Description of Event or Problem · 1
RPTR HAD IMPLANTS PLACED FOLLOWING BILATERAL MASTECTOMIES FOR FIBROCYSTIC DISEASE. RPTR HAS HAD A TOTAL OF TWO BREAST SURGERIES, BEGINNING WITH THE FIRST IMPLANT SURGERY. RPTR HAS BEEN DIAGNOSED WITH THE FOLLOWING AFTER IMPLANTATION: BRAIN LESIONS, ANXIETY AND/OR DEPRESSION, ORGANIZATIONAL DIFFICULTY, LACK OF CONCENTRATION, SHORT-TERM MEMORY LOSS, GETTING LOST OR CONFUSED, BALANCE DISTURBANCES/VERTIGO/DIZZINESS, BIOPSY SUGGESTIVE OF CANCER, PAIN AND/OR BURNING SENSATION, INFLAMMATION, ELEVATED CHOLESTEROL OR TRIGLICERIDES, MACULAR DEGENERATION, DRY EYES, RAYNAUD'S DISEASE, SUBSTANTIAL HAIR LOSS NOT CONNECTED WITH MEDICATIONS, HYPERSENSITIVITY OR ALLERGIES TO CHEMICALS, MOLDS, DUST OR POLLEN, UNUSUAL CHRONIC INFECTIONS, ATYPICAL LUPUS, INFLAMMATION, SWELLING, PAIN/ARTHRALGIA, LIVER PROBLEMS, SUCH AS ENZYME ELEVATIONS, ASTHMA, EXERCISE INDUCED HYPOXIA, CHRONIC UNEXPLAINED MUSCLE SPASMS, FROZEN SHOULDER, MUSCLE PAIN AND BURNING, MUSCLE ATROPHY, FASCITIS, UNEXPLAINED RASHES, SUN SENSITIVITY, NON-RESTORATIVE SLEEP, CHRONIC FATIGUE SYNDROME, CLUMSINESS/DROP THINGS, MISJUDGE DISTANCE/RUN INTO OBJECTS, AND SICCA. A "BILATERAL SUBCUTANEOUS MASTECTOMIES WITH IMPLANTS" WAS DONE 12/19/84 ON A HEALTHY 49 YEAR OLD CAUCASIAN FEMALE OF APPROX 146LBS FOR BENIGN FIBROCYSTIC DISEASE. ONE SET OF TWO IMPLANTS (MEDICAL ENGINEERING CORP/SURGITEK, GEL-SALINE, 190 CC EACH, PRODUCT #2505000S12) WAS PLACED SUBPECTORAL/SUBSERRATUS FOR IMMEDIATE RECONSTRUCTION. ELEVEN WEEKS LATER, BOTH IMPLANTS WERE REMOVED ON 3/5/85, FOR ATTEMPTED RELIEF OF MULTIPLE POST-OP SYMPTOMS WHICH INCLUDED SEVERE SORE THROAT AND CHEMICAL TASTES, FREQUENT CHEST WALL SPASMS, SHORTNESS OF BREATH, INTENSE SCAR REACTION, LEFT LOWER LOBE "PLATELIKE" ATELECTASIS, AND BLADDER WALL SEPTUM FORMATION. BOTH IMPLANTS WERE INTACT ON REMOVAL. IT WAS OBSERVED THAT PAPER BAGS CONTAINING THEM WOULD BECOME OIL-SOAKED WITHIN A FEW HOURS AND THAT ADDED WARMTH AND PRESSURE SEEMED TO CAUSE AN INCREASE IN RATE OF FLOW. THERE WAS AN ALMOST IMMEDIATE ONSET OF MULTISYSTEMIC PROBLEMS THAT SIGNIFICANTLY IMPACTED CARDIOPULMONARY, HEPATIC, SKIN/MUSCLOSKELETAL, NEUROLOGICAL, AND IMMUNOLOGICAL FUNCTION, THUS DISRUPTING BODY FUNCTION AND STRUCTURE, PHYSICAL ACTIVITIES, AND QUALITY OF LIFE. PRE-OP LAB WAS NORMAL. DOCUMENTED POST-OP WERE INCREASING ELEVATIONS IN SED-RATE (7-65, N=20), ALKPHOS (54-129, N=100), SGPT (20-63, N=30), SGOT (23-58, N=30), AND IN GGPT (83, N=24). THIS OVER THE FIRST FOUR MONTHS. SIX MONTHS AFTER IMPLANT REMOVAL, CPK'S (N=128) WERE IN THE 400-500 RANGE AND ANA STUDIES WERE ATYPICAL. EVENTUALLY THERE WERE FINDINGS OF IMMUNOLOGICAL AND NEUROLOGICAL ABNORMALITIES AND, IN JANUARY OF 1990, "SIGNIFICANT EXERCISE-INDUCED OXYGEN DESATURATION" WHICH HAS SINCE PROGRESSED TO A POINT WHERE PREMATURE DEMISE FROM CARDIOPULMONARY FAILURE APPEARS A DISTINCT POSSIBILITY. SOME OF THE DIAGNOSES ASSIGNED: SYSTEMIC REACTION TO SILASTIC BREAST IMPLANTS. CHEST WALL PAIN SYNDROME SECONDARY TO SILASTIC REACTION, 10/1/85. POLYMORPHIC LIGHT ERRUPTION, 5/12/86. LUPUS ERYTHEMATOSIS, 6/2/86. AUTOIMMUNE ENDOCRINE DISEASE, 10/9/86. POST-TRAUMATIC STRESS DISORDER WITH ANXIETY AND DEPRESSION, 7/24/86. LUPUS-LIKE SYNDROME, 6/27/88. MACULAR DEGENERATION - DRY, 6/97. RHEUMATOLOGY CONSULTATION: CHEST WALL AND UPPER EXTREMITY PAIN. HISTORY OF PRESENT ILLNESS: THIS IS A 49 YEAR OLD, REGISTERED NURSE, WHO WAS REFERRED BY MD OF THE PLASTIC SURGERY DEPT FOR FURTHER EVAL OF CHEST WALL DISCOMFORT. SHE DATES THE ONSET OF HER PROBLEMS TO DECEMBER OF 1984. WHEN SHE HAD BILATERAL SIMPLE MASTECTOMIES AND IMPLANTS PERFORMED. THIS WAS DONE BECAUSE OF FIBROCYSTIC BREAST DISEASE, WHICH WAS SAID TO BE EXTENSIVE. THE SURGERY WAS PERFORMED AND THE PT APPRENTLY HAD SILASTIC SURGITEC IMPLANTS. SHE RELATES THAT, FOR ONE WEEK FOLLOWING THE SURGERY, SHE HAD ONLY THE NORMAL TYPE OF POSTOPERATIVE DISCOMFORT. FOLLOWING THAT, SHE DEVELOPED A MULTIPLICITY OF SYMPTOMS AND VERY INTENSE SCAR FORMATION. THE DISCOMFORT IN HER CHEST WALL BECAME PROGRESSIVELY MORE SEVERE, AND SHE IS CONCERNED THAT HER INCISION MAY HAVE INCLUDED MUSCLES, SUCH AS THE LATISSIMUS DORSI, WHICH SHE FEELS SHOULD NOT HAVE BEEN INCISED. SHE EXPRESSES A NUMBER OF CONCERNS ABOUT THE SURGERY ITSELF, AND SHE OBVIOUSLY IS QUITE DISSATISFIED WITH EVERYTHING THAT HAPPENED. EVENTUALLY SHE DID HAVE THE SUBMUSCULAR IMPLANTS REMOVED ON MARCH 5. SINCE THEN, SHE HAS HAD SOME IMPROVEMENT IN TERMS OF HER POOR SLEEP AND GENERALIZED CHEST DISCOMFORT, BUT SHE CONTINUES TO HAVE NUMBNESS AND PARESTHESIAS IN BOTH ARMS AND IN THE CHEST WALL AS WELL, AND THIS ACTUALLY HAS BEEN PRESENT PRIMARILY FOR THE PAST TWO WEEKS. SHE HAD A SERIES OF ULTRASOUND AND DIATHERMY TREATMENTS PRIOR TO THE REMOVAL OF THE IMPLANTS, AND THIS PARTIALLY HELPED SOME OF THE DISCOMFORT IN THE CHEST WALL, AND HELPED SOFTEN SOME OF THE SCAR TISSUE. SHE REPORTS THAT, FOLLOWING THE IMPLANTS, SHE DEVELOPED A SEVERE SORE THROAT, WITHOUT ANY APPARENT REASON, AND THIS PERSISTED UNTIL THE IMPLANTS WERE REMOVED. SHE ALSO REPORTS NOTICING A CHEMICAL TASTE. BOTH OF THESE SYMPTOMS COMPLETELY DISAPPEARED FOLLOWING REMOVAL OF THE IMPLANTS. SHE STATES THAT WHEN SHE BEGINS TO WALK OR EXERCISE, SHE DEVELOPS SPASMS OF THE CHEST MUSCLES, WHICH MAKE BREATHING VERY DIFFICULT FOR HER. SHE FEELS MORE SHORT OF BREATH THAN NORMAL, AND HER PULSE RACES RAPIDLY WITH MINIMAL EXERCISE. THE MAJOR PAIN IS THE SEVERE SPASM OF THE ENTIRE CHEST WALL AND PECTORALIS AREA WHENEVER SHE SITS DOWN OR LIES DOEWN. HOWEVER, THIS HAS BEEN CONSIDERABLY IMPROVED SINCE REMOVAL OF THE IMPLANTS. PHYSICAL EXAMINATION: ON EXAMINATION, SHE IS A VERY PLEASANT, ALERT WOMAN WHO ACTUALLY APPEARS QUITE HEALTHY, ALTHOUGH SOMEWHAT OVERWEIGHT. HER CERVICAL SPINE RANGE OF MOTION WAS LIMITED TO 50% OF NORMAL INLATERAL FLEXION AND LATERAL ROTATION, WITH MARKED MYOFASCIAL DIFFUSE MUSCLE TENDERNESS OVER THE TRAPEZIUS AND POSTERIOR CERVICAL AND OCCIPITAL MUSCULATURE. SHE STATES THAT THIS IS NEW SINCE THE DECEMBER SURGERY.