tag:blogger.com,1999:blog-3609683919099708226.post3071342568547984011..comments2023-06-16T09:39:07.504-04:00Comments on Harpocrates Speaks: The Case of Justina Pelletier Still Requires NuanceTodd W.http://www.blogger.com/profile/16192694127268195554noreply@blogger.comBlogger107125tag:blogger.com,1999:blog-3609683919099708226.post-20609209828689704182017-04-11T16:47:24.148-04:002017-04-11T16:47:24.148-04:00My first question was very simple-how would the fa...My first question was very simple-how would the facts come out without a lawsuit?<br /><br />I will post later with a detailed and coherent breakdown of the issues but considering the blogger criticized the lawsuit filed by the parents there must be an alternative of which I am unaware.Lawgalhttps://www.blogger.com/profile/09448176770723717373noreply@blogger.comtag:blogger.com,1999:blog-3609683919099708226.post-87579902802316385562017-03-18T09:06:59.494-04:002017-03-18T09:06:59.494-04:00I haven't replied because I've been rather...I haven't replied because I've been rather busy, for starters, and second, any response would involve speculation. I think I've made it pretty clear that I'm not going to do that. We don't have enough of the facts. At this point, we're just going in circles.Todd W.https://www.blogger.com/profile/16192694127268195554noreply@blogger.comtag:blogger.com,1999:blog-3609683919099708226.post-83228007654757901782017-02-28T23:35:16.650-05:002017-02-28T23:35:16.650-05:00As far as I know, diagnosis and treatment of psych...As far as I know, diagnosis and treatment of psychological disorders are defined in the DSM, in this case DSM-IV, which was current at the time this began. As I stated in my post of October 14, there were three criteria to be applied in the diagnosis of somatoform disorder. Two out of three were not met, in my opinion, yet the diagnosis was made in something like 24 hours. I have never seen any justification for the somatoform diagnosis based on the DSM-IV criteria on any forum, nor have I seen a rational justification of the permanent termination of parentap rights. I believe that here is a reluctance to oppose the state on questions of this type based on the perception that the state and any outside consultants it may employ are more "professional" and knowledgeable than anyone else, and therefore not to be questioned.DARhttps://www.blogger.com/profile/11705086220230550975noreply@blogger.comtag:blogger.com,1999:blog-3609683919099708226.post-87194467806379251192017-02-28T14:55:19.193-05:002017-02-28T14:55:19.193-05:00Still no response as to any inquiry of dhs or bch ...Still no response as to any inquiry of dhs or bch general standards and guidelines on diagnosis or treatment of Somatoform/medical child abuse. There are dozens of articles on how junk science has sent multitudes of people to prison and death row. The blogger on this site seems oblivious or uninterested in safeguards that require a scientific basis for evidence admitted in a juvenile protection proceeding.Lawgalhttps://www.blogger.com/profile/09448176770723717373noreply@blogger.comtag:blogger.com,1999:blog-3609683919099708226.post-74318048765233747712017-02-20T13:20:51.101-05:002017-02-20T13:20:51.101-05:00I never did get a response as to how the parents c...I never did get a response as to how the parents could get "truth and accountability" without a lawsuit. <br /><br />I also never got a response as to any general proof (not specific details) as to peer review scientific vetting as to either the diagnosis, prognosis or treatment of somatoform.<br /><br />And even if the above scientific methods had support -there is also no proof that mass dcf had safeguards in place so diagnosing entities were not used for treatment and independent entities were used to confirm conflicting diagnoses.Lawgalhttps://www.blogger.com/profile/09448176770723717373noreply@blogger.comtag:blogger.com,1999:blog-3609683919099708226.post-60872692392341920292017-01-10T16:49:06.562-05:002017-01-10T16:49:06.562-05:00If anyone wants to read about a child protection c...If anyone wants to read about a child protection case that was very difficult (and tragic) but actually deserves nuance see below-people who work in this area will immediately pick up on the significant issues that distinguish this case from justinas..thicles/2016/10/03/doctors-said-they-shook-their-baby-to-death-they-Lawgalhttps://www.blogger.com/profile/09448176770723717373noreply@blogger.comtag:blogger.com,1999:blog-3609683919099708226.post-83068868163546160282017-01-10T16:42:43.083-05:002017-01-10T16:42:43.083-05:00FYI Dr newton failed in her summary judgment motio...FYI Dr newton failed in her summary judgment motion to dismiss-in other words there were facts alleged that she exceeded her role as a claimed"mandatory reporter" Lawgalhttps://www.blogger.com/profile/09448176770723717373noreply@blogger.comtag:blogger.com,1999:blog-3609683919099708226.post-26177367257666378082017-01-10T16:39:57.613-05:002017-01-10T16:39:57.613-05:00JusTina's parents did not need to be correct-t...JusTina's parents did not need to be correct-the state did both in negating mito, and ruling out I other physical causes. AND affirmatively proving somatoform which was NOT possible in the given time-frameLawgalhttps://www.blogger.com/profile/09448176770723717373noreply@blogger.comtag:blogger.com,1999:blog-3609683919099708226.post-35624892382774890812017-01-05T18:26:13.077-05:002017-01-05T18:26:13.077-05:00"What matters is the Constitution invests the..."What matters is the Constitution invests the right to privacy and liberty and self determination in the individual. In the case of child, that is vested in the parent until the child comes of age."<br /><br />I believe you have identified the core of this issue. Unless imminent danger to the child has been clearly identified, and I don't believe it was in this case, Constitutional rights must be upheld. To do otherwise violates the founding principles upon which this country and its Constitution are based. This is tyranny.DARhttps://www.blogger.com/profile/00325438245989285174noreply@blogger.comtag:blogger.com,1999:blog-3609683919099708226.post-66297507962503052252017-01-05T16:34:33.878-05:002017-01-05T16:34:33.878-05:00It doesn't matter if her parents were 'cor...It doesn't matter if her parents were 'correct'. What matters is the Constitution invests the right to privacy and liberty and self determination in the individual. In the case of child, that is vested in the parent until the child comes of age. If we abridge those rights, it should be done very carefully. In this case, there is a great deal of uncertainty that anyone is "correct". Where there are any reasonable doubts, the Human Rights should stay with the Individual. I am concerned that our so-called Justice System has a very low standard by which it chooses to imprison sixteen year old girls against their will and the will of their parents, and very few protections afforded to safeguard human rights, in the arena of our civil courts.DFW Momhttps://www.blogger.com/profile/02088859665250254730noreply@blogger.comtag:blogger.com,1999:blog-3609683919099708226.post-24211915638567257002016-12-02T19:06:08.635-05:002016-12-02T19:06:08.635-05:00A rather cryptic post! What is the "crap"...A rather cryptic post! What is the "crap" to which you are referring? What is the claimed non-existent science and the evidence-based science?DARhttps://www.blogger.com/profile/00325438245989285174noreply@blogger.comtag:blogger.com,1999:blog-3609683919099708226.post-3725987028758515132016-12-01T03:39:26.435-05:002016-12-01T03:39:26.435-05:00Ah, invent crap.
Invent more crap.
Invent even mor...Ah, invent crap.<br />Invent more crap.<br />Invent even more crap, which reality has never met, as in the previous two cases.<br />Claimed science, which does not exist vs evidence based science, BS loses and we get to witness sour grapes.Wzrd1https://www.blogger.com/profile/11709454392659584792noreply@blogger.comtag:blogger.com,1999:blog-3609683919099708226.post-44046426628567978732016-11-30T14:56:20.160-05:002016-11-30T14:56:20.160-05:001. The standard is clear and convincing evidence n...1. The standard is clear and convincing evidence not POE. The standards are loosened somewhat for emergency hearings bUT you have to put prove an emergency which was probably not proven.<br /><br />2. The scientific method is not only used it is necessary! The daubert and frye standards were probably not followed and had they been this debacle may have been stopped at the outset.<br />3. Children are only removed from homes because they are being abused and/or neglected which are very specific legal standards.(if a likelihood of "harm" was the standard my colleagues with children playing tackle football would not have custody of their children)There is no level playing field where the state can remove your child if the child could be raised better elsewhere-children families are harmed when a child is removed from the home and the only justification is abuse which would require a compelling diagnosis of somatoform (not enough time) negating mito(not enough time) and ruling out medical causes (nit enough time).<br /><br />This situation reminds me a lot of the sexual abuse panic in the 80s and 90s- a lot of the "evidence" presented was based on faulty assumptions and improper diagnostic techniques. Children and families were harmed when state actors took action that was not scientifically warranted or vetted. Lawgalhttps://www.blogger.com/profile/09448176770723717373noreply@blogger.comtag:blogger.com,1999:blog-3609683919099708226.post-23538220176760603542016-11-18T11:22:02.580-05:002016-11-18T11:22:02.580-05:00Here is the amended complaint.
http://media.myf...Here is the amended complaint. <br /><br />http://media.myfoxbostoncom.cmgdigital.com/document_dev/2016/02/25/Amended%20Complaint_2430189_ver1.0.pdf<br /><br />The complaint refers to medical records which the attorneys of Justina have complete and unfettered access to. The complaint lays out a legal review of the medical history of Justina Pelletier including the first reports of "Medical Abuse" by Tufts (of all people) yet was later dismissed after work with Dr. Korson and his diagnosis = also the extensive work of Dr. Hokanson, her psychologist who ruled out somotaform and had been treating her for Dysthymia since 2006, and full time since 2011 (so this carp about how the parents had a problem with psychological services is just that). We have spent some space saying how Dr. Korson was left out of the team. What also should be noted is that while Dr. Korson was contacted (belatedly) Dr.Hokanson was NEVER contacted save for a questionnaire sent two weeks after the fact.<br /><br />Also interesting: While the defendants made noise about questionable diagnosis of mito, they never ruled it out either. The medical records (according to the plaintiffs) also show that when they removed the hypertension medication, she suffered tachycardia for the remainder of her stay.<br /><br />Now Todd is going to say that legal documents given in light of the plaintiffs will be naturally disposed toward their arguments. That can be easily rendered by consulting with the records which everybody has now, including the plaintiffs and the court. The Mass Tribunal certainly made short thrift of the case = hearing it on August 23rd, and rendering judgment on August 25th saying there was question of liability on behalf of all defendants. The case for now has been pretty dormant - no further items in the docket. Nothing in the media say of a few articles in HuffPost, as well as an upcoming one in Rolling Stone. Watch for either a full court press after the first of the year, or a fairly large settlement offer. Just my experienced opinion of course.<br /><br />CRACRAhttps://www.blogger.com/profile/10134496741314864988noreply@blogger.comtag:blogger.com,1999:blog-3609683919099708226.post-30005128591856790062016-11-15T23:08:01.229-05:002016-11-15T23:08:01.229-05:00continuation:
On the original point, you state th...continuation:<br /><br />On the original point, you state that the preponderance of evidence suggested that harm would come to the child if she were left in the care of the physician chosen by her parents. I strongly disagree, and the reason is this: the evidence consisted of a disagreement on the part of the BCH physician with the diagnosis of the Tufts physician, a practitioner whose credentials were at least equal to those of the BCH physician. The main difference, as far as I am able to determine, was that the BCH physician had state sanction while the Tufts physician did not. I will digress briefly to address a previous comment by Todd W. concerning my reliance on credentials. The State of MA, as do all other states, requires physicians to have certain credentials in order to practice medicine. The state license assures that the physician has graduated from an accredited medical school, has completed internship and residency requirements, and is qualified, therefore, to provide at least a minimum standard of care. Board certification in particular specialties assures patients that the physician has the required knowledge of a specific medical area of concentration, confirmed by examination, to provide a correct diagnosis and treatment within that area to the satisfaction of his/her peers. All this is done for the protection of patients. Beyond this, the only further knowledge a prospective patient has of a particular physician is from internet sites such as Healthgrades or recommendations from former patients. I don’t think the State has more. Credentials, then, are the only parameters, other than personal experience, by which a physician’s abilities can be assessed, either by the patient or by the State.<br /><br />As to your pronouncement that Lawgal would prefer that a child die rather than have the court intervene to prevent further harm, that is quite over-the-top, and appears to be more an emotional rant than a logical argument based on fact. Let me turn it around. Would you accept the serious harm to, or even the death of a child in order to uphold the authority of the State? I pose this question because denying a patient a prescribed treatment for an extended period of time simply because a State-sanctioned physician thinks the prescribing physician is wrong, without sound scientific data to back it up, risks precisely that. Now, to address your accusation that Lawgal considers a minor child to be the mere chattel of the parents, I would ask you if you consider that minor child the chattel of the State, to be used and abused at the whim of the State? That mode of thought, I had hoped, passed with the demise of several totalitarian regimes over the last century.<br />Finally, somewhere back in the earlier part of this thread, the justification for the impending lawsuit was discussed. Aside from the medical details, one must remember that the child’s parents stand accused of child abuse, a serious crime. The fact that they were never formally charged and tried for this crime leaves them under this cloud since they were never afforded the opportunity to present exculpatory evidence. This suit allows them that opportunity to clear their names, and I believe this is sufficient justification.<br />DARhttps://www.blogger.com/profile/00325438245989285174noreply@blogger.comtag:blogger.com,1999:blog-3609683919099708226.post-72072878435977206592016-11-15T23:06:57.729-05:002016-11-15T23:06:57.729-05:00I think your characterization of Lawgal’s use of t...I think your characterization of Lawgal’s use of the term ‘Star Chamber’ as hyperbole-ridden is unjustified. While your description of the original purpose of the Star Chamber is correct, if you continue to the conclusion of the Wikipedia article from which it was excerpted, you find that eventually, it was so abused by the State (in this case, the King) that the term became a pejorative. In current usage, the same article states “As the U.S. Supreme Court described it, "the Star Chamber has, for centuries, symbolized disregard of basic individual rights. The Star Chamber not merely allowed, but required, defendants to have counsel. The defendant's answer to an indictment was not accepted unless it was signed by counsel. When counsel refused to sign the answer, for whatever reason, the defendant was considered to have confessed." If counsel was loyal to the State rather than the defendant, the State, of course, had its way. It is in this context, I believe, that Lawgal used it.<br /><br />In civil cases, preponderance of evidence is sufficient because the liberty of the defendant is not placed in jeopardy. The question is usually a matter of whether payment is due the plaintiff. In this case, the liberty of the child was placed in jeopardy, and was, in fact abridged for over a year. The liberty of a family to continue to function as a family was also abridged. This being the case, it would seem that a stronger standard of proof should have been required. Family court cases are usually decided by a bench trial, where the judge decides the case without referring the evidence to a jury. Concerning the gag order, you state “Gag orders, while a case is current and ongoing are also common, as violating such can prejudice a potential jury pool.” In a bench trial this is irrelevant, so the gag order, in this instance, serves only to deny the defendant the opportunity to solicit evidence in his favor and plead his case effectively. As the justification based on the possibility of prejudicing a jury is invalid here, the gag order would seem to be a violation of the first amendment to the Constitution. Perhaps Lawgal could offer a professional opinion on this point, as I am not a lawyer myself. Another point that must be made is that the judge in this case is not impartial. The State is the plaintiff, and the judge, as an agent of the State, favors the State position. He also determines what, if anything, the defendant may present as evidence in his favor. I have read of similar cases in other states where the judge allowed the defendants to present no evidence whatsoever on the grounds that it was only an administrative procedure, and did not even allow the defendants to be present at the proceedings.<br />DARhttps://www.blogger.com/profile/00325438245989285174noreply@blogger.comtag:blogger.com,1999:blog-3609683919099708226.post-8803420856958148082016-11-13T12:14:32.275-05:002016-11-13T12:14:32.275-05:00The law, in civil cases, does not operate beyond t...The law, in civil cases, does not operate beyond the shadow of a doubt, nor does it utilize the scientific method. It relies upon the preponderance of the evidence.<br />That is a law 101 matter.<br />You might want to rethink your hyperbole ridden "star chamber" as well. Court cases involving minor children are kept confidential, to prevent scandalizing a minor child.<br />Gag orders, while a case is current and ongoing are also common, as violating such can prejudice a potential jury pool.<br /><br />"The Star Chamber was established to ensure the fair enforcement of laws against socially and politically prominent people so powerful that ordinary courts would likely hesitate to convict them of their crimes."<br /><br />Returning to the original point, the court may and should intervene when the preponderance of the evidence suggests that harm may befall a minor child, rather than await harm to occur or recur. It seems that you'd prefer a child to die or suffer drastic harm, rather than a court decide that the likelihood of harm being imminent, separation of parent and child should occur. We used to permit that, filling cemeteries with tiny graves, ignoring raped children and repeatedly broken bones and ignoring refused lifesaving medical treatments.<br />We've decided that the societal burden vs the burden of the child is better served by lessening the burden of the abused child.<br />That you rail against that strongly suggests that you think of a minor child as nothing more than property, mere chattel, to be used and abused at the whim of the parent. That mode of thought passed with the notion of female hysteria, fainting couches and women suffering from the vapors.Wzrd1https://www.blogger.com/profile/11709454392659584792noreply@blogger.comtag:blogger.com,1999:blog-3609683919099708226.post-11121631644578484212016-11-13T11:32:05.819-05:002016-11-13T11:32:05.819-05:00No, separation of an allegedly abusive parent is p...No, separation of an allegedly abusive parent is part of the treatment-which needs a proper diagnosis FIRST*which requires an elimination of medical causes-not just mito), and if that diagnosis of sd is imposed by the state it needs to be at least close to certainty with an actual scientific basis(like Cassie c-the state did not order dangerous chemicals pumped into her veins without an all but 100% diagnosis)<br /><br />The original post was critical of the parents' decision to sue, but is also repeatedly asserts only one side is being presented-so how does all info come out unless there is a lawsuit? What infuriates so many people about this case is the secrecy-in my state and many others cp proceedings are open and there is a lot more accountability and you just don't hear about theses types of cases. The star chamber in this case exemplified by the gag order (also extraorinary) allows government take extremely radical action and maybe years later-IF the parents sue we might get the facts? <br /><br />Given the legal standards and burdens of proof required in cp Cases(*not an equal playing field where maybe parents right maybe bch right) there was no was no basid for the initial action-state needs to prove diagnosis and treatment-parents needed to prove nothing. <br /><br />For a blog so heavily based on scientific method I think irpt is odd that decisions made with essentially no scientific backing are defended.<br />Lawgalhttps://www.blogger.com/profile/09448176770723717373noreply@blogger.comtag:blogger.com,1999:blog-3609683919099708226.post-16695647136576477162016-10-25T13:20:42.546-04:002016-10-25T13:20:42.546-04:00"Some of the worst mistakes are made in haste..."Some of the worst mistakes are made in haste."<br /><br />Patient complains of severe headache, desires to be left alone to rest. Patient presented with pupils equal and reactive, "normal respiration", BP elevated, pulse mildly elevated.<br />Several hours later, patient is observed to have slow, shallow respiration and patient's head is lying in a large pool of blood. Secret Service search the grounds for a shooter.<br />President Franklin Delano Roosevelt died on 29 March 1945 of a massive cerebral hemorrhage at 15:35.<br />Of course, today, we'd still lose him, as we'd not want to be hasty and control that brain bleed. We'd need a pulmonologist, to keep the law people happy.Wzrd1https://www.blogger.com/profile/11709454392659584792noreply@blogger.comtag:blogger.com,1999:blog-3609683919099708226.post-17941744681033446382016-10-25T10:58:57.660-04:002016-10-25T10:58:57.660-04:00To a fair extent, somatiform disorder is treated s...To a fair extent, somatiform disorder is treated symptomatically, plus with psychiatric medication. <br />That you'd think that some "harsh behavior modification program" is a first line of treatment displays a lack of understanding at all of modern treatment of any mental illness. Things have changed a great deal since the Victorian era ended, indeed, with great advances in the late 20th and early 21st centuries.<br />Where we once locked people into "the snake pit" and shocked them with insulin, we now use neuromodulating drugs, blocking reuptake of some neurotransmitters and more. Why, every once in a while, treatment is effective on the first try/dosage regimen!*<br /><br />*Yeah, there is quite a bit of individual variability to various psychiatric drugs, so dosages and even medications have to be adjusted on a somewhat regular basis by a mental health care professional. But, such adjustments aren't uncommon in other fields of medicine. It took 18 months to find blood pressure medication that controlled my blood pressure for a full 24 hours, attempting various medications and dosages until we found one medication that worked for a full 24 hours. Then, it stopped working and my ACE inhibitor was replaced with a beta blocker that's taken twice per day.Wzrd1https://www.blogger.com/profile/11709454392659584792noreply@blogger.comtag:blogger.com,1999:blog-3609683919099708226.post-77136131941633938882016-10-25T10:57:21.678-04:002016-10-25T10:57:21.678-04:00My original post asserted that dcf's actions i...My original post asserted that dcf's actions in filing legal and physical custody were not supported by the law-*regardless of the ultimate diagnosis. This is still true and additional information is unnecessary.<br /><br />Mass dcf sought to remove life support for hayleigh Poutre one week after a severe head injury claiming irreversible vegetative state. WAY too soon(brain injuries like this need time for a prognosis, especially in children)another lawyer in mass agreed and took the case pro Bono specifically to give the child time to heal. Months later after trial and appellate courts adopted the docs opinions-she started improVing.<br /><br />Diagnosing somatoform and negating mito in two days was malpractice by the docs and overreach by dcf.<br /><br />You would think dcf would have learned after that fiasco-one of the reforms was mandating opinions from more than one institution on end of life issues-jp was not end of life but was life threatening.<br /><br />But ultimately-a second opinon may not have saved hp-time did. Some of the worst mistakes are made in haste.<br /><br />Lawgalhttps://www.blogger.com/profile/09448176770723717373noreply@blogger.comtag:blogger.com,1999:blog-3609683919099708226.post-80832020396498266792016-10-24T20:24:51.042-04:002016-10-24T20:24:51.042-04:00Somatic symptom disorder can cause real physical s...Somatic symptom disorder can cause real physical symptoms resulting in very real suffering, as you say. So what do you do about it? Do you stop treating those symptoms and instead apply a possibly harsh behavior modification program? Do you dismiss the possibility that there is an underlying physical disorder and risk administering a psychotropic medication that might be contraindicated in the presence of that disorder? (I'm not saying BCH did this - we have no information about most of BCH's treatment) I do understand that somatic symptom disorder is very different than factitious disorder.DARhttps://www.blogger.com/profile/00325438245989285174noreply@blogger.comtag:blogger.com,1999:blog-3609683919099708226.post-6016445842355195032016-10-24T20:06:13.981-04:002016-10-24T20:06:13.981-04:00Todd W., I didn't mean to be dismissive of the...Todd W., I didn't mean to be dismissive of the very real symptoms that comprise somatic symptom disorder, as I may have experienced a minor instance of this myself. I once was told of an abnormality in my EKG discovered during a routing physical. The anxiety that caused resulted in a period of severe insomnia that was eventually relieved by a mild sedative and reassurance that the finding was benign. I understand that some people experience significantly worse symptoms. I question, however, that the symptoms she presented at the time of admission to BCH could result only from somatic symptom disorder (to use the DSM-V term). If her symptoms were the result of this psychological disorder, I imagine that the clinical psychologist on her treatment team, Dr. Dean Hokanson, would have suggested consideration of that earlier in her treatment. <br /><br />I take issue with several of your statements. First, you state that "there apparently were no physical tests done by Dr. Korson to arrive at his diagnosis of mito disorder". I don't think you can claim this because HIPAA restrictions limit the public dissemination of details of a patient's clinical examination. You can say that we don't know what tests he did or did not do with the exception of the muscle biopsy, so, as you stated concerning BCH, any conclusions we can come to about Dr. Korson's diagnostic procedure are also based on assumptions.<br /><br />Second, your argument is internally inconsistent because in one paragraph you claim that Dr. Korson performed no physical tests to arrive at his diagnosis, and in the next paragraph you state "there are no validated physical tests that definitively show whether someone does or does not have a mito disorder". Does one then deny the existence of mito? I don't, because I have seen a large body of published research concerning it.<br /><br />From what I have read and experienced personally about somatic symptom disorder, I believe it includes symptoms arising from an over-reaction to real physical symptoms, such as my insomnia due to anxiety over my EKG. The DSM-V work group of the APA states that "Psychiatric symptoms and general medical symptoms can and do coexist." So what is the clinician to do? To ignore one in favor of the other does the patient a dis-service. Either the mental aspect can be ignored, allowing the patient to suffer needless anxiety, or the physical aspect can be ignored, as BCH did, allowing the patient to suffer the effects of the underlying medical problem.<br /><br />PS: I just found out that my next-door neighbor's daughter, who had been diagnosed with mito, just passed away from the effects of that disease at the age of 15, so please don't tell me it doesn't exist.DARhttps://www.blogger.com/profile/00325438245989285174noreply@blogger.comtag:blogger.com,1999:blog-3609683919099708226.post-72554596479419060042016-10-24T15:47:38.188-04:002016-10-24T15:47:38.188-04:00The skepticism concerning the diagnosis of mitocho...The skepticism concerning the diagnosis of mitochondrial disease in this patient generally depends on the lack of a muscle biopsy, which implies that it is a ‘gold standard’ for diagnosis this disorder. There are, however, valid reasons for avoiding it. As Todd W. stated earlier, “there is, currently, no objective test for mitochondrial disorder, nor is there a gold-standard accepted means of diagnosing mito disorder”. This is in agreement with a published opinion of the Cleveland Clinic:<br />MYTH<br />A muscle biopsy is the "gold standard" for diagnosis of mitochondrial disease.<br />FACT<br />Although the muscle biopsy is a powerful diagnostic tool, it should not be considered a “gold standard.” A biopsy examination includes microscopic evaluation, enzyme testing, and genetic testing. Although all U.S. labs that offer muscle biopsy meet strict laboratory guidelines, there is no agreed-upon standard approach for enzyme testing. Furthermore, a muscle biopsy with full analysis costs well over $10,000 and poses both surgical and anesthetic risks. In some patients, the diagnosis can be made based on clinical symptoms and a positive blood test (identifying a genetic mutation) or a combination of clinical findings and other non-invasive testing. In either case, a muscle biopsy is not necessary. Finally, since biopsy results usually do not alter the long-term outcome or treatment considerations, some specialists and patients choose to treat without the need for a muscle biopsy. (1)<br />Muscle biopsy is a surgical procedure, which carries greater risk for mito patients than for the general population:<br />Mitochondrial disease (mtD) is a genetically, biochemically, and clinically heterogeneous group of disorders that arise most commonly from defects in the oxidative phosphorylation or electron transport chain involved in energy metabolism. These patients have an increased risk for cardiac, respiratory, neurologic, and metabolic complications from anesthesia. Consequently, there are several anesthetic considerations for patients with mtD.(2)<br />Since mito is known to commonly be an inherited disorder, involving nuclear as well as mtDNA, the collection of symptoms plus the knowledge that her sister has been diagnosed with it by muscle biopsy provides some justification for suspecting it to be present in Justina.<br />1. http://my.clevelandclinic.org/health/diseases_conditions/hic-what-are-mitochondrial-diseases/hic_myths_and_facts_about_mitochondrial_diseases<br />2. Clinical Pediatric Anesthesia: A Case-Based Handbook Edited by Kenneth Goldschneider, Andrew Davidson, Eric Wittkugel, and Adam Skinner<br />DARhttps://www.blogger.com/profile/00325438245989285174noreply@blogger.comtag:blogger.com,1999:blog-3609683919099708226.post-1209045055970328352016-10-24T14:41:44.495-04:002016-10-24T14:41:44.495-04:00Indeed! Any psychiatric disorder is a very real di...Indeed! Any psychiatric disorder is a very real disorder, the suffering is very real and it's not some flight of fancy.<br />Perhaps that is where some people become confused, thinking that any psychiatric disorder then is in someone's imagination, which is utterly wrong.<br /><br />For those who are confused, here:<br />https://en.wikipedia.org/wiki/Somatic_symptom_disorder<br />Wzrd1https://www.blogger.com/profile/11709454392659584792noreply@blogger.com