Posted on 04/20/2005 9:22:15 AM PDT by GOPcapitalist
In Terri's case, there was a damn good medical reason -- she couldn't swallow.
"Anyone who deprives anyone else of natural means of hydration (or breathing, etc.) acts with the intent of killing."
Terri was unable to hydrate naturally.
"Terri never asked to be killed. It is illegal in Florida to kill or assist in suicide."
Terri refused medical treatment. It is legal in Florida to refuse medical treatment.
"I will not be ashamed for speaking up for the weak against the high-handedness of someone who is not a just judge."
Well, that's not what you're doing. You're pontificating. You're lecturing. You're sticking your nose where it doesn't belong. You're imposing your extreme right-to-life fanaticism into a case where is has no business being. You should be ashamed.
The evidence is in years of experience with swallowing studies, feeding tubes and end of life decisions. (Note: not everyone who shows aspiration on the barium swallowing test - defined as "failure" in the notes on Terri - undergo the placement of a feeding tube.)
Do a google on swallowing studies. I will, and post the results and a summary, later tonight. (I'm visiting my parents and each time I log on, I tie up their phone line.)
Totally irrelevant. I don't care about other people. We're talking about Terri's swallow tests, which were all negative. The feeding tube was in place for 10 years -- no one even discussed it until 2003.
TheWolfson Report, dated December 1, 2003, concludes, "the neurological and speech pathology evidence in the file support the contention that she cannot take oral nutrition or hydration".
From a Google search on "Barium Swallow Study"
http://pcs.mgh.harvard.edu/heal_lang_art7.htm
Differentiates between barium swallow and modified barium swallow.
http://www.jcge.com/pt/re/jclngastro/abstract.00004836-199703000-00005.htm;jsessionid=CseEZys1RVAXvqDrOehyXuKwXoo8JmW5ULb4GJQtxThfRRZr1RJP!802112076!-949856031!9001!-1
Modified Barium Swallow Does Not Affect How Often PEGs Are Placed After Stroke.
Journal of Clinical Gastroenterology. 24(2):74-78, March 1997.
Akpunonu, Basil E. M.D.; Mutgi, Anand B. M.D.; Roberts, Carolyn M.D.; Khuder, Sadik A. Ph.D.; Federman, Douglas J. M.D.; Lee, Lisa M.D.
Abstract:
Dysphagia frequently follows stroke, but often resolves quickly. Percutaneous endoscopic gastrostomy (PEG) or other feeding tubes are placed to improve nutrition and hydration, and reduce the risk of aspiration pneumonitis. We evaluated the impact of modified barium swallow in determining PEG placements and the influence of specific swallowing abnormalities on PEG placement. The abnormalities assessed were presence of pharyngeal stasis and/or visualization of posterior pharyngeal transfer problems and aspiration of liquid or solids. A total of 302 patients with stroke were admitted to our hospital between 1989 and 1993, but only those with hemorrhagic or nonhemorrhagic stroke by computed tomographic (CT) scans or magnetic resonance imaging (MRI) or autopsy were included in our study. Patients with transient ischemic attacks (TIAs), central nervous system tumors, and traumas were excluded. Barium swallow studies were performed on 69 (23%) of patients; 49 (71%) were abnormal, based on aspiration of barium, pharyngeal stasis, or postpharyngeal transfer dysphagia. PEGs were placed in only 18% of those with abnormal studies. Of the patients with normal barium swallow studies, 25% had a PEG placed. Two hundred thirty-three patients underwent no barium swallow studies, but 11 (4.72%) of these had PEG placed. The rate of PEG placement was not related to any one of the abnormalities noted on the modified barium swallow. Rather, patients who received PEG had significant neurological deficits and increased prevalence of aspiration pneumonitis. The decision to insert PEG was made on clinical grounds and not on abnormal barium studies alone.
(C) Lippincott-Raven Publishers
http://www.gihealth.com/html/education/peg.html
8. How much feeding solution is given? Every patient and situation is different. Some patients can't eat at all and depend completely on the feeding tube for all of their nutrition. They may receive as much as 8 cans a day (2400 calories). Other just need a little help and require less. Ask the patient's doctor or health care provider how much feeding solution to administer and how often.
9. Can the patient still eat and swallow once the PEG feeding tube is inserted? Again every patient and situation is different. Some patients can't swallow at all because of thoat cancer or a stroke. They can not eat normally. But if the patient can still swallow without choking, there is no reason why food can not be taken by mouth in addition to the lquid supplement give through the PEG tube.
http://www.theberries.ns.ca/Archives/Dysphagia.html
DYSPHAGIA PROGRAM
ST. MARTHA'S REGIONAL HOSPITAL
ASSESSMENT THROUGH CLINICAL OBSERVATION AND MODIFIED BARIUM SWALLOW STUDY
Patients with dysphagia following stroke are at high risk for complications of aspiration. In our hospital when a referral for a patient with dysphagia is received, a Dysphagia Team member (Speech-Language Pathologist and/or Dietitian) will review the chart, complete a bedside clinical assessment of the patient's level of alertness, oral motor skill, complete test swallows with a variety of food consistencies and determine if further investigation with a modified barium swallow study is indicated.
Note that observation of presence or absence of the gag reflex is not used as part of the clinical assessment.
TO GAG OR NOT TO GAG
Traditionally, presence or absence of a gag reflex has been used as a clinical indicator in determining the patient's readiness and safety in accepting food orally however.
THE GAG REFLEX
* is not elicited during a normal swallow
* is not protective for the swallow. The protective reflex for swallowing is the cough, which should be triggered when food enters the larynx. The cough reflex is frequently not elicited in dysphagic patients. (See UNRELIABLE COUGH REFLEX below)
* is not elicited when food falls into the pharynx or airway prematurely or in an uncontrolled way
[from Logemann, J., (1985) The Diagnosis and Treatment of Dysphagia. Evanston, Ill.]
Additional evidence in the lack of predictability of the gag reflex in swallowing safety is provided by the following two studies.
Leder, S. Gag Reflex and Dysphagia, "Head & Neck", March 1996.
* 86% of subjects with no gag could safely swallow at least a puree diet
* 13% of normal nondysphagic subjects had no gag reflex
Davies, Kidd, Stone, MacMahon, Pharyngeal Sensation and Gag Reflex in Healthy Subjects, "The Lancet", February, 1995
* 37% of normal subjects had no gag reflex (43% of normal elderly subjects, 26% of young subjects)
* Presence or absence of a gag reflex is not a predictor of swallowing safety.
INFORMATION OBTAINED FROM A MODIFIED BARIUM SWALLOW STUDY
If a modified barium swallow study is recommended, the procedure used is different than a standard barium swallow study. That is, the patient is given small, graduated quantities of various food consistencies (usually thin liquids, thickened liquids, pudding and cookie) while in a sitting position. The MBS gives information on:
1. whether the patient is aspirating,
2. the safest diet, and
3. strategies to improve swallowing safety.
Specific strategies to improve swallowing function are tested and observed during videofluoroscopy. Strategies may include changes in head position, increasing sensory input (through changes in food temperature, pressure on the tongue), variation in food consistency or variation in bolus size.
THE UNRELIABLE COUGH REFLEX
Of the 41 studies completed (May 1996 - May 1997) at St. Martha's Regional Hospital, seventeen studies showed aspiration on videofluoroscopy. Of the seventeen studies, three cases (17.6%) showed visible signs of aspiration, i.e., choking, coughing, during the study. The remaining 14 cases (82.4%) aspirated "silently" during the study. Coughing, the protective reflex for aspiration, was not observed in response to aspiration in the majority of cases. Our findings are higher than those documented by the dysphagia literature which cites silent aspiration at 30-50% of cases.
THE BEST DIET
Consistencies Aspirated during Study
Percentage
Thin Liquid 13/17 76.4%
Thickened Liquid 1/17 5.8%
Pudding 1/17 5.8%
Two consistencies2/17 11.7%
The first oral diet traditionally ordered for new CVA patients is a "clear fluid diet". Our findings, supported by the dysphagia literature, suggest that this diet is the least safe for dysphagic patients. If a patient is suspected of having dysphagia and is placed on an oral diet, the safest choice is a diet consisting of thickened liquids and pureed solids. Medications should be crushed and given with these food consistencies. Aspiration indicators such as a wet cough, gurgly voice after swallowing, respiratory stress and temperature peaks should be monitored when dysphagia is suspected. Further assessment by the Dysphagia Team may be indicated.
sounds like a great reason to starve her to death, does it? --->>it's a rhetorical question.
Even then, it admits, "The rate of PEG placement was not related to any one of the abnormalities noted on the modified barium swallow. Rather, patients who received PEG had significant neurological deficits and increased prevalence of aspiration pneumonitis. The decision to insert PEG was made on clinical grounds and not on abnormal barium studies alone."
The actual effectiveness of Terri's swallowing, her actual ability to take in sufficient hydration and nutrition by natural means, is irrelevant to the fact that Greer had no legal standing to prohibit natural means, only "medical" or "artificial" treatment.
He had no right to prohibit food and water by natural means, since Florida law did not give him authority over spoons and ice chips, only over tubes and medications.
He broke Florida law and should be prosecuted and tried for breaking that law.
The fact that an article mentions stroke (others mention cancer) and that Terri's diagnosis was "PVS" is not relevant.
As a matter of fact, the cardiac arrest caused a stroke - which is a general term for an event of temporary or permanent impairment of the blood flow in the brain, which can be due to cessation of total body blood circulation, local blood vessel spasm, trauma or other structural damage, bleeding, clotting, or mass effect.
The stroke led to the altered state of consciousness. One diagnosis within the spectrum of altered consciousness is the PVS.
I've never seen documentation that Terri had even one episode of aspiration pneumonitis. Have you any such reference?
The meaning of the study which you quote is points out that the rate or actual use of the PEG tube is not related to the findings of swallowing studies, but, rather "clinical" evidence.
He had the authority to reject an "experimental therapeutic procedure", which is how the oral hydration and nutrition motion read.
Oh, you weren't aware of that? You didn't know about that motion? You haven't seen those documents? You were unaware of the controversy?
Of course you knew. But that doesn't stop you from acting ignorant and posting that "Judge Greer had no authority and should be prosecuted", does it?
Do you see what I mean about the lies and distortions by your side?
"The situation with (Monsignor Thaddeus) Malanowski developed last summer (2002), when Terri began coughing up blood and appeared to have aspiration pneumonia."
"He told WorldNetDaily he saw her Saturday to administer the Sacraments and was impressed with the way she had recovered from her mid-August illness and a bout with pneumonia and sepsis over the Labor Day Weekend."
-- worldnetdaily.com/news/article.asp?ARTICLE_ID=35006
We have discussed the motion in question. http://abstractappeal.com/schiavo/trialctorder030805.pdf
and,
http://www.freerepublic.com/focus/f-chat/1387447/posts?page=456#456
Posted by hocndoc to robertpaulsen
On General/Chat 04/22/2005 3:41:15 AM CDT · 456 of 512
""The Order says explicitly that the hearing on March 7th concerned an "Emergency Expedited Motion for Permission to Provide Theresa Schiavo with Food and Water by Natural Means after the assisted nutrition and hydration are discontinued..." ""
In fact, I have read the Petition:
http://www.terrisfight.org/documents/022805EmMotionNaturalFeeding.pdf
And it notes that Terri swallowed water when her teeth were brushed.
Greer stated that "it has become clear.." He did not state that the petition was for an experiment, but rather that the arguments were "part and parcel," and that it "appears" that they are the same.
He forbade natural means of oral hydration and nutrition after the assisted methods were discontinued, ignoring that the circumstances had changed and that the March 2005 petition was not asking for swallowing tests. I sincerely hope that there is an enterprising and just DA or Attorney General who will allow a jury to decide whether or not Greer broke the law of Florida.
Thank you, I knew there was one episode of pneumonia, but had not seen any opinion that the cause was aspiration pneumonitis.
Amazing that there was only one and that she recovered, since bed bound patients often have reflux of stomach contents, as well as the risk of choking on oral secretions and the germs are much more virulent. In a patient with less cognitive function, it would also be expected that there would be less coughing.
filled with emotion-based propaganda, distortions of the truth, outright lies and name-calling
Yea, those pro-deather's were a pain weren't they?
Correct
Most of those excessively mean people, I believe, are people who have no control in their jobs and are probably dumped on all day in their real life, and they save all that bile and throw it on people online, behind the warm comfort of their perceived anonymity. I used to post to a local board, and after putting two and two together I figured out that the bully of the forum was a co-worker I knew who was a meek milquetoast at the company.
For the rest, it seems their real selves take over hidden behind their screen name personnas, the selves they don't dare show in real life. More than once, my primal urge has been to repay in kind; only once I got so mad at a poster on another forum that I called her the b-word and later apologized with the caveat that it was only partially sincere.
There are at least two people on this forum I wish would be banned, but I've banished myself instead, but not because of them. And they are not the ones who hurt me. I can't remember their screen names even because I guess I don't want to remember, but I remember the hurt.
Now I've broken my self-imposed taboo, but will try to stay in lurk mode and wean myself away from here. I'll work on my hobbies instead.
I'm pretty much a shut-in now, but I once had a real life and know what it is like to work with a bunch of people. I always tried really hard to get along with everyone, used to be very friendly, cheerful, helpful, self-effacing and outgoing, but there were some real rotten apples in my life. I am no longer the person I once was and doubt I can ever be again in this life.
I've been treated like s*** a lot in and out of the workplace, and I've tried very hard never to take it out on other people.
People in my world until the last 20 years or so generally didn't behave like what we are seeing now, and I don't know how to deal with it. And I'm not a pansy either. One time some big minority guy got mad at me because I was ahead of him in line and was writing a check. I can't remember what I said to him, it wasn't swearing or anything, but I didn't just lie down and take it. I was later warned that I could be shot for doing whatever I did. And the h*** of it is more than once I've let a minority ahead of me in line when I have a full cart and they don't have as much or have crabby kids, etc.
The bottom line is that I can feel as mean as anybody else, but I was just not brought up to behave the way some people do.
There are a few nice people here, but the other ones just get too nasty on a regular basis.
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