Wednesday, March 23, 2005

The Differences Between Terri Schiavo and Kate Adamson

I was watching FOX News last night and saw an interview of Kate Adamson. Adamson was a healthy, vital woman until age 33 when she suffered a "double brainstem stroke". I'm not exactly sure what that means but a google search using that term only brought up references to her.

On FOX, she made an impassioned plea for sparring Terri Schiavo's life stating that during her own ordeal, she had been much worse off than Schiavo. The text flashing on the bottom of the screen stated that she had recovered from being in a persistent vegetative state (PVS).

However, Adamson described herself as having been completely paralyzed and ventilator-dependent yet entirely aware of her environment. As anyone who has read my article on the definition of PVS would know, she most assuredly did not meet the criteria for this condition. That being the case, her prognosis was far different than Schiavo's.

Adamson's condition appears to be what physicians refer to as a "locked-in" state. The precipitating event was probably a pontine stroke. This is a stroke effecting a primitive but vital area of the brain that transmits impulses from the cerebral cortex to the rest of the body to initiate movement.

Such patients often have an utter lack of any volitional movement (muscle reflexes are generally possible). Ponder that. No speech, no writing, no communication. Yet they can see, hear, feel, taste, smell and most notably think. Hence the term locked-in. (Occasionally, they can move their eyelids and thereby communicate. In those situations, they are not completely locked in.)

These patients are literally prisoners within their own bodies.

Adamson relates her experience to that of Schiavo's. At one point, her tube feedings were apparently stopped and she discussed how torturous her impending starvation and dehydration was. She stated unequivocally that Schiavo is now experiencing the same thing since her tube feedings were stopped.

Emotional yes, but not comparable...and not true. Adamson's experience is very different. If Schiavo's diagnosis is correct, and there is extraordinary evidence to suggest that it is, then she is not a sentient being. She has no sense of awareness, no consciousness. She may undergo sleep-wake cycles yet rather than rule out PVS, this is actually a criteria for PVS. She may occasionally display outward signs of emotionality and smile, frown, grimace, etc. She may be able to inconsistently track objects with her eyes. However, as my article states, all evidence suggests that she does these things randomly and inconsistently. Unfortunately, such behavior does not imply cognitive function i.e. awareness and is fully compatible with the diagnosis of PVS.

In short, there is no comparison between Schiavo's condition and that of Adamson's. On the surface, Adamson's prognosis might have appeared far worse in that Schiavo is not ventilator dependent and has rudimentary motor functioning. The reality is, however, that Adamson had a functioning cerebral cortex. Schiavo does not. This makes all the difference. Adamson's condition was reversible. Schiavo's is not. Recovery in adults with nontraumatic causes of PVS is infinitesimally rare after one year let alone fifteen.

I find it disappointing that in reporting this story, FOX failed to inform its viewers of this critical distinction. This is typical of the stunning misinformation about this case now propagating throughout the media.

Again, I would urge anyone truly interested in understanding the nature of PVS and the gravity of Schiavo's state to read my article.

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Blogger Kat said...

Dear Doc,

I found a doc that might disagree with you in the blog world.

Just thought I'd hook you two up.

March 25, 2005 2:11 AM  
Anonymous Anonymous said...

I was grateful to see your post citing the differences between these two cases. there has been quite a bit of press on Kate Adamson these last weeks and a google search of her name is chock full of her appearances on talk shows, booking information for public appearances for her, etc. Most of the stories about her seem to very specifically leave out any info on the length of her coma. She began to wake and make attempts at communication
within three months., Terry Schiavo has been in a PVS for 15 years. Kate Adamson did not have a CAT scan that revealed the absence of a cerebral cortex, in essence disintegration of the parts of the brain that control thought and cognition and communication. I think Kate Adamson is admirable in her tenacious and courageous recovery and she is certainly a role model for persons recovering from stroke but she was not in a PVS like Terri Schiavo and she knows enough about stroke and brain injury to know the difference.

March 30, 2005 1:23 PM  
Blogger The Medicine Man said...

Thank you Anon, I agree with everything you said. And as for this:

"she was not in a PVS like Terri Schiavo and she knows enough about stroke and brain injury to know the difference."

I was trying to be kind and not say anything!


March 30, 2005 8:54 PM  
Anonymous Anonymous said...

Thank you for your site. I would like people to realize that Kate Adamsons tube feedings were held for a gastrointestinal medical problem and that she was not being "starved". She was being hydrated. It was medically necessary to hold her tube feedings. She used a communication board in the ICU unit to write messages and plans were made for aggressive rehab while in the ICU unit. She was never in a persistent vegetative state.

April 13, 2005 3:31 AM  

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