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  MGH Residents' Clinic - Where the nightmare began  
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  Confidentiality? Not at Meridian Plast. Surg. Center  
  Dr. Barry Eppley plays "Blame the Victim"  
  Response to Dr. Eppley's Allegations  
  Plastic surgery experts question Dr. Eppley's methods.  
  Neck- soft tissue  
  Analysis by Radiologist, Steve Doak,M.D.  
  Evaluation by Experienced Radiologist: Steve Doak, M.D.  
  ENT Specialist confirms Dr. Doak's opinion and more  
  Modified Barium Swallow - Report 5/03  
  MBS 5/03 and 12/03  
  MBS report by Speech Pathologist 12/9/03  
  Consultation with Pulmonary Specialist  
  Follow-up report from pulmonologist  
  ENT report July 2, 2004  
  ENT Report - July 16, 2004  
  Comparison of X-rays  
  My Experience at MGH Residents' Clinic  
  My experience at MGH part 2  
  My Experience at MGH part 3  
  Operative Reports - 11/24/97 and 1/28/98  
  Evidence of my first complaint  
  Explanation regarding my results  
  Ignored repeated requests for dermatology consultation  
  Letter to MGH Chief Medical Officer  
  Letter to Dr. Schneider - March 20, 1998  
  Letter to Facelift Specialist, Dr. Feldman - September 9, 1998  
  Dr. Feldman's response - September 15, 1998  
  Letter to Facelift Specialist, Dr. Joel Feldman, 11-7-1998  
  Letter to Dr. May - 11/4/1998 (request for derm consult)  
  Letter to MGH President 12/15/1998 (request for derm consult)  
  Letter to JPRS - Re: Zide editorial  
  Zide E-Mail - (exhibit 3)  
  Zide E-Mail - (exhibit 5)  
  Response to Eppley.. page2  
  Response Page 3  
  Page 4  
  Libelous Editorial in Plastic & Reconstructive Surgery  
  Boston Globe Story - 9/23/2002  
  Patient as teacher  
  "THREAT" OF THE SEVERED HEAD  
  Lies, more lies and missing medical records  
  The Fateful Letter of March 19, 1999  
  Letter from my therapist to Dr. Feldman - 2/24/1999  
  Letter to doctors at MGH - 1/13/1999  
  Letter to Dr. Schneider - 1/20/1999  
  Response from Dr. Feldman - 2/17/1999  
  My mental stability - Letter from my neurologist  
  Subj: Letter from my boss - 11/3/2003  
  Letter to Dr. Schneider - 7/8/1999  
  Letter to Dr. Eric Johnson (primary care)  
  Response from Dr. Johnson -re: request Dr. Feldman meet with me  
  E-mail to Dr. May - 5/3/2000  
  E-mail just before revision surgery  
  Dr. Eppley's response  
  Video - Very specific - No room for "misunderstanding"  
  Eppley pre-op consultation notes  
  After the operation  
  If I only knew...  
  Dr. Eppley's talent for twisting the truth  
  Dr.Barry Eppley - Operative Report 4/18/2001  
  E-mail to Dr. Barry Eppley.. one year later  
  Immediate denial by Dr. Eppley  
  Never answered this or many other questions  
  Dr. Barry Eppley omitted most important part of operation  
  x-rays (narrowed airway)  
  Hospital-Based Spas ~ Are They Really a Good Idea?  
  MBS 11-7-07 continued  
  Dentist's note on crowns  
  ceph - 6/27/06  
  Preface written September 7, 2006  
  Dr. Barry Eppley- FDA finds "serious violations"  
  Comparison of tongue position in Panex films  
  Regret participation in HBO's Plastic Disasters  
  *UPDATE*  
  Desperate Measures - Surviving, but for how long?  
  Compassion  
  Beginning of the Nightmare - Overview  
  "NECK LIFT" by Dr. Joel Feldman - An interesting read indeed.  
  Water-bed fluctuance  
  Previously on Home page  
  My response to Almitra 1  
  Dr. Barry Eppley - Height of Hypocrisy  
  Misc. documents  
  Modified Barium Swallow- 11-07-2007  
  White Wall of Silence  
  The nightmare began here..  
  Dr. Eppley & Meridian Plastic Surgery Center  
  Dr. Eppley & Ology Spa Spam the Blogosphere  
  An Open Letter to Dr. Joel Feldman  
  Enough is ENOUGH -- Confirmation bias & Attribution error  
  Has Artificial Beauty Become the New Feminism?  
  Attention: Dr. Joel Feldman  
  Dr. Feldman's letter to Rich Bergeron  
  letter.. continued  
  letter.. continued 2  
  Hospital-based Spas - Are they Really Safe?  
  Malpractice lawsuits against Dr. Barry Eppley  
  Disturbing discovery - Dr. Barry Eppley's malpractice lawsuit  
  Links to Important Content  
  FDA's Botox warning falls short  
  Anesthesiologist Said he was Not Present - Dr. Eppley?  
  Does this have a familiar ring?  
  On TRUTH...and how Dr. Joel Feldman exempts himself from it  
  Dr. Feldman- Still Beating a Dead Horse  
  Rachael's Voice  
  Rachael - page2  
  Rachael - page 3  
  Rachael - page 4  
  Push for stricter plastic surgery rules swells in wake of death  
  Another victim of Dr. Barry Eppley  
  What Dr. Barry Eppley Doesn't Want You to Know  
  
  
  Tools  
 
Cape Cod Hospital, Hyannis, MA 02701
Ord Phys:  Steven Mucci, M.D.
Att Phys:  Steven Mucci, M.D.
 
MODIFIED BARIUM SWALLOW
DATE OF EVALUATION: 12/09/03
MEDICAL HISTORY:
THE PATIENT IS A 54 YEAR OLD FEMALE WHO RETURNS AS AN OUTPATIENT FOR HER SECOND MBS, THE INITIAL COMPLETED BY THIS CLINICIAN ON 5/02/03. SHE UNDERWENT COSMETIC FACE AND NECK LIFT SURGERY 2.5 YEARS AGO IN INDIANA AND HAS COMPLAINED OF BREATHING AND SWALLOWING DIFFICULTIES SINCE THAT TIME. PRIOR MBS RESULTS SHOWED  DYSPHAGIA WITH SOME PREMATURE SPILL INTO THE PHARYNX AND TRANSIENT LARYGNEAL PENETRATION WITH THIN LIQUIDS WHICH WAS ELIMINATED WITH A CHIN TUCK MANEUVER WHICH THE PATIENT WAS SPONTANEUSLY DOING. TODAY, THE PATIENT COMES EQUIPPED WITH 2 PAIRS OF FOCEPS TO ASSIST HER IN A MANEUVER WHERE SHE PULLS UP ON THE PLATYSMAS MUSCLES WHICH SHE SAYS IMPROVES NOT ONLY HER SWALLOW FUNCTION, BUT HER BREATHING, AS WELL. SHE REPORTS SENSATION OF REDUCED AIRWAY AND HAS RECENTLY HAD AN E.R. VISIT 10/21/03 FOR SAME. SHE IS C/O DIFFICULTY BREATHING THAT REQUIRES HER TO KEEP HER NECK FLEXED AND IS C/O ASSOCIATED NECK PAIN NOW, AS WELL. THIS IS AFFECTING HER DAILY ACTIVITIES AND ESPECIALLY DRIVING. OTHER PMHX INCLUDES MITRAL VALVE PROLAPSE AND NARCOLEPSY.  SOCIAL HX: SHE IS A GARDENER. SHE IS VEGETARIAN.
 
CONSISTENCIES ADMINISTERED
THIN LIQUIDS, LORNA DOONE COOKIE.
ORAL PREPARATORY PHASE
This patient showed: Normal control and bolus transit: Efficient oral motility and bolus formation; no oral residue; mastication is brisk and thorough.
 
REFLEX INITIATION PHASE
This patient showed: ANATOMY: Normal: reflex initiated at the back or base of tongue above the epiglottis. TIMING: Normal: no hesitation; smooth and continuous motility from posterior tongue into pharynx.
PHARYNGEAL PHASE (Pharyngeal - Laryngeal, Cricopharyngeal)
This patient showed: Limited laryngeal excursion; epiglottis may achieve horizontal position, but fails to invert fully; a laryngeal vestibule gap may be seen during the swallow.
PHARYNGEAL CLEARANCE (PERISTALSIS)
This patient showed: Mild residue: «10%) of a small bolus remains in the mid and/or lower pharynx after the first swallow.
ASPIRATION
This patient showed: no aspiration. There is transient laryngeal penetration on thin liquids with head in neutral position. This is eliminated when the patient uses a chin tuck. This is reduced somewhat, but not eliminated when the patient pulls up on the platysma muscles.
PHARYNGEAL - ESOPHAGEAL SEGMENT
(Proximal or cervical esophagus; upper esophageal sphincter/UES) This patient showed: Normal Relaxation of the UES; caliber of opening is full. 
TYPE OF MODIFICATION
POSITION OF HEAD:
Chin Down Tuck-------------Helpful
"LIFTING" NECK MUSCLES-----Somewhat  helpful
SUMMARY AND IMPRESSION:
The patient continues to present with  pharyngeal dysphasia, essentially unchanged from prior evaluation, which is characterized by  reduced laryngeal elevation and intermittent reduction in epiglottic deflection with resulting transient laryngeal penetration of thin liquids worse with head in neutral position. Penetration is eliminated with a chin tuck and reduced with the patient lifting up the muscles of her neck with forceps. Difficulty breathing is also major complaint which she describes as a sense that her tongue is somehow obstructing her airway.
Signed Electronically 12/17/03
 
MARIA DEPASQUALE, MS CCC-SLP
 
SPEECH-LANGUAGE PATHOLOGIST
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
                                      
Left:  Method. Pull with forceps     Right:  Video fluoroscopy

  * My note:  The fact of visible improvement in swallowing with upward pull on platysma (in opposite vector of INAPPROPRIATE tension which was employed in my surgery) is ABSOLUTE PROOF  that failure to release this muscle with a transverse incision is the cause of my swallowing disorder.  Of course, I am not able to FULLY correct this by manual manipulation of the tissue with fingers or forceps because it is IMPOSSIBLE for me to place that much opposing force to FIXED and AGGRESSIVELY EXCISED tissue.   It takes all the strength in my fingers simply to grasp and relieve this tension for a few seconds, as THE TISSUE ITSELF IS SO SCANT AND UNDER SO MUCH TENSION THAT IT PULLS RIGHT THROUGH MY GRASP. 
Grasping sufficient tissue between forceps for the MBS did not allow a strong enough hold, as this would have cut right through my flesh.  This is not a difficult problem for any surgeon to understand.  It is so blatantly EXTREME that only a surgeon who is deliberately trying to minimize such a catastrophe would fail to recognize its seriousness  and functional repercussions..  It is very odd, indeed, that my ENT  as well as the speech pathologist who performed and read the study, consider this to be "tangible" evidence of a specific muscle (platysma) is exerting tension sufficient enough to alter the internal structures of the neck (tongue base and epiglottis)  to cause dysphagia.  The force (tangible and measurable) demonstrates an improvement (tangible difference in the position of internal structures when force is applied).  Yet this study was IGNORED by the very surgeons who have the most experience with this anatomy.  How do they explain this?

 

 


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