Patrick Dodd and Small Revolutions: Lab Rats n Cadavers

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Arrogance, Abuse, Fraud, and Medical Malpractice:

How Some Physicians Beg for Lawsuits

Our health care system is much sicker than even Michael Moore understands. Greedy physicians addicted to money are literally abusing and battering patients for the sake of profit.

TEACHING RAPE:

Medical parishioners validate and perpetuate rape culture.

If you are an Oregonian woman in need of medical care that requires anesthesia beware. We all heard about the recent incident with the anesthesiologist in the dentist’s office, but few realize that you are more likely to suffer sexual assault while under anesthesia in Oregon than if you had the same procedure in 42 other states. Women have been lead to believe they are protected while under anesthesia. This is not the case. You will be told that law requires a “nurse” be with you while under anesthesia, they rarely tell you that “Nurse” can be a male, even if the patient is a female. They do not tell you that Oregon allows Drs to bring in male students and resident trainees to watch and participate in procedures while a patient is unconscious, often without her knowledge before or after. . Students have described as many as five and six students lining up to do pelvic exams on a single anesthetized patient. If Drs bother to tell patients at all about a student they often bring in a student after a patient has been prepped for a procedure, introduce the student and shove a consent form in your face. Now at this time when you are naked, perhaps even in many cases partly sedated, Drs acknowledge that 100% of the time patients do not feel free to read what they are signing or object, regardless of previously expressed preferences. Drs. admit the fear that a patient will say NO, or a patient having already said, NO is the very reason they trump patients will by last moment introductions or fail to introduce all together. Thus, Drs. admit to subjecting women to touching and exams by people, they have in many cases never even been introduced. Yet, research indicates that if women are asked ahead of time, before the introduction, and the number of students is limited, most will not object. Some will; but then should that not be our right?
Not only do such practices expose patients to risks they have not given informed consent for Drs. to subject them to, risks resulting from prolonged anesthesia, multiple penetrations beyond medical necessity for the patients health, and risks of error by inexperienced trainees, but also subject them to the increased risks of sexual assault while under anesthesia. Now the first three seem rather obvious, but the latter? How can that be? Well, think about it. These students and all the medical personnel from tech to nurse watch as women are violated, listen as Drs. rationalize that women have a duty, and students have a right to access women’s bodies against their will and/or knowledge. Take the student’s quote below who was subjected to an ethical Dr. during OBGYN rotations and complained, “at what point do the patient's wishes get trumped by the need to train students?" One might just as well ask, “At what point do the woman’s wishes get trumped by the need for sex?” Now one will argue that education is not sex, but let us look closer. The message that is being relayed, being taught, culturally reinforced is that men's needs/desires are trump women's right to control what happens to their own bodies. Women’s will is irrelevant in light of the desires and needs of men, in this case male students and Drs. to learn, to educate, and to practice medicine as they see fit. While all patients suffer the risk of student error and prolonged anesthesia from teaching situations, and therefore should enjoy a civil right to informed consent prior to prep and prior to student presence. In many cases like the one above women, patients are in addition suffering the risks of psychological trauma from rape and/or the fear of rape. In Oregon, it seems that risk is higher than 42 other states. There is a connection between the resistance of the medical professionals to relinquish the privileges they find in a rape culture and the violation of women under anesthesia. What privileges? Access to women’s bodies against their knowledge and/or will. OHSU is just one example. In spite of all their “woman centered” propaganda. OHSU is teaching it’s medical students to rape patients. How? By teaching them that they have a right to access women’s bodies in spite of women’s expressed will against or ignorance of that access. Such practices can and do lead to rape.



http://www.ncvli.org/objects/Oregon.v.Burleson.pdf

Are Portland V.A. patients being used and abused for the sake of training OHSU residents?

The media has focused on vets access to medical care, and claimed the quality of care is just fine. I beg to differ. While the quality of health care is generally poor in America, Vets have literally become the lab rats and breathing cadavers of the U.S. health care system. It has been conventional wisdom that vets may improve their odds of quality care if a V.A. medical facility is joined at the hip to a teaching facility such as is the case with OHSU and PDX VA. Reality is much different than most people would ever dream. I was reminded of a story told to me by an old C.N.A. who used to work a V.A./teaching hospital. This resident happened to mention that he had not “done a hernia”, the surgeon promptly began going about raising the gowns of old men until he found a hernia (a small one that did not require surgery and the man was very old), and ordered the prep and “trained” that young resident proper. The most present lesson? Poor elderly V.A. patients are little more than a cadaver.

What occurred above is patient abuse pure and simple. So why did he feel so free to do what he did? The odds of him suffering any repercussions are relatively low when the patient is a V.A. patient. OHSU is sued by the public on average of 23 times a year for malpractice. At this point in my research, under the umbrella of the V.A. they seem to have suffered none.

While this sort of risking harm for the sake of teaching puts all vets at risk, women Vets, may find themselves not only put at risk of physical harm, not only physically assaulted in the name of “teaching” OHSU residents at the PDX V.A., but also at risk of having ones stated gender preferences violated in the most vial ways.

Many women, history of assault or not, prefer female doctors in certain situations—OBJYN, surgical procedures such as mastectomies or colonoscopies. Given the historically evident risk of assault women face while under sedation, this is a time when more than the gender of the physician, but the gender of the nurse may be relevant. In the case of GYN surgery such as an oophorectomy a women may not want men present at all.

Here is one story that illustrates my point as told through a couple of letters to PDX VA Chief of staff.


V.A. Medical Center, PDX
Chief of Staff
Dr. John Dryden
P.O. Box 1034
Portland, OR 97207

I have some concerns regarding my care at the Portland V.A. While both my husband and I have repeatedly expressed to several staff members from bottom up, (from C.N.A. to DR) that I am not comfortable with men being involved in my care if that care involves exposure of sensitive areas, I am not evidently being heard or understood clearly. I have been in O.R. a couple of times in the last year. I am not at ease with being unconscious generally, and very uncomfortable with the presence of men during unconsciousness and/or procedures the likes of these two events. The first event was a mastectomy/bilateral oophorectomy on June 18th ‘07, the second was a colonoscopy on Dec. 12th ‘07. I had done my best both times to ensure I was not only in the care of a woman, but women, that is that not only the surgeon, but also the entire “team” was female. Both times I asked and understood that not only was the person performing the surgery, but also all in the room would be women. Neither time did this turn out to be the case.
In the first case, this may be due to a difference in understanding the term “team” in conjunction with a failure upon the part of the V.A. policy to respond fully to the needs of many women who might specifically request female Doctors. In spite of asking and being told that we were going into the O.R. with, “an all female team”, in the case of the mastectomy/bilateral oophorectomy a male Ronald J Gschwend was involved on the prep team and support staff during the surgery; according to the record he seems to be in the room during the entire prep and all three operations. Given the exposure in such a prep and surgeries, I am not happy with this situation for two reasons. One being unconscious, I cannot KNOW that I was never in the room alone with him at any time before, between, or after surgeries, and secondly the overwhelming eroticization even comodification of violence against women in this culture ensures that I can never be assured that such procedures as a mastectomy that comes at a very high price for me will not be an erotic experience for a male. For both these reasons, I am upset about Ronald’s presence. I am also not happy with the fact that a Jeffery J. Hoke seemed to be in charge of my care in POCU for well over an hour while I was still under the influence of sedation. I awoke in a Room to find no women around (there did not seem to be a woman on the ward that night) and men in charge of my care. My husband was there so I said nothing at the time (did not seem to care until latter when the sedative had worn completely off.) My husband did at that time warn the male nurse that I would not like this once sedation wore off. It seems to me if a woman makes gender specific requests; there is good reason to assume a need for this gender specificity to apply from the top all the way down unless the patient indicates otherwise.
It appears to me that a Dr. Shabnam Chaugle MD is listed as the surgeon and Dr. Kwan as attending on the mastectomy. (Kwan has assured me she did the operation, but according to the records, this is not the case.) I do not remember being introduced to any Dr. Chaugle but based on a Google, this person was a Resident at OHSU, who is now in California. It also appears that Dr. Chaugle is a woman, but I am not sure this info is accurate. My husband told me that a male in scrubs introduced himself as assisting; but after reviewing the medical records, I have come to the conclusion this must have been Dr. Chaugle or perhaps Dr. Galic, and that, he was simply mistaken about her gender. I find this sort of bait and switch to a relatively inexperience resident at the last minute a problem itself when a procedure is blown (in case of the mastectomy and oophorectomy it certainly was not), if gender is also switched in the process, as occurred with my colonoscopy on Dec. 12th. , it is even more complicated. Again as in the case of the first surgery, I requested a woman when I made the appointment, was introduced to Dr. Judith Collins, and told this would be the woman doing the procedure, asked and was again assured it was an all female team. Again this turned out not to be the case. After I was prepped and in the O.R. room a young male, Dr. Mitchal A. Shreiner was introduced to me, and I was told he would do the procedure. Dr. Collins told me in the phone conversation I had with her latter about the issue she did indeed understand that I wanted all women present. She did apologized for bringing Dr. Shreiner’s in when she was well aware that I did not want a man present. In addition, however, and perhaps more of a concern to me is how in both cases (June 18th and Dec 12th) men were involved in my care on a lower level. On 12/12 there was also a male “tech” that introduced himself, identified his job as transport of any tissue to lab, and said he would be on the “other side of the door unless needed” and then preceded to remain in the room the entire time. During my phone conversation with Dr. Collins, she confirmed that I heard him correctly, that he said he would be on the outside of the door unless and until needed and could not account for why he remained in the room. When I looked at him like what the hell are you still doing here, rather than asking him to leave, Dr. Collins tried to reassure me by blocking his view with her body, but that only lasted for a short while until she had to “step away”. I am very upset that he stayed in the room and this issue I would like to be addressed. Why did this man lie? Why did he stay in the room? He obviously knew I did not want him there, yet he lied to get consent for one thing and did another. I am not sure this tech’s behavior legally amounts to sexual harassment, but from my standpoint this is at least a case of sexual harassment. Being introduced literally seconds before the procedure, I did not feel I had the power or time to object. (I did display behavior that was evidence of my discomfort, however, including trying to cover up when left in his full view. That is the last thing I remember before being rushed out the door to go home. I cannot even remember being given the post op instructions, but then neither does my husband.) I see no reason for his being there. The attending nurse could have easily handed any tissue that needed transport (his stated purpose for being there) out the door. WHY DID HE STAY???

The next day I noticed signs of much more physical trauma than I expected—excessive bruising in the area (a deep blue circle all the way around my anal cavity extending out about an inch beyond the opening, and continues into the canal), as well as, pain both in the local area and lower abdomen. A few days latter I talked with a breast cancer friend I call when I need understanding. She had just had a colonoscopy a couple of weeks earlier and she said she had no such trauma immediately concluding I was assaulted. Now, I do not know this to be true; however, given no other explanation I do not know what else to think. Dr. Collins could think of no reason why there should be such trauma from the procedure.
However, it is logically unavoidable that either:
Dr. Collins not having done a preliminary exam is unaware of some condition that may have caused this and likely should have also then eliminated me as a good person for Resident training. (Which in my opinion any patient currently suffering chronic pain is not a good candidate for training risking the infliction of further suffering.) or,
Dr. Shreiner needs to fail that procedure, be taught better on a couple of cadavers and then try again on a living human. Dr. Collins insists he did just fine. He certainly seemed to be doing ok as I went under; but something went wrong somewhere, or,
I was assaulted while under sedition. Dr. Collins assured me that it is PDX policy to have a female nurse present the entire time a woman is under sedation, but I am not confident that protocol is consistently followed, nor that Dr. Collins would know if it were not. While I was told that the female nurse who was supposed to be there the whole time would call and assure me that she did indeed follow that protocol, I have received no such call. I would like to talk with her. I do not know her name, and again as in the case of the tech, I was unable to find it in the records. (This indicates to me other people could have been involved including men and their names would not necessarily show up on my records.)

Again, I do not know why the extent of the physical trauma. It is my lack of ability to KNOW what occurred in conjunction with knowing things did not occur, as they should have that concerns me. (I was traumatized when I did not go under during a colonoscopy four years ago, but to go under and wake up harmed is worse.) I certainly think an investigation is warranted. Why did this man stay in the room? Who had any contact with me before I was returned to my husband? What are the professional and criminal histories of these people? Did opportunity present itself? Why am I so badly bruised? I want to know did the resident under Cr. Collins supervision (or lack of supervision if she left the room), botch this colonoscopy or was I assaulted? Elatedly, unless Dr. Collins can KNOW beyond a shadow of a doubt that nothing occurred and in the absence of any explanation for the level of physical trauma, it seems to me I now need to be tested for STDs before returning to active relations with my partner. Thus, I would like an investigation into whether or not Dr. Collins or you can GUARANTEE no need for concern, and inform me of the results. Did both Dr. Shreiner and the “tech” leave the room before or with Dr. Collins? Did Dr. Collins leave the room while either male was still in the room? Did either of them return to the room? Was I ever left alone or in care of a man or men during or after the procedure? What is the history and character of this nurse? What is her name? I would like to talk with her. WHAT HAPPENED???? Why am I hurt???

I understand that I am writing a male Dr. concerning this issue, which guarantees you will not be able to understand this on the level I would like and may even find my preferences sexist and certainly inconvenient for male colleagues, perhaps even staffing. From my perspective, given not only my personal experience, but the experience of many women in the world and nation wide, in conjunction with the fact that Oregon has a higher instance of sexual offenses against women under sedation in medical care than 40 other states, indicating a lack of sufficient law and/or monitoring to guarantee women’s safety; it is essential to my security to never be left alone in the care of a male while under the influence of anesthesia. I understand that such sex specific criteria will not guarantee the absence of an inappropriate event (women abuse and silently allow abuse); it will certainly decrease the odds.

In addition to the unexplained physical trauma, or should I say even in the absence of this physical trauma, I would continue to feel distressed over the presence of male “techs” during these procedures. If the general population of breast cancer patients feel anything like I do, cancer itself leaves one a bit out of control of ones life and even body. In this case, it seems to me, a lack of sensitivity training and adequate policy or enforcement has exacerbated this feeling (rather not just a feeling but actual reality of lack of control). Doctors are in a habit it seems of bringing Residents in at the last moment. (I am starting to suspect this is because if they give us time to think we will not consent, either to a student or a male.) As stated before, I suspect it may well be that pushing the limits of my tolerance for men in such situations benefits education and keeps from complicating staffing; but it has taken an emotional/psychological toll on me that is not acceptable. If a woman expresses a preference for female Doctors in general or in relation to a specific procedure, it should be assumed she has a reason for such a preference. More questions need to be asked to see how deep that sensitivity goes and how best to accommodate the patients medical needs in a way that will allow her to get the care she needs without unnecessary psychological discomfort. The way it is being done, (ask nothing just bring the men in at the last moment; if she does not assert herself enough to throw them out, she must not mean it when she claims she does not want men present or involved), not only is it similar to rationalizations for sexual assault, it lends itself to an attitude that is conductive to assault, a hostile environment if you will. It amounts to an attitude of people as objects rather than free subjects, giving staff the idea that stated preferences do not matter if she does not yell or stop her feet (or if you think she will not remember doing so) keep going. Also, some of us experience this lack of consideration of our expressed preferences while under sedation as sexual assault, and repeated requests by staff to include men while in the men’s presence as sexual harassment. It is a problem when Doctors feel more compelled to take you into a private room to talk you into a procedure they think you may resist (this has occurred several times) but do not seek the same sort of meaningful informed and expressed consent when they bring in a male and/or student knowing you may be resistant. I am either, never told men will be present and may or may not find out from my charts, or men are brought in at the last minute, after prep after in the O.R. when it is much harder to protest, and drugs may have been administered, “to help you relax”. At this point, it seems to me, women’s expressed limitations regarding male participation are being intentionally pushed, even ignored.

From the perspective of a sensitive woman and patient, I would suggest that policy change to something akin to:
ALL women who are to undergo a procedure requiring the exposure and or invasion of sensitive areas (breasts, vagina, anus), are asked what their comfort level is;
a. Ok w/ specified procedure(s) performed by males
b. Not ok w/a. but ok w/ male support staff being present during procedure, involved in prep, or post op care.
c. Not ok with male presence of any kind during specified procedure, prep, or post op.

I have been assured it is policy not to leave women alone w/any males while under the influence of anesthesia, regardless of perceived or expressed patient comfort level. If this is the case, make sure it is strictly enforced. If it is not the case, it should be.
2. Only in an emergency effecting patient health should such gender preferences as described and reported by patient be violated.

Please do not tell me to go to, “patient advocacy”; I called them and was told that due to the nature of my complaint I needed to write this to letter to the “Chief of Staff”.

Beyond the requests made above, what do I want?
While the above events are the most disturbing I have experience of late, they are not isolated. I was open to some exceptions (male students who I was introduced to ahead of time, had a chance to talk with and then asked to approve or not by the female supervising Doctor after the male student has left, so I can speak frankly about how I feel concerning his participation). However, given the fact that if I am asked at all I am not being asked ahead of time (before prep, before the administration of any medications even a mild tranquilizer, before being taken to the procedure room), and given the fact that when I ask and am assured of an all female team up to moments before the procedure, yet can have no confidence that this will indeed be the case, I not only want the flag in my chart as Dr. Collins suggested, but I want a member of my family present at all such procedures including O.R. I realize this is unconventional, but at this point, after so many lies, and now there is this unexplained physical trauma, I have no trust of your staff male or female from C.N.A. to Dr.
I would also like the name of the tech on 12/12. I remember his face, but I want to know his name and have it put in my charts that he is never to be involved in my care in any way what so ever in the future. I feel very strongly about this. Education, staffing, there was absolutely NO valid reason for him to stay in the room. He was getting off on doing so; he could, so he did. If I had the power, I would fire him. (As an old labor activist, I do not say this lightly.) I would applaud your doing so, but doubt I will see this satisfaction unless I am not the first to complain. He lied, and did so intentionally and smoothly; at the very least I would like a write up on the event in his personal file. Then, in case such behavior is repeated on his part, there will be a record in his personnel file making the pattern evident.

I would like a min-by-min account of what occurred 12/12 during and after the procedure. I would like to know what medications where administered and when. (The records on 12/12 seem incomplete from the exclusion of this tech’s name to the absence of notes on prep complications and a bad decision to administer a third bottle of fleet.) If there is any sort of recording of the procedure, I would like to hear it. I DO NOT want you to withhold any information you may discover for any reason, including that such knowledge may negatively affect my health physically or psychologically. (If you have been following the recent case in PDX you will know that a higher court has now overturned the lower court declaring that patients do have a right to know if they have been assaulted, in spite of perceived psychological/physical harm.) In addition, given this administrations use of Verichips, and expressed desire to expand that use, I would also like to know if any kind of chip was placed during either procedure above. Aside from the obvious problems with such a practice, these chips have been proven to cause cancer.
I would like a referral to a private physician of my choosing to do a follow up exam to check for physical damage. (I am still suffering abdominal cramping and canal discomfort, and spotting.) Dr. Collins volunteered, but at this point, I would like an independent examination. Unless you can guarantee it is not necessary, I would like the same to be done in terms of testing for and STDs. I cannot afford to pay for this myself, and it seems to me outside/third party care only makes sense in terms of these two requests. The V.A. should pay for this, and I should still be able to choose my own Dr. or clinic.

While in the V.A. health care system I have received both the best and the worst of care. In many ways the V.A. system is the best American health care has to offer. If my experience of late is any indication, however, much work still needs to be done in terms of women’s health and safety. I am looking forward to hearing from you.


After another encounter w/Dr. Collins and reading updated notes in her medical records, this woman writes another letter before she hears back regarding the first. That letter follows.

V.A. Medical Center, PDX 1/22/08
Chief of Staff
Dr. John Dryden
P.O. Box 1034
Portland, OR 97207

Dr. Dryden,

This is a follow up to a letter I sent to you (forgot to date but) you rec’d on 1/9/08 I would like to make an addition to my complaint referred to above. I am not sure why my follow up was with Dr. Collins rather than Kingge other than this gave her an opportunity make misleading notes to out and out lies in my chart in an attempt to cover her own back side, an attempt that ends up providing further evidence of her incompetence and raise more questions regarding her medical ethics and what happened on 12/12.

First are the conflicting notes. While the notes I previously obtained on 12/13 stated that both prep and procedure where “uneventful”, and claims of “no complications” were made in notes by Dr. Schreiner, and verbally by Dr. Collins in phone conversations and at the appointment on the 16th,” in the notes following that appointment Collins now claims, the procedure was “quite difficult from prep onward”. She does not elaborate. The failure to elaborate may be because the difficulties were a direct result of Dr. Collins’ incompetence.

Indications of incompetence:
The prep was problematic because of Dr. Collins not allowing enough time for the laxative to work. It seems to me the low digestive motility indicated more time be allotted; but instead she insisted that I needed a third dose as I had previously thrown up some of the a.m. dose. I told her I did not throw it all up and felt what I had thrown up was due to consuming too much already; but she insisted I needed a second a.m. dose indicating that it would be a shame to have to start over again another day. Not wanting to go through the prep again, and living 5 hours from Portland, against my better judgment, I acquiesced and WAS OVERDOSED. 10 min or so after the last dose, I really started throwing up. This may account for some of the difficulty in OR if I continued to heave during the procedure, but I have never been told this was the case. Also, I told them not to put a tube down my throat as I had a serious gag reflex problem; if they did so, knowing my own history, I have every reason to believe this would have further complicated things. It certainly did the last colonoscopy that was done four years ago concurrently w/a UGI.

The procedure was 45 min long. This is unacceptable!!! Why was a procedure that should have lasted 20 –30 min tops going on for another 15 min? When I asked Dr. Collins about this, she once again said the procedure was uneventful and indicated that I should find comfort in the fact that is was thorough. This is in reference to locating cancer; but if this can be achieved for the mass of cases in 20-30 min, being thorough cannot explain 45 min. What, is everyone else getting a cursory exam? An exam this long for the sake of training is patient abuse.

Most of your staff members seem to be able to read charts. The pain clinic seems very good. What is wrong with Collins and her fellow? After repeatedly telling these people I am not using pain medication because of an impaction, their conclusions continue to hypothesize pain medication use as a factor. Furthermore, Dr. Collins seems to think the GI issues are recent, starting A.I. use. This is simply not the case and she should know this if she had read my chart. I do not like medications and for the last 10 years have not taken medications until recently, but this condition has been consistently present and progressive over that same time. Unless it has something to do with a past medication such as Serizon, which I have previously inquired about and was told there is no relation, it is not likely med related. Also, indicating an unwillingness or inability to effectively read charts she stated in these same notes that I never had a UGI, which I did four years ago.

Indications that Dr. Collins is not an ethical practitioner:
The notes Dr. Collins put in my charts on 1/16 do not reflect the facts, not even as she knows them. Dr. Collins knows that I never gave permission for the male tech to be in the room save to receive tissue samples if needed. She admitted this over the phone and stated she did not understand why he stayed in the room. As I stated before, his stated purpose was transportation of tissue and he promised to remain on the other side of the door until needed. Dr. Collins knows this and what she was willing to admit to me over the phone is not reflected in her notes; in fact she provides conflicting statements. I never gave permission for him to participate in the procedure, “suctioning” or other wise. Dr. Collins knows this, and has previously admitted to this understanding, yet now Dr. Collins’ states I did consent to him being in the room and his participation. I assume this is to cover her butt, and thus he did indeed participate in the procedure. Why was he needed for this if there were two Drs. and a nurse in the room? From what orifice was he suctioning, and why was the nurse not doing this? Why is a “tech” doing this? He was not even scrubbed. If there were extenuating circumstances that indicated he be used in such a capacity for which he is not qualified it seems such circumstances warrant a note in the chart and a post op explanation to me. Dr. Collins claims she informed me that, “JECHO requires a tech” she did not and if she had bothered to talk with me in that sort of detail, I would have rejected the male tech. If she had asked if a “trainee” could do the procedure, I would have said no regardless of gender. I was hustled pure and simple, and in the most vile way—kin to rape. Again, Dr. Collins knew I did not want men involved and set things up so I would know as little as possible and know it as late as possible. This is not ethical.

Dr. Collins had many opportunities (including when I expressly asked, and when she had me in a room to talk me into an overdose) to ask about her “trainee” (he was introduced only as an MD to me, not as a “trainee”, another of Collins’ lies), and failed to do so until I was in the OR. While she states in my chart I was “OK” with these men being in the room; she admitted over the phone that she was well aware that I was not “OK” with it, (as I had asked for women and expressly confirmed less than 20 min prior to the procedure that this would be the case), at the time and apologized for moving forward in spite of this understanding. Furthermore, this “request” concerning Dr. Schreiner did not come in the form of a question, but in the form of an introduction and the statement that he would be doing the procedure while shoving a paper to sign in my face. Laying down prepped for procedure is not a time when a patient feels they have the leisure to object, let alone to sit up ask for light and some glasses to read a document. I was never told a tube would be put down my throat; and had told them when they asked about a feeding tube that this would cause an ongoing gage reflex. The only reason I can see for this late request concerning the men, and the misrepresentation of the techs participation, is manipulation. If this does not break the letter of the law, it certainly breaks the spirit of the law concerning consent. Was a tube put down my throat? Did this still unnamed tech participate in the procedure? If so why? There were more mistakes made than the overdose and disrespectful manipulation and lies regarding the men here. Either Dr. Collins did not honestly attend the entire procedure, or she knows more than she is telling or entering in my charts, as the physical trauma remains unexplained. She seemed to present a hypothesis at the last appointment about the tub being curled when pulled out causing a descending colon. I did not understand what she was talking about; but my husband explained it latter. If this happened, who had a hold of the tube at the time? Why was I not told?

At this point, it has become evident to me that Dr. Collins is a very poor physician. She does not read or interpret charts well, she does not listen to patents nor respect their perspective or feelings, and she is not good at making decisions. Furthermore, she is willing to lie to cover her mistakes, as well as what appears to be abuse of Vets for the sake of training her fellows. Certainly in the sea of evidence indicating incompetence the probability of the physical trauma resulting from said incompetence rises. However, such incompetence in a team can also lead to assault and thus this remains to be ruled out. She ignored my request men not be present and did what she wanted to do, and did it after she overdose me making me sick. She employed the threat of having to do it all again if I did not go along with her plan. Given the fact that I was lied to about the nature of the techs role, if he was involved in the procedure, I call that RAPE. If he was not involved, it remains a case of serious sexual harassment and perhaps medical malpractice.

Your V.A. advocate (or so called “patient” advocate) assured me that it is only the sort of men that I would associate with that would rape; certainly no man she knew at home or at the V.A. This woman seems to think the real problem is that as I am not a Christian who associates with Christian men (FYI 70% of Christian men report “sex addictions”), thus undermining my faith in the goodness of men. She is ignorant, insulting, offensive, and certainly, no “patient” advocate. She gave indications of bigotry and internalized sexism. She actually reminded me of what is referred to as a “silent partner” with all her claims of the goodness and innocence of men. Furthermore, I am sick of people indicating that only a “victim” would object to men in such intimate care. This is not true. Many young women raised by feminist are taught to avoid male practitioners to keep from being victims. I have heard more than one female practitioner inform me that she would insist upon women in such cases, not because she had been assaulted, but because she knew the men of which she was speaking on a personal enough level not to trust them. Also, why is it your staff seems to feel such freedom to dump their religious B.S. on patients; from this “advocate” to an oncologist insisting that whatever happens is “gods will” or part of “gods plan”? I find this highly offensive. Has the V.A. deteriorated as much as active military health care where Army Doctors are willing to hand rape kits over to perps.? Has the V.A. been infiltrated by crazy fundamentalist Christians as has reportedly much of the military?

Which reminds me I do expect an answer to the verichip question.

While I have no intentions of a civil law suite, (I find them a bit restrictive if one wants honest dialogue and quick change); a lack of appropriate response to my concerns could change my mind. I will have these questions answered to my satisfaction one way or another. This includes a detailed account of the procedure as it was performed and every persons role in the room, (if it was taped I want access), a min-by-min account of all events and complications, all involved and in what way, including an explanation of the physical trauma. In spite of what your staff seems to want me to believe, effects have causes. I expect full disclosure. If criminal behavior is indicated I expect charges be filed and V.A. support in prosecution. I would also like to know what the qualifications/ training this “tech” has assisting in colonoscopy procedures. If policy violation is evident, then I expect an administrative response. To the extent that policy is at fault, I expect reform. My expectations are not unreasonable.

BTW, while Dr. Collins seems to minimalize the harm she has done, not only am I waking up every morning with this first on my mind each and every day, not only can I not watch a movie because I cannot keep these thoughts from creeping into my head and disrupting the flow of the movie, not only am I avoiding all including my family to keep from dumping this crap on them, but I STILL HURT!!! Yet the only follow up I have been offered is w/ Dr. Collins. If G.I. has anything constructive to offer, I am desperate enough to return for Dr. Knigge. In terms of a follow up exam regarding any harm that may have resulted from the colonoscopy, I want this follow up fee based and I want to pick the Dr. so there are no conflicts of interests.

Patients Name


This same patient has been inspired because of the above experiences to do a little research on how the above story may fit into teaching practices in general and the attitudes these practices foster towards women.

Perhaps one of the most interesting finds is a web site where student Drs. chat.
http://forums.studentdoctor.net/showthread.php?t=82833

On this board, a question is posed.

“From some personal experience and hearing stories from others, there seems to be a trend where male students are often being asked to leave during a Gyn visit. This seems unfair, especially to those of us interested in ObGyn. At what point do the patient's wishes get trumped by the need to train students?”

Of course the answer to this is at all points. Part of the lessons that need to be learned are those relating to respecting patients; yet many of these young students are being taught a different lesson.

This is one student’s response, for example.

“this is the case at many schools, particularly if you rotate through a private hospital. If you are interested in obgyn (why??), try to rotate through a county or city hospital.”

One could also assume V.A.

The comments go on to include a detailed explanation of how to manipulate women.

“have found that it really depends on the attitude of the attending (or the nurse) who presents the option of a student to the patient. On my FP rotation I was introduced to the patients as a medical student working with the physician, by the attending. It was said in a manner that implied this was the norm and was expected. He tells them this right on the spot, while I was already in the room. I was not turned down a single time. I am sure that some women would have declined if asked in a subtler manner….On the other hand my OB rotation and a few other electives, nurses would first ask a patient. I did not directly hear, but can guess that it was phrased something like " You don't want a medical student examining you, do you?” Or at least with that connotation.”



“If it was a CLINIC patient, who almost by definition was either...
A) Coming in for free care (of course they're uninsured!!!)
B) "No Ingles..." (& can't bring someone who does!!)
C) On welfare with 3 kids by 3 different "baby-daddy"s
D) All of the above (more than 90% of the time)

I didn't even bother to ask. It is MY education, after all....”


“Well, actually...for me MALPRACTICE is a trivial issue...errr...actually it's a NON-issue as I am Navy HPSP with every intention of making Navy Medicine a career. I already have 6 years active duty...only 14 more 'till retirement 

Not only will I NEVER have to worry about malpractice insurance, I also don't have to worry about student loans 

Go Navy!”


What these young men, and educators of both genders do not realize it the heyday of doing as you will with women are over. This is pointed out by one responded who pointed to an ACOG news release, "The issue of physician gender is also an important criterion for women," Dr. Miller said. According to the Gallup survey, about half (47%) of the women surveyed prefer a female ob/gyn, while 15% state a preference for a male ob/gyn, and 37% say they have no preference." click here to read the whole article.

Just to show how strong some women feel about that preference, here are some of the women’s statements at that same chat.

“Males aren’t welcome into ob/gyn.... thats the bottom line”

“The patient's wishes NEVER get trumped by the need to train students. It's my cervix, thank you, and as long as I am conscious I get to choose who sees it.”

“I had a pelvic done this week and the (male) physician came in, then the MALE nurse came in. I said: hey, why are you here, it's supposed to be a FEMALE in here with me.

The male nurse got nasty and said: no, it's only supposed to be a "nurse."

Silly me, I forgot I was in Utah, home of the MORMONS. 

So even tho it was a teaching hospital and you'd think they were actually living in the 21st century, they apparently are not. Women are definitely second class citizens here, and the doctors are still men - for the most part. I was really very angry - they were incredibly patronizing and insulting towards me and it was clear that I had no rights in their eyes.”

“You are the one who don't got it pal. Male gyno will continue to exist, but not abundantly. Like it or not gender is the issue here. No male doctor likes to think he one day won't have such access to a woman's body, but the fact is he is not, and don't you forget that.

You got it.”

Women are starting to stand up and state, “It is our bodies and you boys have no rights to access, no matter what you may think. Push us more and see if we do not push back. If you do not understand that, you have no business in OBJYN, or medicine for that matter.” The rape culture and what other men have done and do to women will have it’s impact. This is not only going to affect your training, but your practice. DEAL WITH IT!!!

While not in the majority, there were very mature intelligent responses. Here is a mature response from a man that is suited for medicine.

“In the end, figured that each women could choose their own providers (and in my case observer) - Although I was really attracted to OB/Gyn I could feel the limitations as a male - In the end, my interest (and eventual application) to ENT told me that my practice would eventually be limited to just north of the clavicle. I just appreciated a side of medicine I would never see again. And loved every minute of it.”

The point to all this is to pose the question is OHSU doing to V.A. patients what it cannot get away with doing to OHSU patients? It is this V.A. patient’s opinion that yes, indeed they are abusing V.A. female patients, not necessarily in OBJYN, but certainly by one Dr. Collins in G.I. If such things as described in the letters and the Residents comments by residents above are common practice at the PDX VA, then the very attitude that serves as a underpinning of this Rape culture, the very attitude that founds the sexual assault of female vets, that is the attitude that men have a right to access women’s bodies over their objections, is shared by their medical providers.

VA Patients are being killed by substandard care

By JIM SUHR – 6 days ago

ST. LOUIS (AP) — Substandard care at a southern Illinois Veterans Affairs hospital may have contributed to 19 deaths over the past two years, a VA official said as he apologized to affected families and pledged reform.

The hospital in Marion, Ill., initially drew scrutiny over deaths connected to a single surgeon, but two federal reports found fault with five other doctors.

The hospital undertook many surgeries that its staffing or lack of proper surgical expertise made it ill-equipped to handle, and hospital administrators were too slow to respond once problems surfaced, Dr. Michael Kussman, U.S. veterans affairs undersecretary for health, said Monday.

"I can't tell you how angry we all are and how frustrated we all are. Nothing angers me more than when we don't do the right thing," Kussman told reporters during a conference call after releasing findings of the VA's investigation and summarizing a separate inspector general's probe.

Still, Kussman insisted, "what happened in Marion is an exception to what otherwise is a truly quality health-care system" across the VA.

The VA will help affected families file administrative claims under the VA's disability compensation program, he said. Families also could sue.

The VA investigation found that at least nine deaths between October 2006 and March last year were "directly attributable" to substandard care at the Marion hospital, which serves veterans from southern Illinois, southwestern Indiana and western Kentucky.

Kussman declined to identify those cases by patient or doctor, though Rep. Jerry Costello, an Illinois Democrat, said those nine deaths were linked to two surgeons he did not name.

Of an additional 34 cases the VA investigated, 10 patients who died received questionable care that complicated their health, Kussman said. Investigators could not determine whether the care actually caused the deaths.

Inpatient surgeries have not been performed at the facility since problems first became public last August. They will remain suspended indefinitely, Kussman said.

In pledging reforms, Kussman said the VA has launched an administrative investigatory board to review care problems and matters raised by employee groups.

The VA last September also installed interim administrators to replace the Marion VA's director, chief of staff, chief of surgery and an anesthesiologist, moving them to other positions or placing them on leave, Kussman said. The anesthesiologist has since quit, Kussman said.

"The previous leadership will not return" to their former jobs, he said.

The VA's investigation cited by Kussman covered a two-year span, the VA said.

The inspector general's office blamed three deaths on substandard care at the Marion site, but that review covered only the past fiscal year, which ended in October, the VA said. That report was not immediately available Monday.

Telephone calls on Monday seeking comment from the Marion VA were directed to spokespeople with the agency's Washington headquarters.

Neither Kussman nor the VA investigation's 41 pages of findings named surgeons involved in the deaths, though Kussman acknowledged that much of the criticism has focused on Dr. Jose Veizaga-Mendez.

Veizaga-Mendez — identified in Monday's report as "Surgeon A" — resigned from the hospital Aug. 13, three days after a patient from Kentucky bled to death after gallbladder surgery. All inpatient surgeries stopped a short time later.

Sen. Dick Durbin, an Illinois Democrat, has said Veizaga-Mendez is linked to 10 patients' deaths at the Marion facility, about 120 miles southeast of St. Louis. Kussman declined to discuss that claim Monday, saying he didn't want to influence additional internal investigations of six of the site's surgeons he said had "at least one episode of substandard care."

Veizaga-Mendez and another surgeon no longer practice at the Marion VA. The remaining four surgeons remain on staff but are "only doing minor cases at this time," Kussman said.

"We don't think the physicians killed the patients," he said. "We think the physicians were trying to care for the patients and did so in an inadequate way."

Costello and fellow Rep. John Shimkus, a Republican from Collinsville, Ill., called Monday's findings "shocking." Durbin said the reports "confirm what many of us in Illinois feared" — that the Marion VA's medical care was substandard and that protocol for protecting patients was ignored.

"As the inspectors who reviewed the Marion hospital put it, the quality of care at Marion was 'horrible,'" Durbin said.

Veizaga-Mendez's whereabouts are unclear. He has no listed telephone number and has been unreachable for comment.

The Marion VA hired Veizaga-Mendez in January 2006 after he practiced in Massachusetts, where he was under investigation for substandard care in 2004 and 2005. The claims include allegations that he botched seven cases, two ending in deaths.

Veizaga-Mendez was permanently barred from practicing medicine in Massachusetts last November — a disciplinary move that also requires him to resign other state medical licenses he may hold and withdraw pending license applications. He has also made payouts in two Massachusetts malpractice lawsuits.
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When the ranting of a mad man in the lobby makes more sense than the health care providers.

The most telling contrast made itself present to me over the last couple of days. While in the waiting room at the Roseburg V.A. a very irritated man began to rant and rave about the Bush administration and American Corporate fascism. He went on to suggest that something needed to be done or we were all doomed to some great evil empire. Now this man was in no way in a healthy state of mind, yet what he was saying was largely right on target. Bush is most assuredly sadistic. Oil and military industrial profits are the driving force of the ruling politics. Vets are getting the shaft; and the American medical system is in shambles. If we do not do something about this administration we are doomed to a state of fascism. I thought to myself, when the ranting of a mad man reflect the truth of our situation, then what does that say about the current state of affairs? The fact that his ranting rang true to the ear said much more about the truth of the ill state of American politic, than it did this man’s level of mental health.
In contrast the day before I was at the PDX V.A. for a colenoscopy where some members of the medical staff appeared to be less able to grasp what needed to be done in the context of the procedure than this mad man did in the context of national/global politics.
What I am saying is that in a real way certain members of this medical team appeared to be less competent at thinking than this ranting mad man.

My best advise to anyone dealing w/western medicine is DO YOUR HOMEWORK AND TAKE CONTROL OF YOUR CARE!!!!! The mad man may be mentally ill, but the health care professionals may be CRAZY. Weather blunted from overwork or a Corporate directed misseducation, if you let them do anything they want, well you are not likely to start feeling better, and may even die. It seems this week they were hell bent on overdosing me on Sodium Phosphate. After getting fairly sick from the first bottle the night before, upon drinking the second bottle cramping, nausea, and vomiting started, followed shortly by symptoms of dehydration. In spit of the facts that these were symptoms that the enclosed literature had identified as concerns in relation to overdose and dehydration, the medical staff showed no concern of overdose or dehydration. Although I asked several times and explained I felt dehydrated I was told not to drink anything as they claimed that drinking more fluids may interfere with the Phosphate. This is contrary to the homework I did, which suggests you need to drink a lot of extra fluid to assist the process. Giving me more to drink should have been their first response. Had I been confident enough to over rule the “professionals” and just drink some water or 7 up, things would have been fine. That is the lesson of this day, do your homework, and then trust your judgement. The Dr. insisted that what I needed was a third dose of the phosphate. I told her I was concerned about overdosing which can cause kidney failure among other problems. She said, “but you didn't keep the second bottle down". I let her know it did not all come back up and I thought it best to give it a little more time to finish the flush. Without asking me any questions concerning how much came up and how much stayed down, without checking the fluid coming from by body to determine progress, she blindly insisted something else must be done. I consented to an enema, which she suggested, and then dropped, insisting that what I needed was another bottle of Phosphate. At this point I was very thirsty from dehydration, wanted a drink desperately and it became evident that the dehydration would continue until I consented to another dose, or refused further care and left the PDX V.A. without having completed the procedure (one that I agreed with the Drs was a good idea). I went against my best judgment and let them give me another bottle. This time it seemed like it all came back up (at least I hope it all did as this was an obvious overdose). I am convinced that if they had given me more fluids like I asked from the start the prescribed second bottle would have worked just fine with no need for the third. But, this overdose is not the worse of it all, nor the end of their efforts that could have resulted in grave harm. No, after throwing up the third bottle consumed some evidently not so bright nurse with the worse bedside mannor I have every experienced, came and suggested a feeding tub to dump a fourth bottle on my stomach. I told her “NO”, on very clear and certain terms. Yet she continued to go about advocating with the Dr. and other medical staff to shove a tube down my throat. As I went into the bathroom I passed their little pow wow they were having at my expense and in a low voice told them, “they were doing the procedure today, and they were going to do it WITHOUT a feeding tube!!!” This time, without any suggestion on their part, I left the fluid coming out the lower end inthe toilet, so they could see the progress, objective evidence they already should have requested. On my way out of the john, I told them I left them something more substantial upon which to base their opinions, and that things were clearing up quickly now. The Dr. asked me when I was throwing up, while I was drinking in response to the taste, or after it had hit my stomach. I reiterated that it was indeed after a being on my stomach for 15 min. or so that it came back up. She turned her attention back to the group, once again to talk about me rather than to me and finally ruled out the feeding tube with a, “it would not work then anyway.” The subject was finally closed. The decision to move ahead was made, and things worked out just fine within minutes of that decision the fluid finally ran clear. So, while unlike the madman, I will not rant at the V.A. where other people are sick and trying to get care. Like the madman I will rant; but here in writing on this page. Why??? CUZ WHEN THE MADMAN IN THE LOBBY MAKES MORE SENSE THAN THE PROFFESIONALS IN CARE OF YOUR HEALTH IT IS TIME TO SPEAK UP!!!!!

By Christine Wenc, AlterNet. Posted December 6, 2007. - The Health Industry's Secret History of Delaying the Fight Against Cancer

In her new book, Devra Davis exposes scientists and government officials who have worked to downplay or dismiss preventable causes of cancer.

Cancer is on the rise for a reason. Perhaps folks like myself should sue the Gov't for violation of my consitutional right to "equal protection under the law" and right to "life". Anyone for a class action????

The Polticial Economics of Cancer - Ridding the Cash Cow

If there is a cure for cancer, it is bound to go the way of the electric car. Blocked from production and distribution by big money. From the Drs. to imaging, from implant manufactures to pharmaceuticals they all make a bundle off Cancer. Breast cancer may be the most profitable of all cancers. Tissue conservation often requires other forms of expensive treatments. If you have a mastectomy, reconstruction requires multiple surgeries and is a temporary fix that will require a return to the cutting room in a few years. Complications from their treatments even prove profitable. I discovered yesterday even the retail giant, Macy’s/Nordstrom’s takes rides on the back of the Breast Cancer Cash Cow.
After complaining at a PDX V.A. surgery follow-up that wearing a bra with the “softy” (a cloth bag full of stuffed animal fill) sent to me by Reach for Recovery was so painful that I was opting to isolate at home rather than wear the “prosthesis”, he very apologetically explained that the V.A. had no prosthesis to offer. Hmmm. He sent me to Nordstrom’s. Postponing the fight with the V.A. over why they are not providing women who opt out of implants and reconstruction (saving the V.A. many $$$) prosthesis, and desperate for even the smallest degree of relief from the pain I went to Nordstrom’s. As I walked in the door my body tensed and heart shrunk. I knew I could not afford anything they had to sell. Now feeling sick in more ways than one, I went to the counter and asked for the women who fit prosthesis. She raised her hand, ushered me into a back dressing room and proceeded to show me bras with the prosthesis. The bras were a bit pricey for me; but I was willing to pay whatever I could to get some relief so we kept up the parade through a dozen bras. As nausea began to overwhelm, I put on the breaks, quickly chose a couple of bras and asked the price of the prosthesis. Now I was expecting something between $65 and $150, but she answered $280. Now I quickly added, prosthesis and two bras were going to cost $400. I started to cry. She quickly told me they were covered by insurance. I was not hopeful. I have Champ V.A. (insurance for the wives of disabled vets), and have yet to find anyone who accepts the insurance. But, I told her about Champ V.A. and she quickly let me know that Nordstrom’s, “treats all insurance companies the same”, meaning they refuse to negotiate costs w/insurance companies or the government. So, I guess it is just tuff titty, or tuff no titty, for women like myself. I have to say; the women working at Nordstrom’s were very nice and went out of their way to help. The fitter went to call Champ V.A. to see if they even covered prosthesis; they left her on hold for what must have been 45 min. She gave up, without ever speaking to Champ V.A., but she did come back with a couple of numbers where I might be able to get help w/a prosthesis, if a “used” one. I will make those calls today; but honestly I suspect I will have to go back and fight the V.A. for a posttests. Nordstrom’s sucks. The prosthesis is not substantial enough to cost $280. Refusing to negotiate in good faith with insurance companies and the government to ensure women of less means are not left without, well, if there were any sisterhood, and solidarity between women of different classes, women of the middle and upper classes should refuse to buy their prosthesis from Nordstrom’s unless they negotiate with insurance companies and the government. Hell all women should boycott Nordstrom’s until they negotiate. Wonder what the world would think of a thousand lop sided women of means marching in front of Nordstrom’s, rather than poor women hiding out lopsided at home?
The following is a interesting dialouge on $$$ and Cancer.
http://www.npr.org/blogs/mycancer/2007/05/adding_insult_to_injury.html

By Lucinda Marshall - Breast Cancer Sells

AlterNet
Posted on October 24, 2007, Printed on October 24, 2007
http://www.alternet.org/story/65943/
October means falling leaves, ghosts and goblins, and pink, lots of Pepto-Pink as we observe National Breast Cancer Awareness Month (NBCAM). From Campbell's Soup to Breast Cancer Barbie, it seems as if just about everyone has jumped on the pinkified bandwagon. And although October is also Domestic Violence Awareness Month (DVAM), we'd much rather be aware of breasts, even sick ones, than talk about black eyes and things that aren't supposed to go on behind closed doors. That point is reflected in women's magazines, which devote much more space in their October issues to breast cancer than they do to domestic violence.

Of nine publications that I recently found on a grocery store magazine rack, all of which advertised breast cancer articles on the covers of their October issues, only two also contained coverage of Domestic Violence Awareness Month (and mentioned that on their covers).* And, what's worse, of the coverage dedicated to breast cancer, much of it was offensive, superficial, misleading, or flat-out wrong.

This year there is even called Beyond Breast Cancer that cheerfully proclaims that there are "10 Good Things About Breast Cancer." Who knew? And just what are the pluses of getting this dreaded disease? According to the bubblegum-colored magazine, one perk is a pair of new boobs that "will face the horizon, not the South Pole.' Better yet, they will be paid for by insurance. Oh, and you get lots of cards and flowers.

Meanwhile, both Good Housekeeping and Woman's Day give incorrect information about mammograms. Good Housekeeping claims that "[N]o one disputes that all women 50 and over should be screened annually." Yet physicians in different countries disagree on how often women over 50 should be screened. While doctors in the United States recommend annual mammograms, those in Europe say every two to three years. In Australia, where a study out last year shed significant doubt on the extent to which mammograms save lives, the recommendation is every two years. Interestingly, in some of these countries, the incidence and death rates for breast cancer are actually lower or comparable to the United States.

When they're not spewing misinformation, the October issues of the traditional women's magazines are offering overly simplistic information about breast cancer risk factors and tips for preventing it. Woman's World (not to be confused with Good Housekeeping discuss factors you can change, such as smoking, and those you can't, like genetics. Missing is any mention about the purported connection between breast cancer and hormone replacement therapy. Also absent is information on parabens, phthalates and other carcinogenic chemicals, which are disturbingly common in consumer goods from lipstick to lotion.

The silence on these subjects mirrors the focus that both the American Cancer Society and Susan G. Komen for the Cure place on the profitable business of curing cancer rather than preventing it, which likely would hurt the bottom line of many of their biggest donors. Consumers are told that shopping will help find a cure -- a message that is not lost on advertisers.

Vogue sings the praises of one prolific advertiser, Ralph Lauren, who this year is selling polo shirts with bullseyes above the breast to target breast cancer. The ad shows a group of young, mostly white women wearing skimpy thongs, the polo shirts and nothing else. Subtle, huh?

A Pine Sol ad in Essence features motorcycle riders Aj Jemison and Jan Emanuel "driving for the cure," which is awfully hard when your vehicle is spewing cancer-causing exhaust. On top of that, Pine Sol contains 2-butoxyethanol (EGBE), which has been linked to fertility disorders, birth defects and other medical problems.

Redbook carries a sparkling wine "Cheers for the Cure" ad. Curiously, their article, "Who Beats Cancer and Who Doesn't," was one of the few risk factor pieces that failed to mention the link between alcohol and breast cancer, something that is highlighted in several of the other magazines.

And what if you or someone you love gets breast cancer? Not to worry, the women's magazines are full of inspiring survivor stories. Unfortunately, while most breast cancer victims are over the age of 50, not one of the nine magazines I analyzed focused on those women and the impact the disease has on their lives. Far more typical is a piece in Vogue discussing a very attractive young woman's agonizing choice to have a preventive double mastectomy because she carries the genes that can cause breast cancer. And with the exception of Essence, whose target audience is black, most of the women in these survivor stories are white, even though black women are more likely to die from the disease.

Despite most of these magazines having sections on health, family and love, only two of them (Redbook and Essence) had any mention of Domestic Violence Awareness Month.

While it is questionable that additional awareness of breast cancer is useful, in the case of domestic violence, more coverage would be helpful. Domestic violence is the most common type of violence experienced by women both globally and in the United States. The Family Violence Prevention Fund reports that one out of every three women worldwide is "beaten, coerced into sex or otherwise abused during her lifetime." Here in the United States, the rate is one in four. In 2005 (the latest year for which statistics are available), 976 women in the United States were killed by by men that they knew. Yet because we tend to see this violence as a private, shameful issue, only 20 percent of rapes and 25 percent of physical assaults against women in this country are reported to the police.

Also underreported is the great financial toll domestic violence takes on communities. FVPF estimates that the health-related costs of "rape, physical assault, stalking and homicide committed by intimate partners exceed $5.8 billion each year." About 70 percent of that goes toward direct medical costs; the other 30 accounts for indirect costs such as lost wages.

Though lacking in many other details, this month's article in Redbook did attempt to demonstrate how common domestic violence really is, with featured pictures of two women as well as two men who knew a woman who had been affected by domestic violence.

And the article in the October issue of Essence, which delves into why black America is "so silent" about the violence that is committed against black women (a number that nearly doubled between 2003 and 2004, according to the Bureau of Justice Statistics), also pinpoints why more coverage in these magazines would be more useful. ""Awareness, or lack thereof, is also a factor, says Rose Pulliam, president of the National Domestic Violence Hotline and the National Teen Dating Abuse Helpline. "We have to find a way to talk about domestic abuse that doesn't demonize our men but creates a way of looking at this as something to discuss openly," she says.

What to take away from all this? The bottom line, literally, is that we shrink away from black eyes. Breasts, on the other hand, are highly marketable commodities, as these magazines' advertising and helpful hints about pink products attest. Glamour even uses breast cancer awareness as an opportunity for a little full frontal nudity, featuring young, pretty and oh-so-white survivors with their best come hither looks. This emphasis on youth and whiteness is a true disservice to older women who are far more likely to get this disease and black women who are more likely to die from it.

Such irresponsible coverage of breast cancer and blindness to domestic violence suggest that many publications are less concerned with women's health than with making a buck. By tugging at consumers' purse strings instead of promoting their well-being, these magazines fail to serve the women who read them.

*The magazines surveyed for this article were: Essence, Redbook, Good Housekeeping, Women’s Day, Women’s World, Ladies Home Journal, Glamour, Vogue and Beyond Breast Cancer.

Lucinda Marshall is a feminist artist, writer and activist. She is the Founder of the Feminist Peace Network, www.feministpeacenetwork.org.

FYI

1. Do not let an insurance company tell you cannot have reconstruction. Not true and they are required by law to pay for it and all complications arising there from. V.A. same thing.
2. Think long and hard before you accept an implant.
3. Do not let the Drs. guide your treatment. Research the research and be active, even demanding.
4. Remember that much research is corporate funded, check the sources of the research you read.
5. Do not be afriad to use the press as a tool of power. Drs often treat patients as objects rather than subjects. Using the power to talk back in a public forem forces them to face you as a subject.

On Femera and Sexual Disfunction

I called the V.A. Hemo/oncology to let them know that the A.I. I was given, Femera, was interfering w/sexual function that is making it hard to impossible to have a climax. I checked it out on the net and found body builders taking Femera chatting about errectile dysfunction. So, I called. I was first off accused of just generally having a problem, claiming 80% of women were anti-climatic. I corrected her that no, 80% of women do not climax vaginally, but most climax w/clitoral stimulation; and I have been well aware for a very long time what it takes to reach that climax. She argued that this was not a listed side effect, implied the problem may be post surgical psychology and suggest experimenting w/stopping and starting the drug. I did so, and was still convinced this was a side effect. I call a couple of women w/a bit more experience. Our dialogue confirmed we all had experienced not only sexual dysfunction but dizziness as well. So, I called back. The woman that answered the phone seemed insulted that a patient would have the gall to experience, investigate, and assert knowledge of a side effect. With quite the attitude in her voice she let me know she would forward the message. That is the main problem w/the V.A. It is far to difficult to reach a Dr. and the staff acts like you have no right to that access and put them out in the asking.

Breast Cancer and the V.A.

Breast Cancer and V.A. Care
For women, the personal seems to always be political. Perhaps one of the most offensive realities is how women's health care can be driven more by politics and/or profit than by good science. We all know that politics has interfered w/ women's reproductive health care. We know that politics has affected research and treatment of women's health issues.

But, what about cancer, breast cancer?

The following is a story in the making. It is not something that has happened; it is something that is happening, to me and to many other women.

In March I agreed to have a mammogram as I was approaching 50. Now I had a baseline done at 40 and it seemed a little rough, so I expressed my concerns and the Roseburg V.A. facilitator assured me that the new machines were not bad and I could get a state of the art, no pain mammogram in Roseburg.

Boy did I feel betrayed. This idiot tortured me for over an hour while she failed time after time to get a good image, likely due to the fact that she was over compressing. Each time she failed to get a viable image she just came back and clamped down harder. I was ready to b slap the woman. This was much worse than anything I remembered a decade ago. How could this be better? My breast was red and swollen when she was finished. Well the images were no good and the whole thing had to be repeated, this time in Portland at OHSU. What a difference!!!! No pain, little compression. Now I knew this woman who tortured me either did not know what she was doing or needed to be incarcerated to protect the general public. I complained to the Roseburg V.A.; the reply was that is the only imaging place in Roseburg. Hell man, tell these women the truth; I am sure they will not mind going to Portland to avoid useless torture. Roseburg promised they would call the image company and talk w/them. I complained to the imaging company; he said Roseburg had not called him, and then did not call me back himself regarding follow-up. SO LADIES IF YOU ARE IN OR NEAR ROSEBURG, GET YOUR MAMMOGRAPHY DONE ELSEWHERE, NOT ONLY WILL ROSEBURG CAUSE YOU PAIN, BUT IF YOU DO HAVE CANCER THEY MAY WELL MAKE IT SPREAD!!!!! (How will become clear as you read further.) I know of no response to date; yet significant harm may well have been caused by this mammography.

But, we move on. OHSU asked if there were any earlier images available for a bass line. I called Eugene were images were taken 10 years ago, only to find out they had been destroyed. Why did I have that "baseline" again?

Throughout this whole process, I was convinced I did not have cancer. The Roseburg V.A. kept looking at a lump I had for decades, had been aspirated once, and had not changed. Roseburg was also convinced it was likely not cancer; but the wise Dr. requested a Portland consult.

After the new images were in, it was suggested that I have a core biopsy. At this time I was told by an OHSU Dr. that it was not the old lump at which they were looking, it was a different location, and this one did not look benign; there was a 50% chance it was cancer. It hit me like a rock. The biopsy was done; the results came back. Invasive ductile carcinoma.

Now it was time to do research, so I thought. But, as it turns out, I should have done the research before the mammography. What? Research a condition before you know you have it? That is what you would have to do; it turns out, if you want to protect yourself from the medical establishment and their killer breast cancer tests and treatments.
What killer treatments? What do you mean?

Well, I found research, then more research, and then more and more, indicating that trauma inducing mammography, biopsy, and surgery, all may increase the rate of cancer growth. Now metastasis is the most dangerous feature of cancer. Yet, cancer diagnosis and treatment it seems can often induce metastases.
A few of many sources are:

"Excisional surgery for cancer cure: therapy at a cost", the Lancet Oncology, Coffey... at

Does the act of surgery provoke activation of "latent" metastasis in early breast cancer?
Trauma-associated growth of suspected dormant micrometastasis"

"Treatment-induced growth factor causes cancer progression", a Vanderbilt study, at http://www.brightsurf.com

"Wounding from biopsy and breast-cancer progression", Lancet, 2001 Mar 31;357(9261):1048

"Does surgery unfavorably perturb the natural history of early breast cancer..." Baum, Eur J Cancer2005, Mar:41 (4):508-15

"Wound-healing genes promote cancer progression", Lancet Oncol. 2004;5:138.

Now I was freaked! A cancer that I could have had for years, and could have grown slowly for many years more, may now kill me in a matter of a few years. Why was I not told of this risk? Why was nothing done to hedge against such a risk? The science on the risk was enough to justify warning and response. What the hell happened to "informed consent"? The lack of communication on the issue breached all trust; I would no longer consent to anything I have not checked out for myself. (note: this turned out to be an overwhelming task.)

Of course one might argue that, "it may be better not to know, that is that it could be that there no good reason to warn about what cannot be helped and will only cause anxiety. Core biopsy is the best way to distinguish cancer from benign tissue, and there is no known means to offset the rate of growth." "NO other way" is usually a logical fallacy; "No better way", is in this case, as I discovered, highly suspect if not simply wrong.

It MAY be that a core biopsy is the best way to find cancer; but in many cases there are known means to offset the treatment-induced stimulation of growth. In my case where 90% of my cancer cells test ER+, that is dependent upon estrogen for growth, (49% were PgR+) something known within 3 days after the core biopsy, it seems logical that neo-adjuvant (pre-surgery) hormone suppression starting right after the ER status is known to be + might be a good means to offset treatment/trauma induced growth. There are several ways this can be done including for premenopausal women like myself removal of the ovaries, radiation of the ovaries, or chemical suppression. "New opportunities in premenopausal breast cancer? goserelin (Zoladex) plus Aromatase inhibition" Jakesz, Breast Cancer Online, Cambridge Univ. Press 2006,

After that rough Roseburg mammography and the core biopsy, I have repeatedly asked for immediate therapy in the form of tamoxifen, hormone suppression, goserelin, oophorectomy, something to offset this risk of treatment induced growth. Nadda, no help, just condensation and patronizing B.S. It seems the V.A. will not do anything that is not considered a "standard of care", which in the case of cancer, where patients seek state of the art care, often equals a minimal standard of care.

While there were several choices; some approved in UK, some off label use in U.S., some in phase III trials, some in phase II; no option for immediate treatment was offered in face of repeated requests.

Also, being somewhat concerned about long term side effects of tamoxifen, including cervical cancer, I asked about surgical oophorectomy at the time of breast surgery or before, a treatment of choice in Italy.
Ovarian oblation vs. goserelin with or without tamoxifen in pre-perimenopausal patients with advanced breast cancer..."
also see. "Breast Cancer Growth and Surgical oophorectomy", Love and Neiderhuber, Ann Surg Oncol Vol.11 No 9 2004, 818-828
The idea that something should be done to offset surgical stimulation of growth was not in question but now assumed knowledge. Oophorectomy is "comparable in efficacy to usual chemotherapy programs", what matters is tumor genetics in determination of appropriate therapy. Certainly what we knew about my tumor thus far suggested further investigation into this line of thinking, that is in using hormone suppression as indicated by the ER+ status but not using chemo until testing proves effectiveness. Yet again, without further examination, my suggestion was refused. Oophorectomy would take two surgeons I was told, not practical. (In the end an oophorectomy was allowed) I asked about testing for chemo effectiveness, and was ignored, No 21 gene test (in the end it was explained that chemo was not an option they were considering), no neoadjuvant test, just the old fashioned if it is outside the breast you get radiation/chemo regardless (this may still be the case). What happened to "do not harm"?
Baum and others have suggested that hormone suppression and COX2 inhibitors might, "in part suppress the activation of dormant metastases by the act of surgery. If this is the case, IAs should be initiated at (or even before) surgery in order to optimize this effect. Furthermore, this benefit might be enhanced by the concomitant use of a COX2 inhibit." An exploration of relapse data by hazard rate as a means of developing biological insights into the natural history and treatment of breast cancer...
"...the next leap forward would depend on "stabilizing" these latent metastases...before letting a surgeon near a patient" (Baum, Breast Cancer Res, 2004 6/4: 160-161)
Vanderbuilt is experimenting w/ TGF-beta inhibitors.
others are experimenting w/ Bisphosphonates....

I asked about using Goserelin and an IA, and quoted the recent guidelines by the "American Society of Clinical Oncology and the National Comprehensive Cancer Network that "tamoxifen therapy (what I was being told I would be given sometime after surgery, perhaps after radiation and chemo (a delay in hormone suppression which research has shown could further harm my chances) should no longer be considered optimal therapy, and that all adjuvant treatment regimes should now include an AI, in combination with goserelin for premenopausal women. See.
"Breast Cancer Growth and Surgical oophorectomy", Love and Neiderhuber, Ann Surg Oncol Vol.11 No 9 2004, 818-828-
"Management of premenopausal women with early-stage breast cancer: is there a role for ovarian suppression?" Clinical Journal of Breast Cancer 2002; 3(4):260-267


I pointed to UK research concluding that, while, "no obvious survival benefit (quality of life, number of surgeries, treatment side effects... are not considered) to women with breast cancer...it does allow avoidance of surgery in some cases..." 14% in this small sample, and can allow for the testing effectiveness of systemic therapy.

His comment simply contradicted the study pointing to the small sample, ignoring the fact that the numbers were amazing. 14% of the women who underwent pre-breast surgery oophorectomy of some kind did not have to have breast surgery after 4 months of treatment. Now this was the most significant scientific discovery I could imagine. Take the ovaries first and in many cases then save the breast? Hmmm. Not in time to help me, but interesting non the less.

Again I was refused the up to date treatment and told I would get the best of care as was determined 25 years ago. Surgery followed by radiation and chemo if indicated followed by 5 years of tamoxifen.

Which brings me to chemo and radiation, which have proved only effective in a sub population of cancer patients, but continues to be applied to a larger population, potentially doing more harm than good. Sandra M Swain of the National Cancer Institute using Recurrence scores claims that patients w/ a low RS do not benefit from chemotherapy and ER+ tumors have a small benefit from chemotherapy."A step in the right direction:" Journal of Clinical Oncology Vol 24, no23, aug 10, 2006. Why do this harm again? Are there not test to narrow treatment down to the appropriate subgroup? There are ways. Yet none are being employed in my case, in spite of repeated request.

Gene Expression and Benefit of Chemotherapy in Women with Node-Negative, Estrogen Receptor-Positive Breast Cancer

"Genomic Test Improve Prediction of Breast Cancer Response to Chemotherapy, Hormonal Therapy" Univ. of Tx, MD Anderson Cancer Center, 12/14/06, at http://www.mdanderson.org

Radiation not unlike other treatments is also only effective in the case of some tumors. "Predicting Recurrence" by Beth W. Orenstein, Radiology Today Vol 8 No. 1 p20.

Despite the fact that hormone suppression is the best thing that we know can be done in my case, why two months after discovery, after biopsy may have increased the growth rate of my cancer, two months after status and type of cancer was known, has no therapy has been administered. In fact not only have I been refused any type of hormone suppression in spite of my repeated requests, but they insist I must move forward with surgery, and accept that hormone suppression may be further delayed for radiation and chemo if there are any signs of metastasis or lymph positive status is discovered, and no plans of a test to ensure the chemo or radiation will even be effective.

Now some Drs. may claim these treatments are not approved. But, off label use of drugs and phase III experimental treatments are employed often, and insurance companies often do not have the choice not to cover such treatments. In fact, treatments can become standards of care prior to FDA approval.
The U.S. Congress passed a law in 1993 requiring Medicare the federally funded health care program for elderly and disabled people, to cover off-label drugs used in cancer treatment when the use is supported by: a citation in at least one of the following authoritative drug reference books.
The American Society of Health-System Pharmacists' American Hospital Formulary Service (AHFS). There is a regularly updated online version.
U.S. Pharmacopoeia Drug Information
two or more peer-reviewed articles published in respected medical journals.

The drug reference books are not available online to us lay-folk, but I have provided the V.A. oncologists with an abundance of peer-reviewed articles published in respected medical journals. However, while Drs. can help a patient in seeking insurance coverage for treatment, the V.A. is my Dr. and insurance coverage. Are the Drs. told what treatments they can offer and what treatments they cannot based on economic factors overriding health concerns? What is going on with breast cancer care and the V.A.? I can remember when the V.A. did no women's medicine referring us to private Drs. Did they take us on only to provide us with substandard care? Can the force inherent in refusal of any legal options in treatment, offering only one treatment plan or no treatment at all be interpreted as consent? Should a patient that rejects one treatment/plan be denied all treatment?
I guess now is a good time to update and pass on some info.

So far it seems good herbs in my case are Cats Claw, Tumeric, Tomato (fresh leaves), and Astragalus (after surgical wound is no longer at risk of bleeding).

The second oncologist at the V.A. agreed to an oopherectomy and an A.I. Still, no neoadjuvant treatment. The major problem seems to be the uncertainty surrounding the "margins", that is the area surrounding the surgical site that is clear of cancer cells. The neoadjuvant treatment may create "false margins". This is understandable. However, in my case, a mastectomy is the order of the day, I will not agree to radiation, and will only accept chemo if a test of one sort or another proves it to be effective in my case. On the other side of this if the better margins after neoadjuvant treatment are not "false" margins but are real clean margins then it may be that I would have been better off w/neoadjuvant treatment.
If they are willing to risk "false" margins in the case of shrinking a tumor so a lumpectomy can be performed rather than a mastectomy....?
There is still something missing in the logic.

I understand the Drs. want to do things according to "standards of care". Accurate
staging is critical from their perspective.
From my perspective, there is only so much I am willing to go along with in terms of treatment, which lessens the importance of accurate staging and maximizes the importance of clear surgical margins, immediate suppression of cancer growth. The only way to have gotten this done is for the oncologist to have dropped the patronizing B.S., like 'we need to take this one step at a time". I am left with the feeling that their determination to control my treatment, and thus control my life is interfering with me getting the best treatment I can given the limits of the risks I am willing to take. Quality of life is not weighed heavily enough, not in research and not in treatment. Patients need to have more input into treatment decisions.

M.C. Kean

managing risks and profits: theirs not mine

Well, well, well, it seems bean counting determines health care alternatives. No real surprise there. This reality results in a sort of sick double standard in health care. A treatment can prove great benefit; but until all the risks are known; and it has been accepted as a "standard of care"; Drs. such as oncologists are reluctant to give it a try. What is profitable to large corporations has an impact on "standards of care" in several ways from corp. funded research to political influence and kickbacks in the form of "consultant fees" to politicians and Drs. Thus, a treatment can be of great benefit to the patient, but unless it is also profitable, it is likely to take some time to become accepted as a standard of care, if ever. On the other hand, if a treatment is highly profitable, all sorts of risks will be taken and reasonable standards of care thrown to the wind, as any suites will be offset by very high profits. This is the case w/implants. Yes, while I cannot get neoadjuvant hormone suppression to restrict the growth of cancer, implants were not just offered, but promoted. I almost made a mistake given the snake oil job that was being done on me and the fact that it is very hard to have ones breast cut off; but by now they were a bit leery of my and my comment about, "informed consent". Thus, they had a woman sit in; who may well have been a lawyer. While the plastic surgeon insisted there was no link b/w the immune system problems (that it turns out over 400,000 women have reported) and silicone implants, briefly mentioning some other risks, but giving no stats or probabilities, the woman cautioned that the issue was still under research. He made a comment about, "that woman lost the suite". Now, I want to thank that woman, who I think was a lawyer, there not to protect my interests but that of the V.A.'s. Still, honesty and full disclosure is in both our interests; so I was glad she was there; having thrown up this big red flag to me that I did not know enough and needed to look further into this issue. It is hard to do all the research on all of the issues dealing w/breast cancer treatment, but it seems there is no stone that you can safely leave unturned. It turns out that the implants were put on the market w/o FDA approval. Subsequently the FDA took control, but allowed the implants to continue to be used w/o evidence of safety. After many complaints and law suites the FDA took the silicone implants off the market and requested the manufactures do research. Two manufacturers did research, bad research, research leading to whistle blowing and investigations. Yet the FDA allowed the silicone implants back on the market. I thought, ok lets go w/saline. Opps, no cannot do that either. Fact is no implant is safe. 40% of the women who have implants will have to go back in to deal w/a complication from an implant with in three years. Though complications w/ saline are not as dangerous as complications w/silicone, as stated before surgeries themselves are more risky for a cancer patient that others. Flap (using your own tissue from stomach or elsewhere) surgery is an alternative if you have enough fat; I do not. Still, one has to keep in mind full reconstruction takes multiple surgeries. Many women stop somewhere along the way. I considered the risks of multiple surgical sites w/flap against the prospects of not having a breast, I thought I might stop w/the first mound reconstruction, no nipple, no match, no multiple surgeries; but even that was too risky in the end.

Speaking of nipples, during the interview w/the plastic surgeon I heard the most unsettling news that could have come from his mouth. He was talking about nipple reconstruction. I asked where he borrowed the tissue from, he simply said, "down there". I was on my way out the door by this time, and was not sure I heard right. Not planning to go that far I did not immediately follow up; but this answer left me quite unsettled. Could "down there" mean the labia? Now, I had studied the history of Genital mutilation in the U.S., as a response to ethnocentric ideas that the abuse women in other countries suffer is different in kind that that suffered by U.S. women. While historically western women have been mutilated as treatments for lesbianism, masturbation, promiscuity, "hysteria", ... the last case I knew about was in the 1950s. A man conspired w/his wife's Dr. to cut off the labia while she was undergoing surgery for something else. The husband had heard that this would make her multi-climatic. It made sex painful and she was unable to climax at all. Talk about the, "Story of O" syndrome. Is the U.S. really back to practicing genital mutilation; this time in the name of natural looking breasts? YES they are!!!! Good goddesses save us from the beast.

NOW I THINK "THE STORY OF O" IS MANDATORY PORNOGRAPHY FOR ALL YOUNG WOMEN TO READ.

Publishing this earned me a total lack of communication from the V.A. No surgery date has been set; Drs. nor facilitators return my calls. (surgery has been set for June 18th; three months after diagnosis, three months without treatment, three months for the cancer to grow after stimulation. Three months of unchecked accumulated medically induced harm.

lies and reconstruction

In the last few days any trust that I had in the V.A./U.S. medical system has just gone to the dogs. Not only do they not listen to patients; but also they lie, time after time. I got my records; I was amazed at the P.S. description of our meeting. It did not describe our actual meeting at all; but the physician notes were obviously written for the sake of legal defense. (Not only his notes; but several other statements where blatant misrepresentations and obviously for legal reasons. At one point I was described as, "happy with my care". I do not know how the history of calls, emails, and more could not prove the contrary. The Plastic Surgeon claimed to have spent more time w/me than he did (the lack of time was not his fault; I did not want to wait another week to see him and when I called to check apt. times the recording failed to mention the P.S. consult, which I subsequently missed, so he fit me in between surgeries; for which I was thankful.) His point was to claim to have given much more detail concerning risks than was actually presented. Unlike his description, at no time during this interview were several of the "risks" he lists in the notes actually mentioned at the meeting. No numbers/probabilities were attached to the risks he did mention; in fact at no time in this whole process have numbers on risks or relative benefits or any treatment been offered. I have had to hunt these stats myself. A task that is much more work that it sounds. So, why not cover you butt as a plastic surgeon, by handing out a summery of all the risks w/stats? If that P.S. would have listed all the risks explicitly, or given me the probabilities on the most likely complications; or just ran down the complete list of possible complications, or told me the whole truth about the history of complaints and law suits, I would have left his office that day knowing I did not want any sort of reconstruction requiring an implant. Of course few women would; and breast implants are a very profitable business. The focus seems to be not on full disclosure to women who have cancer and are thinking about reconstruction; but they actually promote reconstruction while failing to effectively disclose the risks.

The day after the meeting w/the P.S. I once again took on the task of educating myself about the risks. NOT GOOD!!! So, I called back rejecting reconstruction. I think in part to confirm rejection and in part to ask why. It sounded like she was doing research on this subject. She mentioned that 70% of the women given the option of immediate reconstruction take it, while 70% of the women who are offered delayed reconstruction end up rejecting the option. I told her it was a matter of risk assessment. More time to assess risks--less likely taking them. Save if you are so old, and close to death that nice "perky" tits make a good joke on the way out.

I have to admit that while I was opposed to reconstruction at the first meeting w/the surgeon, the depressing thought of a breast having been removed, in conjunction w/ their enthusiasm, and the advent of flap surgery had me going for a while. Even though I knew the additional surgeries would increase the risks of metastasis; I though we might be able to manage that risk w/hormone suppression. I was very uneasy about the extra surgical site and surgical time; but was also uneasy about the idea of not having reconstruction. Add on the risks of an implant and the scales tipped hard and fast. I not only will live with one breast; but I will let the world know why. After much risk assessment, I have become convinced that reconstruction after mastectomy is so risky, particularly w/implants that it simply should not be done elective or otherwise. Furthermore, the use of genital mutilation to reconstruct the nipple is the epitome of the problem. Women are giving their very bodies over to profit and subjugation, to sexual objectification. READ THE "STORY OF O” folks. I read this as a teenager. It is listed as porn. It can be read as a feminist statement against the reduction of women to mere sexual objects. O "elected" for her surgeries as well? The procedure that could not make this more blatantly clear is cutting of the labia in order to reconstruct the nipple. A nipple that will have no feeling; thus will not operate as a sexual organ for the woman's sake. Furthermore, cutting the labia can lead to her displeasure of sex.

So, I have come to the conclusion that breast cancer is nothing more to the medical profession than it is to the herbal industry a chance to make big profits selling snake oil, much of it harmful.


BTW; as a note I wanted to add that after accessing the medical records I discovered that the P.S. had written down that I was a D cup. Now I do not like being a C and would prefer being B, but if I had moved forward w/o checking his notes would have ended up a D. We have been making jokes about this; but if it had happened it would be no joke.

Follow-up

I once again felt compelled to write, if for no other reason to tie things up a bit. Surgery is over. I want to thank Dr. Kwong. It was she that provided the space for me to have some input into my care. While she has no power to tell oncology what to do; she does have the power to order surgery. Thus, while I was denied any sort of hormone treatment prior to surgery; I was allowed a bilateral oopherectomy concurrently w/the mastectomy.
While there was some noise concerning the availability of this option right before surgery; when I made it clear this was a provision upon which my consent to surgery at all was based; an OBJYN surgeon became available. This may have been to cover their legal asses; or it may have gone down just as presented w/no hidden agenda. No matter; the ooperectomy would be performed.
The pathology report was all positive, that is positively negative. The sentinel node-negative, surgical margins clear, and the tumor turned out to be less than 1cm rather than 1.5-2cms as estimated based on imaging. Not a single reason I should have to argue w/oncology over radiation or chemo. Wahoo!!!!
The path report makes it hard to complain. When it comes to Dr. Kwong and the surgical team it is hard not to rave. Still, I am not happy with the state of oncology not only at the V.A. but more broadly. Furthermore, medicine needs to work on the “informed” part of “informed consent”. The V.A. in particular needs to work on patient access. The system puts up so many barriers between patients and care providers that one could die of a post surgical complication before a message gets to the Dr. Yet the patient is warned that if they seek help outside the V.A. system they are likely to get stuck w/a steep bill.
While Kwong’s follow-up has been well done; OBGYN follow-up has been absent. Currently I am experiencing increased pain around one of the OBGYN incisions, along w/redness. There also seems to be increased swelling. Post surgical instructions tell you to call if you have such problems. But, true to typical V.A. form; I cannot get a response. I called the V.A. on Friday w/problems at 12:30. It took several attempts to get a message left. At 4:25 I called back. The message had been sent to several Drs, but none had signed off that they had rec’d the message. Several of these Drs are not at the V.A. more than one day a week. It should be up to the V.A. to make sure I get a response; but nothing. I was told to go to Roseburg. I did. E.R. diagnosed a pulled muscle. Hmm. Ok, could be. But does not seem right to me. I am currently staying very still, as movement hurts like hell, and I am worried. I plan to try to call the V.A. in Portland again on Monday and see if I can get a response. In the meantime I am watching the redness, the area is growing, but very slowly. Not sure what any of this means.

Save my access to medical care is poor.
It took 3 months from diagnosis to treatment.

( read this: Racial Inequalities in US Cancer Treatment
Le Nouvel Observateur

Monday 16 May 2005

An American scientific study indicates that close to 27% of black women wait as long as three months between their first visit to a doctor and the beginning of treatment.
Black women in the United States often wait longer than other women to be diagnosed with breast cancer and begin treatment, according to a study published Sunday, May 15, by the annual conference of the American Society of Clinical Oncology (ASCO).

This research, the most extensive to date on this subject, shows that close to 27% of black women wait as long as three months between their first visit to a doctor and the beginning of treatment.

This percentage is only 17% among Hispanic women and 15% among white women, emphasized Colombia University Professor Sherri Sheinfeld Gorin, who directed this study.

"A two month delay can reduce the chance of survival for five years by 10-15%," estimated Dr. David Johnson, ASCO president, during the same press conference.

Difference in Waiting Time

"Even though this study confirms more limited research done previously, we were very surprised by the difference in waiting time for diagnosis and the beginning of treatment between black women suffering from breast cancer and other women," Dr. Gorin said.

The researchers analyzed the length of time between the initial examination, the diagnosis, and the outset of treatment for 49,865 women aged 64 and over - including 2,982 black women - diagnosed with breast cancer between 1992 and 1999.

They also calculated that a black woman had an 89% higher chance than other women of waiting over a month between the first visit and a diagnosis and a 58% higher chance of having as long a wait before being treated.

Overall, black women have an 81% higher chance than white women of having to wait over a month between the initial visit and the outset of treatment whatever their cancer's stage of development, these researchers also revealed.


Now follow-up is good in terms of Dr. Kwong, but not OBJYN for some reason, and access to anyone through the V.A. takes days, appointments a week or more, even when what you are calling about could be an infection.
As it is my body seems to be fighting it all off well enough for now. I will see OBJYN on a followup Friday, five days short of a month from surgery, and only as a result of a complication. hmmm.

The Disturbing Truth About Doctors and Your Medical Safety

There are many upsetting things about capitalistic medicine, including a health care system that makes health decisions based on corp profits rather than patient health.
This is a constant challenge to the health care consumer to research everything and hope they are not harmed more than helped by the medical system.
Here is another problem with medical care. Just as a note: I asked the Portland V.A. at least four times about infection rates before surgery. This is one question they would never answer. Nor could I find the answer published. Hmmm.

here is a link about infection
http://www.truthout.org/issues_06/051807HB.shtml

Doctors Reap Millions for Anemia Drugs - By Alex Berenson and Andrew Pollack

Drs. making money off cancer treatments contributes to resistance to change.

Wednesday 09 May 2007

Two of the world's largest drug companies are paying hundreds of millions of dollars to doctors every year in return for giving their patients anemia medicines, which regulators now say may be unsafe at commonly used doses.

The payments are legal, but very few people outside of the doctors who receive them are aware of their size. Critics, including prominent cancer and kidney doctors, say the payments give physicians an incentive to prescribe the medicines at levels that might increase patients' risks of heart attacks or strokes.

Industry analysts estimate that such payments - to cancer doctors and the other big users of the drugs, kidney dialysis centers - total hundreds of millions of dollars a year and are an important source of profit for doctors and the centers. The payments have risen over the last several years, as the makers of the drugs, Amgen and Johnson & Johnson, compete for market share and try to expand the overall business.

Neither Amgen nor Johnson & Johnson has disclosed the total amount of the payments. But documents given to The New York Times show that at just one practice in the Pacific Northwest, a group of six cancer doctors received $2.7 million from Amgen for prescribing $9 million worth of its drugs last year.

Yesterday, the Food and Drug Administration added to concerns about the drugs, releasing a report that suggested that their use might need to be curtailed in cancer patients. The report, prepared by FDA staff scientists, said no evidence indicated that the medicines either improved quality of life in patients or extended their survival, while several studies suggested that the drugs can shorten patients' lives when used at high doses. Yesterday's report followed the FDA's decision in March to strengthen warnings on the drugs' labels.

The report was released in advance of a hearing scheduled for tomorrow, during which an FDA advisory panel will consider whether the drugs are overused.

The medicines - Aranesp and Epogen, from Amgen; and Procrit, from Johnson & Johnson - are among the world's top-selling drugs, with combined sales of $10 billion last year. In this country, they represent the single biggest drug expense for Medicare and are given to about a million patients each year to treat anemia caused by kidney disease or cancer chemotherapy.

Dr. Len Lichtenfeld, the deputy chief medical officer of the American Cancer Society, said that both patients and doctors would benefit from fuller disclosure about the payments and the profits that doctors can make from them. "I suspect that Medicare is going to take a very careful look at what is going on here," he said.

Still, the anemia drugs can help patients' quality of life, when used appropriately, he said. "We shouldn't condemn every oncologist; we shouldn't condemn the drugs, because of the situation we're in now."

Federal laws bar drug companies from paying doctors to prescribe medicines that are given in pill form and purchased by patients from pharmacies. But companies can rebate part of the price that doctors pay for drugs, like the anemia medicines, which they dispense in their offices as part of treatment. The anemia drugs are injected or given intravenously in physicians' offices or dialysis centers. Doctors receive the rebates after they buy the drugs from the companies. But they also receive reimbursement from Medicare or private insurers for the drugs, often at a markup over the doctors' purchase price.

Medicare has changed its payment structure since 2003 to reduce the markup, but private insurers still often pay more. Combined with those insurance reimbursements, the rebates enable many doctors to profit substantially on the medicines they buy and then give to patients.

The rebates are related to the amount of drugs that doctors buy, and physicians that agree to use one company's drugs exclusively typically receive higher rebates.

Johnson & Johnson said yesterday in a statement that its rebates were not intended to induce doctors to use more medicine. Instead, the rebates "reflect intense competition" in the market for the drugs, the company said.

Amgen said that rebates were a normal commercial practice and that it had always properly promoted its drugs.

"Amgen is dedicated to patient safety," said David Polk, a spokesman. "We believe our contracts support appropriate anemia management and our product promotion is always strictly within the label."

Both companies' stocks fell yesterday after release of the FDA report. Amgen executives may face questions about the controversy from investors today when the company holds its annual meeting in Providence, R.I.

Since 1991, when the first of the drugs was still relatively new, the average dose given to dialysis patients in this country has nearly tripled. About 50 percent of dialysis patients now receive enough of the drugs to raise their red blood cell counts above the level considered risky by the FDA.

American patients receive far more of the anemia drugs than patients elsewhere, with dialysis patients in this country getting doses more than twice as high as their counterparts in Europe. Cancer care shows a similar pattern. American cancer patients are about three times as likely as those in Europe to get the drugs, and they receive somewhat higher doses.

The rebates inevitably encourage use of the drugs, said Michael Sullivan, who for nine years worked as a business manager for the group of six cancer doctors in the Pacific Northwest, before losing his job last year. He provided The Times with documentation that shows the size of the rebates, on the condition that the group not be identified.

"Personally, I think rebates should go away," said Mr. Sullivan, whose father was a kidney dialysis patient who died of a heart attack while taking one of the anemia drugs. "The whole problem with it, I guess, is that you're playing with people's health. It's not the same as buying widgets."

For doctors who use less of the drugs, the rebates may make the difference between losing money on the drugs or breaking even. Mr. Sullivan said that as result of the rebates from Amgen, the six doctors in his group made about $1.8 million in net profit on the drugs they prescribed.

Unlike most drugs, the anemia medicines do not come in fixed doses. Therefore, doctors have great flexibility to increase dosing - and profits. Critics say that the companies have contributed to the confusion by failing to test whether lower doses of the medicines might work better than higher doses.

"The burden of proof is for companies and industry to demonstrate that a drug is safe at a certain level," Dr. Ajay Singh, an associate professor at Harvard Medical School. Dr. Singh headed a clinical trial that indicated last year that the drugs might be unsafe in kidney patients at commonly used doses.

Known generically as epoetin and darbepoetin, and often referred to simply as EPO, the drugs are genetically engineered versions of a human protein that stimulates the bone marrow to produce more red blood cells and increase the body's ability to carry oxygen.

Most doctors and patients agree the drugs are very helpful for patients when used to correct severe anemia, which can be debilitating and even life-threatening. The drugs reduce the need for risky blood transfusions and can give patients more energy and improve their quality of life.

"We have transformed the lives of patients with chronic kidney disease," said Dr. Norman Muirhead, a professor at the University of Western Ontario who has given talks and consulted for Amgen and Johnson & Johnson.

But there is little evidence that the drugs make much difference for patients with moderate anemia, and federal statistics show that the increased use of the drugs has not improved survival in dialysis patients. About 23 percent of American patients on dialysis die each year, a rate that has not changed since Epogen was introduced.

Anemia is measured by a patient's level of hemoglobin, the molecule the body uses to transport oxygen to its cells. Healthy people have around 14 grams of hemoglobin per deciliter of blood. Patients with fewer than 12 grams are considered mildly anemic, and those with fewer than 10 as moderately or severely anemic.

The labels on the drugs, as currently approved by the FDA, encourage doctors to aim for a hemoglobin level of 10 to 12. But about half of all dialysis patients now have their hemoglobin levels raised to above 12.

Critics of the drugs say their increased use has been driven by profit. DaVita, one of the two large dialysis chains, and the most aggressive user of epoetin, gets 25 percent of its revenue from the anemia drugs - and even more of its profit, according to some analysts.

Dr. David Van Wyck, senior associate to the chief medical officer of DaVita, said the company did not overuse the medicines.

Doctors determine how much to use, Dr. Van Wyck said. "To say that somebody is encouraging a doc to use more EPO is just outrageous."

Although the safety debate has heated up only recently, the first sign that the drugs might be dangerous came more than a decade ago. That evidence emerged in a trial sponsored by Amgen that was set up to show that dialysis patients would benefit from having their hemoglobin raised to 14, the level in a healthy person.

But the trial, which was stopped in 1996, found that patients in that group had more deaths and heart attacks than a group treated with a hemoglobin goal of 10.

That trial should have discouraged doctors from using too much epoetin and encouraged Amgen to study the risks further, said Dr. Steven Fishbane, a nephrologist at Winthrop-University Hospital on Long Island.

Instead, use of epoetin continued to soar. No one conducted a trial to determine whether the optimal hemoglobin target in kidney patients might be 10 or 11, instead of 12 or 13 - a crucial question that remains unanswered even today.

Dr. Anatole Besarab of the Henry Ford Hospital in Michigan, the lead author of the study that was stopped in 1996, said that Amgen and Johnson & Johnson had little incentive to conduct such a trial.

Dr. Robert M. Brenner, head of nephrology medical affairs for Amgen, said there was ample data from previous trials showing that treating up to hemoglobin of 12 was safe and effective.

Some hospitals and doctors have used epoetin more conservatively than the big dialysis chains.

Dr. Ronald A. Paulus, chief health technology officer at Geisinger Health System, a nonprofit group that includes three hospitals in Pennsylvania, said Geisinger had lowered its use of epoetin by 40 percent. Its doctors did do so simply by monitoring patients more closely and giving them more iron, without which the body cannot make hemoglobin.

Dr. N. D. Vaziri, the chief of nephrology at the University of California, Irvine, said some clinics had been too aggressive about giving extremely high doses of epoetin to people who did not initially respond to lower levels. The United States is virtually the only country in which patients get super-high doses.

"You create a toxicity situation," said Dr. Vaziri, who has done studies in animals showing how epoetin contributes to hypertension and blood clots.

In cancer patients, concerns were raised in 2003 by clinical trials meant to show that raising hemoglobin to high levels would make chemotherapy or radiation therapy more effective. Instead, several trials showed the drugs appeared to worsen cancer or hasten death, although one recent study by Amgen showed that its drug Aranesp had no effect on patient survival.

The conflicting studies are among the issues the FDA advisory committee is expected to discuss tomorrow. Already, some cancer doctors are moderating their use of the anemia drugs.

Dr. Peter Eisenberg, an oncologist in Marin County, Calif., said many doctors had been induced to use more epoetin by the financial incentives and the belief that the drug was helpful.

"The deal was so good," he said. "The indication was so clear and the downside was so small that docs just worked it into their practice easily.

"Now it's much scarier than that," he said. "We could really be doing harm."





http://www.truthout.org/issues_06/printer_050907HA.shtml

Radiation and Cancer - By H. Josef Hebert The Associated Press

Time after time I was told several chest xrays and "nuking" my thyroid did not contribute to my cancer. I knew they were wrong, and this is why I fear more than one cancer may pop up.

Panel Affirms Radiation Link to Cancer

Wednesday 29 June 2005

Even very low doses of radiation pose a risk of cancer over a person's lifetime, a National Academy of Sciences panel concluded. It rejected some scientists' arguments that tiny doses are harmless or may in fact be beneficial.

The findings, disclosed in a report Wednesday, could influence the maximum radiation levels that are allowed at abandoned reactors and other nuclear sites and raises warnings about excessive exposure to radiation for medical purposes such as repeated whole-body CT scans.

"It is unlikely that there is a threshold (of radiation exposure) below which cancers are not induced," the scientists said.

While at low doses "the number of radiation-induced cancers will be small ... as the overall lifetime exposure increases, so does the risk," the experts said.

Even common X-rays pose some risk of adverse health effects, the scientists found, although the panel said there was not enough information available to accurately estimate the cancer risk from X-rays. Nevertheless, the report said, there is evidence that per unit of absorbed radiation, X-rays may be more dangerous than other radiation.

The panel also said that approximately one person out of 1,000 would develop cancer from exposure to the amount of radiation from a single, average whole body CT-scan.

But the report should not scare people away from nuclear medicine, said Dr. Henry Royal, a professor of radiology at Washington University in St. Louis. He said most often the benefits of such tests and treatments outweigh the risks.

But Royal also said that procedures such as CT scans should be used to deal with a specific medical problems and not part of annual medical screenings. "You should not be exposed to radiation for superficial reasons," Royal said in a telephone interview.

Scientists for years have debated how extremely low doses of radiation affect human health.

Pro-nuclear advocates, as well as some independent scientists, have maintained that the current risk models for low-level radiation has produced more stringent requirements than is necessary to protect public health.

It is an issue in determining decontamination requirements at abandoned reactors and at federal weapons sites.

The academy's panel stood by the "linear, no threshold" model that generally is the acceptable approach to radiation risk assessment. This approach assumes that the health risks from radiation exposure decline as the dose levels drop, but that each unit of radiation - no matter how small - is assumed to cause cancer.

"The scientific research base shows that there is no threshold of exposure below which low levels of ionized radiation can be demonstrated to be harmless or beneficial," said Richard R. Monson, the panel's chairman. He is a professor of epidemiology at Harvard's School of Public Health.