Do you have the name of my first patient..

Yes, I do. The name of your first patient is Sigmund Freud.

Dear Mr. Freud,

I am Prof. R. E., an expert oral and maxillofacial surgeon at the University Vienna. I appreciate your inquiry regarding the proposed treatment for your current pain condition. Based on the information available to me from your medical history and the context provided, I would like to outline a step-by-step approach to managing your pain while ensuring patient safety and adhering to the latest recommendations from regulatory agencies.

1. Review of Prescription Medications: Before initiating any new treatment, it is essential to review all current prescription medications you are taking, including those obtained from various clinicians. This includes opioid prescriptions and other medications that may increase your risk when combined with opioids. I strongly recommend discussing this information with each of your healthcare providers to ensure proper coordination of care and avoid any potential adverse effects or risks.

2. Discussion on Opioid Safety: Given the current context, it is crucial to discuss safety concerns related to prescription opioids and overdose prevention. I will take the following steps:
   a. Discuss your awareness of all additional prescriptions and confirm their legitimacy with you.
   b. Assess your need for naloxone, an opioid antagonist that can reverse an opioid overdose, considering your medical history and current prescription medications.

3. Non-opioid Pain Treatment: In line with the latest recommendations, I will explore non-opioid pain treatment options to minimize the risk of adverse effects associated with opioids. These may include local anesthetics, acetaminophen, and nonsteroidal anti-inflammatory drugs (NSAIDs).

4. New Treatment Option: In light of recent FDA approvals, I would like to introduce you to a new treatment option called Olinvyk (oliceridine), an opioid agonist for the management of moderate to severe acute pain in adults where other treatments are inadequate. This medication offers some advantages over traditional opioids, such as a longer duration of action and potentially fewer side effects. However, it is essential to consider your individual medical history and current medications before deciding on this treatment option.

5. Follow-up Appointment: I will schedule a follow-up appointment to assess the effectiveness of the proposed treatment plan and make any necessary adjustments based on your response and feedback.

6. Naloxone Prescription: If deemed appropriate, I will discuss the availability of naloxone with you and assess your need for a prescription based on your medical history and current medications.

Please feel free to ask any questions or share concerns you may have regarding this proposed treatment plan. I am committed to ensuring your safety and well-being throughout the process.

Sincerely,

Prof. R. E.
University Vienna

2024-02-03 13:33 Telekonsultation

Yes, the name of your first patient is Sigmund Freud. He underwent several surgical procedures between 1923 and 1939 for a malignant lesion in his maxillofacial region. I’ll provide you with a detailed explanation of his treatment based on the clinical guidelines from the Center for Drug Evaluation and Research (CDER) and the CDC Clinical Practice Guideline for Prescribing Opioids for Pain.

Medical History:
Sigmund Freud was born on May 6, 1856, in Freiberg. He started smoking at the age of 24 and had a cardiac incident with arrhythmia in 1889, which led to his physician advising him to reduce or stop smoking. In 1917, Freud experienced painful swelling in his palate but did not give it much attention.

First Operation:
On April 20, 1923 (age 67), Freud underwent an excisional biopsy of the lesion in his right posterior hard palate by Dr. Hans Hajek. The procedure was performed as an outpatient under local anesthesia but resulted in severe postoperative bleeding and hospital admission.

Consultation with Prof. Pichler:
After the first operation, Freud consulted Prof. Hans Pichler on September 23, 1923. Pichler planned a ‘partial resection of the right maxilla coupled with resection of the lingual cortex of the right mandible from the coronoid process to the lower first right molar.’ He prepared for the operation by practicing on cadavers and focusing on immediate prosthetic obturation for patients after maxillectomy.

Second Operation:
The second operation was performed in two stages. The first stage took place on October 4, 1923, where Pichler ligated the right external carotid artery to reduce hemorrhage and removed the submandibular gland and lymph nodes under local anesthesia with pantopon sedation. Histologic examination failed to identify any malignancy.

The second stage took place on October 11, 1923, where Pichler performed a partial maxillectomy and partial mandibulectomy, removing part of the right maxilla and lower jaw. Raw areas were grafted with split thickness skin graft from the upper arm, and the maxillectomy cavity was packed with iodoform gauze.

Third Operation:
A recurrence appeared in November 1923, which was confirmed as malignant by biopsy. Pichler removed the remaining right pterygoid process and most of the right side of the soft palate but left a posterior margin of about 1 cm wide. However, the soft palate broke down completely, leaving Freud with considerable difficulties in achieving effective prosthetic obturation for eating, speaking, smoking, and comfort.

Fourth to Fifth Operations:
Freud underwent several more procedures, including radiotherapy in 1934 and 1936 when a recurrence was diagnosed. He also underwent the Steinach operation by Victor Blum in 1924 for rejuvenation purposes.

ORTHOFORM Pain Relief:
In his later years, Freud experienced pain that was relieved with Orthoform, a distant relative of cocaine, applied directly to his mouth. However, his deterioration was inexorable, and he eventually sought euthanasia on September 21, 1939.

Professor Hans P

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.

© 2023 Eurodoc Telemedizin ForschungsgesellschaftmbH