X-Message-Number: 33384
From: 
Date: Mon, 28 Feb 2011 02:53:03 EST
Subject: Melody Maxim's Distorted Reality 19

Content-Language: en

 
You write:  
Mike: "In fact, they require a lot of accessory knowledge that many  
contemporary perfusionists will not have; such as solvent bonding techniques,  
detailed knowledge of in-house ethylene oxide sterilization procedures,  

interaction of circuit components (polysulfone pseudomembranes, arterial  
filters, 
etc.) with cryoprotective chemicals, thermal (mis)behavior of some  circuit 
components at near 0 deg C and on and on and on."   
While Mike is correct in regard to the interaction of circuit  components 
with cryoprotective chemicals, (something I am still kicking myself  for, for 
not immediately recognizing the issue, when I first became involved in  
cryonics), I think he is making too much of other issues. Things such as 
solvent  bonding techniques and detailed knowledge of in-house ethylene oxide  
sterilization procedures are unnecessary, in my opinion, and it was my  

observation at SA and CI, that ordinary perfusion circuit components performed
exceptionally well at near-zero temperatures. The only thing I remember being  
solvent bonded on the SA circuit, (prior to my revisions), was an 

undesirable  tube-inside-a-tube connection, below the venous reservoir, and I 
believe 
Mathew  told me this was Mike's design. This was totally unnecessary, as 
there were  reducers readily available to accommodate the connection, and it 
isn't necessary  to solvent bond anything on the venous side, as it is an area 
of negative  pressure. It isn't really necessary to solvent bond anything 
on the arterial  side, either, though perfusion manufacturers do routinely 
solvent bond the  connections around the arterial filter, as that is the 

highest pressure area of  the circuit, and a disruption there could be difficult
to deal with. In fact,  when using occlusive pumps, (as is usually the case 
in cryonics), it is wise not  to have all of the connections be 

"bulletproof," as it would be a heck of a lot  better to blow apart the circuit,
than 
over-pressurize the patient to the point  that would be required to rupture a 
bonded connection. Even if solvent bonding,  or ethylene oxide sterilization 
procedures were necessary, these procedures are  EXTREMELY easy to learn. 
Certainly, anyone who is capable of having "a working  knowledge of perfusion 
at Board Certification level," can master either of these  tasks in one 
day, or less.  
Please don't make the mistake of picking any one issue out of  context; my 
point was that solvent bonding IS used by some cryonics  organizations and 
rather than give it up and use reducing connectors, or  subcontract to a 
manufacturer as Mathew Sullivan has suggested, they have  demanded that it be 
used, and be used by people who are unfamiliar with it. A  short prACcis of 
fuck-ups Ive personally observed:  
Attempting to bond PVC tubing to polypropylene or polyethylene  fittings; 
you cannot do this because those plastics are impervious to  cyclohexane and 
most other solvents.  
Bonding to plastics that are degraded by cyclohexane resulting in a  

plastic connector or component fracturing or breaking in two after  
sterilization. 
 
Making connections with bubbles in them that are unreliable.   
Trying to bond the WRONG SIZES of tubing together with resultant  failure 
under pressure; or entrainment of air in the negative pressure areas of  the 
circuit.  
Bonding and then using the tubing/connectors/joins before the  solvent has 
cured and been baked out with resulting hemolysis.   
Contractors and hired experts want very much to please, and they  have no 
way of knowing they are dealing with people who are often colossally  

ignorant, or worse, ignorant, stupid and arrogant; the worst possible  
combination. 
I gather it took you awhile to come to this realization during your  tenure 
at SA. You are to be commended that you were honest enough to walk away.  
My point (yet again) is that all too many such experts, including some people 
I  otherwise respect a great deal do not do that; they stay and take the 
money, or  mistakenly believe that things are better off with them than 
without them. This  is never the case. All they do is to serve as legitimizing 

beards which allow  the incompetence (now morphed in fraud) to continue. I have
no patience with  such behavior.  
You write:  
Mike: "This is but one of countless examples that cut across the  full 

spectrum of doing cryonics on a medical-model, or in a technologically  complex
way. It is THE major source of disaster when medical professionals or  
technologists are 'brought in to provide expertise. These well-meaning folks  
believe they know cryoprotective perfusion or even TBW perfusion because they  
are Board Certified perfusionists or cardiac surgeons. And, without 

exception,  they are trusted completely by the people who hire them - even when
cold, hard,  logical and well documented objections to the specific dangerous 
things they do,  or recommend be done, are made."  
The "dangerous things" I've done, or suggested, in regard to  perfusion in 
cryonics, can't even BEGIN to compare to the level of "dangerous  things" 
that have done, and are STILL BEING DONE by the non-professionals  amongst the 
cryonics organizations. For Mike to put forth that it is disastrous  to 
consult with medical professionals is extremely offensive, and promotes a  
mentality that is sure to keep cryonics right where it is...in the dark ages,  
with golf pros and fabricators, and other laymen, performing complex medical  
procedures.  
I said no such thing and implied no such thing. I simply said that  
cryonics is a professional discipline like any other in medicine and that a  
frequent mistake (endlessly repeated) by cryonicists and people in other  

professions, is to assume that an allergist is the same as a neurosurgeon or  
even 
that a cardiothoracic surgeon is a perfusionist. This is NOT so. I am a  

professional in cryonics, perhaps the only one left that co-created and used the
 medical paradigm with evidenced based decision making. I could just as 
easily  say I resent your assertion that I am no such thing. What good would 
that do me,  or you or anyone else?  
No one is more aware of, or has railed more loudly or for any  greater 
length of time than I have, at the utter incompetence that has overtaken  the 
biomedical sphere of cryonics. I spent years of my life publicly pointing  out 
the same issues that you are apparently pounding away at to no avail.   
I learned that public criticisms are generally and are perceived as  

attacks. Worse than that, they completely alienate the community and destroy  
your 
reputation. The you I'm speaking of here is not you, but rather me.  
However, I believe that that shoe may very well fit your case too. I stopped  
engaging in such behavior almost ten years ago and avoid being drawn into.   
I do strongly believe there is a time and place for public  criticism of 
the fraud and shenanigans that are going on in cryonics; but that  time and 
place have to be carefully leveraged and chosen and, above all, there  has to 
be an alternative. We are in the unfortunate position of atheists arguing  
to the believing saved; they may be crazy or foolish for believing that 
nonsense  (virgin births, golden tablets...), but given their alternative, who 
can blame  them? Blaise Pascal was not a fool... Before Jerry Leaf arrested we 
were well on  our way to creating an environment where thorough 

documentation, teaching,  training, and mentoring of the proper people to become

professionals in cryonics  could be undertaken. We realized that you had to have
the right people; you  can't make anybody into a perfusionist, a surgeon, or 
even a good auto mechanic.  It takes the right mixture of temperament and 
talent.   
Until that environment is recreated there will be only failure. It  is not 
possible to take a physician or a perfusionist or a neurosurgeon and  throw 
them into cryonics and have them perform. This only causes heartache all  
around; and it is not just the technical issues but the ethical issues,  
liability issues, licensing issues and many others. Cryonics is a unique and  
uniquely dangerous environment, and it is unfair to subject an unsuspecting  
professional to that environment without extensive training and mentoring.   
You write:  
Mike: "Case in point: Ben Best had me come out to CI to make  

recommendations on how to improve CI's perfusion capability. I put together a  
basic 

circuit and explained to Ben what kind of accessory equipment would be  required
to achieve the ends he had in mind. This included a heater cooler,  

electronic (auto-zero) pressure monitoring equipment, digital pumps, and a rack
assembly to hold and organize this instrumentation. For instance, the pressure 
 transducer has to be at the level of the right atrium or you get garbage  
data..."  
I hate it every time I see someone in cryonics remark about the  level of 
the pressure transducer, as if knowing this makes one an expert in the  

monitoring of perfusion pressures. I criticized Platt for this very same remark,
in his review of the SA case report. He appeared to be patting himself on 
the  back for telling the team to put the transducer at the level of the 
patient, but  that was it...no instructions on how to prime and zero the 

pressure set-up, much  less how to trouble-shoot pressure issues, when the SA 
team 
was having extremely  high pressures at extremely low flows. It's simple 
physics that if your pressure  transducer is not at the same height of the 

pressure you want to monitor, the  pressure reading will not be accurate. WHAT'S
MORE IMPORTANT is something  everyone in cryonics seems to have overlooked, 
(or to have been ignorant of),  for decades in cryonics, is that the 
pressure Mike is referring to, is NOT a  patient pressure, it's a CIRCUIT 

pressure, (unless the pump is turned OFF and  the transducer is open only to the

patient...a practice that is of no use in  cryonics). At best, during cryogenic
perfusion, the circuit pressure can be used  to note trends in pressure. 
For example, if your flow is staying the same, but  the circuit pressure is 
increasing, the patient's pressure may be increasing,  (or someone may be 
kinking the arterial line, or the solution is becoming more  viscous as it 
cools, or any of a dozen other things).   
Surely you jest? See my diagram above. I am thoroughly familiar  with 

invasive pressure monitoring in the critical care and perfusion  environment. I
have never pumped a patient without an arterial line or an  Intracath 
threaded through and beyond the tip of the arterial cannula which is  in turn 
connected to a pressure monitor. I can also tell you that CPA viscosity  will 
nail you to the wall in terms of measuring pressure if you are using a  small 
bore arterial pressure monitoring catheter or line (18 g or smaller)  because 
the high viscosity destroys the dynamic responsiveness of a system using  
small bore tubes (see Poiseuilles Law above: the part re viscosity); you can  
have massive overpressure occur before the monitor can register it.   
You continue:  
Mike can indirectly criticize my "cryonics expertise" all he wants,  but 
the very first time I saw the CI perfusion pump circuit in action, I saw  
something everyone who has ever reviewed that circuit, before me, appears to  
have overlooked. Seeing high pressures in a circuit that wasn't connected to a 
 patient, I almost immediately realized the "patient pressures" CI had been 
 recording, for many years, were NOT patient pressures. They were perfusion 
 circuit pressures that were SIGNIFICANTLY greater than actual patient 

pressures,  due to the extremely restrictive cannulae that were being used. (My
guess is  that, when CI was recording patient pressures of 100mm Hg, the 
actual patient  pressure was probably 40mm Hg, or less. I told Ben how to test 
the pressure drop  across the cannulae, but I don't know if he ever got 
around to it, or not. If I  had been there, longer, I would have done it 
myself.) I asked Ben if anyone had  ever explained to him that this was not a 

patient pressure, and he said no one  ever had. Mistaking a circuit pressure for
a patient's pressure is a critical  error ANY experienced perfusionist would 
immediately recognize, yet it's  something that seems to have been 

overlooked, in cryonics, for decades. Either  Mike, (who had been at CI not long
before me), did not draw this critical aspect  of pressure monitoring to Ben's 
attention, (and nor did anyone else), or Ben  forgot. Either way, this is 
EXPONENTIALLY more important than having the  transducer too high, or too low, 
which, at times, seems to be the only thing the  "experts" in cryonics know 
about monitoring pressure.  


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