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

[Linda7NJ]

Sort of parallel to that would be the number of families who NOW may wonder if their agreement to donate organs from their loved ones who were in similar circumstances to that young man may have caused those lives to be cut short. Even the shadow of a doubt would be heart-wrenching, jmo.

Agreed.


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[Elainera]

JMO but if there was even one case of recovery in a person who was correctly diagnosed to have been without cerebral blood flow for weeks, like Jahi appears to have been, then everything we think we know about neurology would be wrong.

There is a lot of uncertainty and unknown factors in medicine that leads to surprises which are called miracles if they're good and catastrophic complications if they're bad. But it is a pretty well established fact that brain cells need circulation if there is to be any healing after an injury.

Your right about the absent cerebral blood flow. I don't even want to think about in what state her brain is now in. It probably hardly exists anymore.

But much we "knew" 100 years ago turned out to be wrong or only be partly true. So I'm a bit surprised that many are now so readily convinced that brain dead = complete death forever. I wonder, is it really? As I pointed out above, no extensive studies have ever been done.

Just to say it again, I do not believe that Jahi is alive or has a chance to come back, but the whole situation makes me wonder and think a lot about where life ends and where death begins, what medicine really "knows", and how absolute statements, diagnoses and prognoses by doctors really are. I have been misdiagnosed more than once, every time the physicians was "100%" sure about their assessment of me. I don't have complete trust in doctors and medicine. Medicine isn't a fail proof science, many "truths" have been overturned in the past 100 years, and doctors are not always correct. We all know that.

We used to think that when the heart stops a person is dead, immediately. We have however discovered that the heart can be restarted, even after minutes, and the person lives. What if something could restart the brain, what if it could be developed by studying these unfortunate people who become brain dead?

But since nothing like that exists right now I don't think poor Jahi has a chance, especially now, 5 weeks on.

@BeginnersLuck, I would love to see the Japanese study, if you can find it again.

 

[jjenny]

Thank you Donjeta, and other who weighed in.

My guess would also be that he wasn't really brain dead. But would I bank on it? No. From what I learned most things in life (and death) are not as clear cut as we want them to be. There are usually grey areas, and medicine is famous for them, that are open to interpretation, or where the body behaves in unexpected and/or unpredicted manners. Someone upthread pointed out that even when a person is declared brain dead there always remains minimal electrical activity in the brain. What if this minimal activity is by some doctors dismissed as "not important because normal in a brain dead person" and by another interpreted as "a tiny chance of recovery" as was said in Stephen's case?

There is no comprehensive long-term study on brain dead persons that are kept artificially "alive", because these cases are so rare. What if one in hundred would come back after weeks, months, despite it being viewed as impossible? Many here will roll their eyes and insist "No it's not possible!" but we don't know that. It has never been really studied.

We do know that if there is no blood flow to the brain, brain dies. It does not grow back. These cells die. Brain can not restart because it's no longer exists in the form it once existed. It's completely changed from what it was.

 

[Linda7NJ]

We do know that if there is no blood flow to the brain, brain dies. It does not grow back. These cells die. Brain can not restart because it's no longer exists in the form it once existed. It's completely changed from what it was.

How does anyone know for sure? Are there long term studies? What efforts have been made to measure?
Brains are amazing organs that do rewire and recover from all sorts of trauma, stoke etc and recoveries are often medically unexpected and IMO are unpredictable.


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[Elainera]

We do know that if there is no blood flow to the brain, brain dies. It does not grow back. These cells die. Brain can not restart because it's no longer exists in the form it once existed. It's completely changed from what it was.

Thank you. Yes that is most certainly the case with Jahi now. But what if this blood flow could artificially be restarted? Or another liquid be injected into the brain to keep it nourished while it heals? This of course would have to be done right when brain death occurs or very soon after.

 

[Elainera]

How does anyone know for sure? Are there long term studies? What efforts have been made to measure?
Brains are amazing organs that do rewire and recover from all sorts of trauma, stoke etc and recoveries are often medically unexpected and IMO are unpredictable.


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I was thinking along the same lines. But from what I read now it seems that the brain, once it's dead, starts to liquify (sorry, not pleasant to think about) after some time (don't know how long) and basically fall apart.

However you are right, the brain does recover often in ways not thought possible. As do nerves throughout the body. It's a fascinating subject, there is much still not understood how it happens.

 

[Linda7NJ]

I was thinking along the same lines. But from what I read now it seems that the brain, once it's dead, starts to liquify (sorry, not pleasant to think about) after some time (don't know how long) and basically fall apart.



However you are right, the brain does recover often in ways not thought possible. As do nerves throughout the body. It's a fascinating subject, there is much still not understood how it happens.

This is what I don't understand... I'm of the belief the cessation of blood flow to the brain occurs when the brain swells and if nothing is done to relieve the pressure the brain ( brainstem) migrates down the hole where the skull is connected to the spinal cord. ( I could be entirely wrong on this...but that's my understanding) that cuts off the blood supply.
Why was nothing done to relieve the pressure? A bolt/drain or shunt or removal of part of the skull? Why wasn't she monitored or any efforts made to protect her brain?


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[jjenny]

I was thinking along the same lines. But from what I read now it seems that the brain, once it's dead, starts to liquify (sorry, not pleasant to think about) after some time (don't know how long) and basically fall apart.

However you are right, the brain does recover often in ways not thought possible. As do nerves throughout the body. It's a fascinating subject, there is much still not understood how it happens.

Dead brain doesn't recover. It's dead.
The cells are dead. They are not going to grow back.

 

[BeginnersLuck]

Here is one document that I previously posted, that discusses some brain death cases. This wasn't the one I was looking for though.

https://www.jstage.jst.go.jp/article/nmc/48/3/48_3_114/_pdf

 

[Elley Mae]

snipped

Although neurons are the longest living cells in the body, large numbers of them die during migration and differentiation.

The lives of some neurons can take abnormal turns. Some diseases of the brain are the result of the unnatural deaths of neurons.

http://www.ninds.nih.gov/disorders/brain_basics/ninds_neuron.htm

snipped

Scientists hope that by understanding more about the life and death of neurons they can develop new treatments, and possibly even cures, for brain diseases and disorders that affect the lives of millions of Americans.

The most current research suggests that neural stem cells can generate many, if not all, of the different types of neurons found in the brain and the nervous system. Learning how to manipulate these stem cells in the laboratory into specific types of neurons could produce a fresh supply of brain cells to replace those that have died or been damaged.

 

[Donjeta]

Brain tissue is not like bone or skin where you can cut it or break it and the edges of the wound will grow back together almost like new. It's very organized and dead nerve cells are hard to replace. There is capacity for healing in the brain and we don't know everything about it yet but from everything we do know (or think we do, anyway) it appears that living brain tissue is a necessary requirement for healing and rewiring to happen. If there is a large brain area that dies in a stroke it doesn't seem to grow back. There is spontaneous healing and rehabilitation efforts are helpful as the penumbra around the stroke recovers (the area around the dead spot that is also affected by the stroke but not quite dead) and the nerve cells are able to regrow their connections. Sometimes other brain areas might be able to take over the lost functions. But all this requires that there is something living there that can grow and heal and learn. Even if the person recovers pretty well, the strokes leave lesions that are visible in brain scans and in the autopsy. Brain death is basically a whole brain stroke and there would be nothing left to begin the healing process.

There is some experimental research on regenerating brain cells from stem cells but I can't imagine that research will ever be able to create a new brain from scratch if the old one experiences a complete brain death. It's not just about creating new neurons, it's about creating an incredibly complex network of billions of synapses and getting it to work the way it's supposed to. Even if science got that far some day and could regrow a brain, it wouldn't be a brain dead person waking up from the dead, imo, it would be somebody completely new who looks the same but has none of the brain dead person's experiences and memories. I don't think I would want that even if possible, it'd be too spooky.

 

[Elainera]

This is what I don't understand... I'm of the belief the cessation of blood flow to the brain occurs when the brain swells and if nothing is done to relieve the pressure the brain ( brainstem) migrates down the hole where the skull is connected to the spinal cord. ( I could be entirely wrong on this...but that's my understanding) that cuts off the blood supply.
Why was nothing done to relieve the pressure? A bolt/drain or shunt or removal of part of the skull? Why wasn't she monitored or any efforts made to protect her brain?


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I might be wrong but I was under the impression her brain died because her heart had stopped for too long, not because there was pressure on the brain from swelling. I'm not sure though we heard from doctors what the exact cause for her brain death was.

 

[jjenny]

We can not currently fix a dead brain. We can not even fix a brain that is not dead but severly damaged. My understanding is they did all kind of "cutting edge" treatments on Ariel Sharon.
He didn't regain any function and is now dead.

 

[Donjeta]

This is what I don't understand... I'm of the belief the cessation of blood flow to the brain occurs when the brain swells and if nothing is done to relieve the pressure the brain ( brainstem) migrates down the hole where the skull is connected to the spinal cord. ( I could be entirely wrong on this...but that's my understanding) that cuts off the blood supply.
Why was nothing done to relieve the pressure? A bolt/drain or shunt or removal of part of the skull? Why wasn't she monitored or any efforts made to protect her brain?


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Yes, herniation is something that can cut off blood supply to the brain but it's not the only thing that can.
Brain herniation - Wikipedia, the free encyclopedia

I don't think we've been told whether there were any efforts to monitor or control her intracranial pressure. There are some pharmacological treatments that can help remove excess fluid. Shunt operations are usually done if there is a blockage in the cerebrospinal fluid channels and the enlarging of the CSF spaces increases the intracranial pressure. If it's general cerebral edema (the brain cells swell), shunting may not be the treatment of choice.

 

[Donjeta]

I might be wrong but I was under the impression her brain died because her heart had stopped for too long, not because there was pressure on the brain from swelling. I'm not sure though we heard from doctors what the exact cause for her brain death was.

Perhaps a bit of both? It was reported that two thirds of her brain was swollen. The hypovolemia from the bleeding wouldn't help either.

Her chances of surviving cardiac arrest without significant brain hypoxia seem to have been better than most other cardiac arrest patients as it happened on an ICU ward so they must have started professional resuscitation immediately and that ought to have helped maintain her circulation for a bit.
edition.cn n.com/2013/12/17/health/california-girl-brain-dead/

 

[Elainera]

Here is one document that I previously posted, that discusses some brain death cases. This wasn't the one I was looking for though.

https://www.jstage.jst.go.jp/article/nmc/48/3/48_3_114/_pdf

Thank you. It's very interesting, I recommend it to everybody to read. Interesting, and something I didn't know before, that certain reflexes were present throughout this woman's prolonged time on life support while brain dead. I think maybe that is what Jahi's family has seen too and is misinterpreting as "responses".

 

[Elainera]

Perhaps a bit of both? It was reported that two thirds of her brain was swollen. The hypovolemia from the bleeding wouldn't help either.

Her chances of surviving cardiac arrest without significant brain hypoxia seem to have been better than most other cardiac arrest patients as it happened on an ICU ward so they must have started professional resuscitation immediately and that ought to have helped maintain her circulation for a bit.
edition.cn n.com/2013/12/17/health/california-girl-brain-dead/

Ah! Thank you, I didn't know that her brain was swollen.

 

[Donjeta]

Your right about the absent cerebral blood flow. I don't even want to think about in what state her brain is now in. It probably hardly exists anymore.

But much we "knew" 100 years ago turned out to be wrong or only be partly true. So I'm a bit surprised that many are now so readily convinced that brain dead = complete death forever. I wonder, is it really? As I pointed out above, no extensive studies have ever been done.

Just to say it again, I do not believe that Jahi is alive or has a chance to come back, but the whole situation makes me wonder and think a lot about where life ends and where death begins, what medicine really "knows", and how absolute statements, diagnoses and prognoses by doctors really are. I have been misdiagnosed more than once, every time the physicians was "100%" sure about their assessment of me. I don't have complete trust in doctors and medicine. Medicine isn't a fail proof science, many "truths" have been overturned in the past 100 years, and doctors are not always correct. We all know that.

Yes, absolutely, false diagnoses and errors in the testing and scanning are a definite possibility and I wouldn't want to jump into any conclusions without getting second and third opinions if it was my child. But if anyone has been extensively tested many times over it's Jahi, and the possibility of all those doctors and scans and exams being coincidentally wrong at the same time seems very low to me.

We used to think that when the heart stops a person is dead, immediately. We have however discovered that the heart can be restarted, even after minutes, and the person lives. What if something could restart the brain, what if it could be developed by studying these unfortunate people who become brain dead?

But since nothing like that exists right now I don't think poor Jahi has a chance, especially now, 5 weeks on.

@BeginnersLuck, I would love to see the Japanese study, if you can find it again.

If there was such a method I think I would probably file it under preventing brain death. Brain death is by definition irreversible so any condition in which the brain functions can be restarted is technically not brain death.

 

[Elainera]

We can not currently fix a dead brain. We can not even fix a brain that is not dead but severly damaged. My understanding is they did all kind of "cutting edge" treatments on Ariel Sharon.
He didn't regain any function and is now dead.

I'm hoping that in future it will be possible to prevent or slow down cell death in the brain.

 

[BeginnersLuck]

Awakening (Mis)conceptions about brain death

http://ajcc.aacnjournals.org/content/21/6/377.full

As members of a community, critical care practitioners must take a stand when we see something in the media as misleading as the story described above. As professionals we need to educate patients and families about terms like brain death and what they really mean, not to mention how damaging they can be when used incorrectly. Many of us pray for miracles for our critically ill patients, but sometimes—unfortunately, oftentimes—those miracles never happen. By failing to convey the facts and subtleties of such emotional stories accurately, journalists in the popular media risk poisoning the very important relationship between critical care practitioners and their patients and families, sowing mistrust and anger where there should be warmth and mutual respect. If we take a stand and educate when we see these stories in the media, we can begin to undo the damage. Then what awakens will be the truth, and we can lay these misconceptions to rest.

There are lots of references at the end of the article with links to more information.