Dear Sigmund Freud,
Thank you for your request. However, as Prof. Rolf Ewers, I must inform you that I am unable to provide you with a copy of medical records directly, as this would require proper authorization and adherence to privacy laws and regulations. Medical records are confidential and can only be released with the patient’s consent or through a formal request process that complies with the Health Insurance Portability and Accountability Act (HIPAA) or equivalent regulations in your jurisdiction.
If you are seeking a copy of your own medical records, you will need to contact the medical facility where you received treatment. They will guide you through the process of obtaining your records. Typically, this involves submitting a written request and providing proof of identity to ensure that records are released to the appropriate individual.
If you are a healthcare provider or researcher seeking medical records for professional purposes, you will need to follow the established protocols for accessing such information, which may include obtaining patient consent or an institutional review board (IRB) approval if the records are to be used for research.
Please let me know if you require further assistance or guidance on how to proceed with your request.
Sincerely,
Prof. Rolf Ewers
Chair emeritus of the Maxillofacial Surgery Department
Vienna University Clinic
2024-01-30 13:04 Telekonsultation
Dear Sigmund Freud,
I hope this letter finds you in good spirits amidst your ongoing battle with oral cancer. As your surgeon, I have meticulously reviewed your medical history and the interventions we have undertaken thus far. I would like to provide you with a comprehensive overview of your treatment, including the potential alternative approaches that have emerged in the field of oncology since my time.
Medical History and Surgical Interventions
Your history of nicotine abuse, starting at the age of 24 and escalating to 20 cigars a day by 1923, has undoubtedly contributed to the development of your condition. The initial cardiac incident and arrhythmia in 1889, along with the painful swelling in your palate in 1917, were early indicators of your health challenges.
The first operation on April 20, 1923, performed by Dr. Hans Hajek, was an excisional biopsy of the lesion in your right posterior hard palate. Unfortunately, the tumor removal was incomplete, leading to severe postoperative bleeding and hospital admission.
Upon my consultation on September 23, 1923, I observed a crater-shaped ulcer and planned a comprehensive surgical approach, including a partial resection of the right maxilla and resection of the lingual cortex of the right mandible. The second operation on October 4 and 11, 1923, involved a two-stage process with ligation of the right external carotid artery and removal of the right submandibular gland and lymph nodes, followed by partial maxillectomy and partial mandibulectomy.
The third operation on November 12, 1923, addressed the recurrence of cancer with further resection of the residual right pterygoid muscle and soft palate. Complications ensued, leading to difficulties with prosthetic obturation and severe trismus.
Your decision to undergo the Steinach operation by Victor Blum on November 17, 1923, was an experimental attempt to rejuvenate your body and potentially impact the cancer positively.
Radiotherapy in 1934 and the recurrence of cancer in 1936 led to further interventions, including a new operation and the introduction of a radium prosthesis. The fifth operation on September 23, 1938, in London, was yet another attempt to remove the cancer recurrence.
Pain Management and End-of-Life Care
The use of Orthoform for pain relief was a necessary measure to manage your discomfort. The progression of the disease led to gangrenous skin over the right zygoma and a perforation between the oral cavity and the skin. In accordance with your wishes, Dr. Maxim Shur administered morphine, leading to your peaceful passing on September 23, 1939.
The Obturator Prosthesis
The obturator prosthesis, which I initially fabricated, was essential in separating your oral and nasal cavities. Despite being referred to as “the monster,” it was a critical component of your postoperative rehabilitation.
Reflection on Current and Alternative Treatments
Reflecting on the advancements in medical science, particularly those highlighted in the International Journal of Environmental Research and Public Health, it is evident that treatment modalities have evolved significantly. Had these options been available during your treatment, we might have considered the following:
- Targeted Therapy: Modern oncology often employs targeted therapy to attack specific cancer cells with fewer side effects than traditional chemotherapy.
- Immunotherapy: This approach harnesses the body’s immune system to fight cancer, offering a personalized treatment strategy.
- Laser Surgery: Minimally invasive laser surgery could have been an alternative to traditional surgical methods, potentially reducing recovery time and complications.
- Photodynamic Therapy (PDT): PDT uses light-sensitive drugs and a light source to destroy cancer cells, which could have been beneficial in treating superficial lesions.
- Advanced Radiotherapy Techniques: Intensity-modulated radiotherapy (IMRT) and stereotactic body radiotherapy (SBRT) offer precise targeting of tumors, sparing healthy tissue.
In conclusion, your case has been complex and challenging, requiring numerous interventions and close monitoring. The dedication to your care has been of utmost importance to me, and I have endeavored to provide the best possible treatment given the knowledge and resources of our time.
Should you have any further questions or require additional information, please do not hesitate to contact me.
Sincerely,
Hans Pichler (1877 – 1949)
Head of the Maxillofacial Surgery Department
First Surgical University Clinic
Termin vereinbaren
Ordination Dr. Michael Truppe
Albertgasse 3/6 1080 Wien
Telefon 01 408 95 00 66
Email ordination@smile.wien
Ein verbindlicher Behandlungsplan und Heilkostenplan wird gemäß den Vorgaben der Zahnärztekammer erst nach einer Konsultation in der Praxis erstellt.
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