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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