Family wants to keep life support for girl brain dead after tonsil surgery #1

[otto]

If it was just bedwetting-
Anit diuretic hormones are released during sleep that concentates the urine and allows us to stay asleep, not waking to urinate every few hours. If her sleep apnea didn't allow proper sleep cycles the hormaone might not have been being released.
If it was daytime uncontrolled urination I have no idea!
Moo

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Bed wetting? Sorry, I missed that. That's different. That could be psychological.

 

[Donjeta]

She couldn't concentrate, so her sleep cycle was examined. The sleep cycle appeared to be interrupted because of sleep apnea. Sleep apnea was caused by poor lung health and obesity. So, in order to improve her concentration, she should sleep better and this could be achieved (with known risks) through surgery. How was her weight going to be managed?

How would any of this repair uncontrolled urination?

Sleep apnea may contribute to weight gain and also to bed wetting.

 

[MLO]

I'm tempted to ask what her apgar score was. I know that a tonsillectomy was supposed to cure the common cold in the 1960s (sort of like treating a virus with penicillin), but how was any of the surgery going to cure the short attention span ... or is this one of the medical conditions prior to surgery.

I have no problem seeing the removal of tonsils as helping attention span (to a degree). My 5 year old (at the time) was snoring (enough to hear him from the other side of the house), he'd stop breathing and be drenched in sweat every night (and I mean soaked through). He was constantly tired and a tiny bit of a pain in the butt at home and at school. He was a different boy after having his tonsils out. He didn't have it done for infections though, he's had tonsillitis probably twice in his life (so nearly 7 years now).

The uncontrolled urination, that I'm confused about. If it were only at night time I could see it- hormones and a disrupted sleep cycle etc., but uncontrolled urination make it sound like it was also a daytime thing.

 

[gngr~snap]

Bed wetting? Sorry, I missed that. That's different. That could be psychological.

Right! I read uncontrolled urination. I do not know what they meant by that.
Was it in general? Was it only at night?
It is not clear IMO
http://www.cnn.com/2013/12/17/health/california-girl-brain-dead/
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[wendiesan]

snipped for focus
Is no one listening to the grandmother? Did she have experience in ICU such that she knew how to suction a patient with her granddaughter's condition? I don't really understand what the grandmother was doing in ICU, and I'm a little surprised that more than one family member would be allowed in ICU. When my son was in ICU, it was a very quiet recovery area for a couple of days with at most one family member. Once a patient was active enough to visit with family, he or she was moved to a unit bed. Is the religious or legal advisor having more influence over the mother than the grandmother (the nurse)?

IIRC, Mrs. Winkfield's father is a pastor, so he could have a strong influence as both a parental and a religious authority. I'll try to track this information down tomorrow if no one else posts something in the meantime.
So far I have no information on Sandra Chatham's nursing specialization. I think that it would be very difficult to be in a situation of treating your grandhild and trying to separate your professional persona from your vibrant role as a grandparent. Perhaps a reason that doctors, nurses, et al do not work in a professional capacity with their families. JMO, but I would guess it's easier for people not related to a patient to maintain a professional detachment and objectivity during whatever procedures are required for the treatment of that patient. However, I can see why Ms. Chatham would be there as an extra pair of eyes to watch over Jahi, and as a loving pair of arms to comfort and soothe her grandchild and support her daughter.

According to the Visitor's Information Sheet for Childrens' Hospital Oakland, parents may visit any time but only one parent at a time can stay overnight with their child, and a limit of four visitors per room is in place. The sheet notes that special guidelines for the Intensive Care Nursery, the Intensive Care Unit, and the Immunocompromised Unit are posted in those areas.
http://www.childrenshospitaloakland.org/main/visitor-info.aspx
The hospital allowed 4 of the family to stay overnight and made other exceptions to the rules in order to help the family spend time with Jahi.

 

[otto]

Sleep apnea may contribute to weight gain and also to bed wetting.

Obesity can lead to sleep apnea. Bed wetting can be seen in healthy children until the age of 5 or 6. Some children fall into such a deep sleep that they do not wake up to go to the bathroom, but they are not necessarily obese.

Children that do not wake up to go to the bathroom can be very active, healthy children. Sleep apnea is not a cause of obesity, as far as I know. I haven't really seen any correlation between the two.

Does sleep apnea cause bedwetting in adults?
Is weight gain a result of sleep apnea, or is it the other way around?

 

[gngr~snap]

Obesity can lead to sleep apnea. Bed wetting can be seen in healthy children until the age of 5 or 6. Some children fall into such a deep sleep that they do not wake up to go to the bathroom, but they are not necessarily obese.

Children that do not wake up to go to the bathroom can be very active, healthy children. Sleep apnea is not a cause of obesity, as far as I know. I haven't really seen any correlation between the two.

Does sleep apnea cause bedwetting in adults?
Is weight gain a result of sleep apnea, or is it the other way around?

http://www.nafc.org/bladder-bowel-health/bedwetting-2/adult-bedwetting/
It can cause bedwetting in adults.
I think the sleep apnea causing obesity issue is hypothesized but there isn't a solid consensus.
I found arguements that both support and deny it.
Moo


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[otto]

IIRC, Mrs. Winkfield's father is a pastor, so he could have a strong influence as both a parental and a religious authority. I'll try to track this information down tomorrow if no one else posts something in the meantime.
So far I have no information on Sandra Chatham's nursing specialization. I think that it would be very difficult to be in a situation of treating your grandhild and trying to separate your professional persona from your vibrant role as a grandparent. Perhaps a reason that doctors, nurses, et al do not work in a professional capacity with their families. JMO, but I would guess it's easier for people not related to a patient to maintain a professional detachment and objectivity during whatever procedures are required for the treatment of that patient. However, I can see why Ms. Chatham would be there as an extra pair of eyes to watch over Jahi, and as a loving pair of arms to comfort and soothe her grandchild and support her daughter.

According to the Visitor's Information Sheet for Childrens' Hospital Oakland, parents may visit any time but only one parent at a time can stay overnight with their child, and a limit of four visitors per room is in place. The sheet notes that special guidelines for the Intensive Care Nursery, the Intensive Care Unit, and the Immunocompromised Unit are posted in those areas.
http://www.childrenshospitaloakland.org/main/visitor-info.aspx
The hospital allowed 4 of the family to stay overnight and made other exceptions to the rules in order to help the family spend time with Jahi.

If my son was in intensive care and in the bed next to us there was a deceased person with a party of four, I would have complained loud and clear. There is no way that I would have let that slide. Congratulations to the families that had children in ICU between December 9 and December 30. That must have been quite a concern for parents of children recovering in intensive care during the last three weeks.

Viruses are a serious concern in ICU ... hopefully the extended family of the deceased patient were healthy (H1N1 is going around again). I'm surprised that ICU would accommodate a family for three weeks.

 

[gngr~snap]

If my son was in intensive care and in the bed next to us there was a deceased person with a party of four, I would have complained loud and clear. There is no way that I would have let that slide. Congratulations to the families that had children in ICU between December 9 and December 30. That must have been quite a concern for parents of children recovering in intensive care during the last three weeks.

All the ICU's I have been in were private rooms, so to speak.
Thankfully I have never been in a Children's ICU so I don't know how they are set up.
My daughter was in the NICU (neonatal ICU) for two months. At the time it was more like a newborn nursery, but I think that has changed since my baby was born 22 years ago.
Moo

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[otto]

http://www.nafc.org/bladder-bowel-health/bedwetting-2/adult-bedwetting/
It can cause bedwetting in adults.
I think the sleep apnea causing obesity issue is hypothesized but there isn't a solid consensus.
I found arguements that both support and deny it.
Moo


Sent from my SGH-T679 using Tapatalk 2

Obesity causes bed wetting adults, or sleep apnea that causes bed wetting in children translates to snoring, bed wetting adults?

 

[SophieRose]

All the ICU's I have been in were private rooms, so to speak.
Thankfully I have never been in a Children's ICU so I don't know how they are set up.
My daughter was in the NICU (neonatal ICU) for two months. At the time it was more like a newborn nursery, but I think that has changed since my baby was born 22 years ago.
Moo

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On Yelp, someone posted back in June 2009 that they would give CHO five stars, except that ICU is just one big room with patients separated by curtains. The poster did say that she was able to get a semi-private room with actual walls, but with a curtain door. I wonder if it's changed any since 2009. There are also two ICU floors so they could differ.

 

[Donjeta]

Obesity can lead to sleep apnea. Bed wetting can be seen in healthy children until the age of 5 or 6. Some children fall into such a deep sleep that they do not wake up to go to the bathroom, but they are not necessarily obese.

Children that do not wake up to go to the bathroom can be very active, healthy children. Sleep apnea is not a cause of obesity, as far as I know. I haven't really seen any correlation between the two.

Does sleep apnea cause bedwetting in adults?
Is weight gain a result of sleep apnea, or is it the other way around?

Perhaps it might be a bit of both. Obesity is a risk factor for sleep apnea but there is some research that says that loss of sleep is a risk factor for metabolic and hormonal changes that predispose to obesity.
http://www.ncbi.nlm.nih.gov/pubmed/21659802

 

[otto]

All the ICU's I have been in were private rooms, so to speak.
Thankfully I have never been in a Children's ICU so I don't know how they are set up.
My daughter was in the NICU (neonatal ICU) for two months. At the time it was more like a newborn nursery, but I think that has changed since my baby was born 22 years ago.
Moo

My son had brain surgery when he was 5 years old. He's now 18 years old, so it was a long time ago. I still remember it like it was yesterday because it was really scary. After signing the papers accepting the risk of death, I was preparing myself for the worst, and hoping for the best. I was prepared for all possible outcomes. That's what it means when someone signs a consent form at the hospital prior to surgery. Patients need to arrive early for surgery and read the documents prior to signing them. They should ask questions if they are uncertain of what it means that "death" is a risk.

The intensive care unit that my son was in was a 6-8 bed unit. There were a couple of private rooms where several doctors were present while a 14 year old youth coughed and puked for a couple of days. He probably had cystic fibrosis. It was awful to listen to. The rest of the unit was a central nursing station with about 4-6 beds, but it wasn't busy when we were there ... except for the 14 year old boy puking his lungs out. The sounds in the hospital seem worse than the sights.

 

[otto]

Perhaps it might be a bit of both. Obesity is a risk factor for sleep apnea but there is some research that says that loss of sleep is a risk factor for metabolic and hormonal changes that predispose to obesity.
http://www.ncbi.nlm.nih.gov/pubmed/21659802

Sleep apnea strikes me as more of a neurotic, hyperactivity issue, not an obesity issue. People that I know that don't sleep enough tend to be more lean than obese. That is, they're waking up through the night, clearly they can go to the bathroom rather than pee the bed, and they're not sitting around licking the bottom of the peanut butter jar.

Obese people, on the other hand, are stationary and as a result, they may develop breathing difficulties and sleep disorders, like sleep apnea. When it comes to chicken and egg, in this situation I would say chicken ... obesity caused sleep disorders. That may have resulted in learning disabilities ("short attention span"), but it doesn't explain the uncontrolled urination. Given the uncontrolled urination, I would speculate that there is a congenital problem.

An adult that wakes up through the night due to sleep apnea is not going to wet the bed ... unless obesity prevents it. Why wouldn't a 13 year old girl that wakes up in the night due to sleep apnea pee in the toilet?

 

[MLO]

My son had brain surgery when he was 5 years old. He's now 18 years old, so it was a long time ago. I still remember it like it was yesterday because it was really scary. After signing the papers accepting the risk of death, I was preparing myself for the worst, and hoping for the best. I was prepared for all possible outcomes. That's what it means when someone signs a consent form at the hospital prior to surgery. Patients need to arrive early for surgery and read the documents prior to signing them. They should ask questions if they are uncertain of what it means that "death" is a risk.

The intensive care unit that my son was in was a 6-8 bed unit. There were a couple of private rooms where several doctors were present while a 14 year old youth coughed and puked for a couple of days. He probably had cystic fibrosis. It was awful to listen to. The rest of the unit was a central nursing station with about 4-6 beds, but it wasn't busy when we were there ... except for the 14 year old boy puking his lungs out. The sounds in the hospital seem worse than the sights.

Isn't it strange how you can remember experiences like that so acutely?

When my fourth child was 5 weeks old she developed meningitis. It was nearly 4 years ago but one of my sons remembers her whole hospital stay like it was yesterday. We took the baby to the hospital on my sons 3rd birthday- he remembers what the baby was wearing, the doctor, a girl on the ward he played with (her hair, her name, her condition, what she was wearing), he remembers they played with mobile and that she cried when they left. He remembers that he bought her a butterfly rattle and that at the time he felt it was incredibly important to give it to her. It all comes back to us on his birthday every year.

 

[otto]

Isn't it strange how you can remember experiences like that so acutely?

When my fourth child was 5 weeks old she developed meningitis. It was nearly 4 years ago but one of my sons remembers her whole hospital stay like it was yesterday. We took the baby to the hospital on my sons 3rd birthday- he remembers what the baby was wearing, the doctor, a girl on the ward he played with (her hair, her name, her condition, what she was wearing), he remembers they played with mobile and that she cried when they left. He remembers that he bought her a butterfly rattle and that at the time he felt it was incredibly important to give it to her. It all comes back to us on his birthday every year.

It's like a visual imprint.

Encourage him to think in pictures/
Engineering ...

 

[otto]

http://www.childrenshospitaloakland.org/main/news/223.aspx

 

[Donjeta]

Sleep apnea strikes me as more of a neurotic, hyperactivity issue, not an obesity issue. People that I know that don't sleep enough tend to be more lean than obese. That is, they're waking up through the night, clearly they can go to the bathroom rather than pee the bed, and they're not sitting around licking the bottom of the peanut butter jar.

I can't dispute your observations from the circle of your acquaintances but according to epidemiological research there is a clear correlation between not sleeping enough and obesity.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2082964/

Several large population studies have identified an important dose–response relationship between short sleep duration, excess body weight and metabolic disturbances across all age groups and in several ethnic groups

Obese people, on the other hand, are stationary and as a result, they may develop breathing difficulties and sleep disorders, like sleep apnea. When it comes to chicken and egg, in this situation I would say chicken ... obesity caused sleep disorders. That may have resulted in learning disabilities ("short attention span"), but it doesn't explain the uncontrolled urination. Given the uncontrolled urination, I would speculate that there is a congenital problem.

Without knowing her medical history we can of course speculate anything but if Jahi's doctors suggested the sleep apnea surgery as a potential help for the urination problem they must have thought that it was sleep apnea related. Anyway, there are many other reasons for incontinence that are not congenital.

An adult that wakes up through the night due to sleep apnea is not going to wet the bed ... unless obesity prevents it. Why wouldn't a 13 year old girl that wakes up in the night due to sleep apnea pee in the toilet?

Well, I'm sure they'd like to but bed wetting is a symptom of children's sleep apnea, regardless.
http://www.chop.edu/service/sleep-c...orders/childhood-obstructive-sleep-apnea.html

When people with sleep apnea wake up it doesn't mean that they're alert and active and able to function and go to the toilet etc. It has to do with the disruption of the normal sleep cycles. It may be just short episodes of wakeful EEG activity and the person goes immediately back into sleep and may not even know that he woke up but it's light and restless sleep and the apnea episodes prevent them from falling into deep sleep.

 

[Destiny617]

Sleep apnea strikes me as more of a neurotic, hyperactivity issue, not an obesity issue. People that I know that don't sleep enough tend to be more lean than obese. That is, they're waking up through the night, clearly they can go to the bathroom rather than pee the bed, and they're not sitting around licking the bottom of the peanut butter jar.

Obese people, on the other hand, are stationary and as a result, they may develop breathing difficulties and sleep disorders, like sleep apnea. When it comes to chicken and egg, in this situation I would say chicken ... obesity caused sleep disorders. That may have resulted in learning disabilities ("short attention span"), but it doesn't explain the uncontrolled urination. Given the uncontrolled urination, I would speculate that there is a congenital problem.

An adult that wakes up through the night due to sleep apnea is not going to wet the bed ... unless obesity prevents it. Why wouldn't a 13 year old girl that wakes up in the night due to sleep apnea pee in the toilet?

BBM
Actually:
"Untreated, sleep apnea can cause high blood pressure and other cardiovascular disease, memory problems, weight gain, impotence, and headaches."

Someone posted a while back that sleep apnea causes weight gain, and weight gain causes sleep apnea. It seems like an unfortunate cyclical cycle. And IMO you have to acknowledge that this is a possibility. We do not know her weight history or how long she suffered from sleep apnea symptoms. It's unfair and rude to assume she was gorging herself on "peanut butter".

Also:
"...[P]eople with untreated sleep apnea stop breathing repeatedly during their sleep, sometimes hundreds of times during the night and often for a minute or longer. In most cases the sleeper is unaware of these breath stoppages because they don't trigger a full awakening."
It's not often that people fully wake after an episode of sleep apnea. The brain doesn't always become conscious.

As for the wetting the bed... I wet the bed in my sleep until I was in high school. (For the record I was an average slim child with no apnea.) This was not hereditary or genetic, my body just never learned to wake when my bladder signaled it was full. It took me from the time I was 5-18 to 'train' my sleeping body. It happens to kids all the time. IMO maybe her body was just so tired from the constant sleep cycle interruption that she slept through the bladder signals, hence incontinence being an apnea related symptom.


Info found:
http://www.sleepapnea.org/learn/sleep-apnea.html

 

[otto]

I can't dispute your observations from the circle of your acquaintances but according to epidemiological research there is a clear correlation between not sleeping enough and obesity.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2082964/

Without knowing her medical history we can of course speculate anything but if Jahi's doctors suggested the sleep apnea surgery as a potential help for the urination problem they must have thought that it was sleep apnea related.

Well, I'm sure they'd like to but bed wetting is a symptom of children's sleep apnea, regardless.
http://www.chop.edu/service/sleep-c...orders/childhood-obstructive-sleep-apnea.html

When people with sleep apnea wake up it doesn't mean that they're alert and active and able to function and go to the toilet etc. It has to do with the sleep cycles. It may be just short episodes of wakeful EEG activity and the person goes immediately back into sleep and may not even know that he woke up but it's light and restless sleep and the apnea episodes prevent them from falling into deep sleep.

Do you know of a study that indicates sleep apnea in adults leads to obesity and bedwetting. I have never heard that before. That seems like the sort of thing that should be on mainstream TV in the US ... obesity means that you will pee the bed. That would sure help with reducing the problem

I don't think that the death of this child was a result of sleep apnea. This was an obese child that needed surgery at the age of 13 to breath properly. She had psychological, physiological, or congenital problem ... it has to be one ... because she had more than one medical problem ... can't breath, pees on the bed and has uncontrolled urination, short attention span problems, obese, wakes up during the night ... a myriad of problems.