PM's doctors discuss their ordeal

Sharon continues to improve as the media backs down and he is left to recover.

By JPOST STAFF
January 11, 2006 02:38
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"We admit that the medicine given to the prime minister [Ariel Sharon] to thin his blood may have caused his stroke," Dr. Felix Omanski, one of the neurosurgeons who operated on Sharon, acknowledged in an interview with Channel 2 on Wednesday night. "However, with that, we do not think that giving him the medicine was a mistake. This is a known phenomenon," he said. "It is not something that is surprising. An aspirin tablet can have the same effect." He rejected all accusations of having made a mistake. He projected that were the doctors not to have given the prime minister the anti-coagulants and he still suffered from hemorrhaging, the same deriders would have shouted at them for not medicating.

READ MORE ON ARIEL SHARON'S TREATMENT:
Dr. Jose Cohen, another member of the neurosurgery team, told Channel 2 that the doctors were not thinking about the identity of their patient, they just saw him as a man who urgently needed surgery, and they thought about the best way to go about operating on him. Only in retrospect, Cohen said, did they realize how important that first surgery was. Omanski recalled that he asked Sharon's son, Gilad, to speak to his father while he was unconscious. "Gilad said 'hello dad, how are you, I'm here next to you,' and right away the prime minister's blood pressure went up, which is a sure sign he was responding," said Dr. Omanski. Cohen admitted that the doctors were legitimately scared at the beginning, as Sharon was "very unstable." He noted that operating on such an unstable patient is always dangerous. Dr. Omanski was certain that working so hard to save Sharon was the right thing; he was sure that Sharon would want to survive. "He's a warrior." He continues to be optimistic. "The man was about to die, and now he's alive. Let's give him medicine and time, and see what they can do." Cohen cited the high-point of the ordeal as being when the anesthesia was reduced. "When we saw him move, we knew we were on the right track," he beamed. Omanski expressed his view of the best-case scenario: Sharon would go back to his ranch and invite his doctors down for asado. Earlier Wednesday, media tents outside Hadassah-University Hospital in Jerusalem's Ein Kerem neighborhood were dwindling in numbers as doctors announced that Sharon's condition improved slightly and that he remained under light sedation. Doctors at the hospital had earlier said that Sharon would be removed from sedatives completely Wednesday as they try to bring him out of a medically-induced coma to see how much damage he suffered from his massive stroke. According to Army Radio, Sharon was breathing almost entirely independently. The Prime Minister has "stepped five meters away from the precipice" and is "no longer in immediate danger," Dr. Yoram Weiss, one of the prime minister's anesthesiologists, said in a briefing outside Hadassah Hospital Tuesday evening. Hadassah Medical Organization (HMO) director-general Shlomo Mor-Yosef added that while he continued to be in serious condition, he moved his left arm for the first time in reaction to a pain stimulus, and the movements of his right arm and right leg were stronger than they were on Monday, when Sharon's anesthesia was first gradually reduced to bring him out of an induced coma. All vital signs - such as pulse, blood pressure, urine production and intracranial pressure - remain steady and within the normal range, Mor-Yosef said. But he and Weiss said it would be impossible to assess the extent of his cognitive abilities for several days or even weeks. Omri Sharon thanked the public on Tuesday for offering their hopes and prayers for his father's recovery from the massive stroke. "I came to thank, in the name of my family, the citizens of Israel, who since Wednesday have supported us with their concern, their prayers and good wishes," he told reporters in a brief statement. He also thanked the hospital staff, in particular Sharon's physicians, for their devoted care. Mor-Yosef said that while he has avoided commenting on criticism by anonymous physicians of Hadassah's cardiological treatment after Sharon's first mild stroke, he strongly denied a front-page report in Haaretz on Tuesday quoting an anonymous Hadassah source "involved in Sharon's treatment" who claimed that early diagnosis at Hadassah of a chronic condition he allegedly has - called cerebral amyloid angiopathy (CAA) - could have prevented Sharon's having twicedaily injections of powerful anticoagulants after his mild stroke. These blood thinners have been blamed for triggering the devastating second stroke. Mor-Yosef said that management continued to stand by its policy of not commenting on criticism "until after we complete our struggle for the prime minister's life." But without naming Haaretz, he declared that the story in the paper was "not true." Hadassah doctors knew Sharon's diagnosis the night he arrived after the first stroke, "and there is no new diagnosis from this second hospitalization," he said. CAA refers to the accumulation of bamyloid protein in small and mid-sized arteries (and less frequently in veins) of the cerebral cortex and other parts of the brain. It has been recognized as one of the morphological hallmarks of Alzheimer's disease, but it is also often found in the brains of elderly patients who are neurologically healthy. It occurs in about 15 percent of all people over the age of 60 and often presents no symptoms. Prof. Amos Korczyn, one of the country's leading neurologists, who works at Tel Aviv University's Sackler Medical Faculty and Tel Aviv's Sourasky Medical Center - who does not have access to Sharon's medical file - told The Jerusalem Post that if Sharon indeed had CAA, it would have been "impossible" for Hadassah doctors to have diagnosed it, as this can be done only in a pathology exam after death. "It couldn't have been a neurologist who leaked what Haaretz claimed, because he should have known better. It is just wrong," he said. But Korczyn suggested that if Sharon indeed has CAA, which rules out the giving of powerful anti-coagulant drugs and could cause a hemorrhagic stroke, his second stroke could have been the result of the combination of these blood-thinning drugs and the CAA. However, his medical team at Hadassah could not have known if Sharon did have CAA, because "it doesn't show up in any computerized tomography [CT] or magnetic resonance imaging [MRI] scan." Korczyn also told the Post that despite signs of neurological progress in the past two days, he feared that the prime minister's cognitive prognosis is "grave." "I hope I will be proved wrong," he said. He added that "by Thursday, we should be able to see what the effect of the anesthesia drugs has been and what remains as brain damage." Mor-Yosef said that the neurological changes in the previous 24 hours showed "mild improvement in his neurological condition. Sharon's anesthesia drugs will continue to be gradually withdrawn," he said, adding that Sharon is still breathing spontaneously on his own but is being helped by a hi-tech respirator that responds to and complements the pace and depth of the patient's breathing. Weiss, one of three anesthesiologists always at Sharon's bedside, urged reporters and the public to have patience. "There has been significant change in his condition, but there is a long way still to go. We reached stability of vital signs, but we still have to wait for the time when the drugs will be completely out of his system. It could take days before we know... There are still drugs in his bloodstream that prevent his cognitive abilities from showing... We can't predict what the final level will be." Prof. Motti Ravid, medical director of Bnei Brak's Ma'ayanei Hayeshua Hospital, commented after hearing Mor-Yosef and Weiss that "we have learned very little. We expected more movement on his right side, as the main damage was on the right side of his brain and not the left. The new movement of his left arm signals some optimism that perhaps the damage to his right brain was less than thought originally, but we don't know how much he moved it and what part of his arm - moving a shoulder is less significant than moving a hand." Saying Sharon is not in immediate danger is "a matter of semantics," Ravid added, because "while there is less danger today, there are still plenty of dangers. The fact that his blood pressure is normal is not surprising, as the anesthesia drugs he had been given, and which are now dissipating, themselves lowered blood pressure, so a return to normal is expected. A return to consciousness takes time, even a long time, weeks, not days - and you can't speed it up... Things are going slowly; they are moving, but we don't know how far." Asked about reports of Sharon's sons speaking to him, of staff continuously playing his favorite Mozart compositions and even a song sung by Rivka Zohar, and of Sharon's favorite dish of shwarma being brought in so he could smell the fragrance of meat, Ravid said: "There is no proof that such things bring people back to consciousness. I have spoken to numerous people who regained consciousness after a coma, and nobody remembered such things. They even had amnesia of events before they went into a coma." The Health Ministry spokeswoman said on Tuesday night that she knew nothing about the anonymously attributed "senior ministry source" who purportedly said the ministry would set up an investigatory committee to look into Sharon's medical treatment "if there is enough public demand" for it. Jerusalem Post staff contributed to this report.

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