X-Message-Number: 33371
From:
Date: Mon, 28 Feb 2011 01:41:36 EST
Subject: Melody Maxim's Distorted Reality 6
Content-Language: en
How Professionals Behave
February 10 2009 at 6:51 PM Mike Darwin Mike Darwin (Login mgdarwin)
Veteran Member
Response to Now, see what you started, FD???
________________________________________
Melody Maxim writes:
"Gee, thanks.
Maybe I'll find time to deal with this, next week...or maybe I just won't
bother. If anyone, (like FD), wants to take the time to wade through all
this and ask me to remark on something specific, I might oblige."
You have made serious and damaging accusations about the competence,
history and accomplishments of a number of people who have exemplary records of
service to cryonics and the delivery of excellent care to cryopatients. You
have also denied that specialized knowledge and skills are required in the
delivery of perfusion to cryopatients; insisting instead that any medical
professional can enter the field and perform safely and responsibly. You
have refused to cite examples of the many documents I have supposedly written
on perfusion procedure (in or out of cryonics contexts) that contain
erroneous information. You have not provided any evidence that any cryopatient
under the care of either Jerry Leaf or I suffered iatrogenic injury as a
result of the extracorporeal care we delivered.
You have also refused to answer basic questions about the
contraindications for applying perfusion procedures to cryopatients, as well as
fundamental
questions about the technical parameters that should be used in conducting
in-field extracorporeal procedures. You have alleged that you were in
receipt of photographic evidence showing air emboli in the arterial leg of a
perfusion circuit I was responsible for, but have provided no documentation to
substantiate this allegation. You raise complex technical issues here on
CF and then, when challenged, assert that this is not the proper place to
discuss or debate or them.
You repeatedly claim that, 'you are too busy' or that, 'you cannot be
bothered' to respond to clearly defined and objective questions about the
charges you level, or the technical positions that you assert are the only
proper way to deliver extracorporeal support or TBW to cryopatients, while at
the same time you post many thousands of words on this forum dealing with
comparatively trivial issues in cryonics. You attack the experience and
professionalism of a fellow perfusionist (Jerry Leaf) with decades of clinical
and research experience as well as numerous peer-reviewed publications
(including in perfusion journals) and yet you provide no information about your
work experience, professional accomplishments or scientific or technical
publications. *Who are you?* What are your credentials and what is your work
history in extracorporeal medicine? How many years of clinical or research
experience have you had and at what institutions?
This not how professionals in any discipline behave and it is certainly
not how fair minded people with even a passing respect for due process
behave. Have you no shame?
Lack of Expertise Boldly Demonstrated
February 10 2009 at 10:32 PMMike Darwin (Login mgdarwin)
Veteran Member
Response to Shame
________________________________________
Melody Maxim writes:
"Mike objected to me writing that I believe one of his recently posted
images clearly showed air in the raceway of the pump, in a perfusion circuit.
That was easy for me to find, so I'll post it, now. (I have recently
apologized, to someone else, for posting something from another forum, on this
forum, but since Mike asked for his own image, I don't think anyone should
object.)
There is clearly a bolus of air/foam in the raceway of the pump. (There's
a clamp lying on top of the pump; look under it.) Mike seems to insist on
promoting the use of soft-shell reservoirs with occlusive pumps. Some people
will say you can't pump air with a soft-shell reservoir, but that is not
true. If the reservoir is emptied, when combined with an occlusive pump, that
pump will draw a negative pressure that can result in air being pulled out
of solution and the creation of foamy air in the circuit. I believe that
is probably what happened in the image above.
I've criticized, I've speculated, I've raised a lot of questions, but I
don't think I've actually libeled Mike, (George informed us all, some time
ago, that slander is spoken and libel is written)."
Mike Darwin: Ms. Maxim: Look closely at that photo and you will see that
what you are saying is 'air' has a yellow cast to it and does not have the
characteristic elliptical end-cap of a bubble.
The reasons for this are that it is NOT a bubble: it is plasma. This photo
was of a canine cerebral resuscitation dog CPB circuit and these animals
were supported with bypass only for a short period during initial
resuscitation. Before perfusion was finally discontinued, the animal
decannulated and
the wounds closed, the animal was left connected to the extracorporeal
circuit with the pump off and the lines clamped. An additional reason for
doing this was that due to some of the drugs in the resuscitation protocol
(including vasopressin) it was not possible to re-infuse the blood in the
extracorporeal circuit immediately after terminating bypass. The animals were
thus left connected to the circuit and blood was slowly re-infused until the
acutely unstable period following resuscitation was over. A consequence of
this was sedimentation of the cellular components of the blood under the
influence of gravity resulting in plasma in the pump raceway. Once the animals
were stable, any remaining blood in the circuit was transferred to an
emptied 1-liter IV bag (usually the Normosol-R bag used in priming the
circuit).
What is seen (enlarged in the photo below) is PLASMA not air. That is why
the liquid has a straw-yellow color. The pump was not running when that
picture was taken and if you look very carefully at the entire raceway you will
see that there is some sedimentation on the other side (right of the
photo) of the raceway as well evidenced by a slight 'milky' appearance of the
fluid in the tubing.
Another tip-off that this is an off-pump photo is the small bubbles that
have formed in the static blood at nucleation sites on the venous reservoir
bag wall.
The expert who has no expertise in this area is wrong.
The Defense Rests
February 11 2009 at 5:00 PMMike Darwin (Login mgdarwin)
Veteran Member
Response to Indeed
________________________________________
No, Ms. Maxim, blood does not sediment at equal rates throughout a CPB
circuit and, in particular, when the tubing on the inlet side of the pump is
nearly perpendicular to the floor you will see plasma separation occur there.
When the pump is subsequently very slowly operated to give small boluses
of blood back to the animal, that plasma will be drawn into the raceway.
Additionally, blood foam appears pinkish-white and is NOT transparent or
translucent.
Certainly bubbles can and does form on the venous reservoir bag wall
during bypass, but NOT towards the bottom of the bag in the turbulent, high
flow
areas.
Finally, since Ms. Maxim states she can tell that the pump was indeed off
(how, I wonder?) then assuming that what she says is foam IS actually foam
(which is not the case) then how can she know if it was of any
significance? If, as I assert, this animal was off CPB and was getting
re-infused blood
at very slow rates of infusion and at discrete intervals, then the
presence of foam would be irrelevant. Indeed, near the end of such infusions,
the
entire circuit up to the level of the arterial filter is full of air - air
used to displace blood.
*While that was not the case in photo in question*, it points up the
danger of assuming things without adequate information. I'd also note that Ms.
Maxim's hypothesizing that 'there could have been air leak around the venous
cannula' is incorrect (and under the circumstances absurd and impossible)
because the dogs in these experiments were undergoing fem-fem CPB with
Biomedicus cannula and cannulae was so tight in the vessels that it typically
took a fair bit of time and a great deal of careful effort to place them
(they were also ligated in place with silk snares). We had to use the largest
cannulae we could get into the femoral vein in order to accommodate the very
high flows required in this model. Secondly, in order to have a continuous
column of 'foam' in the pump raceway as she asserts, the reservoir bag
would have to have been pumped dry; and yet the bag and the tubing leading up
to the pump are blood-filled. Even more on point, such a continuous bolus
of foam can only be created when blood is subjected to substantial
mechanical agitation such as having been mixed with air in the pump. Thus, such
foam
should be present not on the intake side of the raceway, but on the output
side; headed towards the arterial filter.
Other obvious questions are, "Why would I select a photo that shows an
iatrogenic event? Why would I use such a photo in public presentations,
including in front of physicians and perfusionists?" Similarly, these
experiments
involved many people and were witnessed by many more. For them to have
been 'faked' would have involved the existence of a 'conspiracy'; the oft
favored explanation on CF for events not understood and for which it would take
substantial effort to gain understanding. Using this case as an example, if
anyone on CF wants to know if air was pumped during the CRS experiments
(indeed, it was, once, and by me, but not in this case)or if the experiments
were real, they could go to the considerable effort of tracking down the
people who were present at some of them. They would then have to ask
questions and perhaps decide who had an axe to grind and who was telling the
truth.
Frankly, in the case of these experiments, I don't think anyone present
would be other than honest and forthright.
However, and this THE most important point, they would have to evaluate
any and all evidence in a FAIR as well as a critical manner. This is so
because if your starting position is that 'Mike Darwin and everyone at 21st
Century Medicine and everyone who witnessed these experiments is a liar,' then
you will ALWAYS be able to come up with an alternate explanation. Indeed, if
videotapes of these experiments were posted on-line, the response would
be, They are computer generated fakes paid for out of Saul Kent's millions.
The fundamental basis of scientific inquiry (which extends out of the
laboratory and into forensics and the law) is that you don't start an inquiry
or
investigation with your conclusion in-hand. In the law this reality is
summed up by the injunction: 'innocent until proven guilty.
Mostly, I have agreed with Ms. Maxim on her criticisms of cryonics. Where
I have disagreed I have offered concrete reasons which have NOT been
responded to by her. Thus, I have been genuinely puzzled from the start that the
operational premise used by Ms. Maxim is that I am a bad guy and am
'guilty.' Guilty of what? Guilty of disagreeing with her on two technical
issues
(pumps & reservoirs) and one philosophical issue (medical professionals
entering cryonics will require additional training and mentoring)? So what?
Where
is her rebuttal to the many points I've made in support of my positions on
these issues? And, what if I am, indeed wrong on all three issues? Well,
then Ms. Maxim and I disagree and it would be my poor judgment that was
demonstrated. That doesn't mean that I'm a diabolical liar.
Honest people of great knowledge and wisdom often disagree over all sorts
of matters, but they do not accuse (or worse, insinuate) that their
opponent in the debate is a dishonest fraud or an incompetent fool. To the best
of
my knowledge, no facts in evidence on this forum suggest that of me.
The take home message here is that if the starting assumption is that a
person is a psychopathic liar or a con artist then there is ultimately no
resolution possible. Every reasonable explanation given, as well as the
supporting evidence, will be explained away, ignored, or, most often, not
answered only to be replaced by an endless series of other questions/accusations
which take enormous amounts of time to answer whereupon those answers will be
ignored or denied and a fresh round of accusations will be leveled.
So, I've done my duty here which was to serve up an honest answer to the
distortions and outright mis-statements being made by Ms. Maxim in regard to
both the care of cryopatients during the tenure of both Jerry Leaf and I.
I've asked critically important questions of Ms. Maxim which she has ignored
or failed to answer. That's all that can reasonably be achieved here. And
yes, it is important to go on record declaring such persistent and
pernicious speculations, insinuations and allegations as false. Ive done that
and
that's all I can do under the circumstances.
Content-Type: text/html; charset="UTF-8"
[ AUTOMATICALLY SKIPPING HTML ENCODING! ]
Rate This Message: http://www.cryonet.org/cgi-bin/rate.cgi?msg=33371
Warning: This message was filtered from the daily CryoNet digest
because the poster sent too many messages per digest.
It thus may need to be rated.