Showing posts with label quack. Show all posts
Showing posts with label quack. Show all posts
Sunday, July 13, 2014
Thursday, March 27, 2014
How IHRT started ~ Adhesion Related Disorder International Human Rights Team.vs Endogyn Kruschinski
IHRT was founded in 2003 based on words of "Miracles" coming out of Germany.
IHRT embraces our first amendment right to free speech ~ Satire and parody have served for generations as a means of criticizing public figures, exposing political injustice, communicating social ideologies, and pursuing such artistic ends as literary criticism. Satirists usually find themselves subjected in turn to criticism, contempt and, sometimes, lawsuits.
The First Amendment protects satire and parody as a form of free speech and expression.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
In the beginning....
Saturday, May 07, 2005
Dawn Rose blows the whistle on Frankfurt……..
Dawn,
You just won't quit will you? I hope you are enjoying yourself. If anyone said anything to Daniel it was due to the fact that you and others were discrediting his work "behind the board".
I have emails to prove so. I am really tired of your game and I am sure others are as well. You hate the work we are doing because you see it as a threat to your first love: the IAS. The IAS
has been behind you and certain other people, but the IAS does not support people that have a heart to HELP the ARD patient. If they did, they would not be fighting this new work so very hard.
I never said a word about you not singing Daniel's praises, I was too busy singing my own. Dawn, I personally did not care what you were or were not doing.
Rules, rules, rules. I never read any of them. My heart is for the person begging for help. You can't even
decide WHO you are really out to attack. We are connected to Daniel, so go for it. Make a name for
yourself.
You paid money to join this club?? It did not cost me anything.
I am sure you have swam with much bigger sharks, as you seem like the type that would.
God help you, Dawn
[Edit by gingirl on Saturday, July 19, 2003 @ 05:42 AM]
----- Original Message -----
From:
To: "Dawn"
Sent: Thursday, June 12, 2003 12:14 PM
Subject: Re: Need guidance
Dear Dawn,
How are you, I hope you feel better ?
I would like to comment and to ask you if you like to continue to be on
my website as one of my patients contacts... (In your last email you wrote:
I still feel like a million buck compared to before. I have not spoken a
word of this to anyone nor will I as I get letters all the time and tell
everyone to go as you are their only hope and the relief is amazing.)
Dawn, Once I told a patient from Netherlands to go to my website and to contact one of the patients contacts and she contacted you and asked you about me. She send me your reply and it was one that directed her to another surgeon.
Today I got an email to look what advices you give on the IAS
Message board.
( Dear Elaine, Welcome, You are not crazy....if you have had prior surgeries you may indeed be suffering from ARD. A great way to check is to get your operative reports and see if adhesions were encountered during >the surgeries. If you need help locating a doctor in your area who is sympathic to the plight of the ARD sufferer, a great resource is in the support section under worldwide support listed by county and states. Hopefully you will find and IAS contact person in your area. If not you could contact Dr. Wiseman, the founder of the site. He may know of a doctor that is sympathetic to and understands ARD. He has many emails to answer and is very busy but he eventually will get back to you...he always does. An advocate should be able to help you though. Hang on, there is hope. Much love Dawn )
Dawn, I really don't believe that this kind of answers are a help for adhesion
sufferers as the exactly send them where there is NO HOPE... To
surgeons who perform surgeries after surgeries with no or only a litte
success results. Adhesion sufferers are the most complex, complicated
patients to treat. Surgeons who knows that adhesions are coming back
in a large number of theirs surgeries or that one who are gynecologic
surgeons without experience in bowel surgery, are harming the patients
knowing about alternatives. Could you explain if this is your intended purpose ? I have no problem if you continue to do so, then let me know and I will
take you out of my contact list for US.
KInd regards
Daniel
Daniel Kruschinski, MD EndoGyn® Institute for Endoscopic Gynecology
From Daniel
To: Dawn Rose
Date: Fri, 13 Jun 2003 19:37:07 +0200
From: Dr.Kruschinski@t-online.de
To:Dawn <>
Dear Dawn,
I got a little confused by your answers on the board and that you say, patients should ask Dr. Wiseman for further help and should search in the IAS website and so on. I mean, you should tell people to see where there are good results and help. Of course it doesn't work always but in many cases. The techniques I'm using are so extremely
important for adhesions sufferers as they show, at least in my hand,
better results than every other surgeons technique. About such
techniques it should be written and recommended to patients and not to
say them to go for gas laparoscopy with gas and no SprayGel...
I don't need everyone posting about that but it's nice that some are
doing it and patients remember to ask me and send me emails... This is
the result of Karen's and Carolyn's posting and I am able to provide much more patients with a successful adhesiolysis than ever before.
Every week there are two new victories against adhesions. And please
show me another surgeon who has the same results !!!
Why can't you all work together and keep up posting about gasless
laparoscopy and SprayGel ? Why it can't be posted about the doctor
who has till now the best tools and techniques and results for
adhesion sufferers ?
I won't be glad, if David Wiseman will stop patients posting about
this successes and then I probably will go out of the IAS.
My priority is surgery and this is what I'm living for. I don't have
any other interest in my life except surgery and changing concepts of
surgery that went wrong... I even don't have the time to deal with all
the problems, my closest family, like Shirli, my kids and some others
have... I'm a work-o-holic and yes, I'm fanatic (this is what Shirli
says) in my visions of a better surgery, to provide doctors with something that
they did a mistake in (CO2). And I will continue to provide ARD sufferers with best results. But I was counting on you as you were kind here and you spoke so
much what you wanted to do as a patients advocate, like to make fundraising and some other things... Anyway I hope you fight your pain, probably you are right with that
the ovary could be the cause of your pain... and probably it should be removed and replaced bya hormonal replacement therapy which could be controlled much better than the ovary.
Thank you
DAniel
Daniel Kruschinski, MD EndoGyn® Institute for Endoscopic Gynecology Seligenstadt(Germany)
============================================================
From Daniel
To: Dawn Rose
Dear Dawn,
I'm not angry at you. My vision is that YOU ALL cooperate together and
make my dream come through, that gasless laparoscopy is a better
tool for laparoscopic surgery.
If you send me the records I could see if I could help. But how do you
want to tell her to fly if she doesn't want and how to collect the money ?
Regards
Daniel
Daniel Kruschinski, MD
EndoGyn®
Institute for Endoscopic Gynecology
"The world is too complex for simple solutions..."
or"The world is very complex that only brilliant simple solutions will
succeed ...
----- Original Message -----
From: Karen Steward
To:
Sent: Thursday, June 26, 2003 2:10 PM
Subject: date
Hi to all,
Daniel has asked me to contact people that have had surgery with him
and request that you fill out the data form on the IAS site. I know I don't have
everyone on this list; however, will get others email addresses and send to
them also.........
Karen
From Daniel
To: Dawn Rose
----- Original Message -----
From:
To: "Dawn" <>
Sent: Monday, June 30, 2003 5:53 AM
Subject: Re: Need your advice
Hi Dawn,
This is a follow up on your surgery. As some time passed, I need
to collect some data. Please be as helpfull as possible to determine
all the issues.
Actual date:
Name:
Surgery date:
Second look date:
Average Pain score (0 - 10) before surgery:
Average Pain score (0 - 10) after surgery:
Pain medication before surgery, which and how much:
Pain medication today, which and how much:
Activity before surgery (0 - 10):
Activity after surgery (0 - 10)
Bowel movements before surgery:
Bowel movemnts after surgery:
Re-surgery becuase of adhesions ?
Bowel obstruction ?
Surgery for other indications than adhesions:
Daniel Kruschinski, MD
EndoGyn®
Institute for Endoscopic Gynecology
"The world is too complex for simple solutions..."
or "The world is very complex that only brilliant simple solutions will
succeed ..."
----- Original Message -----
From: "Dawn" <>
To: "Beverly J.Doucette" >
Sent: Thursday, July 17, 2003 11:33 AM
Subject: My PUBLIC message on Daniel site
Posted Friday, July 18, 2003 @ 00:34 AM
>
> While reviewing my operative reports that have been stowed away for some
> time I have some urgent questions that all have a right to see answered
> here.
> I feel I am pretty well educated as a lay person with ARD and I seek
> further clarification as to what happened to me.
> What do you do to acheive meticulous hemostasis? I see many blood clots
> and they are covered over in spray gel. I also see that you introduced
> gauze into my abdomin.
> I quote from my operative report"after securing hemostasis at all the
> surgery sites, Spray Gel Was applied to all the adhesiolysis areas, in
> total 6 kits of spray gel were used. After rinsing, a small amount of
> ringer fluid was left behind and an intraabdominal drainage was
> introduced into the abodomen" why did you put this drain in? I see no
> scar from it, where did you put it. Why add ringers after spray gel?
> would this not dilute it. I am seeing these blood clots covered with
> spay gel. Does not meticulous hemostasis before the introduction of
> spray gel give us the best chance? My second look op report states"
> Situs: the peritoneum all over was reddish and covered with old blood
> (reaction to the spray gel?)" Where'd all that old blood come from. Now
> I am going to tell the world I am sure I have adhesions back. I know
> what they feel like. I have written to you several times with my
> concerns and you were mad that I was not "shouting it from the rooftops"
> Your last personal email to me said " Good luck with fighting your
> pain." I am not the only one having problems either! I have remained
> silent untill now thinking I will have to return to you as you are my
> only hope. I don't think that anymore. With out valid answers to these
> questions why would your surgery be any different than the others we
> have been through? I offer my operative report to any who wish to see
> them. I am patient # 10 from the US. I urge others to break their
> silence and review their operative reports. I am happy you have this
> site Daniel but unfortunatly it's not going to be all smiley face icons
> and we have a pal for a doctor. These are matters of life and death! We
> have enough friends now lets hear from our doctor. To any who wish them
> I will email you my operative reports and the pictures so you can see
> for yourself.
> Thank you for facing these tough issues,
> Dawn
=======================================================
From Daniel
To: Dawn Rose
Posted Friday, July 18, 2003 @ 02:18 AM
From Daniel Kruschinski
to Dawn Rose, Mass.
July 2003
Hi Dawn,
I knew that some of you will cause trouble, induced by others ..
To answer your questions is very easy and I will do that, but please don't say untruth things here: First I never wrote back to you "Good luck with fighting your pain" !!!
This is what I wrotea as a part of my message to your from June 13, 2003:
"... Anyway I hope you fight your pain, probably you are right with that the
ovary could be the cause of your pain... and probably it should be
removed and replaced by hormonal replacement therapy which could
be controlled much better than the ovary.
Thank you"
This was a logical advice to your email. And it's not true that you contacted me so many times about your condition, I have nice aemails from you and even from your daughter about you joining the life now and one about that you are in pain... and I have a copy of them, so I can show it to everyone.
OK, now to your Questions:
1)To achieve hemostasis we have a wonderful instrument, the bipolar scissors, which comes from laparotomy and can be only used in gasless laparsocopy. With this instrument you can achieve a very good hemostasis.
2) Gauze is not used in the surgery, only a sponge which does help tp make the preparation very easy and doesn't cause any problems. It gives me the same tools as in laparotomy (which are anyway better than the long ones from laparoscopy where the surgeon doesn't feel what he is doing... he loses the tactile sense of his hands... so he is a surgeon without a hand ...)
3)The drain is important to recognize bleedings after surgery and by this drain the little ringer which I put inside disappears. Why I put a drain because I want to see the bleeding which can occure after every surgery, even by one who doesn't put the drain ... so in by this I can earlier plan an additional intervention if there is a bleeding...other doctors without a drain deosn't recogize e blleding at all...
4)The body / peritoneum answers to everything that is a foreign body (SpraGel is also one) with inflammation and some blood escape... individually in some patients more in others less, this blood is already without any coagulative substances so it can’t coagulate and so thus can’t cause adhesions as it doesn’t contain fibrinogen... Nothing to worry about, this is not blood that makes adhesions, this is a peritoneal fluid and is reddish and as it can’t escape while it is covered by SprayGel, it shows exactly the reaction I describe in the operative report and which shows a “healthy”, smooth and shining peritoneum with neovascularistion ! The inflammation is exactly what we want, it causes a neovascularisation (new vessels are building and bringing Oxygen and high blood supply to the wounded area which heals by this quicker... !!! And this I can say as I use very high amounts of SprayGel and have the most experience with using many kits and not only two...
Adhesions can come back after every surgery, even after mine, I never stated that we have 100% adhesions free patients... Also pain can be related to other organs or issues thany adhesions... Medicine is never 100 % as we know, so some might develop adhesion and some others not... but with the combination fo both, gasless laparoscopy and SprayGel I still have the best results...
So Dawn, you are still welcome to perform a third look as done by Lisa Graven and than we could detect if adhesions came back. This would be also good to know, as no procedure is 100 %, we are not magicians, we are humans, and we might mistake in our theories about adhesions, as adhesions are the “chameleon” of the surgical treatment and there are plenty of doctors who don’t touch this patients (as you yourself know). I’m at least trying to help and I helped many of ARD patients ... If I can heal at least one or two it is worth to work on it and to work out how and what to do better in the future, so you could help to educate my self even much more in my undertakings to fight adhesions...
Many kind regards and I’m sorry, you are trying to fight me, but I know it’s someoen else behind you... it is not you that is trying to do so... But I have the right on my side so I’m not afraid and I’m not going to remove your post like some others would do and did already on other boards... this is a free seech board and everyone can post anything, also bad things about me. This will give me the opportunity to answer officially and not get fighters behind my back ... Still your friend
Daniel
===============================================================
---- Original Message -----
From: Beverly J.Doucette
To: Dawn
Sent: Thursday, July 17, 2003 5:48 PM
Subject: RE: Your response to Daniel and Karen..
Hello Dawn,
I know your upset, and you do have a right to ask more questions as sometimes answers lead to more questions!
Here is the best way to answer Daniels email and Karen’s as well, all in one.
Stay strong, don't react, your doing what you have a right to do, if you had never met me, you would have a right to ask questions of Daniel! Remember that! Do not allow Karen to blindside you now, she is wicked with a bat, but miles away from you so your safe, her words cannot hurt unless you think they are true, and they are not.
Both Daniel and Karen are using an old psychological ploy called a, " smoke screen!"
This means that in order to avoid dealing with issues they are responsible for, they will trey to bring OTHER issues into the conversation so that your time and energy are used to deal with those lesser issues and issues with out basis so that you forget the REAL issues at hand and are more apt to focus on the crap stuff then your real concerns, thus they get out of being held accountable for what they are responsible for!
IN this case, nothing your saying is your words, thus they are not taken seriously, and Daniel uses words like "troublemeker" as it demeans you and flusters you, name calling is always a great smkoke screen! :-) Accusations will also throw the focus off the real issues as the person then spends time defending themselves and all other pertinent issues get lost in the garbage of defense.
Daniel is a pro at this stuff...and then to use medical descriptions of equipment..give me a break! And the medical physiological terms about the "body / peritoneum answers to everything that is a foreign body (SpraGel is also one) with inflammation and some blood escape... individually in some patients more in others less, this blood is already without any coagulative substances so it can’t coagulate and so thus can’t cause adhesions as it doesn’t contain fibrinogen... Nothing to worry about, this is not blood that makes adhesions, this is a peritoneal fluid and is reddish and as it can’t escape while it is covered by SprayGel, it shows exactly the reaction"
This is okay for them to do as long as you understand it..okay? Nothing to react to..unless we do it intentional, like below!
You can call me if you like...I will be sending Daniels explanations to Confluent and either Tom will get to you or he will get to me. May I give him your phone number please?
I am so sorry you have to go through this with Daniel, and I am so sorry your not well, but I will try to help you as much as possible! Stay strong! Bev
=============================================================
From Dawn Rose
to Daniel Kruschinski
July 2003
Hello Daniel, (and Karen)
Daniel, you have no idea how upset and scared I am that I may have adhesions back! I have thought it for some time, and we have talked or rather communicated about that, maybe it was not as often as I stated, and maybe your words were as you said and I read them the way I saw it, remember, I am not as well as I hoped I would be, I cannot see any way I will ever be able to get back to you and who can I turn to here for help..no one! I am desperate and in pain! Then I hear you saw that yes, it could be the ovary, and I had gone all the way to Germany only to return with this message telling me I still have problems! Yes, I saw red, and I feel sick that I have problems that may need surgery, I thought I came top you for all that only to hear you tell me that the ovary might be bad....
how will I ever know as who here can do a surgery...I am sick and afraid of adhesions...and now you say I am making trouble because I need answers!
I fell like I am starting all over again here, begging to see a Dr. for what..diagnostic tests to tell me I have nothing wrong with me, start taking pain meds again.and talking to you IN Germany doesn't help me get medications here in the USA!
Others putting me up to dragging out my operatives from Germany now that you have a message board but not before that..well, if you must know why I dug them up now it is because a patient of your just returned NOT WELL at all and having a fit because I sent her over to you! She is angry and seeking answers to HER operative reports from every DR. and surgeon she can! And she blames ME for all of this and for wasting her money too! Karen, say what ever you want about me trying to make a problem, it IS a problem to be sure, and yes, someone is behind it all, but NOT who you and Daniel think it is. You want to blame Bev for everything, she says so be it, it is okay. She never mentioned anything about Daniel to me or on the IAS, always answered my concerns in private as your saying to do, and yet never putting Daniel down, even stating I might have to go back to him!! Karen you did all the public name calling and blaming..never Bev! I mentioned her name one time on the IAS, which I regret and apologized to her for doing as she had no part in it all, I did that, but she wanted no retractions at all, just to be left out of the public display!
I have talked to Bev about this recent issue with this patient because this patient didn't want to talk to Bev, she allowed me to send her operatives to Bev and asked questions. I have no idea what has transpired since then as Bev will not discuss this persons case with me and this lady is very angry at me...I dug out MY reports to show this lady that I was sorry for not being upfront with her as to how I felt and that her decision to go to Germany was based on my lies, etc...I told her I would share everything with her, I feel terrible guilt Daniel and Karen, terrible guilt for not telling her how I really felt! THIS is why I had my reports and pictures out, to send to her!
I asked Bev to look at MY reports and explain them to me in medical terminology so I would know what to say to this lady..and Bev actually said the same things that you just told me, and she pointed out that there was "old un-oxygenated blood" in the first pictures you took at the start of the initial procedure and that there were lots of adhesions, and of course that blood left in the cavity very well could cause adhesions, but to keep on mind that I did not have a barrier used here in the states so one would expect adhesions to form! Then she explained that there appeared to be blood in the cavity prior to you applying the Spraygel, but maybe you picked that out before the application of the Spraygel. (She explained that Dr. Reich picks the blood out at the end of the surgery as well as aggressive irrigation.) Then I asked her if I might have adhesion again if blood was left in and that I saw what looked like a gauze pad in two of the pictures and that gauze can cause adhesions to.
Bev, yes, Bev told me to email my questions to you, I also asked her about a drain, she told me to ask you as how could she know if I didn't remember having one and had no site where it would be how could she know. If it is in the report, then she said I had one, but to ask you as she can't know where it came out of!!
I know I come on strong and angry, but I am causing trouble because I now need answers, and now I get out my reports, it is Bev's fault? And I should tell who this person is when she asks me not to tell you yet she is screaming accusation at ME for not being honest to her and now she is WORSE then when she went over to you! This is BEV'S fault and I am making trouble induced by others!! IF only Bev would give me some time and answers, she too thinks I didn't do the right thing, yes, Karen, I too got that email!! I feel guilt, and I did wrong when this lady contacted me before going to Daniel, I WAS the cause of her wasting her money and coming back very ill! This is how I feel....and I am making trouble Daniel?
I can't afford to come back, Daniel, I am desperate and I am scared, and you don't need to tell me I don't know what I am doing and have to be "put up to it" by anyone else! I choose to say what I did to this lady, no one but me, and I did wrong. No one put me up to saying how wonderful you were when I did feel well, and even when I didn't..not even Bev put me up to that! I did it...so Daniel, give ME credit for knowing what I am doing when I write to you!
I know you can show patients emails to everyone, you did that with Lisa, remember! And Daniel, I WAS well and thought I would stay well, but now I am NOT well, so what do you ant me to do, shut up and suffer? Write happy faces all over my emails?? And I AM guilty of lying to this lady...happy faces on that too!
Your report states you achieved hemostasis, what I am asking is if that means you remove the blood clots I saw in the pictures, it doesn't matter to me the instrument, I have no idea what that even is, all I want to know is if you cleaned out the clotted blood before the application of Spraygel, that's all I am asking. I am trying to figure out if I now have adhesions..and did Spraygel make me bleed as it states in your report? If it did, how can I use it again? Why did it make me bleed?
The pictures of the blood were before the Spraygel was put on Bev said...is that true? ( And she said to ask you, she was not attacking you or anything!)
I saw a gauze pad in two pictures, that's why I asked about them. Can't I ask that without being a troublemaker?
If there is bleeding after surgery, won't adhesions form?
And I asked WHERE on my body the drain was. This lady said her drain was in her side, I didn't know I had one and told her that I didn't have one, only to read on my reports that I did, now she thinks I am lying to her again!!
Now I am confused again, inflammation causes adhesions we all have heard...and now you say I had inflammation too? I do not understand anything about the bleeding or blood part, but I asked Bev to explain it, just so you know, and she said she had to forward it to Confluent as it was all news to her and it is best someone there answers these issues, not her!
Is that blood clotting gone now do you think or did I get adhesions from them again??
Daniel, you said that each second look was 100% clear of adhesions, mine too, what does that mean then? I fear having to live with adhesions again, and I did believe that you had 100% success, maybe you did not say it but I was led to think that!! Maybe from Lisa, I don't remember! I am so afraid of having adhesions...
I don't see how I will ever get back there to you, I am so frightened, and you can keep saying someone is behind my words, Daniel, it doesn't matter, the real issues are that I think I have adhesions again, and when I got out my reports to send south, I asked Bev to read them and explain them to me. She did NOT put your surgery down, nothing like that at all, she explained what she knew, told me to email you and said I might have to go back to you too, as this other lady is supposed to do! Bev told me nothing different then you just did! But Daniel, I can't get back to there, and I do not trust anyone here! It doesn't matter what Karen says, I told this lady a lie, and that I didn't have a drain, then it is on my report...Bev told me to ask you about it, not her! I do not want Bev to dislike me, she helped me get to you...but I think she doesn't like me anymore then the others! Think what you want, Karen too, but it doesn't change my worry's and my needs!
I didn't do this behind your back and even if I asked the question in the other area to ask you stuff, everyone will see it anyway, so I wrote it here! I do NOT want to ever be accused of not being upfront again, and Karen even if you don't like that I ask Daniel questions publicly, to bad as this is how I am going to always do things, upfront and open and honest! I lied once and caused a serious problem for someone, maybe others too, but for sure one person, I will never do it aging, even if you don't like it! I am not you Karen!
Daniel, you make it sound so simple to just return as Lisa did, but I am a single parent with an ill child and no money...and how do I know it would even work a next time? Your right, nothing is 100%, but what about IF blood left in after surgery does create adhesions?? What about a drain tube creating adhesions and bleeding after surgery..creates adhesions...do I get a laporoscopic procedure done here to see if there are adhesions and not allow for any to be lysed? Is that possible to do?
Aside of all the garbage and accusations, what do I do?
You accuse me of making trouble because I ask questions, do you say that to me so I do NOT ask you questions? Why is that making trouble, Daniel? Is this why other patients don't approach you with their issues or IS everyone well except for me and this lady who just returned, and Lisa, and Sally?
I need answers for me, for me, Daniel...and if your message board can't handle truth but only smiley faces and praise..then it is not any better then any other message board that wants to be perfectly sterile and "happy" al the time, which isn't what ARD is all about all the time! To bad..you did my surgery, I have my op reports out and I need answers..and not in such a medical jabber that I cannot understand a word of, tell me in layman's terms please. That is considerate and more helpful then this email. Karen, stay out of this, YOU never had a surgery with Daniel so how can you talk to me that way..I am suffering, not you, you cannot know what I feel at all as you do not have to face this, your daughter does! It is no wonder to me she is not around to post, she got well and then ran miles away from you being overbearing in her life! Stay out of MINE!
Karen, you attacked EVERYONE on the other message boards at every post that you didn't like, now your going to start it here again?? Thats okay with me, I am going to ask my questions to Daniel as MY money was as good as anyone elses was and I deserve answers to MY questions!
( Daniel, this is part of a report I have in MY files...MY files, Karen, I can read and I understand what this says!!! Maybe it is wrong, but this is what I read.)
Cont: AETIOPATHOGENESIS OF ADHESIONS
The omentum plays a protective role in adhesion formation. Adhesive obstruction after colectomy is well known. This is because the operation involves, omentectomy and this will remove the organ that forms safe adhesions. As a result it would leave adhesiogenic areas exposed to the small bowel and will result in higher incidence of small bowel adhesions.
Another significant factor is a frequent practice to divide any adhesions that are total encountered. The division of adhesions which involves the small bowel are at a high risk of later obstruction.
PREVENTION
As yet there are no definite methods of completely preventing adhesions. The two commonly used solutions that have anti-adhesive effects in animals povidone iodine and 30% dextran 70.[13] Povidone iodine is used by surgeons more for its antimicrobial action rather than that of its anti adhesive effect.[11] Dextran is a popularly used solution in gynaecologic practice to prevent adhesions in infertility surgery.
The most important way of preventing adhesions is by meticulous technique.
The following are a few operative steps which could be undertaken to reduce the incidence of post operative adhesions.
Careful handling of the bowel to reduce serosal trauma.
Avoid rough unnecessary dissection.
Avoid contact of foreign material from the peritoneum e.g. use of absorbable material as far as possible, avoid excess use of guaze swabs, or wearing starch free gloves.
Adequate excision of ischaemic or infected debris within the peritoneum.
Preserve the omentum as far as possible. Placement of omentum around the site of surgery and run the omentum under the wound to encourage low risk adhesions to form.
Avoid dividing adhesions which do not involve the small intestines.
============================================================
From Daniel
To: Dawn Rose
----- Original Message -----
From:
To: "Dawn" <>
Sent: Sunday, July 20, 2003 3:05 PM
Subject: Re: your attacks
> Hi Dawn,
> I feel sorry for you that the drugs drives you crazy, but I would like you
> to answer my questions: Why are you doing it ? What have I done to
> you ? Why are you slandering me ? For what reasons are you lying ?
> No one of my patients was near to dy, this is really hard... to see one of
> my patients speeking such crazy things... as I am always trying to have
> avery good relationship with my patients... Why didn't you continue to
> communicate with me after June ? You stopped the communication
> after Beverly told you to do so... I really don't want why you as a adult human that I have done so much for, have to act like this... if you continue ... than I wish I would never
> have met you... if you think you can stop this mess, please come back to me.... there is nothing wrong on what I'm doing...Let's come together again, let's try at least to behave like intelliegent adult human...
> Regards
> Daniel Kruschinski, MD
> EndoGyn®
> Institute for Endoscopic Gynecology
===============================================================
Original Message -----
From: Beverly J.Doucette
To: Dr.Kruschinski@t-online.de
Sent: Sunday, July 20, 2003 9:38 PM
Subject: Re: your attacks
Dear Daniel,
What is THIS all about? My name has been tossed around the IAS and now in this email to Dawn Rose...Daniel, I have nothing to do with Dawn Rose other to tell her TO email YOU with her many questions! Dawn emailed me with her operative reports as week or so ago asking me to explain them to her as she was sending them to one of your recent patients who just returned...I answered some questions, but then told her to deal directly with you as I did not want to get into the middle of anything between Dawn and the patient!
This lady was VERY irate at Dawn and demanded that Dawn answer questions about things that Dawn told her prior to the lady coming to Frankfurt! Dawn wanted ME to speak to the lady, and I did, but only to tell her to communicate with you. This lady also said that I misrepresented Frankfurt by telling her that I would go there myself if I couldn't get Dr. Reich. This I did say to her, but that was before I found out that not everyone returning home and saying they were 100% well were actually NOT doing so well after all. I was a victim of this misinformation the same as she was! I have NOT spoken to the lady since! ( And I will not either!)
This is what Dawn explained to me prior to asking me to look at her operatives and why she asked me to do that!
This same lady called Dawn a lire and a fraud, Dawn told her she would let her see anything she wanted to see regarding Dawns operatives from Frankfurt, as Dawn felt guilty I guess...Dawn told this lady something about her ( Dawn) NOT having a drain tube post surgically, and then when Dawn found her operatives, it stated she did in fact have a drain, so the lady once again called her a lier and said Dawn scammed her for "pushing" Frankfurt!
Dawn feels terrible, she asked me to look at the operatives, and I did, she asked where a drain would have been if she had one, which she says she doesn't remember, that is when I told her to discuss her issues with you as I do NOT want to remain involved with anything to do with Frankfurt, and I told that to Dawn well over a week ago! I do commend Dawn for trying to make amends with this lady by trying to be honest with her now....
This same lady also says that Lisa Graven scammed her after I referred her to talk to Lisa about Frankfurt, so it was MY fault again! I want no part of any of this, Daniel!
And to see my name used in this manner here when I have neither posted anything negative about you or your procedure on the IAS or anywhere else...what some of your patients did was wrong Daniel, whether you like it or not, they were not sharing current information about their current health, be it adhesions or not, and people felt that they were not hearing the truth prior to going over to see you! I emailed my issues to YOU and to the women who reported that they were well, when in fact they reported elsewhere that they were NOT well!
False reports posted public for all to see and to use in making a decision as to where to seek a surgery, is not something that I want to see happen to victims of ARD, and I don't think you did either! It is always best to report how a person is feeling and living after ANY adhesiolysis so that others do not have false expectations when they elect to go to a certain surgeon!
NOT one time did I ever mention anything about your surgery, Daniel and never did I ever go public with this issue, the other ladies did that! I never saw your procedure or skill or compassion as being anything but that it is, decent and offering a good chance of improvements from ARD symptoms! What I take issue to, was the women not sharing the truth! A simple as that! You can look back many months in the IAS archives and you will have seen me post maybe two times in that year..and it was never to put down or slander you or your procedure, Daniel!
Daniel, If anyone wanted to see Frankfurt go, who do you think that would be??? Perhaps me a little bit, I was the one who introduced Frankfurt..of course I want to see it be productive, but only with honesty and respect, and some of those you choose to speak on your behalf, well, they remain less then of moral charachter! Not just MY thinking, Daniel, they were caught in dishonest behavior, and now they are very unhappy with me for asking them to be honest to thier fellow ARD sufferers and speak the truth, and they all did, but they also all left the IAS for some reason, shame I am guessing, and then stating that they were thrown off by Davie, that is not truth again, and people can see that...and it was again, from thier own mouths, Daniel, not mine!
I don't think you want to secure patients by former patients not being honest with them, Daniel, and that is what happened, and that is what is behind the issues with Dawn, I am sure! ( At least what I knew, this other stuff I have no idea about !!and I don't want to know either..leave me out of all this stuff, all of it looks CRAZY to me!)
I have not posted on the IAS for ages, and I do not plan to start now! I do not need nor want anyone to post for me, in fact, Dawn Rose DID post something about me in response to someone calling me a lier etc, etc..and I emailed Dawn to never use my name again unless she has permission from me, which she did not have! I don't care what any thinks I am doing or did, that is the least of anything that bothers me, because it is said doesn't make it fact, and your words here are far from being fact, Daniel, as why would I care if Dawn Rose emails you?? I hardly know her! I'm going to take MY time to deal with her issues and the other ladies issues?? Why would I do that? Remember, I also sent that email about not being honest to Dawn as well as the others, and she wasn't honest, non of them were, so why in the world would I NOW deal with her?
My God, Daniel, I have no idea what all that stuff is that your saying in this email!! About someone dying??? Who is sandering you, it isn't me!! I haven't emailed you sice that issue with some not telling the truth..and that was NOT you, it was them! How is that slandering you, Daniel??
I am not aware at all about any contacts Dawn had with you at anytime...now or before June! She doesn't email me Daniel...only to see her operatives and to tell me she was trying to be honest with this lady now! I am NOT interested in her trying to be honest now, or any of the ladies, they did share the truth, and it has offered and allowed prospective patients to ask more questions of them and hopefully you, so that when anyone comes to Frankfurt, they are prepared fully as to what to expect..and it is NOT all" miracles" as these ladies were saying over and over and over Daniel..it simply wasn't! Maybe you didn't know that these particular ladies ( Karen, Sally, Dawn. Lisa, & Carolyn) where telling people that there were 100% success's coming our of Frankfurt, and that they were all well..given Karen speaking for her daughter, then I hear that this is NOT the fact, and emailed you and them to begin to share the truth so others who elect to go to you will not have unrealistic expectations, as this lady now states she had because these same ladies, and ME included, falsified information about Frankfurt!
Daniel, I have not dealt with anyone or anything to do with Frankfurt since my email to you and to ONE time look at Dawn Rise's operatives, and tell her to go to you with her issues! I want out of ALL ARD issues...not because of you, David Wiseman or anyone else, but this lady is going to cause some trouble, Dawn should worry, as should the rest of those women she talked to or who posted false information, if this lady and her husband decide that they were frauded by them ...they are all in deep trouble! Not you, Daniel, as you did not make the statements that everything was 100% success's, and neither did I as I was advocate for Harry only!
I will also share that I was saddened when Karen would attack anyone who talked about any other surgeon or surgery or that they could not get funds to go to Frankfurt, she hurt so many innocent people who are the victims living with ARD, she doesn't live with that pain and suffering the same as the victims do, yet she was unmerciful in her behaviors to them! This was sad as you were trying so hard to open the doors in Frankfurt...and that type of behavior was only serving to close them! I am not sure if you know this or not, but their appreciation of your skill, went to far and they became dishonest backers of you...not it is difficult even for me to get excited for Helen surgery with you, as I wonder if the second looks really were all 100% free of adhesions, and once I found out that a number of your patients were not well after some months, be it adhesions or not, I will wait and hold my breath as time goes by for Helen...praying and hoping that she will be one of the fortunate ones who had your adhesiolsysi, many are well, ( I THINK!!) and may Helen be among them, Daniel! I know you did your best with her, and God, I pray she will have success to a great %!
I cannot be to optimistic since the ladies didn't tell the truth, I too feel like a victim of their over zealous words....but this is NOT your fault Daniel, as I have no doubt that you did not know they were saying such things!
I cannot stop anyone from using my name or placing suspician on me for things..but that doesn't cause me to do anything different as I am not doing any of it anyway! Maybe you would be best served to look at issues as if that patient or person or whomever you think is not acting on their own, as Daniel, in the case of Dawn Rose, it is not me, so deal with her and hold her accountable for whatever it is she is doing....and use me if you want to, but you will never be able to deal with the reality of the issues as she states them or does them, as she is doing them, not me, and it seems you have some issues here...I wouldn't touch this with a ten foot pole! You know, I am NOT even curious as to what the hell this is all about, my name in it or not, I don't want to even know about it!!
Good Luck Daniel, and unless you have proof I am doing something, Daniel, keep me out of it. Beverly
----- Original Message -----
> From: "Dawn" <>
> To: "Beverly J.Doucette" <>
> Sent: Sunday, July 20, 2003 6:01 PM
> Subject: Need assistance or the shot heard round the world.
>
Holy crap Beverly.......it is the shot heard round the world...leaves me
> > all a bit nausoues....but anyhow I am done with the posting
> > part........and ......um I think David is going to be pissed at me as
> > Karen came gunning for me over on the IAS...well I guess you'll see....I
> > am a bit ashamed I was so nasty but whats done is done........I think
> > the message got out to more that I ever imagined.
> > What I need help with is......well.......maybe David might not want to
> > hear my voice right now as Karen is all over him demanding I be banned
> > from IAS as well. I need my second look pics and as best I know, David
> > has the only copy.......it is probably sitting unopened in a pile some
> > where.....but Jo and I are going to compare pics of our adhesiolysis...I
> > think they should have this as they are concerned and "got it"....I am
> > sure that David would not go out of his way for Jo....but they are our
> > sister too.
Thank you again so much.... Thank you, Love, Dawn
Original Message -----
From: "Beverly J.Doucette" <>
To: "Dawn" <>
Sent: Monday, July 21, 2003 9:55 AM
Subject: Re: Need assistance or the shot heard round the world.
I see my email got to you to late, not that it is my business to tell you
> what to do, but I was out of town and got home very late last night to
> respond to your email.
>
> I see that you already posted..as did dear Karen...and I am not sure what
> you mean about Jo...xxxxxxxx perhaps?
>
> Please do NOT post anything that will open a door for Karen as she is
> spiteful and will hurt anyone who so much as gets in her way! So many who
> post and are attacked by her are innocent..posting anything that will elicit
> a response from her is not worth it. It is nauseating to be sure, Dawn.
> please do not post anything about Frankfurt, dear, speak to David about
> things before you post as if you feel your not getting answers from Daniel,
> perhaps David can answer them as well!!
>
> Like I said before, Dawn, please do not get caught up in any battles on the
> IAS as it only hurts us all. Perceived involvement or not, when our names
> are brought up like that, it hinders anything we might want to do or say to
> support other victims of ARD.
>
> These posts are said and done now...but try to think about not responding no
> matter how frustrated you are or if the issues are about Frankfurt and
> Daniel, take them to his site if nothing else. I cannot tell you what to
> do, and I did mention before not do anything on the IAS board that is
> negative, but now I am begging you not to keep it going, dear, please?
>
> I am not sure what you mean by got out to more then you thought?? I, this
> morning, got hate mail in my private email, and I had nothing to do with any
> of this. My involvement is perceived, even by Daniel mentioning my name all
> the time, so there is nothing I am going to do about it, but walk away from
> ARD issues, which is fine with me actually.
>
> But please Dawn, don't post negative things on the IAS, your a valuable
> asset to the IAS, try to talk to David about things before you post, if you
> will. One day someone will need your advice and you want to be there for
> them, and NOT be perceived as "reactive" shall I say.
I don't know what you and Jo will find, but if it is an issue for Daniel,
> take it to Daniel, I am not sure how, but you might want to talk to David
> first, he is really a wonderful person and will NOT be angry, he will help
> resolve your issues and he will want to do that before posts start a
> controversy on the IAS. I mentioned that before...and I will mention it
> again, please, I really, really beg you, Dawn, not to respond to anymore of
> anyone's ( Karen) posts on the IAS that elicit negative issues.
> Your message is well taken by those who see it, as long as you want to share
> what your story out of Frankfurt is, offer to do it in a private
> email...that is much better for both you and who ever requests any
> information about Frankfurt. It serves everyone better, my dear..okay?
>
> I don't know what to say, other then to ask again not to post about
> Frankfurt on the IAS, I have no right to ask that of you or anyone, but we
> have talked about it, and you know where I sit as to that issue, bickering
> on the IAS serves no useful purpose, and Dawn, you can avoid it and be just
> as effective in getting your message shared by using email, in fact, it will
> be taken more seriously then if seeing it posted in a public way, don't you
> think so? This makes me so sad, sick as you put it....it is past, but now
> you can stop it in it's tracks by letting it all fade away, at least on the
> IAS if you want to deal with Daniel and issues of his making, but you can
> let it fade away on the IAS, dear, please think about this. You probably
> feel worse now then before you posted on the IAS, and if that is so, then
> try not to keep it going.
>
> I have heard no more from XXXXXX, so maybe she is okay. I did put her in
> touch with a surgeon who she can ask questions of, nothing more either of us
> can do. You are free of her, Dawn....!
>
Take care now, I will help you too! Bev
You just won't quit will you? I hope you are enjoying yourself. If anyone said anything to Daniel it was due to the fact that you and others were discrediting his work "behind the board".
I have emails to prove so. I am really tired of your game and I am sure others are as well. You hate the work we are doing because you see it as a threat to your first love: the IAS. The IAS
has been behind you and certain other people, but the IAS does not support people that have a heart to HELP the ARD patient. If they did, they would not be fighting this new work so very hard.
I never said a word about you not singing Daniel's praises, I was too busy singing my own. Dawn, I personally did not care what you were or were not doing.
Rules, rules, rules. I never read any of them. My heart is for the person begging for help. You can't even
decide WHO you are really out to attack. We are connected to Daniel, so go for it. Make a name for
yourself.
You paid money to join this club?? It did not cost me anything.
I am sure you have swam with much bigger sharks, as you seem like the type that would.
God help you, Dawn
[Edit by gingirl on Saturday, July 19, 2003 @ 05:42 AM]
----- Original Message -----
From:
To: "Dawn"
Sent: Thursday, June 12, 2003 12:14 PM
Subject: Re: Need guidance
Dear Dawn,
How are you, I hope you feel better ?
I would like to comment and to ask you if you like to continue to be on
my website as one of my patients contacts... (In your last email you wrote:
I still feel like a million buck compared to before. I have not spoken a
word of this to anyone nor will I as I get letters all the time and tell
everyone to go as you are their only hope and the relief is amazing.)
Dawn, Once I told a patient from Netherlands to go to my website and to contact one of the patients contacts and she contacted you and asked you about me. She send me your reply and it was one that directed her to another surgeon.
Today I got an email to look what advices you give on the IAS
Message board.
( Dear Elaine, Welcome, You are not crazy....if you have had prior surgeries you may indeed be suffering from ARD. A great way to check is to get your operative reports and see if adhesions were encountered during >the surgeries. If you need help locating a doctor in your area who is sympathic to the plight of the ARD sufferer, a great resource is in the support section under worldwide support listed by county and states. Hopefully you will find and IAS contact person in your area. If not you could contact Dr. Wiseman, the founder of the site. He may know of a doctor that is sympathetic to and understands ARD. He has many emails to answer and is very busy but he eventually will get back to you...he always does. An advocate should be able to help you though. Hang on, there is hope. Much love Dawn )
Dawn, I really don't believe that this kind of answers are a help for adhesion
sufferers as the exactly send them where there is NO HOPE... To
surgeons who perform surgeries after surgeries with no or only a litte
success results. Adhesion sufferers are the most complex, complicated
patients to treat. Surgeons who knows that adhesions are coming back
in a large number of theirs surgeries or that one who are gynecologic
surgeons without experience in bowel surgery, are harming the patients
knowing about alternatives. Could you explain if this is your intended purpose ? I have no problem if you continue to do so, then let me know and I will
take you out of my contact list for US.
KInd regards
Daniel
Daniel Kruschinski, MD EndoGyn® Institute for Endoscopic Gynecology
From Daniel
To: Dawn Rose
Date: Fri, 13 Jun 2003 19:37:07 +0200
From: Dr.Kruschinski@t-online.de
To:Dawn <>
Dear Dawn,
I got a little confused by your answers on the board and that you say, patients should ask Dr. Wiseman for further help and should search in the IAS website and so on. I mean, you should tell people to see where there are good results and help. Of course it doesn't work always but in many cases. The techniques I'm using are so extremely
important for adhesions sufferers as they show, at least in my hand,
better results than every other surgeons technique. About such
techniques it should be written and recommended to patients and not to
say them to go for gas laparoscopy with gas and no SprayGel...
I don't need everyone posting about that but it's nice that some are
doing it and patients remember to ask me and send me emails... This is
the result of Karen's and Carolyn's posting and I am able to provide much more patients with a successful adhesiolysis than ever before.
Every week there are two new victories against adhesions. And please
show me another surgeon who has the same results !!!
Why can't you all work together and keep up posting about gasless
laparoscopy and SprayGel ? Why it can't be posted about the doctor
who has till now the best tools and techniques and results for
adhesion sufferers ?
I won't be glad, if David Wiseman will stop patients posting about
this successes and then I probably will go out of the IAS.
My priority is surgery and this is what I'm living for. I don't have
any other interest in my life except surgery and changing concepts of
surgery that went wrong... I even don't have the time to deal with all
the problems, my closest family, like Shirli, my kids and some others
have... I'm a work-o-holic and yes, I'm fanatic (this is what Shirli
says) in my visions of a better surgery, to provide doctors with something that
they did a mistake in (CO2). And I will continue to provide ARD sufferers with best results. But I was counting on you as you were kind here and you spoke so
much what you wanted to do as a patients advocate, like to make fundraising and some other things... Anyway I hope you fight your pain, probably you are right with that
the ovary could be the cause of your pain... and probably it should be removed and replaced bya hormonal replacement therapy which could be controlled much better than the ovary.
Thank you
DAniel
Daniel Kruschinski, MD EndoGyn® Institute for Endoscopic Gynecology Seligenstadt(Germany)
============================================================
From Daniel
To: Dawn Rose
Dear Dawn,
I'm not angry at you. My vision is that YOU ALL cooperate together and
make my dream come through, that gasless laparoscopy is a better
tool for laparoscopic surgery.
If you send me the records I could see if I could help. But how do you
want to tell her to fly if she doesn't want and how to collect the money ?
Regards
Daniel
Daniel Kruschinski, MD
EndoGyn®
Institute for Endoscopic Gynecology
"The world is too complex for simple solutions..."
or"The world is very complex that only brilliant simple solutions will
succeed ...
----- Original Message -----
From: Karen Steward
To:
Sent: Thursday, June 26, 2003 2:10 PM
Subject: date
Hi to all,
Daniel has asked me to contact people that have had surgery with him
and request that you fill out the data form on the IAS site. I know I don't have
everyone on this list; however, will get others email addresses and send to
them also.........
Karen
From Daniel
To: Dawn Rose
----- Original Message -----
From:
To: "Dawn" <>
Sent: Monday, June 30, 2003 5:53 AM
Subject: Re: Need your advice
Hi Dawn,
This is a follow up on your surgery. As some time passed, I need
to collect some data. Please be as helpfull as possible to determine
all the issues.
Actual date:
Name:
Surgery date:
Second look date:
Average Pain score (0 - 10) before surgery:
Average Pain score (0 - 10) after surgery:
Pain medication before surgery, which and how much:
Pain medication today, which and how much:
Activity before surgery (0 - 10):
Activity after surgery (0 - 10)
Bowel movements before surgery:
Bowel movemnts after surgery:
Re-surgery becuase of adhesions ?
Bowel obstruction ?
Surgery for other indications than adhesions:
Daniel Kruschinski, MD
EndoGyn®
Institute for Endoscopic Gynecology
"The world is too complex for simple solutions..."
or "The world is very complex that only brilliant simple solutions will
succeed ..."
----- Original Message -----
From: "Dawn" <>
To: "Beverly J.Doucette" >
Sent: Thursday, July 17, 2003 11:33 AM
Subject: My PUBLIC message on Daniel site
Posted Friday, July 18, 2003 @ 00:34 AM
>
> While reviewing my operative reports that have been stowed away for some
> time I have some urgent questions that all have a right to see answered
> here.
> I feel I am pretty well educated as a lay person with ARD and I seek
> further clarification as to what happened to me.
> What do you do to acheive meticulous hemostasis? I see many blood clots
> and they are covered over in spray gel. I also see that you introduced
> gauze into my abdomin.
> I quote from my operative report"after securing hemostasis at all the
> surgery sites, Spray Gel Was applied to all the adhesiolysis areas, in
> total 6 kits of spray gel were used. After rinsing, a small amount of
> ringer fluid was left behind and an intraabdominal drainage was
> introduced into the abodomen" why did you put this drain in? I see no
> scar from it, where did you put it. Why add ringers after spray gel?
> would this not dilute it. I am seeing these blood clots covered with
> spay gel. Does not meticulous hemostasis before the introduction of
> spray gel give us the best chance? My second look op report states"
> Situs: the peritoneum all over was reddish and covered with old blood
> (reaction to the spray gel?)" Where'd all that old blood come from. Now
> I am going to tell the world I am sure I have adhesions back. I know
> what they feel like. I have written to you several times with my
> concerns and you were mad that I was not "shouting it from the rooftops"
> Your last personal email to me said " Good luck with fighting your
> pain." I am not the only one having problems either! I have remained
> silent untill now thinking I will have to return to you as you are my
> only hope. I don't think that anymore. With out valid answers to these
> questions why would your surgery be any different than the others we
> have been through? I offer my operative report to any who wish to see
> them. I am patient # 10 from the US. I urge others to break their
> silence and review their operative reports. I am happy you have this
> site Daniel but unfortunatly it's not going to be all smiley face icons
> and we have a pal for a doctor. These are matters of life and death! We
> have enough friends now lets hear from our doctor. To any who wish them
> I will email you my operative reports and the pictures so you can see
> for yourself.
> Thank you for facing these tough issues,
> Dawn
=======================================================
From Daniel
To: Dawn Rose
Posted Friday, July 18, 2003 @ 02:18 AM
From Daniel Kruschinski
to Dawn Rose, Mass.
July 2003
Hi Dawn,
I knew that some of you will cause trouble, induced by others ..
To answer your questions is very easy and I will do that, but please don't say untruth things here: First I never wrote back to you "Good luck with fighting your pain" !!!
This is what I wrotea as a part of my message to your from June 13, 2003:
"... Anyway I hope you fight your pain, probably you are right with that the
ovary could be the cause of your pain... and probably it should be
removed and replaced by hormonal replacement therapy which could
be controlled much better than the ovary.
Thank you"
This was a logical advice to your email. And it's not true that you contacted me so many times about your condition, I have nice aemails from you and even from your daughter about you joining the life now and one about that you are in pain... and I have a copy of them, so I can show it to everyone.
OK, now to your Questions:
1)To achieve hemostasis we have a wonderful instrument, the bipolar scissors, which comes from laparotomy and can be only used in gasless laparsocopy. With this instrument you can achieve a very good hemostasis.
2) Gauze is not used in the surgery, only a sponge which does help tp make the preparation very easy and doesn't cause any problems. It gives me the same tools as in laparotomy (which are anyway better than the long ones from laparoscopy where the surgeon doesn't feel what he is doing... he loses the tactile sense of his hands... so he is a surgeon without a hand ...)
3)The drain is important to recognize bleedings after surgery and by this drain the little ringer which I put inside disappears. Why I put a drain because I want to see the bleeding which can occure after every surgery, even by one who doesn't put the drain ... so in by this I can earlier plan an additional intervention if there is a bleeding...other doctors without a drain deosn't recogize e blleding at all...
4)The body / peritoneum answers to everything that is a foreign body (SpraGel is also one) with inflammation and some blood escape... individually in some patients more in others less, this blood is already without any coagulative substances so it can’t coagulate and so thus can’t cause adhesions as it doesn’t contain fibrinogen... Nothing to worry about, this is not blood that makes adhesions, this is a peritoneal fluid and is reddish and as it can’t escape while it is covered by SprayGel, it shows exactly the reaction I describe in the operative report and which shows a “healthy”, smooth and shining peritoneum with neovascularistion ! The inflammation is exactly what we want, it causes a neovascularisation (new vessels are building and bringing Oxygen and high blood supply to the wounded area which heals by this quicker... !!! And this I can say as I use very high amounts of SprayGel and have the most experience with using many kits and not only two...
Adhesions can come back after every surgery, even after mine, I never stated that we have 100% adhesions free patients... Also pain can be related to other organs or issues thany adhesions... Medicine is never 100 % as we know, so some might develop adhesion and some others not... but with the combination fo both, gasless laparoscopy and SprayGel I still have the best results...
So Dawn, you are still welcome to perform a third look as done by Lisa Graven and than we could detect if adhesions came back. This would be also good to know, as no procedure is 100 %, we are not magicians, we are humans, and we might mistake in our theories about adhesions, as adhesions are the “chameleon” of the surgical treatment and there are plenty of doctors who don’t touch this patients (as you yourself know). I’m at least trying to help and I helped many of ARD patients ... If I can heal at least one or two it is worth to work on it and to work out how and what to do better in the future, so you could help to educate my self even much more in my undertakings to fight adhesions...
Many kind regards and I’m sorry, you are trying to fight me, but I know it’s someoen else behind you... it is not you that is trying to do so... But I have the right on my side so I’m not afraid and I’m not going to remove your post like some others would do and did already on other boards... this is a free seech board and everyone can post anything, also bad things about me. This will give me the opportunity to answer officially and not get fighters behind my back ... Still your friend
Daniel
===============================================================
---- Original Message -----
From: Beverly J.Doucette
To: Dawn
Sent: Thursday, July 17, 2003 5:48 PM
Subject: RE: Your response to Daniel and Karen..
Hello Dawn,
I know your upset, and you do have a right to ask more questions as sometimes answers lead to more questions!
Here is the best way to answer Daniels email and Karen’s as well, all in one.
Stay strong, don't react, your doing what you have a right to do, if you had never met me, you would have a right to ask questions of Daniel! Remember that! Do not allow Karen to blindside you now, she is wicked with a bat, but miles away from you so your safe, her words cannot hurt unless you think they are true, and they are not.
Both Daniel and Karen are using an old psychological ploy called a, " smoke screen!"
This means that in order to avoid dealing with issues they are responsible for, they will trey to bring OTHER issues into the conversation so that your time and energy are used to deal with those lesser issues and issues with out basis so that you forget the REAL issues at hand and are more apt to focus on the crap stuff then your real concerns, thus they get out of being held accountable for what they are responsible for!
IN this case, nothing your saying is your words, thus they are not taken seriously, and Daniel uses words like "troublemeker" as it demeans you and flusters you, name calling is always a great smkoke screen! :-) Accusations will also throw the focus off the real issues as the person then spends time defending themselves and all other pertinent issues get lost in the garbage of defense.
Daniel is a pro at this stuff...and then to use medical descriptions of equipment..give me a break! And the medical physiological terms about the "body / peritoneum answers to everything that is a foreign body (SpraGel is also one) with inflammation and some blood escape... individually in some patients more in others less, this blood is already without any coagulative substances so it can’t coagulate and so thus can’t cause adhesions as it doesn’t contain fibrinogen... Nothing to worry about, this is not blood that makes adhesions, this is a peritoneal fluid and is reddish and as it can’t escape while it is covered by SprayGel, it shows exactly the reaction"
This is okay for them to do as long as you understand it..okay? Nothing to react to..unless we do it intentional, like below!
You can call me if you like...I will be sending Daniels explanations to Confluent and either Tom will get to you or he will get to me. May I give him your phone number please?
I am so sorry you have to go through this with Daniel, and I am so sorry your not well, but I will try to help you as much as possible! Stay strong! Bev
=============================================================
From Dawn Rose
to Daniel Kruschinski
July 2003
Hello Daniel, (and Karen)
Daniel, you have no idea how upset and scared I am that I may have adhesions back! I have thought it for some time, and we have talked or rather communicated about that, maybe it was not as often as I stated, and maybe your words were as you said and I read them the way I saw it, remember, I am not as well as I hoped I would be, I cannot see any way I will ever be able to get back to you and who can I turn to here for help..no one! I am desperate and in pain! Then I hear you saw that yes, it could be the ovary, and I had gone all the way to Germany only to return with this message telling me I still have problems! Yes, I saw red, and I feel sick that I have problems that may need surgery, I thought I came top you for all that only to hear you tell me that the ovary might be bad....
how will I ever know as who here can do a surgery...I am sick and afraid of adhesions...and now you say I am making trouble because I need answers!
I fell like I am starting all over again here, begging to see a Dr. for what..diagnostic tests to tell me I have nothing wrong with me, start taking pain meds again.and talking to you IN Germany doesn't help me get medications here in the USA!
Others putting me up to dragging out my operatives from Germany now that you have a message board but not before that..well, if you must know why I dug them up now it is because a patient of your just returned NOT WELL at all and having a fit because I sent her over to you! She is angry and seeking answers to HER operative reports from every DR. and surgeon she can! And she blames ME for all of this and for wasting her money too! Karen, say what ever you want about me trying to make a problem, it IS a problem to be sure, and yes, someone is behind it all, but NOT who you and Daniel think it is. You want to blame Bev for everything, she says so be it, it is okay. She never mentioned anything about Daniel to me or on the IAS, always answered my concerns in private as your saying to do, and yet never putting Daniel down, even stating I might have to go back to him!! Karen you did all the public name calling and blaming..never Bev! I mentioned her name one time on the IAS, which I regret and apologized to her for doing as she had no part in it all, I did that, but she wanted no retractions at all, just to be left out of the public display!
I have talked to Bev about this recent issue with this patient because this patient didn't want to talk to Bev, she allowed me to send her operatives to Bev and asked questions. I have no idea what has transpired since then as Bev will not discuss this persons case with me and this lady is very angry at me...I dug out MY reports to show this lady that I was sorry for not being upfront with her as to how I felt and that her decision to go to Germany was based on my lies, etc...I told her I would share everything with her, I feel terrible guilt Daniel and Karen, terrible guilt for not telling her how I really felt! THIS is why I had my reports and pictures out, to send to her!
I asked Bev to look at MY reports and explain them to me in medical terminology so I would know what to say to this lady..and Bev actually said the same things that you just told me, and she pointed out that there was "old un-oxygenated blood" in the first pictures you took at the start of the initial procedure and that there were lots of adhesions, and of course that blood left in the cavity very well could cause adhesions, but to keep on mind that I did not have a barrier used here in the states so one would expect adhesions to form! Then she explained that there appeared to be blood in the cavity prior to you applying the Spraygel, but maybe you picked that out before the application of the Spraygel. (She explained that Dr. Reich picks the blood out at the end of the surgery as well as aggressive irrigation.) Then I asked her if I might have adhesion again if blood was left in and that I saw what looked like a gauze pad in two of the pictures and that gauze can cause adhesions to.
Bev, yes, Bev told me to email my questions to you, I also asked her about a drain, she told me to ask you as how could she know if I didn't remember having one and had no site where it would be how could she know. If it is in the report, then she said I had one, but to ask you as she can't know where it came out of!!
I know I come on strong and angry, but I am causing trouble because I now need answers, and now I get out my reports, it is Bev's fault? And I should tell who this person is when she asks me not to tell you yet she is screaming accusation at ME for not being honest to her and now she is WORSE then when she went over to you! This is BEV'S fault and I am making trouble induced by others!! IF only Bev would give me some time and answers, she too thinks I didn't do the right thing, yes, Karen, I too got that email!! I feel guilt, and I did wrong when this lady contacted me before going to Daniel, I WAS the cause of her wasting her money and coming back very ill! This is how I feel....and I am making trouble Daniel?
I can't afford to come back, Daniel, I am desperate and I am scared, and you don't need to tell me I don't know what I am doing and have to be "put up to it" by anyone else! I choose to say what I did to this lady, no one but me, and I did wrong. No one put me up to saying how wonderful you were when I did feel well, and even when I didn't..not even Bev put me up to that! I did it...so Daniel, give ME credit for knowing what I am doing when I write to you!
I know you can show patients emails to everyone, you did that with Lisa, remember! And Daniel, I WAS well and thought I would stay well, but now I am NOT well, so what do you ant me to do, shut up and suffer? Write happy faces all over my emails?? And I AM guilty of lying to this lady...happy faces on that too!
Your report states you achieved hemostasis, what I am asking is if that means you remove the blood clots I saw in the pictures, it doesn't matter to me the instrument, I have no idea what that even is, all I want to know is if you cleaned out the clotted blood before the application of Spraygel, that's all I am asking. I am trying to figure out if I now have adhesions..and did Spraygel make me bleed as it states in your report? If it did, how can I use it again? Why did it make me bleed?
The pictures of the blood were before the Spraygel was put on Bev said...is that true? ( And she said to ask you, she was not attacking you or anything!)
I saw a gauze pad in two pictures, that's why I asked about them. Can't I ask that without being a troublemaker?
If there is bleeding after surgery, won't adhesions form?
And I asked WHERE on my body the drain was. This lady said her drain was in her side, I didn't know I had one and told her that I didn't have one, only to read on my reports that I did, now she thinks I am lying to her again!!
Now I am confused again, inflammation causes adhesions we all have heard...and now you say I had inflammation too? I do not understand anything about the bleeding or blood part, but I asked Bev to explain it, just so you know, and she said she had to forward it to Confluent as it was all news to her and it is best someone there answers these issues, not her!
Is that blood clotting gone now do you think or did I get adhesions from them again??
Daniel, you said that each second look was 100% clear of adhesions, mine too, what does that mean then? I fear having to live with adhesions again, and I did believe that you had 100% success, maybe you did not say it but I was led to think that!! Maybe from Lisa, I don't remember! I am so afraid of having adhesions...
I don't see how I will ever get back there to you, I am so frightened, and you can keep saying someone is behind my words, Daniel, it doesn't matter, the real issues are that I think I have adhesions again, and when I got out my reports to send south, I asked Bev to read them and explain them to me. She did NOT put your surgery down, nothing like that at all, she explained what she knew, told me to email you and said I might have to go back to you too, as this other lady is supposed to do! Bev told me nothing different then you just did! But Daniel, I can't get back to there, and I do not trust anyone here! It doesn't matter what Karen says, I told this lady a lie, and that I didn't have a drain, then it is on my report...Bev told me to ask you about it, not her! I do not want Bev to dislike me, she helped me get to you...but I think she doesn't like me anymore then the others! Think what you want, Karen too, but it doesn't change my worry's and my needs!
I didn't do this behind your back and even if I asked the question in the other area to ask you stuff, everyone will see it anyway, so I wrote it here! I do NOT want to ever be accused of not being upfront again, and Karen even if you don't like that I ask Daniel questions publicly, to bad as this is how I am going to always do things, upfront and open and honest! I lied once and caused a serious problem for someone, maybe others too, but for sure one person, I will never do it aging, even if you don't like it! I am not you Karen!
Daniel, you make it sound so simple to just return as Lisa did, but I am a single parent with an ill child and no money...and how do I know it would even work a next time? Your right, nothing is 100%, but what about IF blood left in after surgery does create adhesions?? What about a drain tube creating adhesions and bleeding after surgery..creates adhesions...do I get a laporoscopic procedure done here to see if there are adhesions and not allow for any to be lysed? Is that possible to do?
Aside of all the garbage and accusations, what do I do?
You accuse me of making trouble because I ask questions, do you say that to me so I do NOT ask you questions? Why is that making trouble, Daniel? Is this why other patients don't approach you with their issues or IS everyone well except for me and this lady who just returned, and Lisa, and Sally?
I need answers for me, for me, Daniel...and if your message board can't handle truth but only smiley faces and praise..then it is not any better then any other message board that wants to be perfectly sterile and "happy" al the time, which isn't what ARD is all about all the time! To bad..you did my surgery, I have my op reports out and I need answers..and not in such a medical jabber that I cannot understand a word of, tell me in layman's terms please. That is considerate and more helpful then this email. Karen, stay out of this, YOU never had a surgery with Daniel so how can you talk to me that way..I am suffering, not you, you cannot know what I feel at all as you do not have to face this, your daughter does! It is no wonder to me she is not around to post, she got well and then ran miles away from you being overbearing in her life! Stay out of MINE!
Karen, you attacked EVERYONE on the other message boards at every post that you didn't like, now your going to start it here again?? Thats okay with me, I am going to ask my questions to Daniel as MY money was as good as anyone elses was and I deserve answers to MY questions!
( Daniel, this is part of a report I have in MY files...MY files, Karen, I can read and I understand what this says!!! Maybe it is wrong, but this is what I read.)
Cont: AETIOPATHOGENESIS OF ADHESIONS
The omentum plays a protective role in adhesion formation. Adhesive obstruction after colectomy is well known. This is because the operation involves, omentectomy and this will remove the organ that forms safe adhesions. As a result it would leave adhesiogenic areas exposed to the small bowel and will result in higher incidence of small bowel adhesions.
Another significant factor is a frequent practice to divide any adhesions that are total encountered. The division of adhesions which involves the small bowel are at a high risk of later obstruction.
PREVENTION
As yet there are no definite methods of completely preventing adhesions. The two commonly used solutions that have anti-adhesive effects in animals povidone iodine and 30% dextran 70.[13] Povidone iodine is used by surgeons more for its antimicrobial action rather than that of its anti adhesive effect.[11] Dextran is a popularly used solution in gynaecologic practice to prevent adhesions in infertility surgery.
The most important way of preventing adhesions is by meticulous technique.
The following are a few operative steps which could be undertaken to reduce the incidence of post operative adhesions.
Careful handling of the bowel to reduce serosal trauma.
Avoid rough unnecessary dissection.
Avoid contact of foreign material from the peritoneum e.g. use of absorbable material as far as possible, avoid excess use of guaze swabs, or wearing starch free gloves.
Adequate excision of ischaemic or infected debris within the peritoneum.
Preserve the omentum as far as possible. Placement of omentum around the site of surgery and run the omentum under the wound to encourage low risk adhesions to form.
Avoid dividing adhesions which do not involve the small intestines.
============================================================
From Daniel
To: Dawn Rose
----- Original Message -----
From:
To: "Dawn" <>
Sent: Sunday, July 20, 2003 3:05 PM
Subject: Re: your attacks
> Hi Dawn,
> I feel sorry for you that the drugs drives you crazy, but I would like you
> to answer my questions: Why are you doing it ? What have I done to
> you ? Why are you slandering me ? For what reasons are you lying ?
> No one of my patients was near to dy, this is really hard... to see one of
> my patients speeking such crazy things... as I am always trying to have
> avery good relationship with my patients... Why didn't you continue to
> communicate with me after June ? You stopped the communication
> after Beverly told you to do so... I really don't want why you as a adult human that I have done so much for, have to act like this... if you continue ... than I wish I would never
> have met you... if you think you can stop this mess, please come back to me.... there is nothing wrong on what I'm doing...Let's come together again, let's try at least to behave like intelliegent adult human...
> Regards
> Daniel Kruschinski, MD
> EndoGyn®
> Institute for Endoscopic Gynecology
===============================================================
Original Message -----
From: Beverly J.Doucette
To: Dr.Kruschinski@t-online.de
Sent: Sunday, July 20, 2003 9:38 PM
Subject: Re: your attacks
Dear Daniel,
What is THIS all about? My name has been tossed around the IAS and now in this email to Dawn Rose...Daniel, I have nothing to do with Dawn Rose other to tell her TO email YOU with her many questions! Dawn emailed me with her operative reports as week or so ago asking me to explain them to her as she was sending them to one of your recent patients who just returned...I answered some questions, but then told her to deal directly with you as I did not want to get into the middle of anything between Dawn and the patient!
This lady was VERY irate at Dawn and demanded that Dawn answer questions about things that Dawn told her prior to the lady coming to Frankfurt! Dawn wanted ME to speak to the lady, and I did, but only to tell her to communicate with you. This lady also said that I misrepresented Frankfurt by telling her that I would go there myself if I couldn't get Dr. Reich. This I did say to her, but that was before I found out that not everyone returning home and saying they were 100% well were actually NOT doing so well after all. I was a victim of this misinformation the same as she was! I have NOT spoken to the lady since! ( And I will not either!)
This is what Dawn explained to me prior to asking me to look at her operatives and why she asked me to do that!
This same lady called Dawn a lire and a fraud, Dawn told her she would let her see anything she wanted to see regarding Dawns operatives from Frankfurt, as Dawn felt guilty I guess...Dawn told this lady something about her ( Dawn) NOT having a drain tube post surgically, and then when Dawn found her operatives, it stated she did in fact have a drain, so the lady once again called her a lier and said Dawn scammed her for "pushing" Frankfurt!
Dawn feels terrible, she asked me to look at the operatives, and I did, she asked where a drain would have been if she had one, which she says she doesn't remember, that is when I told her to discuss her issues with you as I do NOT want to remain involved with anything to do with Frankfurt, and I told that to Dawn well over a week ago! I do commend Dawn for trying to make amends with this lady by trying to be honest with her now....
This same lady also says that Lisa Graven scammed her after I referred her to talk to Lisa about Frankfurt, so it was MY fault again! I want no part of any of this, Daniel!
And to see my name used in this manner here when I have neither posted anything negative about you or your procedure on the IAS or anywhere else...what some of your patients did was wrong Daniel, whether you like it or not, they were not sharing current information about their current health, be it adhesions or not, and people felt that they were not hearing the truth prior to going over to see you! I emailed my issues to YOU and to the women who reported that they were well, when in fact they reported elsewhere that they were NOT well!
False reports posted public for all to see and to use in making a decision as to where to seek a surgery, is not something that I want to see happen to victims of ARD, and I don't think you did either! It is always best to report how a person is feeling and living after ANY adhesiolysis so that others do not have false expectations when they elect to go to a certain surgeon!
NOT one time did I ever mention anything about your surgery, Daniel and never did I ever go public with this issue, the other ladies did that! I never saw your procedure or skill or compassion as being anything but that it is, decent and offering a good chance of improvements from ARD symptoms! What I take issue to, was the women not sharing the truth! A simple as that! You can look back many months in the IAS archives and you will have seen me post maybe two times in that year..and it was never to put down or slander you or your procedure, Daniel!
Daniel, If anyone wanted to see Frankfurt go, who do you think that would be??? Perhaps me a little bit, I was the one who introduced Frankfurt..of course I want to see it be productive, but only with honesty and respect, and some of those you choose to speak on your behalf, well, they remain less then of moral charachter! Not just MY thinking, Daniel, they were caught in dishonest behavior, and now they are very unhappy with me for asking them to be honest to thier fellow ARD sufferers and speak the truth, and they all did, but they also all left the IAS for some reason, shame I am guessing, and then stating that they were thrown off by Davie, that is not truth again, and people can see that...and it was again, from thier own mouths, Daniel, not mine!
I don't think you want to secure patients by former patients not being honest with them, Daniel, and that is what happened, and that is what is behind the issues with Dawn, I am sure! ( At least what I knew, this other stuff I have no idea about !!and I don't want to know either..leave me out of all this stuff, all of it looks CRAZY to me!)
I have not posted on the IAS for ages, and I do not plan to start now! I do not need nor want anyone to post for me, in fact, Dawn Rose DID post something about me in response to someone calling me a lier etc, etc..and I emailed Dawn to never use my name again unless she has permission from me, which she did not have! I don't care what any thinks I am doing or did, that is the least of anything that bothers me, because it is said doesn't make it fact, and your words here are far from being fact, Daniel, as why would I care if Dawn Rose emails you?? I hardly know her! I'm going to take MY time to deal with her issues and the other ladies issues?? Why would I do that? Remember, I also sent that email about not being honest to Dawn as well as the others, and she wasn't honest, non of them were, so why in the world would I NOW deal with her?
My God, Daniel, I have no idea what all that stuff is that your saying in this email!! About someone dying??? Who is sandering you, it isn't me!! I haven't emailed you sice that issue with some not telling the truth..and that was NOT you, it was them! How is that slandering you, Daniel??
I am not aware at all about any contacts Dawn had with you at anytime...now or before June! She doesn't email me Daniel...only to see her operatives and to tell me she was trying to be honest with this lady now! I am NOT interested in her trying to be honest now, or any of the ladies, they did share the truth, and it has offered and allowed prospective patients to ask more questions of them and hopefully you, so that when anyone comes to Frankfurt, they are prepared fully as to what to expect..and it is NOT all" miracles" as these ladies were saying over and over and over Daniel..it simply wasn't! Maybe you didn't know that these particular ladies ( Karen, Sally, Dawn. Lisa, & Carolyn) where telling people that there were 100% success's coming our of Frankfurt, and that they were all well..given Karen speaking for her daughter, then I hear that this is NOT the fact, and emailed you and them to begin to share the truth so others who elect to go to you will not have unrealistic expectations, as this lady now states she had because these same ladies, and ME included, falsified information about Frankfurt!
Daniel, I have not dealt with anyone or anything to do with Frankfurt since my email to you and to ONE time look at Dawn Rise's operatives, and tell her to go to you with her issues! I want out of ALL ARD issues...not because of you, David Wiseman or anyone else, but this lady is going to cause some trouble, Dawn should worry, as should the rest of those women she talked to or who posted false information, if this lady and her husband decide that they were frauded by them ...they are all in deep trouble! Not you, Daniel, as you did not make the statements that everything was 100% success's, and neither did I as I was advocate for Harry only!
I will also share that I was saddened when Karen would attack anyone who talked about any other surgeon or surgery or that they could not get funds to go to Frankfurt, she hurt so many innocent people who are the victims living with ARD, she doesn't live with that pain and suffering the same as the victims do, yet she was unmerciful in her behaviors to them! This was sad as you were trying so hard to open the doors in Frankfurt...and that type of behavior was only serving to close them! I am not sure if you know this or not, but their appreciation of your skill, went to far and they became dishonest backers of you...not it is difficult even for me to get excited for Helen surgery with you, as I wonder if the second looks really were all 100% free of adhesions, and once I found out that a number of your patients were not well after some months, be it adhesions or not, I will wait and hold my breath as time goes by for Helen...praying and hoping that she will be one of the fortunate ones who had your adhesiolsysi, many are well, ( I THINK!!) and may Helen be among them, Daniel! I know you did your best with her, and God, I pray she will have success to a great %!
I cannot be to optimistic since the ladies didn't tell the truth, I too feel like a victim of their over zealous words....but this is NOT your fault Daniel, as I have no doubt that you did not know they were saying such things!
I cannot stop anyone from using my name or placing suspician on me for things..but that doesn't cause me to do anything different as I am not doing any of it anyway! Maybe you would be best served to look at issues as if that patient or person or whomever you think is not acting on their own, as Daniel, in the case of Dawn Rose, it is not me, so deal with her and hold her accountable for whatever it is she is doing....and use me if you want to, but you will never be able to deal with the reality of the issues as she states them or does them, as she is doing them, not me, and it seems you have some issues here...I wouldn't touch this with a ten foot pole! You know, I am NOT even curious as to what the hell this is all about, my name in it or not, I don't want to even know about it!!
Good Luck Daniel, and unless you have proof I am doing something, Daniel, keep me out of it. Beverly
----- Original Message -----
> From: "Dawn" <>
> To: "Beverly J.Doucette" <>
> Sent: Sunday, July 20, 2003 6:01 PM
> Subject: Need assistance or the shot heard round the world.
>
Holy crap Beverly.......it is the shot heard round the world...leaves me
> > all a bit nausoues....but anyhow I am done with the posting
> > part........and ......um I think David is going to be pissed at me as
> > Karen came gunning for me over on the IAS...well I guess you'll see....I
> > am a bit ashamed I was so nasty but whats done is done........I think
> > the message got out to more that I ever imagined.
> > What I need help with is......well.......maybe David might not want to
> > hear my voice right now as Karen is all over him demanding I be banned
> > from IAS as well. I need my second look pics and as best I know, David
> > has the only copy.......it is probably sitting unopened in a pile some
> > where.....but Jo and I are going to compare pics of our adhesiolysis...I
> > think they should have this as they are concerned and "got it"....I am
> > sure that David would not go out of his way for Jo....but they are our
> > sister too.
Thank you again so much.... Thank you, Love, Dawn
Original Message -----
From: "Beverly J.Doucette" <>
To: "Dawn" <>
Sent: Monday, July 21, 2003 9:55 AM
Subject: Re: Need assistance or the shot heard round the world.
I see my email got to you to late, not that it is my business to tell you
> what to do, but I was out of town and got home very late last night to
> respond to your email.
>
> I see that you already posted..as did dear Karen...and I am not sure what
> you mean about Jo...xxxxxxxx perhaps?
>
> Please do NOT post anything that will open a door for Karen as she is
> spiteful and will hurt anyone who so much as gets in her way! So many who
> post and are attacked by her are innocent..posting anything that will elicit
> a response from her is not worth it. It is nauseating to be sure, Dawn.
> please do not post anything about Frankfurt, dear, speak to David about
> things before you post as if you feel your not getting answers from Daniel,
> perhaps David can answer them as well!!
>
> Like I said before, Dawn, please do not get caught up in any battles on the
> IAS as it only hurts us all. Perceived involvement or not, when our names
> are brought up like that, it hinders anything we might want to do or say to
> support other victims of ARD.
>
> These posts are said and done now...but try to think about not responding no
> matter how frustrated you are or if the issues are about Frankfurt and
> Daniel, take them to his site if nothing else. I cannot tell you what to
> do, and I did mention before not do anything on the IAS board that is
> negative, but now I am begging you not to keep it going, dear, please?
>
> I am not sure what you mean by got out to more then you thought?? I, this
> morning, got hate mail in my private email, and I had nothing to do with any
> of this. My involvement is perceived, even by Daniel mentioning my name all
> the time, so there is nothing I am going to do about it, but walk away from
> ARD issues, which is fine with me actually.
>
> But please Dawn, don't post negative things on the IAS, your a valuable
> asset to the IAS, try to talk to David about things before you post, if you
> will. One day someone will need your advice and you want to be there for
> them, and NOT be perceived as "reactive" shall I say.
I don't know what you and Jo will find, but if it is an issue for Daniel,
> take it to Daniel, I am not sure how, but you might want to talk to David
> first, he is really a wonderful person and will NOT be angry, he will help
> resolve your issues and he will want to do that before posts start a
> controversy on the IAS. I mentioned that before...and I will mention it
> again, please, I really, really beg you, Dawn, not to respond to anymore of
> anyone's ( Karen) posts on the IAS that elicit negative issues.
> Your message is well taken by those who see it, as long as you want to share
> what your story out of Frankfurt is, offer to do it in a private
> email...that is much better for both you and who ever requests any
> information about Frankfurt. It serves everyone better, my dear..okay?
>
> I don't know what to say, other then to ask again not to post about
> Frankfurt on the IAS, I have no right to ask that of you or anyone, but we
> have talked about it, and you know where I sit as to that issue, bickering
> on the IAS serves no useful purpose, and Dawn, you can avoid it and be just
> as effective in getting your message shared by using email, in fact, it will
> be taken more seriously then if seeing it posted in a public way, don't you
> think so? This makes me so sad, sick as you put it....it is past, but now
> you can stop it in it's tracks by letting it all fade away, at least on the
> IAS if you want to deal with Daniel and issues of his making, but you can
> let it fade away on the IAS, dear, please think about this. You probably
> feel worse now then before you posted on the IAS, and if that is so, then
> try not to keep it going.
>
> I have heard no more from XXXXXX, so maybe she is okay. I did put her in
> touch with a surgeon who she can ask questions of, nothing more either of us
> can do. You are free of her, Dawn....!
>
Take care now, I will help you too! Bev
Wednesday, February 26, 2014
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Rob Frappier
Karen's quote:
#1 karen on 12.11.09 at 8:39 am
Facebook was presented to me as a way to build my business via networking. Many whom I’ve befriended are also on facebook to build their business connections. With that concept, one would have to add unknown friends. Also, if someone simply googles your name, it is easy to find their address, etc. There’s lots of personal information on the internet about a person that the person did not place there themselves. So, please explain how building a network of friends on facebook is any worse than just being alive and vulnerable to GOOGLE.
http://www.reputation.com/blog/2009/12/08/many-facebook-users-willingly-give-out-personal-information/
December 8th, 2009
Facebook, Internet Safety, Online Reputation Management, Privacy, Social Networking
Rob Frappier
Karen's quote:
#1 karen on 12.11.09 at 8:39 am
Facebook was presented to me as a way to build my business via networking. Many whom I’ve befriended are also on facebook to build their business connections. With that concept, one would have to add unknown friends. Also, if someone simply googles your name, it is easy to find their address, etc. There’s lots of personal information on the internet about a person that the person did not place there themselves. So, please explain how building a network of friends on facebook is any worse than just being alive and vulnerable to GOOGLE.
http://www.reputation.com/blog/2009/12/08/many-facebook-users-willingly-give-out-personal-information/
Wednesday, June 15, 2011
FDA Risk of Air or Gas Embolism When Using Air- or Gas- Pressurized Spray Devices
Ummm do you mean like Sprayshield too???????Does Kruschinski know about this...another way to maim his poor patients. Is Carl aware of this too? I'm betting he does not!
FDA Safety Notification: Risk of Air or Gas Embolism When Using Air- or Gas- Pressurized Spray Devices
Date Issued: July 9, 2010
Audience: Surgeons, Operating Room Nurses, and other support personnel in the Operating Room
Products:
Air- or gas-pressurized sprayers are dual syringe products that simultaneously mix and apply two non-homogeneous liquids within a single spray head that is connected to a pressure regulator and a source of compressed air or gas. Air- or gas-pressurized sprayers can be used to mix and apply hemostatic drug or biological products (products that help control bleeding from blood vessels during surgery) including fibrin and non-fibrin sealants.
They include devices such as:
EasySpray and spray set used with Duploject system(Baxter Healthcare Corporation)
Tissomat and spray set used with Duploject system (Baxter Healthcare Corporation)
Evicel application device (Omrix Medical)
FibriJet Aerosol Applicator (MicroMedics)
HemaMyst Surgical Applicator System (Heamacuare Corporation)
MicroMyst Applicator and Air Pump Models 20-5000 and AP-A-6063 (Confluent Surgical)
Vitagel Hemostat Spray Set (Orthovita, Inc.)
Summary of Problem and Scope:
FDA has received reports of air or gas embolisms occurring during or immediately after application of hemostatic drug or biological products using air- or gas- pressurized sprayers. Although rare, the reports describe air embolisms that are life threatening and include one fatality.
These adverse events appear to be related to use of spray devices inconsistent with the approved product labeling and instructions for use. In some reports the device was used at higher than recommended pressure or at a distance too close to the surface of the bleeding site.
Recommendations/Actions:
Given the life-threatening consequences of an air or gas embolism, FDA is recommending that clinicians using air- or gas- pressurized spray devices for application of hemostatic drug or biological products:
Use the applicator, spray set, and pressure control device or regulator as recommended in the labeling or Information For Use (IFU) of the hemostatic agent.
Use an air or gas pressure setting within the range recommended by the manufacturer of the sprayer.
Ensure that distance between the spray head and the tissue surface is not less than the minimum recommended by the manufacturer of the sprayer.
Monitor blood pressure, pulse, oxygen saturation and end tidal CO 2 for signs of an air or gas embolism.
Make sure the regulators are maintained properly and checked for safe performance regularly.
FDA Activities:
In cooperation with the FDA, Baxter Healthcare Corporation and Omrix Pharmaceuticals, the manufacturers of all fibrin sealants licensed in the U.S., have updated the Warning and Precautions sections of the labels of EVICEL, T isseel and ARTISS to emphasize the risk of air embolism and the need to use the recommended ranges of pressure and distance.
The labeling of the spray devices and non-fibrin hemostatic drug or biological products also includes information on recommended pressures and distances.
Report Problems to FDA:
Prompt reporting of adverse events can help FDA identify and better understand the risks associated with medical products. If you suspect problems with the use of fibrin sealants and/or air or gas pressurized fibrin sprayers, we encourage you to file a voluntary report through MedWatch, the FDA Safety Information and Adverse Event Reporting program1. Healthcare personnel employed by facilities that are subject to FDA's device user facility reporting requirements2 should follow the reporting procedures established by their facilities.
Contact Information:
If you have questions about this communication, please contact the Division of Small Manufacturers, International and Consumer Assistance (DSMICA) at DSMICA@FDA.HHS.GOV or 800-638-2041.
http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm218523.htm
FDA Safety Notification: Risk of Air or Gas Embolism When Using Air- or Gas- Pressurized Spray Devices
Date Issued: July 9, 2010
Audience: Surgeons, Operating Room Nurses, and other support personnel in the Operating Room
Products:
Air- or gas-pressurized sprayers are dual syringe products that simultaneously mix and apply two non-homogeneous liquids within a single spray head that is connected to a pressure regulator and a source of compressed air or gas. Air- or gas-pressurized sprayers can be used to mix and apply hemostatic drug or biological products (products that help control bleeding from blood vessels during surgery) including fibrin and non-fibrin sealants.
They include devices such as:
EasySpray and spray set used with Duploject system(Baxter Healthcare Corporation)
Tissomat and spray set used with Duploject system (Baxter Healthcare Corporation)
Evicel application device (Omrix Medical)
FibriJet Aerosol Applicator (MicroMedics)
HemaMyst Surgical Applicator System (Heamacuare Corporation)
MicroMyst Applicator and Air Pump Models 20-5000 and AP-A-6063 (Confluent Surgical)
Vitagel Hemostat Spray Set (Orthovita, Inc.)
Summary of Problem and Scope:
FDA has received reports of air or gas embolisms occurring during or immediately after application of hemostatic drug or biological products using air- or gas- pressurized sprayers. Although rare, the reports describe air embolisms that are life threatening and include one fatality.
These adverse events appear to be related to use of spray devices inconsistent with the approved product labeling and instructions for use. In some reports the device was used at higher than recommended pressure or at a distance too close to the surface of the bleeding site.
Recommendations/Actions:
Given the life-threatening consequences of an air or gas embolism, FDA is recommending that clinicians using air- or gas- pressurized spray devices for application of hemostatic drug or biological products:
Use the applicator, spray set, and pressure control device or regulator as recommended in the labeling or Information For Use (IFU) of the hemostatic agent.
Use an air or gas pressure setting within the range recommended by the manufacturer of the sprayer.
Ensure that distance between the spray head and the tissue surface is not less than the minimum recommended by the manufacturer of the sprayer.
Monitor blood pressure, pulse, oxygen saturation and end tidal CO 2 for signs of an air or gas embolism.
Make sure the regulators are maintained properly and checked for safe performance regularly.
FDA Activities:
In cooperation with the FDA, Baxter Healthcare Corporation and Omrix Pharmaceuticals, the manufacturers of all fibrin sealants licensed in the U.S., have updated the Warning and Precautions sections of the labels of EVICEL, T isseel and ARTISS to emphasize the risk of air embolism and the need to use the recommended ranges of pressure and distance.
The labeling of the spray devices and non-fibrin hemostatic drug or biological products also includes information on recommended pressures and distances.
Report Problems to FDA:
Prompt reporting of adverse events can help FDA identify and better understand the risks associated with medical products. If you suspect problems with the use of fibrin sealants and/or air or gas pressurized fibrin sprayers, we encourage you to file a voluntary report through MedWatch, the FDA Safety Information and Adverse Event Reporting program1. Healthcare personnel employed by facilities that are subject to FDA's device user facility reporting requirements2 should follow the reporting procedures established by their facilities.
Contact Information:
If you have questions about this communication, please contact the Division of Small Manufacturers, International and Consumer Assistance (DSMICA) at DSMICA@FDA.HHS.GOV or 800-638-2041.
http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm218523.htm
Tuesday, June 09, 2009
Surgical gel gets blame for pain
By RUTH HILL - The Dominion Post
NATALIE SLADE/Dominion Post
SCARRED: Carla Gardiner had to have a four-hour operation to remove the scar tissue caused by anti-scarring gel during her initial surgery
Related Links'Scarring more painful than original illness'
A surgical spray gel that may have left hundreds of New Zealand women with painful internal scarring and fertility problems has been modified but doctors have not been told why.
Wellington gynaecologist Hanifa Koya, who first raised concerns about Confluent SprayGel in 2005, accuses the manufacturer of evading its responsibility toward "millions of women" worldwide who have been potentially injured by the gel.
The blue gel renamed SprayShield was supposed to prevent scarring during gynaecological surgery, but left some women with their reproductive organs "super-glued" together.
Up to 1200 New Zealand women were treated with the gel between 2004 and 2008.
Mrs Koya has learned that Covidien, which manufactures and distributes the gel, has replaced the suspect dye, methylene blue, with a vegetable dye. "The fact they withdrew it voluntarily suggests they know there was something wrong with it."
She began using the gel in October 2002, but stopped in April 2006 after her rate of repeat keyhole laparoscopies went from under 2 per cent to 10 per cent. Since switching to an alternative product, she has not repeated any laparoscopies, but patients were still returning from four years ago with "sheets of scarring".
She complained to American manufacturer Confluent Surgical and wrote repeatedly to MedSafe the Government's drug safety agency and professional bodies asking for action, but says she was stonewalled.
Medsafe investigated but accepted the manufacturers' assurances that the product was safe and that clinical trials were continuing.
"[But] methylene blue has never been tested on humans and the gel has never been approved for use in the United States," Mrs Koya said.
At the World Congress on Endometriosis in Melbourne last year, Mrs Koya was appalled to meet other specialists who had stopped using the gel because of complications.
ACC has not accepted any claims by victims for treatment injuries. Most of her patients' repeat operations which cost between $6000 and $12,000 have been covered by insurance, and she has waived her own fee for those with partial cover.
"That's a huge cost to the health system, it leads to increased insurance premiums and makes it harder for people to have their claims accepted. Ultimately it's patients who pay the price."
Health Minister Tony Ryall declined to be interviewed, referring comment to Medsafe.
Medsafe group manager Stewart Jessamine said because the gel was classified as a medical device under the Medicines Act rather than a drug, the legislation did not allow Medsafe to assess its safety or efficacy before it entered the market.
"However ... it has been assessed to very high standards by medical device regulatory authorities in Europe and Australia."
Some studies had showed increased rates of complications, including those described by Mrs Koya, he said. "However, there was no evidence that the rate of adverse effects was significantly different from that expected historically."
TIMELINE
2001: American-made Confluent SprayGel approved for use in Europe and subsequently Australia and New Zealand but not the United States.
OCTOBER 2002: Wellington gynaecologist Hanifa Koya begins using the gel.
2005: Mrs Koya first notices patients coming for repeat surgery and contacts the company, which tells her the product is being monitored in clinical trials.
APRIL 2006: Mrs Koya stops using the gel because of ongoing concerns. She alerts the College of Obstetricians and Gynaecologists and the Centre for Adverse Reaction Monitoring. Both refer her to Medsafe, the Government's drug-safety body.
FEBRUARY 2007: Mrs Koya complains to Medsafe.
NOVEMBER 2007: After reviewing international literature, Medsafe finds some reports of complications similar to those described by Mrs Koya. It asks the company include "additional precautions" on packaging but says the product is still safe.
DECEMBER 2007: Mrs Koya writes to the college again with her concerns.
JANUARY 2008: The college says Medsafe appears to have investigated the issue thoroughly.
FEBRUARY 2008: An affected patient talks to The Dominion Post and Mrs Koya speaks publicly about her concerns.
APRIL 2008: Mrs Koya writes to Medical Assurance Committee of the college.
JUNE 2008: Pharmaceutical company Covidien Tyco takes over distributing the gel in New Zealand from Intermed Medical.
AUGUST 2008: Mrs Koya writes to the health and disability commissioner, but is told the matter is outside the commission's jurisdiction.
OCTOBER 2008: Covidien relaunches the product as SprayShield Adhesion Barrier, which uses a vegetable dye instead of chemical dye methylene blue. The gel is available in Europe, the Middle East, South Africa, Australia and New Zealand but still not approved for use in the US.
http://www.stuff.co.nz/national/health/2480461/Scarring-more-painful-than-original-illness
NATALIE SLADE/Dominion Post
SCARRED: Carla Gardiner had to have a four-hour operation to remove the scar tissue caused by anti-scarring gel during her initial surgery
Related Links'Scarring more painful than original illness'
A surgical spray gel that may have left hundreds of New Zealand women with painful internal scarring and fertility problems has been modified but doctors have not been told why.
Wellington gynaecologist Hanifa Koya, who first raised concerns about Confluent SprayGel in 2005, accuses the manufacturer of evading its responsibility toward "millions of women" worldwide who have been potentially injured by the gel.
The blue gel renamed SprayShield was supposed to prevent scarring during gynaecological surgery, but left some women with their reproductive organs "super-glued" together.
Up to 1200 New Zealand women were treated with the gel between 2004 and 2008.
Mrs Koya has learned that Covidien, which manufactures and distributes the gel, has replaced the suspect dye, methylene blue, with a vegetable dye. "The fact they withdrew it voluntarily suggests they know there was something wrong with it."
She began using the gel in October 2002, but stopped in April 2006 after her rate of repeat keyhole laparoscopies went from under 2 per cent to 10 per cent. Since switching to an alternative product, she has not repeated any laparoscopies, but patients were still returning from four years ago with "sheets of scarring".
She complained to American manufacturer Confluent Surgical and wrote repeatedly to MedSafe the Government's drug safety agency and professional bodies asking for action, but says she was stonewalled.
Medsafe investigated but accepted the manufacturers' assurances that the product was safe and that clinical trials were continuing.
"[But] methylene blue has never been tested on humans and the gel has never been approved for use in the United States," Mrs Koya said.
At the World Congress on Endometriosis in Melbourne last year, Mrs Koya was appalled to meet other specialists who had stopped using the gel because of complications.
ACC has not accepted any claims by victims for treatment injuries. Most of her patients' repeat operations which cost between $6000 and $12,000 have been covered by insurance, and she has waived her own fee for those with partial cover.
"That's a huge cost to the health system, it leads to increased insurance premiums and makes it harder for people to have their claims accepted. Ultimately it's patients who pay the price."
Health Minister Tony Ryall declined to be interviewed, referring comment to Medsafe.
Medsafe group manager Stewart Jessamine said because the gel was classified as a medical device under the Medicines Act rather than a drug, the legislation did not allow Medsafe to assess its safety or efficacy before it entered the market.
"However ... it has been assessed to very high standards by medical device regulatory authorities in Europe and Australia."
Some studies had showed increased rates of complications, including those described by Mrs Koya, he said. "However, there was no evidence that the rate of adverse effects was significantly different from that expected historically."
TIMELINE
2001: American-made Confluent SprayGel approved for use in Europe and subsequently Australia and New Zealand but not the United States.
OCTOBER 2002: Wellington gynaecologist Hanifa Koya begins using the gel.
2005: Mrs Koya first notices patients coming for repeat surgery and contacts the company, which tells her the product is being monitored in clinical trials.
APRIL 2006: Mrs Koya stops using the gel because of ongoing concerns. She alerts the College of Obstetricians and Gynaecologists and the Centre for Adverse Reaction Monitoring. Both refer her to Medsafe, the Government's drug-safety body.
FEBRUARY 2007: Mrs Koya complains to Medsafe.
NOVEMBER 2007: After reviewing international literature, Medsafe finds some reports of complications similar to those described by Mrs Koya. It asks the company include "additional precautions" on packaging but says the product is still safe.
DECEMBER 2007: Mrs Koya writes to the college again with her concerns.
JANUARY 2008: The college says Medsafe appears to have investigated the issue thoroughly.
FEBRUARY 2008: An affected patient talks to The Dominion Post and Mrs Koya speaks publicly about her concerns.
APRIL 2008: Mrs Koya writes to Medical Assurance Committee of the college.
JUNE 2008: Pharmaceutical company Covidien Tyco takes over distributing the gel in New Zealand from Intermed Medical.
AUGUST 2008: Mrs Koya writes to the health and disability commissioner, but is told the matter is outside the commission's jurisdiction.
OCTOBER 2008: Covidien relaunches the product as SprayShield Adhesion Barrier, which uses a vegetable dye instead of chemical dye methylene blue. The gel is available in Europe, the Middle East, South Africa, Australia and New Zealand but still not approved for use in the US.
http://www.stuff.co.nz/national/health/2480461/Scarring-more-painful-than-original-illness
Tuesday, November 18, 2008
The fate of Stacey Mullens
Stanford Surgeon's Procedures Raise Ethical and Legal Red Flags
Supporters say Camran Nezhat is a miracle worker -- critics call his operations bizarre and barbaric...
With a white surgical mask dangling rakishly below his chin, Dr. Camran Nezhat looks every bit the part in his promotional video: medical pioneer, gifted surgeon, millionaire inventor of operating room tools. The Stanford clinical professor, recruited from his lucrative Atlanta practice, is a rainmaker for the university's medical center and obstetrics and gynecology department. Since he arrived at Stanford in 1993, he has brought patients, prestige, and scores of surgeons to study at the Stanford Endoscopy Center, which he directs.
But along with his brother gynecologists, Drs. Farr and Ceana Nezhat, he has also brought trouble to this elite enclave of high-tech medicine.
Trailing him to Stanford are allegations of reckless and unethical medical conduct. Critics accuse the Nezhats of performing a bizarre and dangerous medical experiment on the rectums of vulnerable female patients and of falsifying data reported in medical journal articles.
In the past five years, 20 doctors and surgeons across the country have signed statements of serious concern about the Nezhats' surgeries and published research and have called for an investigation.
''In my experience in the fields of law and medicine, I can't imagine a group of men who have crossed the line in more ways in the field of bioethics than the Nezhats,'' said Andrea Scott, a Los Angeles attorney and bioethicist.
And if the allegations against the Nezhats are true, soon top Stanford administrators may face troubling questions about the extent to which they heeded repeated warnings about the Nezhats and investigated the charges against them.
While the American College of Gynecology's code of ethics requires members to report questionable medical practices, a top Stanford official threatened at least one doctor with a lawsuit if he continued to criticize the Nezhats.
''There are serious, serious problems going on at Stanford,'' said Dr. Tom Margolis, a former Stanford Medical School professor who has signed a sworn affidavit charging the Nezhats with misconduct. ''Certain people are covering this up because there is a hell of a lot of money going to Stanford because of the Nezhats.''
The Nezhat brothers have declined to be interviewed. Through their Atlanta attorneys, they deny any wrongdoing and question the motives of their accusers, citing professional rivalry and economic competition. Stanford officials say they have thoroughly investigated and rejected allegations of scientific fraud.
Camran Nezhat is embraced by a large cadre of supporters, including Stanford colleagues and patients, who admire him personally and are awestruck by his abilities in the operating room.
''People like (Nezhat) are a rarity,'' said Salinas gynecologist Dr. Rene Charles. ''I'd compare him to Michelangelo, in terms of his surgical skills.''
In a letter of support sent to The Chronicle, 39 Stanford nurses and other health-care staff members describe Nezhat as a worker of ''miracles'' who takes cases ''others have given up on.''
Yet doubts about the Nezhats date back well into the 1980s, when Camran emerged in Georgia as a pioneer in the nascent art of laparoscopic surgery.
And they have been rekindled by recent developments in an astounding malpractice case that has been languishing in Atlanta courts for six years.
That case could determine once and for all whether the Nezhats are the pioneering surgeons they claim to be or whether they catapulted their careers to Stanford on the basis of a dangerous and grotesque medical fraud.
BUILDING A PRACTICE, 1988
Camran Nezhat and his brothers grew up in prerevolutionary Iran, where each attended medical school. Camran emigrated to the United States in 1974 and completed his obstetrics and gynecology residency at the State University of New York at Buffalo.
In 1978, he received a two-year reproductive endocrinology fellowship at Medical College of Georgia in Augusta. Farr and Ceana followed their older brother to Augusta and eventually joined Camran's growing practice in Atlanta.
During the 1980s, while practicing at Atlanta's Northside Hospital, the Nezhats began to develop a reputation for their skills in laparoscopy, a type of surgery in which laser scalpels, miniature cameras and long-stemmed instruments are worked inside the body through dime-sized incisions.
They published scores of articles in medical journals, claiming a remarkable series of ''surgical firsts.'' They also developed a number of ingenious instruments for the laparoscopic operating room. A company they co-founded, American Hydro-Surgical Instruments Inc., eventually sold for $40 million.
Their specialty was treating endometriosis, a painful ailment afflicting an estimated 5 million American women. It is caused when cells that make up the lining of the uterus migrate and bind to other parts of the abdominal cavity, swelling with the monthly menstrual cycle, sometimes causing debilitating pain. The condition is often linked to infertility.
Northside Hospital began promoting the Nezhats, hiring a public relations firm to spread the word about the doctors and their accomplishments. Camran was featured in Newsweek and the Chicago Tribune, and on MSNBC, CNN, ABC's ''20/20'' and elsewhere.
The brothers garnered a reputation as some of the world's foremost innovators of laparoscopic surgery, attracting cash-paying patients from around the globe.
THE MULLEN CASE, 1991
Suffering from endometriosis, 28-year-old Stacey Mullen flew from Southern California to Atlanta's Northside Hospital in 1988 to be operated on by Camran Nezhat. The surgery was quick, the pain was gone, and Mullen was elated as she walked out of the hospital the next day.
''I was ready to name my firstborn after Camran Nezhat,'' she said.
But, as often happens, the endometriosis and the pain returned. And in December 1991, Mullen flew back to Atlanta for what she thought would be another ''quick little surgery.''
The surgery, however, was neither little nor quick.
Camran and his brother Farr, with colorectal surgeon Dr. Earl Pennington assisting, spent hours using laparoscopic techniques to cut Mullen's colon and rectum free of nerves, blood vessels and connecting tissue. Her ''mobilized'' rectum was pulled inside out through her anus, and suspected endometrial tissue was removed. Her patched-up rectum was then pushed back inside.
Then the complications began.
Hours after surgery, part of her colon dropped out of her body as she sat on the toilet. For months, she suffered from extreme constipation. Sometimes she burped up her own feces.
Mullen never regained normal use of her bowel. Eventually, she received a colostomy and must insert a tube into an opening in her side to go the bathroom.
In December 1993, after nearly two years of continuing pain, she filed a malpractice suit against the Nezhats. ''Those bastards ruined my life,'' she said.
THREE ARTICLES, 1993
Shortly after taking Mullen's case, attorney James Neal discovered two medical journal articles that the Nezhats and Pennington had published after Mullen's operation.
The first appeared in Fertility & Sterility in May 1992, describing a single case using the new pull-through procedure for treating rectal endometriosis. ''As with all new procedures,'' the article said, ''there are no data to establish its safety.''
The second was published in the September 1992 issue of Surgical Laparoscopy & Endoscopy. It detailed a series of 16 rectal surgeries, similar to Mullen's, performed in late 1991 and early 1992 - the period during which her surgery took place.
Yet Mullen's case - and her complications - were not mentioned.
The article listed only a single complication: The doctors had to perform traditional open abdominal surgery in order to complete the suturing of one patient's bowel.
''This procedure has been performed safely in this initial series,'' the Nezhats wrote, and they claimed fewer problems than would be expected with regular open abdominal surgery.
The Nezhats aggressively publicized the ''success'' of the new procedure. It was touted by Ethicon Inc., the Johnson & Johnson subsidiary that made the instruments the Nezhats had used. ''For the estimated 185,000 women who suffer from endometriosis of the rectum, this new advance provides them with relief from the digestive symptoms,'' the company said.
At a 1991 American Fertility Society meeting in Orlando, and a 1992 convention of the American College of Obstetricians and Gynecologists in Las Vegas, Ethicon promoted their instruments and the Nezhats, even including a video of the surgery.
But skepticism about the Nezhats and their procedure was beginning to grow. The lack of complications did not make sense for such radical bowel surgery, doctors said. Some surgeons who viewed the promotional video were puzzled: They could not see evidence of endometriosis.
Stories began circulating in the surgical community around Atlanta's Northside Hospital. The medical journal articles said the average operating time for the surgeries was three hours, but during the time of the study, the Nezhat operating room had been burning lights deep into the Georgia night.
Then Neal discovered a third journal publication, written by one of Nezhat's Atlanta colleagues and published more than a year after Mullen's operation.
The article in Surgical Endoscopy described a ''pilot'' study testing the same procedure on pigs in order to assess its safety on humans.
''Some damage to the sphincter might occur,'' the authors wrote, but the long-term effects were unknown: The pigs were ''sacrificed'' before they awoke from anesthesia.
Neal and Mullen were stunned: Not only had the Nezhats omitted Mullen's case from their series - and in doing so did not report her complications - they apparently had tried out the new procedure on her and other women before it was tested on pigs.
Nezhat attorney David Walbert said the pig study ''had nothing whatever to do with the safety and efficacy'' of the human surgery described in the medical journals. The purpose of the pig experiment, he said, was to determine whether the procedure was suitable for treating cancer.
'BARBARIC,' 1993
When Neal began contacting medical experts about Mullen's surgery, many sent him letters and affidavits calling the operation radical and experimental; they characterized it as ''bizarre'' and ''barbaric.'' It resembled a cancer surgery that had been discredited years before, after complication rates as high as 50 percent were reported.
The surgery had not been vetted before a Northside Hospital Institutional Review Board, the usual requirement for an experimental procedure.
''Normally you go before an IRB, come up with scientific background, present a plan, torturous documentation, nine pages of informed consent, and you cannot charge for it,'' said Ohio general surgeon Dr. Francis Barnes.
Mullen and her insurance company, however, were billed $9,900 for the rectal surgery. She eventually ran up more than $1 million in additional medical expenses as a result of the operation, according to Neal.
Neal also learned that Mullen - and possibly four other women whose cases were included in the Nezhats' articles - had signed an unusual document, recently created by the Georgia legislature. It was called a ''waiver of informed consent,'' and it set aside a patient's right to detailed information about a surgery.
''This is incomprehensibly unethical,'' said Arthur Caplan, director of the University of Pennsylvania Center for Bioethics and one of the nation's foremost medical ethicists. ''You can no more sign away your right to informed consent than you can voluntarily sell yourself to slavery.''
''I never knew I was signing such a document,'' Mullen said. ''I thought it was a regular consent form.''
Yet the most disturbing discovery was made in Mullen's own medical records. In his operative notes, Camran Nezhat wrote: ''There was evidence of severe endometriosis of the rectum.''
But Mullen's pathology lab report disclosed that there had been no endometriosis on the wall of her rectum at all - just a few cells in the adjoining fat. The surgery had not been necessary in the first place.
16 MEDICAL RECORDS
Neal went to court and demanded to see the medical records of the 16 other patients the Nezhats had operated on in Georgia, convinced they would show complications, more waivers of informed consent, and surgical data different from what was reported in the Nezhat articles.
But the Nezhat legal team refused to turn them over, citing privacy concerns of other patients - at least 10 of whom signed affidavits opposing any release.
Mullen was given the waiver form by mistake, they explained, and she was told about the procedure's risks. Medical experts for the Nezhats also insist that the rectal surgery was not experimental, so no Institutional Review Board process was required.
''In my opinion, the surgery performed on Mary (Stacey) Mullen was a necessary procedure and would not require any special consent form for experimental surgery,'' said Dr. Robert R. Franklin, a clinical professor in the department of obstetrics and gynecology at Houston's Baylor College of Medicine.
The Nezhat lawyers also argue that Mullen's rectal surgery did not cause her bowel problems. ''She reported constipation before the procedure,'' said Walbert.
THE FIRST WARNING, 1993
In the early 1990s, Stanford Medical School's department of obstetrics and gynecology was in trouble. Despite the school's lofty reputation, the department was not fully accredited.
The Chicago-based Accreditation Council for Graduate Medical Education demanded more ''surgical volume'' before it would upgrade the program's ''provisional'' status.
Yet when Dr. Nick Spirtos heard that Stanford was recruiting the Nezhats, he could not believe it.
Spirtos is a Palo Alto gynecological oncologist with an august reputation of his own. Like the Nezhats, he is a clinical professor, which means he serves on the school's voluntary teaching faculty with surgical privileges at the medical center. He also holds the elected post of deputy chief of the obstetrics and gynecology department.
During the past nine years, he has become a leading critic of the Nezhats and their Stanford defenders.
''I think everything they've written is fraudulent,'' said Spirtos, whose office is just one floor below the Nezhats' in an upscale medical office building near Stanford. ''I don't think they should be allowed to practice medicine.''
Spirtos had traveled with colleagues to a gynecology convention in Florida to see the 1991 presentation by Camran and Farr Nezhat sponsored by Ethicon. The program included videos of two new Nezhat operations, one of them showing the rectal procedure that would be performed two months later on Mullen.
''We couldn't believe what we saw,'' Spirtos said, noting that there was no evidence of endometriosis. ''The surgeries didn't make any sense.''
But before they could quiz the Nezhats about their presentation, Spirtos recalled, the Nezhats left the podium, refusing to answer questions.
Two years later, after studying their journal articles, he warned university administrators not to bring them to Stanford. Spirtos argued that the Nezhats' published data were simply too good to be true.
But Spirtos said his advice was ignored.
''It was a perfect marriage,'' he said. ''The Nezhats had all the dough in the world but no title. And Stanford needed desperately to have surgical volume to legitimize their (obstetrics and gynecology) department.''
NEW TROUBLE, 1993
Within two years of the Nezhats' arrival in Palo Alto, Camran became director of the new Stanford Endoscopy Center for Training and Technology. And Ethicon, which had retained Nezhat as a surgical investigator, agreed to provide a $125,000 annual grant to the center.
Quickly, the Nezhats began pairing up with surgeons outside their immediate discipline - including specialists in cancer, heart and brain surgery - with the goal of expanding the use of minimally invasive surgical techniques.
The practice troubled Spirtos, and when he learned that Camran Nezhat intended to operate on a patient of one of Spirtos' medical partners, he wrote in protest to Dr. Mary Lake Polan, the chief of the obstetrics and gynecology department.
The patient was a 74-year-old woman who had undergone extensive surgery for the removal of pelvic cancer, and Spirtos told Polan that the patient's cancer had spread so extensively that laparoscopic surgery would be useless.
''Certainly, (Nezhat) has no experience in this area (treating cancer), and it seems to me serious patient care issues are being placed on the back burner in your headlong rush to promote the Nezhats,'' he said in a 1993 letter to Polan.
Despite Spirtos' protests, Nezhat and Stanford cancer surgeon Dr. Nelson Teng went ahead with the operation.
The patient was on the operating table for seven hours and was hospitalized for seven days afterward. Her bladder and bowel were punctured during the operation, Spirtos said, and the doctors could not remove all the cancer. In his report to the university's ''quality assurance'' review committee, Spirtos charged that Nezhat, credentialed as a gynecologist, was performing cancer surgeries, a specialty that requires years of extra formal training. He also laid out four other Nezhat cancer cases for the quality assurance review committee.
''No other hospital would allow a gynecologist to perform (cancer) surgeries,'' said Spirtos.
But his hope for a quick review of the five cases soon faded. ''Stanford sat on those cases for years,'' he said.
NEZHAT'S AFFIDAVIT, 1994
Meanwhile, Mullen and her attorney continued to press for the release of the files on the 16 other women who had undergone the rectal procedure. And the Nezhats continued to refuse.
In a sworn 1994 affidavit, Camran Nezhat declared it would disrupt his practice for months if he were ordered to produce records demanded by Mullen's legal team.
He described a filing system with 20,000 patients, each listed only alphabetically, with no index, no computer database and no cross-referencing by type of treatment, surgery performed, or journal publication.
''I would . . . have to manually review every single patient record . . . to determine whether the record referenced a patient whose procedure was the subject of a journal article,'' he testified.
The affidavit shocked Nezhat's critics, who say it has cast a pall on the validity of the Nezhats' research ever since.
''I've been doing this kind of research for 25 years. There is a substantial problem if you cannot link patient records to publications,'' said Dr. David Grimes, former chief of obstetrics and gynecology at San Francisco General Hospital, who briefly served as a paid expert to Mullen's legal team.
How, asks Grimes, can the Nezhats publish extensive studies based on old charts and old data involving hundreds of patients over many years if those patients' files are not indexed or cross-referenced?
Grimes was not the first doctor to question the Nezhats' research. Long before they publicized their controversial bowel surgery, competitors and collaborators alike were skeptical of the brothers' claims of surgical firsts and problem-free procedures. In 1987, Dr. Harry Reich, a world-renowned laparoscopic surgeon at New York's Columbia-Presbyterian Medical Center, agreed to collaborate with Camran Nezhat on a surgical study of 105 tubal pregnancies.
But Reich was bothered by Nezhat's repeated failure to share his data on 40 patients to be included in their article in the Journal of Reproductive Medicine.
''So we had to delete the data from the paper,'' Reich recalled.
The Nezhats' lawyers say Reich never requested any data that were not provided.
In 1990, a Nezhat report in the journal Obstetrics and Gynecology also raised eyebrows. The Nezhats stated they had performed 4,000 laparoscopic surgeries without injuring a ureter, the tube connecting the kidney and bladder.
Their claim drew a sarcastic response from three Yale University doctors: ''The authors are to be congratulated. . . . Either these surgeons had other complications, perhaps as serious, or they possess an unbelievably high level of skill and judgment.''
Other articles in which the Nezhats claim to have reviewed thousands of old cases include:
-- A 1995 textbook article describing 214 complications among 6,949 cases in Atlanta and Stanford from 1982 to 1993.
-- A 1996 medical journal report of severe urinary tract endometriosis in 28 women among 2,226 treated for endometriosis from 1989 to 1994.
-- A 1997 study examining 5,300 surgeries dating back to 1988, counting up 11 hernias caused by insertion of the laparoscope.
Atlanta attorney Walbert scoffs at accusations of medical fraud. ''Many, many surgeons'' have conducted research with the Nezhats, he said. ''Those who have any knowledge have never claimed there was anything 'bogus' about any of the reports.''
Dr. Sally Tazuke, a Stanford reproductive endocrinologist who has worked with Camran Nezhat frequently, said his reported complications are low because he is exceptionally good at what he does - even while taking on the riskiest cases. ''If I were a patient, I would sign up with him. I'd send any family member,'' she said.
Skeptics say the stakes are high. Dr. Thomas Lyons, an Atlanta gynecological surgeon who believes the Nezhats have published journal articles with phony data, said medical fraud can lead unsuspecting doctors to hurt their patients.
''This is as dangerous a situation as you can run into in medicine, because people may be making medical decisions based on something that doesn't exist,'' he said.
If someone ever questioned the veracity of his own data, Lyons said, ''The first thing I would do is throw that data right in their face. . . . The best defense in the world is the truth.''
NEAL'S LETTER, 1995
In January 1995, Mullen's attorney, James Neal, wrote to Stanford, alerting the university to the allegations his legal team was making against the Nezhats. As a former hospital counsel himself, he said he thought they would appreciate a copy of the Mullen lawsuit.
''I feel that your institution should have the opportunity to evaluate these matters . . . given your understandable and overriding concern for the patients within your institution,'' Neal wrote.
But Stanford took no action.
Instead, Margaret Eaton, a university lawyer, forwarded the letter to Nezhat's attorney in Atlanta, with a note saying that ''we do not intend to respond to this letter, nor are further communications from Mr. Neal welcome.''
In June 1995 the Accreditation Council for Graduate Medical Education approved full accreditation to Stanford.
ALLEGATIONS, 1996
A year later, Neal sent Stanford a thick package of documents, laying out in more detail the charges against the Nezhats and asking Stanford to investigate.
Dr. Richard Popp, Stanford's senior associate dean for academic affairs, said Neal provided a ''massive amount'' of what he called ''disorganized'' information.
Popp finally opened an inquiry into the charge of scientific misconduct. But university officials contend that by that time, some of the allegations, including Neal's claim of medical journal fraud, had been thrown out by the Georgia courts.
Neal, who freely admits that he has become obsessed with exposing the Nezhats, was running up a list of legal setbacks. In his dogged pursuit of the Nezhats, he was building a reputation as a crank.
He was disqualified from the malpractice case by a Georgia judge in 1995 for ''unethical behavior'' and could no longer represent Mullen. After a federal judge last year tossed out his attempt, on behalf of another client charging malpractice, to use racketeering charges against the Nezhats, Neal was charged with contempt of court. The judge also assessed $384,000 in ''sanctions'' against the plaintiff and her remaining attorneys. The sanctions are on appeal.
Neal denies the unethical conduct allegation, and the contempt of court charge was recently dropped. The only thing he is guilty of, he says, is aggressively representing his clients against institutions willing to look the other way.
''These guys are bad doctors, some have even said evil, and they have to be stopped,'' he said.
WITNESS, 1996
Shortly after Dr. Tom Margolis joined Stanford as an assistant professor and chief of pelvic surgery, Farr Nezhat invited the newcomer to watch him perform a complex laparoscopic procedure.
During the operation, Nezhat cut the patient's ureter. Margolis, who had also served as director of urogynecologic/pelvic surgery at Northwestern University Medical School, assumed it was an accident, a known but unwelcome complication of the difficult surgical technique. He stepped in to assist Nezhat in repairing it.
But a short time later Margolis learned that, in a post-operative review session and the operative report, Nezhat described the cut as deliberate. He said he sliced the ureter to remove endometriosis that could have blocked urine flow.
Margolis was outraged. He said that he saw no endometriosis on the ureter and that the pathology report proved it.
''It was clear that Dr. Nezhat was performing an unnecessary procedure,'' he said in a sworn affidavit.
THE POLAN MEETING, 1996
More than two years passed before Stanford's quality assurance committee took up the review of the five cancer cases in which Spirtos had alleged improper surgeries by Camran Nezhat.
Just before the review committee was finally set to meet, Dr. Mary Lake Polan, chairman of obstetrics and gynecology, dropped by Margolis' office. He was one of the physicians reviewing the cases.
''We need to make sure that Nezhat is cleared on all these (cancer) cases,'' she told him, according to his affidavit.
Ultimately Margolis - and the other members of the quality assurance committee - voted in favor of Nezhat on all charges.
Polan said Margolis' allegations are false.
''I adamantly deny the statements attributed to me and deny there has been any pressure to exonerate any physician during the quality of care committee process," she declared in a written response to The Chronicle.
Margolis' decision to vote to exonerate Nezhat would haunt him for more than a year, until finally he had to act.
THE SHUER LETTER, 1998
In April 1998, Margolis met with Dr. Lawrence Shuer, chief of staff of the medical center. He told Shuer about the cut ureter incident and the pressure Polan had allegedly exerted on him.
''He (Shuer) acutely and abruptly ended our conversation, and I was excused from his office,'' Margolis said.
More than a year later, when Shuer learned Margolis was still criticizing the Nezhats and Stanford, he sent a written warning:
''Rest assured that Stanford Hospital and Clinics intends to pursue its full legal remedies if these defamatory and libelous statement do not cease,'' Shuer wrote.
Furious, Margolis, who had left Stanford to practice with Spirtos at the Women's Cancer Center in Palo Alto and Los Gatos, wrote back, saying that Shuer's job as chief of staff was ''patient protection not doctor protection.''
''The data which (the Nezhats) have published, including the rectal eversion procedure, is fraudulent, yet their publications are being accepted as standards in the surgical community. Stanford, by not auditing this clinical data, has ignored the concerns of scores of surgeons,'' Margolis wrote.
STANFORD'S DUTY, 2000
Defenders of the Nezhats at Stanford dismiss both Spirtos and Margolis as jealous competitors. But other medical experts say Stanford should have demanded a review of the 16 cases and has shirked its responsibility to verify the Nezhats' research claims.
''Stanford has a duty to review this,'' said Dr. Warren Grundfest, chairman of Biomedical Engineering at UCLA and an expert in new medical technologies. ''Serious allegations have been made by credible people, but Stanford has played like an ostrich with its head in the sand.''
But Stanford officials contend they are not obligated to review the 16 patient records because the rectal surgeries were performed in Georgia before the Nezhats came to the West Coast. Shuer said the procedure in question has never been performed at Stanford.
It was appropriate for the Nezhats to leave Mullen's case out of the medical journal, according to Stanford, because she was ultimately found not to have rectal endometriosis like the other patients.
Stanford reviewers have never asked the Nezhats or Northside Hospital for the records to verify the accuracy of the other 16 cases. ''We have no right to the records and do not want to violate patient privacy,'' said Stanford's lawyer Debra Zumwalt.
The university also never interviewed Mullen or the 20 doctors who have expressed concern over the Nezhats' research.
According to Stanford, the appropriate institutions to investigate the Nezhats are Northside Hospital, the Georgia Medical Board and Mercer University, where the Nezhats were clinical professors at the time of the surgeries. ''Stanford will carefully review the conclusions of those investigations,'' said Popp.
But a spokesman for Mercer, a Macon, Ga., medical school founded in 1986, said the school has no investigation pending.
The Georgia Medical Board's investigation of the Nezhats is continuing. The board will not comment on its status.
Stanford attorney Zumwalt said Margolis' complaint to Shuer regarding the cut ureter incident was never put in writing. Shuer said he asked Margolis for more information, and none was provided, but the case has now been identified and is being investigated by the quality assurance committee.
The university said the Nezhats have been cleared of allegations that they operated outside their specialty. Officials would not comment, however, on any details of the five quality assurance cases because they are confidential.
''One thing I can point out,'' said Zumwalt, ''is that doctors and patients and their families can reasonably disagree as to how aggressive to be in treating terminal diseases.''
GEORGIA COURTROOM, 2000
Mullen has refused to engage in monetary settlement talks with the Nezhats and promises to continue her suit until the records of the 16 other women are made public.
''My life has been changed in a very horrible and profound way by the experiment (that) Camran Nezhat has conducted upon me without my knowledge,'' Mullen said in an affidavit. ''I despair that other women will be injured by well-meaning surgeons who believe Camran Nezhat's article that there were no complications from this new surgery.''
In November, after a battle spanning six years - and six judges - Superior Court Judge Melvin Westmoreland in Atlanta ordered a confidential release of the records to Mullen's lawyers, and in January, the Nezhats and Northside Hospital turned them over.
While the records remain sealed, medical experts hired by Mullen's legal team to review the documents have written Judge Westmoreland expressing their concern about what the records contain, and urging that they be unsealed, in the public interest. ..
William Carlsen can be reached at wcarlsen@sfgate.com. Sabin Russell can be reached at sabin@sfgate.com.
Supporters say Camran Nezhat is a miracle worker -- critics call his operations bizarre and barbaric...
With a white surgical mask dangling rakishly below his chin, Dr. Camran Nezhat looks every bit the part in his promotional video: medical pioneer, gifted surgeon, millionaire inventor of operating room tools. The Stanford clinical professor, recruited from his lucrative Atlanta practice, is a rainmaker for the university's medical center and obstetrics and gynecology department. Since he arrived at Stanford in 1993, he has brought patients, prestige, and scores of surgeons to study at the Stanford Endoscopy Center, which he directs.
But along with his brother gynecologists, Drs. Farr and Ceana Nezhat, he has also brought trouble to this elite enclave of high-tech medicine.
Trailing him to Stanford are allegations of reckless and unethical medical conduct. Critics accuse the Nezhats of performing a bizarre and dangerous medical experiment on the rectums of vulnerable female patients and of falsifying data reported in medical journal articles.
In the past five years, 20 doctors and surgeons across the country have signed statements of serious concern about the Nezhats' surgeries and published research and have called for an investigation.
''In my experience in the fields of law and medicine, I can't imagine a group of men who have crossed the line in more ways in the field of bioethics than the Nezhats,'' said Andrea Scott, a Los Angeles attorney and bioethicist.
And if the allegations against the Nezhats are true, soon top Stanford administrators may face troubling questions about the extent to which they heeded repeated warnings about the Nezhats and investigated the charges against them.
While the American College of Gynecology's code of ethics requires members to report questionable medical practices, a top Stanford official threatened at least one doctor with a lawsuit if he continued to criticize the Nezhats.
''There are serious, serious problems going on at Stanford,'' said Dr. Tom Margolis, a former Stanford Medical School professor who has signed a sworn affidavit charging the Nezhats with misconduct. ''Certain people are covering this up because there is a hell of a lot of money going to Stanford because of the Nezhats.''
The Nezhat brothers have declined to be interviewed. Through their Atlanta attorneys, they deny any wrongdoing and question the motives of their accusers, citing professional rivalry and economic competition. Stanford officials say they have thoroughly investigated and rejected allegations of scientific fraud.
Camran Nezhat is embraced by a large cadre of supporters, including Stanford colleagues and patients, who admire him personally and are awestruck by his abilities in the operating room.
''People like (Nezhat) are a rarity,'' said Salinas gynecologist Dr. Rene Charles. ''I'd compare him to Michelangelo, in terms of his surgical skills.''
In a letter of support sent to The Chronicle, 39 Stanford nurses and other health-care staff members describe Nezhat as a worker of ''miracles'' who takes cases ''others have given up on.''
Yet doubts about the Nezhats date back well into the 1980s, when Camran emerged in Georgia as a pioneer in the nascent art of laparoscopic surgery.
And they have been rekindled by recent developments in an astounding malpractice case that has been languishing in Atlanta courts for six years.
That case could determine once and for all whether the Nezhats are the pioneering surgeons they claim to be or whether they catapulted their careers to Stanford on the basis of a dangerous and grotesque medical fraud.
BUILDING A PRACTICE, 1988
Camran Nezhat and his brothers grew up in prerevolutionary Iran, where each attended medical school. Camran emigrated to the United States in 1974 and completed his obstetrics and gynecology residency at the State University of New York at Buffalo.
In 1978, he received a two-year reproductive endocrinology fellowship at Medical College of Georgia in Augusta. Farr and Ceana followed their older brother to Augusta and eventually joined Camran's growing practice in Atlanta.
During the 1980s, while practicing at Atlanta's Northside Hospital, the Nezhats began to develop a reputation for their skills in laparoscopy, a type of surgery in which laser scalpels, miniature cameras and long-stemmed instruments are worked inside the body through dime-sized incisions.
They published scores of articles in medical journals, claiming a remarkable series of ''surgical firsts.'' They also developed a number of ingenious instruments for the laparoscopic operating room. A company they co-founded, American Hydro-Surgical Instruments Inc., eventually sold for $40 million.
Their specialty was treating endometriosis, a painful ailment afflicting an estimated 5 million American women. It is caused when cells that make up the lining of the uterus migrate and bind to other parts of the abdominal cavity, swelling with the monthly menstrual cycle, sometimes causing debilitating pain. The condition is often linked to infertility.
Northside Hospital began promoting the Nezhats, hiring a public relations firm to spread the word about the doctors and their accomplishments. Camran was featured in Newsweek and the Chicago Tribune, and on MSNBC, CNN, ABC's ''20/20'' and elsewhere.
The brothers garnered a reputation as some of the world's foremost innovators of laparoscopic surgery, attracting cash-paying patients from around the globe.
THE MULLEN CASE, 1991
Suffering from endometriosis, 28-year-old Stacey Mullen flew from Southern California to Atlanta's Northside Hospital in 1988 to be operated on by Camran Nezhat. The surgery was quick, the pain was gone, and Mullen was elated as she walked out of the hospital the next day.
''I was ready to name my firstborn after Camran Nezhat,'' she said.
But, as often happens, the endometriosis and the pain returned. And in December 1991, Mullen flew back to Atlanta for what she thought would be another ''quick little surgery.''
The surgery, however, was neither little nor quick.
Camran and his brother Farr, with colorectal surgeon Dr. Earl Pennington assisting, spent hours using laparoscopic techniques to cut Mullen's colon and rectum free of nerves, blood vessels and connecting tissue. Her ''mobilized'' rectum was pulled inside out through her anus, and suspected endometrial tissue was removed. Her patched-up rectum was then pushed back inside.
Then the complications began.
Hours after surgery, part of her colon dropped out of her body as she sat on the toilet. For months, she suffered from extreme constipation. Sometimes she burped up her own feces.
Mullen never regained normal use of her bowel. Eventually, she received a colostomy and must insert a tube into an opening in her side to go the bathroom.
In December 1993, after nearly two years of continuing pain, she filed a malpractice suit against the Nezhats. ''Those bastards ruined my life,'' she said.
THREE ARTICLES, 1993
Shortly after taking Mullen's case, attorney James Neal discovered two medical journal articles that the Nezhats and Pennington had published after Mullen's operation.
The first appeared in Fertility & Sterility in May 1992, describing a single case using the new pull-through procedure for treating rectal endometriosis. ''As with all new procedures,'' the article said, ''there are no data to establish its safety.''
The second was published in the September 1992 issue of Surgical Laparoscopy & Endoscopy. It detailed a series of 16 rectal surgeries, similar to Mullen's, performed in late 1991 and early 1992 - the period during which her surgery took place.
Yet Mullen's case - and her complications - were not mentioned.
The article listed only a single complication: The doctors had to perform traditional open abdominal surgery in order to complete the suturing of one patient's bowel.
''This procedure has been performed safely in this initial series,'' the Nezhats wrote, and they claimed fewer problems than would be expected with regular open abdominal surgery.
The Nezhats aggressively publicized the ''success'' of the new procedure. It was touted by Ethicon Inc., the Johnson & Johnson subsidiary that made the instruments the Nezhats had used. ''For the estimated 185,000 women who suffer from endometriosis of the rectum, this new advance provides them with relief from the digestive symptoms,'' the company said.
At a 1991 American Fertility Society meeting in Orlando, and a 1992 convention of the American College of Obstetricians and Gynecologists in Las Vegas, Ethicon promoted their instruments and the Nezhats, even including a video of the surgery.
But skepticism about the Nezhats and their procedure was beginning to grow. The lack of complications did not make sense for such radical bowel surgery, doctors said. Some surgeons who viewed the promotional video were puzzled: They could not see evidence of endometriosis.
Stories began circulating in the surgical community around Atlanta's Northside Hospital. The medical journal articles said the average operating time for the surgeries was three hours, but during the time of the study, the Nezhat operating room had been burning lights deep into the Georgia night.
Then Neal discovered a third journal publication, written by one of Nezhat's Atlanta colleagues and published more than a year after Mullen's operation.
The article in Surgical Endoscopy described a ''pilot'' study testing the same procedure on pigs in order to assess its safety on humans.
''Some damage to the sphincter might occur,'' the authors wrote, but the long-term effects were unknown: The pigs were ''sacrificed'' before they awoke from anesthesia.
Neal and Mullen were stunned: Not only had the Nezhats omitted Mullen's case from their series - and in doing so did not report her complications - they apparently had tried out the new procedure on her and other women before it was tested on pigs.
Nezhat attorney David Walbert said the pig study ''had nothing whatever to do with the safety and efficacy'' of the human surgery described in the medical journals. The purpose of the pig experiment, he said, was to determine whether the procedure was suitable for treating cancer.
'BARBARIC,' 1993
When Neal began contacting medical experts about Mullen's surgery, many sent him letters and affidavits calling the operation radical and experimental; they characterized it as ''bizarre'' and ''barbaric.'' It resembled a cancer surgery that had been discredited years before, after complication rates as high as 50 percent were reported.
The surgery had not been vetted before a Northside Hospital Institutional Review Board, the usual requirement for an experimental procedure.
''Normally you go before an IRB, come up with scientific background, present a plan, torturous documentation, nine pages of informed consent, and you cannot charge for it,'' said Ohio general surgeon Dr. Francis Barnes.
Mullen and her insurance company, however, were billed $9,900 for the rectal surgery. She eventually ran up more than $1 million in additional medical expenses as a result of the operation, according to Neal.
Neal also learned that Mullen - and possibly four other women whose cases were included in the Nezhats' articles - had signed an unusual document, recently created by the Georgia legislature. It was called a ''waiver of informed consent,'' and it set aside a patient's right to detailed information about a surgery.
''This is incomprehensibly unethical,'' said Arthur Caplan, director of the University of Pennsylvania Center for Bioethics and one of the nation's foremost medical ethicists. ''You can no more sign away your right to informed consent than you can voluntarily sell yourself to slavery.''
''I never knew I was signing such a document,'' Mullen said. ''I thought it was a regular consent form.''
Yet the most disturbing discovery was made in Mullen's own medical records. In his operative notes, Camran Nezhat wrote: ''There was evidence of severe endometriosis of the rectum.''
But Mullen's pathology lab report disclosed that there had been no endometriosis on the wall of her rectum at all - just a few cells in the adjoining fat. The surgery had not been necessary in the first place.
16 MEDICAL RECORDS
Neal went to court and demanded to see the medical records of the 16 other patients the Nezhats had operated on in Georgia, convinced they would show complications, more waivers of informed consent, and surgical data different from what was reported in the Nezhat articles.
But the Nezhat legal team refused to turn them over, citing privacy concerns of other patients - at least 10 of whom signed affidavits opposing any release.
Mullen was given the waiver form by mistake, they explained, and she was told about the procedure's risks. Medical experts for the Nezhats also insist that the rectal surgery was not experimental, so no Institutional Review Board process was required.
''In my opinion, the surgery performed on Mary (Stacey) Mullen was a necessary procedure and would not require any special consent form for experimental surgery,'' said Dr. Robert R. Franklin, a clinical professor in the department of obstetrics and gynecology at Houston's Baylor College of Medicine.
The Nezhat lawyers also argue that Mullen's rectal surgery did not cause her bowel problems. ''She reported constipation before the procedure,'' said Walbert.
THE FIRST WARNING, 1993
In the early 1990s, Stanford Medical School's department of obstetrics and gynecology was in trouble. Despite the school's lofty reputation, the department was not fully accredited.
The Chicago-based Accreditation Council for Graduate Medical Education demanded more ''surgical volume'' before it would upgrade the program's ''provisional'' status.
Yet when Dr. Nick Spirtos heard that Stanford was recruiting the Nezhats, he could not believe it.
Spirtos is a Palo Alto gynecological oncologist with an august reputation of his own. Like the Nezhats, he is a clinical professor, which means he serves on the school's voluntary teaching faculty with surgical privileges at the medical center. He also holds the elected post of deputy chief of the obstetrics and gynecology department.
During the past nine years, he has become a leading critic of the Nezhats and their Stanford defenders.
''I think everything they've written is fraudulent,'' said Spirtos, whose office is just one floor below the Nezhats' in an upscale medical office building near Stanford. ''I don't think they should be allowed to practice medicine.''
Spirtos had traveled with colleagues to a gynecology convention in Florida to see the 1991 presentation by Camran and Farr Nezhat sponsored by Ethicon. The program included videos of two new Nezhat operations, one of them showing the rectal procedure that would be performed two months later on Mullen.
''We couldn't believe what we saw,'' Spirtos said, noting that there was no evidence of endometriosis. ''The surgeries didn't make any sense.''
But before they could quiz the Nezhats about their presentation, Spirtos recalled, the Nezhats left the podium, refusing to answer questions.
Two years later, after studying their journal articles, he warned university administrators not to bring them to Stanford. Spirtos argued that the Nezhats' published data were simply too good to be true.
But Spirtos said his advice was ignored.
''It was a perfect marriage,'' he said. ''The Nezhats had all the dough in the world but no title. And Stanford needed desperately to have surgical volume to legitimize their (obstetrics and gynecology) department.''
NEW TROUBLE, 1993
Within two years of the Nezhats' arrival in Palo Alto, Camran became director of the new Stanford Endoscopy Center for Training and Technology. And Ethicon, which had retained Nezhat as a surgical investigator, agreed to provide a $125,000 annual grant to the center.
Quickly, the Nezhats began pairing up with surgeons outside their immediate discipline - including specialists in cancer, heart and brain surgery - with the goal of expanding the use of minimally invasive surgical techniques.
The practice troubled Spirtos, and when he learned that Camran Nezhat intended to operate on a patient of one of Spirtos' medical partners, he wrote in protest to Dr. Mary Lake Polan, the chief of the obstetrics and gynecology department.
The patient was a 74-year-old woman who had undergone extensive surgery for the removal of pelvic cancer, and Spirtos told Polan that the patient's cancer had spread so extensively that laparoscopic surgery would be useless.
''Certainly, (Nezhat) has no experience in this area (treating cancer), and it seems to me serious patient care issues are being placed on the back burner in your headlong rush to promote the Nezhats,'' he said in a 1993 letter to Polan.
Despite Spirtos' protests, Nezhat and Stanford cancer surgeon Dr. Nelson Teng went ahead with the operation.
The patient was on the operating table for seven hours and was hospitalized for seven days afterward. Her bladder and bowel were punctured during the operation, Spirtos said, and the doctors could not remove all the cancer. In his report to the university's ''quality assurance'' review committee, Spirtos charged that Nezhat, credentialed as a gynecologist, was performing cancer surgeries, a specialty that requires years of extra formal training. He also laid out four other Nezhat cancer cases for the quality assurance review committee.
''No other hospital would allow a gynecologist to perform (cancer) surgeries,'' said Spirtos.
But his hope for a quick review of the five cases soon faded. ''Stanford sat on those cases for years,'' he said.
NEZHAT'S AFFIDAVIT, 1994
Meanwhile, Mullen and her attorney continued to press for the release of the files on the 16 other women who had undergone the rectal procedure. And the Nezhats continued to refuse.
In a sworn 1994 affidavit, Camran Nezhat declared it would disrupt his practice for months if he were ordered to produce records demanded by Mullen's legal team.
He described a filing system with 20,000 patients, each listed only alphabetically, with no index, no computer database and no cross-referencing by type of treatment, surgery performed, or journal publication.
''I would . . . have to manually review every single patient record . . . to determine whether the record referenced a patient whose procedure was the subject of a journal article,'' he testified.
The affidavit shocked Nezhat's critics, who say it has cast a pall on the validity of the Nezhats' research ever since.
''I've been doing this kind of research for 25 years. There is a substantial problem if you cannot link patient records to publications,'' said Dr. David Grimes, former chief of obstetrics and gynecology at San Francisco General Hospital, who briefly served as a paid expert to Mullen's legal team.
How, asks Grimes, can the Nezhats publish extensive studies based on old charts and old data involving hundreds of patients over many years if those patients' files are not indexed or cross-referenced?
Grimes was not the first doctor to question the Nezhats' research. Long before they publicized their controversial bowel surgery, competitors and collaborators alike were skeptical of the brothers' claims of surgical firsts and problem-free procedures. In 1987, Dr. Harry Reich, a world-renowned laparoscopic surgeon at New York's Columbia-Presbyterian Medical Center, agreed to collaborate with Camran Nezhat on a surgical study of 105 tubal pregnancies.
But Reich was bothered by Nezhat's repeated failure to share his data on 40 patients to be included in their article in the Journal of Reproductive Medicine.
''So we had to delete the data from the paper,'' Reich recalled.
The Nezhats' lawyers say Reich never requested any data that were not provided.
In 1990, a Nezhat report in the journal Obstetrics and Gynecology also raised eyebrows. The Nezhats stated they had performed 4,000 laparoscopic surgeries without injuring a ureter, the tube connecting the kidney and bladder.
Their claim drew a sarcastic response from three Yale University doctors: ''The authors are to be congratulated. . . . Either these surgeons had other complications, perhaps as serious, or they possess an unbelievably high level of skill and judgment.''
Other articles in which the Nezhats claim to have reviewed thousands of old cases include:
-- A 1995 textbook article describing 214 complications among 6,949 cases in Atlanta and Stanford from 1982 to 1993.
-- A 1996 medical journal report of severe urinary tract endometriosis in 28 women among 2,226 treated for endometriosis from 1989 to 1994.
-- A 1997 study examining 5,300 surgeries dating back to 1988, counting up 11 hernias caused by insertion of the laparoscope.
Atlanta attorney Walbert scoffs at accusations of medical fraud. ''Many, many surgeons'' have conducted research with the Nezhats, he said. ''Those who have any knowledge have never claimed there was anything 'bogus' about any of the reports.''
Dr. Sally Tazuke, a Stanford reproductive endocrinologist who has worked with Camran Nezhat frequently, said his reported complications are low because he is exceptionally good at what he does - even while taking on the riskiest cases. ''If I were a patient, I would sign up with him. I'd send any family member,'' she said.
Skeptics say the stakes are high. Dr. Thomas Lyons, an Atlanta gynecological surgeon who believes the Nezhats have published journal articles with phony data, said medical fraud can lead unsuspecting doctors to hurt their patients.
''This is as dangerous a situation as you can run into in medicine, because people may be making medical decisions based on something that doesn't exist,'' he said.
If someone ever questioned the veracity of his own data, Lyons said, ''The first thing I would do is throw that data right in their face. . . . The best defense in the world is the truth.''
NEAL'S LETTER, 1995
In January 1995, Mullen's attorney, James Neal, wrote to Stanford, alerting the university to the allegations his legal team was making against the Nezhats. As a former hospital counsel himself, he said he thought they would appreciate a copy of the Mullen lawsuit.
''I feel that your institution should have the opportunity to evaluate these matters . . . given your understandable and overriding concern for the patients within your institution,'' Neal wrote.
But Stanford took no action.
Instead, Margaret Eaton, a university lawyer, forwarded the letter to Nezhat's attorney in Atlanta, with a note saying that ''we do not intend to respond to this letter, nor are further communications from Mr. Neal welcome.''
In June 1995 the Accreditation Council for Graduate Medical Education approved full accreditation to Stanford.
ALLEGATIONS, 1996
A year later, Neal sent Stanford a thick package of documents, laying out in more detail the charges against the Nezhats and asking Stanford to investigate.
Dr. Richard Popp, Stanford's senior associate dean for academic affairs, said Neal provided a ''massive amount'' of what he called ''disorganized'' information.
Popp finally opened an inquiry into the charge of scientific misconduct. But university officials contend that by that time, some of the allegations, including Neal's claim of medical journal fraud, had been thrown out by the Georgia courts.
Neal, who freely admits that he has become obsessed with exposing the Nezhats, was running up a list of legal setbacks. In his dogged pursuit of the Nezhats, he was building a reputation as a crank.
He was disqualified from the malpractice case by a Georgia judge in 1995 for ''unethical behavior'' and could no longer represent Mullen. After a federal judge last year tossed out his attempt, on behalf of another client charging malpractice, to use racketeering charges against the Nezhats, Neal was charged with contempt of court. The judge also assessed $384,000 in ''sanctions'' against the plaintiff and her remaining attorneys. The sanctions are on appeal.
Neal denies the unethical conduct allegation, and the contempt of court charge was recently dropped. The only thing he is guilty of, he says, is aggressively representing his clients against institutions willing to look the other way.
''These guys are bad doctors, some have even said evil, and they have to be stopped,'' he said.
WITNESS, 1996
Shortly after Dr. Tom Margolis joined Stanford as an assistant professor and chief of pelvic surgery, Farr Nezhat invited the newcomer to watch him perform a complex laparoscopic procedure.
During the operation, Nezhat cut the patient's ureter. Margolis, who had also served as director of urogynecologic/pelvic surgery at Northwestern University Medical School, assumed it was an accident, a known but unwelcome complication of the difficult surgical technique. He stepped in to assist Nezhat in repairing it.
But a short time later Margolis learned that, in a post-operative review session and the operative report, Nezhat described the cut as deliberate. He said he sliced the ureter to remove endometriosis that could have blocked urine flow.
Margolis was outraged. He said that he saw no endometriosis on the ureter and that the pathology report proved it.
''It was clear that Dr. Nezhat was performing an unnecessary procedure,'' he said in a sworn affidavit.
THE POLAN MEETING, 1996
More than two years passed before Stanford's quality assurance committee took up the review of the five cancer cases in which Spirtos had alleged improper surgeries by Camran Nezhat.
Just before the review committee was finally set to meet, Dr. Mary Lake Polan, chairman of obstetrics and gynecology, dropped by Margolis' office. He was one of the physicians reviewing the cases.
''We need to make sure that Nezhat is cleared on all these (cancer) cases,'' she told him, according to his affidavit.
Ultimately Margolis - and the other members of the quality assurance committee - voted in favor of Nezhat on all charges.
Polan said Margolis' allegations are false.
''I adamantly deny the statements attributed to me and deny there has been any pressure to exonerate any physician during the quality of care committee process," she declared in a written response to The Chronicle.
Margolis' decision to vote to exonerate Nezhat would haunt him for more than a year, until finally he had to act.
THE SHUER LETTER, 1998
In April 1998, Margolis met with Dr. Lawrence Shuer, chief of staff of the medical center. He told Shuer about the cut ureter incident and the pressure Polan had allegedly exerted on him.
''He (Shuer) acutely and abruptly ended our conversation, and I was excused from his office,'' Margolis said.
More than a year later, when Shuer learned Margolis was still criticizing the Nezhats and Stanford, he sent a written warning:
''Rest assured that Stanford Hospital and Clinics intends to pursue its full legal remedies if these defamatory and libelous statement do not cease,'' Shuer wrote.
Furious, Margolis, who had left Stanford to practice with Spirtos at the Women's Cancer Center in Palo Alto and Los Gatos, wrote back, saying that Shuer's job as chief of staff was ''patient protection not doctor protection.''
''The data which (the Nezhats) have published, including the rectal eversion procedure, is fraudulent, yet their publications are being accepted as standards in the surgical community. Stanford, by not auditing this clinical data, has ignored the concerns of scores of surgeons,'' Margolis wrote.
STANFORD'S DUTY, 2000
Defenders of the Nezhats at Stanford dismiss both Spirtos and Margolis as jealous competitors. But other medical experts say Stanford should have demanded a review of the 16 cases and has shirked its responsibility to verify the Nezhats' research claims.
''Stanford has a duty to review this,'' said Dr. Warren Grundfest, chairman of Biomedical Engineering at UCLA and an expert in new medical technologies. ''Serious allegations have been made by credible people, but Stanford has played like an ostrich with its head in the sand.''
But Stanford officials contend they are not obligated to review the 16 patient records because the rectal surgeries were performed in Georgia before the Nezhats came to the West Coast. Shuer said the procedure in question has never been performed at Stanford.
It was appropriate for the Nezhats to leave Mullen's case out of the medical journal, according to Stanford, because she was ultimately found not to have rectal endometriosis like the other patients.
Stanford reviewers have never asked the Nezhats or Northside Hospital for the records to verify the accuracy of the other 16 cases. ''We have no right to the records and do not want to violate patient privacy,'' said Stanford's lawyer Debra Zumwalt.
The university also never interviewed Mullen or the 20 doctors who have expressed concern over the Nezhats' research.
According to Stanford, the appropriate institutions to investigate the Nezhats are Northside Hospital, the Georgia Medical Board and Mercer University, where the Nezhats were clinical professors at the time of the surgeries. ''Stanford will carefully review the conclusions of those investigations,'' said Popp.
But a spokesman for Mercer, a Macon, Ga., medical school founded in 1986, said the school has no investigation pending.
The Georgia Medical Board's investigation of the Nezhats is continuing. The board will not comment on its status.
Stanford attorney Zumwalt said Margolis' complaint to Shuer regarding the cut ureter incident was never put in writing. Shuer said he asked Margolis for more information, and none was provided, but the case has now been identified and is being investigated by the quality assurance committee.
The university said the Nezhats have been cleared of allegations that they operated outside their specialty. Officials would not comment, however, on any details of the five quality assurance cases because they are confidential.
''One thing I can point out,'' said Zumwalt, ''is that doctors and patients and their families can reasonably disagree as to how aggressive to be in treating terminal diseases.''
GEORGIA COURTROOM, 2000
Mullen has refused to engage in monetary settlement talks with the Nezhats and promises to continue her suit until the records of the 16 other women are made public.
''My life has been changed in a very horrible and profound way by the experiment (that) Camran Nezhat has conducted upon me without my knowledge,'' Mullen said in an affidavit. ''I despair that other women will be injured by well-meaning surgeons who believe Camran Nezhat's article that there were no complications from this new surgery.''
In November, after a battle spanning six years - and six judges - Superior Court Judge Melvin Westmoreland in Atlanta ordered a confidential release of the records to Mullen's lawyers, and in January, the Nezhats and Northside Hospital turned them over.
While the records remain sealed, medical experts hired by Mullen's legal team to review the documents have written Judge Westmoreland expressing their concern about what the records contain, and urging that they be unsealed, in the public interest. ..
William Carlsen can be reached at wcarlsen@sfgate.com. Sabin Russell can be reached at sabin@sfgate.com.
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