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CNN Live Today
Interview With Barry Kinzbrunner
Aired October 22, 2003 - 11:04 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
DARYN KAGAN, CNN ANCHOR: Lot of medical questions that come up with this story and the Terri Schiavo case. Joining us now from Miami is Dr. Barry Kinzbrunner. He is the medical director for a company that runs hospice programs throughout the country. Doctor, good morning. Thanks for being with us.
DR. BARRY KINZBRUNNER, HOSPICE MEDICINE EXPERT: Good morning.
KAGAN: We should say you are not Terri Schiavo's doctor, but you are familiar with this type of case.
KINZBRUNNER: Yes, I am, that's correct.
KAGAN: First can you explain to me why you can't put a feeding tube in right away once it's been removed for a week?
KINZBRUNNER: Well if in fact the feeding tube was a tube that requires surgical intervention through a gastroscope, what one would have to do first is one would have to make sure the patient can tolerate the procedure.
In this particular case, not having had any food or fluids for a period of six days would mean that the kidneys have started to shut down and therefore before you could subject the patient to any kind of procedure you have to make sure that the patient is properly hydrated and that the patient could tolerate the reinsertion of the tube.
KAGAN: However you fall on this side of the issue, whether the tube should be in or out, I think people have a great concern that this woman is in pain. What is the standard procedure when a tube is removed to make sure they are not in pain?
KINZBRUNNER: Well, as far as we know, as best as we can tell, people are not in pain when tubes are removed. I have had many experiences where patients and families have made such decisions.
When people stop eating, what happens is they develop condition called ketosis. The elevation of the ketones in the body do a number of things. They blunt the thirst and hunger mechanism so in fact people don't feel hunger and thirst.
In addition, ketones have been shown in some studies to even have positive effects on controlling pain. So, in fact, the presence of the ketones may even blunt the pain response and keep people more comfortable. And of course, if we perceive that the patient is in pain based on our assessments, we would administer judicious doses of opioids or other analgesics to control their pain. KAGAN: And then I have to wonder, a week in -- this is a woman who's not in fantastic health anyway -- a week in without the feeding tube, what kind of damage would have already been done?
KINZBRUNNER: Well, probably the major issue would be damage to the kidneys in terms of the kidneys starting to shut down, which would be a normal process as the body dehydrates. The kidneys try to hold on to whatever fluid they can and then gradually they will shut down.
So, that's the reason why she's being hydrated so that she can, in fact, hopefully they can make sure her kidneys start to work again.
KAGAN: And the finally if you could take us inside of your world for just a moment. This is a very public battle between the family members, between the husband and the immediate family. It's public. And yet I would imagine in your world, you see this type of struggle about what is best for patient to take place many times.
KINZBRUNNER: Yes, that's correct. In hospice our philosophy is to try to work with patients and families and help them come to consensus around these issues. We not to be judgmental and we try to help them work through these issues as family groups so hopefully we don't run into these kinds of contentious situation.
And usually we're successful in resolving them so that we can ultimately do what's in the best interest of the patient based on the needs that have been expressed by the patient while they were able to and by the family as a group at that point.
KAGAN: Because there has been already so much pain all the way around, people, I think, trying to do the best they can.
KINZBRUNNER: That's right.
KAGAN: Doctor, thank you. Appreciate it. You answered a lot of questions people had in Terri Schiavo's situation.
KINZBRUNNER: You're welcome.
TO ORDER A VIDEO OF THIS TRANSCRIPT, PLEASE CALL 800-CNN-NEWS OR USE OUR SECURE ONLINE ORDER FORM LOCATED AT www.fdch.com
Aired October 22, 2003 - 11:04 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
DARYN KAGAN, CNN ANCHOR: Lot of medical questions that come up with this story and the Terri Schiavo case. Joining us now from Miami is Dr. Barry Kinzbrunner. He is the medical director for a company that runs hospice programs throughout the country. Doctor, good morning. Thanks for being with us.
DR. BARRY KINZBRUNNER, HOSPICE MEDICINE EXPERT: Good morning.
KAGAN: We should say you are not Terri Schiavo's doctor, but you are familiar with this type of case.
KINZBRUNNER: Yes, I am, that's correct.
KAGAN: First can you explain to me why you can't put a feeding tube in right away once it's been removed for a week?
KINZBRUNNER: Well if in fact the feeding tube was a tube that requires surgical intervention through a gastroscope, what one would have to do first is one would have to make sure the patient can tolerate the procedure.
In this particular case, not having had any food or fluids for a period of six days would mean that the kidneys have started to shut down and therefore before you could subject the patient to any kind of procedure you have to make sure that the patient is properly hydrated and that the patient could tolerate the reinsertion of the tube.
KAGAN: However you fall on this side of the issue, whether the tube should be in or out, I think people have a great concern that this woman is in pain. What is the standard procedure when a tube is removed to make sure they are not in pain?
KINZBRUNNER: Well, as far as we know, as best as we can tell, people are not in pain when tubes are removed. I have had many experiences where patients and families have made such decisions.
When people stop eating, what happens is they develop condition called ketosis. The elevation of the ketones in the body do a number of things. They blunt the thirst and hunger mechanism so in fact people don't feel hunger and thirst.
In addition, ketones have been shown in some studies to even have positive effects on controlling pain. So, in fact, the presence of the ketones may even blunt the pain response and keep people more comfortable. And of course, if we perceive that the patient is in pain based on our assessments, we would administer judicious doses of opioids or other analgesics to control their pain. KAGAN: And then I have to wonder, a week in -- this is a woman who's not in fantastic health anyway -- a week in without the feeding tube, what kind of damage would have already been done?
KINZBRUNNER: Well, probably the major issue would be damage to the kidneys in terms of the kidneys starting to shut down, which would be a normal process as the body dehydrates. The kidneys try to hold on to whatever fluid they can and then gradually they will shut down.
So, that's the reason why she's being hydrated so that she can, in fact, hopefully they can make sure her kidneys start to work again.
KAGAN: And the finally if you could take us inside of your world for just a moment. This is a very public battle between the family members, between the husband and the immediate family. It's public. And yet I would imagine in your world, you see this type of struggle about what is best for patient to take place many times.
KINZBRUNNER: Yes, that's correct. In hospice our philosophy is to try to work with patients and families and help them come to consensus around these issues. We not to be judgmental and we try to help them work through these issues as family groups so hopefully we don't run into these kinds of contentious situation.
And usually we're successful in resolving them so that we can ultimately do what's in the best interest of the patient based on the needs that have been expressed by the patient while they were able to and by the family as a group at that point.
KAGAN: Because there has been already so much pain all the way around, people, I think, trying to do the best they can.
KINZBRUNNER: That's right.
KAGAN: Doctor, thank you. Appreciate it. You answered a lot of questions people had in Terri Schiavo's situation.
KINZBRUNNER: You're welcome.
TO ORDER A VIDEO OF THIS TRANSCRIPT, PLEASE CALL 800-CNN-NEWS OR USE OUR SECURE ONLINE ORDER FORM LOCATED AT www.fdch.com
