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June 16, 2005
Terri Schindler Schiavo: Brain weight and Science 101 - Can you say fraud?
Filed in: Bioethics, Current Affairs, Politics, Science

Terri's autopsy report was issued yesterday and aspects of it were discussed at a press conference by the medical examiner.

The LSM dutifully reported the findings.

Thogmartin1 The St. Peterburg Times in Tampa Bay Florida today laud the 'voice of science' that brings the unhappy matter to an end. Referring to Pinellas-Pasco ME Thogmartin, the Times writes :

His words, and the way he delivered them, stood in stark contrast to the insistent, even shrill voices heard during Schiavo's last days. Where Schiavo's advocates on both sides had appealed to emotion, Thogmartin called for reason. Where they cried and prayed, he explained.

Please, his words implored, listen. There are things that science can reveal and things that are unknowable. There is nothing left to uncover, no tissue left to dissect, nothing more to fight over.

One of the centerpieces of the autopsy report is from the part that was produced by Dr. Stephen Nelson - in his capacity as Neuropathologist:

Schiavoautopsybrainweightcomment

Around the world, this 'half brain weight' story is repeated over and over again like some mantra that proves a point.

It really doesn't seem that anyone wants to subject this particular lynchpin to any critical thinking. Shall we?

What is the brain composed of?

Braincomposition

That's 77-78% water. Other references say up to 85% of the brain is composed of water.

The same autopsy that concluded that Terri died from dehydration (and specifically not from starvation) noted her weight in preparation for the autopsy:

Schiavoautopsybodyweight

Terri Schiavo had experienced massive weight loss during the 13 days that she was deprived of her feeding tube.

I can't find a reference to her weight prior to the tube being removed - but from pictures I would venture that she weighed somewhere between 155 and 175 pounds.

There are, fortunately, limited scientific studies on the weight loss effects of forced dehydration. But we have a contemporary example that demonstrates the massive weight loss involved.

You may remember the story of uber-hiker Aron Ralston, who in a 2003 freak hiking accident, had an 800-1,000 pound boulder pin his arm to a canyon wall inside of a crevice. To survive, Ralston eventually amputated his own arm. In his book Between A Rock And A Hard Place, Ralston says this in the epilogue:

Ralstonweightloss

Ralston lost 40 of his 165 lean, conditioned pounds in six days - during which time he consumed a little water and resorted to drinking his own urine to survive.

How much weight did Terri Schiavo lose in 13 days?

It's certainly difficult to make an exact determination, but she clearly would have lost at least, and probably more than one-third of her body weight. It is not unreasonable to conclude that her brain tissue lost the same or even more percentage of weight as well.

Which brings us to the 'atrophied brain'. Here we are in the middle of a detailed autopsy report addendum and the Neuropathologist determines to make a comment that amounts to advocacy rather than reporting medical findings. He focuses on Terri's brain weight as the significant pathology and then makes a comparison to Karen Ann Quinlan's brain.

I'm old enough to remember the controversy over Ms. Quinlan when her parents were allowed to unplug her respirator - and she shocked everyone by breathing on her own. No one in the 1970s could conceive of the barbarism of pulling Ms. Quinlan's feeding tube so she lived on it until she died of pneumonia nine years later. When Ms. Quinlan died she was at least reasonably hydrated.

We can be certain that doctor Nelson is aware of these facts.

What am I saying? Am I saying that Terri Schiavo didn't have brain damage? No, not saying that. It was obvious. Am I saying that there's no medical truth in the autopsy? Nope. Not saying that either.

What I am saying is that the discussion of pathology of Terri's brain due to brain weight is medical fraud - prior to the removal of the feeding tube Terri's brain weight would have been at least 922 grams and could have easily been over 1,000 grams. These doctors know this. Her significantly reduced brain weight was due to the dehydration and starvation that was imposed on her.

It is telling that there is such an effort at the ME's office that performed this autopsy. Why the need by those pledged to 'first do no harm' to introduce advocacy in a scientific document which should be free of ideology? Why tell such a significant lie?

UPDATE: A reader wants to know if all brains aren't dried out in an autopsy so there's a standard of moisture content. Nope. It is quite rare to autopsy a dehydrated subject so there's been no need to establish some water content protocol (I would think that it's safe to say that any other autopsy that has ever been performed on someone as dehydrated as Terri Schiavo was would result in a criminal investigation). Here's a good (safe to look - just cartoons) description of the process of autopsy.

UPDATE 2: At Sue Bob's Diary, Jerri Lynn has a great series of posts - asking great questions about the details of the autopsy report - and asking the 'dehydration' question before I did. The first post is here. In the post that is tracked to this one she asks:

What is more important, brain weight or brain architecture?

That's a great question.

Jerri Lynn also references an article in the medical literature: Dehydration confounds the assessment of brain atrophy. (Full article requires a paid subscription).

Taking that lead, I've also found: Fluid intake affects brain volume: a possible confounder in the assessment of brain atrophy, Magnetic Resonance Imaging of the Brain in Diabetes (look for 'dehydration' in the article - a reason for brain atrophy), and Biomarkers and Surrogate Outcomes in Neurodegenerative Disease: Lessons from Multiple Sclerosis (look for 'dehydration' again in the article - impact on brain volume).

Thanks for the link Michelle!



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» What Do You Have To Say Now? from Bring It On!
So after two months of waiting the autopsy results that the religious right said would never come out, are out. The verdict simplified; Terri Schiavo's condition was irreversible, if the righties would have had their way she would have been laying in... [Read More]

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» The head shrinkers from Editors in Pajamas
Hmm... told you so. (That's not very sport of you.-Ed Your point?) [Read More]

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» Terri Schiavo's Autopsy--The Spin and The Meaning- from Sue Bob's Diary
I want to sum up some of the questions that I believe should be asked based on the topics I have discussed here, here, here and here. 1. With regard to the extent of the brain damage: a. Two parts of the brain appear to be important here, the c... [Read More]

TrackPulled on Jun 16, 2005 5:50:21 PM

» THE SCHIAVO AUTOPSY: A SOBER LOOK from Michelle Malkin
Late last night, I took the time to read the 39-page autopsy report of Terri Schiavo--something which, it is clear to me, most of the callous gloaters on the other side of this debate have not bothered to do. And... [Read More]

TrackPulled on Jun 16, 2005 8:48:20 PM

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Just a question, but how are brains weighed. I would think that scientists/pathologiists would account for water loss in their calculations.
By this, I mean - and my question is - why aren't brains weighed after a dehydration process (meaning all brains being weighed after water is removed)?

I'm just asking if you are scientifically correct in your assertion. You are if all brains are simply removed and weighed right there at the table. You are not if there is a drying process or if they simply remove from the calculation an anticipated amount of water.

If for example, they statistically removed a standard weight, to account for the amount of water for a person of her size and weight, it is possible that her actual brain size could be either more or less than reported.

Again, you may be correct, but there may also be some procedure that you are not aware of that accounts for water weight. Moreover, even if there is not, it is hardly a "lie" to report the actual brain weight. Although it may constitute poor reasoning to fail to factor in dehydration.

EMCEE: Brains are typically weighed on a grocer's scale along with the other major organs during the autopsy. No 'drying' process is used - it is quite rare to autopsy a person that has been fully dehydrated so there has been no need to develop some kind of standardized fluid measurement baseline. Brains are often immersed in a fluid called a fixative for subsequent study - which, given the details of the Schiavo autopsy was done. Sorry - but it is a lie for them to use Terri's brain weight as the most significant sign of pathology.

Posted by: Kid Handsom at Jun 16, 2005 1:07:05 PM

Come on folks......the rationalizations and generalizations here are BAD!

The brain, when atrophied, as was Terri's, finds a replacement in the area of atrophication...the replacement is LIQUID.

Brains are NOT fat!

When dehydration occurs, the loss will be to the fluids in the atrophied areas of the brain....not to the brain itself.

I knew when the "nit-pickers" heard the logical report from the Medical Examiner they would go "tinhat"....and they have.

The smallest phrase, nuance of wording, etc. is subject to rehash, and the "scientific analysis" of people who have NO possible contact with, nor access to the actual records.

Get a grip folks. The woman was alive only in terms of breathing. She could not take sustance, nor think, see, hear, feel, etc.

Let the poor woman's history reflect caring by many, but a loss-of-life circa 1990!

Duke

EMCEE: Of course, I knew making such a post would bring out the wingnuts. If you are talking about the hydrocephalus in vacuo cerebrospinal fluid, that was removed because it was external to the brain when the skull was opened. Did you read the autopsy? The autopsy says, for example, that the tongue was atrophied. It describes other tissues as being dry. Why do you think that was? This is where you say "Hey, all the other tissues dried out because of dehydration - but the brain. Nope! Didn't happen."

Posted by: Duke of DeLand at Jun 16, 2005 1:34:59 PM

Far be it from me to argue here, but is it likely then that Ralston lost a significant % of his brain weight during his six days also?

I'm not inclined at this point to argue with the coroners about what her brain weight was at any stage and what that might mean. Fact is, all other evidence showed she was not brain-dead, vegetative or anything else. What they are doing is like arguing that that based on chemical analysis the sky is really red despite the fact that we're all looking up and seeing that it's blue.

EMCEE: Hi Jeff - I would say that he (Ralston) did lose a significant percentage of his brain weight during his ordeal. I've read his book and his symptoms included blurred vision, difficulties remaining conscious, horrible bouts of thirst, headache and the like. I know you well enough to know that you've never experienced a hangover - but you've heard people, no doubt, down at the Canyons talk about it - that horrible headache is due to the fact that the brain gives up some of its water to flush out alchohol (and other toxins) - it's pretty much the only organ that does that. In a situation where the liver and kidneys are fighting to keep toxicity down (which would be the case for both Ralston and Terri) it's the brain that loses water.

Re 'chemical analysis': We're certainly on the same page on that.

Posted by: Jeff at Jun 16, 2005 1:57:07 PM

Mac,

Thought I'd pass on a little personal and still upsetting information on the science ( or lack of science) of the brain's function. My son, Patrick, was born with a heart defect. Tetrology of Falot to be specific. At six weeks he suffered complete heart failure. He was revived at the hospital, but the damage had been done. He suffered severe brain injury.

He grew older and it became obvious there was something wrong, physically and developmentally. Soon, he began to experience siezures. They became uncontrollable and occurred many times a day. Strong medications were perscribed to no avail. In short, his life was terrible.

My wife and I were told by the "All Knowing" Medical Community that his life would never be normal and he should be institutionalized until he died. Much like the Schindlers, we choose to look for another opinion. We found one. It was in the form of a neurologist at Milwaukee Children's Hospital. After examing Pat, he told us there was nothing he could do. But, he had heard of a radical new treatment being performed at Mayo Clinic. It might work, he told us.

We went and a after a multitude of tests, we were told Patrick was a candidate for the surgery. It was then that a hemospherectomy was performed. Yes, they removed the entire left hemosphere of Patrick's brain. He survived and almost imediately his siezures stopped. What was more amazing was he started to talk. As the pain from surgery subsided, he began to laugh and play. Things he had not done much of for years.

Over the years Pat became a happy, verbal, independent person. He always had the simple honesty of a child. I think that was what made him so well liked by everyone he met. How could that be? He only had the right hemosphere of his brain (Yes, that is only 1/2 of his brain for all you scientific geniuses)and he was performing functions attributed to the left hemosphere. As the Drs. at Mayo explained it, the brain is a powerful and versitile organ. Although it cannot be regenerated it can adapt. In Patrick's case functions he should not have been able to perform had been adapted to his remaining lobe.

Conclusion, just because one area of the brain is non-functional doesn't mean another area can't pick up that function. Had proper exams been made on Terry Shiavo when she was alive, they might just have found out that other parts of her brain had indeed taken over the function of parts that had been damaged.

Patrick died on October 5, 2002. The original heart problem finally caught up with him. The doctors at Mayo who wouldn't listen to conventional wisdom gave us the happiest years of our lives. Patrick was a true blessing.

Ron_L

EMCEE: Ron, I know that this is a deeply personal story that you've shared with us. I want to thank you from the bottom of my heart for being willing to. It's a great tribute to you and your wife that you kept looking for answers - and it's a great tribute to the indomitable spirit of dear Patrick who blessed your lives - and now has blessed all of us who know about him and how much you love him.

Posted by: Ron LaCanne at Jun 16, 2005 8:45:19 PM

Thanks for the answer. I'm just clarifying here, I was not suggesting that it was the correct choice to let her die of dehydration. I just thought that scientists would have accounted for weight loss due to dehydration.

I was just questioning the science behind the autopsy, not the morality of it, and I appreciate your answer. By my "it's not a lie" comment, I meant that to me it seemed to be a factual statement in its most literal sense (prove - disprove). I guess I was suggesting that the autopsy physician was not making a political statement - all the erroneous political statements had been made.

My only problem from a conservative standpoint was Congressional involvement. I thought Florida made the wrong choice, but I thought Congress had no grounds to get involved - it seemed like a liberal move to me. The wrong action - even if for the right reason - is not necessarily good for the country. It is scenarios such as these that make politics much more difficult in practice than in theory (to me).

I, again, appreciate your analysis and your answer. I don't believe, as many have said (but not you) that Michael Schiavo was responsible for her condition (ie. the arguable state of PVS) and I wish conservatives would attack the position and not the person (again, I know you did not do that, it is just a general observation).

EMCEE: Kid, I appreciate your thoughts. I don't really want to rehash how we got here... I just remain disturbed about the autopsy. They were wrong: It wasn't "70-90 percent of her brain was gone." It was "70-90 percent of her brain was there." The lie I'm referring to isn't about whether the political statements had been made - the lie is that the key issue in the pathology of Terri's brain was its weight. The issue is that her brain structures (architecture) were primarily intact and the weight of her brain was impacted by the process that killed her.

Posted by: Kid Handsome at Jun 16, 2005 9:04:47 PM

For most issues, I agree with and support neoconserviative positions... And even if I didn't, the sheer hysteria of the people democrats closely associate with turns me off.

Which is why I hate life-related issues. Because people who usually talk sense magically turn into a bunch of frickin hysterical, gibbering, luddite democrat-lookalikes. Its like watching Lassie turn into Cujo.

The autopsy report challenges conservatives' preconcieved notions with hard science. It is not the prove-all pancea that Kos likes to think it is, but the reaction to is just plain unacceptable.

All this word-parsing... but severe, irreversable brain damage doesn't mean she meets the Webster.com defintion of PVS!! and seeking out of nitpicks Well, she may have been blind, but the coronor didn't say exactly what day it happened - show me that no one is interested in learning from this... they are simply twisting themselves into pretzels justifying positions they had before the report.

Which, I admit, is exactly what the 'other side' would have done if the report had shown data supporting, rather than mostly disproving, the family's claims.

My mistake was to expect better of you than of them.

Let me end with this note: The doctor said that Terri's brain was, and I quote, "half of the expected weight" (emphasis mine). Not half of a normal brain's weight after death, half the expected weight. What, your position is that the coroner was incompetant and didn't know how much weight to expect after being starved?

All you 'the dehydration did it!' luddite nutcases sould be beaten with sticks every time you open your fool mouths, and the people right next to you in the stocks are Michael Moore, the head of Amnesty Int'l, Nancy Pelosi, and Al Sharpton. You all have an equal grasp of reality.

EMCEE: Well, after that explication, I'm supposing that you'll need to join E. J. Dionne on the respirator. I would deign to engage with you should you have demonstrated that you can perform simple division. I have a link in this post to a 'brain facts' site that clearly defines what 'normal' brain weight is. Please pass third grade math before freely displaying your ignorance. In the meantime, I think I hear your mommy calling you.

Posted by: Ryan Waxx at Jun 18, 2005 11:33:06 AM

What happened to the cerebral cortex? Didn't the proponents of Ms Schindler's death say that she didn't have one? That it was only spinal fluid? No one has yet to address this anywhere.

EMCEE: Hi Jay - Look at my bioethics category - there are a few other posts that are follow up to this one - see the links to Sue Bob's site and Dr. Sherry Eros' site.

Posted by: Jay at Jul 5, 2005 5:18:48 PM

This is not about brain weight, but about brain size. They keep referring to her brain being 1/2 the size of a person HER AGE. Yet all of our brains shrink as we grow older. I read that her brain was about the size of a 75-year-old, though I have no clue if that's true or not. However, I do know that my mother had a CT Scan a couple of years ago after a stroke, and her brain shows some pretty good shrinkage...but she's extremely bright. Everything still connects! I've also heard of folks with severe epilepsy where they remove half the brain, and these folks function fine. As you stated, she was obviously severely brain damaged, but I think they overdid on the conclusions they drew from brain weight and size.

Posted by: Janet at Jul 13, 2005 7:08:44 AM

For me ,after doing in hospital care for many years .I prayed that Terry could leave this world .Her brain size reflects to me the extent of her activity- plus the cortex . Why do we feel under any cicumstance we must keep people alive ? Doesnt it violate the paradise that they say is waiting ? How could her life here be better with the brain she had than her ife after death ?I see her ex as a hero .Sorry if that offends anyone ,but go take care of someone just like her for awhile .She had no idea what was going on around her .She was living as means to punish her ex and to make her family feel better .but what was it like for her ?

Posted by: ellen crockett at Aug 26, 2006 5:05:51 PM

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