Family wants to keep life support for girl brain dead after tonsil surgery #8

[CHERIE.T]

In the court declaration filed by Flori, she said any measures to help Jahi will only slow post-mortem deterioration. Jahi's body is also unable to regulate her temperature and "blankets are needed to maintain a temperature of greater than 35 degrees Celsius (95 degrees Fahrenheit)."

http://www.latimes.com/local/lanow/la-me-ln-jahi-mcmath-body-deteriorating-20140108,0,4831276.story

bbm

Bumping up

From above:

BLANKETS ARE NEEDED TO MAINTAIN A TEMP OF GREATER THAN 95 degrees.

 

[K_Z]

I'm unclear on what would be the optimum temperature for her to stay at. Obviously 98.6 is the average live human temp, give or take a few tenths of degrees. For someone whose body is deteriorating, however, wouldn't a LOWER temperature be better in order to keep infection risk lower?

After one of my parents had surgery, I remarked to a nurse about how cold it was in the room afterward. It's ALWAYS cold, it seems, in most patient spaces. She said that it was deliberate, because bacteria prefers things to be nice and warm to thrive. It certainly made sense to me. They were not necessarily trying to lower body temperatures, but just helping to keep the rooms and patients from getting too warm.

OTOH, squashing a fever, depending on how high it is, is also squashing the body's natural defenses. All that activity means there's a battle going on inside between the immune system and "invaders". It doesn't FEEL very good, but a certain amount of that is often beneficial in the big picture.

SO, what's the consensus on temperatures? Post-surgery and ER areas may be a good idea to be cold, but I don't remember in-patient hospital rooms as being especially cold, so maybe it's only in a more susceptible environment that they do that.

Jahi's immune system is probably on high-alert, and THAT may be why her temperature was raised "by Jahi" (assuming we can take that tidbit as true). It really IS just a matter of time before an infection of one kind or another launches a DEFCON 1 attack that Jahi's body simply will NOT be able to withstand.

This is older information. The relationship between hypothermia and infection is pretty well documented and studied. Maintenance of normothermia peri operatively is examined by a number of evaluative criteria. An exception to this is deliberate hypothermia for neuro protective effects post cardiac arrest. But. Jahi is well beyond that time frame, so i don't think there is any justification for deliberate hypothermia.

Patients who become brain dead become poikelothermic.

Regulation of Body Temperature
Rodbard[36] suggested that the neural mechanisms governing homeostatic temperature control developed in the hypothalamus from circulatory control neurons in the course of evolution from reptile to mammal. Body temperature is regulated when changes in blood temperature stimulate heat-sensitive receptors in the hypothalamus. Nerve impulses from cold receptors in the skin can also activate heat-producing neurons. The most important heat producers are the skeletal muscles, brain, liver, and heart. The greatest heat radiator is the skin, especially that on the hands. Local electrical stimulation of the heat-producing center induces shivering and constriction of blood vessels in the skin, activating vasomotor nerves and decreasing blood flow. Warming of the heat-loss center suppresses vasomotor nerve activity and in this way increases blood flow through the skin.

In brain death, the neural connection between the temperature-regulating center and peripheral body tissues is lost, and the patient becomes poikilothermic. When criteria from the National Institute of Neurological Diseases and Stroke (NINDS) were applied to establish brain death, such patients showed only a “tendency for the temperatures to be subnormal.”[17] In contrast, when brain death was established using the criterion of cessation of all brainstem functions, “poikilothermia was found in all patients later than 24 hours after brain death.”[37] Even if infection occurs, fever should not develop in cases of brain death, because the temperature-regulating centers no longer function. After brain death, body temperature tends to be hypothermic, even with vigorous application of external heat.

http://www.mdconsult.com/books/page...type=bookPage&from=content&uniqId=435437796-2

 

[Donjeta]

In the court declaration filed by Flori, she said any measures to help Jahi will only slow post-mortem deterioration. Jahi's body is also unable to regulate her temperature and "blankets are needed to maintain a temperature of greater than 35 degrees Celsius (95 degrees Fahrenheit)."

http://www.latimes.com/local/lanow/la-me-ln-jahi-mcmath-body-deteriorating-20140108,0,4831276.story

bbm

Paul Byrne thinks that proper dead people should be cold and stiff so if they can keep Jahi as warm as that even if they need warming blankets to achieve it it's all evidence that she's not dead for him.

January 14, 2014
Jahi McMath is a living person

By Paul A. Byrne, M.D.

Jahi is a living person and has been a living person on earth since her conception within her mother. Jahi's heart is beating 100,000 times a day, a rate similar to most persons on earth. Her heart beat is initiated in her heart just like yours and mine. Your heart beat does not begin in your brain either. Jahi's pulse and blood pressure are normal and strong. Jahi digests her food, puts out urine and has bowel movements just like the rest of us. Jahi's temperature is 98 with only a blanket to help keep her warm. Her body metabolism keeps her temperature warm just like yours. Her natural thermostat to control her temperature is in her hypothalamus, which is part of her brain. You have such a thermostat in your brain also.

http://www.renewamerica.com/columns/byrne/140114

Intentionally or unintentionally, he also completely glosses over the vasopressin and whatever else Dr. Frankenstein & al. might be using to keep her blood pressure normal. Everything that approaches normal or can be maintained at however abnormal rates constitutes evidence that Jahi is alive for him because it's different from a cadaver with no pulse and cellular metabolism.


An article saying that people are advised to turn off life support too soon when there is still a chance to recover (but again, the examples are people who had strokes, were in coma or in PVS, and not brain dead)
http://www.oregonlive.com/opinion/index.ssf/2014/01/the_importance_of_not_letting.html

The importance of not letting go too soon: Guest opinion
on January 18, 2014 at 10:53 AM
By Robert L. Folmer, Ph.D.

In 1991, I was part of a team at the University of California, San Francisco that evaluated the brain and cognitive functions of Terri Schiavo and other patients in persistent vegetative states. Because Terri Schiavo’s non-responsive condition had not changed significantly in 15 years, I did not disagree with Michael Schiavo's decision to end his wife's life in 2005. Fifteen years seems long enough -- too long, some might argue -- to remain in such a state with no chance for improvement. However, because it is often difficult to predict the course of recovery within the first week or month after a patient suffers a sudden brain injury or incapacitating event, I recommend proceeding with caution in the early stages. In some cases, weeks or months are required to determine the extent of a patient’s brain damage and to estimate the potential for recovery.

While Dr. Bascom wrote that “palliative medicine embraces the power of letting go,” we should guard against letting our loved ones go too soon after their sudden incapacitation.

Bascom's article the above refers to:
http://www.oregonlive.com/opinion/index.ssf/2014/01/palliative_medicine_and_the_po.html

Our culture seems to believe that death occurs principally when doctors withhold potentially life-saving medical procedures. It’s this misperception that has made Sarah Palin’s “death panel” accusation so powerful. But palliative medicine is not the death panel, with the power to decide who should live and die. It has power of a different sort. Palliative medicine helps discern who is dying. Palliative medicine offers patients and families the opportunity to relinquish faint or false hopes for recovery. At the end of life, fighting against inexorable disease only increases suffering. Palliative medicine embraces the power of letting go.

 

[Sedonia Sunset]

This is older information. The relationship between hypothermia and infection is pretty well documented and studied. Maintenance of normothermia peri operatively is examined by a number of evaluative criteria. An exception to this is deliberate hypothermia for neuro protective effects post cardiac arrest. But. Jahi is well beyond that time frame, so i don't think there is any justification for deliberate hypothermia.

Patients who become brain dead become poikelothermic.



http://www.mdconsult.com/books/page...type=bookPage&from=content&uniqId=435437796-2

Thank you for that information, K_Z.

Ever since this whole thing started I, like many people, was affected not only by the horror of it all, but also by personal experience. In my case, my fiance had an aneurysm that led to a massive sub-arachnoid brain hemorrhage. This was in 1970, and it started the day after Thanksgiving. He was in a coma for 9 days before he died. I remember they had put patches over his eyes so that they wouldn't dry out as much, but before they did that, I saw that his eyeballs looked like bloody meat, which was horrifying. On the day he died, he had a VERY high temperature, and there was a rash all over. I was very young (15 and pregnant) and numbed by it all, so I didn't have all the information that his parents had, and I never asked them for more details because I didn't want to bring up bad memories for them. He was their only child. I think they were also trying to protect ME from more than I really needed to know at the time. They are both gone now, and I miss them dearly.

Up until now, as I have been reading all the information on brain death, I began to wonder if, and then assume, HE had been brain dead. He had no response to painful stimuli or anything else. I know they had to do a tracheotomy and that he was on a ventilator. Back then, the term "brain dead" wasn't known by the public at large. Based on the body temperature info you provided, though, he must have at least had brain-stem activity if he developed a raging fever.

 

[momrids6]

The Freedom From Religion Foundation has contacted the Office of the General Counsel of Oakland Unified School District in the wake of complaints it received over the proselytizing nature of a recent assembly at E.C. Reems Academy, Oakland, Calif., intended to honor Jahi McMath.

http://www.secularnewsdaily.com/201...paign=Feed:+paliban/RDkF+(Secular+News+Daily)

 

[popsicle]

When Dead Is Dead
Medical Ethics Distinguish a Person from a Body

Sunday, January 19, 2014
by BEN BYCEL

While it may not be unethical to do as Jahi’s parents have done, I think it sets dangerous and unrealistic expectations and adds unnecessary cost to our health-care system. It’s also simply bad public policy to encourage people to believe that being brain-dead is a recoverable state. As heartless as it sounds — dead is dead.

http://www.independent.com/news/2014/jan/19/when-dead-dead/

 

[Nore]

Absolutely!! And what about when she develops pneumonia or some other complication of being kept alive by machinery? Does an acute care hospital have to accept her for admission? I work at a Children's Hospital not far from the TBI facility where Jahi's body will reportedly be transferred. We are wondering if our Medical Director can refuse admission based on the fact that the patient is brain dead=dead.

----------
Hi mymeow, my son did develope pneumonia more than once despite being turned. His ability to breathe in was affected but still he was able to breathe on his own. He was transported to the hospital each time. Nurses used to ask him about the rock bands. He was able to respond with his eyes. a brain uses two different "parts" to breathe, one in, one out!! Could you imagine her being brought to a hospital? I dont think anyone HAS to admit her as she is legally dead. I would have to quit my job if I was a nurse. Now I could handle a dead body if I was asked but not in her condition. This is morbid..:scared::banghead:

 

[LaLaw2000]

I have a question for anyone who may know.

Jahi had been termed as morbidly obese. Her Mom called it 'thick' rather than overweight. My question is whether or not Jahi will lose a tremendous amount of weight in the (artificial) state she is in. Will her little body waste away?

I know this sounds morbid, but I went to the funeral of a friends Mother many, many years ago and heard someone say, "Rose was so overweight when she got sick. She would be so proud of how small she is now." I don't know why, but I was horrified at what this person said. I was only 10 years old at the time and I have never forgotten it.

Will the breakdown of Jahi's (deceased) body cause her to get smaller, or does whatever the unethical doctor's are doing keep her weight maintained?

This is an uneducated question on my part because I am not knowledgeable of the medical aspects.

TIA & MOO

 

[Elley Mae]

LaLaw2000

I too have wondered that. I have read that she was heavy, over weigh,t obese, and thick yet I have seen a weight mentioned. I have seen a # mentioned in one of the comments about this but I don't know that it's true. I have looked at pictures and tried to measure her to other things in the picture. The one picture of her and her mom shows them to be about the same other then height.

I just can't imagine how her body would be able to stay in the over weight state. I can't imagine how a body that is dead is able to process food/liquid nutrient. It's doesn't make sense to me. I am one to believe that it is a tall tale that is being told. jmo idk

 

[LaLaw2000]

TY, Elley Mae!

 

[Elainera]

As I understand it, she as a person is dead (because her brain is), the body however can be kept functioning artificially to a certain extent. Now whether you call that functioning 'life' is another matter ...

As for the weight question, I read that a brain dead body that is kept functioning with a ventilator, breathing tube and feeding tube, does process the nutrients but not as well as a normal, alive, person would. Certainly they would not feed her heavy foods now, fatty things etc, but kind of a mix of basic nutrients and vitamins/minerals the body needs to function. And I would strongly assume that she will lose weight, probably has already. It's been 5 weeks, and at first she didn't even have the feeding tube iirc.

 

[Elainera]

Can their body still process food?

Yes, but poorly, Caplan said. While a feeding tube is needed to get food into the body, those nutrients aren’t being properly processed.

"You need a lot of energy to function," Caplan added. “Your heart could eventually stop for a lack of energy.”

http://usnews.nbcnews.com/_news/201...s-questions-about-life-after-brain-death?lite

 

[Karmady]

As I understand it, she as a person is dead (because her brain is, the body however can be kept functioning artificially to a certain extent. Now whether you call that functioning 'life' is another matter ...

As for the weight question, I read that a brain dead body that is kept functioning with a ventilator, breathing tube and feeding tube, does process the nutrients but not as well as a normal, alive, person would. Certainly they would not feed her heavy foods now, fatty things etc, but kind of a mix of basic nutrients and vitamins/minerals the body needs to function. And I would strongly assume that she will lose weight, probably has already. It's been 5 weeks, and at first she didn't even have the feeding tube iirc.

My experience with a family member on life support of various kinds for a few months and having seen patients in pvs's ...they lose a lot of weight very quickly. My family member went in as a morbidly obese middle-aged man and came out a few months later looking like an eldery POW. jmo

 

[LaLaw2000]

Thanks for the answers. Jahi wouldn't even look like herself now, IMO.

 

[meme4]

My father was in a PVS for 3 months, he weighed less than 115 lbs when he died....

 

[Elainera]

I don't know what to make of this after reading so much about brain death and that there is no chance of recovery:

'Miracle recovery' of teen declared brain dead by four doctors

Steven Thorpe, then 17, suffered horrific injuries in a multiple car crash, leaving him in a medically-induced coma and another man dead.

Doctors told his family he would never recover and asked them to consider donating his organs before his life-support machine was turned off.

Instead, Steven’s father enlisted the help of private GP Julia Piper to check his son again as doctors at University Hospital in Coventry, West Midlands, agreed to let a neurologist re-examine him.

Remarkably, he detected faint brain waves indicating Steven had a slim chance of recovery and medics decided to attempt to bring him out of his coma.

Just five weeks later, he was discharged from hospital having made a near-full recovery.

Long article here:
http://www.telegraph.co.uk/health/h...teen-declared-brain-dead-by-four-doctors.html

 

[wendiesan]

There are all kinds of insurance fraud cases for companies submitting claims for dead people. These are in most cases billings for services that weren't rendered. I don't know about billing for services that "are" rendered to a brain dead body. I would not put it past them to bill insurance as Byrne does not believe that Jahi is dead according to his criteria. It could be another messy battle like what happened in court. The insurance company should be alerted to potential fraud. There are certainly services that they are providing that wouldn't be deemed "medically necessary" considering she is deceased. For example: speech therapy among many other things.
snipped by me for space/[/url]

Jumping off from services for a brain-dead body, do you think insurance companies would see this as an area for future development? That is, could they begin offering more policies along the line of what are now available as Final Expenses, or Pre-Planned Funeral Expenses? Could there be a policy to specifically to deal with those medical expenses for brain-dead patients just in case such a thing might happen to a member of a family?

The expenses of caring for a brain-dead family member has become the subject of debate and conjecture in discussions about the case in Texas, and the expenses are, to say the least, staggering. Conservative estimates in that case run between a million and 1.6 million dollars. (http://www.medpagetoday.com/OBGYN/Pregnancy/43736) Re the case of Jahi McMath, Dr. Art Caplan, head of Division of Medical Ethics at NYU Langone Medical Center, estimates her treatment could cost $7,500 per day (http://usnews.nbcnews.com/_news/201...s-questions-about-life-after-brain-death?lite). Most families are not in the position to take on such debt, no matter how much the affected family member is loved.

It just seems, from the comments I've read over the several threads discussing this case, that most people do not have medical insurance which would begin to cover the expenses accumulating over Jahi's care in CHO, let alone what her further treatment in a private facility would cost. IIRC, the family may be receiving help from private foundations as well as from their own ******** Jahi McMath Fund. If Caplan is correct, they'll certainly need financial help. However, I could have missed previous posts dealing with this aspect of this case.

These are just examples of kinds of insurance available now.
http://www.carnells.com/help-support-article.aspx?id=48
http://www.tdinsurance.com/products-services/life-health-insurance/final.jsp
http://www.coverme.com/products/coverme-guaranteed-life.jsp
https://www.statefarm.com/insurance/life

 

[NevadaMom]

I don't know what to make of this after reading so much about brain death and that there is no chance of recovery:

'Miracle recovery' of teen declared brain dead by four doctors

Steven Thorpe, then 17, suffered horrific injuries in a multiple car crash, leaving him in a medically-induced coma and another man dead.

Doctors told his family he would never recover and asked them to consider donating his organs before his life-support machine was turned off.

Instead, Steven’s father enlisted the help of private GP Julia Piper to check his son again as doctors at University Hospital in Coventry, West Midlands, agreed to let a neurologist re-examine him.

Remarkably, he detected faint brain waves indicating Steven had a slim chance of recovery and medics decided to attempt to bring him out of his coma.

Just five weeks later, he was discharged from hospital having made a near-full recovery.

Long article here:
http://www.telegraph.co.uk/health/h...teen-declared-brain-dead-by-four-doctors.html

B/I/UBM ... those are your keywords that make that case totally not the same as JM ... she has ZERO brain waves because she has no blood flow to her brain, and her brain stem is also dead. She is not in coma medically induced or otherwise.

 

[popsicle]

When does life end? Two emotional cases probe the complexities.
Two young women – teenager Jahi McMath in California and mother Marlise Munoz in Texas – have both been deemed brain-dead, a final state according to statutes. But both cases have spawned legal fights.

By Daniel B. Wood, Staff writer, Gloria Goodale, Staff writer / January 19, 2014

In Jahi's case, the hospital probably never anticipated that her family would take the issue this far, she says. "They expected the family to just accept the hospital's decision and go away quietly," she says via e-mail.

It is highly likely, she continues, that among other concerns, the hospital is worried that it "will never be fully reimbursed for the expensive treatment Jahi" was receiving.

snip

In Jahi's case, ethicists note two other factors. First, the hospital, by law, is prevented from revealing details of the case, and thus is probably hampered in its ability to clearly explain its side of things.

snip

"Naturally the California hospital would have preferred to have a very limited audience: the hospital, the parents, and perhaps a priest," he says via e-mail. "But as the media picks up the story, and (most importantly) as the parents become unsatisfied with the presented remedy, the issue becomes 'socialized' in the hope that better, newer members of the 'audience' will side with the parents."

http://www.csmonitor.com/USA/Justice/2014/0119/.UtxPZHDlIck.twitter

 

[Nore]

B/I/UBM ... those are your keywords that make that case totally not the same as JM ... she has ZERO brain waves because she has no blood flow to her brain, and her brain stem is also dead. She is not in coma medically induced or otherwise.

---------
Hi NevadaMom, your right. Any type of coma is not brain death. This is from a U.K. paper. Maybe their laws are different than ours. In U.S. you must be dead as a doornail to be declared dead..Even if the blood started flowing to her brain after, it is still dead. Cannot comeback. I dont understand why people cant "see" this. Oh well we keep trying.:loveyou:

P.S. we have more frigid temps coming. Low Mon/tues. 04 degrees!:coldcase:verreaction: