 |
 |
 |
|
|
Shlomo Mor-Yosef, Director of Hadassah: no more press conferences (AP file)
|
|
|
|
|
|
| By Associated Press January 12, 2006 |
|
| |
Ariel Sharon's doctors came under criticism on Thursday for failing to divulge a brain disease discovered after an initial, mild stroke suffered by the prime minister and for prescribing drugs that may have been inappropriate for a patient suffering from it, possibly causing his second, massive stroke.
The criticism added to a growing chorus of questions about Sharon's treatment, and whether his doctors' decisions were the right ones. Some experts, however, said there was no right or wrong.
As Sharon lay comatose for an eighth day Thursday, a brain scan showed positive results, indicating that the remnants of the blood in his brain from his Dec. 4 stroke have been absorbed, hospital officials said in a statement.
In response, doctors removed a tube they had inserted into Sharon's skull to relieve pressure on his brain, the statement from Hadassah Hospital said. Doctors also inserted a new intravenous line into Sharon's arm in order to prevent infection.
In the coming days, doctors may have to cut a hole in Sharon's neck to assist breathing, while still waiting for the clearest sign of improvement: the moment he opens his eyes.
With Sharon, 77, still incapacitated, U.S. President George W. Bush called acting Prime Minister Ehud Olmert for the first time since the Israeli leader's stroke. Bush sent his regards to Sharon and his family, and pledged to work to implement the vision for Mideast peace that he shared with Sharon.
Olmert could visit Washington in the coming weeks, Israeli and U.S. officials said.
After Sharon suffered an initial, minor stroke Dec. 18, doctors put him on Cloxane, an anticoagulant injected twice a day. At a news conference a few days later, doctors acknowledged that blood-thinners increased the risk of brain hemorrhage, but said the fear of a clot leading to another stroke was greater in this case.
The debate gained momentum after the Haaretz daily revealed that Sharon also suffered from cerebral amyloid angiopathy, known as CAA, a disease that weakens the blood vessels in the brain and increases the risk of hemorrhaging. CAA, which is linked to dementia and Alzheimer's Disease, is common in the elderly.
Doctors were prescribing the Cloxane until they could seal a small hole in Sharon's heart that they said caused Sharon's first stroke.
Doctors confirmed that they knew about the disease after the first stroke, but prescribed the blood thinners anyway, a move that outside experts criticized Thursday.
"If someone has a disease that caused bleeding, that causes bleeding, that could cause bleeding in the future, giving anticoagulants ... is certainly an undesirable situation," said Amos Korczyn, head of the Tel Aviv University Medical School's neurology department.
Doctors at Hadassah Hospital were prescribing the Cloxane until they could seal a small hole in Sharon's heart that they said caused the first stroke.
But some experts questioned that theory and said the initial stroke was more likely caused by Sharon's brain condition. Sharon suffered a massive stroke Jan. 4, a day before he was to undergo the procedure to seal the hole in his heart.
"The likelihood is that the hole in the heart was of no relevance," said Dr. Anthony Rudd, a stroke specialist at London's St. Thomas' Hospital, adding that CAA could have caused the first stroke.
Doctors did not disclose the condition at their Dec. 26 news conference and several Israeli media outlets chided Sharon's medical team for keeping it under wraps.
Israel's Channel 10 TV quoted an anonymous medical official as saying that Sharon's advisers asked them not to divulge it ahead of the March 28 election.
Asaf Shariv, a top Sharon adviser, denied the report, saying he learned about the condition from the media. "I don't even know if the prime minister knew," Shariv said.
Rudd said he would not have prescribed Cloxane if he suspected CAA, and might have gone for a weaker drug, such as aspirin, or a lower dose of blood-thinners.
Other doctors disagreed, saying there are no clear-cut answers, and each physician must weigh the risks based on their knowledge of the drug and the patient's condition.
"This is a very difficult situation because you are between the devil and the deep blue sea," said Dr. John Martin, a professor of cardiovascular medicine at University College in London. "The decision is always different and it's never black and white, and it's very easy in hindsight to say that was the wrong decision."
Sharon's medical team said the criticism was inappropriate.
"Let's say they would have given him less or wouldn't have given him anything and then suddenly he would have developed a clot in the brain instead of bleeding in the brain. Then everybody would have asked why didn't you give him a higher dosage of blood thinners?" Dr. Jose Cohen, one of Sharon's neurosurgeons, told Israel TV.
For the moment, Cohen said, doctors are still trying to get Sharon out of danger and draw him out of his medically induced coma.
Over the past three days, doctors worked to slowly wean Sharon from the sedatives. They completely removed the anesthetics for a few hours at a time, but Sharon's blood pressure spiked and at one point his heart beat irregularly, forcing doctors to resume the sedation.
The Israeli daily Maariv reported that if Sharon does not wake up in the next few days, doctors may conduct a tracheotomy, cutting a small hole in the neck to insert a tube directly into the windpipe.
Ron Krumer, a Hadassah spokesman, said the hospital will inform the public if doctors decide to conduct the procedure.
If Sharon remains on a respirator, doctors will have to conduct a tracheotomy, Martin said, because the plastic tube currently in the prime minister's windpipe begins to cause damage after a week.
The fact that doctors are considering such a procedure means they are preparing for the long haul, Martin said. It is also becoming more probable that Sharon will remain in a vegetative state, he said.
"If there was no brain damage, I would have expected him to wake up at this point," Martin said.
|
|
 
|
|
|
|
Click on the blue headline to read a Talkback comment and respond to it. Click on the  icon to send a private email to the talkback writer. The icon appears only if the writer has decided to be contacted. If no popup window appears, please make sure your popup blocker allows israelinsider.com.
|
|
| |
|
|
