foundation will be to make nutrition and hydration basic care, not medical treatment. I think this will be a vital step to halting the pro-death movement.

A special thank you to Suzanne, Michael, Mr. and Mrs. Schindler and Bobby. Our prayers are with all of you!

3 comments:

  1. Great post Mary. I linked to it here.

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  2. Karen Ann Quinlan did NOT die from dehydration and starvation; she died of pneumonia in 1985, nine years after her RESPIRATOR was removed.

    The Quinlan and Schiavo cases are completely different. Let's not engage in any inaccuracies or lump them together.

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  3. Susan,
    thank you. please see correction above.

    MW

    ReplyDelete